About CHOP and Rituxan
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There's a growing consensus among
many experts that CHOP + Rituxan (CHOP+R) is the new gold standard for treating transformed
indolent, or
aggressive lymphomas that express CD20. [1,
2]
Is CHOP+R
appropriate as frontline treatment of indolent lymphoma?
This can only be determined in well-controlled clinical
trials. So far, the data is encouraging 4,
but not yet conclusive. Selection of initial treatment for indolent
lymphomas is complex and controversial. See Treatment
Decisions - Factors that Influence
CHOP
chemotherapy agents
C Cyclophosphamide (Cytoxan®) DNA-Altering
Medline
H Doxorubicin (Adriamycin®) or Rubex® or Hydroxydaunomycin Antitumor
Antibiotic Medline
O Vincristine
(Oncovin®) Blocks Cell Duplication
Medline
NOTE:
Clearance of Vincristine varies significantly.
Therefore it's important to
report
symptoms associated with vincristine promptly to your doctor.
See for details
P Prednisone (Deltasone®) steroidal:
anti-inflammatory, Immunosuppressant
MedlinePlus
* About CHOP CancerHelp.org.UK
* About Rituxan- a monoclonal antibody (Mab) Lymphomation.org
| rxlist
Abstracts on CHOP + Rituxan
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Rituximab Plus Chemo More Effective in Elderly Lymphoma Patients.
vidyya
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Immunochemotherapy in indolent non-Hodgkin's
lymphoma. Semin Oncol. 2002 Apr; 29(2 Suppl 6):11-7. Review.
PMID: 12040529 PubMed
-
Histological conversion of
follicular lymphoma with structural alterations of t(14;18) and
immunoglobin genes. Leukemia. 1995 Oct;9(10):1748-55. PMID:
7564520 PubMed
-
Immunochemotherapy in indolent non-Hodgkin's
lymphoma. Semin Oncol. 2002 Apr;29(2 Suppl 6):11-7. Review.
PMID:
12040529 | Related
abstracts
-
[ASH 1493] Patients with Low-Grade NHL Treated with Rituximab
+ CHOP Experience Prolonged Clinical and Molecular Remission.
docguide
Rituxan plus CHOP extends survival in advanced follicular
lymphoma oncolink.upenn.edu
Jan 2005
See also
 |
Clinical Implications of Antibody Mechanisms of Action - Medscape (free login req.)
"The Groupe d'Etudes des Lymphomes de l'Adulte group compared
CHOP with rituximab/CHOP in a group of 399 elderly patients
ranging from 60 to 80 years of age with diffuse large B-cell
NHL.[22] Administered in the same fashion as described in the Vose
study above, the following results were observed at a median
follow-up of 2 years (Table 2)."
Table 2. CHOP Vs CHOP/Rituximab in Elderly
Patients With Diffuse Large B-Cell NHL: A GELA Study
| Regimen |
CR/CRu |
PR |
Progression |
Treatment-Related Death Rate |
| CHOP |
62% |
6% |
21% |
7% |
| CHOP/rituximab |
76% |
6% |
9% |
5% |
CHOP, cyclophosphamide, doxorubicin, vincristine, prednisone;
NHL, non-Hodgkin's lymphoma; GELA, Groupe d'Etudes des Lymphomes
de l'Adulte; CR, complete response; CRu, unconfirmed complete
response; PR, partial response
|
Strategies that May Enhance the Efficacy of
CHOP
Note: There are no clinical studies
for lymphoma that provide definitive proof for the following concepts and considerations.
Decreasing the Time between Dose Cycles?
When your receive chemotherapy, your
white cell counts will typically drop, and the next round of therapy
cannot begin until your counts have come back to normal or near-normal
levels. During this time of low counts you are more susceptible to
infection. Long delays between treatment cycles may allow
malignant cells to recover and adapt to treatment.
Based on the results described below for breast cancer, and the
rational theory that supports it, we ask treating physicians to
consider the use of Neupogen (Filgrastim) for their lymphoma patients in
order to raise neutrophil counts when needed so that treatments are
not delayed unnecessarily. We also ask that studies be initiated
as soon as possible to determine if "dose density" can
improve outcomes for NHL patients as it has apparently done for breast cancer
patients.
Aggressive lymphomas
| Incidence and Predictors of Low Chemotherapy Dose-Intensity
in Aggressive Non-Hodgkin's Lymphoma: A Nationwide Study. J Clin
Oncol. 2004 Sep 20 PMID:
15381684 | Related
articles
|
| Two-weekly or 3-weekly CHOP chemotherapy with or without
etoposide for the treatment of YOUNG patients with good-prognosis
(normal LDH) aggressive lymphomas: results of the NHL-B1 trial of
the DSHNHL. Blood. 2004 Aug 1;104(3):626-33. Epub 2004 Feb 24. PMID:
14982884 | Related
articles
|
| Two-weekly or 3-weekly CHOP chemotherapy with
or without etoposide for the treatment of ELDERLY patients with
aggressive lymphomas: results of the NHL-B2 trial of the DSHNHL.
Blood. 2004 Aug 1;104(3):634-41. Epub 2004 Mar 11. PMID:
15016643 | Related
articles
|
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Feasibility and preliminary efficacy of R-CHOP-14 in patients with diffuse large B-Cell lymphoma (DLBCL).
lymphomafoundation
|
|
Is more better? Two
parallel trials suggest that intensified CHOP is
superior to standard CHOP in the management of
aggressive NHL. "The authors of these papers conclude that
they have defined new "preferred therapies"
for histologically aggressive NHL, but the standard
therapy today (although not when these trials were
started) is not CHOP-21, it is CHOP-21 plus rituximab. Although
rituximab may add further to the benefits of CHOP-14 or
CHOEP-21 (CHOP plus etoposide), it is possible that the use of
rituximab may negate any benefits due to dose intensification.
In the rituximab era, it remains unclear whether "more
is better," and further trials are required."
bloodjournal.org
|
|
Two-weekly CHOP with G-CSF: New Standard Regimens for Elderly Patients with Aggressive Non-Hodgkin's
Lymphoma
mednet.ca
"Finally, it appears that improvements on CHOP21 for the elderly are
emerging from different directions. One approach involves the delivery of
CHOP cycles over the shorter period of 14 days with granulocyte-colony
stimulating factor (G-CSF) support (CHOP14G), while the other adds the
anti-CD20 monoclonal antibody rituximab to CHOP21 (R-CHOP21)."
|
General
|
The Case for Caution: Dose Intensive and Dose Dense CHOP Regimens - Abstracts
and Commentary CTCLconsult.com
"Even if these dose-dense or intense regimens were to show
some advantage they would not be appropriate for a large
proportion of patients who are either older or have significant
comorbid illness."
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High-dose intensity cyclophosphamide,
epidoxorubicin, vincristine and prednisone by shortened intervals
and granulocyte colony-stimulating factor in non-Hodgkin's
lymphoma: a phase II study. Br J Cancer. 1998 Sep;78(6):777-80.
PMID: 9743300 PubMed
|
Fish Oil?
Supplementing with fish oil (docosahexaenoic and eicosapentaenoic
acids) might enhance the efficacy of some chemotherapy agents,
specifically doxorubicin.
Caution: Fish oil consumption
may increase the risk of bleeding in susceptible individuals.
|
Cell-specific enhancement of doxorubicin toxicity in human
tumour cells by docosahexaenoic acid. Anticancer Res. 2001
Jan-Feb;21(1A):29-38. PMID: 11299749 PubMed
|
|
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Genistein?
|
Genistein sensitizes diffuse large cell lymphoma to
CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone)
chemotherapy. Mol Cancer Ther. 2003 Dec;2(12):1361-8. PMID:
14707277
|
Reducing the Toxicity
of CHOP / Alternatives to Doxirubicin?
Alternative Agents for Elderly Patients or
Patients with Other (co-morbid) Conditions?
Liposomal versions of chemotherapy agents. Are
they equivalent/safer?
Liposomal versions of
doxorubicin and vincristine may have less toxicity than their
counterparts, and equivalent efficacy.
|
Pegylated liposomal doxorubicin in combination
chemotherapy in the treatment of previously untreated aggressive
diffuse large-B-cell lymphoma.
Med Oncol. 2002;19(1):55-8. PMID: 12025891 PubMed
|
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Cyclophosphamide, pegylated liposomal doxorubicin
(Caelyx"), vincristine and prednisone (CCOP) in elderly
patients with diffuse large B-cell lymphoma: results from a
prospective phase II study. Haematologica. 2002 Aug;87(8):822-7.
PMID: 12161358 PubMed
|
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Targeted delivery and triggered release of
liposomal doxorubicin enhances cytotoxicity against human B
lymphoma cells. Biochim Biophys Acta. 2001 Dec 1;1515(2):144-58.
PMID: 11718670 PubMed
|
|
Liposomal Doxorubicin: A phase I/II trial of liposomal
doxorubicin (TLC D-99, Myocet) with cyclophosphamide, vincristine,
and prednisone in newly diagnosed aggressive non-Hodgkins lymphoma
(NHL) Year: 2002 Abstract No: 1133
|
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Liposomal encapsulated anthracyclines: new
therapeutic horizons.
Curr Oncol Rep. 2001 Mar;3(2):156-62. Review. PMID: 11177748
PubMed
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Other Alternative Agents
Dexrazoxane (Zinecard) as
a cardioprotectant
Under investigation for treatment of childhood
leukemias and lymphomas to see if it can prevent damage to the heart
caused by doxorubicin, a drug commonly used to treat childhood
leukemia and lymphoma. Results from this part of the study are not yet
available. nih.gov
|
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| Use of dexrazoxane as a cardioprotectant in patients
receiving doxorubicin or epirubicin chemotherapy for the treatment
of cancer guideline.gov
|
Continuous infusion doxorubicin,
instead of bolus
|
Reduction of doxorubicin cardiotoxicity by prolonged
continuous intravenous infusion. Ann Intern Med. 1982
Feb;96(2):133-9.
PMID: 7059060 PubMed
|
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Adriamycin (doxorubicin) Gan To Kagaku Ryoho. 2001
Oct;28(10):1331-8. Review. Japanese. PMID: 11681238 PubMed
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Melatonin
Melatonin
is a natural hormone, normally created by the pineal gland. It is
stimulated by darkness and inhibited by light. It regulates the
human biological clock. Melatonin is a highly important
antioxidant, it may also modulate immune function.
Caution: Please consult with your oncologist
before supplementing with this or any supplement during treatment.
| A randomized trial of CHOP chemotherapy with or without melatonin in patients with favorable prognosis large B-cell lymphoma.
ASCO 2004 ~ Abstract No: 8066
"The addition of melatonin to CHOP chemotherapy did *NOT* decrease the incidence of neutropenia after cycle 1 in this patient population. In addition, this study suggests that there is no improvement in neutrophil nadir, CR rate, infection rate, or change in hemoglobin or platelet counts with the addition of melatonin."
|
| Melatonin: reducing the toxicity and increasing the efficacy
of drugs.
J Pharm Pharmacol. 2002 Oct;54(10):1299-1321. PMID: 12396291
PubMed
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| Melatonin as an effective protector against
doxorubicin-induced cardiotoxicity.
Am J Physiol Heart Circ Physiol. 2002 Jul;283(1):H254-63. PMID: 12063298
PubMed
|
| Cyclophosphamide plus somatostatin, bromocriptin, retinoids,
melatonin and ACTH in the treatment of low-grade non-Hodgkin's
lymphomas at advanced stage: results of a phase II trial. Cancer
Biother Radiopharm. 2001 Apr;16(2):171-7. PMID: 11385964 PubMed
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What's Next?
Your treating physicians can also
adjust treatments, add or remove agents in response to changing
circumstances. Treatment responses can also be consolidated
(maintained) with
additional treatments, such as
Related abstracts
|
Combined therapy in advanced stages (III
and IV) of follicular lymphoma increases the possibility of cure:
results of a large controlled clinical trial. Eur J Haematol. 2002
Mar;68(3):144-9. PMID: 12068794 PubMed
|
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Durable Remissions Obtained with Zevalin in Recurrent Follicular Lymphoma
CancerConsultants.com
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Research News
-
Immunochemotherapy in indolent non-Hodgkin's
lymphoma. Semin Oncol. 2002 Apr;29(2 Suppl 6):11-7. Review.
PMID: 12040529 PubMed
-
Monitoring of minimal residual disease after CHOP
and rituximab in previously untreated patients with follicular
lymphoma.
Blood. 2002 Feb 1;99(3):856-62. PMID: 11806987 PubMed
-
Successful autologous peripheral blood stem cell
transplantation in transformed follicular lymphoma previously
treated with radioimmunotherapy (iodine (131)I tositumomab). Bone
Marrow Transplant. 2002 Mar;29(6):523-5.
PMID: 11960274 PubMed
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