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ICE

Find out what ICE is, how you have it and other important information about having ICE.

ICE is a chemotherapy drug combination made up of the drugs:

  • I – ifosfamide
  • C – carboplatin
  • E – etoposide (also known as Vepesid, Etopophos or Eposin)

It is a treatment for non Hodgkin lymphoma that has come back. Most people who have ICE will also have a stem cell transplant. Your doctor will explain this treatment to you in detail. 

How it works

These chemotherapy drugs destroy quickly dividing cells, such as cancer cells.

How you have it

You have these drugs into your bloodstream (intravenously).

Mesna and GCSF

You usually have ifosfamide with another drug called mesna. You have mesna either as a drip (infusion) into your bloodstream or as tablets.

Mesna is not a chemotherapy drug. It stops the ifosfamide from irritating your bladder and making the lining bleed.

You usually also have a drug called granulocyte colony stimulating factor (GCSF). This makes your bone marrow produce white blood cells more quickly after the chemotherapy.

Into your bloodstream

You have the treatment through a drip into your arm. A nurse puts a small tube (a cannula) into one of your veins and connects the drip to it.

You might need a central line. This is a long plastic tube that gives the drugs into a large vein, either in your chest or through a vein in your arm. It stays in while you’re having treatment, which may be for a few months.

Taking your tablets

You must take tablets according to the instructions your doctor or pharmacist gives you

Whether you have a full or empty stomach can affect how much of a drug gets into your bloodstream.

You should take the right dose, not more or less.

Never stop taking a cancer drug without talking to your specialist first.

When you have it

You usually have ICE chemotherapy as cycles of treatment. You might have between 2 and 4 cycles. Each cycle lasts 3 weeks so the whole course of chemotherapy may last from 6 to 12 weeks.

You can have ICE chemotherapy in a number of ways. Two common ways are described below as schedule A and schedule B. Your doctor or nurse will explain to you exactly how you will have treatment.

Schedule A

Day 1
  • You have carboplatin as a drip (infusion) into your bloodstream for 1 hour
  • You have etoposide as a drip into your bloodstream for 1 hour
  • You have ifosfamide as a drip into your bloodstream for 6 hours
Day 2
  • You have ifosfamide as a drip into your bloodstream for 18 hours
  • You have etoposide as a drip into your bloodstream for 1 hour
  • You have mesna as a drip into your bloodstream for 6 hours
Day 3 to 21
  • You have no treatment

You then start a new treatment cycle. You usually need to stay in hospital overnight between day 1 and 2 of each cycle. 

Schedule B

Day 1
  • You have etoposide as a drip into your bloodstream for 1 or 2 hours
Day 2
  • You have etoposide as a drip into your bloodstream for 1 or 2 hours
  • You have carboplatin as a drip into your bloodstream for 1 hour
  • You start a 24 hour drip of ifosfamide and mesna and may need to stay in hospital overnight
Day 3
  • You finish the ifosfamide and mesna drip
  • You have etoposide as a drip into your bloodstream for 1 hour
  • You start a mesna drip for 12 hours or you may have mesna tablets to take
Day 4 to 21
  • You have no treatment

You then start a new treatment cycle. 

Tests during treatment

You have blood tests before starting treatment and during your treatment. They check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.

Side effects

Important information

Other medicines, foods and drink

Cancer drugs can interact with some other medicines and herbal products. Tell your doctor or pharmacist about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies.

Pregnancy and contraception

This treatment might harm a baby developing in the womb. It is important not to become pregnant or father a child while you are having treatment and for a few months afterwards. Talk to your doctor or nurse about effective contraception before starting treatment.

Fertility

You may not be able to become pregnant or father a child after treatment with these drugs. Talk to your doctor before starting treatment if you think you may want to have a baby in the future. Men may be able to store sperm before starting treatment. Women may be able to store eggs or ovarian tissue but this is rare.

Breastfeeding

Don’t breastfeed during this treatment because the drugs may come through in your breast milk.

Treatment for other conditions

Always tell other doctors, nurses or dentists that you’re having this treatment if you need treatment for anything else, including teeth problems.

Immunisations

Don’t have immunisations with live vaccines while you’re having treatment and for at least 6 months afterwards.

In the UK, live vaccines include rubella, mumps, measles, BCG, yellow fever and Zostavax (shingles vaccine).

You can:

  • have other vaccines, but they might not give you as much protection as usual
  • have the flu vaccine
  • be in contact with other people who've had live vaccines as injections

Avoid contact with people who’ve had live vaccines taken by mouth (oral vaccines). This includes the rotavirus vaccine given to babies. The virus is in the baby’s urine for up to 2 weeks and can make you ill. So, you mustn't change their nappies for 2 weeks after their vaccination.

You also need to avoid anyone who has had oral polio or typhoid vaccination recently.

More information about this treatment

For further information about this treatment go to the electronic Medicines Compendium (eMC) website.

You can report any side effect you have to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.

Information and help

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