R-CHOP Chemotherapy: Side Effects, Dosage, and More

Medically reviewed by Monica Bien, PA-C on June 13, 2016Written by Ann Pietrangelo on June 13, 2016

What is R-CHOP chemotherapy?

Chemotherapy drugs can shrink tumors or kill stray cancer cells left behind after surgery or radiation. It’s also a systemic treatment, meaning its purpose is to kill cancer cells throughout your body.

All chemotherapy drugs work to kill cancer cells, but they do it in different ways. This is why oncologists often choose a combination of drugs. They base their choices on factors such as the type of cancer you have, how far it has spread, and your overall health.

R-CHOP includes five chemotherapy drugs:

You can get R-CHOP with or without other treatments such as surgery and radiation therapy.

Learn more: Common types of chemotherapy for breast cancer »

What does R-CHOP treat?

Doctors mainly use R-CHOP to treat non-Hodgkin lymphoma (NHL) and other lymphomas. Lymphoma is cancer that begins in the lymphatic system.

R-CHOP can also treat other types of cancer.

How does R-CHOP work?

Three of the drugs in R-CHOP are powerful cytotoxics, which means they kill cells. One is a type of immunotherapy and the last is a steroid, which has shown to have anticancer effects.

Rituximab (Rituxan)

Rituximab is generally used to treat NHL. It’s a monoclonal antibody. It targets a protein called CD20 on the surface of white blood cells called “B cells. Once the drug attaches to the B cells, your immune system attacks and kills them.

Cyclophosphamide (Cytoxan)

This drug can treat a variety of cancers, including lymphoma and cancer of the breast and lung. Cyclophosphamide targets the DNA of cancer cells and signals them to stop dividing.

Doxorubicin hydrochloride (Adriamycin, Rubex)

This drug is an anthracycline that can treat many types of cancer, including breast, lung, and ovarian cancer. Doxorubicin blocks an enzyme cancer cells need to grow and reproduce. It’s bright red color has earned it the nickname “the red devil.”

Vincristine (Oncovin, Vincasar PFS, Vincrex)

Vincristine is an alkaloid that can treat many types of cancer, including advanced-stage breast cancer, lymphomas, and leukemia. It interferes with genes to stop them from replicating. This drug is a vesicant, meaning it can damage tissue and vessels.

Prednisolone

This drug is a corticosteroid available under a variety of brand names. Unlike the others, this is an oral medication. It works with your immune system to help reduce:

  • inflammation
  • nausea
  • vomiting
  • allergic reactions
  • low platelet levels, or thrombocytopenia
  • high calcium levels, or hypercalcemia

Together, these drugs create a potent cancer-fighting cocktail.

How is it given?

Standard dosing is based on height and weight. Your doctor will also consider any other health conditions you have, your age, and how well they expect you to tolerate the medications when determining dosing and number of cycles.

People generally get these drugs every two to three weeks. Usually, doctors give a total of at least six doses or cycles. Treatment will take 18 weeks or longer if you have additional cycles.

Before each treatment, you’ll need a blood test to check blood counts and to determine if your liver and kidneys are functioning well enough. If they’re not, your doctor may need to delay your treatment or reduce your dose.

Individual treatments can take several hours, and a healthcare provider will administer the drugs intravenously, meaning through a vein in your arm. You can also get it through a port that a surgeon can implant into your chest. You may need to stay in the hospital to receive your treatment, but people can get it at an outpatient infusion center in many cases.

You’ll always be closely monitored. During the first treatment, healthcare providers will monitor you carefully for any signs of an allergic reaction or another life-threatening effect of cancer treatment called tumor lysis syndrome.

Prednisolone is an oral drug that you take at home for several days after receiving the other drugs.

What are the potential side effects?

Chemotherapy drugs attack cancer cells. They can also damage healthy cells in the process. That’s why there are so many potential side effects. It’s unlikely you’ll have all of them.

Chemotherapy affects everyone differently. Side effects may change the longer you’re on these drugs, but they’re usually temporary. Your healthcare team can provide information on how to deal with them.

The most common side effects are:

  • irritation around the intravenous or port site
  • red or pink urine for a few days due to doxorubicin
  • appetite changes
  • weight changes
  • indigestion
  • nausea
  • vomiting
  • fatigue
  • sleeping difficulties
  • low blood counts
  • anemia
  • nose bleeds
  • a runny nose
  • bleeding gums
  • mouth sores
  • mouth ulcers
  • hair loss
  • a loss of menstruation, or amenorrhea
  • a loss of fertility
  • early menopause
  • skin sensitivity
  • nerve problems, or neuropathy

Less common side effects may include:

  • a skin rash due to an allergic reaction
  • burning or painful urination
  • changes in taste
  • changes to fingernails and toenails
  • changes to heart muscles
  • diarrhea

Rare side effects include changes to lung tissue and developing another type of cancer in the future.

What should you know before you start treatment?

Before starting chemotherapy, you’ll meet with your oncologist. This is the time to ask questions about what you can expect during and after treatment. Follow these tips:

  • Tell your doctor if you’re taking birth control pills, other medications, or dietary supplements. Some of these products, even the ones that are over the counter, may cause harmful interactions.
  • If you’re currently breast-feeding, you should stop because these drugs can pass through your breast milk to your baby.
  • Tell your doctor if you think you may be pregnant. These drugs can harm your baby and cause birth defects.
  • Chemotherapy drugs can affect your fertility and induce early menopause. If you’re planning a family, talk to your doctor about family planning options and possibly meeting with a fertility specialist if necessary before your first treatment.
  • Chemotherapy drugs affect your immune system. Don’t get any vaccinations during chemotherapy, and ask your doctor when it will be safe to do so.
  • Side effects from chemotherapy are to be expected, but they can be manageable with medications, home remedies, and complementary therapies. Don’t hesitate to talk to your doctor about troubling side effects.

What else do you need to know?

As the weeks go by, you’ll get used to the treatment schedule, but side effects may persist. You may become increasingly fatigued. It’s a good idea to have someone else drive you to and from chemotherapy and support you in other ways during treatments.

These tips can help you make having chemotherapy more comfortable and less stressful:

  • Wear comfortable clothing and bring a sweater or blanket. Some people even bring along their favorite pillow or slippers.
  • Bring reading material or games to pass the time.
  • If you’re tired, allow yourself to drift off to sleep during treatment.
  • Tell your nurse or doctor if you have any unusual symptoms.

Beyond chemotherapy, it’s also important to do the following:

  • Continue to eat nutritious food, even if you have no appetite.
  • Drink plenty of fluids and stay hydrated.
  • Get plenty of rest.
  • Participate in mild physical activity whenever you can.
  • Reach out for help with chores and errands.
  • Avoid being around people who have contagious illnesses because your immune system will be weak.
  • Stay socially involved with your family and friends, but take time for yourself when you need to do so.
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