CHOP+R Treatment
This handout gives general information about this cancer treatment.
You will learn:
-
who to contact for help
-
what the treatment is
-
how it is given
-
what to expect while on treatment
This handout was created by Ontario Health (Cancer Care Ontario) together with patients and their caregivers who have also gone through cancer treatment. It is meant to help support you through your cancer treatment and answer some of your questions.
This information does not replace the advice of your health care team. Always talk to your health care team about your treatment.
My cancer health care provider is: _____________________________________________
During the day I should contact: _______________________________________________
Evenings, weekends and holidays: _____________________________________________
This page gives general information about this cancer treatment.
You will learn:
-
who to contact for help
-
what the treatment is
-
how it is given
-
what to expect while on treatment
This information was created by Ontario Health (Cancer Care Ontario) together with patients and their caregivers who have also gone through cancer treatment. It is meant to help support you through your cancer treatment and answer some of your questions.
This information does not replace the advice of your health care team. Always talk to your health care team about your treatment.
CHOP+R is the code name of your lymphoma treatment regimen.
A regimen is a combination of medications to treat cancer.
This regimen name is made up of one or more letters from the names of the 5 medications in your treatment.
Here are the names of the medications in this regimen:
C = Cyclophosphamide
H = doxorubicin (also called Hydroxyldaunorubicin),
O = vincristine (also called Oncovin®)
P = Prednisone
+
R = Rituximab
For most people, treatment lasts 18 weeks. The treatment is divided into 6 cycles. Each cycle is 3 weeks long.
Here is a picture of the schedule for CHOP+R treatment:
Cycle 1 CHOP+R (3 weeks)
Cycle 2 CHOP+R (3 weeks)
Cycle 3 CHOP+R (3 weeks)
Cycle 4 CHOP+R (3 weeks)
Cycle 5 CHOP+R (3 weeks)
Cycle 6 CHOP+R (3 weeks)
For some people, treatment may last 24 weeks. The treatment is divided into 8 cycles. Each cycle is 3 weeks long. Your health care team will tell you how many cycles you need.
During each 3 week cycle you will have CHOP+R treatment on day 1 at the hospital. You will continue to take P (prednisone) tablets on days 2-5 at home.
Each cycle looks like this:
Day 1
Treatment Day:
Go to the hospital for CHOP+R treatment
2
Take your prednisone
3
Take your prednisone
4
Take your prednisone
5
Take your prednisone
6
No CHOP+R Treatment
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
Remember To:
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Tell your health care team about all of the other medications you are taking.
-
Keep taking other medications that have been prescribed for you, unless you have been told not to by your health care team.
You will have a blood test to check for hepatitis B before starting treatment. See the Hepatitis B and Cancer Medications pamphlet for more information.
Cycle 1: For the first cycle in your treatment these medications will be given through an IV (injected into a vein) at the hospital:
C = Cyclophosphamide
H = doxorubicin (also called Hydroxyldaunorubicin)
O = vincristine (also called Oncovin®)
R = Rituximab
You will also take your Prednisone (P) by mouth.
Other Cycles: If your first cycle of rituximab goes well you may get this medication under your skin (subcutaneously or Subcut) for the rest of your cycles. This will happen on day 1 at the hospital. Getting the rituximab under your skin instead of through an IV will make your treatment visit at the hospital go faster.
You will have a blood test before each treatment cycle to make sure it is safe for you to get treatment.
P (Prednisone) tablets in your treatment are taken by mouth.
-
Swallow tablets whole with a glass of water, with a meal.
-
If possible, take prednisone tablets in the morning right after eating breakfast.
To Prevent Nausea and Vomiting
You will be given medications to help prevent nausea (feeling like throwing up) and vomiting (throwing up) before they start.
- These are called anti-nausea medications and include medications such as ondansetron (Zofran®), granisetron (Kytril®), or others.
To Prevent Allergic Reaction
You will be given medications before your treatment to help prevent allergic reactions before they start.
- There are different types of medications to stop allergic reactions. They are called:
- antihistamines (such as diphenhydramine or Benadryl®)
- analgesics/antipyretics (such as acetaminophen or Tylenol®)
- H2 blockers (such as ranitidine or famotidine)
- corticosteroids (such as prednisone)
- Prednisone is part of the CHOP+R regimen. You will take your prednisone by mouth on day 1 of your cycle before your IV treatment.
To Prevent Tumor Lysis Syndrome (TLS)
TLS can happen when a large number of cancer cells die quickly and your body cannot get rid of them fast enough. TLS can make you very sick. Ask your health care team if you are at risk for TLS.
If you are at risk for TLS, you may be given medications before your CHOP+R treatment to help prevent it.
- These are called anti-uricemics (such as allopurinol), or others.
To Prevent Hepatitis B Flare Ups
If you have ever been infected with hepatitis B, there is a risk that this treatment can cause it to flare up (come back). Tell your health care team if you have had hepatitis B. You may need to take medication to prevent a hepatitis B flare-up.
To Prevent Infection
You may also be given a medication after each treatment day to increase your white blood cell count (neutrophils). This helps to prevent infection and make sure it is safe for you to get your next treatment.
- The medication may be called filgrastim (for example, Neupogen®, Grastofil®, or others) or pegfilgrastim (for example, Neulasta®, Lapelga™, or others).
-
DO tell your health care team about any other medical conditions that you have such as heart, liver, lung, kidney, and nerve problems, or any allergies.
-
DO check with your health care team before getting any vaccinations, surgery, dental work or other medical procedures.
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DO drink plenty of fluids (unless told otherwise) and pee often for 2 or 3 days after your CHOP+R treatment to prevent bladder irritation. It is normal for your urine (pee) to be red for up to 2 days after CHOP+R. Tell your health care team if your pee stays red for more than 2 days.
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DO tell your health care team if you have any new pain, numbness or tingling of your hands or feet. This is especially important if you are having trouble doing tasks (like doing up buttons, writing, walking) or if you have severe pain or numbness.
-
DO talk to your health care team about your risk of getting other cancers and heart problems after this treatment.
-
DO consider asking someone to drive you to and from the hospital on your treatment days. You may feel drowsy or dizzy after your treatment.
-
DO NOT take any other medications, such as vitamins, over-the-counter (non-prescription) drugs, or natural health products without checking with your health care team.
-
DO NOT start any complementary or alternative therapies, such as acupuncture or homeopathic medications, without checking with your health care team.
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DO NOT eat or drink grapefruit, starfruit, Seville oranges or their juices (or products that contain these) while on this treatment. They may increase side effects.
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DO NOT smoke or drink alcohol while on treatment without talking to your health care team first. Smoking and drinking can make side effects worse and make your treatment not work as well.
-
DO tell your health care team about any other medical conditions that you have such as heart, liver, lung, kidney, and nerve problems, or any allergies.
-
DO check with your health care team before getting any vaccinations, surgery, dental work or other medical procedures.
-
DO drink plenty of fluids (unless told otherwise) and pee often for 2 or 3 days after your CHOP+R treatment to prevent bladder irritation. It is normal for your urine (pee) to be red for up to 2 days after CHOP+R. Tell your health care team if your pee stays red for more than 2 days.
-
DO tell your health care team if you have any new pain, numbness or tingling of your hands or feet. This is especially important if you are having trouble doing tasks (like doing up buttons, writing, walking) or if you have severe pain or numbness.
-
DO talk to your health care team about your risk of getting other cancers and heart problems after this treatment.
-
DO consider asking someone to drive you to and from the hospital on your treatment days. You may feel drowsy or dizzy after your treatment.
-
DO NOT take any other medications, such as vitamins, over-the-counter (non-prescription) drugs, or natural health products without checking with your health care team.
-
DO NOT start any complementary or alternative therapies, such as acupuncture or homeopathic medications, without checking with your health care team.
-
DO NOT eat or drink grapefruit, starfruit, Seville oranges or their juices (or products that contain these) while on this treatment. They may increase side effects.
-
DO NOT smoke or drink alcohol while on treatment without talking to your health care team first. Smoking and drinking can make side effects worse and make your treatment not work as well.
Yes, the medications in this regimen can interact with other medications, vitamins, foods and natural health products. Interactions can make the treatment not work as well or cause severe side effects.
Tell your health care team about all of your:
- prescription and over-the-counter (non-prescription) medications
- natural health products such as vitamins, herbal teas, homeopathic medicines, and other supplements
Check with your health care team before starting or stopping any of them.
If you take medications to help with your blood pressure, your health care team may ask you to stop these medications 12 hours before and during your treatment.
If you take seizure medications (such as phenytoin), your health care team may monitor your blood levels closely and may change your dose.
- Anti-inflammatory medications such as ibuprofen (Advil® or Motrin®), naproxen (Aleve®) or Aspirin®.
- Over-the-counter products such as dimenhydrinate (Gravol®)
- Natural health products such as St. John’s Wort
- Supplements such as vitamin C
- Alcoholic drinks
- Tobacco
- All other drugs, such as marijuana or cannabis (medical or recreational)
-
Always check your temperature to see if you have a fever before taking any medications for fever or pain (such as acetaminophen (Tylenol®) or ibuprofen (Advil®)).
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Fever can be a sign of infection that may need treatment right away.
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If you take these medications before you check for fever, they may lower your temperature and you may not know you have an infection.
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How to check for fever:
Keep a digital (electronic) thermometer at home and take your temperature if you feel hot or unwell (for example, chills, headache, mild pain).
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You have a fever if your temperature taken in your mouth (oral temperature) is:
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38.3°C (100.9°F) or higher at any time
-
-
OR
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38.0°C (100.4°F) or higher for at least one hour.
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If you do have a fever:
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Try to contact your health care team. If you are not able to talk to them for advice, you MUST get emergency medical help right away.
-
Ask your health care team for the Fever pamphlet for more information.
If you do not have a fever but have mild symptoms such as headache or mild pain:
- Ask your health care team about the right medication for you. Acetaminophen (Tylenol®) is a safe choice for most people.
Talk to your health care team before you start taking ibuprofen (Advil®, Motrin®), naproxen (Aleve®) or ASA (Aspirin®), as they may increase your chance of bleeding or interact with your cancer treatment.
Talk to your health care team if you already take low dose aspirin for a medical condition (such as a heart problem). It may still be safe to take.
Talk to your health care team about:
- How this treatment may affect your sexual health.
- Changes to your menstrual cycle (periods), if this applies to you.
- Symptoms of menopause such as hot flashes, vaginal dryness or changes in your mood, if this applies to you.
- How this treatment may affect your fertility (ability to have a baby), if this applies to you.
This treatment may harm an unborn baby. Tell your health care team if you or your partner are pregnant, become pregnant during treatment, or are breastfeeding.
- If there is any chance of pregnancy happening, you and your partner together must use 2 effective forms of birth control at the same time while you are on treatment. Talk to your health care team about which birth control options are best for you, and how long you should use them after your last treatment dose.
- Do not breastfeed while on this treatment. Talk to your health care team about how long to wait before you start breastfeeding after your last treatment dose, if this applies to you.
Cyclophosphamide, doxorubicin, vincristine and rituximab are given and stored at the hospital.
Prednisone:
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Keep tablets in the original packaging at room temperature in a dry place, away from heat and light.
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Keep out of sight and reach of children and pets.
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Do not throw out any unused tablets at home. Bring them to your pharmacy to be thrown away safely.
The following table lists side effects that you may have when getting CHOP+R treatment. The table is set up to list the most common side effects first and the least common last. It is unlikely that you will have all of the side effects listed and you may have some that are not listed.
Read over the side effect table so that you know what to look for and when to get help. Keep this paper during your treatment so that you can refer to it if you need to.
| Very Common Side Effects (50 or more out of 100 people) | |
| Side effect and what to do | When to contact health care team |
|
Allergic reaction (May be severe with IV rituximab) What to look for?
What to do?
|
Get emergency medical help right away for severe symptoms
|
|
Hair thinning or loss What to look for?
What to do?
|
Talk to your health care team if this bothers you |
|
Low neutrophils (white blood cells) in the blood (neutropenia) (May be severe) When neutrophils are low, you are at risk of getting an infection more easily. Ask your health care team for the Neutropenia (Low white blood cell count) pamphlet for more information. What to look for?
You have a fever if your temperature taken in your mouth (oral temperature) is:
OR
What to do? If your health care team has told you that you have low neutrophils:
If you have a fever: If you have a fever, try to contact your health care team. If you are unable to talk to the team for advice, you must get emergency medical help right away. |
If you have a fever, try to contact your health care team. If you are unable to talk to the team for advice, you MUST get emergency medical help right away. |
|
Low platelets in the blood (May be severe) When your platelets are low you are at risk for bleeding and bruising. Ask your health care team for the Low Platelet Count pamphlet for more information. What to look for?
What to do? If your health care team has told you that you have low platelets:
If you have signs of bleeding:
If you have bleeding that does not stop or is severe (very heavy), you must get emergency medical help right away. |
Talk to your health care team if you have any signs of bleeding. If you have bleeding that doesn’t stop or is severe (very heavy), you MUST get emergency medical help right away. |
| Common Side Effects (25 to 49 out of 100 people) | |
| Side effect and what to do | When to contact health care team |
|
Nausea and vomiting What to look for?
What to do? To help prevent nausea:
If you have nausea or vomiting:
|
Talk to your health care team if nausea lasts more than 48 hours or vomiting lasts more than 24 hours or if it is severe
|
|
Neuropathy (Tingling, numb toes or fingers) (May be severe) What to look for?
What to do?
In rare cases, it may continue long after treatment ends. If you continue to have bothersome symptoms, talk to your health care team for advice. |
Talk to your health care team, especially if you have trouble doing tasks like doing up buttons writing, moving, or if you have severe pain or numbness |
|
Reactions at the injection site
What to do?
|
Talk to your health care team if this bothers you |
|
Mouth sores What to look for?
What to do? To help prevent mouth sores:
If you have mouth sores:
Ask your health care team for the mouth care pamphlet for more information. |
Talk to your health care team as soon as you notice mouth or lip sores or if it hurts to eat, drink or swallow |
| Less Common Side Effects (10 to 24 out of 100 people) | |
| Side effect and what to do | When to contact health care team |
|
Fatigue What to look for?
What to do?
Ask your health care team for the Fatigue pamphlet for more information. |
Talk to your health care team if it does not improve or if it is severe |
|
Headache, Flu-like symptoms You may feel like you have the flu for around 2 days after your IV treatment. These flu-like symptoms may not be signs of an infection.
What to do?
|
Talk to your health care team if it does not improve or if it is severe |
|
Rash; dry, itchy skin (May be severe) What to look for?
What to do? To prevent and treat dry skin:
Rash may be severe in some rare cases and cause your skin to blister or peel. If this happens, get emergency medical help right away. |
Talk to your health care team if it does not improve or if it is severe |
|
Diarrhea What to look for?
What to do? If you have diarrhea
Ask your health care team for the diarrhea pamphlet for more information. |
Talk to your health care team if no improvement after 24 hours of taking diarrhea medication or if severe (more than 7 times in one day)
|
|
Constipation
What to do?
To help treat constipation:
See the Constipation Pamphlet for more information.
|
Talk to your health care team if it does not improve or if it is severe |
|
Side effects of taking steroids (With prednisone) What to look for?
What to do?
|
Talk to your health care team if it does not improve or if it is severe |
Other rare but serious side effects are possible with this treatment.
If you have any of the following, talk to your cancer health care team or get emergency medical help right away:
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Pain and swelling or hardening of a vein in your arm or leg
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New coughing or breathing problems
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Coughing up blood
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Any chest pain
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Sudden confusion, trouble speaking, or difficulty moving your arms or legs
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Any changes in your vision
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Irregular heartbeat or passing out (fainting)
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Any severe belly pain or bloating
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Yellowish skin and eyes and red-brown coloured pee
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Unexpected changes in your weight
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Swelling of your body and not going pee as much as usual
-
New problems with balance
For more information on how to manage your symptoms ask your health care provider, or visit: https://www.cancercareontario.ca/symptoms.
October 2023 Updated "How will this treatment affect sex, pregnancy and breast feeding" section
For more links on how to manage your symptoms go to www.cancercareontario.ca/symptoms.
The information set out in the medication information sheets, regimen information sheets, and symptom management information(for patients) contained in the Drug Formulary (the "Formulary") is intended to be used by health professionals and patients for informational purposes only. The information is not intended to cover all possible uses, directions, precautions, drug interactions or side effects of a certain drug, nor should it be used to indicate that use of a particular drug is safe, appropriate or effective for a given condition.
A patient should always consult a healthcare provider if he/she has any questions regarding the information set out in the Formulary. The information in the Formulary is not intended to act as or replace medical advice and should not be relied upon in any such regard. All uses of the Formulary are subject to clinical judgment and actual prescribing patterns may not follow the information provided in the Formulary.