CHOP / CEOP 化療療程
25週CHOP/CEOP療程是獸醫腫瘤學中用於治療犬中高惡性度淋巴瘤的標準多藥物化療方案。它利用具有不同作用機制的藥物輪替，以最大化殺死腫瘤細胞，同時減少重疊的毒性反應。 > **嚴重警告：** 長春新鹼和阿黴素/表柔比星是強烈的**發泡劑**。所有病例都必須放置靜脈留置針，且只能使用「一針見血」成功放置的留置針。如果發生藥物外滲，請立即聯繫腫瘤科獸醫。 **臨床提示：** 呋塞米（Furosemide）與環磷醯胺同時給藥可誘導利尿，顯著減少有毒代謝物（丙烯醛）與膀胱黏膜的接觸時間，從而將無菌性出血性膀胱炎的風險降至最低。
作用機制: This protocol relies on the synergistic action of four distinct drug classes: * **Cyclophosphamide:** Alkylating agent → cross-links DNA strands, preventing replication. * **Doxorubicin/Epirubicin:** Anthracycline antibiotic → inhibits **topoisomerase II**, intercalates DNA, and generates free radicals. * **Vincristine:** Vinca alkaloid → binds to **tubulin**, inhibiting microtubule formation and arresting cells in metaphase. * **Prednisolone:** Glucocorticoid → induces apoptosis in lymphoid cells.
各物種劑量
- Lymphoma (CHOP/CEOP Protocol - Vincristine) · 0.7 mg/m2 · IV · once · Weeks 1, 3, 6, 8, 11, 15, 19, 23 · Strict first-stick IV catheter only. Vesicant.
- Lymphoma (CHOP/CEOP Protocol - Prednisolone) · 2 mg/kg (Wk 1); 1.5 mg/kg (Wk 2); 1 mg/kg (Wk 3); 0.5 mg/kg (Wk 4) · PO · q24h · First 4 weeks only, then stopped · Tapering dose.
- Lymphoma (CHOP/CEOP Protocol - Cyclophosphamide) · 250 mg/m2 · PO/IV · once · Weeks 2, 7, 13, 21 · Administer with Furosemide.
- Lymphoma (CHOP/CEOP Protocol - Furosemide) · 1 mg/kg · PO · q12h · For 48h (4 doses) concurrent with cyclophosphamide · To prevent haemorrhagic cystitis.
- Lymphoma (CHOP/CEOP Protocol - Doxorubicin or Epirubicin) · 30 mg/m2 (Use 1 mg/kg for patients <15 kg) · IV · once · Weeks 4, 9, 17, 25 · Give in 0.9% NaCl (not Hartmann's) over 20 minutes. Vesicant.
- Lymphoma (CHOP/CEOP Protocol - Maropitant) · 1 mg/kg · SC · once · Prior to doxorubicin/epirubicin · Anti-emetic premedication.
- Lymphoma (CHOP/CEOP Protocol - Omeprazole) · 1 mg/kg · PO · q12h or q24h · First 21 days · GI protectant. Ranitidine with sucralfate is an alternative.
- Lymphoma (Alternative to Cyclophosphamide - Chlorambucil) · 20 mg/m2 · PO · once · As needed · Used if haemorrhagic cystitis develops.
- Lymphoma (Alternative to Doxorubicin - Mitoxantrone) · 5.5 mg/m2 · IV · once · As needed · Given over 10 minutes. Used in cases of cardiac dysfunction.
劑量為持牌獸醫專業人員的臨床參考。請務必對照最新藥品說明書及個別病患確認。
給藥途徑
禁忌症
- Severe myelosuppression (neutrophil count < 3 x 10^9/l)
- Pre-existing severe cardiac dysfunction (relative contraindication for doxorubicin; use mitoxantrone instead)
- Active haemorrhagic cystitis (substitute cyclophosphamide with chlorambucil)
- MDR1 mutation (requires significant dose reduction or avoidance of vincristine and doxorubicin)
不良反應
- Myelosuppression (neutropenia, thrombocytopenia)
- Gastrointestinal toxicity (vomiting, diarrhea, anorexia)
- Haemorrhagic cystitis (specific to cyclophosphamide)
- Severe tissue necrosis if extravasated (vincristine, doxorubicin)
- Cardiotoxicity (specific to doxorubicin)
- Alopecia (breed dependent)
藥物相互作用
- Cimetidine · Alters hepatic cytochrome P450 enzyme pathway, potentially altering the metabolism and increasing toxicity of chemotherapeutics. · major
監測
- Haematology prior to each treatment
- Nadir neutrophil count 7 days after the first doxorubicin treatment
- Free-catch urine dipstick prior to each cyclophosphamide administration (check for blood)
- Urine culture if blood is noted on dipstick
- Biochemistry prior to first treatment and minimum every 6 months
- Baseline echocardiography (especially before doxorubicin if pre-existing heart disease is suspected)
過量
Overdosage of any component of the CHOP protocol can lead to **life-threatening myelosuppression** (profound neutropenia and sepsis), severe gastrointestinal mucosal sloughing, and acute cardiotoxicity (doxorubicin). Treatment is strictly supportive, including broad-spectrum IV antibiotics, aggressive fluid therapy, anti-emetics, and potentially granulocyte colony-stimulating factor (G-CSF).
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