Comparative Effectiveness of COP and CHOP Chemotherapy Protocols in Feline Intermediate- to Large-Cell Lymphoma: A Systematic Review and Meta-Analysis.

Authors

Yeuk Wan Sharon Lam, Pedro Antônio Bronhara Pimentel, Omid Nekouei, Antonio Giuliano

Published in

Veterinary and comparative oncology. Oct 25, 2026. Epub Oct 25, 2026.

Abstract

Feline intermediate- to large-cell lymphoma is commonly treated with COP or CHOP chemotherapy, but the clinical benefit of adding doxorubicin (CHOP) remains controversial given its associated toxicity profile and cost. This systematic review and exploratory meta-analysis summarized response and survival outcomes reported for COP- and CHOP-based protocols in feline intermediate- to large-cell lymphoma. Searching PubMed, Scopus, and CAB Abstracts (2000-2024), we included 21 studies comprising 1054 cats. An exploratory random-effects meta-analysis utilizing Restricted Maximum Likelihood (REML) estimation was conducted to evaluate overall (ORR), complete (CR), and partial response (PR) rates. The overall pooled ORR was 81.0%. Subgroup meta-regression revealed no statistically significant differences between COP and CHOP for ORR (83.0% vs. 77.0%, p = 0.360), CR (57.0% vs. 49.0%, p = 0.350), or PR (28.0% vs. 22.0%, p = 0.468). Profound heterogeneity (overall I² = 85.4%-89.6%) persisted across all analyses, driven primarily by the pooling of diverse anatomical subtypes and uncontrolled confounding by Feline Leukaemia Virus (FeLV) status. Furthermore, inadequate variance reporting and a widespread lack of standardized response criteria (e.g., VCOG-RECIST) precluded a formal meta-analysis of survival outcomes. Descriptively, reported median survival times ranged broadly (COP: 108-610 days; CHOP: 62-973 days) without a clear advantage for CHOP. A custom weighted risk-of-bias assessment highlighted significant methodological deficiencies across the literature. In conclusion, current aggregate evidence does not demonstrate a statistically detectable difference in response rates between CHOP- and COP-based protocols. Severe methodological heterogeneity and retrospective selection bias prevent definitive conclusions regarding long-term survival, emphasizing the critical need for homogeneous, prospective randomized trials utilizing standardized reporting guidelines.

PMID:
42928650
Bibliographic data and abstract were imported from PubMed on 26 Oct 2026.

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