[PyrNet-L] CHAT, HEALTH: Lymphoma/Clondike Update

[David P Kintsfather Jr <kintsfat@kutztown.edu>]

Clondike is an 11 year-old Pyr bitch diagnosed with lymphoma back in May.
We did chemotherapy all summer and she was in complete remission until
early December.

We have tried two of the basic chemo drugs since she lost the remission
and she has been able to hold a partial remission for a little over a
week.  She has, however, shown some rear end weakness that appears
neurological which our vets think is related to 2 sequential doses of
vincristine, while the oncologist suspects the cancer as the underlying
cause.

We have wanted to avoid adriamycin, the most effective chemo agent against
lymphoma, but one that almost killed Clondike during her first cycle of
drugs.  We were able to skip it during the 2nd cycle and use a patented
monoclonal antibody treatment to get 4 months of remission w/o chemo.

This past week Clondike's nodes were swelling at an alarming rate and
Thursday and Friday she really looked like the cancer was making her feel
bad for the first time (so far the chemo has caused far more symptoms than
the cancer).  The oncologist proposed trying a new protocol just developed
at Ohio State which uses entirely different drugs than the 1st line
agents.  She said that these drugs are better tolerated by the digestive
system and don't turn on the MDR (multi-drug response) gene which makes
the cells immune to future treatments.  I believe the down side is that
fewed dogs respond to this protocol than the standard one.

The oncologist still feels a protocol involving adriamycin can be given
safely and would result in a higher probability of attaining a full
remission, but feels that this alternative protocol may work well and does
not preclude trying adriamycin in the future.  An additional attraction of
this new protocol is that it does not include vincristine and none of the
individual agents appears to be a neurotoxin, so hopefully we won't mess
up Clondike's rear end function any further.

For the vets out there this is the DMAC protocol employing a cycle of two
drug combinations given one a week, usually for 5-8 cycles (10-16 weeks).
The first treatment is dexamethasone, cytosar and actinomycin D.  This
requires a 4 hour drip.  The 2nd treatment is actinomycin D and melphalan.
It is just a shot and tablets.

I was pretty nervous about this, but as we got the first 4 hour drip, I
met a lady who is on the 2nd cycle of the same protocol.  She said her dog
had no side effects at all and that his nodes had gone down considerably.
The technician also said she has not encountered major side effects with
several dogs she has treated.  We elected to use darbazine for nausea
prevention, the stronger of their basic drugs.  We also got a prescription
for zofran, a very effective anti-nausea drug that costs $60 a day :(.

The amazing news is that last night, 24 hours after treatment, Clondike's
nodes were down dramatically!!  With the conventional drugs it usually
takes 4 days for any effect to be noticable.  This may be a transitory
effect of the steroid (dex) in the mix, but at this point we'll take any
response as a positive sign.

We are now more than 48 hours post treatment, the time at which you
usually see nausea if it is going to develop.  Clondike appears to be
feeling better (her eyes are brighter) and she ate with great enthusiasm.

I am not expecting any miracle cure, but in the roller coaster ride of
chemo therapy, I think we may be on an upswing.  I don't know if Clondike
would be a candidate for another round of monoclonal antibodies if this
protocol results in a complete remission, but I will ask.  It hadn't
occurred to me before that this might even be a possibility.

I think we are pretty much out in uncharted territory with this protocol,
which apparently has only been in clinical use for a month or 2.  I'll
keep you posted.

David

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 David Kintsfather              | PHONE:       (610) 683-4497
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 PO Box 730                     |   "We need not think alike to love alike."
 Kutztown, PA  19530-0730       |                Francis David
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