CHOP-R PROTOCOL
Other names: LYCHOP-R
C
Cyclophosphamide
H
Doxorubicin (also known as ADRIAMYCIN®)
O
Vincristine (also known as ONCOVIN®)
P
Prednisone (taken by mouth)
R
Rituximab (also known as RITUXAN®
• CHOP-R is a drug treatment given for Non-Hodgkin’s Lymphoma with the
expectation of destroying cancer cells.
• CHOP-R is currently offered to patients with Non-Hodgkin’s Lymphoma
(diffuse large B-cell).
Treatment Plan:
• Your treatment plan consists of several (up to 8) chemotherapy cycles. Each
cycle lasts 3 weeks (21 days). For each cycle you will have four
chemotherapy drugs, plus a drug called prednisone taken as a pill by mouth.
• Your very first treatment cycle will be over 2 days. The first day (Day 1) will be
about 2 hours; the next day (Day 2) plan to spend about 5 hours in the
treatment room. Each cycle thereafter will be approximately 3 hours. You
may receive all the drugs on Day 1 or you may receive the drugs on two
separate days (Day 1 and 2). You will take the oral medication, prednisone,
daily for the first five days of each cycle.
• The day before each scheduled chemotherapy treatment you will have a
blood test and an appointment with your nurse and doctor to assess how you
are tolerating your treatment.
Drugs:
• Five chemotherapy drugs (cyclophosphamide, doxorubicin, vincristine,
prednisone and rituximab) will be given at each cycle. All drugs, except the
prednisone, are given by injection into a vein. Rituximab may be given on
separate days throughout the treatment or may be given the same day (Day
1) after the first cycle.
• You will be given an oral medication (prednisone) to start on Day 1 and you
will need to take this daily for a total of 5 days (Days 1-5).
• You will be given a prescription for anti-nausea pills to help prevent nausea
and vomiting. Fill this prescription at your drugstore. Please also buy
acetaminophen 325 mg and diphenhydramine 25 mg, you will need these
prior to rituximab.
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• During the rituximab infusion, the nurse will monitor your heart rate, breathing
and blood pressure at frequent intervals.
• During the course of your treatment, your oncologist (cancer doctor) may
decide that you need a drug called filgrastim (also known as G-CSF,
granulocyte colony stimulating factor, NEUPOGEN®) to improve your white
blood cell count. If it is needed, the drug is given as an injection under the
skin (subcutaneous, SC) daily for 3 to 5 days, starting a few days after the
chemotherapy (your doctor will specify when to start this). Your nurse will
teach you or a family member how to give a SC injection. The filgrastim
prescription is filled at your community pharmacy and, since it is not
commonly available the drugstore may require 1-2 days to obtain the drug.
• A blood test will be taken prior to each cycle of treatment. Your doctor will
determine whether you need filgrastim based on your blood counts; the dose
of chemotherapy may be changed based on your blood tests and/or other
side effects.
• If needed, radiation therapy will start approximately 3-4 weeks after your last
cycle of chemotherapy.
• Bring your anti-nausea drugs, and the acetaminophen and diphenhydramine
with you to take before each IV treatment. The nurse will instruct you when to
take your pills. You may also need to take anti-nausea drugs at home after
the chemotherapy. It is easier to prevent nausea than treat it once it has
occurred, so follow directions closely.
• Call your cancer doctor immediately (day or night) at the first sign of any
infection but especially if you have a fever over 38°C or 100°F.
• Check with your doctor or pharmacist before you start taking any new drugs.
Other drugs such as barbiturates, digoxin (LANOXIN®), ciprofloxacin
(CIPRO®) and similar antibiotics, phenytoin (DILANTIN®), carbamazepine
(TEGRETOL®), ketoconazole (NIZORAL®) and similar antibiotics, nifedipine
(ADALAT®), blood pressure medications and warfarin (COUMADIN®), may
interact with CHOP-R.
• We may ask you to skip your dose of blood pressure medication 12
hours before and during rituximab treatment.
• Drink 8-12 cups of liquid a day on the day of your treatment and the day after
your treatment. Empty your bladder (pass urine) every 2 hours while you are
awake and at bedtime for at least 24 hours after your treatment. Your doctor
may also tell you to get up in the night to empty your bladder. This helps
prevent bladder and kidney problems.
• You may drink small amounts of alcohol, as it will not affect the safety or
effectiveness of your treatment. Drinking alcohol may increase the risk of
some side effects of prednisone; discuss this with your doctor or pharmacist.
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• Tell other doctors or dentists that you are being treated with CHOP-R
chemotherapy before you receive any treatment from them.
• Use effective contraception (birth control) if you could become pregnant or if
your partner could become pregnant. Becoming pregnant while on
chemotherapy will likely harm the baby. Do not breast feed.
Serious Side Effects:
Unexpected and unlikely side effects can occur with any drug treatment.
The ones listed below are particularly important as they are directly related
to the common actions of the drugs in your treatment plan.
• Infection: The number of white blood cells that help fight infections will be
lowered by the treatment. Your blood count is expected to return to normal by
Day 1 of the next cycle. If your white blood cell count becomes very low you
could get a serious infection. If you have a fever over 38ºC or 100ºF, call
your cancer doctor immediately (24 hours a day) or go immediately to
your nearest Hospital Emergency and tell the doctor that you are on
chemotherapy. It is recommended you have a working thermometer at
home.
• Allergic Reaction: Rituximab can cause allergic type reactions during or
hours after your treatment. Report any light-headedness or dizziness,
difficulty breathing, shortness of breath, cough, rash, skin flushing, itchy skin,
tickle in throat, or chest tightness to your chemotherapy nurse immediately.
• Bleeding Problems: If you develop black tarry stools, blood in your urine,
pinpoint red spots on the skin, or prolonged nose bleeds report them
immediately to your doctor or nurse.
• Tissue Injury: Doxorubicin and vincristine can cause tissue injury if they leak
out of the vein while they are being given. Report any sensation of burning,
stinging or pain to your chemotherapy nurse immediately.
• Early menopause: If you are a woman still having menstrual periods, CHOP-
R may cause your ovaries to stop working, resulting in menopausal
symptoms (such as hot flashes) and infertility. Your periods may stop. This
may be permanent especially if you are 40 years of age or older.
• Heart failure: Rarely, doxorubicin can have an effect on the heart in some
patients causing failure of the heart’s pumping action which results in
shortness of breath, fatigue and leg swelling. Report shortness of breath,
chest pain, or a fast or uneven heart beat to your doctor immediately.
• Bladder problems: Rarely, cyclophosphamide may cause damage to the
lining of the bladder. Report any signs of blood in urine, frequent need to
pass urine, or pain on passing urine to your doctor immediately.
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Common Side Effects and Management:
SIDE EFFECTS:
Nausea and vomiting can occur with this
treatment and you will need to take anti-
nausea medications before and after your
chemotherapy.
You will be given a prescription for anti-
nausea drugs to take before your IV
treatment and later at home.
• It is easier to prevent nausea than
treat it once it has occurred, so follow
directions closely.
• Refer to the following pamphlets: For
the Patient: Managing Nausea;
Chemotherapy & You; Food choices to
help control nausea*
Fevers and chills may occur especially
during the first Rituximab treatment.
MANAGEMENT:
TYLENOL®) and diphenhydramine (eg,
BENADRYL®) before and every 4 hours
during your rituximab treatment. Tell
your nurse immediately if you have a
reaction during treatment.
Hives, a type of allergic reaction, may
occur. Hives are red or pale raised
patches on your skin and are usually itchy.
These reactions usually occur during or up
to 24 hours after the infusion.
• Take diphenydramine (eg,
BENADRYL®) 25 or 50 mg up to 4 times
a day. (Note: diphenhydramine causes
drowsiness)
Hair Loss. Your hair will fall out 2-4
weeks after treatment begins. Your scalp
may feel tender. You may lose hair on
your face and body. Your hair will grow
back once your treatments are over and
sometimes between treatments. The
colour and texture of the new hair growth
may be different.
• Cutting your hair short or shaving your
head may be more comfortable.
• Avoid hair spray, bleaches, dyes and
perms.
• Apply mineral oil to your scalp to
reduce itching.
• If you lose your eyelashes and
eyebrows, protect your eyes from dust
and grit with a broad-rimmed hat and
glasses.
• Ask your nurse about information on
wigs and head coverings.
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SIDE EFFECTS:
Mouth Sores may occur a few days after
treatment. Mouth sores can occur on the
tongue, gums and sides of the mouth or in
your throat. Mouth sores or bleeding
gums can lead to an infection.
FATIGUE AND BODY ENERGY SLOW DOWN
PLATLETS DOWN
MANAGEMENT:
Brush your teeth gently after eating
If your gums bleed use gauze instead
of a brush. Use baking soda instead of
toothpaste.
• Try baking soda mouth rinses (using ¼
tsp baking soda in 1 cup warm water)
and rinse several times a day. Try
ideas in Easy to chew, easy to swallow
food ideas*.
• Tell your doctor about a sore mouth, as
your chemotherapy doses may need to
be decreased if mouth sores are
severe.
Fatigue is common especially in the first
1-2 weeks after your treatment. As the
number of cycles increases fatigue may
get worse.
• Your energy level should slowly
improve (weeks – months) after your
final treatment is completed.
• Refer to the pamphlet ‘Your Bank to
Energy Savings-How people with
cancer can handle fatigue’
Your platelets may decrease
AVOID FOOD THAT CAN DRAW PLATLETS DOWN:
ONION,GARLIC,GRAPEFRUIT
6-13 days after your treatment. They willreturn to normal with time. Platelets help
your blood clot if you cut yourself. You
may bruise or bleed more easily than
usual.
To help prevent bleeding problems:
• Try not to bruise, cut or burn yourself.
• Clean your nose by blowing gently; do
not pick your nose.
• Avoid constipation:
EAT DRYIED FRUITS SUCH AS PRUNES
recommended by your doctor.
• For minor pain use acetaminophen
(TYLENOL®). Take your temperature
prior to taking acetaminophen-
containing products.
• Do not take common painkillers such
as ibuprofen (eg, ADVIL®, MOTRIN®)
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SIDE EFFECTS:
Severe constipation could occur due to
vincristine.
MANAGEMENT:
you get severe constipation.
• Drink plenty of fluids
• Add prunes or prune juice to diet
• Eat foods high in fibre such as bran,
whole grain breads and cereals, nuts,
raw fruits and vegetables.
SIDE EFFECTS :
Numbness or tingling of fingers or toes
could occur due to vincristine.
MANAGEMENT:
• Numbness and tingling of the toes andfingers will slowly return to normal after
your last chemo.
• Tell your doctor at your next visit if you
develop numbness or have trouble
picking up small objects, doing up
buttons or writing.
• Be careful handling sharp, hot or cold
objects.
SIDE EFFECTS:
2 days after your treatment.
This is expected as doxorubicin is red and
is passed in your urine.
Sugar control may be affected in people
with diabetes.
MANAGEMENT:
are diabetic. See your doctor if your have
signs of blood sugar problems such as
thirst and frequent need to pass urine.
SIDE EFFECTS:
sleeping may be due to prednisone.
• The days you take your prednisone
you may feel as though you have extra
energy.
• You may also have difficulty sleeping
at night.
MANAGEMENT:
morning to prevent insomnia at night.
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If you experience symptoms or changes in your body that have not
been described above but worry you, tell your doctor about them at the
time of your next visit.
If you have symptoms that are severe or need emergency services, go
to your local hospital’s Emergency Department.
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