Combo of Drugs Targets This Cancer in Different Ways
- R-CHOP is a drug cocktail used to treat non-Hodgkin lymphoma
- It consists of three chemotherapy drugs, plus an antibody drug and a steroid
- Doctors give R-CHOP in cycles spaced three weeks apart
"R-CHOP is a cocktail of drugs. There are five different drugs in that recipe," Dr. Jennifer Crombie, medical oncologist at Dana-Farber Cancer Institute, tells SurvivorNet.
Read MoreWhat to Expect From R-CHOP
Doctors give R-CHOP in cycles that are spaced three weeks apart. Each cycle starts with the three chemotherapy drugs and Rituxan. You get these medicines through a vein in your arm.Along with those medicines, you’ll get prednisone, which comes in a pill you can take on your own. "The prednisone is given over a five day course, so patients can continue that at home," says Dr. Crombie.
Expect to get several cycles of R-CHOP. You will usually get six cycles of this chemotherapy, but the exact number of cycles can vary if you have early stage cancer. The entire treatment can take a few months.
Because chemotherapy drugs attack quickly dividing cells, both cancerous and healthy ones, they can cause side effects. The other drugs in the combo have side effects of their own.
It can be hard to predict which side effects, if any, you'll have, but some of the more common ones are:
- Tiredness and weakness
- Hair loss
- Mouth sores
- Bruising and bleeding
- Increased risk of infection
- Appetite loss and weight loss
- Changes in bowel movements
There are also a few rare, but serious side effects that are possible with this treatment, including:
- Nerve damage called peripheral neuropathy
- Heart damage (cardiomyopathy and heart failure)
- Bladder damage
Your doctor has treatments to relieve some of these side effects. Many of them should ease up for good once you finish treatment, though some side effects may persist after you complete treatment.
What if R-CHOP Doesn't Work?
R-CHOP is very effective at keeping non-Hodgkin lymphoma under control, but it doesn't always work for everyone who tries it. If R-CHOP doesn't help you, your doctor can give you another cocktail with a different combination of chemotherapy drugs. This is called salvage chemotherapy, and there are a variety of different options.
Your doctor may decide that after salvage chemotherapy, you need an autologous stem cell transplant (a transplant using your own stem cells), which is a method of giving you high-dose chemotherapy. This is part of the standard of care for the treatment of non-Hodgkin B-cell lymphomas that don't respond to R-CHOP, or that come back after being treated with R-CHOP.
The treatment that ultimately works for you might not include chemotherapy at all. "For patients with a disease that’s not sensitive to chemotherapy, we try to look for different types of therapy that use different approaches," Dr. Crombie says. "That’s when we would look for immune-type therapies, and the most exciting one at the moment is CAR T-cell therapy."
CAR T-cell therapy is a personalized treatment that uses your body's own immune cells to fight cancer. Your doctor first collects a sample of your T-cells, and then re-engineers them in a lab so that they produce special substances called chimeric antigen receptors (CARs) on their surface. When the engineered CAR T-cells are infused back into your body, they seek out and attach to a special protein on the cancer cells' surface and destroy those cells.
CAR T-cell therapy can work, even in people who didn't respond to chemotherapy. "We’re glad to have a novel approach for those patients," Dr. Crombie says. Having this treatment available gives your doctor more effective options against your cancer. CAR-T cell therapy is currently approved for people with aggressive B-cell lymphomas that haven’t responded to two previous treatments, but it is being studied in clinical trials to see whether it can also be used earlier and in less aggressive B-cell lymphomas.
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