Chemotherapy is a large medical field involving the pharmaceutical therapy of cancer.
Individual chemotherapy regimens depend on a number of critical factors such as form of neoplasia, breed of dogs, evidence of metastasis and general health of the dog.
Specific chemotherapeutic agents:
- Corticosteroids - prednisolone - rescue or palliative therapy
- Anti-inflammatories - mesna, lansoprazole
- Protein kinase inhibitors - toceranib, ganetespib, imatinib, sunitinib, masitinib, cediranib
- Antimicrobial enzymes - L-asparaginase, bleomycin, doxorubicin (adriamycin), doxil, idarubicin, epirubicin, actinomycin D
- Tubulin-binding mitotic inhibitors - vincristine, vinblastine, paclitaxel, docetaxel, vinorelbine
- Antimetabolite - cytarabine, cytarabine ocfosfate
- Alkylating agents
- - Methylating alkylating agents - procarbazine, dacarbazine, temozolomide
- - Nitrogen mustard alkylating agents - cyclophosphamide, chlorambucil, melphalan, mechlorethamine, ifosfamide
- - Chloroethylating nitrosourea alkylating agents - lomustine (CCNU), carmustine (BCNU) , fotemustine
- - Platinum-based alkylating agents - cisplatin, carboplatin
- Pyrimidine thymidylate-synthase inhibitors - fluorouracil, gemcitabine, azathioprine
- Immunomodulators - acemannan
Commonly used agents
|Actinomycin-D||lymphoma||0.5 - 0.8 mg/m2 every 1 - 3 weeks||IV||monitor CBC, may cause gastroenteritis|
|Asparaginase||lymphoma||10, 000 units/m2||SQ, IM||monitor CBC|
|Carboplatin||osteosarcoma, other carcinomas||<15 kg: 250 mg/m2, >15 kg: 300 mg/m2 given once every 3 - 4 weeks||IV||acute renal injury, pretreatment with diuretic 4 hrs prior and 2 hrs post|
|Chlorambucil||low-grade lymphoma, lymphocytic leukemia||6 - 8 mg/m2 daily for 14 days then q 2nd day, or 15 mg/m2 for 4 days repeated every 3 weeks||PO||neutropenia, thrombocytopenia, monitor CBC/MBA fortnightly for first 2 months|
|Cisplatin||osteosarcoma and other carcinomas||<5 kg: 50 mg/m2, 5-20 kg: 60 mg/m2, >20 kg:70 mg/m2||IV, intralesional||acute renal injury, pretreatment with diuretic 4 hrs prior and 2 hrs post|
|Cyclophosphamide||lymphoma||200 - 250 mg/m2||PO, IV||Monitor CBC|
|Doxorubicin||lymphoma, osteosarcoma||small dogs 1 mg/kg, large dogs 30mg/m2 given every 2 - 3 weeks||IV||monitor CBC, may caused gastroenteritis|
|Ifosfamide||hemangiosarcoma, leiomyosarcoma||375 mg/m2||IV||acute renal injury, pretreatment with diuretic 4 hrs prior and 2 hrs post|
|Lomustine||lymphoma, mast cell tumors, glioma, meningioma||60 - 90 mg/m2 every 3 - 4 weeks||PO||leucopenia and thrombocytopenia common|
|Mechlorethamine||MOPP protocol for lymphoma||3 mg/m2||IV||caution with extravasation|
|Melphalan||multiple myeloma||1.5 mg/m2 on alternate days or 10 days on, 10 days off||PO||monitor CBC|
|Mitoxantrone||transitional cell carcinoma||5 - 6 mg/m2 every 3 weeks||IV||monitor CBC|
|Procarbazine||MOPP protocol for lymphoma||50 mg/m2 daily for 14 days||PO||monitor CBC|
|Vinblastine||lymphoma, mast cell tumors||2 mg/m2 every 7 - 14 days||IV||monitor CBC|
|Vincristine||lymphoma, sarcomas, transmissible venereal tumor||0.5 - 0.75 mg/m2||IV||monitor CBC|
Types of chemotherapy regimens vary depending on the form of neoplasia:
- Surgical debulking of single solid tumors if restricting vital organs
- Multi-drug protocol - use of several chemotherapy drugs (prednisolone, L-asparaginase, vincristine, cyclophosphamide, doxorubicin, idarubicin and epirubicin). Weekly chemotherapy treatments are given for approximately 8 weeks. The treatments are then spaced to every 2 weeks to complete a total of 6 months of treatment. The average survival time for patients with stage IIIa or IVa lymphoma treated with this protocol is 1 and 1/2 years.
- Madison Wisconsin lymphoma protocol
- MOPP lymphoma protocol
- University of Florida protocol - lomustine, vincristine, procarbazine and prednisolone
- University of California CHOP protocol - cyclophosphamide, doxorubicin, vincristine and prednisone. Average survival time 8 - 10 months.
- Doxorubicin - a total of 5 treatments of doxorubicin at 3-week intervals. The average survival time with this approach is 10-11 months.
- Prednisolone - often used as a palliative drug in non-compliant patients or financially challenged cases. Survival time limited to 2 - 3 months.
- Total body irradiation and autologous transplantation
- Immunotherapy with multivalent immunogens
Lansoprazole has also been used as a rescue protocol in dogs undergoing chemotherapy for lymphoma that have adverse side-effects associated with treatment.
- Spugnini EP et al (2011) Lansoprazole as a rescue agent in chemoresistant tumors: a phase I/II study in companion animals with spontaneously occurring tumors. J Transl Med 9:221
- Vail DM et al (2012) Phase I study to determine the maximal tolerated dose and dose-limiting toxicities of orally administered idarubicin in dogs with lymphoma. J Vet Intern Med 26(3):608-613
- Elliott JW et al (2012) Epirubicin as part of a mufti-agent chemotherapy protocol for canine lymphoma. Vet Comp Oncol Feb 28
- Fahey CE et al (2011) Evaluation of the University of Florida lomustine, vincristine, procarbazine, and prednisone chemotherapy protocol for the treatment of relapsed lymphoma in dogs: 33 cases (2003-2009). J Am Vet Med Assoc 239(2):209-215
- Rebhun RB et al (2011) CHOP chemotherapy for the treatment of canine multicentric T-cell lymphoma. Vet Comp Oncol 9(1):38-44
- Escobar C et al (2012) Hematologic changes after total body irradiation and autologous transplantation of hematopoietic peripheral blood progenitor cells in dogs with lymphoma. Vet Pathol 49(2):341-343
- Henson MS et al (2011) Immunotherapy with autologous tumour antigen-coated microbeads (large multivalent immunogen), IL-2 and GM-CSF in dogs with spontaneous B-cell lymphoma. Vet Comp Oncol 9(2):95-105
- Zandvliet M et al (2013) Masitinib reverses doxorubicin resistance in canine lymphoid cells by inhibiting the function of P-glycoprotein. J Vet Pharmacol Ther Jan 31
- Bannink EO et al (2008) Actinomycin D as rescue therapy in dogs with relapsed or resistant lymphoma: 49 cases (1999--2006). J Am Vet Med Assoc 233(3):446-451
- Ricci Lucas SR et al (2004) Carmustine, vincristine, and prednisone in the treatment of canine lymphosarcoma. J Am Anim Hosp Assoc 40(4):292-299
- Kruth SA (1998) Biological response modifiers: interferons, interleukins, recombinant products, liposomal products. Vet Clin North Am Small Anim Pract 28(2):269-295