R-CHOP is an acronym that represents a combination of chemotherapy drugs used in the treatment of non-Hodgkin lymphoma. In the term ‘R-CHOP’, R stands for rituximab, C for cyclophosphamide, H for hydroxydaunorubicin (commonly known as doxorubicin), O for oncovin or vincristine and P for prednisolone which is a steroid. Cyclophospahamide, doxorubicin and vincristine are used in the treatment of other cancers as well so it is rituximab that is a quite unique chemotherapy drug used in the R-CHOP chemotherapy regimen.

Rituximab falls into the category of monoclonal antibodies, which is nothing but a group of drugs that function in a peculiar way. The basic function of any chemotherapy drug is to destroy the cancer cells but in the course of destroying the cancer cells, these drugs also tend to harm the normal cells. Rituximab is one of those chemotherapy drugs that causes less of an ill-effect to the normal cells and therefore it is used in the treatment of different types of B-cell non Hodgkin lymphoma. What this drug does is that it binds itself with the protein called CD20 which is found on the surface of B-cells. Cancer cells also have proteins on its surface and rituximab binds itself with these proteins in a way that the immune system of the body attacks the cancer cells. The cancer cells could also be automatically destroyed after this process takes place. The drug destroys the malignant cancer cells but it also tends to destroy the normal B-cell lymphocytes or a group of white blood cells. However, the body replaces the normal white cells that were destroyed or damaged with the healthy cells. Because of the use of the drug ‘rituximab’ in the chemotherapy treatment, it is also referred to as CHOP Rituxan chemotherapy (Rituxan is the brand name of rituximab).

Administration of R-CHOP Chemotherapy Regimen

R-CHOP chemotherapy regimen is usually administered as an outpatient treatment. However, the first time the treatment is given could require the patient to either stay overnight in the hospital or the patient could come in the next day for the remaining treatment to be carried out. Before starting with the chemotherapy treatment, the patient is required to take blood tests to check the blood cell counts and to ascertain the normal functioning of certain body parts. When the blood tests are normal, no other tests are required and the doctor determines that the patient is good to go through the chemotherapy treatment, the preparations for it begin, which could take an hour or two. Once the chemotherapy drugs are prepared for the treatment, the drugs are administered to the patient intravenously. For this, a cannula is inserted into the vein in the arm or the drug could also be given using a port a cath. The doctor will explain thoroughly about the way in which the drugs can be given before undertaking the treatment. While undergoing chemotherapy the patient may experience sickness and to avoid it anti-sickness meds are given before starting with the administration of chemotherapy drugs. They could either be given orally to the patient or can be injected intravenously. After giving anti-sickness drugs, a dose of rituximab is infused into the vein slowly, this could take a few hours but the reason for giving it slowly is that a sudden infusion of the drug may cause allergic reactions in some patients. If any allergic reactions are noticed on the patient, the drip is stopped and then slowly started again when the reaction is reduced.
To monitor the response of the first dose of rituximab, the patient may be asked to stay overnight however some may be allowed to go home and come back the next day to start with the second dosage. In R-CHOP chemotherapy regimen usually the drugs are given in the following order i.e. rituximab, doxorubicin, vincristine and cyclophosphamide. Please note that prednisolone is a steroid that is taken in the form of tablets. The first dose of this steroid is taken before the infusion of rituximab and will be prescribed by the doctor to take later, usually in the course of five days from the treatment. The patient is ready to leave after the treatment, but may be left with a PICC or central line that is used to give the drugs. The patients are given instructions as to how to handle them until the next chemotherapy cycle.

As other chemotherapy treatment and regimens, R-CHOP chemotherapy regimen is also given in cycles. It means that the treatment is given followed by a rest period of some days. Each chemotherapy cycle of R-CHOP chemotherapy regimen may take 21 days or it can also be given over 14 days. Sometimes, because of the number of days in each cycle these regimens are also called as R-CHOP 14 or R-CHOP 21. The number of cycles may vary due to certain factors bu t mostly  the course contains 6 to 8 chemotherapy cycles given over a period of 3 to 4 months.

Potential Side Effects of R-CHOP Chemotherapy Regimen

Chemotherapy drugs travel through the entire system to reach and destruct the cancer cells and in the process they also harm the healthy cells that play a vital role in the healthy functioning of the body system. Some of the possible R-CHOP chemotherapy regimen side effects are as follows:

• Allergic reactions
• Low blood cell counts leading to anemia, lowering infection resistance and making the patient prone to bleeding or bruising
• Low blood pressure
• Fatigue
• Mouth sores
• Hair loss
• Constipation
• Nausea / vomiting
• Increased appetite resulting with the intake of the steroid, prednisolone
• Peripheral neuropathy or tingling and numbness in toes and fingers

These were some of the commonly noticed side effects of R-CHOP chemotherapy regimen. These side effects are reversible so if any of the mentioned or other side effects are noticed it should be brought to the immediate notice of the doctor. Please do not take any of the mentioned medicines without consulting with the oncologist.