1
|
Ferrer‐Jorda E, Rodriguez‐Piza I. Complete recovery of a cyclophosphamide overdose after vincristine administration in a dog. VETERINARY RECORD CASE REPORTS 2023. [DOI: 10.1002/vrc2.591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
|
2
|
Veluvolu S, Willcox JL, Skorupski KA, Al-Nadaf S, Rebhun R, Wittenburg L. Fractionated oral dosing and its effect on cyclophosphamide pharmacokinetics in dogs with high-grade multicentric lymphoma. Vet Comp Oncol 2023; 21:20-27. [PMID: 36057542 PMCID: PMC9928601 DOI: 10.1111/vco.12856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/09/2022] [Accepted: 08/29/2022] [Indexed: 11/28/2022]
Abstract
Cyclophosphamide (CP) is an alkylating agent commonly included in multi-drug treatment protocols for canine cancer. As a prodrug, CP requires hepatic metabolism for activation to the intermediate compound 4-hydroxycyclophosphamide (4-OHCP) which then spontaneously forms alkylating phosphoramide mustard. CP is frequently administered in a fractionated manner, with the total dose given over multiple days. CP is reported to cause auto-induction of metabolism in humans, with faster CP clearance and relatively increased 4-OHCP formation following fractionated versus bolus dosing, however canine pharmacokinetic studies of CP dose fractionation are lacking. The study objective was to evaluate the pharmacokinetics of fractionated oral CP dosing at a dose of 200-250 mg/m2 over 3 to 4 days in a prospectively identified population of cancer-bearing dogs. Plasma concentrations of CP and 4-OHCP were measured by ultra-high performance liquid chromatography tandem-mass spectrometry in eight dogs following the first and last doses to assess for auto-induction of CP metabolism. No significant difference in the rate of CP elimination between first and last doses were detected (0.73 ± 0.46 vs. 1.22 ± 0.5 h-1 ; p = .125). Additionally, no significant difference in dose-normalized 4-OHCP exposure was identified between first and last doses (5.9 ± 2.1 vs. 7.9 ± 6.4 h × ng/ml; p = .936). These results suggest that fractionated dosing may not increase exposure to the active metabolite of CP in dogs as it does in humans. As such, standard bolus dosing and fractionated dosing may be equivalent in terms of bio-activation of CP in dogs administered a dose of 200-250 mg/m2 .
Collapse
Affiliation(s)
- Sridhar Veluvolu
- William R Pritchard Veterinary Medical Teaching Hospital,
School of Veterinary Medicine, University of California – Davis, Davis, CA,
USA
| | - Jennifer L. Willcox
- William R Pritchard Veterinary Medical Teaching Hospital,
School of Veterinary Medicine, University of California – Davis, Davis, CA,
USA,Department of Surgical and Radiological Sciences, School of
Veterinary Medicine, University of California – Davis, Davis, CA, USA
| | - Katherine A. Skorupski
- William R Pritchard Veterinary Medical Teaching Hospital,
School of Veterinary Medicine, University of California – Davis, Davis, CA,
USA,Department of Surgical and Radiological Sciences, School of
Veterinary Medicine, University of California – Davis, Davis, CA, USA
| | - Sami Al-Nadaf
- William R Pritchard Veterinary Medical Teaching Hospital,
School of Veterinary Medicine, University of California – Davis, Davis, CA,
USA,Department of Surgical and Radiological Sciences, School of
Veterinary Medicine, University of California – Davis, Davis, CA, USA
| | - Robert Rebhun
- William R Pritchard Veterinary Medical Teaching Hospital,
School of Veterinary Medicine, University of California – Davis, Davis, CA,
USA,Department of Surgical and Radiological Sciences, School of
Veterinary Medicine, University of California – Davis, Davis, CA, USA
| | - Luke Wittenburg
- Department of Surgical and Radiological Sciences, School of
Veterinary Medicine, University of California – Davis, Davis, CA, USA
| |
Collapse
|
3
|
Iwaki Y, Gagnon J, MacDonald-Dickinson V. Incidence of Sterile Hemorrhagic Cystitis in Dogs Treated with Cyclophosphamide and Low-Dose Furosemide. J Am Anim Hosp Assoc 2022; 58:85-90. [PMID: 35195711 DOI: 10.5326/jaaha-ms-7169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2021] [Indexed: 11/11/2022]
Abstract
Cyclophosphamide is a commonly used chemotherapy in the treatment of lymphoma. It can cause sterile hemorrhagic cystitis (SHC), and furosemide is used to decrease the incidence of SHC. The aim of this study is to evaluate the incidence of SHC in dogs treated with a bolus maximum tolerated dose of oral cyclophosphamide and oral furosemide at a dose of 1 mg/kg. Medical records were reviewed to determine the incidence of SHC, dose and number of oral cyclophosphamide treatments, and the dose of furosemide. Other side effects from cyclophosphamide were also recorded. Eighty-one client-owned dogs that received a single oral maximum tolerated dose of cyclophosphamide concurrent with oral furosemide as part of a chemotherapy protocol for lymphoma were included in the study. A total of 252 doses of cyclophosphamide were administered to 81 dogs. The median dose of cyclophosphamide was 239.3 mg/m2. The median dose of furosemide was 1.08 mg/kg. SHC was suspected in 2 dogs (2.46%). Concurrent use of furosemide at a dose of 1 mg/kg with cyclophosphamide yields a similar incidence of SHC than using a higher dose of furosemide as previously reported.
Collapse
|
4
|
Lee JJ, Liao AT, Wang SL. Outcome of Canine Multicentric Lymphoma after Single or Divided Treatment with Cyclophosphamide in Multidrug Chemotherapy. Top Companion Anim Med 2020; 41:100461. [PMID: 32823160 DOI: 10.1016/j.tcam.2020.100461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 06/22/2020] [Accepted: 06/23/2020] [Indexed: 10/24/2022]
Abstract
Cyclophosphamide is commonly used in combination chemotherapy to treat dogs with lymphoma. The metabolite of cyclophosphamide, acrolein, can irritate urinary bladder and cause sterile hemorrhagic cystitis. Dividing the administration of cyclophosphamide across multiple days may reduce the concentration of this metabolite in urinary bladder and reduce the possibility of cystitis. However, the impact of the therapeutic effect of this modification is not evaluated and compared to traditional single maximum-tolerated dose regimen. Seventy-two dogs with multicentric lymphoma received either bolus doses or divided doses of cyclophosphamide were included in this study. The incidence of hemorrhagic cystitis between 2 cyclophosphamide treatment groups was not significantly different (P = .357). There was no statistical difference in progression-free survival and survival time between 2 groups (P = .267 and P = .346). This modification of cyclophosphamide administration did not reduce the side effect of cystitis or affect remission and survival times in lymphoma dogs.
Collapse
Affiliation(s)
- Jih-Jong Lee
- Graduate Institute of Veterinary Clinical Science, School of Veterinary Medicine, National Taiwan University, Taipei, Taiwan; Animal Cancer Center, College of Bioresources and Agriculture, National Taiwan University, Taipei, Taiwan; National Taiwan University Veterinary Hospital, College of Bioresources and Agriculture, National Taiwan University, Taipei, Taiwan
| | - Albert Taiching Liao
- Department and Graduate Institute of Veterinary Medicine, School of Veterinary Medicine, National Taiwan University, Taipei, Taiwan; Animal Cancer Center, College of Bioresources and Agriculture, National Taiwan University, Taipei, Taiwan
| | - Shang-Lin Wang
- Graduate Institute of Veterinary Clinical Science, School of Veterinary Medicine, National Taiwan University, Taipei, Taiwan; Animal Cancer Center, College of Bioresources and Agriculture, National Taiwan University, Taipei, Taiwan; National Taiwan University Veterinary Hospital, College of Bioresources and Agriculture, National Taiwan University, Taipei, Taiwan.
| |
Collapse
|
5
|
Matsuyama A, Schott CR, Wood GA, Richardson D, Woods JP, Mutsaers AJ. Evaluation of metronomic cyclophosphamide chemotherapy as maintenance treatment for dogs with appendicular osteosarcoma following limb amputation and carboplatin chemotherapy. J Am Vet Med Assoc 2019; 252:1377-1383. [PMID: 29772973 DOI: 10.2460/javma.252.11.1377] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine the effectiveness of metronomic cyclophosphamide (MC) chemotherapy (primary treatment of interest) with adjuvant meloxicam administration as maintenance treatment for dogs with appendicular osteosarcoma following limb amputation and carboplatin chemotherapy. DESIGN Retrospective case series with nested cohort study. ANIMALS 39 dogs with a histologic diagnosis of appendicular osteosarcoma that underwent limb amputation and completed carboplatin chemotherapy from January 2011 through December 2015. PROCEDURES Dogs were grouped by whether carboplatin chemotherapy had been followed with or without MC chemotherapy (15 mg/m2, PO, q 24 h) and meloxicam (0.1 mg/kg [0.045 mg/lb], PO, q 24 h). The Breslow rank test was used to assess whether MC chemotherapy was associated with overall survival time (OST) and disease progression-free time (PFT) after limb amputation. RESULTS 19 dogs received carboplatin and MC chemotherapy, and 20 dogs received only carboplatin chemotherapy. No differences were identified between these groups regarding age, reproductive status, body weight, serum alkaline phosphatase activity, tumor location, or histologic grade or subtype of osteosarcoma. Median duration of MC chemotherapy for dogs in the carboplatin-MC group was 94 days (range, 7 to 586 days); this treatment was discontinued for 11 (58%) dogs when cystitis developed. Overall, 11 (28%) dogs survived to the time of analysis, for a median follow-up period of 450 days (range, 204 to 1,400 days). No difference in median PFT or OST was identified between the 2 groups. CONCLUSIONS AND CLINICAL RELEVANCE Maintenance MC chemotherapy following limb amputation and completed carboplatin chemotherapy was associated with no increase in PFT or OST in dogs with appendicular osteosarcoma. Cystitis was common in MC-treated dogs, and prophylactic treatment such as furosemide administration could be considered to reduce the incidence of cystitis in such dogs.
Collapse
|
6
|
Ekena J, Wood E, Manchester A, Chun R, Trepanier LA. Glutathione-S-transferase-theta genotypes and the risk of cyclophosphamide toxicity in dogs. Vet Comp Oncol 2018; 16:529-534. [PMID: 29984447 DOI: 10.1111/vco.12411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 05/15/2018] [Accepted: 05/17/2018] [Indexed: 01/15/2023]
Abstract
The antineoplastic agent cyclophosphamide (CP) has dose-limiting side effects including sterile haemorrhagic cystitis (SHC), bone marrow (BM) suppression and gastrointestinal (GI) toxicity in dogs. The metabolites acrolein and phosphoramide that mediate these toxicities are glutathione-S-transferase (GST) substrates, and low functioning GST alleles are associated with CP toxicity in humans. The aim of this study was to determine whether variants in 2 canine GST genes, GSTT1 and GSTT5, were over-represented in dogs that developed CP toxicity. Dogs undergoing pulse or metronomic CP chemotherapy were recruited (n = 101) and genotyped for 6 GSTT1 polymorphisms and 1 GSTT5 6-bp deletion that leads to non-functional enzyme. Median cumulative CP dosages for dogs with SHC (1350 mg/m2 ) were significantly higher than for dogs with GI/BM toxicity (871 mg/m2 ) or no toxicity (991 mg/m2 ; P = .0012). Dogs with SHC were more likely to have had metronomic (84.2%, 16 of 19 SHC cases) vs pulse (15.8%, 3 of 19 SHC cases) CP dosing (P < .0001). All dogs with BM or GI toxicity (n = 30) had pulse chemotherapy. GSTT1 and GSTT5 variant allele frequencies were not significantly different in CP-treated dogs with SHC or GI/BM toxicity compared to dogs without documented adverse effects. Work is underway to identify which canine GSTs detoxify acrolein and phosphoramide, so that better tools are available to predict the risk of CP toxicity in dogs.
Collapse
Affiliation(s)
- J Ekena
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin
| | - E Wood
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin
| | - A Manchester
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin
| | - R Chun
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin
| | - L A Trepanier
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin
| |
Collapse
|
7
|
Matsuyama A, Poirier VJ, Mantovani F, Foster RA, Mutsaers AJ. Adjuvant Doxorubicin with or without Metronomic Cyclophosphamide for Canine Splenic Hemangiosarcoma. J Am Anim Hosp Assoc 2017; 53:304-312. [PMID: 28892429 DOI: 10.5326/jaaha-ms-6540] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This retrospective study investigated the outcome of 33 dogs with splenic hemangiosarcoma treated with surgery followed by adjuvant dose-intensified doxorubicin (DOX) with or without low-dose metronomic cyclophosphamide (LDM-C) maintenance therapy. Among the 33 dogs, 18 dogs received LDM-C. Clinical stage was available for all dogs (5 stage I, 18 stage II, and 10 stage III). Nine dogs had macroscopic, and 24 dogs had microscopic disease at the start of DOX treatment. Median progression-free survival (PFS) and overall survival were 125 and 133 days, respectively. Clinical stage and tumor burden (microscopic versus macroscopic) at the start of chemotherapy was prognostic for PFS. No significant difference was observed in PFS or overall survival for the addition of LDM-C after a completed DOX protocol (P = .563 and P = .148, respectively). Based on the results of this retrospective study, the addition of LDM-C therapy as a maintenance regimen following a completed protocol of DOX adjuvant treatment of canine hemangiosarcoma may not improve outcome.
Collapse
Affiliation(s)
- Arata Matsuyama
- From the Department of Biomedical Sciences (A.M., A.J.M.), Department of Clinical Studies (F.M., A.J.M.), Health Sciences Centre (V.J.P.), and Department of Pathobiology (R.A.F.), Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Valerie J Poirier
- From the Department of Biomedical Sciences (A.M., A.J.M.), Department of Clinical Studies (F.M., A.J.M.), Health Sciences Centre (V.J.P.), and Department of Pathobiology (R.A.F.), Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Fernanda Mantovani
- From the Department of Biomedical Sciences (A.M., A.J.M.), Department of Clinical Studies (F.M., A.J.M.), Health Sciences Centre (V.J.P.), and Department of Pathobiology (R.A.F.), Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Robert A Foster
- From the Department of Biomedical Sciences (A.M., A.J.M.), Department of Clinical Studies (F.M., A.J.M.), Health Sciences Centre (V.J.P.), and Department of Pathobiology (R.A.F.), Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Anthony J Mutsaers
- From the Department of Biomedical Sciences (A.M., A.J.M.), Department of Clinical Studies (F.M., A.J.M.), Health Sciences Centre (V.J.P.), and Department of Pathobiology (R.A.F.), Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| |
Collapse
|
8
|
Setyo L, Ma M, Bunn T, Wyatt K, Wang P. Furosemide for prevention of cyclophosphamide-associated sterile haemorrhagic cystitis in dogs receiving metronomic low-dose oral cyclophosphamide. Vet Comp Oncol 2017; 15:1468-1478. [DOI: 10.1111/vco.12292] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 10/23/2016] [Accepted: 10/24/2016] [Indexed: 11/30/2022]
Affiliation(s)
- L. Setyo
- Perth Veterinary Oncology; Perth Veterinary Specialists; Perth Australia
| | - M. Ma
- Perth Veterinary Oncology; Perth Veterinary Specialists; Perth Australia
| | - T. Bunn
- Perth Veterinary Oncology; Perth Veterinary Specialists; Perth Australia
| | - K. Wyatt
- Perth Veterinary Oncology; Perth Veterinary Specialists; Perth Australia
| | - P. Wang
- School of Veterinary and Life Sciences; Murdoch University; Murdoch Australia
| |
Collapse
|
9
|
Chan CM, Frimberger AE, Moore AS. Incidence of sterile hemorrhagic cystitis in tumor-bearing dogs concurrently treated with oral metronomic cyclophosphamide chemotherapy and furosemide: 55 cases (2009–2015). J Am Vet Med Assoc 2016; 249:1408-1414. [DOI: 10.2460/javma.249.12.1408] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
10
|
Robertson LM, Clark A. Looking beyond the angiotensin receptor blocker: A case of anaphylaxis to mesna. Ann Allergy Asthma Immunol 2016; 117:324-5. [PMID: 27424127 DOI: 10.1016/j.anai.2016.06.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 06/20/2016] [Accepted: 06/21/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Leanna-Marie Robertson
- Department of Internal Medicine, University Hospitals Case Medical Center, Cleveland, Ohio.
| | - Amanda Clark
- Department of Internal Medicine, University Hospitals Case Medical Center & Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio
| |
Collapse
|
11
|
Affiliation(s)
- Jane Dobson
- Department of Veterinary Medicine; University of Cambridge; Madingley Road Cambridge CB3 0ES UK
| |
Collapse
|