RE: Haemangiosarcoma treatment with Turkey Tail

nikianna nicholas — Sat, 30 Mar 2019 09:43:01 GMT

I used this in two of my own dogs who were diagnosed with splenic HSA within 18 months of each other. I would not normally consider trying anything other conventional pathways but with such a poor prognosis I opted to try with the ‘nothing to lose approach’ .

Both dogs were under the care of an oncologist and had this alongside metronomic chemotherapy, both were outliers in terms of survival but the reason(s) for this are obviously not possible to determine.

A couple of things which may be useful

I used the ‘I’m Yunnity’ PSP formulation as this at least a standardised product although it was a lot more expensive.

One dog developed a hepatopathy with a marked elevation in ALT a month or so after starting the PSP - the ALT reduced to normal following withdrawal. We assumed based on cause and effect that this was due to the PSP. Although it was an assumption his oncologist had anecdotally heard reports of this occurring in other dogs so may be worth watching liver enzymes. He died around 3 years later of unrelated causes.

The second dog tolerated the PSP ok. She survived for just over 12 months post splenectomy and was PTS due to metastatic disease.

I also tried Yunnan Bayio in the second dog but one batch gave her really bad diarrhoea which would stop and start with discontinuing/resuming the capsules. Interestingly the diarrhoea was the same orange colour as the capsule contents.My understanding is that there can be issues with quality/ composition between batches and I discontinued it.

RE: Haemangiosarcoma treatment with Turkey Tail

Beats — Fri, 29 Mar 2019 19:49:07 GMT

Not being an oncologist doesn't stop me having an opinion, but perhaps it should give me the sense to keep it to myself ;-)

Here's an abstract and some lines from a recenti-ish peer-reviewed publication studying something else to do with canine haemangiosarcoma:

Journal article : Veterinary Surgery 2018 Vol.47 No.8 pp.1039-1045

Abstract : Objective: To determine the influence of administering allogeneic blood products (ABP) on the progression of hemangiosarcoma in dogs. Study design: Multi-institutional, retrospective study. Sample population: One hundred four dogs with hemangiosarcoma that survived until postoperative discharge from the hospital. Methods: Medical records of dogs that had been operated on for hemoangiosarcoma were reviewed for signalment, presence of a hemoabdomen, presence of metastatic disease, and whether the dog had received chemotherapy or Yunnan Baiyao. Data that were collected were compared between dogs that received perioperative ABP and those that did not. Disease-free interval was compared between groups. The Kaplan-Meier method was used to obtain univariate descriptive statistics for time to clinical decline. A multivariable Cox regression model was used to analyze association or effect of potential predictor variables. Results: The median disease-free interval (DFI) was shorter in the 67 dogs that received a blood transfusion (76 days; range, 1-836) than in the 37 dogs that did not receive a blood transfusion (120 days; range, 38-916). According to the multivariable Cox regression model, administration of blood products (P=.04) and the presence of gross metastatic disease at the time of surgery (P<.01) shortened the DFI, whereas administration of Yunnan Baiyao (P=.01) prolonged the DFI. Conclusion: Allogeneic blood product administration was associated with a shorter disease-free interval in this population. However, we could not demonstrate the association between blood products and shorter DFI because of confounding factors. Clinical significance: Dogs that receive ABP at the time of surgical therapy for hemangiosarcoma may have accelerated disease progression compared with dogs that do not receive ABP.

[and from the text: “Yunnan Baiyao (Yunnan Baiyao Group, Tianjin, China) is a Chinese herbal supplement with reported anti‐inflammatory, procoagulant, and wound healing properties. No studies on the effect of this herb on clinical outcome in dogs with naturally occurring splenic HSA have been published.” And “To the best of authors' knowledge, this is the first published study to evaluate the clinical effects of Yunnan Baiyao in dogs with splenic HSA. Yunnan Baiyao slows the growth of cultured HSA cells in vitro, but little clinical data are available.43 A retrospective study of dogs with pericardial effusion from right atrial masses found that Yunnan Baiyao was not associated with a delay in recurrence of clinical signs after pericardiocentesis.44 Our data provide evidence to support an association between prolonged DFI and Yunnan Baiyao administration. The beneficial effect may be due to the anti‐inflammatory, hemostatic, pain relieving, or wound healing properties of the medication or due to a type I error because of the small number of study dogs that received this treatment. Yunnan Baiyao was prescribed for 13 dogs, 8 of which had presented with stage III HSA. Because of the small number of dogs that received Yunnan Baiyao and the uncertainty of how often this was offered as a treatment option, the effect of this variable on DFI is difficult to interpret. We did not analyze the effect of Yunnan Baiyao on survival time.”]

Otherwise, there was A "VetGirl" podcast interviewing the researchers from Penn (IIRC):

https://vetgirlontherun.com/mushroom-im-yunity-used-treatment-canine-hemangiosarcoma-vetgirl-veterinary-ce-blog/

[the comments section has remained alive to 2019 should you wish to follow this]

As my last 3 bleeding splenectomies are all still alive and well on thin air alone (one in today had histopath confirmed hemagiosarcoma in October 2017), while the previous 3 were all dead within 3 months IIRC (also on thin air alone), I am reminded how easy it can be to assume that an intervention beyond splenectomy is making a difference. Thus in the absence of any decent studies on promising agents, the problem becomes which *promising agents* to "give a go". Thus the question becomes not is Yunnan helpful, but is Yunnan more likely to be helpful than palmitoylethanolamide or whatever else. That probably comes down more to general reasoning than the reported results of small non-controlled studies.

Out of interest at what else has trended recently in the world of canine hemangiosarcoma, I trawled the frist 200hits on Cab abstracts and here are a selection in no particular order and without further comment:

Journal article : Journal of the American Veterinary Medical Association 2017 Vol.251 No.5 pp.559-565 ref.20

Abstract : OBJECTIVE: To determine histologic and clinical factors associated with survival time in dogs with stage II splenic hemangiosarcoma treated by splenectomy and a chemotherapy protocol in which an anthracycline was alternated with lomustine. DESIGN: Retrospective case series. ANIMALS: 30 dogs with stage II splenic hemangiosarcoma. PROCEDURES: Medical records of 3 facilities were reviewed to identify dogs treated for stage II splenic hemangiosarcoma between June 2011 and October 2014. Information collected included signalment, disease staging data, whether anemia was present, date of splenectomy, chemotherapy protocol, adverse effects, and date of death or last follow-up. Histologic slides were reviewed and scored by pathologists. Associations between variables of interest and survival data were evaluated statistically. RESULTS: Median survival time for all dogs was 158 days (range, 55 to 560 days), and the 1-year survival rate was 16%. On multivariate analysis, only the histologically determined mitotic score was significantly associated with survival time. The median survival time of 292 days for dogs with a mitotic score of 0 (<11 mitoses="" 10="" hpf="" n="9)" was="" significantly="" longer="" than="" that="" for="" dogs="" with="" higher="" scores="" indicating="" mitotic="" rates="" the="" 1-year="" survival="" rate="" these="" 42="" conclusions="" and="" clinical="" relevance:="" results="" suggested="" future="" studies="" should="" take="" histologic="" factors="" particularly="" as="" well="" tumor="" stage="" into="" account="" when="" assessing="" treatment="" effects="" on="" time="" of="" splenic="" hemangiosarcoma="" p="">

Journal article : Journal of the American Animal Hospital Association 2017 Vol.53 No.6 pp.304-312

Abstract : This retrospective study investigated the outcome of 33 dogs with splenic hemangiosarcoma treated with surgery followed by adjuvant dose-intensified doxorubicin (DOX) with or without low-dose metronomic cyclophosphamide (LDM-C) maintenance therapy. Among the 33 dogs, 18 dogs received LDM-C. Clinical stage was available for all dogs (5 stage I, 18 stage II, and 10 stage III). Nine dogs had macroscopic, and 24 dogs had microscopic disease at the start of DOX treatment. Median progression-free survival (PFS) and overall survival were 125 and 133 days, respectively. Clinical stage and tumor burden (microscopic versus macroscopic) at the start of chemotherapy was prognostic for PFS. No significant difference was observed in PFS or overall survival for the addition of LDM-C after a completed DOX protocol (P=.563 and P=.148, respectively). Based on the results of this retrospective study, the addition of LDM-C therapy as a maintenance regimen following a completed protocol of DOX adjuvant treatment of canine hemangiosarcoma may not improve outcome.

Journal article : Canadian Veterinary Journal 2018 Vol.59 No.9 pp.967-972 ref.36

Abstract : The purpose of this retrospective study was to determine survival times and prognostic factors of dogs with visceral hemangiosarcoma (HSA) treated with surgery alone or surgery and doxorubicin. Medical records from 2 hospitals from 2005 to 2014 were searched for dogs with histopathologically confirmed visceral HSA. Data relevant to patient demographics, tumor characteristics, and outcomes were abstracted. The most common primary organ affected was the spleen; however, primary tumor location had no influence on prognosis. Twenty-three dogs were treated with surgery alone, while 14 dogs were treated with surgery and doxorubicin. There was a significant difference in survival times between dogs treated with surgery alone and with surgery followed by doxorubicin (66 days versus 274 days). Dogs with stage I tumors (196 days) had a longer median survival time (MST) than dogs with stage II (117 days) and stage III (23 days) disease. The overall MST was 179 days with a 1-year survival rate of 29.2%.

Journal article : Veterinary and Comparative Oncology 2017 Vol.15 No.1 pp.25-35 ref.39

Abstract : Canine hemangiosarcoma (HSA) is a neoplasm of vascular endothelial origin that has an aggressive biological behaviour, with less than 10% of dogs alive at 12-months postdiagnosis. Treatment of choice consists of surgery followed by adjuvant doxorubicin-based chemotherapy. We prospectively compared adjuvant doxorubicin and dacarbazine (ADTIC) to a traditional doxorubicin and cyclophosphamide (AC) treatment, aiming at determining safety and assessing whether this regimen prolongs survival and time to metastasis (TTM). Twenty-seven dogs were enrolled; following staging work-up, 18 were treated with AC and 9 with ADTIC. Median TTM and survival time were longer for dogs treated with ADTIC compared with those receiving AC (>550 versus 112 days, P=0.021 and >550 versus 142 days, P=0.011, respectively). Both protocols were well tolerated, without need for dose reduction or increased interval between treatments. A protocol consisting of combined doxorubicin and dacarbazine is safe in dogs with HSA and prolongs TTM and survival time.

Journal article : Journal of the American Veterinary Medical Association 2015 Vol.247 No.4 pp.393-403

Abstract : Objective - To determine survival time for dogs with splenic hemangiosarcoma treated with splenectomy alone, identify potential prognostic factors, and evaluate the efficacy of adjuvant chemotherapy. Design - Retrospective case series. Animals - 208 dogs. Procedures - Medical records were reviewed, long-term follow-up information was obtained, and survival data were analyzed statistically. Results - 154 dogs were treated with surgery alone, and 54 were treated with surgery and chemotherapy. Twenty-eight dogs received conventional chemotherapy, 13 received cyclophosphamide-based metronomic chemotherapy, and 13 received both conventional and metronomic chemotherapy. Median survival time of dogs treated with splenectomy alone was 1.6 months. Clinical stage was the only prognostic factor significantly associated with survival time. When the entire follow-up period was considered, there was no significant difference in survival time between dogs treated with surgery alone and dogs treated with surgery and chemotherapy. However, during the first 4 months of follow-up, after adjusting for the effects of clinical stage, survival time was significantly prolonged among dogs receiving any type of chemotherapy (hazard ratio, 0.6) and among dogs receiving both conventional and metronomic chemotherapy (hazard ratio, 0.4). Conclusions and Clinical Relevance - Clinical stage was strongly associated with prognosis for dogs with splenic hemangiosarcoma. Chemotherapy was effective in prolonging survival time during the early portion of the follow-up period. Combinations of doxorubicin-based conventional protocols and cyclophosphamide-based metronomic protocols appeared to be more effective than either type of chemotherapy alone, but prolongations in survival time resulting from current protocols were modest.

Journal article : Veterinary and Comparative Oncology 2016 Vol.14 No.3 pp.281-294 ref.46

Abstract : Yunnan Baiyao is a Chinese herbal medicine that has been utilized for its anti-inflammatory, haemostatic, wound healing and pain relieving properties in people. It has been utilized in the veterinary profession to control bleeding in dogs with hemangiosarcoma (HSA) and has been anecdotally reported to prolong survival times in dogs with this neoplasm. This study evaluated the in vitro activity of Yunnan Baiyao against three canine HSA cell lines after treatment with increasing concentrations of Yunnan Baiyao (50, 100, 200, 400, 600 and 800 µg mL^-1) at 24, 48 and 72 h. Mean half maximum inhibitory concentration (IC₅₀) at 72 h for DEN, Fitz, SB was 369.9, 275.9 and 325.3 µg mL^-1, respectively. Caspase-3/7 activity increased in correlation with the IC₅₀ in each cell line which was confirmed by the terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL, APO-BRDU Kit; BD Biosciences, San Jose, CA, USA) assay. VEGF in cell supernatant was also quantified. Overall, the study found that Yunnan Baiyao causes dose and time dependent HSA cell death through initiation of caspase-mediated apoptosis, which supports future studies involving Yunnan Baiyao.

Journal article; Conference paper : Life Sciences 2016 Vol.159 pp.55-60

Conference Title : Proceedings of the Fourteenth International Conference on Endothelin, Savannah, Georgia, U.S.A., 2-5 September 2015.

Abstract : Aims: Hemangiosarcoma (HSA) that originates from vascular endothelial cells is the most common splenic malignant neoplasm in dogs, as it accounts for approximately 20% of all canine soft tissue sarcomas. In this study, inhibitory effects of endothelin receptor antagonists on the growth of HSA cells were examined using cell lines established from canine HSA. Main methods: The preproendothelin-1 (PPET-1), endothelin type A receptor (ETA) and endothelin type B receptor (ETB) mRNA expression levels in HSA cell lines (n=5) were analyzed quantitatively by real-time RT-PCR. These levels were compared with those in HSA tissues (n=11) and those in normal splenic tissues (n=6). ETA and ETB protein expression was examined by western blot. The production and secretion of endothelin-1 (ET-1) and big ET-1 by cell lines were analyzed by measuring the levels in the culture medium by ELISA. The inhibitory effects of endothelin receptor antagonists (ambrisentan, BQ788 and bosentan) on cell growth were evaluated by WST-8 assay. Key findings: The PPET1 and ETA mRNA expression levels were elevated in HSA tissues and HSA cell lines compared with normal tissues. In cell lines, the production of ET-1 and big ET-1 peptide as well as the expression of ETA protein were detected, but the levels of ETB were not measured. Ambrisentan and bosentan inhibited growth activity in cell lines. Ambrisentan was more effective than bosentan. Significance: These findings demonstrate the importance of the ETA axis in canine HSA as well as the potential of ETA inhibitors in the treatment of canine HSA.

Journal article : Journal of Veterinary Medical Science 2016 Vol.78 No.4 pp.649-656 ref.37

Abstract : Canine hemangiosarcoma (HSA) is a progressive malignant neoplasm of dogs for which there is currently no effective treatment. A recent study suggested that receptor tyrosine kinases (RTKs), the PI3K/Akt/m-TOR and MAPK pathways are all activated in canine and human HSA. The aim of the present study was to investigate the overexpression of these proteins by immunohistochemistry in canine splenic HSA to identify potential molecular therapeutic targets. A total of 10 splenic HSAs and two normal splenic samples surgically resected from dogs were sectioned and stained with hematoxylin and eosin for histological diagnosis or analyzed using immunohistochemistry. The expression of RTKs, c-kit, VEGFR-2 and PDGFR-2, as well as PI3K/Akt/m-TOR and MEK was higher in canine splenic HSAs compared to normal spleens. These proteins may therefore be potential therapeutic targets in canine splenic HSA.

Journal article : Journal of the American Veterinary Medical Association 2016 Vol.248 No.11 pp.1267-1273 ref.19

Abstract : OBJECTIVE: To determine the frequency of malignancy and survival rates of dogs that underwent splenectomy for incidentally detected nonruptured splenic masses or nodules. DESIGN: Retrospective case series. ANIMALS: 105 client-owned dogs. PROCEDURES: Medical records of dogs that underwent splenectomy at a veterinary teaching hospital between 2009 and 2013 were examined to identify patients with incidentally detected nonruptured splenic masses or nodules without associated hemoperitoneum. Only dogs with histologically confirmed diagnoses were included. Information regarding signalment, preoperative diagnostic tests, perioperative blood product transfusions, splenic mass diameter, histologic findings, adjunctive treatments, and survival time was collected and analyzed. RESULTS: 74 of 105 (70.5%) patients had benign splenic lesions and 31 (29.5%) had malignant neoplasia, most commonly hemangiosarcoma (18/31 [58%]). The hazard of death decreased as preoperative PCV increased; histopathologic diagnosis of malignant neoplasia was significantly associated with an increased hazard of death. Median life expectancy of dogs with benign and malignant lesions was 436 and 110 days, respectively; 41 of 74 patients with benign lesions and 3 of 31 patients with malignant neoplasia were still alive at study conclusion. Median life expectancy of dogs with hemangiosarcoma was 132 days; only 7 of these 18 dogs received any adjunctive chemotherapeutic treatments. CONCLUSIONS AND CLINICAL RELEVANCE: Incidentally found, nonruptured splenic masses or nodules without associated hemoperitoneum were most commonly benign. Results suggested that life expectancy for these dogs with incidentally detected benign or malignant splenic lesions that received prompt intervention was better than has previously been reported for other studied populations.

Journal article : Canadian Veterinary Journal 2016 Vol.57 No.8 pp.842-846 ref.15

Abstract : Canine splenic hematoma can be indistinguishable from hemangiosarcoma on clinical presentation and grossly at the time of surgery. However, hemangiosarcoma represents an aggressive malignancy and a misdiagnosis of hematoma would forgo indications for chemotherapy. This study describes a long-term follow-up of cases with a histologic diagnosis of splenic hematoma following splenectomy to determine if the clinical course of the disease corroborated the diagnosis. Thirty-five dogs were evaluated to determine survival and prognostic associations with signalment and clinical data. Overall median survival time was 647 days (range: 0 to 3287 days). Statistically significant variables included a palpable abdominal mass during physical examination, sub-clinical coagulopathy, and metastasis. Four cases (11%) had reported evidence of metastasis at the time of euthanasia; 1 case was histologically confirmed. Overall prognosis for splenic hematoma appears excellent, as expected, but a small proportion of cases may have an undiagnosed malignant component.

Journal article : Journal of the American Veterinary Medical Association 2008 Vol.232 No.4 pp.553-558 ref.19

Abstract : Objective - To determine prevalence of splenic hemangiosarcoma in anemic dogs with a splenic mass and hemoperitoneum requiring a transfusion and to identify factors that could differentiate between dogs with hemangiosarcoma and dogs with other splenic masses at the time of hospital admission. Design - Retrospective case series. Animals - 71 dogs. Procedures - Medical records, blood bank logs, and histologic reports of dogs with a splenic mass and hemoperitoneum that required a transfusion between 2003 and 2005 were reviewed. Dogs that received a transfusion of packed RBCs, were splenectomized, and had a definitive histologic diagnosis were included. Results - Signalment of dogs was similar to that in other reports. Malignant splenic neoplasia was identified in 54 of 71 (76.1%) dogs, whereas 17 of 71 (23.9%) dogs had a benign splenic lesion. Of 54 dogs with malignant splenic neoplasia, 50 (92.6% [70.4% of all dogs]) had splenic hemangiosarcoma. In addition, dogs with splenic hemangiosarcoma had significantly lower total solids (TS) concentrations and platelet counts at admission. Finally, hemoperitoneum was strongly associated with a diagnosis of splenic hemangiosarcoma. Conclusions and Clinical Relevance - In this clinical population of dogs, prevalence of hemangiosarcoma was higher than in other studies. Dogs with hemangiosarcoma in this study had significantly lower TS concentrations and platelet counts at the time of admission, compared with values for dogs with other splenic masses. No other markers were useful in differentiating dogs with hemangiosarcoma. It is important to discuss the prevalence of and poor prognosis associated with hemangiosarcoma with owners when they are contemplating whether to proceed with treatment.

Journal article : Journal of the American Holistic Veterinary Medical Association 2014 Vol.35 pp.22-27 ref.12

Abstract : Subcutaneous Hemangiosarcoma (HSA) is a highly malignant tumor in dogs, and most die within 6 months of diagnosis. This article reports on a canine patient that had an advanced case of subcutaneous HSA, was not eating, and was just laying around in a very lethargic state. The goal was to evaluate the effects of a complex homeopathic on an advanced stage of HSA with the possibility of an improved quality of life for the patient. A mixed breed canine was treated for 3.5 months; soon after the start of treatment and throughout there was a much improved quality of life up until the final rapid decline. Quality of Life is the predominant goal of pet owners whose pet is being treated for cancer, and this protocol warrants further investigation.

Journal article : BMC Veterinary Research 2015 Vol.11 No.131 pp.(11 June 2015) ref.46

Abstract : Background: Spenic hemangiosarcoma (HSA) in dogs treated with surgery alone is associated with short survival times, and the addition of doxorubicin (DOX) chemotherapy only modestly improves outcome. The purpose of this study was to evaluate the impact of toceranib administration on progression free survival in dogs with stage I or II HSA following splenectomy and single agent DOX chemotherapy. We hypothesized that dogs with splenic HSA treated with adjuvant DOX followed by toceranib would have prolonged disease-free interval (DFI) and overall survival time (OS) when compared to historical dogs treated with DOX-based chemotherapy alone. Results: Dogs with stage I or II splenic HSA were administered 5 cycles of single-agent DOX every 2 weeks beginning within 14 days of splenectomy. Dogs were restaged 2 weeks after completing DOX, and those without evidence of metastatic disease began toceranib therapy at 3.25 mg/kg every other day. Forty-three dogs were enrolled in this clinical trial. Seven dogs had evidence of metastatic disease either before or at re-staging, and an additional 3 dogs were found to have metastatic disease within 1 week of toceranib administration. Therefore 31 dogs went on to receive toceranib following completion of doxorubicin treatment. Twenty-five dogs that received toceranib developed metastatic disease. The median disease free interval for all dogs enrolled in this study (n=43) was 138 days, and the median disease free interval for those dogs that went on to receive toceranib (n=31) was 161 days. The median survival time for all dogs enrolled in this study was 169 days, and the median survival time for those dogs that went on to receive toceranib was 172 days. Conclusions: The use of toceranib following DOX chemotherapy does not improve either disease free interval or overall survival in dogs with stage I or II HSA.

Journal article : Journal of the American Veterinary Medical Association 2017 Vol.250 No.10 pp.1148-1154 ref.26

Abstract : OBJECTIVE: To assess causes of splenomegaly and postsurgical outcomes in small-breed (ie, <16-kg 35="" 2-lb="" dogs="" that="" underwent="" splenectomy="" and="" evaluate="" associations="" among="" malignant="" disease="" hemoperitoneum="" survival="" time="" in="" these="" patients="" design:="" retrospective="" case="" series="" animals:="" 45="" client-owned="" procedures:="" medical="" records="" of="" 2="" veterinary="" facilities="" were="" reviewed="" to="" identify="" small-breed="" had="" a="" histologic="" diagnosis="" recorded="" data="" analyzed="" included="" signalment="" presence="" or="" absence="" results:="" 21="" neoplasia="" 24="" benign="" splenic="" diseases="" hemangiosarcoma="" was="" the="" most="" common="" malignancy="" 14="" 67="" lymphoid="" nodular="" hyperplasia="" hematoma="" extramedullary="" hematopoiesis="" alone="" combination="" commonly="" diagnosed="" with="" 17="" 71="" wheaton="" terriers="" significantly="" more="" likely="" have="" than="" other="" breeds="" significant="" negative="" not="" associated="" conclusions="" clinical="" relevance:="" causes="" for="" splenomegaly="" times="" similar="" those="" previously="" reported="" populations="" primarily="" large-breed="" there="" approximately="" equal="" numbers="" this="" population="" results="" suggested="" higher="" likelihood="" may="" be="" predictor="" however="" further="" research="" including="" larger="" number="" is="" needed="" confirm="" findings="" p="">

Journal article : Canadian Veterinary Journal 2013 Vol.54 No.3 pp.237-242 ref.59

Abstract : Canine hemangiosarcoma (HSA) is a highly malignant tumor for which standard chemotherapy has done little to substantially improve survival. Cyclooxygenase-2 (Cox-2) plays a role in the formation, growth, and metastasis of tumors and inhibitors have demonstrated therapeutic benefit with certain canine cancers. In this prospective study, 21 dogs received adjuvant therapy combining the selective Cox-2 inhibitor deracoxib with doxorubicin, following splenectomy for HSA. The combination was well-tolerated with only low-grade gastro-intestinal and hematologic toxicities noted. An overall median survival of 150 days (range; 21 to 1506 days) was noted. Although there was no significant difference in survival based upon stage of disease, dogs with stage III HSA (n=11) had a median survival of 149 days, which appears to be longer than previously reported. Further studies are warranted to evaluate the potential benefit of Cox-2 inhibitors in the treatment of canine HSA.