Drug Formulary information is intended for use by healthcare professionals. It is not intended to be medical advice. Some of the information, including information about funding for cancer drugs, does not apply to all patients. Cancer treatment plans are unique to each patient. If you are a patient, please speak with your healthcare team to understand how this information applies to you.

regimen-monograph

A - Regimen Name

ESHAP Regimen
Etoposide-SODUMEDROL® (Methylprednisolone)-High dose ARA-C (Cytarabine)-PLATINOL® (CISplatin)


Disease Site
Hematologic - Lymphoma - Non-Hodgkin's (Salvage Therapy - Aggressive Histology)
Salvage Therapy- Advanced Stage

Intent
Curative

Regimen Category
Standard : Standard therapy endorsed by the Disease Site Group or a regimen widely used by most Regional Cancer Centres in this disease site.  The category is unrelated to the source or availability of funding.

Rationale and Uses
Salvage therapy for aggressive histology lymphoma
 
B - Drug Regimen

etoposide

(Round to nearest 10mg)
40-60 mg /m²/day IV Days 1 to 4

 

Methylprednisolone:                500mg                          IV                                         Days 1 to 5

CISplatin

(Round to nearest 1mg)
25 mg /m²/day IV (continuous infusion) Daily (continuous infusion for 4 days, starting Day 1)

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cytarabine
2 g /m² IV (over 2 hours) Day 5 only
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C - Cycle Frequency

REPEAT EVERY 28 DAYS

 
D - Premedication and Supportive Measures

Antiemetic Regimen:

High

Other Supportive Care:

  • Ensure good urinary output during chemotherapy visit.
  • Oral hydration is strongly encouraged; poorly hydrated patients may need more IV hydration.
 
E - Dose Modifications

Doses should be modified according to the protocol by which the patient is being treated. The following recommendations are in use at some centres.

Dosage with toxicity

Hematologic Toxicities

See Appendix 6 for general recommendations.

 

 



Hepatic Impairment

Bilirubin (µmol/L)
 
                     % usual dose
 
1-2 x ULN
REDUCE Etoposide to 50% dose
2-4 x ULN
REDUCE Etoposide to 25% dose
 > 4 x ULN
 OMIT Etoposide dose

Renal Impairment

Creatinine Clearance
% usual dose
0.5-1.0mL/sec
REDUCE Cisplatin* to 50% dose
0.2-0.8mL/sec
REDUCE Etoposide to 75% dose
                               < 0.5mL/sec
OMIT Cisplatin dose
 < 0.2mL/sec
REDUCE Etoposide to 50% dose
* Upon the discretion of the prescriber, less dose reduction may be suggested. See cisplatin drug monograph. (Dosage reduction)

 
F - Adverse Effects
Refer to etoposide, CISplatin, cytarabine, methylprednisolone drug monograph(s) for additional details of adverse effects
 
G - Interactions
Refer to etoposide, CISplatin, cytarabine, methylprednisolone drug monograph(s) for additional details
 
H - Drug Administration and Special Precautions
Refer to etoposide, CISplatin, cytarabine, methylprednisolone drug monograph(s) for additional details
 
I - Recommended Clinical Monitoring

Recommended Clinical Monitoring

  • Clinical toxicity assessment (including gastrointestinal, stomatitis, neurotoxicity, ototoxicity, CNS toxicity, conjunctivitis, and pulmonary toxicity).
  • Routine blood glucose test.
  • CBC before each cycle. Interim counts should be done in first cycle and repeated if dose modification necessary.
  • Baseline and regular liver & renal function tests (including magnesium and electrolytes) and urinalysis.
  • Baseline blood pressure at each treatment; monitor for hypotension.
  • Grade toxicity using the current NCI-CTCAE (Common Terminology Criteria for Adverse Events) version

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K - References

Cabanillas F, Rodriguez MA, Swan F. Recent trends in the management of lymphomas at M. D. Anderson Cancer Centre.Semin Oncol, 1990; 17: 28-33

Velasquez WS, McLaughlin P, Tucker S et al. ESHAP – an effective chemotherapy regimen in refractory and relapsing lymphoma: a 4-year follow-up study. Journal of Clinical Oncology 12(6): 1169 ; 1994.

October 2017 Updated antiemetic classification. Revised July 2010.


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M - Disclaimer

Regimen Abstracts
A Regimen Abstract is an abbreviated version of a Regimen Monograph and contains only top level information on usage, dosing, schedule, cycle length and special notes (if available). It is intended for healthcare providers and is to be used for informational purposes only. It is not intended to constitute or be a substitute for medical advice, and all uses of the Regimen Abstract are subject to clinical judgment. Such information is provided on an “as-is” basis, without any representation, warranty, or condition, whether express, or implied, statutory or otherwise, as to the information’s quality, accuracy, currency, completeness, or reliability, and Cancer Care Ontario disclaims all liability for the use of this information, and for any claims, actions, demands or suits that arise from such use.
Information in regimen abstracts is accurate to the extent of the ST-QBP regimen master listings, and has not undergone the full review process of a regimen monograph.  Full regimen monographs will be published for each ST-QBP regimen as they are developed.
Regimen Monographs
Refer to the New Drug Funding Program or Ontario Public Drug Programs websites for the most up-to-date public funding information.
The information set out in the drug monographs, regimen monographs, appendices and symptom management information (for health professionals) contained in the Drug Formulary (the "Formulary") is intended for healthcare providers and is to be used for informational purposes only. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects of a particular drug, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for a given condition. The information in the Formulary is not intended to constitute or be a substitute for medical advice and should not be relied upon in any such regard. All uses of the Formulary are subject to clinical judgment and actual prescribing patterns may not follow the information provided in the Formulary.
The format and content of the drug monographs, regimen monographs, appendices and symptom management information contained in the Formulary will change as they are reviewed and revised on a periodic basis. The date of last revision will be visible on each page of the monograph and regimen. Since standards of usage are constantly evolving, it is advised that the Formulary not be used as the sole source of information. It is strongly recommended that original references or product monograph be consulted prior to using a chemotherapy regimen for the first time.
Some Formulary documents, such as the medication information sheets, regimen information sheets and symptom management information (for patients), are intended for patients. Patients should always consult with their healthcare provider if they have questions regarding any information set out in the Formulary documents.
While care has been taken in the preparation of the information contained in the Formulary, such information is provided on an “as-is” basis, without any representation, warranty, or condition, whether express, or implied, statutory or otherwise, as to the information’s quality, accuracy, currency, completeness, or reliability.
CCO and the Formulary’s content providers shall have no liability, whether direct, indirect, consequential, contingent, special, or incidental, related to or arising from the information in the Formulary or its use thereof, whether based on breach of contract or tort (including negligence), and even if advised of the possibility thereof. Anyone using the information in the Formulary does so at his or her own risk, and by using such information, agrees to indemnify CCO and its content providers from any and all liability, loss, damages, costs and expenses (including legal fees and expenses) arising from such person’s use of the information in the Formulary.


Last Updated: July 21, 2026