COP化学療法プロトコル
COP Chemotherapy Protocol
Cyclophosphamide, Vincristine, Prednisolone
別名: COP Protocol · High-dose COP · Cyclophosphamide, Oncovin, Prednisone · CVP protocol
VetSheet 獣医チームが監修更新日 2026年4月5日エビデンスに基づく獣医学リファレンス
用量は獣医専門家向けの臨床参考資料です。必ず最新の医薬品情報および個別症例に基づいて確認してください。
動物種別用量
🌎 NA — North America🌍 EU — Europe
犬
| 適応 | 用量 | 経路 | 頻度 | 期間 | 地域 |
|---|---|---|---|---|---|
| COP Protocol - Induction (Cyclophosphamide) | 250 mg/m2 | PO | q21d | First 6 months | 🌍 EU |
| COP Protocol - Induction (Vincristine) | 0.70 mg/m2 | IV | q7d for 4 weeks, then q21d | First 6 months | 🌍 EU |
| COP Protocol - Induction (Prednisolone) | 2 mg/kg (week 1), 1.5 mg/kg (week 2), 1 mg/kg (week 3), 1 mg/kg thereafter | PO | q24h (weeks 1-3), then q48h | First 6 months | 🌍 EU |
| COP Protocol - Adjunct (Furosemide) | 1 mg/kg | PO | q12h | For 48h (4 doses) concurrent with cyclophosphamide | 🌍 EU |
| COP Protocol - Maintenance after 6 months (Cyclophosphamide) | 250 mg/m2 | PO | q28d | Months 6 to 12 | 🌍 EU |
| COP Protocol - Maintenance after 6 months (Vincristine) | 0.70 mg/m2 | IV | q28d | Months 6 to 12 | 🌍 EU |
| COP Protocol - Maintenance after 6 months (Prednisolone) | 1 mg/kg | PO | q48h | Months 6 to 12 | 🌍 EU |
| Alternative to Cyclophosphamide (Chlorambucil) | 20 mg/m2 | PO | As directed replacing cyclophosphamide | Ongoing | 🌍 EU |
- COP Protocol - Induction (Cyclophosphamide): Administer with Furosemide to prevent haemorrhagic cystitis.
- COP Protocol - Induction (Vincristine): On q21d schedule, give on the same day as cyclophosphamide.
- COP Protocol - Induction (Prednisolone): Tapering dose schedule.
- COP Protocol - Adjunct (Furosemide): Administered to promote diuresis and reduce risk of haemorrhagic cystitis.
- COP Protocol - Maintenance after 6 months (Cyclophosphamide): Stop protocol after 12 months and monitor for relapse.
- COP Protocol - Maintenance after 6 months (Vincristine): Administer with cyclophosphamide.
- COP Protocol - Maintenance after 6 months (Prednisolone): Stop protocol after 12 months and monitor for relapse.
- Alternative to Cyclophosphamide (Chlorambucil): Use if haemorrhagic cystitis develops or if blood is noted on urine dipstick and culture is negative.
用量は獣医専門家向けの臨床参考資料です。必ず最新の医薬品情報および個別症例に基づいて確認してください。
概要
COPプロトコル（シクロホスファミド、ビンクリスチン、プレドニゾロン）は、主にリンパ腫の治療に使用される獣医腫瘍学において一般的な多剤併用細胞毒性療法です。
臨床的警告： ビンクリスチンは強力な発泡薬（壊死性抗がん剤）です。血管外漏出は重度の組織壊死を引き起こします。
臨床のポイント： 多くの腫瘍科医はCHOPプロトコルを好みますが、高用量COPは一般診療においても非常に有用で比較的実施しやすいプロトコルです。
作用機序
The COP protocol utilizes three distinct mechanisms to target neoplastic cells:
- Cyclophosphamide: An alkylating agent that cross-links DNA strands → prevents DNA replication and transcription → induces cell death.
- Vincristine: Binds to tubulin → inhibits microtubule formation and mitotic spindle assembly → arrests cell division in metaphase.
- Prednisolone: A glucocorticoid that binds to specific intracellular receptors → alters gene expression → induces apoptosis in neoplastic lymphocytes.
安全性・警告
禁忌
- Severe neutropenia (< 2 x 10^9/L)
- Pre-existing haemorrhagic cystitis
- Known MDR1 mutation (requires extreme caution/dose adjustment for vincristine)
有害事象
- Myelosuppression (neutropenia)
- Haemorrhagic cystitis (cyclophosphamide)
- Gastrointestinal toxicity (vomiting, diarrhoea, anorexia)
- Tissue necrosis if extravasated (vincristine)
注意事項
Vesicant Warning: Vincristine is a vesicant. IV catheters must be placed in all cases, and ONLY catheters placed by a clean 'first-stick' should be used.
Myelosuppression: Discontinue cyclophosphamide if neutrophil count decreases to < 2 x 10^9/L. Check weekly and do not resume until > 3 x 10^9/L. If neutropenia recurs, decrease dose by 10-25%.
MDR1 Mutation: Certain breeds (generally Collie type) are very sensitive to vincristine due to the MDR1 mutation; commercial testing is highly recommended prior to treatment.
Clinical Pearl: GI protectants (e.g., Omeprazole 1 mg/kg q12-24h or Ranitidine with sucralfate) are recommended for the first 21 days of the protocol.
医薬品相互作用
Inhibits hepatic cytochrome P450 enzyme pathway, potentially altering the metabolism and increasing toxicity of chemotherapeutics.
監視
- Haematology (prior to each vincristine treatment)
- Biochemistry (prior to first treatment, then minimum every 6 months)
- Free-catch urine dipstick (prior to each cyclophosphamide administration to check for blood)
- Urine culture (if blood is noted on dipstick)
薬物動態
半減期
吸収
Cyclophosphamide and Prednisolone are well absorbed orally. Vincristine must be given IV.
分布
Vincristine binds extensively to tissues. Cyclophosphamide is widely distributed.
代謝
Cyclophosphamide requires hepatic activation (CYP450) to active alkylating metabolites. Vincristine is metabolized by the liver.
消失
Cyclophosphamide metabolites are excreted in urine (causing local toxicity). Vincristine is primarily excreted in feces via bile.
過剰投与
Severe toxicity: Overdose of these chemotherapeutics can lead to fatal myelosuppression, severe gastrointestinal sloughing, sepsis, and death. Extravasation of vincristine causes severe, progressive tissue necrosis requiring immediate management (e.g., hyaluronidase, warm compresses).
製品
製剤
- Oral tablets (Cyclophosphamide, Prednisolone, Chlorambucil, Furosemide)
- Intravenous injection (Vincristine)
動物用医薬品
- Prednisolone tablets (various strengths)
- Furosemide tablets (various strengths)
ヒト用医薬品
- Cyclophosphamide tablets
- Vincristine sulfate injection
- Chlorambucil tablets
規制ステータス
Protocol utilizes a mix of veterinary-approved (prednisolone, furosemide) and human-approved (cyclophosphamide, vincristine) drugs under the cascade.
Administered under the prescribing cascade.
規制データなし: 🇺🇸 US · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU
保管・安定性
Store oral chemotherapeutics in their original, clearly labeled containers away from food and children. Vincristine injection requires refrigeration and protection from light. Follow strict hazardous drug handling protocols.
飼主向け情報
あなたのペットはCOPと呼ばれる多剤併用化学療法を受けています。
- 安全な取り扱い： 抗がん剤はペットの尿や便に排泄されます。治療後少なくとも48時間は、排泄物の処理や粗相の掃除をする際に使い捨て手袋を着用してください。その後は十分に手を洗ってください。
- 投薬について： 抗がん剤の錠剤は絶対に砕いたり割ったりしないでください。
- 観察のポイント： 感染の兆候（元気消失、発熱）、胃腸の不調（嘔吐、下痢、食欲不振）、または血尿がないか注意深く観察してください。
- 血尿に気づいた場合は、直ちにシクロホスファミドの投与を中止し、獣医師に連絡してください。これは膀胱の炎症（出血性膀胱炎）を示している可能性があります。
VetSheet医薬品リファレンスは獣医専門家の臨床意思決定支援を目的としており、専門的判断または製造業者の最新医薬品情報の代替にはなりません。