Golden Retriever diagnosed with Lymphoma

#11 · April 12, 2022, 3:32 pm

Quote from dragondawg on April 12, 2022, 3:32 pm
Actually Lomustine is more aggressive, and is usually used with Prednisone, and/or Elspar. Here a research paper trial result on its use as a front line therapy with Prednisone:

http://www.ncbi.nlm.nih.gov/pubmed/17571992

Lomustine like Cytoxan is an alkylating agent. It is typically used as a rescue therapy, after a Chemo dog comes out of remission, and is resistant to Cytoxan. Typically if a 2nd remission is achieved, Lomustine is then used as a maintenance Chemo drug. My Lymphoma puppy never made it that far. So no direct experience with Lomustine. Side effects are said to be nausea, vomiting, and diarrhea. Then again, Cytoxan lists vomiting, and I never encountered it, giving the anti-nausea drug metoclopromide back in 2003. Now days there's better drugs for nausea. Lomustine can be rough on the liver. Lomustine can cause severe neutropenia. Supression of the production of neutrophile WBCs - the first responders to infection. It can suppress for up 2 weeks out with the effect slowly building. Blood tests before a second and subsequent administrations required. Lomustine is a slow acting drug.

If finances are playing into your decision, then mono therapy with Doxorubicin is probably the best "bang for buck". Given every 2 weeks IV, 3 times. Usually provides up to 6 months of remission. The treatments are expensive, but only 3 are given. After 3 treatments there's a chance Doxorubicin can damage the heart. So 3 is usually the limit. Discuss with your Vet. Major side effect is nausea&vomiting easily controlled by anti-nausea drugs. My dog never had any problems with it, as part of her LCOPA protocol. Despite using a much less effective anti-nausea drug than is used today. Peak side effects occur at 2-3 days, and then a second time 7-10 days out. The main problem is with your dog already on Prednisone, the Doxorubicin mono-therapy would have to start now, while withdrawing from the Prednisone in steps. Again, the specter of the MDR induced by Prednisone, per the link previously posted. Prednisone has the decision clock ticking.

Unknown is how your dog with an apparent intestinal involvement will react to any of these drugs per GI upsets. Assuming the Lymphoma has spread to the intestines. Other sites such as the liver could also cause nausea, lack of appetite without any intestinal involvement. Only one way to find out. Supportive anti-nausea drugs should minimize the side effects. Presumably your dog is starting to eat again, while being on the Prednisone, without any GI problems.

Actually Lomustine is more aggressive, and is usually used with Prednisone, and/or Elspar. Here a research paper trial result on its use as a front line therapy with Prednisone:

http://www.ncbi.nlm.nih.gov/pubmed/17571992

Lomustine like Cytoxan is an alkylating agent. It is typically used as a rescue therapy, after a Chemo dog comes out of remission, and is resistant to Cytoxan. Typically if a 2nd remission is achieved, Lomustine is then used as a maintenance Chemo drug. My Lymphoma puppy never made it that far. So no direct experience with Lomustine. Side effects are said to be nausea, vomiting, and diarrhea. Then again, Cytoxan lists vomiting, and I never encountered it, giving the anti-nausea drug metoclopromide back in 2003. Now days there's better drugs for nausea. Lomustine can be rough on the liver. Lomustine can cause severe neutropenia. Supression of the production of neutrophile WBCs - the first responders to infection. It can suppress for up 2 weeks out with the effect slowly building. Blood tests before a second and subsequent administrations required. Lomustine is a slow acting drug.

If finances are playing into your decision, then mono therapy with Doxorubicin is probably the best "bang for buck". Given every 2 weeks IV, 3 times. Usually provides up to 6 months of remission. The treatments are expensive, but only 3 are given. After 3 treatments there's a chance Doxorubicin can damage the heart. So 3 is usually the limit. Discuss with your Vet. Major side effect is nausea&vomiting easily controlled by anti-nausea drugs. My dog never had any problems with it, as part of her LCOPA protocol. Despite using a much less effective anti-nausea drug than is used today. Peak side effects occur at 2-3 days, and then a second time 7-10 days out. The main problem is with your dog already on Prednisone, the Doxorubicin mono-therapy would have to start now, while withdrawing from the Prednisone in steps. Again, the specter of the MDR induced by Prednisone, per the link previously posted. Prednisone has the decision clock ticking.

Unknown is how your dog with an apparent intestinal involvement will react to any of these drugs per GI upsets. Assuming the Lymphoma has spread to the intestines. Other sites such as the liver could also cause nausea, lack of appetite without any intestinal involvement. Only one way to find out. Supportive anti-nausea drugs should minimize the side effects. Presumably your dog is starting to eat again, while being on the Prednisone, without any GI problems.

#12 · April 12, 2022, 3:33 pm

Yes. Sr was eating even before prednisone as long as it was human food. Eggs. Rice. Steak. Etc but appetite has increased more with prednisone. I really wanted to do a treatment that could be administered orally at home. She gets scared easily so going in for Iv treatments would be highly stressful and I assume more expensive than anything that can be given orally at home versus a doctor administering it. A month supply of Lomustine still seems awfully expensive and I wonder if there are other drugs that don't require constant visits to the vet

#13 · April 12, 2022, 3:35 pm

Quote from dragondawg on April 12, 2022, 3:35 pm

Quote from Lifesgood1970 on April 12, 2022, 3:30 pm

There is one vet school in town. That does chemo treatments where I live. All vets refer to them for chemo. They are extremely expensive. I would probably be looking at into the 1,000s and they are booked till mid August. My dog doesn't have a regular vet. So the vet that diagnosed her this week. It was the first time he had ever seen her. I can request that he contact the oncology at the vet school. It would be the only way they would even see her. But that's a lot to ask and the cost and wait list to get in are all very big factors. Keeping in mind that she has already lost 25% of her body weight over the last few weeks doesn't make her an ideal candidate for chemo. I love her immensely. Cannot even imagine her being gone in a matter of months. But it's a very expensive slippery slope to go down with not even a good chance she would be a good candidate not to mention the chemo would be tough on her. She likes being at home.

Wish I had seen this post first before my last response.

Yes, Chemo protocols such as the gold standard UW-Madison, and lessor ones such as LCOPA, CHOP can be very expensive into the $1000s. Suggest you find out what Doxorubicin treatments would cost per my other post. Maybe $500/treatment/3 treatments(?). Add another couple hundred for supportive drugs. Again the Prednisone clock is ticking, and August is too late for the Doxorubicin mono-therapy option.

True most Vets won't perform any IV Chemo, deferring to Vet Oncologists. Although there is the rare Vet who will do Chemo IV treatments. A possible plan is to ask your Vet if he could speed up the process as an emergency to get the dog into the Vet school for a Doxorubicin treatment if interested in mono-therapy. If the Vet school still can't take her before mid August, ask for feedback on whether withdrawing from Prednisone immediately, and giving oral Cytoxan, and Elspar might give the dog enough time to reach mid August. When Doxorubicin treatment at the Vet school remains an option. If you choose it. Need an Oncologist to say whether that's a viable strategy or not . Given an Oncologist's blessing, the local Vet should be able to provide drugs like Cytoxin&Elspar, while awaiting to be seen by the Vet School.

In my area, VSH Carolinas is well staffed, and has about a 5 day waiting period. Sooner if an emergency. Not sure how long it takes to get into the NC Vet School. So I've never been in the difficult situation you are in of not having the Vet Oncology resources.

The alternative is to continue the Prednisone, with oral Cytoxan (or Lomustine), and Elspar as helper Chemo drugs. Something the local Vet should be willing to help out with. Maybe where they need to consult with the Oncologist over the phone first(?).

The 25% weight loss is dramatic, but not unheard of. If the T-cell type, with vomiting, and diarrhea already present during the weight loss, signaling intestinal involvement, then that makes the dog a poor candidate for Chemo to be successful. What you have described is an anorexic dog with the previously undiagnosed Lymphoma causing the weight loss.

Quote from Lifesgood1970 on April 12, 2022, 3:30 pm

There is one vet school in town. That does chemo treatments where I live. All vets refer to them for chemo. They are extremely expensive. I would probably be looking at into the 1,000s and they are booked till mid August. My dog doesn't have a regular vet. So the vet that diagnosed her this week. It was the first time he had ever seen her. I can request that he contact the oncology at the vet school. It would be the only way they would even see her. But that's a lot to ask and the cost and wait list to get in are all very big factors. Keeping in mind that she has already lost 25% of her body weight over the last few weeks doesn't make her an ideal candidate for chemo. I love her immensely. Cannot even imagine her being gone in a matter of months. But it's a very expensive slippery slope to go down with not even a good chance she would be a good candidate not to mention the chemo would be tough on her. She likes being at home.

Wish I had seen this post first before my last response.

Yes, Chemo protocols such as the gold standard UW-Madison, and lessor ones such as LCOPA, CHOP can be very expensive into the $1000s. Suggest you find out what Doxorubicin treatments would cost per my other post. Maybe $500/treatment/3 treatments(?). Add another couple hundred for supportive drugs. Again the Prednisone clock is ticking, and August is too late for the Doxorubicin mono-therapy option.

True most Vets won't perform any IV Chemo, deferring to Vet Oncologists. Although there is the rare Vet who will do Chemo IV treatments. A possible plan is to ask your Vet if he could speed up the process as an emergency to get the dog into the Vet school for a Doxorubicin treatment if interested in mono-therapy. If the Vet school still can't take her before mid August, ask for feedback on whether withdrawing from Prednisone immediately, and giving oral Cytoxan, and Elspar might give the dog enough time to reach mid August. When Doxorubicin treatment at the Vet school remains an option. If you choose it. Need an Oncologist to say whether that's a viable strategy or not . Given an Oncologist's blessing, the local Vet should be able to provide drugs like Cytoxin&Elspar, while awaiting to be seen by the Vet School.

In my area, VSH Carolinas is well staffed, and has about a 5 day waiting period. Sooner if an emergency. Not sure how long it takes to get into the NC Vet School. So I've never been in the difficult situation you are in of not having the Vet Oncology resources.

The alternative is to continue the Prednisone, with oral Cytoxan (or Lomustine), and Elspar as helper Chemo drugs. Something the local Vet should be willing to help out with. Maybe where they need to consult with the Oncologist over the phone first(?).

The 25% weight loss is dramatic, but not unheard of. If the T-cell type, with vomiting, and diarrhea already present during the weight loss, signaling intestinal involvement, then that makes the dog a poor candidate for Chemo to be successful. What you have described is an anorexic dog with the previously undiagnosed Lymphoma causing the weight loss.

#14 · April 12, 2022, 3:36 pm

Quote from dragondawg on April 12, 2022, 3:36 pm

Quote from Lifesgood1970 on April 12, 2022, 3:33 pm

Yes. Sr was eating even before prednisone as long as it was human food. Eggs. Rice. Steak. Etc but appetite has increased more with prednisone. I really wanted to do a treatment that could be administered orally at home. She gets scared easily so going in for Iv treatments would be highly stressful and I assume more expensive than anything that can be given orally at home versus a doctor administering it. A month supply of Lomustine still seems awfully expensive and I wonder if there are other drugs that don't require constant visits to the vet

You're making me hungry with the description of your dog's diet.

Search your general area to see if there is compounding pharmacy that does Veterinary drugs. My Leukemia dog gets his Leukeran from a compounding pharmacy in NC. It's cheaper than ordering from a human pharmacy, and the 3 mg dose size probably isn't even available at a human pharmacy. A compounding pharmacy if available might take the cost down.

See if Cytoxan is any cheaper than the Lomustine. Either drug will require a visit to the Vet to get a CBC differential blood test before the next dose. Especially the Lomustine which is more likely to cause neutropenia. No Vet is going to prescribe either drug, without knowing the neutrophil count first. Suppressing an already suppressed neutrofil count is inviting a massive infection. Depending on the Vet that's anywhere from $55-$120 for the blood test. Some Vets gouge more than others. The good news is Lomustine is once every 3 weeks.

http://onlinelibrary.wiley.com/doi/10.11...1452.x/pdf

http://www.vcaspecialtyvets.com/ckfinder...thPaws.pdf

Unknown if Cytoxan would hold up for 1 treatment every 3 weeks. Usually it's buried in a continuous Chemo protocol. Maybe an Oncologist would know, along with whether alternating between the 2 alkylating drugs is possible, or has ever been tried. There might be other oral medications which can be tried based on cost. Again, an Oncologist might have some suggestions, if your local Vet can contact them, and tell them cost is a huge issue.

Back in 2003 I spent an estimated $9K on my Lymphoma puppy (1/2 Golden, 1/2 Yellow Lab). Somewhere between $3-4K was spent on hospitalization. Maybe $1500 the first week, when she was hit with an infection after the first Chemo treatment. Almost lost her in the beginning. And the remainder in the last 30 hrs when she had another severe infection, with the end near. The remaining $4-5K for Chemo, supportive drugs, blood tests etc. The point being the hospitalizations due to infections was almost as much in cost as the Chemo. My Leukemia dog with two different events of infection last Apr came in at $1.2K for cost. Only 1 involved a 1 night stay at the hospital to break the fever. So the cost of hospitalization due to infections is something that will eventually come your way. Hopefully only at the end.

Quote from Lifesgood1970 on April 12, 2022, 3:33 pm

Yes. Sr was eating even before prednisone as long as it was human food. Eggs. Rice. Steak. Etc but appetite has increased more with prednisone. I really wanted to do a treatment that could be administered orally at home. She gets scared easily so going in for Iv treatments would be highly stressful and I assume more expensive than anything that can be given orally at home versus a doctor administering it. A month supply of Lomustine still seems awfully expensive and I wonder if there are other drugs that don't require constant visits to the vet

You're making me hungry with the description of your dog's diet.

Search your general area to see if there is compounding pharmacy that does Veterinary drugs. My Leukemia dog gets his Leukeran from a compounding pharmacy in NC. It's cheaper than ordering from a human pharmacy, and the 3 mg dose size probably isn't even available at a human pharmacy. A compounding pharmacy if available might take the cost down.

See if Cytoxan is any cheaper than the Lomustine. Either drug will require a visit to the Vet to get a CBC differential blood test before the next dose. Especially the Lomustine which is more likely to cause neutropenia. No Vet is going to prescribe either drug, without knowing the neutrophil count first. Suppressing an already suppressed neutrofil count is inviting a massive infection. Depending on the Vet that's anywhere from $55-$120 for the blood test. Some Vets gouge more than others. The good news is Lomustine is once every 3 weeks.

http://onlinelibrary.wiley.com/doi/10.11...1452.x/pdf

http://www.vcaspecialtyvets.com/ckfinder...thPaws.pdf

Unknown if Cytoxan would hold up for 1 treatment every 3 weeks. Usually it's buried in a continuous Chemo protocol. Maybe an Oncologist would know, along with whether alternating between the 2 alkylating drugs is possible, or has ever been tried. There might be other oral medications which can be tried based on cost. Again, an Oncologist might have some suggestions, if your local Vet can contact them, and tell them cost is a huge issue.

Back in 2003 I spent an estimated $9K on my Lymphoma puppy (1/2 Golden, 1/2 Yellow Lab). Somewhere between $3-4K was spent on hospitalization. Maybe $1500 the first week, when she was hit with an infection after the first Chemo treatment. Almost lost her in the beginning. And the remainder in the last 30 hrs when she had another severe infection, with the end near. The remaining $4-5K for Chemo, supportive drugs, blood tests etc. The point being the hospitalizations due to infections was almost as much in cost as the Chemo. My Leukemia dog with two different events of infection last Apr came in at $1.2K for cost. Only 1 involved a 1 night stay at the hospital to break the fever. So the cost of hospitalization due to infections is something that will eventually come your way. Hopefully only at the end.

#15 · April 12, 2022, 3:37 pm

I guess what confuses me is why the clock is tickin as someone said once you start them on the prednisone. I realize it can make the strong chemo drugs less effective but if you aren't going that route, then can't it only add time? It doesn't make the cancer grow faster. It temporarily stunts it. So I don't really understand.

#16 · April 12, 2022, 3:38 pm

That's correct. The clock is only ticking on the front line Chemo protocols per the MDR glycoprotein pump.

The Prednisone alone should be very effective for 30-45 days. It requires no regular blood work, or visits during that time period.

#17 · April 12, 2022, 3:39 pm

Just to update anyone following this thread. After an x Ray it was determined that my sweet golden has mediastinal lymphoma. Two words. But those two words were so changing. I opted against the Lumostine. The risk it posed to us humans handling the Meds and to or other animals who would come in contact with our dog's space where she uses the restroom, made the risk far worse than the possible reward which would only add 1-2 months for her. She will still likely be gone in 30-60 days which is very hard to fathom. I have noticed her energy level is greatly reduced, she breathes heavier now, still no coughing yet which is good but I did notice her tongue darkening some. Appetite good on the prednisone. In a few more days she will drop from 2 to 1 prednisone a day and I worry what symptoms will appear next.

#18 · April 12, 2022, 3:40 pm

Since mediastinal lymphoma involves the lymph nodes in the lungs, that could be a possible cause of the panting. Although it could also be due to the high Prednisone dose. When lowered some of the panting may or may not go away. Feed her high protein/fat doggy food. Again, the Prednisone should give 30-45 days of remission. Be on the alert for infections. GL.

#19 · April 12, 2022, 3:42 pm

I am nervous as today is the day she goes from 2 prednisone to 1 a day. Hoping no new symptoms come about as the tapering of the Meds happens.

#20 · April 12, 2022, 3:43 pm

Hello, have been following this thread. Very good information from Dragondawg. I don't have any experience with mediastinal lyphoma, but hope your dog is doing OK, despite the tapering off of the pred. If you are into holistics/natural cures, there's a Facebook group called "treating dog cancer naturally" that maybe worthy of checking out for support.