The Goal of R-CHOP

Studies consistently show that R-CHOP is the best combination for aggressive B-cell lymphomas. This group of drugs work together to gain an advantage over this cancer.

“For whatever reason, the lymphoma cells that should have been programmed to die are not dying. So, the R-CHOP combination works together to encourage cells to undergo what’s called apoptosis, or programmed cell death,” Dr. Phillips says.

Here’s how the acronym breaks down:

• R:  Rituximab (Rituxan) is a monoclonal antibody that attaches to a specific protein called CD20, which sits on the surface of B cells. It targets the cancerous cells and destroys them.
• C: Cyclophosphamide is a chemotherapy drug.
• D: Doxorubicin is a chemotherapy drug.
• V: Vincristine is a chemotherapy drug.
• P: Prednisone is a steroid medication that brings down inflammation in the body.

“R-CHOP is primarily administered through an intravenous catheter,” Dr. Phillips says.
“Rituximab and three of the medicines, the C, H, and O, are delivered through an IV. The P stands for prednisone, and that can be given in either IV or pill form.”

In most cases, doctors deliver this regimen in cycles spaced three weeks apart to help minimize toxicities and allow patients time to recover between treatment cycles. To avoid getting stuck with needles every few weeks, some patients choose to have doctors place a port in their veins. Doctors insert a flexible tube, or port, into a vein in the chest. With the port in place, health care professionals can more seamlessly deliver intravenous medication, take blood samples, and administer fluids.

The Goal of R-CHOP

The goal of R-CHOP is to to shrink lymph nodes back to normal and coax patients into a durable remission. “Oncologists don’t like to use the word ‘cure’ too often, but certainly with R-CHOP, our goal is to cure patients, because diffuse large B-cell lymphoma, for example, is a curable malignancy [cancer],” Dr. Phillips says. “Our goal with R-CHOP would first be to shrink lymph nodes, to make the imaging findings disappear completely, and to produce a complete remission.”

Of course, R-CHOP doesn’t always work. Although it remains the standard of care for aggressive B-cell lymphomas, there are clinical trials looking to improve upon that standard by adding or removing medications to improve outcomes or minimize toxicity. If the lymphoma doesn’t resolve with treatment, or if it comes back, doctors may suggest another chemotherapy regimen, or recommend participation in a clinical trial.

It’s important to work with your health care team to learn about all of the available treatment options and importantly, which might work best for your unique case.

 

Reviewed by Dr. Sairah Ahmed, associate professor, Department of Lymphoma/Myeloma, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center

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