Caninecancer.org.au

Hi Dr. Ken,
The other day you provided me with several answers to my questions regarding my pup Clancy including one about him recieving Lomustine after coming out of remission while recieving CHOP. I was feeling good about him trying the Lomustine until a women in one of my facebook groups shared that she was told Lomustine was likely useless without L-Asparginaise. I had actually asked my Internist about L-Asparginaise prior to hearing that and he said he didn't have access to it and I just figurered it wasn't needed. Now I'm wondering again if I should go to Cornell so he can get it there. Any thoughts? Clancy's nodes are reportedly the same 7 days after he had his first dose of the Lomustine. His WBC was very low so he was started on antibiotics but is otherwise doing well. Thank you so much for any info. I wasn't sure if I was suposed to start a new thread or if you continued to read the precious ones.
Thank you!!!!
Michelle and Clancy

Hi Michellle

I am just curious.....was the person who provided the info on the lomustine a vet oncologist?

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The woman that told me was reportedly told by her oncologist so it is second hand info...

Hi Michelle,
great photo of Clancy!
lomustine is effective without l-asparaginase for many dogs. I most commonly use it without. That said, if there is no benefit in 7 days, lomustine will not be effective for you. L-asparaginase is in short supply in the US at the present I believe. There are no problems in Australia just at the moment but this may soon change. it is a useful treatment BUT it does not improve the long term outcome (meaning it helps in the initial control) and if used repeatedly there is rapid resistance. If CHOP and lomustine have failed, then to be frank things are not good. In my hands at this point I would often discuss options with people including high dose cyclophosphamide and metronomic therapy but be guided by your specialist.

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

Dr. Ken,
Thank you once again for answering my questions and for your honest opinion. 7 days after administration of the Lomustine I was told his nodes were the same although I thought they were smaller as I could no longer feel them. The plan is to continue to use a variety drugs and his next cycle is supposed to be cyclophosphamide as you also suggested. This is so difficult and sad. He appears fine at this time but I know that can change at any second. Do you think he could benifit from MAB?
Thank You,
Michelle and Clancy

Hi Michelle,
I don't have access to MAB for lymphoma and haven't had any real feedback yet on it. If Clancy's is B cell then definitely worth looking into!

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

Update on Clancy- I took him to Cornell last Wednesday. We decided to give him L-asparginaise/Elspar and MOPP protocol. The Elspar had to be ordered overnight so we went back on Friday for that and will start MOPP this Thursday. Still hoping to get him to UPenn for MAB. He was re-started on pred and his nodes shrunk 25% from Wednesday to Friday. Fingers and paws crossed