1–2 minutes
DA-R-EPOCH Dosing Strategy (CVC line, 21d cycle)
| Levels | -2 (64%) | -1 (80%) | 1 (100%) | 2 (120%) | 3 (144%) | 4 (173%) | 5 (207%) | 6 (248%) |
|---|---|---|---|---|---|---|---|---|
| Etoposide (mg/m2/day) D1-4 | 50 | 50 | 50 | 60 | 72 | 86 | 104 | 124 |
| Doxorubicin (mg/m2/day) D1-4 | 10 | 10 | 10 | 12 | 14.4 | 17.3 | 20.7 | 24.8 |
| Cyclophosphamide (mg/m2/day) D5 | 480 | 600 | 750 | 900 | 1080 | 1296 | 1555 | 1866 |
Infusion over 96h (together): etoposide, doxorubicin, vincristine (0.4mg/m2/d, max 2mg/day)
Requires G-CSF prophylaxis (filgrastim 5mcg/kg SC daily on D6+ until ANC >0.5 x109/L of nadir)
Dose adjustments (ANC/platelet for etoposide, doxorubicin, cyclophosphamide on the next cycle)
ANC: ≥0.5 (↑ 1 level), <0.5 for 1-2 times (same dose), <0.5 for ≥3 times (↓ 1 level)
Platelet: <2.5 (↓ 1 level)
CrCl: 15-50 (↓ etoposide 25%), 10 (↓ cyclophosphamide 25%, etoposide 50%)
Bilirubin: 20-50 (↓ doxo 50%, vincr 25%, consider etop), 51-85 (↓ doxo 75%, vincr 50%, consider etop), >85 (omit doxo, etop)
Peripheral neuropathy (motor): G2 (↓ vincr 25%), G3 (↓ vincr 50%), G4 (omit vincr)
Peripheral neuropathy (sensory): G3 (↓ vincr 25%), G4 (omit vincr)
Reference: NCCN 2025
Leave a Reply