CHOP regimen

Tsavaris N, Kosmas C, Vadiaka M, et al. Pegylated liposomal doxorubicin in the CHOP regimen for older patients with aggressive (stage III/V) non-Hodgkin s lymphoma. Anticancer Res 2002 22 1845. 

Niitsu N, Hayama M, Okamoto M et al. Phase I study of Rituximab-CHOP regimen in combination with granulocyte colony-stimulating factor in patients with follicular lymphoma. Clin Cancer Res 2004 10 4077 082. 

The combination of rituximab and chemotherapy was evaluated in an open-label phase II study in 40 patients with relapsed low-grade or follicular CD20(+) B-cell NHL (172). The chemotherapy regimen consisted of the standard cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) regimen, given every 3 weeks for six cycles rituximab was administered at 375 mg/m2 for six doses over 20 weeks. Of 40 patients, 38(95%) responded, including 22 CRs (55%) and 16 PRs (40%). This combination was not associated with any novel toxicides. 

In the last 2-5 years, selected monoclonal antibodies have become a routine part of care for certain malignancies. Rituximab, a chimeric monoclonal antibody used against CD 20 positive B-cell non-Hodgkin s lymphoma, is now utilized in combination with the CHOP regimen (cyclophosphamide, doxorubicin, vincristine, and prednisone). Trastuzu-mab, a humanized monoclonal antibody, is a weekly maintenance therapy for HER2neu-positive metastatic breast cancer patients. 

It has been known since the late 1970s that intensive combination chemotherapy can cure some patients with disseminated DLBCL. " Initial studies with COP (same as CVP) produced a plateau on the survival curve of just 10%, with a median survival of less than 1 year. Based on the activity of single-agent doxorubicin, McKelvey and colleagues developed the CHOP regimen (see Table... 

Based on the lack of survival benefit with the newer combination chemotherapy regimens, the less complicated and less expensive CHOP regimen should be considered as the treatment of choice for most patients with DLBCL and other aggressive lymphomas. 

There are certain histologic subtypes of diffuse, aggressive NHL that respond less well to treatment with conventional regimens such as CHOP. Burkitt s lymphoma, lymphoblastic lymphoma, mantel cell lymphoma, and primary CNS lymphoma are examples of disease that benefit from more intensive therapy. Regimens such as hyper-CVAD, which alternate cycles of hyperfractionated cyclophosphamide, doxorubicin, vincristine, and dexamethasone with high-dose cytarabine and methotrexate, often are substituted for CHOP. Intrathecal therapy with methotrexate is indicated with documented CNS infiltration of tumor or involvement of the sinuses. The recent appreciation of the etiology of Helicobacter pylori in the etiology of peptic ulcer disease and the association between colonization and mucosal-associated lymphoma (MALT) has spurred... 

Fisher RI, et al. Comparison of standard regimen (CHOP) with three intensive chemotherapy regimens for advanced non-Hodgkins lymphoma. New Engl J Med 1993 328 1002-1006. 

Standard combination regimens (e.g., CHOP) yield disappointing results. Newer approaches including dose-adjusted EPOCH (etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin), and rituximab-containing combination chemotherapy are promising. 

A major breakthrough in the treatment of lymphoid malignancies was the discovery of monoclonal antibody activity, especially that of rituximab. Rituximab was the first monoclonal antibody approved by the U.S., FDA for the treatment of relapsed follicular lymphoma (1), and it has now been extensively used for the treatment of various lymphoid neoplasm which express CD20 antigen. Its efficacy has been also demonstrated against diffuse large B-cell lymphoma when administered as a combination regimen such as rituximab plus CHOP (R-CHOP) chemotherapy (2). 

Combination chemotherapy is the treatment standard for patients with diffuse non-Hodgkin s lymphoma. The anthracycline-containing regimen CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) has been considered the best treatment in terms of initial therapy. Recently, randomized phase III clinical studies have shown that the combination of CHOP with the anti-CD20 monoclonal antibody rituximab results in improved response rates, disease-free survival, and overall survival compared with CHOP chemotherapy alone. 

The results of treatment with standard chemotherapy regimens, including CHOP, BACOD, and CDE (cyclophosphamide, doxorubicin, and etoposide), have been disappointing. The complete response rate with combination chemotherapy is about 40% to 50%, with a median survival of about 8 months. Newer approaches such as the dose-adjusted EPOCH (etoposide, prednisone, vincristine. 

In 2002, rituximab became the number one, brand name, cancer therapeutic in the world. It is an important component of the current curative combination for aggressive NHL (R + CHOP). In the future, rituximab may become a part of other curative treatment regimens for hematologic malignancies and will also find utility in the treatment of major diseases such as rheumatoid arthritis and other autoimmune disorders. 

Oncogene CHOP not to be corrfused with chemotherapy regimen CHOP (for onexrgene CHOP see Suzuki K et al Oncol Lett 2012 3 293-296). 

Immune T cells and NK cells are recognized monoclonal antibodies appear. Much belatedly, tumor-specific immunotherapy achieved its first firm adjunctive status to chemotherapy with the discovery of monoclonal antibodies (rituximab and trasm-zumab, etc), but none of these original monoclonal antibody discoveries were made at the DDT of MDACCC however they were immediately applied there in clinical trials. The CHOP chemotherapy regimen for malignant lymphomas was designed at the DDT it has made worldwide medical history. Now, with rituximab added, it can induce durable (>5 y) complete remissions (CHOP alone 67 % CHOP-R 100 %, for example in British Columbia, Vancouver, Canada) and elsewhere. Rituxan fails only in the case of defective NK cells, which do not express Fey globulin receptors, and cannot perform the ADCC reaction. 

Herbrecht R, Cernohous P, Engert A, Le GouUl S, Macdonald D, Machida C, et al. Comparison of pixantrone-based regimen (CPOP-R) with doxorubicin-based therapy (CHOP-R) for treatment of diffuse large B-ceU lymphoma. Ann Oncol 2013 24(10) 2618-23. 

---