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/m^2	IV infusion	Day 1
(I)fosfamide	5000 mg/m^2	IV continuous infusion over 24h	Day 2
Mesna for haemorrhagic cystitis prophylaxis with ifosfamide	5000 mg/m^2	IV continuous infusion over 24h	Day 2
(C)arboplatin	Optimized to get AUC = 5 (max. 800 mg)	IV infusion	Day 2
(E)toposide	100 mg/m^2	IV infusion over 1h	Days 1-3
Filgrastim to shorten the period of neutropenia	5 mcg/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