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ICE

ICE is the name of a chemotherapy combination that includes:

  • ifosfamide
  • carboplatin
  • etoposide (also known as Vepesid, Etopophos or Eposin)

It is a possible treatment for Hodgkin and 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 ICE

You have ifosfamide, carboplatin and etoposide as drips into your bloodstream (intravenously).

Into your bloodstream

You can have the drug through a thin short tube (a cannula) that goes into a vein in your arm each time you have treatment.

Or you might have it through a long line: a central line, a PICC line or a Portacath.

These are long plastic tubes that give the drug into a large vein in your chest. The tube stays in place throughout the course of treatment.

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.

When you have ICE

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. A common way of having it is described below.

Day 1
  • You have etoposide as a drip into your bloodstream for 1 hour
Day 2
  • You have etoposide as a drip into your bloodstream for 1 hour
  • You have carboplatin as a drip into your bloodstream for 1 hour
  • You start a 24 hour drip of ifosfamide and mesna
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. You may need to stay in hospital overnight between day 2 and 3 of each cycle. 

Tests

You have blood tests before 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

We haven't listed all the side effects. It's very unlikely that you will have all of these side effects, but you might have some of them at the same time.

How often and how severe the side effects are can vary from person to person. They also depend on what other treatments you're having. For example, your side effects could be worse if you're also having other drugs or radiotherapy.

When to contact your team

Your doctor, nurse or pharmacist will go through the possible side effects. They will monitor you closely during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:

  • you have severe side effects 
  • your side effects aren’t getting any better
  • your side effects are getting worse

Early treatment can help manage side effects better. 

Contact your doctor or nurse immediately if you have signs of infection, including a temperature above 37.5C or below 36C.

Common side effects

Each of these effects happens in more than 1 in 10 people (10%). You might have one or more of them. They include:

Risk of infection

Increased risk of getting an infection is due to a drop in white blood cells. Symptoms include a change in temperature, aching muscles, headaches, feeling cold and shivery and generally unwell. You might have other symptoms depending on where the infection is.

Infections can sometimes be life threatening. You should contact your advice line urgently if you think you have an infection. 

Breathlessness

You might be breathless and look pale due to a drop in red blood cells. This is called anaemia.

Bruising and bleeding

This is due to a drop in the number of platelets in your blood. These blood cells help the blood to clot when we cut ourselves. 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 petechia).

Tiredness and weakness (fatigue)

Tiredness and weakness (fatigue) can happen during and after treatment - doing gentle exercises each day can keep your energy up. Don't push yourself, rest when you start to feel tired and ask others for help.

Feeling or being sick

Feeling or being sick is usually well controlled with anti sickness medicines. Avoiding fatty or fried foods, eating small meals and snacks, drinking plenty of water, and relaxation techniques, can all help.

It is important to take anti sickness medicines as prescribed even if you don’t feel sick. It is easier to prevent sickness rather than treating it once it has started.

Loss of appetite 

You might lose your appetite for various reasons when you are having cancer treatment. Sickness, taste changes or tiredness can put you off food and drinks.

Constipation 

Constipation is easier to sort out if you treat it early. Drink plenty of fluids and eat as much fresh fruit and vegetables as you can. Try to take gentle exercise, such as walking. Tell your doctor or nurse if you are constipated for more than 3 days. They can prescribe a laxative.

Tummy (abdominal) pain 

Tell your treatment team if you have this. They can check the cause and give you medicine to help. 

Liver problems 

You might have liver changes that are usually mild and unlikely to cause symptoms. They usually go back to normal when treatment finishes. You have regular blood tests to check for any changes in the way your liver is working.

Hair loss

You could lose all your hair. This includes your eyelashes, eyebrows, underarm, leg and sometimes pubic hair. Your hair will usually grow back once treatment has finished but it is likely to be softer. It may grow back a different colour or be curlier than before. 

Kidney damage

To help prevent kidney damage, it is important to drink plenty of water. You might also have fluids into your vein before, during and after treatment. You have blood tests before your treatments to check how well your kidneys are working.

Irritation of the lining of the bladder

This treatment can irritate your bladder and kidneys. Drink as much water as possible to flush out the drugs. Make sure that you pass urine often, especially before you go to sleep. You might also have a drug called Mesna to protect your bladder and kidneys.

Changes in the levels of minerals in your blood

You may have changes in levels of minerals and salts in your blood, including low levels of sodium or high levels of uric acid (causing gout). You have regular blood tests during treatment to check this.

You might also have a drug called allopurinol. It lowers the amount of uric acid in the blood and so helps to reduce the symptoms of gout. 

Occasional side effects

Each of these effects happens in more than 1 in 100 people (1%). You might have one or more of them. They include:

  • an allergic reaction that can cause shortness of breath and redness or swelling of the face
  • dizziness
  • heart problems such as an irregular heartbeat and hypertension
  • diarrhoea
  • a sore mouth
  • skin rash, itchy skin and reddening of the skin
  • redness, swelling, pain or leaking at your drip site
  • bleeding
  • numbness or tingling in fingers and toes can make it difficult to do fiddly things such as doing up buttons
  • taste changes
  • hearing loss especially with high pitched sounds
  • problems with your eyes
  • lung problems that can cause difficulty breathing
  • a second cancer some years after treatment

Rare side effect

Each of these effects happens in fewer than 1 in 100 people (1%). You might have one or more of them. They include:

  • fits
  • high temperature (fever)
  • build up of scar tissue in your lungs (fibrosis)
  • a severe skin reaction that may start as tender red patches which leads to peeling or blistering of the skin. You might also feel feverish and your eyes may be more sensitive to light. This is serious and could be life threatening

Coping with side effects

We have more information about side effects and tips on how to cope with them.

What else do I need to know

Other medicines, foods and drinks 

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.

Loss of 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.

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're 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 drugs may come through in your breast milk.

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 up to 12 months afterwards. The length of time depends on the treatment you are having. Ask your doctor or pharmacist how long you should avoid live vaccinations.

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

You can:

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

Avoid close contact with people who have recently had live vaccines taken by mouth (oral vaccines) such as oral polio or the typhoid vaccine.

This also includes the rotavirus vaccine given to babies. The virus is in the baby’s poo for up to 2 weeks and could 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 should also avoid close contact with children who have had the flu vaccine nasal spray if your immune system is severely weakened. 

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.

Last reviewed: 
19 Feb 2019
  • Electronic Medicines Compendium 

    Accessed January 2019

  • Handbook of Cancer Chemotherapy (8th edition)
    Roland K Keel
    Lippincott, Williams and Wilkins, 2012

  • Immunisation against infectious disease: Chapter 6: General contraindications to vaccination
    Public Health England
    First published: March 2013 and regularly updated on the Gov.UK website

  • Outpatient-based ifosfamide, carboplatin and etoposide (ICE) chemotherapy in transplant-eligible patients with non-Hodgkin's lymphoma and Hodgkin's disease.
    MS Hertzberg and others
    Annals of Oncology, 2003. Vol 14, Supplement 1, Pages 11-16

  • ICE (Ifosfamide, carboplatin, and etoposide) Was the Best Salvage Regimen in Patients with Relapsed or Refractory Malignant Lymphoma
    Y Kusano and others
    Blood, 2014. Vol 124, Issue 21, Page 5432

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