Lymphoma protocols for dogs

Re: Lymphoma protocols for dogs

Kerry Peak — Sun, 28 Apr 2013 20:06:18 GMT

These are always difficult cases, but thanks everyone for the responses. I started off yesterday with some vincristine and pred because I was worried about deterioration over the weekend. Thankfully he was much more comfortable in the hospital than he had been previously, and the whole thing went fine without any sedation. I'll try and speak to an oncologist about this and then will be able to have a chat with his owners before we proceed with anything more definite.

Re: Lymphoma protocols for dogs

Andrew Kent — Sun, 28 Apr 2013 11:19:32 GMT

[quote user="David Mills"]

[quote user="Andrew Kent"] But if they want something less intensive and accept that it is likely to be less effective then there are alternatives.[/quote]

Is it less effective? I don't think anyone really knows. Most (all?) the studies into this are referral/uni based therefore are mostly IV-based. I'm not aware of any prospective studies into oral vs IV protocols. May be wrong.

[/quote]

I agree that the studies are limited, that's why I said 'likely'. There are some studies looking at, for example, lomustine as a first line treatment which showed about a 30% complete response rate and a median survival of 100ish days which is less than that reported with Mad-Wisc. So we don't have studies directly comparing the two but I think we can suspect some conclusions by comparing diffierent studies and accepting the limitations of these studies. We rarely have studies that are as prefect as we would like so have to make do with the evidence available.

[quote user="David Mills"]

From a pure welfare perspective, I worry about chemo. Especially if you need to sedate every time. For the dog, is it more beneficial to go for weekly sedations, to a place that stresses them out (more so with every visit), for an undefined extension in MST (remember this is median - meaning half the dogs die before this)? I don't know, really. My dog? Would give preds and leukeran/mephalan only I think. For me, at Cambridge, seeing a dog coming in weekly, who hated being there for 8 weeks for chemo before PTS was completely unjustified.

[/quote]

I also agree with this, which is why I think the owner needs to have the options presented to them and make the best decision for their dog, that they know best. Aggressive chemo isn't for every client or every patient and there are lots of factors, not just duration of remission, that need to be considered. So I present the options and the evidence and let them pick. Equally this doesn't have to be life long choice - we can be flexible with these protocols and make adjustments or change the protocol if it is not tolerated by the patient. Personally I tend not to favour IV chemo in a patient that won't tolerate it without sedation but many people do.

Andy

Re: Lymphoma protocols for dogs

Chris Reichmann — Sun, 28 Apr 2013 08:00:00 GMT

You might have to be careful using chemo drugs like Vincristine and Doxorubicin in a Collie. They can have the same reaction to those drugs as to Ivermectins.

There is a MDR1 gene mutation test available, not sure where though.

Gerry Polton from North Downs Specialist Referrels might be able to help you!

Re: Lymphoma protocols for dogs

David Mills — Sun, 28 Apr 2013 01:57:11 GMT

[quote user="Andrew Kent"] But if they want something less intensive and accept that it is likely to be less effective then there are alternatives.[/quote]

Re: Lymphoma protocols for dogs

Andrew Kent — Sat, 27 Apr 2013 20:02:03 GMT

I guess this will come down to what is more important to the owner - length of remission or frequency/intensity of visits. Multi agent chemo (usually CHOP) will most likely give them the highest chance of remission and longest period of remission and if they want that benefit they have to accept regular visits and sedations are going to be required. But if they want something less intensive and accept that it is likely to be less effective then there are alternatives.

immunophenotyping the lymphoma can help in these cases as can guide likelihood of response to therapy and duration of therapy and also tell you which of the alternative protocols may be most effective. Flow cytometry is the quickest way to do this, which can be done on samples obtained by FNA and squirted into cell preservative through the university of Cambridge lab. It only takes 24 hours whereas immunohisto can take a week or so.

if the dog is sick and you are keen to get going then you can always start with some vincristine and pred and change tack later on if needed.

Andy

Re: Lymphoma protocols for dogs

Elisabeth Knappett — Sat, 27 Apr 2013 18:57:52 GMT

I would agree with sedating if necessary for the dosing, far safer all round. Have you managed to speak to an oncologist about his case? I have recently started using Ian Grant (chemopet) who is extremely helpful and can supply single doses of preformulated drugs as well as creating protocols for your patient if you are unsure/inexperienced at chemo - like me!

Re: Lymphoma protocols for dogs

Rob Loxley — Sat, 27 Apr 2013 10:03:39 GMT

Is anyone using ports or PICC lines in dogs?

Re: Lymphoma protocols for dogs

Kerry Peak — Fri, 26 Apr 2013 22:36:35 GMT

thanks for the replies...

I will consider sedating, I think given his temprament it's a valid option!

i've not typed it yet, i can request this from the lab (having only received the initial report today). my concern is that he is quite unwell so am looking to start something asap. hopefully the typing will be available in the after the weekend.

Re: Lymphoma protocols for dogs

Martin Atkinson — Fri, 26 Apr 2013 19:41:19 GMT

[quote user="Claire Fisher"]

We are currently treating a very bouncy GSD for lymphoma - initially with a Madison-Wisconsin protocol and now DMAC. She is sedated with dom/torb for all her iv meds - might be an option?

[/quote] Madison-Wisconsin is my first choice and I would be likely to advise sedating most patients for the IV meds unless they were very compliant, you just cannot afford to run the risk of something suddenly jumping. With medetomidine it adds little to the cost of an already costly procedure and you can reverse it as soon as your done so why take the risk?

Re: Lymphoma protocols for dogs

Claire Fisher — Fri, 26 Apr 2013 19:28:30 GMT

We are currently treating a very bouncy GSD for lymphoma - initially with a Madison-Wisconsin protocol and now DMAC. She is sedated with dom/torb for all her iv meds - might be an option?

Re: Lymphoma protocols for dogs

Andrew Kent — Fri, 26 Apr 2013 19:28:17 GMT

Have you typed the lymphoma? If its a T cell then consider lomustine as a single agent orally