Is doxorubicin a no-no if grade 3 heart murmur?

RE: Is doxorubicin a no-no if grade 3 heart murmur?

Beats — Tue, 15 Dec 2020 21:16:58 GMT

Thanks Anthony.

Would be due to get on Chirstmas Eve, and given how bad the side effects were last time, I can't bring myself to give it again then, even at a lower dose.

I think I'll give a 2-3 weeks break (just giving bit of vincristine/cyclophosphamide) and then try epirubicin at lower dose in the New Year.

RE: Is doxorubicin a no-no if grade 3 heart murmur?

Anthony Dennison — Tue, 15 Dec 2020 16:26:36 GMT

I'd drop down to the 1mg/kg dose if the side effects were that bad.

RE: Is doxorubicin a no-no if grade 3 heart murmur?

Beats — Mon, 14 Dec 2020 13:06:39 GMT

So the heart wasn't the problem...

Took about a week before ate again after getting the epirubicin... and about 10 days before was able to stop visiting me every day for treatment...

V+ AND regurgitation (former controlled by cerenia OK, latter took 5 days to settle - gave omperazole) and almost total anorexia lasting a week.

Also was drinking excessively for a while after an had calmed a bit, but a month on still more than had been previously (haven't checked creatinine again as yet, urine unremarkable with SG 1.010).

Gave vincristine again3 weeks after had epirubicin, then cyclophosphamide a week after than and oging to give vincristine again this week - doing fine again.

I'm loathed to give epirubicin again to this dog, but thought worth getting some opinion as to whether a dose reduction would likely be tolerated much better?

There is a big decrease in dosing at 1mg/kg rather than 30mg/m2 and I went at the higher dose rate. Now weighs about 15.8Kg. If gave only 7.5ml as opposed to bigger dose got last time is that likely to be well-tolerated or still too big a gamble to justify using again?

RE: Is doxorubicin a no-no if grade 3 heart murmur?

Anthony Dennison — Mon, 09 Nov 2020 17:38:34 GMT

[quote userid="12930" url="~/001/veterinary-clinical/small-animal/oncology/f/discussions/29474/is-doxorubicin-a-no-no-if-grade-3-heart-murmur/226528#226528"]Doxo and epi are same price. there seems to be some suggestion that epi is less cardiotoxic than doxo. Is there any reason to prefer doxo over epi?[/quote]

We use Chemopet and they supply epirubicin, it's what I've used for all my lymphoma cases so far, and so far no significant cardiotoxicity. Iain Grant at Chemopet recommends a 1mg/kg dose for the drug in dogs under 10kg, perhaps with this smaller dog you could consider this (unless it works out higher than mg/m^2)

RE: Is doxorubicin a no-no if grade 3 heart murmur?

Annie Gleed — Sun, 08 Nov 2020 21:03:06 GMT

Hi, I had a lymphoma case a year ago that was on vinc/cyclophos and epirubicin. had a 4/6 murmur and actually then went into hear failure during treatment. was then also on vetmedin and frusemide. it tolerated the epirubicin well but i did infuse over longer and ecg traced every 10 mins during infusion to be sure. Referral centre werent at all worried about it continuing epi after heart failure diagnosis. sadly died just before his last chemo dose.

RE: Is doxorubicin a no-no if grade 3 heart murmur?

Iain Richards — Sun, 08 Nov 2020 16:31:56 GMT

Dox reduces the ejection fraction so it might have an effect if there is any exsiting damage to the muscle.

But it's all realtave to the. lympoma which is more likely to kill it than any impact of the dox

RE: Is doxorubicin a no-no if grade 3 heart murmur?

Beats — Sun, 08 Nov 2020 12:25:06 GMT

That's brilliant roger!

Doxo and epi are same price. there seems to be some suggestion that epi is less cardiotoxic than doxo. Is there any reason to prefer doxo over epi?

RE: Is doxorubicin a no-no if grade 3 heart murmur?

Roger Wilkinson — Sun, 08 Nov 2020 11:03:14 GMT

Generally-speaking the risk of clinically-significant cardiotoxicity is rather low (@4% in low risk breeds without pre-existing risk factors):

https://pubmed.ncbi.nlm.nih.gov/30697816/

That paper is good and contains some useful stats. 304 dogs had pre-treatment echocardiograms. 110 of them had mitral regurgitation. 9 of these dogs with MVD progressed to CHF in the post-doxo monitoring period. We aren't told how long after doxorubicin CHF developed....this would have helped tell us whether the incidence was much worse than it would have been without doxo....obviously some of them would have gone into CHF anyway. Overall, however, it looks as though the risks aren't overwhelming.

The fact that they chose to treat so many dogs with MVD tells us that the clinicians involved in the trial don't see pre-existing valve disease as a contraindication fr doxo in this scenario (paper published 2019).

All the best

Roger

RE: Is doxorubicin a no-no if grade 3 heart murmur?

Beats — Sat, 07 Nov 2020 14:28:00 GMT

I put the scanner on the heart today and contractility looks Ok and subjectively to me the left atrium is not enlarged etc and just has a slightly fluffy left AV valve, so I think I'll go ahead with doxorubicin/epirubicin next week most likely.

RE: Is doxorubicin a no-no if grade 3 heart murmur?

Allison Gleadhill — Sat, 07 Nov 2020 09:23:18 GMT

Epirubicin can be cardiotoxic in people....I think risk of precipitating clinical heart failure would be much greater if dog has cardiomopathy than a leaky valve & would be very dodgy if reduced motility.

I’m currently getting epirubicin & had ecgs & echos pretreatment but nobody’s ascultated my heart for a murmur

RE: Is doxorubicin a no-no if grade 3 heart murmur?

Beats — Fri, 06 Nov 2020 09:59:02 GMT

16.5kg.

I'm fairly ignorant on cardiac things, but I think B1 means that the left atrium doesn't look big on ultrasound - is that correct? If so, I could certainly put the scanner on and check the left atrium wasn't big before ordering, but I'd need to do today probably to give myself time to get the doxo for next week, and might be a bit tight time-wise (I don't start until lunchtime on Fridays now with staff split into 2 x "teams"...).

If there's not a huge risk from a single treatment, I might have gone ahead next week and could check heart at leisure prior to any future doses?

I note epirubicin is same price as doxo - is it any safer?

RE: Is doxorubicin a no-no if grade 3 heart murmur?

Anthony Dennison — Fri, 06 Nov 2020 09:53:09 GMT

Has the dog had a cardiac work up? Just because there is a grade 3/6 murmur, if the dog is B1 I think judicious use of the drug would be safe. How big is the dog?