R-CHOP consists of five separate drugs. These are:
- (R) rituximab (Rituxan)
- (C) cyclophosphamide
- (H) doxorubicin hydrochloride
- (O) vincristine (Oncovin, Vincasar PFS)
- (P) prednisolone
R-CHOP is a systemic treatment, which means that it spreads through the body.
Receiving a chemotherapy prescription can be unsettling and daunting. This article will explain what R-CHOP chemotherapy is, how it works, and how effective it is.
How does R-CHOP chemotherapy work?
R-CHOP chemotherapy is a standard treatment for non-Hodgkin lymphoma.
Three of the drugs in R-CHOP attack cancerous cells. They work in different ways:
- Cyclophosphamide converts to metabolites in the liver. These bind to cancerous cells and interfere with their DNA. This interference prevents the cancer cells from dividing, which stops the tumor from growing.
- Doxorubicin hydrochloride is an enzyme blocker. Cancer cells rely on an enzyme called topoisomerase 2 to spread. Blocking this enzyme slows or stops the growth and division of cancerous cells.
- Vincristine is part of a group of drugs called vinca alkaloids. These drugs prevent cells from dividing, which slows or stops the growth of tumors.
The other two R-CHOP drugs — rituximab and prednisolone — are not chemotherapy drugs.
Rituximab is a type of antibody drug. It belongs to a class of drugs called targeted therapies. Rituximab attaches itself to cancerous cells, which it can trigger the body's immune system to attack.
Prednisolone is a corticosteroid. In the case of cancer, it helps with:
- reducing swelling around the tumor
- combating nausea that can occur during chemotherapy
- protecting and boosting the immune system
- treating allergic reactions
R-CHOP chemotherapy procedure
Each cycle of R-CHOP lasts for about 3 weeks. Depending on the size and type of the tumor, a person may require several courses over a few months.
The treatment will typically take place in a chemotherapy day unit. Some people may need a short stay in the hospital, especially if they have any other medical conditions.
A healthcare professional will take a blood test before the treatment starts to ensure that the person is well enough to proceed.
A chemotherapy nurse will oversee the procedure. They will ask about any notable changes in the person's health. A cancer specialist should also be on hand to answer any questions.
A chemotherapy nurse usually gives the treatment through a line. There are three types of line:
- Cannula — a short, thin tube that the nurse puts into a vein on the arm or hand.
- Central line — a fine tube that enters a vein in the chest.
- PICC line — a thin line that goes in the arm and then into a vein in the chest.
The order of drugs
The delivery of the R-CHOP drugs occurs in the order below:
- The chemotherapy nurse typically offers paracetamol first as it can help with some of the possible side effects of the chemotherapy.
- Anti-sickness drugs and antihistamines are the first medications that the nurse gives. They will deliver these either by injection or in tablet form.
- The person will then take prednisolone, which comes in tablet form. A person will need to take a further 5-day course after each cycle of chemotherapy.
- Rituximab goes through a cannula or line that attaches to a pump. This equipment allows the drug to enter the body over 5 to 10 minutes.
- Doxorubicin (a red fluid) and cyclophosphamide injections follow next.
- Vincristine goes through the line as a drip. The drug delivery will take between 5 and 10 minutes.
- The process uses liquids to flush the line treatments through, which makes sure that the drug has entered the body.
Possible risks during treatment
As with any medical procedure, R-CHOP treatment carries risks. These include:
If a person is breathless during or after chemotherapy, then they should make the nurse aware.
If any of the following symptoms appear during or after the chemotherapy, it is essential to make the nurse aware:
- feeling itchy
- feeling sick
- flu-like symptoms
- pain in the stomach, back, or chest
Low blood pressure
Some people experience a fall in blood pressure after chemotherapy. Anyone who is taking blood pressure medication must tell the nurse ahead of their treatment.
Drug leak around the line
A drug leak could lead to stinging or tingling around the cannula or tube. It is best to inform the nurse if this happens.
Potential side effects
Chemotherapy attacks cancer cells, but it can also damage healthy cells. As a result, there is a long list of potential side effects. However, it is unlikely that a person will experience them all.
Side effects can change during R-CHOP treatment. Some might not appear until months or years after the chemotherapy. Staff at chemotherapy units can provide information on side effects. It is always advisable to contact them if any side effects occur.
The most common side effects are:
- hair loss
- sore mouth
- bladder irritation
- discolored urine
- fluid retention
- increased or suppressed appetite
- stomach ache or indigestion
- high blood sugar
- numbness in hands or feet
- jaw pain
- dry skin
- weakened nails
- weight changes
- changes to menstruation
Less common side effects include:
- mood and behavior changes
- breathing problems
- changes to the heartbeat
- nervous system problems
More serious side effects
If a person has a temperature above 99.5°F, that can be a symptom of an infection.
R-CHOP can reduce the number of platelets in the blood. Platelets help the blood clot, and reduced numbers of platelets can result in easy bruising and bleeding. Sometimes, nosebleeds and bleeding gums can occur.
There is also a risk of infection because R-CHOP can cause a reduction in the number of white blood cells.
Symptoms of an infection include:
- temperature above 99.5°F
- rapidly becoming unwell, with a normal temperature
- frequent passing of urine
- feeling shaky or light-headed
Anyone who experiences any of these symptoms should speak to someone at the chemotherapy unit.
Is R-CHOP right for me?
The drugs that a doctor prescribes will depend on certain factors. These include:
- type of cancer
- size of tumor
- location of tumor
- other medical conditions
R-CHOP is among the most effective treatments for NHL and is often successful. In an analysis of the effectiveness of various chemotherapies on NHL, the authors state that R-CHOP offers "significant advantages" over other chemotherapies for the treatment of this cancer.
The 5-year overall survival rate of NHL is 71 percent when R-CHOP is the treatment.
However, R-CHOP is not suitable for everyone for the following reasons:
- Cancer and chemotherapy can increase the risk of clotting, so people who are prone to blood clots should not have R-CHOP treatment.
- Anyone planning a baby should speak to their doctor before agreeing to the treatment. R-CHOP chemotherapy can affect fertility.
- Women who are breastfeeding should stop doing so during treatment.
- Chemotherapy can affect certain other medical conditions.
- Some people may be taking other medications that are not compatible with the drugs in the R-CHOP combination. A doctor can provide advice on possible drug interactions.
- Cancer medications could affect specific dental procedures, so people should make their dentist aware of their treatment.
Cancer and chemotherapy specialists will be able to discuss specific details with the individual and help them make the right decisions regarding their treatment.