CHOP

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CHOP is an acronym for a chemotherapy regimen used in the treatment of non-Hodgkin's lymphoma. CHOP consists of:

• (C) yclophosphamide, an alkylating agent that destroys DNA by binding it and causing cross link formation
• (H) ydroxydaunorubicin (also called doxorubicin or adriamycin), an intercellular agent that destroys DNA by inserting itself between the DNA bases
• (O) ncovin (vincristine), which prevents cells from duplication by binding to a tubulin protein
• (P) rednison or (P) rednisolone, which is a corticosteroid.

Sometimes anti-CD20 chimeric monoclonal antibodies, rituximab, are added to this treatment regimen to form a R-CHOP regimen.

Video CHOP

Rejimen dosis

R-Maxi-CHOP is used in coated cell lymphoma and administered in a 21-day interval, alternating with R-HDAC (high-dose rituximab cytarabine).

In most other non-Hodgkin's lymphoma (excluding some aggressive forms), standard dosage [R] -CHOP is commonly used as first-line therapy.

Maps CHOP

Usage and indication

Normal cells are more capable than cancer cells to repair damage from chemotherapy drugs.

This regimen can also be combined with rituximab monoclonal antibodies if the lymphoma is derived from B cells; this combination is called R-CHOP . Typically, courses are given at intervals of two or three weeks (CHOP-14 and CHOP-21 respectively). A staging CT scan is generally performed after three cycles to assess whether the disease responds to treatment.

In patients with a history of cardiovascular disease, doxorubicin (which is cardiotoxic) is often regarded as too large a risk and is removed from the regimen. This combination is then referred to as COP (cyclophosphamide, Oncovin, and prednisone or prednisolone) or CVP (cyclophosphamide, vincristine, and prednisone or prednisolone).

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Adverse effects and complications

This combination is generally well tolerated. Chemotherapy-induced nausea and vomiting may require antiemetics (such as ondansetron), and haemorrhagic cystitis is prevented by mesna. Alopecia (hair loss) is common.

Neutropenia generally develops in the second week. During this period, many doctors recommend the use of pegfilgrastim or ciprofloxacin prophylaxis. ^[1] If a fever develops in a neutropenic period, urgent medical assessment is required. for neutropenic sepsis, because infection in patients with low neutrophil counts can develop rapidly.

Allopurinol is usually administered simultaneously prophylactically to prevent hyperuricemia caused by tumor lysis syndrome, the result of rapid death of tumor cells.

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History

An important study published in 1993 compared CHOP with several other chemotherapy regimens (eg m-BACOD, ProMACE-CytaBOM, MACOP-B) for advanced non-Hodgkin lymphoma. ^[2] CHOP emerges as the lowest-to-lowest-but-similar-to-the-same-test regimen.

However, in Germany in 2012, bendamustine has replaced the [R-] CHOP to be the first-line treatment of choice for indolent lymphoma (a less aggressive subset of non-Hodgkin's lymphoma).

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[R] -CHOEP modifications

To develop a more effective first-line chemotherapy regimen for aggressive lymphoma, some researchers tried to add toposide (E) to the standard [R] -CHOP regimen.

There are also attempts to further improve the efficacy of [R] -CHOEP regimens by increasing doses of chemotherapy. This mode is called [R] -High-CHOEP . However, it does not show effectiveness over standard doses [R] -CHOEP while adding more toxicity and cost.

To try to improve the efficacy of [R] -CHOEP, some researchers try to increase chemotherapy to very high doses, requiring the support of autologic stem cells in each cycle. The doses in the regimen were increased from one cycle to another. This regimen is called [R] -MegaCHOEP. But again, such escalations do not seem to increase their effectiveness while adding toxicity.

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See also

• Chemotherapy regimen
• EPOCH chemotherapy

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References

1. ^ Cullen M, Steven N, Billingham L, Gaunt C, Hastings M, Simmonds P, Stuart N, Rea D, Bower M, Fernando I, Huddart R, Gollins S, Stanley A (2005). "Prophylactic antibacterials after chemotherapy for solid tumors and lymphomas". N Engl J Med . 353 (10): 988-98. doi: 10.1056/NEJMoa050078. PMIDÃ,16148284
N Engl J Med . 328 (14): 1002-6. doi: 10.1056/NEJM199304083281404. PMIDÃ, 7680764 Ã,

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