Chemotherapy in the aggressive dog

Re: Chemotherapy in the aggressive dog

karen jones — Fri, 04 Mar 2011 07:58:01 GMT

We have used masivet with great success in one case. It works out cheaper than palladia even with exchange rates and postage though we did order 6 months at a time to decrease postage costs.

Re: Chemotherapy in the aggressive dog

Richard Fox — Fri, 04 Mar 2011 07:44:52 GMT

A friend of mine's dog is on it and doing well but you still have to get the tabs down it?

Re: Chemotherapy in the aggressive dog

jewel1973 — Thu, 03 Mar 2011 23:19:53 GMT

there is also masivet, not used it yet, but we have registered with the site to obtain costs etc for a prospective MCT case.

http://www.masivet.com/

Re: Chemotherapy in the aggressive dog

Heather Toft — Thu, 03 Mar 2011 20:45:07 GMT

[quote user="Rob Wilson"]

Isn't there a new super drug for MCTs ?Pfizer??

[/quote]

Palladia, I think it's called. I know nothing else about it, but I think it's tablet form.

Re: Chemotherapy in the aggressive dog

Robert Wilson — Thu, 03 Mar 2011 15:26:23 GMT

Isn't there a new super drug for MCTs ?Pfizer??

Re: Chemotherapy in the aggressive dog

plantagenet — Thu, 03 Mar 2011 14:41:48 GMT

I have the same situation with a mast cell tumour. We have removed but its back and this is a dog I have to examine at a distance. Is pred. alone going to help this. Even the owners may have difficulty with oral meds if they are not small or tasty!

Re: Chemotherapy in the aggressive dog

sarah mason — Fri, 25 Feb 2011 21:12:31 GMT

Lomustine is given po every three weeks and in combination with pred, but it requires careful monitoring of neutrophil nadirs (7 days post administration and prior to administering) and liver parameters as it can cause a hepatopathy so you would still need to take blood 2 x every 3 weeks http://avmajournals.avma.org/doi/abs/10.2460/javma.230.12.1866?journalCode=javma

If cost is not an issue you could give him a one off shot of L-asparaginase which should get the nodes down before starting any oral meds. It is im and not cytotoxic. Also doesn't require nadirs as not immunosuppressive by itself. You could teach his owner how to measure the nodes at home to assess response.

If the owner wants to pursue more than pred then probably worth chatting to your local oncologist for options

Re: Chemotherapy in the aggressive dog

James Allsop — Fri, 25 Feb 2011 18:56:12 GMT

I would agree with the previous posters and wouldnt consider an i/v protocol in this case and discuss my reasons for this with the owner - ive had a similar situation with a cat that whilst initially the owners were keen on chemo I advised them that repeated iv medications on a frequent basis were not practical in that case and a hands off approach was used. Ive personally found Tom Cave of Cave referrals to bery helpful on the phone - hes a little out of our clients travel distance so rarely send anything to him but hes very knowledgable and helpful and im sure would be able to advise on the most appropriate oral treatment options.

Re: Chemotherapy in the aggressive dog

Richard Fox — Fri, 25 Feb 2011 12:08:47 GMT

I would say the the dog is not a suitable candidate for chemotherapy considering the stress to both parties in giving the treatment - thus I would also opt fo palliative therapy and thus eventually euthanasia.

Re: Chemotherapy in the aggressive dog

Laurence Webb — Thu, 24 Feb 2011 21:57:45 GMT

[quote user="Gillian Mostyn"]

I'd go with preds + cyclophosphamide. No chance I'd embark on regular i/v drugs with this dog I'm afraid.

[/quote]

That was my first thought,

It sounds like you've got a sensible owner so explaining the dangers both to the dog and yourselves of administering Vincristine in the wrong place should be understood. Should they really push for further treatment then I'd refuse to do it for safety reasons. You could consider referral to an oncologist who may have some alternate suggestions, or just have enough letters after their name so that their refusal to adminster IV chemo would be accepted.

I suppose a chemo protocal that lasts a finite amount of time (eg 6 cycles of CHOP) may be more fesible than the indefinate treatment time with COP, but still not an area I'd like to go with this one!

Re: Chemotherapy in the aggressive dog

Andrew Kent — Thu, 24 Feb 2011 21:26:11 GMT

IV Chemo would be impossible in this situation and not worth the risk.

If the owner is keen I would definitely go for oral chemo protocols - I would try chlormbucil (leukeran) and pred first, and lomustine as second line if no response.

Andy

Re: Chemotherapy in the aggressive dog

Catherine Williams — Thu, 24 Feb 2011 20:36:56 GMT

[quote user="Utlendigur"]Lomustine? given orally once every 3wks[/quote]

Thanks, I'll look into that one. I had some vague recollection of some form of infrequent oral drug or a once a month injection but couldn't remember where or what. It's been a while since I had a lymphoma case (is it me or do they seem to be getting scarcer?) and I normally use COP, mainly because I'm familiar and comfortable with it.

I may not be able to manage the case as aggressively as I'd like in clinic but at home he's a fairly relaxed boy (when there are no strangers around) and if there is a compromise that might help I'd like to explore it. I do use pred as a sole agent quite frequently, I find a lot of clients just can't face chemo - either financially or the potential hassle involved. I do like to be sure I'm offering all the options.

There's a strong temptation to refer him and make him someone else's problem but I can't think of any oncologists I don't like Also strangely enough he's actually good with me because I will take it slowly and not strong arm him so actually he's likely to be more bother and more stressed for someone else (yes, a 3 attempted bite attack is a good day - he's very fearful!)

Re: Chemotherapy in the aggressive dog

Julian Earl — Thu, 24 Feb 2011 20:34:48 GMT

Leukeran tablets. The owners can tyhen have the responsibility for the chemotherapy and it may - emphasis on may - be more effective than preds.

Re: Chemotherapy in the aggressive dog

Gillian Mostyn — Thu, 24 Feb 2011 20:20:30 GMT

I'd go with preds + cyclophosphamide. No chance I'd embark on regular i/v drugs with this dog I'm afraid.

Re: Chemotherapy in the aggressive dog

Utlendigur — Thu, 24 Feb 2011 19:34:38 GMT

Lomustine? given orally once every 3wks. I've never used it but have heard it mentioned (BSAVA congress?) as a possibility for refractory lymphoma.

Re: Chemotherapy in the aggressive dog

Catherine Williams — Thu, 24 Feb 2011 18:39:31 GMT

Have to say you're all mirroring my gut instinct on this. There is no way I would even contemplate using iv chemo agents in this dog without serious sedation...he's just the type to look completely out of it on domitor and then suddenly erupt so I'd have to be very confident, particularly if I need a clean stick catheter in place. Am concerned that frequent heavy sedation on a dog with systemic neoplasia is probably a good way to hasten his way to the grave. Am trying to get a realistic idea of options before in depth discussion with his owner with hopefully a better arguement than "it's just not safe for us"

fortunately his owner is realistic, has had a lymphoma case before and doesn't want to put length of life above quality and so will listen to reason about stress if a low tech approach is most appropriate. Just wanted to check there wasn't a relative hands off approach available, am aware that might need to compromise ideal care in this patient

Re: Chemotherapy in the aggressive dog

Rob Davis — Thu, 24 Feb 2011 18:31:55 GMT

I agree with all of the above. I would not consider giving IV chemotherapy to a patient like this - H&S nightmare! It may be worth discussing with an oncologist as there may be options which us mere mortals are unaware of, though as somebody mentioned above, you would still ideally need to be monitoring haematology regularly...

Re: Chemotherapy in the aggressive dog

emma o'connor — Thu, 24 Feb 2011 18:19:51 GMT

Another vote here for the pred option, I've had a few lymphoma cases do well for a good 3-4 months on pred alone, and I think there are quality of life issues for this dog if he needs multiple heavy sedations just to get near him to treat him any other way.

Re: Chemotherapy in the aggressive dog

Bob Russell — Thu, 24 Feb 2011 17:54:30 GMT

The risks of handling the chemo agents alone would require a stationary target. The potential toxicity of these agents may also be greater with domitor etc.

If the owners are seriously considering treatment other than preds it would be worth talking to an oncologist to check on this. If it were my patient I would be very relieved to be told the risk was higher in a sedated dog! A get out of jail free card!

Go for preds!!

Re: Chemotherapy in the aggressive dog

Hannah Wynne Richards — Thu, 24 Feb 2011 17:24:59 GMT

Another who would go with preds

Wynne

Re: Chemotherapy in the aggressive dog

plantagenet — Thu, 24 Feb 2011 17:17:55 GMT

[quote user="Catherine Williams"] I think Max is looking at a short, low interference time on pred as being my fairest option for him[/quote]

I agree very much with this option; if he is going to be stressed by visits/sedation/iv meds etc etc etc then let him have a short, well period and call it a day. Even more important is the possible risk to you if sedation is less deep than you think when you are holding a syringe of an agent with the potential to harm you/your staff.

There are lots of situations where temprement influences treatment options and owners are usually pretty honest about that.

Re: Chemotherapy in the aggressive dog

Mark Holmes — Thu, 24 Feb 2011 17:15:22 GMT

In all honesty I would be encouraging euthanasia (following pred for as long as it is effective) on the basis that lymphoma is a hands on condition and he is not a hands on dog. It sounds like it would be very stressful for him and potentially dangerous for you and I would be encouraging the owners not to go with chemo. Particularly if you consider the ancilliary things like blood counts etc.