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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]
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2
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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 .
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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
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3
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O'Connell K, Thomson M, Morgan E, Henning J. Procarbazine, prednisolone and cyclophosphamide (PPC) oral combination chemotherapy protocol for canine lymphoma. Vet Comp Oncol 2022; 20:613-622. [PMID: 35338560 DOI: 10.1111/vco.12814] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 03/02/2022] [Accepted: 03/22/2022] [Indexed: 11/29/2022]
Abstract
Orally administered daily chemotherapy offers a novel treatment approach for canine lymphoma in a population of dogs that have failed or not tolerated maximum tolerable dose chemotherapy. A multidrug oral chemotherapy protocol was designed and implemented for the treatment of fifty dogs with multicentric lymphoma with minimal side effects. The protocol consisted of oral procarbazine, prednisolone and cyclophosphamide (PPC) administered daily. Efficacy and toxicity were evaluated by clinical and laboratory evaluation. An overall response rate of 70% was achieved, with 24% and 46% of dogs having a partial and complete response, respectively, to treatment with the PPC protocol. Response to the PPC protocol (complete or partial) and age were the only factors identified as prognostic for time from initiation of the PPC chemotherapy until death. Overall, the protocol was very well tolerated with only one dog requiring protocol discontinuation due to grade 4 thrombocytopenia. Eight dogs recorded gastrointestinal toxicities, seven grade I and one grade II toxicity. These findings demonstrate that the administration of a continuous oral combination chemotherapy can provide comparable survival times in the rescue setting in dogs with multicentric lymphoma with minimal side effects.
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Affiliation(s)
- Kathleen O'Connell
- Animal Referral Hospital Brisbane, 532 Seventeen Mile Rocks Road, Sinnamon Park QLD 4073
| | - Maurine Thomson
- Animal Referral Hospital Brisbane, 532 Seventeen Mile Rocks Road, Sinnamon Park QLD 4073
| | - Elizabeth Morgan
- Animal Referral Hospital Brisbane, 532 Seventeen Mile Rocks Road, Sinnamon Park QLD 4073
| | - Joerg Henning
- School of Veterinary Science, The University of Queensland, Gatton, QLD, Australia
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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.
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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.
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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.
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6
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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.
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7
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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.
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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
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8
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Elliott J, Villiers E. Indolent, T-cell, large granular lymphocytic leukaemia in a dog presenting with severe neutropenia and an absence of lymphocytosis. Open Vet J 2018; 8:118-124. [PMID: 29721441 PMCID: PMC5918120 DOI: 10.4314/ovj.v8i2.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 03/21/2018] [Indexed: 11/23/2022] Open
Abstract
In humans, large granular lymphocytic leukaemia (LGLL) is a low-grade, indolent lymphoproliferative disorder of large granular lymphocytes (LGL) associated with autoimmune disorders; including rheumatoid arthritis and single or multiple cytopenias; particularly neutropenia. Therapy largely centres around immunosuppression which aims to resolve the immune-mediated secondary pathology, often without eradicating the neoplastic clone. The most effective agents appear to be cyclophosphamide, cyclosporine and methotrexate. This case report describes the presentation, diagnostics, therapeutic approach and outcome of a 6 year-old Golden Retriever presenting with severe neutropenia. Chlorambucil, prednisolone and cyclosporine failed to improve the neutropenia but subsequent cyclophosphamide resulted in a sustained albeit temporary improvement in neutrophil count and the ability to withdraw prophylactic antibacterials. This case closely mirrors the diagnostics and therapeutic response in human LGLL.
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Affiliation(s)
- James Elliott
- Willows Veterinary Centre & Referral Service, Highlands Road, Solihull, B90 4NH, UK
| | - Elizabeth Villiers
- Dick White Referrals, Station Farm, London Road, Six Mile Bottom, Cambridgeshire, CB8 0UH, UK
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Fournier Q, Serra J, Handel I, Lawrence J. Impact of Pretreatment Neutrophil Count on Chemotherapy Administration and Toxicity in Dogs with Lymphoma Treated with CHOP Chemotherapy. J Vet Intern Med 2018; 32:384-393. [PMID: 29205493 PMCID: PMC5787211 DOI: 10.1111/jvim.14895] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Revised: 10/26/2017] [Accepted: 11/06/2017] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Prechemotherapy absolute neutrophil count (ANC) cutoffs are arbitrary and vary across institutions and clinicians. Similarly, subjective guidelines are utilized for the administration of prophylactic antibiotics in neutropenic dogs. OBJECTIVES To evaluate the impact of various ANC cutoffs on chemotherapy administration in dogs with lymphoma treated with CHOP chemotherapy and to determine whether an association between prechemotherapy ANC and subsequent toxicity exists. The secondary objective was to evaluate a currently used ANC cutoff to indicate prescription of prophylactic antibiotics. ANIMALS Dogs diagnosed with lymphoma treated with CHOP chemotherapy (n = 64). METHODS Six hundred and fifteen ANCs were stratified into 6 classes. The 3 ANC cutoffs 1.5 × 103 /μL, 2.0 × 103 /μL, and 2.5 × 103 /μL were assessed. The presence of an association between prechemotherapy ANC class and toxicity was determined. Afebrile neutropenic dogs with ANC <1.5 × 103 /μL but above the criteria for prophylactic antibiotics were evaluated. RESULTS Chemotherapy was not administered in 7% of visits with an ANC cutoff of 1.5 × 103 /μL; chemotherapy would not have been administered in 10% and 16% of visits with an ANC cutoff of 2.0 × 103 /μL or 2.5 × 103 /μL, respectively. There was no association among the 3 lower prechemotherapy ANC classes and toxicity. All dogs with ANC 0.75-1.5 × 103 /μL recovered spontaneously without medical intervention. CONCLUSION AND CLINICAL IMPORTANCE The number of dose delays was minimized with a prechemotherapy ANC cutoff of 1.5 × 103 /μL, and the prechemotherapy ANC class 1.5-1.99 × 103 /μL was not associated with an increased toxicity. Further investigation of an ANC cutoff near 0.75 × 103 /μL in which to prescribe prophylactic antibiotics is indicated.
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Affiliation(s)
- Q. Fournier
- Royal (Dick) School of Veterinary StudiesRoslin InstituteThe University of EdinburghRoslinUK
| | - J.‐C. Serra
- Royal (Dick) School of Veterinary StudiesRoslin InstituteThe University of EdinburghRoslinUK
| | - I. Handel
- Royal (Dick) School of Veterinary StudiesRoslin InstituteThe University of EdinburghRoslinUK
| | - J. Lawrence
- Royal (Dick) School of Veterinary StudiesRoslin InstituteThe University of EdinburghRoslinUK
- Present address:
Lawrence is presently affiliated with Department of Veterinary Clinical SciencesCollege of Veterinary MedicineUniversity of MinnesotaSaint PaulMN
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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.
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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
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11
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Finlay JR, Wyatt K, North C. Recovery from Cyclophosphamide Overdose in a Dog. J Am Anim Hosp Assoc 2017; 53:230-235. [DOI: 10.5326/jaaha-ms-6411] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
ABSTRACT
An adult female spayed dog was evaluated after inadvertently receiving a total dose of 1,750 mg oral cyclophosphamide, equivalent to 2,303 mg/m2, over 21 days (days −21 to 0). Nine days after the last dose of cyclophosphamide (day +9), the dog was evaluated at Perth Veterinary Specialists. Physical examination revealed mucosal pallor, a grade 2/6 systolic heart murmur, and severe hemorrhagic cystitis. Severe nonregenerative pancytopenia was detected on hematology. Broad spectrum antibiotics, two fresh whole blood transfusions, granulocyte colony stimulating factor, and tranexamic acid were administered. Five days after presentation (day +14), the peripheral neutrophil count had recovered, and by 12 days (day +21) the complete blood count was near normal. A second episode of thrombocytopenia (day +51) was managed with vincristine, prednisolone, and melatonin. The dog made a complete recovery with no long-term complications at the time of writing. To the author's knowledge, this is the highest inadvertently administered dose of cyclophosphamide to result in complete recovery.
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Affiliation(s)
| | - Kenneth Wyatt
- From Perth Veterinary Specialists, Osborne Park, Western Australia, Australia
| | - Courtney North
- From Perth Veterinary Specialists, Osborne Park, Western Australia, Australia
- C. North's current affiliation is Veterinary Specialist Group, Auckland, New Zealand
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12
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Gaspar TB, Henriques J, Marconato L, Queiroga FL. The use of low-dose metronomic chemotherapy in dogs-insight into a modern cancer field. Vet Comp Oncol 2017; 16:2-11. [PMID: 28317239 DOI: 10.1111/vco.12309] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Revised: 02/03/2017] [Accepted: 02/11/2017] [Indexed: 12/22/2022]
Abstract
The era of chemotherapy, which started in the middle of the last century, has been ruled by the routine use of dose-intense protocols, based on the "maximum-tolerated dose" concept. By promoting a balance between patient's quality of life and the goal of rapidly killing as many tumour cells as possible, these protocols still play a prominent role in veterinary oncology. However, with the opening of a new millennium, metronomic chemotherapy (MC) started to be considered a possible alternative to traditional dose-intense chemotherapy. Characterized by a long-term daily administration of lower doses of cytotoxic drugs, this new modality stands out for its unique combination of effects, namely on neovascularization, immune response and tumour dormancy. This article reviews the rationale for treatment with MC, its mechanism of action and the main studies conducted in veterinary medicine, and discusses the key challenges yet to be solved.
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Affiliation(s)
- T B Gaspar
- Department of Veterinary Sciences, University of Trás-os-Montes and Alto Douro, Vila Real, Portugal.,Hospital Veterinário Berna, Lisboa, Portugal
| | - J Henriques
- Hospital Veterinário Berna, Lisboa, Portugal
| | - L Marconato
- Centro Oncologico Veterinario, Bologna, Italy
| | - F L Queiroga
- Department of Veterinary Sciences, University of Trás-os-Montes and Alto Douro, Vila Real, Portugal.,Center for the Study of Animal Sciences, CECA-ICETA, University of Porto, Porto, Portugal.,Center for Research and Technology of Agro-Environment and Biological Sciences (CITAB), University of Trás-os-Montes and Alto Douro, Vila Real, Portugal
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13
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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
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14
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Harper A, Blackwood L. Toxicity of metronomic cyclophosphamide chemotherapy in a UK population of cancer-bearing dogs: a retrospective study. J Small Anim Pract 2017; 58:227-230. [DOI: 10.1111/jsap.12635] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 10/20/2016] [Accepted: 11/30/2016] [Indexed: 11/30/2022]
Affiliation(s)
- A. Harper
- Institute of Veterinary Sciences; University of Liverpool; Liverpool Wirral CH64 7TE UK
| | - L. Blackwood
- Institute of Veterinary Sciences; University of Liverpool; Liverpool Wirral CH64 7TE UK
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15
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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]
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16
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Sinclair KM, Hawkins MG, Wright L, Chin RP, Owens SD, Guzman DSM, Kent MS, BVSc HLS. Chronic T-cell Lymphocytic Leukemia in a Black Swan ( Cygnus atratus ): Diagnosis, Treatment, and Pathology. J Avian Med Surg 2016; 29:326-35. [PMID: 26771322 DOI: 10.1647/2015-075] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
An asymptomatic 14-year old, male black swan ( Cygnus atratus ) housed at a zoological institution was presented for routine preshipment examination. Hematologic findings indicated that the bird had a severe lymphocytic leukocytosis, consistent with chronic lymphocytic leukemia. Radiographs showed the presence of multiple soft tissue masses within the caudal coelomic cavity; ultrasound showed one mass to be an enlarged spleen, a cystic mass near the gonads, and a mass suspected to be associated with the ventriculus. Results of further antemortem diagnostics, including bone marrow aspiration, fine-needle aspirate cytology of the coelomic masses, and immunohistochemical staining confirmed T-cell leukemia with infiltration of the bone marrow and the spleen. The bird showed partial response to treatment with chlorambucil, lomustine, prednisone, l-asparaginase, and whole-body radiation, with neither evidence of adverse effects nor clinical signs of disease. Although the leukemia showed response, there was no evidence of remission at any point. The swan died 433 days after initial evaluation and initiation of therapy. Necropsy, histopathologic findings, and immunohistochemistry results confirmed extensive infiltration of multiple organs, including the liver, spleen, heart, lungs, and kidneys with neoplastic T-cell lymphocytes.
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Wells JE, Sabatino BR, Whittemore JC. Cyclophosphamide intoxication because of pharmacy error in two dogs. J Am Vet Med Assoc 2015; 245:222-6. [PMID: 24984134 DOI: 10.2460/javma.245.2.222] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
CASE DESCRIPTION An 8-year-old spayed female Yorkshire Terrier and 5-year-old castrated male West Highland White Terrier were evaluated because of cyclophosphamide intoxication subsequent to pharmacy error. Both dogs received cumulative doses of approximately 1,080 mg of cyclophosphamide/m(2) after cyclophosphamide was erroneously dispensed instead of cyclosporine by different pharmacies. CLINICAL FINDINGS Both dogs became lethargic, and 1 dog also had anorexia, vomiting, and diarrhea within 2 days after initiation of cyclophosphamide administration. The other dog developed anorexia on the seventh day after initiation of cyclophosphamide administration. The dogs were evaluated by their primary-care veterinarians 9 and 11 days after administration of the first dose of cyclophosphamide, and both had severe leukopenia and thrombocytopenia. TREATMENT AND OUTCOME One dog was treated on an outpatient basis with broad-spectrum antimicrobials, granulocyte colony-stimulating factor, and an appetite stimulant. The other dog was more severely affected and was hospitalized for 7 days, during which it was treated with broad-spectrum antimicrobials, gastroprotectants, granulocyte colony-stimulating factor, and cryopreserved platelet and packed RBC transfusions. Both dogs fully recovered after treatment. CLINICAL RELEVANCE This was the first report of survival for dogs with inadvertent prolonged cyclophosphamide intoxication subsequent to pharmacy error. Although the 2 dogs had similar clinical signs and clinicopathologic findings, the severity of disease and treatment required differed for each dog. Dogs can recover from prolonged cyclophosphamide intoxication provided appropriate supportive care is administered.
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Affiliation(s)
- Jennifer E Wells
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Tennessee, Knoxville, TN 37996
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Leo C, Stell A, Borrego J, Martinez de Merlo E, Ruess-Melzer K, Lara-Garcia A. Evaluation of low-dose metronomic (LDM) cyclophosphamide toxicity in cats with malignant neoplasia. J Feline Med Surg 2014; 16:671-8. [PMID: 24423814 PMCID: PMC11164162 DOI: 10.1177/1098612x13518938] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/10/2024]
Abstract
Oral administration of low-dose cyclophosphamide in pets with spontaneously occurring malignant neoplasms has become a common practice in veterinary medicine. The purpose of this retrospective study was to investigate toxicity events in cats with spontaneous malignancies receiving cyclophosphamide as a metronomic therapy for at least 1 month. The number and severity of clinical, haematological and biochemical adverse events were recorded according to the Veterinary Cooperative Oncology Group's Common Terminology Criteria for Adverse Events v1.1 classification scheme. Twenty-four cats were enrolled in the study with a total number of 27 neoplasms: 13 sarcomas, 12 carcinomas, one melanoma and one neuroendocrine tumour. Seventeen cats presented with macroscopic disease, while seven had microscopic disease. Seven cats (29%) had metastasis either to the regional lymph nodes and/or distant sites at the time of study enrolment. Additional medications, administered concurrently, included non-steroidal anti-inflammatory drugs (17), toceranib (4) and thalidomide (7). Four cats showed grade I gastrointestinal toxicity during the first month of treatment, which was controlled with antiemetics. Overall, 2/24 cats (8%) showed grade I haematological toxicities and 1/24 (4%) showed grade I renal toxicity in the first 4 weeks. Median follow-up for all cats was 30 days (range 30-360 days). For the 15 cats with follow-up longer than 1 month the only additional toxicities observed were two grade III and one grade II azotaemia that occurred after 2 months of therapy. Low-dose cyclophosphamide seems to be a well-tolerated option for cats bearing primary or metastatic tumours. Evaluation of toxicity after long-term administration is still needed.
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Affiliation(s)
- Chiara Leo
- Oncology Service, Royal Veterinary College, University of London, London, UK
| | - Anneliese Stell
- Oncology Service, Royal Veterinary College, University of London, London, UK
| | - Juan Borrego
- Veterinary Institute of Comparative Oncology, Valencia, Spain Veterinary Hospital, University of Veterinary and Experimental Sciences, Catholic University of Valencia 'San Vicente Martir', Valencia, Spain
| | | | | | - Ana Lara-Garcia
- Oncology Service, Royal Veterinary College, University of London, London, UK
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Rassnick KM, Bailey DB, Malone EK, Flory AB, Kiselow MA, Intile JL. Tolerability of Lomustine in Combination with Cyclophosphamide in Dogs with Lymphoma. J Am Anim Hosp Assoc 2014; 50:167-73. [DOI: 10.5326/jaaha-ms-6020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This retrospective study describes toxicity associated with a protocol of lomustine (CCNU) and cyclophosphamide (CTX) in dogs with lymphoma. CCNU was administered per os (PO) at a targeted dosage of 60 mg/m2 body surface area on day 0, CTX was administered PO at a targeted dosage of 250 mg/m2 divided over days 0 through 4, and all dogs received prophylactic antibiotics. Ninety treatments were given to the 57 dogs included in the study. Neutropenia was the principal toxic effect, and the overall frequency of grade 4 neutropenia after the first treatment of CCNU/CTX was 30% (95% confidence interval, 19–43%). The mean body weight of dogs with grade 4 neutropenia (19.7 kg ± 13.4 kg) was significantly less than the mean body weight of dogs that did not develop grade 4 neutropenia (31.7 kg ± 12.4 kg; P = .005). One dog (3%) developed hematologic changes suggestive of hepatotoxicity. No dogs had evidence of either renal toxicity or hemorrhagic cystitis. Adverse gastrointestinal effects were uncommon. On the basis of the findings reported herein, a dose of 60 mg/m2 of CCNU combined with 250 mg/m2 of CTX (divided over 5 days) q 4 wk is tolerable in tumor-bearing dogs.
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Affiliation(s)
- Kenneth M. Rassnick
- Veterinary Medical Center of Central New York, East Syracuse, NY (K.R.); Oradell Animal Hospital, Paramus, NJ (D.B.); MedVet Medical and Cancer Center for Pets, Worthington, OH (E.M.); Veterinary Specialty Hospital, San Marcos, CA (A.F.); Sage Centers for Veterinary Specialty and Emergency Care, Campbell, CA (M.K.); and VCA Veterinary Referral Associates, Gaithersburg, MD (J.I.)
| | - Dennis B. Bailey
- Veterinary Medical Center of Central New York, East Syracuse, NY (K.R.); Oradell Animal Hospital, Paramus, NJ (D.B.); MedVet Medical and Cancer Center for Pets, Worthington, OH (E.M.); Veterinary Specialty Hospital, San Marcos, CA (A.F.); Sage Centers for Veterinary Specialty and Emergency Care, Campbell, CA (M.K.); and VCA Veterinary Referral Associates, Gaithersburg, MD (J.I.)
| | - Erin K. Malone
- Veterinary Medical Center of Central New York, East Syracuse, NY (K.R.); Oradell Animal Hospital, Paramus, NJ (D.B.); MedVet Medical and Cancer Center for Pets, Worthington, OH (E.M.); Veterinary Specialty Hospital, San Marcos, CA (A.F.); Sage Centers for Veterinary Specialty and Emergency Care, Campbell, CA (M.K.); and VCA Veterinary Referral Associates, Gaithersburg, MD (J.I.)
| | - Andrea B. Flory
- Veterinary Medical Center of Central New York, East Syracuse, NY (K.R.); Oradell Animal Hospital, Paramus, NJ (D.B.); MedVet Medical and Cancer Center for Pets, Worthington, OH (E.M.); Veterinary Specialty Hospital, San Marcos, CA (A.F.); Sage Centers for Veterinary Specialty and Emergency Care, Campbell, CA (M.K.); and VCA Veterinary Referral Associates, Gaithersburg, MD (J.I.)
| | - Michael A. Kiselow
- Veterinary Medical Center of Central New York, East Syracuse, NY (K.R.); Oradell Animal Hospital, Paramus, NJ (D.B.); MedVet Medical and Cancer Center for Pets, Worthington, OH (E.M.); Veterinary Specialty Hospital, San Marcos, CA (A.F.); Sage Centers for Veterinary Specialty and Emergency Care, Campbell, CA (M.K.); and VCA Veterinary Referral Associates, Gaithersburg, MD (J.I.)
| | - Joanne L. Intile
- Veterinary Medical Center of Central New York, East Syracuse, NY (K.R.); Oradell Animal Hospital, Paramus, NJ (D.B.); MedVet Medical and Cancer Center for Pets, Worthington, OH (E.M.); Veterinary Specialty Hospital, San Marcos, CA (A.F.); Sage Centers for Veterinary Specialty and Emergency Care, Campbell, CA (M.K.); and VCA Veterinary Referral Associates, Gaithersburg, MD (J.I.)
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20
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Laberke S, Zenker I, Hirschberger J. Mesna and furosemide for prevention of cyclophosphamide-induced sterile haemorrhagic cystitis in dogs - a retrospective study. Vet Rec 2014; 174:250. [DOI: 10.1136/vr.101574] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- S. Laberke
- Clinic of Small Animal Medicine; Ludwig Maximilian University Munich; Veterinärstr. 13 80539 Munich Germany
| | - I. Zenker
- University of California, Davis School of Veterinary Medicine; Department of Radiation Oncology; 1 Shields Avenue Davis CA 95616 USA
| | - J. Hirschberger
- Clinic of Small Animal Medicine; Ludwig Maximilian University Munich; Veterinärstr. 13 80539 Munich Germany
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21
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Affiliation(s)
- Jane Dobson
- Department of Veterinary Medicine; University of Cambridge; Madingley Road Cambridge CB3 0ES UK
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22
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MacDonald V, Dickinson R. Hemorrhagic cystitis in a dog receiving carboplatin. J Am Anim Hosp Assoc 2013; 50:67-70. [PMID: 24216493 DOI: 10.5326/jaaha-ms-5965] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
An 8 yr old castrated male Labrador retriever mixed-breed dog with osteosarcoma (OSA) of the left proximal humerus receiving carboplatin presented 10 days after the third chemotherapy treatment with hematuria, stranguria, and pollakiuria. A presumptive diagnosis of hemorrhagic cystitis was made based on clinical signs, urinalysis, and cytologic analysis of a traumatic catheterization sample. Carboplatin was removed from the chemotherapy treatment plan and was substituted with doxorubicin. The dog was treated with meloxicam for pain, and the cystitis signs subsided over a period of 4 wk. Carboplatin is commonly used as adjuvant chemotherapy for dogs with OSA following amputation and is not known to cause hematuria in dogs, although there are reports of this occurring in humans. To the authors' knowledge, there are no reports in the veterinary literature of this toxicity.
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Affiliation(s)
- Valerie MacDonald
- Department of Small Animal Clinical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK, Canada
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23
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Best MP, Fry DR. Incidence of sterile hemorrhagic cystitis in dogs receiving cyclophosphamide orally for three days without concurrent furosemide as part of a chemotherapeutic treatment for lymphoma: 57 cases (2007–2012). J Am Vet Med Assoc 2013; 243:1025-9. [DOI: 10.2460/javma.243.7.1025] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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24
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Alvarez FJ, Hosoya K, Lara-Garcia A, Kisseberth W, Couto G. VAC protocol for treatment of dogs with stage III hemangiosarcoma. J Am Anim Hosp Assoc 2013; 49:370-7. [PMID: 24051260 DOI: 10.5326/jaaha-ms-5954] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Hemangiosarcomas (HSAs) are aggressive tumors with a high rate of metastasis. Clinical stage has been considered a negative prognostic factor for survival. The study authors hypothesized that the median survival time (MST) of dogs with metastatic (stage III) HSA treated with a vincristine, doxorubicin, and cyclophosphamide (VAC) chemotherapy protocol would not be different than those with stage I/II HSA. Sixty-seven dogs with HSA in different anatomic locations were evaluated retrospectively. All dogs received the VAC protocol as an adjuvant to surgery (n = 50), neoadjuvant (n = 3), or as the sole treatment modality (n = 14). There was no significant difference (P = 0.97) between the MST of dogs with stage III and stage I/II HSA. For dogs presenting with splenic HSA alone, there was no significant difference between the MST of dogs with stage III and stage I/II disease (P = 0.12). The overall response rate (complete response [CR] and partial response [PR]) was 86%). No unacceptable toxicities were observed. Dogs with stage III HSA treated with the VAC protocol have a similar prognosis to dogs with stage I/II HSA. Dogs with HSA and evidence of metastases at the time of diagnosis should not be denied treatment.
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Christensen NI, Brain PH, Langova V, Flory AB. Vaginal discharge in a spayed dog with multiple distinct malignancies. Aust Vet J 2013; 91:287-91. [DOI: 10.1111/avj.12067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2012] [Indexed: 11/29/2022]
Affiliation(s)
- NI Christensen
- Small Animal Specialist Hospital; 1/1 Richardson Place, North Ryde; New South Wales; Australia
| | - PH Brain
- Small Animal Specialist Hospital; 1/1 Richardson Place, North Ryde; New South Wales; Australia
| | - V Langova
- Small Animal Specialist Hospital; 1/1 Richardson Place, North Ryde; New South Wales; Australia
| | - AB Flory
- Veterinary Specialty Hospital; San Marcos; CA; USA
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Gaeta R, Brown D, Cohen R, Sorenmo K. Risk factors for development of sterile haemorrhagic cystitis in canine lymphoma patients receiving oral cyclophosphamide: a case-control study. Vet Comp Oncol 2012; 12:277-86. [DOI: 10.1111/vco.12009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2012] [Revised: 08/31/2012] [Accepted: 09/20/2012] [Indexed: 12/01/2022]
Affiliation(s)
- R. Gaeta
- Department of Clinical Studies; Matthew J. Ryan Veterinary Hospital; University of Pennsylvania School of Veterinary Medicine; Philadelphia PA USA
| | - D. Brown
- Department of Clinical Studies; Matthew J. Ryan Veterinary Hospital; University of Pennsylvania School of Veterinary Medicine; Philadelphia PA USA
| | - R. Cohen
- Department of Clinical Studies; Matthew J. Ryan Veterinary Hospital; University of Pennsylvania School of Veterinary Medicine; Philadelphia PA USA
| | - K. Sorenmo
- Department of Clinical Studies; Matthew J. Ryan Veterinary Hospital; University of Pennsylvania School of Veterinary Medicine; Philadelphia PA USA
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27
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Elliott JW, Cripps P, Marrington AM, Grant IA, Blackwood L. Epirubicin as part of a multi-agent chemotherapy protocol for canine lymphoma. Vet Comp Oncol 2012; 11:185-98. [DOI: 10.1111/j.1476-5829.2011.00311.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- J. W. Elliott
- Small Animal Teaching Hospital; University of Liverpool; Wirral; UK
| | - P. Cripps
- Small Animal Teaching Hospital; University of Liverpool; Wirral; UK
| | - A. M. Marrington
- Small Animal Teaching Hospital; University of Liverpool; Wirral; UK
| | - I. A. Grant
- Small Animal Teaching Hospital; University of Liverpool; Wirral; UK
| | - L. Blackwood
- Small Animal Teaching Hospital; University of Liverpool; Wirral; UK
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Warry E, Hansen RJ, Gustafson DL, Lana SE. Pharmacokinetics of cyclophosphamide after oral and intravenous administration to dogs with lymphoma. J Vet Intern Med 2011; 25:903-8. [PMID: 21564295 DOI: 10.1111/j.1939-1676.2011.0730.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Cyclophosphamide is an alkylating chemotherapeutic drug administered i.v. or p.o.. It is currently assumed that exposure to the active metabolite, 4-hydroxycyclophosphamide (4-OHCP), is the same with either route of administration. OBJECTIVES To characterize the pharmacokinetics of cyclophosphamide and 4-OHCP in dogs with lymphoma when administered p.o. or i.v.. ANIMALS Sixteen client-owned dogs with substage A lymphoma were enrolled in the study. Eight dogs received cyclophosphamide i.v. and 8 received it p.o.. METHODS Prospective randomized clinical trial was performed. Blood was collected from each dog at specific time points after administration of cyclophosphamide. The serum was evaluated for the concentration of cyclophosphamide and 4-OHCP with mass spectrometry and liquid chromatography. RESULTS Drug exposure to cyclophosphamide measured by area under the curve (AUC)(0-inf) is significantly higher after intravenous administration (7.14 ± 3.77 μg/h/mL) compared with exposure after oral administration (P-value < .05). No difference in drug exposure to 4-OHCP was detected after i.v. (1.66 ± 0.36 μg/h/mL) or p.o. (1.42 ± 0.64 μg/h/mL) administered cyclophosphamide. CONCLUSIONS AND CLINICAL IMPORTANCE Drug exposure to the active metabolite 4-OHCP is equivalent after administration of cyclophosphamide either p.o. or i.v..
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Affiliation(s)
- E Warry
- Animal Cancer Center, Colorado State University, Fort Collins, CO 80523-1620, USA.
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29
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Watson M. Furosemide. J Exot Pet Med 2011. [DOI: 10.1053/j.jepm.2010.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Lori JC, Stein TJ, Thamm DH. Doxorubicin and cyclophosphamide for the treatment of canine lymphoma: a randomized, placebo-controlled study. Vet Comp Oncol 2010; 8:188-95. [PMID: 20691026 DOI: 10.1111/j.1476-5829.2010.00215.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Median survival times (STs) for doxorubicin-treated canine lymphoma range from 5.7 to 9 months. Because dogs treated with multi-agent protocols have longer STs, we sought to evaluate whether adding cyclophosphamide would improve outcome in canine lymphoma patients while maintaining an acceptable level of toxicity. Thirty-two dogs with stage III-V multicentric lymphoma were treated with doxorubicin every 3 weeks for five total cycles and prednisone at a tapering dose for the first 4 weeks. Dogs were randomized to receive either cyclophosphamide or placebo concurrently. Seventeen dogs received doxorubicin and placebo, while 15 dogs received doxorubicin and cyclophosphamide. Response, toxicity, progression-free interval (PFI) and ST were evaluated. The combination of doxorubicin and cyclophosphamide was well tolerated, causing no increase in adverse events over doxorubicin alone. Despite a numeric improvement in outcome in cyclophosphamide treated dogs, the addition of cyclophosphamide did not result in statistically improved response rate, PFI or ST.
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Affiliation(s)
- J C Lori
- Animal Cancer Center, Colorado State University College of Veterinary Medicine, Fort Collins, CO 80523-1620, USA
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31
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Chun R. Lymphoma: Which Chemotherapy Protocol and Why? Top Companion Anim Med 2009; 24:157-62. [DOI: 10.1053/j.tcam.2009.03.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2009] [Accepted: 03/21/2009] [Indexed: 11/11/2022]
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Mutsaers AJ. Metronomic Chemotherapy. Top Companion Anim Med 2009; 24:137-43. [DOI: 10.1053/j.tcam.2009.03.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2009] [Accepted: 03/26/2009] [Indexed: 11/11/2022]
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Smith P, Stalin C, Shaw D, Granger N, Jeffery N. Comparison of Two Regimens for the Treatment of Meningoencephalomyelitis of Unknown Etiology. J Vet Intern Med 2009; 23:520-6. [DOI: 10.1111/j.1939-1676.2009.0299.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
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Elmslie RE, Glawe P, Dow SW. Metronomic Therapy with Cyclophosphamide and Piroxicam Effectively Delays Tumor Recurrence in Dogs with Incompletely Resected Soft Tissue Sarcomas. J Vet Intern Med 2008; 22:1373-9. [PMID: 18976288 DOI: 10.1111/j.1939-1676.2008.0179.x] [Citation(s) in RCA: 113] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Affiliation(s)
- R E Elmslie
- Veterinary Cancer Specialists, Englewood, CO, USA
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Vaughan A, Johnson JL, Williams LE. Impact of Chemotherapeutic Dose Intensity and Hematologic Toxicity on First Remission Duration in Dogs with Lymphoma Treated with a Chemoradiotherapy Protocol. J Vet Intern Med 2007. [DOI: 10.1111/j.1939-1676.2007.tb01956.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Camps-Palau MA, Leibman NF, Elmslie R, Lana SE, Plaza S, McKnight JA, Risbon R, Bergman PJ. Treatment of canine mast cell tumours with vinblastine, cyclophosphamide and prednisone: 35 cases (1997?2004). Vet Comp Oncol 2007; 5:156-67. [DOI: 10.1111/j.1476-5829.2006.00125.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lana S, U'ren L, Plaza S, Elmslie R, Gustafson D, Morley P, Dow S. Continuous Low-Dose Oral Chemotherapy for Adjuvant Therapy of Splenic Hemangiosarcoma in Dogs. J Vet Intern Med 2007. [DOI: 10.1111/j.1939-1676.2007.tb03019.x] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Woodward KN. Veterinary pharmacovigilance. Part 3. Adverse effects of veterinary medicinal products in animals and on the environment. J Vet Pharmacol Ther 2005; 28:171-84. [PMID: 15842306 DOI: 10.1111/j.1365-2885.2005.00647.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Like humans, animals may experience adverse effects when treated with medicinal products. These effects may be related to the pharmacological or toxicological properties of the substances used or they may arise because of hypersensitivity. Veterinary medicinal products may also possess the ability to harm the environment. This paper reviews the potential of veterinary medicinal products to cause adverse effects in animals and on the environment.
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Affiliation(s)
- K N Woodward
- Schering-Plough Animal Health, Uxbridge, Middlesex, UK.
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39
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Affiliation(s)
- Marc Kent
- Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, 501 DW Brooks Drive, Athens, GA 30602, USA.
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