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CHOP

Cancer Type: Hematologic, Lymphoma - Non-Hodgkin's High Grade, Lymphoma - Non-Hodgkin's Intermediate Grade  Intent: Curative, Palliative
Regimen Category: Evidence-Informed
Funding:
ODB - General Benefit
    prednisone
A - Regimen Name

CHOP Regimen
Cyclophosphamide-Hydroxyldaunorubicin (DOXOrubicin)-ONCOVIN® (VinCRIStine)-Prednisone


Disease Site
Hematologic - Lymphoma - Non-Hodgkin's High Grade
Hematologic - Lymphoma - Non-Hodgkin's Intermediate Grade

Intent
Curative
Palliative

Regimen Category
Evidence-Informed :

Regimen is considered appropriate as part of the standard care of patients; meaningfully improves outcomes (survival, quality of life), tolerability or costs compared to alternatives (recommended by the Disease Site Team and national consensus body e.g. pan-Canadian Oncology Drug Review, pCODR).  Recommendation is based on an appropriately conducted phase III clinical trial relevant to the Canadian context OR (where phase III trials are not feasible) an appropriately sized phase II trial. Regimens where one or more drugs are not approved by Health Canada for any indication will be identified under Rationale and Use.


Supplementary Public Funding

prednisone
ODB - General Benefit (prednisone) (ODB Formulary )

 
B - Drug Regimen

prednisone
100 mg PO daily Days 1 to 5
(Outpatient prescription in multiples of 50mg tablets)
DOXOrubicin
50 mg /m² IV Day 1
vinCRIStine
1.4 mg /m² IV (maximum 2 mg) Day 1
cyclophosphamide
750 mg /m² IV Day 1
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C - Cycle Frequency

REPEAT EVERY 21 DAYS

For a usual total of 6 to 8 cycles.

 
D - Premedication and Supportive Measures

Antiemetic Regimen:

Moderate


Febrile Neutropenia Risk:

Moderate

 
E - Dose Modifications

Doses should be modified according to the protocol by which the patient is being treated.

 

Dosage with toxicity

Also see general recommendations.

Toxicity
Doxorubicin1
(% previous dose)
Vincristine1
(% previous dose)
Cyclophosphamide1
(% previous dose)
Grade 4 hematological ≥ 7d, febrile neutropenia, bleeding
 
75% or G-CSF
 
 
100%
 
75% or G-CSF
Grade 3 non-hematological toxicity
75%
100%
75%
Grade 4 organ toxicity
Discontinue
Discontinue
Discontinue
Neurotoxicity
100%
Mild: 67%
Mod: hold until recovery ↓ 50%
Severe: discontinue
100%
1Prior to retreatment, major organ toxicity should have recovered to ≤ grade 2 and ANC to ≥ 1.5 x 109/Land platelets ≥ 100 x 109/L.



Hepatic Impairment

Also consider dose modification for doxorubicin and vincristine for severe increase in transaminases.
Bilirubin
Doxorubicin
(% previous dose)
Vincristine
(% previous dose)
Cyclophosphamide
(% previous dose)
1 – 2 X ULN
50%
50%
No dose adjustment required.
2 – 4 x ULN
25%
25%
> 4 ULN
OMIT
OMIT

Renal Impairment

Creatinine Clearance (mL/min)
Doxorubicin
(% previous dose)
Vincristine
(% previous dose)
Cyclophosphamide
(% previous dose)
30-50
No dose adjustment required.
No dose adjustment required.
100%
10-30
50-75%
< 10
50% or OMIT

 
F - Adverse Effects

Refer to prednisone, DOXOrubicin, vinCRIStine, cyclophosphamide drug monograph(s) for additional details of adverse effects


Most Common Side Effects 

Less Common Side Effects, but may be
Severe or Life-Threatening

  • Myelosuppression
  • Nausea and vomiting
  • Neurotoxicity and constipation
  • Stomatitis
  • Cardiotoxicity (may be severe)
  • Hyperglycemia
  • Gastric irritation
  • Alopecia
  • Amenorrhea/infertility
  • Abnormal LFTs
  • Diarrhea
  • Fatigue
  • Headache
  • Cystitis (may be severe)
  • SIADH
  • Tumour lysis syndrome
  • Pneumonitis, Pulmonary fibrosis
  • DIC, hemolytic-uremic syndrome, renal failure
  • Secondary leukemia
  • Arterial/venous thromboembolism
  • Bowel obstruction/perforation
 
G - Interactions

Refer to prednisone, DOXOrubicin, vinCRIStine, cyclophosphamide drug monograph(s) for additional details

 
H - Drug Administration and Special Precautions

Refer to prednisone, DOXOrubicin, vinCRIStine, cyclophosphamide drug monograph(s) for additional details

 
I - Recommended Clinical Monitoring

Recommended Clinical Monitoring

  • Clinical toxicity assessment (including gastrointestinal, stomatitis, local toxicity, cardiotoxicity, neurotoxicity, constipation and cystitis).
  • CBC before each cycle. Interim counts should be done in first cycle and repeated if dose modification necessary.
  • Baseline and regular cardiac examination for patients with cardiac risk factors (including prior therapy with Epirubicin, Mitoxantrone, or other cardiotoxic drug) and cumulative doxorubicin doses > 450mg/m2.
  • Baseline and regular liver & renal function tests and urinalysis.
  • Grade toxicity using the current NCI-CTCAE (Common Terminology Criteria for Adverse Events) version

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J - Administrative Information

Approximate Patient Visit
1.5 to 2 hours
 
K - References

Fisher RI, Gaynor ER, Dahlberg S et al. A phase III comparison of CHOP vs. m-BACOD vs ProMACE-CytaBOM vs. MACOP-B in patients with intermediate- or high-grade non-Hodgkin's lymphoma: results of SWOG-8516 (Intergroup 0067), the National High-Priority Lymphoma Study. Ann Oncol 1994;5 Suppl 2:91-5

Gordon L, Harrington D, Andersen J, et al. Comparison of a second-generation combination chemotherapeutic regimen (m-BACOD) with a standard regimen (CHOP) for advanced diffuse on-Hodgkin’s lymphoma. New England J Med. 1992 Nov 5; 327(19): 1342-9.

 

July 2019 Updated hyperlink to vincristine drug monograph


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M - Disclaimer

Regimen Abstracts
A Regimen Abstract is an abbreviated version of a Regimen Monograph and contains only top level information on usage, dosing, schedule, cycle length and special notes (if available). It is intended for healthcare providers and is to be used for informational purposes only. It is not intended to constitute or be a substitute for medical advice, and all uses of the Regimen Abstract are subject to clinical judgment. Such information is provided on an “as-is” basis, without any representation, warranty, or condition, whether express, or implied, statutory or otherwise, as to the information’s quality, accuracy, currency, completeness, or reliability, and Cancer Care Ontario disclaims all liability for the use of this information, and for any claims, actions, demands or suits that arise from such use.
Information in regimen abstracts is accurate to the extent of the ST-QBP regimen master listings, and has not undergone the full review process of a regimen monograph.  Full regimen monographs will be published for each ST-QBP regimen as they are developed.
Regimen Monographs
Refer to the New Drug Funding Program or Ontario Public Drug Programs websites for the most up-to-date public funding information.
The information set out in the drug monographs, regimen monographs, appendices and symptom management information (for health professionals) contained in the Drug Formulary (the "Formulary") is intended for healthcare providers and is to be used for informational purposes only. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects of a particular drug, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for a given condition. The information in the Formulary is not intended to constitute or be a substitute for 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.
The format and content of the drug monographs, regimen monographs, appendices and symptom management information contained in the Formulary will change as they are reviewed and revised on a periodic basis. The date of last revision will be visible on each page of the monograph and regimen. Since standards of usage are constantly evolving, it is advised that the Formulary not be used as the sole source of information. It is strongly recommended that original references or product monograph be consulted prior to using a chemotherapy regimen for the first time.
Some Formulary documents, such as the medication information sheets, regimen information sheets and symptom management information (for patients), are intended for patients. Patients should always consult with their healthcare provider if they have questions regarding any information set out in the Formulary documents.
While care has been taken in the preparation of the information contained in the Formulary, such information is provided on an “as-is” basis, without any representation, warranty, or condition, whether express, or implied, statutory or otherwise, as to the information’s quality, accuracy, currency, completeness, or reliability.
CCO and the Formulary’s content providers shall have no liability, whether direct, indirect, consequential, contingent, special, or incidental, related to or arising from the information in the Formulary or its use thereof, whether based on breach of contract or tort (including negligence), and even if advised of the possibility thereof. Anyone using the information in the Formulary does so at his or her own risk, and by using such information, agrees to indemnify CCO and its content providers from any and all liability, loss, damages, costs and expenses (including legal fees and expenses) arising from such person’s use of the information in the Formulary.