At a glance

Treatment: Cyclophosphamide + Doxorubicin + Vincristine + Etoposide + Prednisolone
When it may be used: For selected non-Hodgkin lymphomas, including some T-cell lymphomas.
How it is given: Cyclophosphamide, doxorubicin, vincristine and etoposide go through a vein. You take prednisolone tablets by mouth.
Before you start: Check your steroid dates, bowel care plan and 24-hour hospital number. Tell your team about heart conditions, diabetes or existing tingling.

What this treatment is and how it works

CHOEP is a combination of four chemotherapy medicines and the steroid prednisolone. It contains the same medicines as CHOP with etoposide added. The medicines affect lymphoma cells in different ways. Some also affect blood counts, digestion and nerves, so your team checks for side effects and may adjust the next treatment.

When it may be used

Your doctor may discuss CHOEP for some types of non-Hodgkin lymphoma, including selected T-cell lymphomas. The exact lymphoma type on your biopsy, its stage, your age and general health influence this choice. Ask what the team hopes to achieve and how they will check whether it is working.

Before treatment

Tell the team about heart problems, diabetes, constipation, numbness or tingling and past chemotherapy. Bring a list of medicines and supplements. The team usually checks blood counts, kidneys and liver, and may arrange a heart scan because doxorubicin can affect how well the heart pumps. If you might want children in the future, raise this before the first cycle.

Ask for written dates for prednisolone and any medicines you take at home. If you have diabetes, ask how to monitor your blood sugar while taking steroids and who can adjust your diabetes treatment. If you already take a steroid, confirm which prescription to follow.

How treatment is given

The four chemotherapy medicines are given in the cancer unit. In a common three-week plan called CHOEP21, most of the chemotherapy is given on the first day and etoposide may continue on the following days. You take prednisolone for the short course printed on your plan, often in the morning with food. Confirm the dates, especially if your infusion has been rescheduled. Call the unit if you miss a tablet or vomit after taking it.

You may receive anti-sickness medicines, medicine for constipation and sometimes a growth factor injection to support your white blood cells. Tell staff immediately if you feel breathless, itchy or dizzy during an infusion, or if you notice burning, swelling or pain around the drip.

Tests and monitoring during treatment

Before each cycle, the team checks blood results and asks about infection, bowel habits, numbness and energy. It may delay treatment or change a medicine if counts are low or symptoms need assessment. Report any change in heart symptoms or how much you can do before getting breathless. Ask when a scan is planned to see how the lymphoma is responding.

Side effects

Common side effects

Low blood counts. This may lead to infections, tiredness or bruising. Contact the team if you have a fever, shivers or unusual bleeding.
Constipation. Vincristine can slow the bowel. Follow the plan your team gave you and report constipation early. Severe cramps, swelling of the tummy or vomiting needs urgent assessment.
Numbness or tingling. Tell your team if you have difficulty with buttons, walking or holding objects. They may adjust treatment if nerve problems worsen.
Nausea, sore mouth and hair loss. Take anti-sickness medicines as directed and ask about mouth care. Let the team know if mouth pain makes it hard to eat or drink.
Trouble sleeping or higher blood sugar. Prednisolone can increase appetite, disturb sleep, affect mood and raise blood sugar. Follow your monitoring plan if you have diabetes.

Less common and serious side effects

Doxorubicin can make urine look red or orange for a day or two. Blood clots in the urine, burning or red urine that persists need a call to the team. Cyclophosphamide can irritate the bladder. Drink fluids as advised, allowing for any fluid restriction, and empty your bladder regularly.

Doxorubicin can occasionally affect the heart. Tell the team about new breathlessness, palpitations or ankle swelling. An infusion can also cause an allergic reaction or tissue injury if a drug leaks outside the vein. Tell your nurse straight away about symptoms at the drip site.

When to seek urgent help

Call the hospital’s 24-hour cancer care number straight away for fever, shaking chills, sudden illness, a new cough, difficulty drinking or unexplained bruising or bleeding. Follow your hospital’s temperature instructions. If you have no written threshold, call at 37.5°C (99.5°F) or above, or below 36°C (96.8°F). Call even if your temperature is normal when you feel very unwell.

Seek emergency care for severe breathing difficulty, chest pain, collapse, heavy bleeding or severe tummy pain with vomiting or inability to pass stool or wind. Tell staff you are receiving CHOEP and when you last had it.

Practical advice for this treatment

Take a calendar for the steroid and etoposide

Ask which medicines are given in hospital and whether you have any doses to take at home. Confirm when the steroid ends, and ask what to do if you miss a capsule or vomit after one. Keep home doses marked separately from infusion appointments.

Check the effects of vincristine on the bowel and nerves

Tell the team if stool becomes difficult to pass or if you develop cramps, weakness, tingling or trouble walking. Ask which bowel medicine to use. Severe pain, a swollen belly or vomiting with inability to pass stools or wind needs urgent attention.

Tell the team about previous heart or bladder problems

Doxorubicin can affect heart function, and prior cumulative doses or chest radiotherapy can matter. Report new breathlessness or swelling. Cyclophosphamide can irritate the bladder, so contact the unit about painful urination, blood or clots.

Medicines, interactions and vaccinations

Ask your cancer pharmacist to check new medicines, including antibiotics or antifungals, constipation treatments and supplements. Some medicines can increase vincristine side effects. Ask your team before any vaccination and whether you need to wait before having a live vaccine.

Everyday life

Keep a note of when you last passed stool, whether your fingers or toes feel different and which days you take your steroid. Ask about gentle activity, help with meals and support for hair loss. If you are given a white-cell growth factor to inject at home, ask for a demonstration and written dates.

Pregnancy, fertility and breastfeeding

Talk with your team about fertility preservation before treatment. Ask about contraception, how long to continue it after the last cycle and when breastfeeding can safely resume.

After treatment

Tell your team if numbness, constipation or tiredness continues. Ask when you will review your scan results, what follow-up is needed and whom to contact if symptoms return before the next appointment.

Frequently asked questions

What is the difference between CHOP and CHOEP?

CHOEP includes etoposide in addition to the four medicines in CHOP. Your team can tell you why it chose your plan.

Will I have to come back the next day?

Some schedules give etoposide on several days. Check your calendar before leaving the unit.

What if I forget my prednisolone or vomit after taking it?

Call the unit for instructions. Tell them when you took the tablet or when you were due to take it.

Is it normal for my urine to look orange?

Doxorubicin can briefly turn urine red or orange after the drip. Call the unit if you see clots, have pain when passing urine or are unsure whether you are seeing blood, particularly if the colour change persists.

What should I do about constipation?

Follow your bowel plan and report constipation early. Call urgently if it comes with increasing tummy pain, swelling or vomiting.

Why do my fingers feel numb?

Vincristine can affect nerves. Tell the team even if the tingling comes and goes, particularly if you have difficulty with everyday tasks.

Why might I need a heart scan?

Doxorubicin can affect the heart muscle. A scan helps your team check how well your heart pumps.

Can prednisolone affect my diabetes?

It can raise blood sugar. Ask for a written plan for the steroid days and the days just after them.

Will I need a white-cell injection?

Some people do. Your team considers your treatment, risk of infection and blood counts.

What if the drip area hurts after I go home?

Call the unit promptly and describe any pain, redness or swelling. Some drugs can damage tissue if they leak outside a vein.

Can I take a laxative from the pharmacy?

Check the plan with your team first, especially if you have pain, vomiting or a swollen tummy.

Why could my treatment be delayed?

Low blood counts, an infection or side effects may need time or assessment. Ask when your tests and treatment will be reviewed.

How do I know if the treatment is working?

Your team will review your symptoms, examination and scan results. Ask when this will happen and what the results could change.

Can I have dental treatment between cycles?

Contact your cancer team and dentist first. Your blood counts and infection risk may affect the timing.

Individual medicine guides

Sources and further reading

Read this guide alongside your hospital’s plan. Ask your pharmacist to confirm the exact product dispensed in India and follow the instructions for that product.