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RICE

Read about the cancer drug combination RICE, how you have it and what the side effects can be.

What it is

RICE is the name of a combination of cancer drugs for non Hodgkin lymphoma or Hodgkin lymphoma that has come back after previous treatment. It is the ICE chemotherapy combination with the drug rituximab.

Most people who have this type of chemotherapy also have a stem cell transplant. Your doctor or chemotherapy nurse will explain this treatment to you in detail.

RICE is made up of the drugs:

  • R – rituximab (Mabthera), a type of targeted cancer drug (a biological therapy) called a monoclonal antibody
  • I – ifosfamide
  • C – carboplatin
  • E – etoposide

How you have it

You have the drugs into your bloodstream (intravenously).

You usually have ifosfamide with another drug called mesna, either as a drip (infusion) or as tablets. Mesna stops the ifosfamide from irritating your bladder and causing bleeding.

Drugs into the 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 may 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 or capsules

You must take tablets and capsules 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 RICE drugs as cycles of treatment. You may have 3 cycles. Each cycle lasts 3 weeks.

Some people have an allergic reaction to rituximab, causing flu like symptoms such as a fever, chills and shivering (rigors), a headache and feeling sick. So you have the first dose slowly by drip over a few hours. To help prevent an allergic reaction you will have paracetamol and an antihistamine drug before the treatment. You may also have steroids. If you have a reaction, your nurse will stop the drip and start it again at a slower rate once your symptoms have reduced.

Different hospitals give RICE in different ways. Two common ways are described below as schedule A and schedule B.

Schedule A

Day 1
  • rituximab as a drip
Day 2
  • rituximab as a drip
Day 3
  • etoposide as a drip over an hour
Day 4
  • etoposide as a drip
  • carboplatin as a drip
  • a 24 hour drip of ifosfamide and mesna
Day 5
  • etoposide as a drip
Days 7 to 14
  • daily injections of a growth factor drug called G-CSF

G-CSF stimulates your bone marrow to produce white blood cells to reduce the risk of infection. A nurse may do the injections or they may teach you how to give them to yourself. Or you may have one injection of pegfilgrastim, which releases G-CSF slowly over a week.

One week after the growth factor injections finish, you start another cycle of treatment.

Schedule B

Day 1
  • rituximab as a drip
  • etoposide as a drip
Day 2
  • rituximab as a drip
  • carboplatin as a drip
  • a 24 hour drip of ifosfamide and mesna
Day 3
  • etoposide as a drip
Days 7 to 14
  • daily injections of G-CSF (granulocyte colony stimulating factor). Or you may have one injection of pegfilgrastim.

One week after the growth factor injections finish, you start another cycle of treatment.

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.

Breastfeeding

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

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.

Treatment for other conditions

Always tell other doctors, nurses, pharmacists 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 shingles vaccine (Zostavax).

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, avoid changing their nappies for 2 weeks after their vaccination if possible. Or wear disposable gloves and wash your hands well afterwards.

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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