CHOP protocol question

RE: CHOP protocol question

Gerry Polton — Mon, 04 Jun 2018 18:52:05 GMT

Hi Thomas

It's a good question. I don't honestly know if there is a right answer. My feeling is that use of steroids for 4 weeks at the start of a CHOP protocol isn't likely to limit the 'effectiveness' of further prednisolone at relapse. However, if a patient has been on COP for a few months and the disease relapses, prednisolone therapy alone won't achieve a measurable improvement whereas if the patient was on COP without the P (CO?) for a few months before relapse, switching to prednisolone might well result in a temporary clinical improvement, as suggested.

Good question

Gerry

RE: CHOP protocol question

Thomas Johnson — Mon, 04 Jun 2018 18:41:21 GMT

[quote user="Gerry Polton"]They should then stop. You may also be interested to know that there has been some work looking at outcomes when prednisolone wasn't included in the protocol: there was no difference...[/quote]

I was talking to another vet about this several years ago, and he didn't use prednisolone in his lymphoma protocols, and one of the reasons he gave was that when the lymphoma returned he could use prednisolone as a rescue treatment for a couple of months. Do you think there is any merit in this?

RE: CHOP protocol question

Gerry Polton — Mon, 04 Jun 2018 18:25:57 GMT

Hi Anthony

They should then stop. You may also be interested to know that there has been some work looking at outcomes when prednisolone wasn't included in the protocol: there was no difference...

If you want to read the article, it's in the Veterinary Journal 2013, main author is Maurice Zandvliet. Here is the abstract:

Abstract

Chemotherapy protocols for canine lymphoma include the routine use of glucocorticoids for their lympholytic effect. However, glucocorticoids are associated with side effects (e.g. polyphagia, polyuria, and weight gain), limit the use of non-steroidal anti-inflammatory drugs, and can induce drug transporter expression that could lead to drug resistance. Despite these negative effects, there are no data to support the use of glucocorticoids as part of a multidrug chemotherapy protocol for the treatment of canine lymphoma. A prospective, randomized clinical trial was conducted in 81 dogs with multicentric lymphoma and no history of recent glucocorticoid use. All dogs were staged and treated with the same chemotherapy protocol (L-asparaginase, cyclophosphamide, doxorubicin, vincristine, and prednisolone) with half of the dogs receiving prednisolone. Both treatment groups were similar with respect to demographics, immunophenotype, and clinical stage, except for a higher number of substage b patients in the prednisolone group (5 vs. 14; P=0.015). Treatment results obtained with the initial treatment (complete response rate 75%, disease-free period 176 days) and rescue treatment (complete response rate 45%, disease-free period 133 days), overall survival (283 days) and adverse events (number and grade) were similar for both groups. In conclusion, prednisolone, as part of a multidrug chemotherapy protocol, has no additional effect on treatment results and can be omitted from first-line multidrug protocols used for the treatment of canine lymphoma.

To answer the 6 million dollar question, I still use prednisolone in the first four weeks. But I don't use it at uncomfortably high doses in large dogs. That is not a firm recommendation that you do the same and I realise, writing this, that I don't have a good guide to how I dose it. 1mg/kg is a good starting dose for small dogs but once they are past 10-15 kg I tend to freestyle it a little bit. Sorry because I probably shouldn't.

Best regards

Gerry