Caninecancer.org.au

My now 6.5 year old boy Harvey about 14 months ago was diagnosed with late stage Lymphoma (signs of Leukaemia in his blood).

His been on Chemo ever since.
The early weeks were difficult, he went down hill, didn't want to eat and dropped from 23kg to under 17kg. With week break in treatment I got him eating and he picked up will. Since then Chemo is nothing more than a trip in the car and visit for treats to him.

The first 6 month round of treatment sadly only stayed off the horrible thing for 5-6 weeks when the protocol was stopped.

This same protocol (Vincristine, Cycolphosphamide, Doxorubicin) was restarted and was effective for around 4 months this time.

As this point it was decided to changed to a rescue protocol involving Actinomycin, Cytosine Arabinoside and Dexamethasone one week, and just Dex and Melphlan tablets the next.

This also had good effect for a few month, though now over the past few months resistance has become stronger and while his lymphnodes drop down, they grow larger over time still.

Last week we tried L-Asparaginase for the first time. It would hopefully/apparently totally knock the nodes down. Sadly not so, and no more effective than the previous rescue combo of 3x injections.

He goes back in today for treatment. The hope was I think for the L-Asparaginase to have more of an effect, perhaps knocking some resistant cells maybe allowing to see if Vincristine again would have had decent effect, but don't think this will happen now.

Still hold out for some magic drug or something hehe.
.......anyone?? lol

It's hard to just stop treating to the end as his still so happy and healthy, no one every believes that his dying from cancer. Diet here I've learnt is so so important.

I realise his time is very dated, so his a very spoilt dog doing heaps of things at the moment. Less than 2 weeks ago I had to put my younger less than 2 year old dog (Chilli) to sleep whom I'd partly got to give Harv a buddy in his final months.

She had a extremely rare brain cancer that had extended forward into her snout, only becoming obvious a long time later when it started to push her eye out. Inoperable and extensive. Esthesioneuroblastoma is the name they gave it. Apparently they had only human references to this due to it's rarity.

Not at all happy with this Cancer thing I must say

Here's Harvey at around 2


another more recent with poor Chilli, as you can still see he is so happy and healthy

He's a beautiful dog! Its never easy when the cancer becomes resistant to standard therapy. There is no lack of choosing something which might work, but we shouldn't lose sight of the goal of therapy which is improving quality of life through disease control. So long as quality of life is OK then I would do continue to do what I could for my dog. In my practice, I would often consider lomustine at this point - it has different resistance mechanisms to the drugs harvey's had before and it is well tolerated (though will drop the white cells). I also use metronomic cyclophosphamide, which is capsules at home. In people with multi-resitant non-Hodgkins (the human equivalent) response rates are reasonable. There have been no trials in dogs for multi-resistant lymphoma effectiveness (though enough for safety and dosage).
Good luck!

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Dr Ken Wyatt BSc BVMS FANZCVS
Specialist Veterinary Oncologist
Perth Veterinary Oncology

Thanks Ken. That is some good info I can now discuss.

I 100% hear you on quality of life, and trying vincristine again was sadly a failure. Limited effect and made him not well for the first rime in ages

Ken, curious to hear your thoughts or even experiences and opinions on oral Neoplasene and it's possibly assistance with Lymphoma?

From what I've read the stuff dose/can actually work on surface issues but for internal system based cancer (ie Lymphoma) does it have any postive effects at all, or can it be used with Chemo?

I usually box most of these 'alternatives' as unrealistic with limited proof but does seem this stuff (perhaps more in the states) actually gets used by proper vets etc.

The Lymphoma seems 100% resistant to anything we throw at it now. His nodes are golf ball + size in multiple sites.

His energy is drained, his still happy when his got some but walks are very short now, only takes 100's of meters for him to be well tuckered.

The last drug tried was Vinblastine, but has no real noticeable effect. At least it didn't make him sick like last time Vincristine was given.

His Oncologist has sad that even though he would be past the 'ceiling' dose, we could try Doxorubicin one last time as it's been quite a while since that one, and it is the strongest drug. The heart concerns she seemed to think are usually more delayed so would not really be too much of a concern for him at this stage.

However I'm steering away from trying this, largely because there is a chance it will do nothing at all while possibly making him quite unwell in his already drained state.

The last thing I want is for him to suffer more in his last days. I so want to try, maybe given him that little more but I know that no one can guarantee it will have and effect and he'll handle it well at the moment Sad

It's really hard now to just do nothing!

During the night is my main concern, his breathing becomes rapid and at times strained (ie rapid almost panting through the sides of his mouth). Not heat related as I've found that having the A/C on all night quite cold really helps him. Not so much the temperature but I think the dry air.

I know this time has been coming, still doesn't make it any easier once it's staring you in the face.

I'm sorry to hear things aren't going well for Harvey. You've tried so hard to get his health back - it is devastating to see the cancer pulling him down. If quality of life is OK and standard approaches have failed, I have had a degree of success using daily cyclophosphamide. This approach has been used in people with resistant lymphoma with moderate success (40-50%) and trialled in dogs with other cancers (so we know the dose is safe). The only side effect in dogs is bladder irritation which IF it happens is usually months down the track. This approach is NOT likely to improve quality of life so if Harvey is already beyond that, then to be frank, euthanasia may be the kindest choice. as for the doxorubicin, the dose ceiling is a guide not a strict limit and yes, the heart disease that the drug causes can often take months to set in and months more to be a symptomatic problem. In this situation it is of no consequence in my opinion. Mitoxantrone or epirubicin are alternative, similar drugs that can be used in place of doxorubicin.
Good luck

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Dr Ken Wyatt BSc BVMS FANZCVS
Specialist Veterinary Oncologist
Perth Veterinary Oncology

Spoony wrote:
Ken, curious to hear your thoughts or even experiences and opinions on oral Neoplasene and it's possibly assistance with Lymphoma?

From what I've read the stuff dose/can actually work on surface issues but for internal system based cancer (ie Lymphoma) does it have any postive effects at all, or can it be used with Chemo?

I usually box most of these 'alternatives' as unrealistic with limited proof but does seem this stuff (perhaps more in the states) actually gets used by proper vets etc.


Sorry Spoony - I missed this post until now - I am deeply concerned when there is more effort in promotion of a medication than proof of it benefits and transparency with respect to its risks. The fraudulent pushing of shark cartilage in the past should make us all skeptics

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Dr Ken Wyatt BSc BVMS FANZCVS
Specialist Veterinary Oncologist
Perth Veterinary Oncology

Thanks for the reply Ken. Yes it does seem with some of these 'alternatives' that promotion takes precedence over backed researched .

With regards to Harvey, he has had cyclophosphamide extensively on previous protocols. DMAC being the final protocol, stopped a little while ago when it's effectiveness wavered. Since then it's been l-asparaginase a few times, and attempts using previously used drugs (Vincristine again without luck, Vinblastine to see, no luck either etc).

His pretty much been given everything that have at some point including Mitozantrone, Lomustine, Procarbazine some time ago etc .

His Onocologist didn't suggest cyclophosphamide again, perhaps thinking that there would be too much resistance now?

If it helps a little and doesn't risk making him ill then it's worth a shot. I'll mention it to her.

I totally understand about his quality of life. At the moment his good, happy and active for the vast majority, just has his moments during the night. (thursday edit, after getting some Metamusil in his diet he seems to have pepped up a little, was much better last night, so perhaps his been blocked up making him feel worse and struggling to digest dinner at night)

Thanks again
Dan.

my use of cyclophosphamide in this instance would be daily at a 20th of the dose - it is not targetting the cancer but the 'brakes' on the immune system (regulatory T cells) and circulating endothelial cells that build blood supply. So resistance by the cancer to it is less important. It is ONLY suitable if quality of life is OK at present as it will not make things better, just slower.

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Dr Ken Wyatt BSc BVMS FANZCVS
Specialist Veterinary Oncologist
Perth Veterinary Oncology

Ahh ok that makes sense, for it's secondary benefits. Thanks! Smile