Outpatient dose-adjusted EPOCH for B-cell lymphoma proven safe, feasible

A recent study has shown the safety and feasibility of routine outpatient administration of dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin (EPOCH), with a positive annual impact on margin amounting to $1,444,548 at a comprehensive cancer centre.

This single-centre, retrospective chart review was conducted on B-cell lymphoma patients aged ≥18 years and who had received dose-adjusted EPOCH at Moffitt Cancer Center in Florida, US, from 26 April 2017 to 10 August 2019.

Hospital admissions during outpatient chemotherapy administration was the primary endpoint, and safety outcomes included hospitalizations between cycles, infectious complications, extravasations, drug spills, pump-malfunctions, and drug-related adverse events. The authors also performed financial analysis including drug cost, resource utilization, and impact of hospital bed backfill.

Fifty-six patients received 219 cycles of dose-adjusted EPOCH, with 193 cycles administered outpatient. None of the participants needed hospitalization during outpatient administration of dose-adjusted EPOCH, which led to 965 saved hospital days.

Less than half of the patients (n=23, 41 percent) were hospitalized between cycles, most frequently because of neutropaenic fever (52 percent). Extravasations did not occur throughout the study period, but there were few incidences of drug spills or pump malfunctions.

Of note, the annual transition of 84 cycles of dose-adjusted EPOCH to the outpatient setting had a positive impact on margin of $1,444,548 based on current regimen utilization.

“Dose-adjusted EPOCH is a front-line treatment option for aggressive B-cell lymphomas. Due to regimen complexity, inpatient administration of DA-EPOCH has been historically required,” the authors said.

“Moffitt Cancer Center developed an Inpatient/Outpatient programme to facilitate administration of complicated regimens in the outpatient setting,” they added.