Cancer drugs A to Z list
R-ICE is a cancer drug combination. You have:
rituximab (pronounced ri-tuk-si-mab)
ifosfamide (eye-foss-fa-mide)
carboplatin (car-bo-pla-tin)
etoposide(ee-top-o-side)
It is a treatment for non-Hodgkin lymphoma and Hodgkin lymphoma that has come back after treatment.
It is sometimes given for or lymphoma of the brain or spinal cord. This is also known as central nervous system (CNS) lymphoma.
Most people who have this type of treatment also have a . Your doctor or nurse will explain this treatment to you in detail.
Find out about Hodgkin lymphoma and non-Hodgkin lymphoma
Ifosfamide, carboplatin, and etoposide are chemotherapy drugs. They destroy quickly dividing cells, such as cancer cells.
Find out more about chemotherapy
Rituximab is a type of targeted drug called a monoclonal antibody. Monoclonal antibodies target proteins on the surface of cancer cells.
Rituximab targets a protein known as CD20. CD20 is found on white blood cells called B cells. It is the B cells that are cancerous in the most common types of lymphoma.
Rituximab attaches itself to the B cells and marks them. The cells of the immune system then recognise the marked cells and kill them.
You have these drugs through a drip into your bloodstream (intravenously).
You might have treatment through a long plastic tube that goes into a large vein in your chest. The tube stays in place throughout the course of treatment. This can be a:
central line
PICC line
portacath
You might have treatment through a thin short tube (a cannula) that goes into a vein in your arm. You have a new cannula each time you have treatment.
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 (G-CSF). This makes your produce more quickly after the chemotherapy. It helps lower your risk of getting an infection after having this treatment.
You usually start G-CSF at the end of each cycle of chemotherapy, and you have it for around a week. If you have an , you have G-CSF until your stem cells have been collected from your bloodstream. Your healthcare team will tell you more about this.
You have R-ICE as cycles of treatment. This means that you have the drugs and then a rest to allow your body to recover.
Each cycle lasts 21 days (3 weeks). You might have between 3 and 6 cycles.
Rituximab can cause an allergic reaction. Before each dose you have paracetamol, a steroid, and an antihistamine drug such as chlorphenamine (Piriton). This helps to reduce the chance of you having an allergic reaction.
For the first cycle of rituximab, you have it as a drip into your bloodstream slowly over a few hours. Your nurse will increase how fast it goes approximately every 30 minutes if you have no allergic reaction.
Your healthcare team will explain more about how you have your treatment.
Different hospitals give R-ICE in different ways. You may have it as an outpatient or you might need to stay in hospital to have treatment. A common way of having R-ICE as an inpatient is described below.
You have rituximab as a drip into your bloodstream.
You have etoposide as a drip into your bloodstream.
You have etoposide as a drip into your bloodstream.
You have carboplatin as a drip into your bloodstream.
You have ifosfamide and mesna as a drip into your bloodstream.
You have etoposide as a drip into your bloodstream.
You have mesna as a drip into your bloodstream or you may have mesna tablets to take by mouth.
You have no chemotherapy treatment, but you will have some injections of G-CSF for a few days.
You then start a new cycle of treatment.
You have blood tests before and during your treatment. They check your levels of and other substances in the blood. They also check how well your liver and kidneys are working.
Before treatment starts you may have a blood test to check for viruses such as hepatitis B, hepatitis C, and HIV. This is called a viral screen.
It’s important for your doctor to know if you have had any of these viruses. This is because this treatment can weaken your and can cause the virus to become active again (reactivation).
Side effects can vary from person to person. They also depend on what other treatments you're having.
Your doctor, nurse or pharmacist will go through the possible side effects. They will monitor you 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.
We haven't listed all the side effects here. Talk to your healthcare team if you have any new symptoms that you think might be a side effect of your treatment.
Remember it is very unlikely that you will have all of these side effects. But you might have some of them at the same time.
These side effects happen in more than 10 in 100 people (more than 10%). You might have one or more of them. They include:
Increased risk of getting an infection is due to a drop in . Symptoms include a change in temperature, aching muscles, cough, headaches, feeling cold and shivery, pain or a burning feeling when peeing or generally feeling 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.
Less commonly you might get a fungal infection, a chest infection or inflammation in your sinuses . You might get a viral infection such as herpes or hepatitis B. This can happen if you have had a virus in the past, and it becomes reactivated when your immune system is weakened by chemotherapy.
You might be breathless and look pale due to a drop in . This is called anaemia.
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. This is known as petechiae.
Some people have an allergic reaction to rituximab. This reaction is most likely to happen during treatment and when you first have the treatment. Symptoms of an allergic reaction include high temperature (fever), chills, tongue and throat swelling, feeling or being sick and difficulty breathing.
Your nurse will give you medicines beforehand to try to prevent a reaction. Tell your nurse straight away if you have any symptoms of an allergic reaction. They will slow down or stop your drip for a while.
A build up of fluid (oedema) that may cause swelling in your arms, hands, ankles, legs, face, and other parts of the body. Contact your doctor or nurse if this happens to you.
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.
This is usually mild. You can do things to help yourself, including some gentle exercise. It’s important not to push yourself too hard and eat a well balanced diet. Talk to your doctor or nurse if this side effect is stopping you from doing your usual daily activities.
Feeling or being sick is usually well controlled with anti sickness medicines. It might help to avoid fatty or fried foods, eat small meals and snacks and take regular sips of water. Relaxation techniques might also 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 treat it once it has started.
You may have some weight loss. Less commonly, you might lose your appetite and have taste changes.
Eating several small meals and snacks throughout the day can be easier to manage. You can talk to a dietician if you are concerned about your appetite or weight loss.
is easier to sort out if you treat it early. Drink plenty and eat as much fresh fruit and vegetables as you can. Try to take gentle exercise, such as walking. Tell your healthcare team if you think you are constipated. They can give you a if needed.
You might get tummy pain, tell your treatment team if you have this. They can check the cause and give you medicine to help.
You can get pain in other parts of the body including your muscles, joints, back, neck, and in the area where your cancer is, but this is less common.
You might get a high temperature. Or you might feel cold or start shivering (chills).
Let your doctor or nurse know if you have headaches. They can give you painkillers such as paracetamol to help.
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.
You could lose all your hair. This includes your eyelashes, eyebrows, underarms, legs 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.
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.
You might feel that you have to wee more often than usual or have a burning feeling when you have a wee or notice blood. Sometimes there might be a lot of blood. Or you might feel that you can't wait when you need to have a wee. It helps to drink plenty of fluids.
Let your healthcare team know if you have any of these symptoms.
Skin problems include a skin rash, dry skin, and itching. You may have somes changes in skin colour (pigmentation). Less commonly you might have a raised itchy rash on the skin also known as hives.
Skin problems usually go back to normal when your treatment finishes. Let your doctor, nurse, or pharmacist know of any skin changes.
Rituximab can also cause a severe skin reaction, but this is rare. Symptoms usually 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. Contact your advice line if you have these symptoms.
You may have changes in levels of minerals and salts in your blood, including low levels of sodium, potassium, calcium, and magnesium. Or less commonly you might have high levels of creatinine or 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.
Immunoglobulin G is an antibody made by the immune system to fight bacteria and viruses. You have regular blood tests during and after treatment to check for this.[;p']#'/
These side effects happen in between 1 and 10 out of every 100 people (between 1 and 10%). You might have one or more of them. They include:
- a serious reaction to an infection. Signs can include feeling very unwell, not passing urine, a very high or very low temperature, shivering, slurred speech or confusion, breathlessness, mottled or discoloured skin, extreme shivering or muscle pain. Call 999 or go to accident and emergency (A&E) immediately if you have any of these symptoms
heart problems such as abnormal heart rhythm, a fast heartrate and a heart attack
low blood pressure that can cause you to feel lightheaded or dizzy, sometimes this can happen when you stand up from sitting or lying down
high blood pressure that might cause headaches, confusion, problems with your eye sight, or chest pain
loose or watery poo (diarrhoea)
difficulty swallowing
mouth sores, ulcers, and the lining of your throat and food pipe might become sore and swollen
indigestion - symptoms include heartburn, bloating, and burping
unusual feelings of the skin – such as numbness, tingling, pricking, burning, a creeping skin feeling, or reduced sense of touch
hearing loss especially with high pitched sounds and ringing in your ears (tinnitus)
eye problems such as dry or watery eyes or red, sore, itchy eyes (conjunctivitis). You might have problems with your eyesight, rarely these problems may be more serious and longer lasting or permanent
a second cancer some years after treatment
high blood sugar levels - symptoms might include feeling very thirsty, a dry mouth, passing urine very often, feeling tired, blurred vision, or weight loss
high levels of a substance called LDH in the blood. You will have blood tests to check this
difficulty falling or staying sleeping (insomnia)
dizziness
feeling agitated and anxious, rarely rituximab can also make you feel very low in mood or nervous
a blocked, runny or itchy nose, or sneezing
sweating, including night sweats
stiffness in your muscles, arms or legs
flushing - sudden reddening and warmth of the neck, upper chest and face
nerve damage that reduces the reflex reaction between tendons and bones
unusual feelings of the skin – such as numbness, tingling, prickling, burning or ‘pins and needles’
numbness or tingling in fingers or toes (peripheral neuropathy) is often temporary and can improve after you finish treatment
redness, swelling, pain, or leaking at your drip site
lung problems - symptoms include difficulty with breathing, shortness of breath, tightening of the chest, chest pain, and a cough. Rarely you might have asthma, low levels of oxygen, or a lung condition
widening of your blood vessels – symptoms can include becoming very red in the face, feeling dizzy, feeling hot, flushing and changes of skin colour
developing a type of blood cancer called acute leukaemia
These side effects happen in fewer than 1 in 100 people (less than 1%). You might have one or more of them. They include:
a blood disorder where your red blood cells get destroyed faster than they can be made (haemolytic anaemia)
a condition where your bone marrow stops making your blood cells (aplastic anaemia)
changes to the way your blood clots - too little clotting causing bleeding or too much clotting causing blood clots
swollen lymph nodes
heart problems such as a slow heart rate, chest pain or discomfort (angina)
There isn't enough information to work out how often these side effects might happen. You might have one or more of them. They include:
inflammation of the pancreas – symptoms include severe tummy pain, feeling or being sick, and a high temperature. You might also have loose poo
blood clots that can be life threatening; signs are pain, redness, and swelling where the clot is. Feeling breathless can be a sign of a blood clot in the lung. Contact your advice line or doctor straight away if you have any of these symptoms
a second cancer some years after treatment
changes to the levels of chemicals in your body caused by a breakdown of tumour cells (tumour lysis syndrome) - you will have regular blood tests to check for this
changes in the brain that are usually reversible, causing a sudden onset of symptoms including headaches, dizziness, confusion, fits (seizures), and changes to vision
imbalance of substances in your blood (metabolic acidosis) – it can cause confusion, tiredness, shortness of breath and headaches
a serious viral infection that causes inflammation in the brain causing symptoms such as a high temperature, headache, stiff neck, sensitivity to light, confusion and tiredness
SIADH – a syndrome where the body makes too much of the hormone that holds water in the body
Stevens Johnson syndrome (SJS) or toxic epidermal necrolysis - a severe skin reaction that may start as tender patches. Depending on your skin tone this may look red, brown, grey, blue, purple or darker than your normal skin. This can lead 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
a - symptoms can include drooping of one side of the face, being unable to smile, having numbness or weakness on one side of the body or being unable to talk. Dial 999 immediately if you have these symptoms
changes to your mental state such as panic attacks and not being able to speak
If you have other side effects that aren’t listed on this page, you can look at the individual drug pages:
We have more information about side effects and tips on how to cope with them.
Cancer drugs can interact with medicines, herbal products, and some food and drinks. We do not list these interactions on this page. An example is grapefruit or grapefruit juice which can increase the side effects of certain drugs.
Tell your healthcare team about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies. Also let them know if you have any other medical conditions or allergies.
After having this treatment you should only have blood or that are first treated with radiation (irradiated). The radiation lowers the risk of a reaction between your blood cells and the cells in the transfusion. No harm comes from the irradiated blood.
In your medical records there is a note saying you should only have irradiated blood. You have a card to carry with this information. This is in case you need treatment at another hospital.
You may not be able to become pregnant or get someone pregnant 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 might be able to store sperm before starting treatment. And women might be able to store eggs or ovarian tissue. But these services are not available in every hospital, so you would need to ask your doctor about this.
Find out more about fertility treatments and support
This treatment may harm a baby developing in the womb. It is important not to become pregnant or get someone pregnant while you are having treatment.
Women must not become pregnant for at least a year after the end of treatment.
Men should not get someone pregnant for at least 6 months after treatment.
Talk to your doctor or nurse about effective contraception before starting treatment. Let them know straight away if you or your partner become pregnant while having treatment.
Don’t breastfeed during this treatment and for 6 months afterwards. This treatment may come through in the breast milk.
If you are having tests or treatment for anything else, always mention your cancer treatment. For example, if you are visiting your dentist.
Do not have live vaccines while you’re having treatment and for up to 12 months afterwards. For some people, it may be longer than this. The length of time you need to avoid live vaccines depends on the treatment you’ve had.
Ask your doctor or pharmacist how long you should avoid live vaccinations.
In the UK, live vaccines include rubella, mumps, measles, chickenpox, BCG, and yellow fever. You can usually have non-live vaccines. But they might not give you as much protection as usual. These include the:
flu vaccine, as an injection
coronavirus (COVID-19) vaccine
Talk to your doctor or pharmacist about the best time to have a vaccine in relation to your cancer treatment.
You can be in contact with other people who have had live vaccines as injections. If someone has had a live vaccine by mouth or nasal spray there may be a small risk the vaccine virus can be passed onto you if your is weakened.
Your healthcare team will let you know if you need to take any precautions if you are in close contact with someone who has had a live vaccine.
For further information about each drug and the possible side effects go to the electronic medicines compendium (emc) website. You can find patient information leaflets for each drug on this website.
You can report any side effect you have to the Medicines and Healthcare Regulatory Agency (MHRA) as part of their Yellow Card Scheme.
Last reviewed: 16 Sept 2026
Next review due: 16 Sept 2026
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