Hey!!! R-CHOP Vs E-POCHR

vinslymphoma

i (34yrs,Male) have been diagnosed with high grade large diffuse b-cell lymphoma last month and i have had my second chemo of R-CHOP regimen. I have been doing alright with all the common side effects like losing taste buds, hair loss, general tiredness. 

I was trying to get a second opinion on my treatment regimen and was suggested EPOCH-R has better survival rate than R-CHOP and also that it cuts the need of radiation therapy (as i have a primary mediastinal mass).

Has anyone switched regimen like this? ups and down of switching regime in-between? 

Is Radiation therapy so painful and harmful (short/long term effects)? 

Cure rate in general for this high grade diffuse b-cell lymphoma and does it change with different regime methods? 

Max Former Hodgkins Stage 3

Added Drug

Vinslymphoma,

Welcome to the boards.  Your strain of NHL is the most common one, so hopefully many people will chime in regarding it.  CHOP is also one of the most common chemotherapy combinations for NHL, and I am sure a lot of people can answer any questions regarding it as well

r-EPOCH (EPOCH with rituxan) is of course identical to r-CHOP (CHOP with rituxan), with the addition of the drug Etoposide ('EPOCH'  could have been spelled 'CHOP + E', which would have made this more obvious). 

I have NO medical training, but it seems that going from r-CHOP to r-EPOCH is not really a "Switch" of meds; it is just the addition of one more. Ask your oncologist about it.  The insurance company may have some input on his decision as well (insurance companys are second-guessing doctors all the time).

Obviously, the side-effects of EPOCH should be identical to CHOP (since it is the same drugs), plus whatever effects Etoposide adds, but they seem to be the usual ones (see the Etoposide link below).  I notices that Etoposide may cause neuropathy (numb hands and feet), which your Vincristine can also cause, so be aware of that. It is also one of the drugs out there that can cause "metal mouth'" or a temporary loss of sense of taste.  Usually, these symptoms (if you get them at all) clear--up within a few months after ending chemo.

I never received any radiation and know little about it, but hopefully several folks will address that question of yours as well.  I have heard that combining chemo and radiation can in some instances increase the potential for later issues, but undoubtedly this varies with what kind of chemo is mixed with what kinds of radiation, what doses, etc -- a huge number of complex variables.

I suspect your first name is "Vince" -- my son's name. I wish you rapid and complete remission.

max

http://chemocare.com/chemotherapy/drug-info/etoposide.aspx#.UwXyHDAo670

The following article is complex, but addresses many of your questions.

http://www.haematologica.org/content/97/5/758.full

.

 

jimwins

Welcome

Welcome, Vin.  I see you accessed another post that has a lot of the information you were looking for regarding R-EPOCH.  I had the same cancer as you and was treated with R-EPOCH - no radiation but I did have a surgery early on and interrupted treatment.  I responded very well and have been in remission now for over 2 years!  Know there is hope and this type cancer is curable and responds well to treatment.  You are young and that should work in your favor as well .

What I might add is R-EPOCH is normally given in a hospital setting (for me, 4 nights, 5 days every 3 weeks).  I had no radiation treatments.  Also, there are folks and people here who have had radiation and I know there have been discussions about the long term effects of both chemo and radiation.  I wish you the best on your journey and know you are not alone here.

You can message me anytime if you like since our circumstances seem similar.

Hugs and positive thoughts,

Jim 

allmost60

Welcome

Hi Vince,

 I just wanted to "Welcome" you to the group. I have a different type of NHL and had a different chemo with no radiation, so I cannot help with your questions. Others will soon join in and add to what Max and Jim have already said. Let us know if you make any changes in chemo and we will be happy to help and give support in any way we can. Keep your chin up and remember to take it one day at a time. Less daily stress is best while doing our treatments. Keeping you in my prayers.

Best wishes...Sue

(Follicular NHL-stg3-grd2-typA-Dx 6/10-age 63-in remission)

vinslymphoma

allmost60 said:

Welcome

Hi Vince,

 I just wanted to "Welcome" you to the group. I have a different type of NHL and had a different chemo with no radiation, so I cannot help with your questions. Others will soon join in and add to what Max and Jim have already said. Let us know if you make any changes in chemo and we will be happy to help and give support in any way we can. Keep your chin up and remember to take it one day at a time. Less daily stress is best while doing our treatments. Keeping you in my prayers.

Best wishes...Sue

(Follicular NHL-stg3-grd2-typA-Dx 6/10-age 63-in remission)

Thanks Sue/Max/Jim

 

New

Thanks Sue/Max/Jim for your kind words and support..i feel really happy to access a group who are warriors of this demon and feel that i have one extra round of friends..and Max my name is Vinoth :-) vins =wins and also my pet name..

here in UK, the NHS has upper hand in cancer treatment as they are more funded and have large expertise group and clinical trial results. I had a second opinion from Dr. James O Armitage of University of Nebraska (through Advance Medical) and he suggests that its not a proven step to employ DA-EPOCH R over R-CHOP but he recommends it for my case. However my consultants here say that this specific result and recommendation comes from only one part/group from USA and its not yet widely accepted and that there is no proven benefit and also that there is no guarantee that there is not going to be a radiation following EPOCHR. 

So i am bit stuck up on what to do next? Whether to go with the local doctors with RCHOP and see the outcome of my PET scan two weeks after third chemo (march 3rd week) and then employ more heavy dose or continue with the same based on the result or should i just push hard with the consultants to go with this choice (though i dont know how is it going to play on me) and find out option to get it private as i have private cover.

I basically believe that as my disease was diagnosed initially itself, RCHOP only will help me to come out of this. However if there is going to be radiation, its going to be very localaized only at that mediastinal mass. Is there a general stats of how small the mass shrinks after every chemo. mine was at 8cm at nov n 10cm at jan before chemo n hope it has reduced considerably.

I may need to take this to first let me out of this disease but later manage my life well balanced with healthy diets/yoga/physical activities etc., to reduce the long term effects. Or is it something that is out of our hands ? 

vinslymphoma

Max Former Hodgkins Stage 3 said:

Added Drug

Vinslymphoma,

Welcome to the boards.  Your strain of NHL is the most common one, so hopefully many people will chime in regarding it.  CHOP is also one of the most common chemotherapy combinations for NHL, and I am sure a lot of people can answer any questions regarding it as well

r-EPOCH (EPOCH with rituxan) is of course identical to r-CHOP (CHOP with rituxan), with the addition of the drug Etoposide ('EPOCH'  could have been spelled 'CHOP + E', which would have made this more obvious). 

I have NO medical training, but it seems that going from r-CHOP to r-EPOCH is not really a "Switch" of meds; it is just the addition of one more. Ask your oncologist about it.  The insurance company may have some input on his decision as well (insurance companys are second-guessing doctors all the time).

Obviously, the side-effects of EPOCH should be identical to CHOP (since it is the same drugs), plus whatever effects Etoposide adds, but they seem to be the usual ones (see the Etoposide link below).  I notices that Etoposide may cause neuropathy (numb hands and feet), which your Vincristine can also cause, so be aware of that. It is also one of the drugs out there that can cause "metal mouth'" or a temporary loss of sense of taste.  Usually, these symptoms (if you get them at all) clear--up within a few months after ending chemo.

I never received any radiation and know little about it, but hopefully several folks will address that question of yours as well.  I have heard that combining chemo and radiation can in some instances increase the potential for later issues, but undoubtedly this varies with what kind of chemo is mixed with what kinds of radiation, what doses, etc -- a huge number of complex variables.

I suspect your first name is "Vince" -- my son's name. I wish you rapid and complete remission.

max

http://chemocare.com/chemotherapy/drug-info/etoposide.aspx#.UwXyHDAo670

The following article is complex, but addresses many of your questions.

http://www.haematologica.org/content/97/5/758.full

.

 

Thanks Sue/Max/Jim

Thanks Sue/Max/Jim

jimwins

vinslymphoma said:

Thanks Sue/Max/Jim

 

New

Thanks Sue/Max/Jim for your kind words and support..i feel really happy to access a group who are warriors of this demon and feel that i have one extra round of friends..and Max my name is Vinoth :-) vins =wins and also my pet name..

here in UK, the NHS has upper hand in cancer treatment as they are more funded and have large expertise group and clinical trial results. I had a second opinion from Dr. James O Armitage of University of Nebraska (through Advance Medical) and he suggests that its not a proven step to employ DA-EPOCH R over R-CHOP but he recommends it for my case. However my consultants here say that this specific result and recommendation comes from only one part/group from USA and its not yet widely accepted and that there is no proven benefit and also that there is no guarantee that there is not going to be a radiation following EPOCHR. 

So i am bit stuck up on what to do next? Whether to go with the local doctors with RCHOP and see the outcome of my PET scan two weeks after third chemo (march 3rd week) and then employ more heavy dose or continue with the same based on the result or should i just push hard with the consultants to go with this choice (though i dont know how is it going to play on me) and find out option to get it private as i have private cover.

I basically believe that as my disease was diagnosed initially itself, RCHOP only will help me to come out of this. However if there is going to be radiation, its going to be very localaized only at that mediastinal mass. Is there a general stats of how small the mass shrinks after every chemo. mine was at 8cm at nov n 10cm at jan before chemo n hope it has reduced considerably.

I may need to take this to first let me out of this disease but later manage my life well balanced with healthy diets/yoga/physical activities etc., to reduce the long term effects. Or is it something that is out of our hands ? 

Hi Vinoth

 

 

Welcome again विनोद (Vinoth) .  Which ever treatment you decide upon,  know we're here for you.  There are so many variables with long term effects (and how "long term" is one of them) and I don't have enough long term experience, so I can't offer much advice there personally.  

Please keep us updated and hang in there!

Jim

 

 

 

coachmike

epoch

Hi

 

I had Diffuse Large B Cell Lymphoma and did R EPOCH. It only brought series of fatigue and hair loss but other than that it wasnt too bad. I did not receive full remission from it however and had to have a stem cell transplant. I am 18 months in remission and loving life. You will get througb this and soon be a distant memory

 

Mike

illead

coachmike said:

epoch

Hi

 

I had Diffuse Large B Cell Lymphoma and did R EPOCH. It only brought series of fatigue and hair loss but other than that it wasnt too bad. I did not receive full remission from it however and had to have a stem cell transplant. I am 18 months in remission and loving life. You will get througb this and soon be a distant memory

 

Mike

Vin

I wanted to add our welcome also.  Know this is not in our life's plan.  I hope you are able to keep positive and your family too.  Please know that we all care and know that you are welcome anytime.

Our best to you, Bill & Becky

 

Hey Jim, just wanted to say that your language expertise is quite impressive.

 

jimwins

illead said:

Vin

I wanted to add our welcome also.  Know this is not in our life's plan.  I hope you are able to keep positive and your family too.  Please know that we all care and know that you are welcome anytime.

Our best to you, Bill & Becky

 

Hey Jim, just wanted to say that your language expertise is quite impressive.

 

Language Skills

LOL - I'm fluent in Google Translate and found "Vinoth" on Wikipedia and copy/pasted.  I used to know a lot of Spanish and was getting pretty good at ASL (American SIgn Language) years ago when I had a deaf roommate.  But you know my favorite words in any language are  "hugs" and "hope" .

Hugs - Jim

illead

jimwins said:

Language Skills

LOL - I'm fluent in Google Translate and found "Vinoth" on Wikipedia and copy/pasted.  I used to know a lot of Spanish and was getting pretty good at ASL (American SIgn Language) years ago when I had a deaf roommate.  But you know my favorite words in any language are  "hugs" and "hope" .

Hugs - Jim

Yep

the best!

Max Former Hodgkins Stage 3

jimwins said:

Language Skills

LOL - I'm fluent in Google Translate and found "Vinoth" on Wikipedia and copy/pasted.  I used to know a lot of Spanish and was getting pretty good at ASL (American SIgn Language) years ago when I had a deaf roommate.  But you know my favorite words in any language are  "hugs" and "hope" .

Hugs - Jim

"Hope"

Jim knows that one of my favorite slogans is the state motto of SC: "While I breath, I hope."

Following my wreck in 1986, I went into respritory distress twice (once that night, once a week later, when I went on a ventilator for 16 days).

So, I guess I hope even when I do not breath !

max

vinslymphoma

illead said:

Vin

I wanted to add our welcome also.  Know this is not in our life's plan.  I hope you are able to keep positive and your family too.  Please know that we all care and know that you are welcome anytime.

Our best to you, Bill & Becky

 

Hey Jim, just wanted to say that your language expertise is quite impressive.

 

Thanks Mike, Jim, Bill &Becky

Thanks Mike, Jim, Bill &Becky for the kindness and wishes :-) 

I feel i am already out of this disease for past few days as i am feeling quite well..may be after i joined csn and got to connect with you all and your wishes made me feel better..i hope i am going to stay RCHOP for third cycle and see the outcome of three cycles on my PET scan two weeks after third cycle..and decide further.

Jim..btw..your google translation skill is amazing good one..

vinslymphoma

vinslymphoma said:

Thanks Mike, Jim, Bill &Becky

Thanks Mike, Jim, Bill &Becky for the kindness and wishes :-) 

I feel i am already out of this disease for past few days as i am feeling quite well..may be after i joined csn and got to connect with you all and your wishes made me feel better..i hope i am going to stay RCHOP for third cycle and see the outcome of three cycles on my PET scan two weeks after third cycle..and decide further.

Jim..btw..your google translation skill is amazing good one..

helloo

hope everyone is doing well.. Mike, Jim, Bill &Becky, Max,Suresh :-) its been a month or more since i had visited..its been busy n rough days after 3rd and 4th chemo..but getting back to normalcy again..so..i am continuing with RCHOP as my body seems to have responded well to this medicine and therefore havent been given DA-EPOCHR..i was told the tumor isnt looking active from PET scan though the size of tumor has gone down to 5.5cms or so.. i dont know if i have to continue full 6 cycles..n if there is going to be a need for radiotherapy at the end..any idea why we are on full treatment if the tumor isnt active..or what does it mean actually? lately i have been also feeling not to eat anything as my taste buds have gone nasty n cant feel anything + severe constipation..i am seeing this after third and fourth especially ..has anyone got any idea to tackle these issues..did you take anti-fungal/anti-bacterial/anti-viral/vitamin tablets during all your cycles?? 

Shoopy

vinslymphoma said:

helloo

hope everyone is doing well.. Mike, Jim, Bill &Becky, Max,Suresh :-) its been a month or more since i had visited..its been busy n rough days after 3rd and 4th chemo..but getting back to normalcy again..so..i am continuing with RCHOP as my body seems to have responded well to this medicine and therefore havent been given DA-EPOCHR..i was told the tumor isnt looking active from PET scan though the size of tumor has gone down to 5.5cms or so.. i dont know if i have to continue full 6 cycles..n if there is going to be a need for radiotherapy at the end..any idea why we are on full treatment if the tumor isnt active..or what does it mean actually? lately i have been also feeling not to eat anything as my taste buds have gone nasty n cant feel anything + severe constipation..i am seeing this after third and fourth especially ..has anyone got any idea to tackle these issues..did you take anti-fungal/anti-bacterial/anti-viral/vitamin tablets during all your cycles?? 

DLBCL

Vin,

I haven't responded since the others were covering exactly what I would have said.  However, do you know what subtype of DLBCL you have?  I don't know if they classify PMM the same way.  I have just straight up DLBCL...no mass.  I have sub-type 'activated b-cell'.  I started with R-CHOP but was dx as refractory after 2 cycles.  I am so glad to hear you are part of the 60% that react well to R-CHOP.  Seems like you're on your way to cure...which is a possibility with DLBCL. 

If I were a betting man, I think they will want you to complete all 6 cycles.  Even with the turmor inactive, there still might be microbial cancer around.  I know the chemo can get tough but work with your doctors on things like the constipation, the lack of appetite, etc.  don't ever feel like you're bothering them. 

Keep up the good work, Vin!  Remember my motto: I plan to live forever!  So far; so good!

Karl

jimwins

vinslymphoma said:

helloo

hope everyone is doing well.. Mike, Jim, Bill &Becky, Max,Suresh :-) its been a month or more since i had visited..its been busy n rough days after 3rd and 4th chemo..but getting back to normalcy again..so..i am continuing with RCHOP as my body seems to have responded well to this medicine and therefore havent been given DA-EPOCHR..i was told the tumor isnt looking active from PET scan though the size of tumor has gone down to 5.5cms or so.. i dont know if i have to continue full 6 cycles..n if there is going to be a need for radiotherapy at the end..any idea why we are on full treatment if the tumor isnt active..or what does it mean actually? lately i have been also feeling not to eat anything as my taste buds have gone nasty n cant feel anything + severe constipation..i am seeing this after third and fourth especially ..has anyone got any idea to tackle these issues..did you take anti-fungal/anti-bacterial/anti-viral/vitamin tablets during all your cycles?? 

Hi Vinoth

Hi Vin.  It's great to hear from you.  Constipation is common with this type chemo.  They gave me senokot during my cycles and I learned to start taking them the day before I began treatment - seemed to work better for me.  During and around treatment, patients are often given anti fungal/bacterial/viral medications while there counts are down to hopefully prevent infection.  I was given some of these but didn't have to take them very long.  Are they giving you neulasta/neuprogen to help bring up the blood counts after treatment?  If so, claritin is supposed to help with the bone aches most people get after this.  Of course check with your doctors on all of this.

I didn't have the issue with taste buds but I believe it's temporary for those who experience it.  Also, during treatment it's a good idea to avoid acidiic foods if you have any mouth irritation.  Probably a good idea to avoid really spicy foods as well which I realize may be a regular part of your diet. 

Sounds like you are responding well and that is certainly good news!  Write when you can and thanks for checking in with us.

Hugs and peace,

Jim

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