ICE (chemotherapy) explained

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. Rituximab - an anti-CD20 monoclonal antibody, which is able to kill both normal and malignant CD20-bearing B cells;
2. Ifosfamide - an alkylating antineoplastic agent of the oxazafosforine group;
3. Carboplatin - a platinum-based antineoplastic drug, also an alkylating antineoplastic agent;
4. Etoposide - a topoisomerase inhibitor.

Dosing regimen

Drug	Dose	Mode	Days
	375 mg/m^2	IV infusion	Day 1
	5000 mg/m^2	IV continuous infusion over 24 hours	Day 2
Mesna for haemorrhagic cystitis prophylaxis with ifosfamide	5000 mg/m^2	IV continuous infusion over 24 hours	Day 2
	Optimized to get AUC = 5 (max. 800 mg)	IV infusion	Day 2
	100 mg/m^2	IV infusion over 1 hour	Days 1-3
	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 transplantation follows (if the patient is considered eligible for HDCT and ASCT).^{[1] [2]}

Notes and References

1. http://jco.ascopubs.org/content/17/12/3776.full 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. http://www.bloodjournal.org/content/103/10/3684.full?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=1&andorexacttitle=and&andorexacttitleabs=and&andorexactfulltext=and&searchid=1&FIRSTINDEX=0&sortspec=relevance&volume=103&firstpage=3684&resourcetype=HWCIT&sso-checked=true Rituximab and ICE as second-line therapy before autologous stem cell transplantation for relapsed or primary refractory diffuse large B-cell lymphoma