CHOP / CEOP 化療療程
CHOP / CEOP Chemotherapy Protocol
Cyclophosphamide, Doxorubicin (or Epirubicin), Vincristine, Prednisolone
別名: CHOP Protocol · CEOP Protocol · Madison-Wisconsin Protocol · UW-25 Protocol · L-CHOP
由 VetSheet 獸醫團隊審訂更新於 2026年4月5日本內容以實證獸醫文獻為本
劑量為合格獸醫專業人員的臨床參考。請務必對照最新仿單及個別病患確認。
各物種劑量
🌎 NA — North America🌍 EU — Europe
狗
| 適應症 | 劑量 | 途徑 | 頻次 | 療程 | 地區 |
|---|---|---|---|---|---|
| Lymphoma (CHOP/CEOP Protocol - Vincristine) | 0.7 mg/m2 | IV | once | Weeks 1, 3, 6, 8, 11, 15, 19, 23 | 🌍 EU |
| 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 | 🌍 EU |
| Lymphoma (CHOP/CEOP Protocol - Cyclophosphamide) | 250 mg/m2 | PO/IV | once | Weeks 2, 7, 13, 21 | 🌍 EU |
| Lymphoma (CHOP/CEOP Protocol - Furosemide) | 1 mg/kg | PO | q12h | For 48h (4 doses) concurrent with cyclophosphamide | 🌍 EU |
| 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 | 🌍 EU |
| Lymphoma (CHOP/CEOP Protocol - Maropitant) | 1 mg/kg | SC | once | Prior to doxorubicin/epirubicin | 🌍 EU |
| Lymphoma (CHOP/CEOP Protocol - Omeprazole) | 1 mg/kg | PO | q12h or q24h | First 21 days | 🌍 EU |
| Lymphoma (Alternative to Cyclophosphamide - Chlorambucil) | 20 mg/m2 | PO | once | As needed | 🌍 EU |
| Lymphoma (Alternative to Doxorubicin - Mitoxantrone) | 5.5 mg/m2 | IV | once | As needed | 🌍 EU |
- Lymphoma (CHOP/CEOP Protocol - Vincristine): Strict first-stick IV catheter only. Vesicant.
- Lymphoma (CHOP/CEOP Protocol - Prednisolone): Tapering dose.
- Lymphoma (CHOP/CEOP Protocol - Cyclophosphamide): Administer with Furosemide.
- Lymphoma (CHOP/CEOP Protocol - Furosemide): To prevent haemorrhagic cystitis.
- Lymphoma (CHOP/CEOP Protocol - Doxorubicin or Epirubicin): Give in 0.9% NaCl (not Hartmann's) over 20 minutes. Vesicant.
- Lymphoma (CHOP/CEOP Protocol - Maropitant): Anti-emetic premedication.
- Lymphoma (CHOP/CEOP Protocol - Omeprazole): GI protectant. Ranitidine with sucralfate is an alternative.
- Lymphoma (Alternative to Cyclophosphamide - Chlorambucil): Used if haemorrhagic cystitis develops.
- Lymphoma (Alternative to Doxorubicin - Mitoxantrone): Given over 10 minutes. Used in cases of cardiac dysfunction.
劑量為合格獸醫專業人員的臨床參考。請務必對照最新仿單及個別病患確認。
概覽
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。
作用機轉
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.
安全性與警告
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)
注意事項
Myelosuppression Management:
- If neutrophils >3 x 10^9/l and platelets >100 x 10^9/l: Proceed with treatment.
- If neutrophils <3 x 10^9/l: Suspend treatment, recheck in 5-7 days.
- If neutrophils <1 x 10^9/l: Prescribe prophylactic antibiotics. Decrease next dose of the responsible chemotherapy drug by 10%.
- If neutrophils <1 x 10^9/l AND patient is pyrexic/unwell: Administer IV antibiotics and contact an oncologist.
MDR1 Breeds: Collie-type breeds are highly sensitive to vincristine and doxorubicin due to the MDR1 (ABCB1) mutation. Commercial testing is strongly recommended prior to initiating therapy.
藥物交互作用
Alters hepatic cytochrome P450 enzyme pathway, potentially altering the metabolism and increasing toxicity of chemotherapeutics.
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)
藥物動力學
半衰期
吸收
Varies by drug. Cyclophosphamide and prednisolone are well absorbed orally.
分佈
Wide distribution. Doxorubicin concentrates in tissues. Vincristine binds heavily to blood elements.
代謝
Hepatic. Cyclophosphamide requires hepatic activation to its active alkylating metabolites. Doxorubicin and vincristine undergo extensive hepatic metabolism (CYP450).
排除
Vincristine and doxorubicin are primarily excreted in feces via the biliary system. Cyclophosphamide metabolites are excreted in urine.
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).
可用產品
劑型
- Vincristine: Injectable solution
- Cyclophosphamide: Oral tablets, Injectable solution
- Doxorubicin/Epirubicin: Injectable solution
- Prednisolone: Oral tablets
獸醫用
- Various generic formulations available depending on the specific drug
人用標示
- Oncovin (Vincristine)
- Endoxana (Cyclophosphamide)
- Adriamycin (Doxorubicin)
各地核准狀態
Standard of care for canine lymphoma.
Handled under strict hazardous drug protocols.
Handled under strict hazardous drug protocols.
暫無法規資料: 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU
儲存與穩定性
Vincristine and Doxorubicin injectables must be refrigerated and protected from light. Cyclophosphamide tablets should be stored at room temperature. Follow specific manufacturer guidelines for each agent.
飼主須知
您的愛犬正在接受為期25週的綜合化療療程。
- 副作用： 狗對化療的耐受性通常比人類好得多。除了某些特定品種（如貴賓犬或㹴犬）外，很少會掉毛，但在治療後1-2天內可能會出現輕微的腸胃不適或疲倦。
- 感染風險： 由於這些藥物會降低白血球數量，您的愛犬感染的風險較高。如果您的愛犬出現發燒、嚴重嗜睡或拒食，請立即就醫。
- 排尿監測： 密切觀察愛犬的尿液。如果您發現任何血尿或排尿困難的跡象，請立即聯繫您的獸醫，因為這可能是其中一種藥物（環磷醯胺）的副作用。
- 安全注意事項： 化療藥物會透過寵物的排泄物排出。在每次治療後的至少48小時內，清理尿液、糞便或嘔吐物時請務必戴上手套。
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