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ICE Chemotherapy : Treatment Regimen & Side Effects

What is ICE Chemotherapy?

ICE chemotherapy is a treatment that is used for Hodgkin’s and Non-Hodgkin lymphoma. ICE stands for ifosamide, carboplatin, and etoposide.

Chemotherapy is a treatment in which cytotoxic drugs are used to kill cancer cells. The drugs used in chemotherapy work in different ways. The type of drug and combination is used depending on the:

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  • Type of cancer
  • Stage of cancer
  • A person’s overall health

ICE chemotherapy is recommended for people with Hodgkin’s and Non-Hodgkin’s lymphoma.(1) Most of the people who have ICE chemotherapy also have stem cell transplants.

Lymphoma is cancer that starts in the white blood cells in the lymph system.(2) Tissues and organs in the lymph system play a role in producing, storing, and carrying white blood cells. These help in fighting infection. Lymphoma is known to develop in white blood cells.

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ICE chemotherapy involves three drugs that work by killing cancer cells. Along with the drugs in ICE another drug named Rituximab is recommended and the treatment is referred to as R-ICE therapy.(3)

ICE Chemotherapy Treatment Regimen

ICE chemotherapy is injected via a drip into the bloodstream. The program may be different from place to place.

In most cases, 2-4 cycles of treatment are given to a person and each cycle lasts for around 3 weeks.(1)

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Mostly it is given in the following way:

  • Day 1: One hour drip of etoposide is given
  • Day 2: One hour of a drip of etoposide, one hour of a drip of carboplatin, and one hour of ifosfamide is given
  • Day 3: One-hour drip of etoposide is given
  • Day 4-21: No treatment is given

Side Effects of ICE Chemotherapy

Chemotherapy drugs cause various side effects and these vary from person to person.

These drugs travel throughout the body and destroy the fast-growing cancer cells along with the healthy cells in the body. The destruction of healthy cells leads to side effects.

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According to the American Cancer Society (ACS), the drugs used for chemotherapy mostly affect the healthy cells, including:

  • Blood forming healthy cells in the bone marrow
  • Hair follicles
  • Cells present in the mouth
  • Cells present in the digestive tract and reproductive system

A few of the side effects go away quickly, but some can take a longer time. Chemotherapy drugs can also cause long-term damage to the heart, lung, kidney, and reproductive organs. These are also known as late effects.

Common Side Effects of ICE Chemotherapy

A few common side effects are seen occurring in 10% of the people taking ICE chemotherapy.(1) These include:

Occasional Side Effects OF ICE Chemotherapy

Among the people undergoing ICE chemotherapy, 1-10% of people experiences side effects, which include:

  • Diarrhea
  • Rash on the skin
  • Dizziness
  • Change in taste
  • Lung problem
  • Sore mouth
  • Numb or tingly finger and toes
  • Red and itchy skin
  • Eye problem

Rare Side Effects of ICE Chemotherapy

1% of people may experience rare side effects, which include:

  • An allergic reaction
  • Seizures
  • Fever
  • Lung problem
  • A severe skin problem.

ICE chemotherapy may harm the fetus, and therefore, the doctor recommends not getting pregnant if a person or the partner is undergoing chemotherapy.(1)

Vaccines work by making the immune system recognize and fight against infections and diseases. American Cancer Society recommends against vaccines during chemotherapy, but people should get flu shots and can also get the COVID-19 vaccine.(4, 5)

When to Contact a Doctor?

A doctor should be contacted if the side effects include:

  • Intense chills
  • Rash
  • Blood in stool
  • Blood in urine
  • A high temperature of 101°F or higher
  • Unexplained bleeding or bruise
  • Intense headache or unusual pains
  • Persistent vomiting and diarrhea
  • Shortness of breath
  • Allergic reaction in mouth or throat

If someone has difficulty in breathing, emergency care should be contacted.

Outlook of ICE Chemotherapy

The success rate of ICE chemotherapy varies from person to person. It also depends on whether the person is receiving other drugs and treatments in combination with ICE chemotherapy.

The overall survival rate of people with Hodgkin or Non-Hodgkin lymphoma is 88%. If detected in the early stages the 5-year survival rate is 92% and if the cancer is detected after it is spread to other parts of the body the survival rate is 82%.(6)

The success rate of ICE chemotherapy is very good. The success of treatment also depends on the age of the person, tumor type, and the stage of cancer. It is important to discuss the risks and benefits of the treatment plan prior to going ahead with it.

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