What to Expect With R-CHOP Chemotherapy

R-CHOP is a combination of five drugs that work together to target and kill cancer cells. It’s a first-line treatment for aggressive non-Hodgkin’s lymphoma, a group of blood cancers. Most often, R-CHOP is used to treat the most common form of non-Hodgkin’s lymphoma called diffuse large B-cell lymphoma (​DLBCL).

R-CHOP is named for the initials of the five drugs. The R comes from rituximab, which is not a chemotherapy drug but is composed of man-made antibodies that help your immune cells destroy cancerous tumors. The addition of rituximab replaced a longtime therapy called CHOP that didn’t work very well and was highly toxic.

Dosing Schedule

The other drugs in the R-CHOP mix are:

  • (C) Cyclophosphamide, a cancer drug
  • (H) Doxorubicin hydrochloride, a cancer drug
  • (O) Vincristine (older name: Oncovin), a chemotherapy drug that slows or stops cancer cells from growing
  • (P) Prednisone, a steroid that helps boost how well the chemo drugs work

You’ll get your medications at a clinic. Usually, you receive an R-CHOP dose every 21 days. Depending on your cancer and your overall health, you may get more frequent doses, once every 14 days.

On average, people receive six cycles in a row. You may have as many as eight or as few as three. The whole treatment lasts several months. If your cancer is in the earliest stages, I or II, you may start with radiation therapy and then go through three or four cycles of R-CHOP.

How to Take It

On the first day of each cycle, you’ll get the four of the five drugs -- all but prednisone, the steroid. A nurse or another medical professional injects the medication into your vein in one of these ways:

IV infusion. A needle put into a vein in your arm or hand is connected to a tube carrying the drugs.

Central line. Similar to an IV, but it uses a larger tube or a number of tubes that hook up to a port that goes under your skin near your chest. This allows the medication to go directly into a large vein of your heart.

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PICC line. It stands for peripherally inserted central catheter. A long, thin tube called a catheter goes into your arm and is threaded up to a large vein near your heart. This tube stays in place until you finish your treatment.

Each infusion may take several hours. Your doctor may divide your first dose over 2 days to slowly monitor how it affects you.

You might get rituximab as an IV on a separate day from the other three drugs. You take prednisone as a pill once a day for 5 days. You take your first dose the same day that you take the other infused drugs and for 4 days after that.

Side Effects

Heart problems, including heart failure, are possible risks for people being treated for non-Hodgkin’s lymphoma. Two of the R-CHOP drugs -- cyclophosphamide and doxorubicin -- have been linked to problems in one of your heart’s chambers.

Any side effects are most likely to happen when you first start R-CHOP therapy. You may be more likely to get them if you’re also receiving radiation or another treatment.

Common side effects may include:

Less common symptoms may include:

Prednisone is a steroid and can cause its own side effects, including:

  • Thinner skin
  • Increased sugar in your blood
  • Weight gain
  • Swelling from fluid buildup, especially in your face

If you have side effects that are severe, don’t get better, or get worse over time, call your doctor.

Next Steps

If your cancer doesn’t respond well or quickly enough to R-CHOP, your doctor may try other types of chemotherapy. If you respond well to that treatment and are healthy enough, your doctor also may suggest a stem cell transplant. Unlike chemotherapy, stem cell transplantation can help grow new, healthy cells instead of just killing cancerous cells.

WebMD Medical Reference Reviewed by Carol DerSarkissian on May 28, 2020

Sources

SOURCES:

National Cancer Institute: “NCI Drug Dictionary.”

Lymphoma Research Foundation: “Diffuse Large B-Cell Lymphoma.”

Mayo Clinic: “Rituximab (Intravenous Route).”

MedlinePlus: “Cyclophosphamide,” “Doxorubicin,” “Vincristine Injection.”

Cancer Research UK: “Non-Hodgkin Lymphoma.”

BC Cancer Agency: “For the Patient: CHOP-R.”

American Cancer Society: “Treating B-Cell Non-Hodgkin Lymphoma,” “Nausea and Vomiting Caused by Cancer Treatment.”

Macmillan Cancer Support (UK): “R-CHOP.”

Journal of Hematology Oncology Pharmacy: “Making an Informed Treatment Choice for Aggressive Non-Hodgkin Lymphoma: the R-CHOP Regimen versus EPOCH-R.”

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