This page tells you about the chemotherapy drug combination ICE. There is information about
ICE is the name of a combination of chemotherapy drugs used to treat non Hodgkin lymphoma that has come back after treatment. It is made up of the drugs
- I – Ifosfamide
- C – Carboplatin
- E – Etoposide (also known as Vepesid, Etopophos or Eposin)
Most people who have ICE chemotherapy will also have a stem cell transplant. Your doctor will explain this treatment to you in detail.
You have the drugs into your bloodstream (intravenously). You can have them through a thin, short tube (a cannula) put into a vein in your arm each time you have treatment. Or you may have them through a central line, a portacath, or a PICC line. These are long, plastic tubes that give the drugs directly into a large vein in your chest. You have the tube put in before or during your course of treatment and it stays in place as long as you need it.
You can read our information about having chemotherapy into a vein.
You usually have ifosfamide with another drug called mesna, either as a drip (infusion) or as tablets. If you have the tablets you must take them exactly as your doctor prescribes. 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) to make your bone marrow produce white blood cells more quickly after the chemotherapy.
You usually have ICE chemotherapy as cycles of treatment. You may 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.
- On the 1st day you have a carboplatin drip (infusion) for 1 hour, an etoposide drip for 1 hour and then an ifosfamide drip for 6 hours
- On the 2nd day you have an ifosfamide drip for 18 hours. Then you have an etoposide drip for 1 hour and a mesna drip for 6 hours. You usually need to stay in hospital overnight.
- Then you have no treatment for 18 days before starting your next treatment cycle
- On the 1st day you have an etoposide drip for 1 or 2 hours
- On the 2nd day you have an etoposide drip for 1 or 2 hours and a carboplatin drip for 1 hour. You then start a 24 hour drip of ifosfamide and mesna and may need to stay in hospital overnight
- On the 3rd day you finish the ifosfamide and mesna drip and have an etoposide drip for 1 hour. You then start a 12 hour drip of mesna or your doctor may give you mesna tablets to take
- Then you have no treatment for 18 days before starting your next treatment cycle
The side effects associated with ICE combination chemotherapy are listed below. You can use the underlined links to find out more about each one. For general information, see our cancer drugs side effects section or use the search box at the top of the page.
More than 10 in every 100 people have one or more of the side effects listed below.
- An increased risk of getting an infection from a drop in white blood cells – it is harder to fight infections and you can become very ill. You may have headaches, aching muscles, a cough, a sore throat, pain passing urine, or you may feel cold and shivery. If you have a severe infection this can be life threatening. Contact your treatment centre straight away if you have any of these effects or if your temperature goes above 38°C. You will have regular blood tests to check your blood cell levels
- Tiredness and breathlessness due to a drop in red blood cells (anaemia) – you may need a blood transfusion
- Bruising more easily due to a drop in platelets – you may have nosebleeds, or bleeding gums after brushing your teeth. Or you may have lots of tiny red spots or bruises on your arms or legs (known as petechiae)
- Tiredness (fatigue) during and after treatment – most people find their energy levels are back to normal within 6 months to a year
- Numbness or tingling in fingers and toes occurs in 1 in 4 people (25%). It can cause difficulty doing small things such as doing up buttons. This tends to begin a few days or weeks after treatment starts and usually goes within a few months of finishing treatment
- Feeling or being sick is usually well controlled with anti sickness medicines
- Hair loss – most people have complete hair loss but it will grow back when the treatment ends
- Irritation of the lining of the bladder and kidneys – drink plenty of water to flush out the chemotherapy. You may have fluids into your drip before and after your treatment. Tell your doctor or nurse if you have bleeding or pain when passing urine
- Kidney damage – you will have blood tests before your treatment. This makes sure your kidneys are able to cope with the drugs
- Loss of appetite
- A metallic taste when having the drugs through a drip, or loss of taste
- Confusion, sleepiness or extreme lack of energy (lethargy) and hallucinations happen in about 1 in 8 people (12%). If you have any of these effects, it is important to tell your doctor or nurse straight away
- A drop in blood pressure can happen if etoposide is given quickly – if you feel dizzy or faint, call your nurse straight away to slow down the drip
- Women may stop having periods (amenorrhoea) – this may be temporary
- Loss of fertility – you may not be able to become pregnant or father a child after this treatment. 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
Between 1 and 10 in every 100 people have one or more of these effects.
- An allergic reaction with chills, fever, wheezing, a fast heart rate, drop in blood pressure and swelling of the face happens in 1 or 2 out of every 100 people (1 to 2%) – tell your chemotherapy nurse straight away if you have these effects
- Loss of ability to hear some high pitched sounds – this usually gets better on its own after treatment
- Ringing in the ears (tinnitus) affects about 1 in 100 people (1%)
- Inflammation around the drip site – if you notice any signs of redness, swelling or leaking at your drip site, tell your chemotherapy nurse straight away
- Reddening of the skin in areas where you have had radiotherapy in the past – the skin may also get dry and flaky and feel sore and hot. This goes away on its own but keep affected areas out of the sun
- Liver changes that are very mild and unlikely to cause symptoms – the liver will almost certainly go back to normal when treatment finishes. You will have regular blood tests to check how well your liver is working
- A skin rash
- A sore mouth
- Diarrhoea or constipation
There is a small risk that you may get a second cancer some years after ICE treatment. If this does happen, it most often occurs 5 to 8 years afterwards.
You may have a few of the side effects mentioned above. A side effect may get worse through your course of treatment. Or you may have more side effects as the course goes on. This depends on
- How many times you've had a drug before
- Your general health
- How much of the drug you have (the dose)
- Other drugs you are having
Coping with side effects
Talk to your doctor, pharmacist or nurse about all your side effects so they can help you manage them. They can give you advice or reassure you. Your nurse will give you a contact number to ring if you have any questions or problems. If in doubt, call them.
Tell your doctor about any other medicines you are taking, including vitamins, herbal supplements and over the counter remedies. Some drugs can react together.
Pregnancy and contraception
These drugs may 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.
Do not breastfeed during this treatment because the drugs may come through in the breast milk.
You should not have immunisations with live vaccines while you are having chemotherapy or for at least 6 months afterwards. In the UK, these include rubella, mumps, measles (usually given together as MMR), BCG, yellow fever and Zostavax (shingles vaccine).
You can have other vaccines, but they may not give you as much protection as usual until your immune system has fully recovered from your chemotherapy. It is safe to have the flu vaccine.
It is safe for you to be in contact with other people who've had live vaccines as injections. There can be problems with vaccines you take by mouth (oral vaccines), but not many people in the UK have these now. So there is usually no problem in being with any baby or child who has recently had any vaccination in the UK. You might need to make sure that you aren't in contact with anyone who has had oral polio, cholera or typhoid vaccination recently, particularly if you live abroad.
This page does not list all the very rare side effects of this treatment that are very unlikely to affect you. For further information look at the Electronic Medicines Compendium website at www.medicines.org.uk.
If you have a side effect not mentioned here that you think may be due to this treatment you can report it to the Medicines Health and Regulatory Authority (MHRA) at www.mhra.gov.uk.
Rated 5 out of 5 based on 1 votes
Question about cancer? Contact our information nurse team