ERCC8

EPOCH

EPOCH is a chemotherapy regimen used primarily in the treatment of Non-Hodgkin Lymphoma, including Diffuse Large B-Cell Lymphoma (DLBCL). The acronym EPOCH stands for the combination of five drugs: Etoposide, Prednisone, Oncovin (Vincristine), Cyclophosphamide, and Hydroxydaunorubicin (Doxorubicin). This regimen is a variation of the CHOP regimen, with the addition of Etoposide and a continuous infusion of the drugs over several days.

Components of EPOCH

• Etoposide: A topoisomerase inhibitor that prevents DNA unwinding, thereby inhibiting DNA replication and transcription.
• Prednisone: A corticosteroid that helps reduce inflammation and suppresses the immune system.
• Oncovin (Vincristine): A vinca alkaloid that inhibits microtubule formation, disrupting mitosis in cancer cells.
• Cyclophosphamide: An alkylating agent that cross-links DNA, leading to cell death.
• Hydroxydaunorubicin (Doxorubicin): An anthracycline antibiotic that intercalates DNA, inhibiting topoisomerase II and generating free radicals.

Mechanism of Action

EPOCH works by targeting rapidly dividing cancer cells through multiple mechanisms:

1. DNA Damage: Cyclophosphamide and Doxorubicin cause direct DNA damage, leading to apoptosis. 2. Microtubule Inhibition: Vincristine disrupts the mitotic spindle, preventing cell division. 3. Topoisomerase Inhibition: Etoposide inhibits topoisomerase II, preventing DNA replication. 4. Immune Modulation: Prednisone reduces inflammation and modulates immune response, which can help in reducing tumor burden.

Administration

EPOCH is typically administered in cycles, with each cycle lasting 21 days. The drugs are given as a continuous infusion over 4 to 5 days, with Prednisone taken orally. The regimen is often adjusted based on the patient's response and tolerance to the treatment.

Side Effects

Common side effects of EPOCH include:

• Myelosuppression: Decreased production of blood cells, leading to anemia, increased risk of infection, and bleeding.
• Nausea and Vomiting: Often managed with antiemetic medications.
• Alopecia: Hair loss, which is usually temporary.
• Peripheral Neuropathy: Numbness or tingling in the extremities, primarily due to Vincristine.
• Infection: Due to immunosuppression, patients are at increased risk of infections.

Clinical Considerations

EPOCH is often chosen for patients with aggressive lymphomas or those who have not responded to standard CHOP therapy. Dose adjustments may be necessary based on the patient's renal and hepatic function, as well as their overall performance status.

Also see

• CHOP chemotherapy
• Diffuse Large B-Cell Lymphoma
• Chemotherapy
• Oncology