Administering Rituxan in R-CHOP
Dear OncoLink "Ask The Experts,"
I've recently started a job administering chemotherapy [to cancer patients]. Does it matter in what order R-CHOP (R= Rituxan, CHOP = chemotherapy regimen of Cyclophosphamide, Adriamycin, Vincristine, and Prednisone) is given? I was told to always give Rituxan last, even if the MD writes for it first, due to the higher incidence of side effects. Thanks for your input.
Michael Vozniak, PharmD, BCOP, Hematology/Oncology Clinical Pharmacy Specialist, responds:
There are no specific rules that I know of with regards to delivering R-CHOP. I think you could argue either way, i.e. to deliver Rituxan first or last. Depending on whether the patients are treated on an inpatient or outpatient basis, on which of the various regimens Rituxan is used in, and on the availability of lab results, Rituxan is administered both before and after chemotherapy in our institution.
The side effects can occur regardless of the sequence. If the Rituxan is given first, and there is an infusion reaction, we would typically bring the patient back the following day to receive the chemotherapy part of the regimen. If the Rituxan is given last and a reaction occurs, a delay in the chemotherapy until the next day is avoided, which is inevitably more convenient for the patient.