Cost Saving Lymphoma Protocol for Canines
Dear OncoLink "Ask The Experts,"
I'm a Veterinarian and professor of small internal medicine at the Universidade Estadual de Londrina, Paraná, Brazil. We work with dogs and cats that present with lymphoma. Sometime, owners don't have enough money to treat their animals with the protocol called COAP, so we suggest that the animal may be treated with prednisolone alone, and we know that this perhaps will give some quality for a brief time to the animal. So, I would like to know if this is a good option?
Lili Duda, VMD, Section Editor of the OncoLink Veterinary Oncology Menu, responds:
There are a variety of options to treat multicentric lymphoma in dogs, ranging from supportive and inexpensive to aggressive and costly both in terms of time and money. In general, the more intense the treatment, the longer the average remission duration, and the more costly in terms of side effects and money.
Prednisone alone (at 40 mg per meter squared daily) remains a very common supportive measure because it is cheap, relatively free of side effects (apart from increased drinking, urination, and appetite), and easy for the owner to administer at home. About half of dogs will have a good initial response that will last for two to three months on average.
Another possible option is an oral chemotherapy drug called lomustine, or CCNU. This drug is given at a starting dose of 70 mg/meter squared every three weeks. Like other chemotherapy drugs, the primary toxicity is bone marrow suppression, so CBCs should be evaluated at 1, 2, and 3 weeks to see where an individual animal has the lowest white blood cell counts.
CCNU can also be toxic to the liver, so baseline liver profile should be obtained prior to starting CCNU, before the 4th dose, and every other dose thereafter. CCNU should be discontinued if liver enzymes are more than three times the upper limits of normal values or if there is progression of the lymphoma.
A third single agent option is Adriamycin (doxorubin) alone, given every 3 weeks for 3 to 5 total doses. About three quarters of dogs will attain remission for an average of about 6 months.