https://www.vetsurgeon.org/f/clinical-questions/29344/chop-protocol---in-remission-half-way-through Hello, I have taken over a case from a departing colleague of a 7year old labradoodle with stage V B cell lymphoma. He has completed weeks 1-9 of the CHOP protocol and has really been in remission since starting the oral prednisolone. He is very wellen-USTelligent Community 10https://www.vetsurgeon.org/thread/225300?ContentTypeID=1Mon, 07 Sep 2020 21:24:37 GMT146601cc-3922-4be7-9974-7e1d4e45a66b:314498c0-4d11-40c4-8767-fa772d9ab022shanley barber<p>Hi Rodney, &nbsp;thank you so much for your comprehensive reply. &nbsp;I will have a long chat with the owners and go from there. &nbsp;<br />Thanks again!</p> <p>Shanley&nbsp;</p><div style="clear:both;"></div>https://www.vetsurgeon.org/thread/225299?ContentTypeID=1Mon, 07 Sep 2020 18:21:57 GMT146601cc-3922-4be7-9974-7e1d4e45a66b:faf1ae91-ec1c-4aa4-89f2-f3fe95b8056fRodney Ayl<p>Hi Shanley,</p> <p>There are so many CHOP-based protocols that are variations of the same theme, that I&rsquo;m sure you could find a protocol that fits what you may need to do. There is no question that the more chemo you give the more response you can get in the tumor but there are going to be diminishing returns as you go out further in the protocol, as you are going into the realm of resistant cells. I&nbsp;have often chosen of the COP protocol due to financial concerns and in some cases have done better than CHOP based protocols. Statistics tell you everything you want to know about all the cases that have been treated but nothing about the case you are treating. <br />There are a number of possibilities here and you will probably need to speak to the owners to get an idea of exactly what they can afford. You could switch to the COP protocol dropping out the doxorubicin which tends to be the most expensive. You could drop out the weekly drugs and just complete it with the doxorubicin Q3 weeks as, as a single agent is it is the most efficacious. If they are in trouble with money right now you could stop the injectable chemo, which tends to be more expensive than oral and switch to lomustine every three weeks, as a consolidation protocol with a new drug. <br />You will never know how you may affect the outcome of this case by making changes at this point, but as long as you do right by the pet I&rsquo;m sure the clients will be OK. If they come out of remission quickly after stopping I will tend to switch to a different protocol. If they stay in remission for a long time, I may go back to CHOP, as long as the heart is OK based on an echocardiogram. <br />I hope this helps but I&rsquo;m not sure there&rsquo;s a specific right or wrong answer on this. Just go based on what your clients feel that they need to do.</p> <p>Kind regards,&nbsp;</p> <p>Rodney Ayl</p> <p>American Board-Certified Oncologist</p> <p>Paragon Veterinary Referrals</p><div style="clear:both;"></div>