ICE (chemotherapy)

ICE in the context of chemotherapy is an acronym for one of the chemotherapy regimens, used in salvage treatment of relapsed or refractory non-Hodgkin's lymphoma and Hodgkin lymphoma.

In case of CD20-positive B cell lymphoid malignancies the ICE regimen is often combined today with rituximab. This regimen is then called ICE-R or R-ICE or RICE.

[R]-ICE regimen consists of:

  1. (R)ituximab - an anti-CD20 monoclonal antibody, which is able to kill both normal and malignant CD20-bearing B cells;
  2. (I)fosfamide - an alkylating antineoplastic agent of the oxazafosforine group;
  3. (C)arboplatin - a platinum based drug, also with an alkylating mechanism;
  4. (E)toposide - a topoisomerase inhibitor.

Dosing regimen

Drug Dose Mode Days
(R)ituximab 375 mg/m2 IV infusion Day 1
(I)fosfamide 5000 mg/m2 IV continuous infusion over 24 hours Day 2
Mesna for haemorrhagic cystitis prophylaxis with ifosfamide 5000 mg/m2 IV continuous infusion over 24 hours Day 2
(C)arboplatin Optimized to get AUC = 5 (max. 800 mg) IV infusion Day 2
(E)toposide 100 mg/m2 IV infusion over 1 hour Days 1-3
Filgrastim to shorten the period of neutropenia 5 µg/kg S.C. Days 5-12

Cycles are repeated every 14 days for 3 cycles, then high-dose chemotherapy with autologous stem cell transplant follows (if the patient is considered eligible for HDCT and ASCT).[1][2]

References

  1. ↑ Ifosfamide, Carboplatin, and Etoposide: A Highly Effective Cytoreduction and Peripheral-Blood Progenitor-Cell Mobilization Regimen for Transplant-Eligible Patients With Non-Hodgkin’s Lymphoma
  2. ↑ Rituximab and ICE as second-line therapy before autologous stem cell transplantation for relapsed or primary refractory diffuse large B-cell lymphoma
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