Protokol Rcheop

Regimen R-CEOP
Indication Diffuse Large B Cell Lymphoma with contraindications to anthracyclines
Therapeutic Intent Radical/Curative
Day Medication Dose Route Administration Details

Add to sodium chloride 0.9%. See local
1 Rituximab 375mg/m2 IV protocol or product SPC for information of
rate of infusion
Max dose 2mg. 50ml sodium chloride 0.9%
1 Vincristine 1.4mg/m2 IV
minibag over 5-10 minutes.
500ml to 1000ml sodium chloride 0.9% over
1 Etoposide 50mg/m2 IV
1-2 hours
Slow IV bolus injection or add to sodium
1 Cyclophosphamide 750mg/m2 IV
chloride 0.9% and give over 30 minutes.
Take on an empty stomach. Round dose to
2 and 3 Etoposide 100mg/m2 PO
the nearest 50mg.
As a single dose with food in the morning. N.B
1 to 5 Prednisolone 100mg or PO Day 1 may be given prior to the Rituximab
infusion as part of the pre-med
Cycle Frequency Every 21 days for 3-6 cycles depending on stage of disease
FBC, U&E, LFT, Bone profile, glucose, LDH, B2M, serum Igs, hep B screen,
electrophoresis.
Tests required prior to
Undertake relevant staging.
initiation of course
Consider cardiac function tests.
WHO performance status.
Tests required prior to
FBC, U&E, LFT.
individual cycle
Antihistamine, corticosteroid and paracetamol pre-medication prior to
rituximab as per local policy.
Allopurinol for at least the first cycle.
Concurrent Medication Anti-emetics as per local policy.
PPI.
Consider antifungal, antiviral, PCP prophylaxis and mouthwashes as per
local policy.
Page 1 of 3
Dose Modifications
Hepatic There is conflicting information regarding dose reduction of etoposide in hepatic
impairment. Although etoposide is contraindicated in patients with severe hepatic
dysfunction, the following advice is suggested by some reference sources.
Serum Bilirubin OR AST (units/L) Modification
(micromol/L)
<26 <60 100% dose etoposide
26-51 60-180 50% dose etoposide
>51 >180 Clinical Decision
26-51 Or 60-180 50% of vincristine dose
>51 And Normal 50% of vincristine dose
>51 And >180 Omit
Renal Creatinine clearance (ml/min) Modification
>20 100% of cyclophosphamide
10-20 75% of cyclophosphamide
<10 50% of cyclophosphamide
>50 100% of etoposide
15-50 75% of etoposide
<15 50% of etoposide
Haematological No dose modifications for first cycle
Neutrophils (x109/L) Modification
<1.5 on day treatment due Delay cycle one or two weeks. If count has not
recovered after 14 days, stop chemotherapy
Grade 4 neutropenia or any febrile All subsequent cycles given with G-CSF support
neutropenia following any cycle of
chemotherapy
Grade 4 neutropenia leading to Reduce dose of cyclophosphamide and etoposide
infection despite G-CSF support by 50% for all subsequent cycles
Grade 4 neutropenia recurs despite Stop chemotherapy
50% dose reduction in
cyclophosphamide and etoposide
Platelets (x109/L) Modification
Platelets <100 on day treatment due Delay cycle one or two weeks. If count has not
recovered after 14 days chemotherapy will be
stopped
Grade 3 or 4 thrombocytopenia Reduce dose of cyclophosphamide and etoposide
following any cycle of CHOP by 50% for all subsequent cycles
Grade 3 or 4 thrombocytopenia Stop chemotherapy
recurs despite 50% dose reduction in
cyclophosphamide and etoposide
Neurotoxicity Grade 2 motor weakness or Grade 3 Give 50% vincristine
sensory toxicity
Higher grades of neurological toxicity OMIT vincristine
Page 2 of 3
Additional Information None.
1. 408 R-CHOP with Etoposide Substituted for Doxorubicin (R-CEOP):

Excellent Outcome in Diffuse Large B Cell Lymphoma for Patients with a
Contraindication to Anthracyclines. Oral and Poster Abstracts Oral Session:
Lymphoma: Chemotherapy, excluding Pre-Clinical Models - Non-Hodgkin
Lymphoma: Therapy. Monday, December 7, 2009: 11:45 AM
References
2. Dose Adjustments for Cytotoxics in Hepatic Impairment January 2009,
available at www.eastmidlandscancernetwork.nhs.uk
3. Dose Adjustments for Cytotoxics in Renal Impairment January 2009,
available at www.eastmidlandscancernetwork.nhs.uk
4. SPC for rituximab available at www.medicines.org.uk
Author Pharmacy CNG
Approved & Checked by Haematology CNG (Review Date = Jan 2017)
Page 3 of 3

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Protokol Rcheop

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What is the indication for this regimen?

What medications are included in this regimen and at what doses?

Regimen R-CEOP

Indication Diffuse Large B Cell Lymphoma with contraindications to anthracyclines

Therapeutic Intent Radical/Curative

Day Medication Dose Route Administration Details

1. 408 R-CHOP with Etoposide Substituted for Doxorubicin (R-CEOP):

Author Pharmacy CNG

Approved & Checked by Haematology CNG (Review Date = Jan 2017)

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