EVA+EB+ECC
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EVA EB ECC chemotherapy regimen oncology protocol
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EVA EB ECC chemotherapy regimen
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EVA+EB+ECC oncology chemotherapy alternating regimen lymphoma
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https://hemonc.org/wiki/Classical_Hodgkin_lymphoma
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VAPEC-B Hodgkin lymphoma EVA alternating
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VAPEC-B regimen weekly schedule vincristine adriamycin prednisolone etoposide cyclophosphamide bleomycin Hodgkin
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I now have enough information to give a complete answer. The VAPEC-B regimen is the source of "EVA+EB+ECC" - these are just grouped descriptions of the drug combinations given on specific weeks of the weekly schedule.
EVA + EB + ECC - The VAPEC-B Regimen
EVA + EB + ECC is a shorthand way to describe the VAPEC-B weekly chemotherapy regimen, grouping drugs by the weeks they are administered. VAPEC-B is used for Hodgkin lymphoma and high-grade Non-Hodgkin lymphoma.
Drug Expansion
| Abbreviation | Stands for | Drug |
|---|---|---|
| E | Etoposide | VP-16 (oral, days 1-5 of given week) |
| V | Vincristine | Oncovin |
| A | Adriamycin | Doxorubicin 35 mg/m² IV |
| B | Bleomycin | 10 mg/m² IV |
| C | Cyclophosphamide | 350 mg/m² IV |
| C (second C) | Corticosteroid | Prednisolone 50 mg/day oral |
VAPEC-B Weekly Schedule (12-week regimen)
The drugs are given on a weekly basis over 11-12 weeks, which is where the "EVA + EB + ECC" grouping comes from:
| Week | Drugs Given | Group |
|---|---|---|
| 1 | A (Doxorubicin) + C (Cyclophosphamide) + Prednisolone | AC |
| 2 | V (Vincristine) + B (Bleomycin) + Prednisolone | VB |
| 3 | E (Etoposide x5d) + A (Doxorubicin) + Prednisolone | EA |
| 4 | V (Vincristine) + Prednisolone | V |
| 5 | A + C + Prednisolone | AC |
| 6 | V + B + Prednisolone | VB |
| 7 | E + A + Prednisolone | EA |
| 8 | V + Prednisolone | V |
| 9 | A + C + Prednisolone | AC |
| 10 | V + B + Prednisolone | VB |
| 11 | E + A + Prednisolone | EA |
Prednisolone runs continuously: 50 mg/day for weeks 1-6, then 25 mg/day for weeks 7-12.
Complete Drug Doses
| Drug | Dose | Route | Weeks |
|---|---|---|---|
| Doxorubicin (Adriamycin) | 35 mg/m² | IV | 1, 3, 5, 7, 9, 11 |
| Cyclophosphamide | 350 mg/m² | IV | 1, 5, 9 |
| Etoposide | 100 mg/m²/day x 5 days | Oral | 3, 7, 11 |
| Vincristine | 1.4 mg/m² (max 2 mg) | IV | 2, 4, 6, 8, 10 |
| Bleomycin | 10 mg/m² | IV | 2, 6, 10 |
| Prednisolone | 50 mg/day (wks 1-6), 25 mg/day (wks 7-12) | Oral | Daily |
Indications
- Hodgkin lymphoma - used as an alternative to ABVD or MOPP/ABVD; compared unfavorably to ChlVPP/EVA in a phase 3 trial (5-year OS: 79% vs 89%)
- High-grade Non-Hodgkin lymphoma - used as first-line or salvage therapy, with CR rates of ~62%
Key Points
- The regimen is notable for its brevity (only 11-12 weeks total) vs. other multi-cycle regimens
- Main toxicities: myelosuppression (grade 2 leukopenia common), sepsis risk (~10% grade 3 infections), bleomycin-related pulmonary toxicity
- Caution in patients >60 years with stage IV disease - higher treatment-related mortality from sepsis
- CNS prophylaxis should be considered in NHL patients
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