- Welcome back to the vlog.
Today, is part two of my video on metastatic cancer
and how I typically treat it
with something called metronomic or low dose oral chemo.
If you're finding this video, please hit pause,
I promise I'll be here when you come back.
But, I would like you to watch vlog number 105,
and that is where I go through
what metronomic chemotherapy is
and why I'm treating metastatic cancer,
cancer that has spread, whether it's to the lungs,
which is the more common place in dogs and sometimes cat,
or the abdomen, with this type of chemotherapy.
And I go through how it's different
than maximum tolerated dose chemotherapy.
In this video, I'm gonna tell you
the different drugs that I use
that your veterinarian
or your cancer specialist may talk to you about.
Protocols can be a little bit different,
so I'm not gonna give you specific recommendations
for your pet.
I love to hear from you, but I'm not gonna be able
to make those recommendations.
So, please seek out a specialist
or talk to your veterinarian about
the questions regarding your pet.
I do want to share with you a couple of the cases,
because as I talked about in the last video,
I really have seen some remarkable cases over the years,
and before this type of chemotherapy,
we didn't have many options for dogs and cats
with metastatic cancer or cancer that has spread.
So, I'm gonna tell you about Oprah,
which was a case that I treated
and one of the very first cases which was Reeses
and then we'll talk about the different drugs
and then we'll wrap it up.
All right, let's break it down.
So Reeses was, when I first met him,
a nine-year-old male castrated Pit Bull, a pity,
and he was one of the very first dogs
that I used Palladia, which is a mass cell tumor drug,
so, again, I talk about this in the last video,
extra label use, so using it for something
than what it's described for on the label
what it was FDA approved for.
And it's okay, it's legal to do that,
but he came to see me after he had been diagnosed
with an anal sac adenocarcinoma, so
and it was metastasized,
it had spread to sublumbar lymph nodes
and also to his lungs.
And we're gonna show you his X-rays,
and his X-Rays are the ones
that when I was a resident, we'd put up on the light box
or you put up on now, on a computer
and you know, just really, really bad
because he had metastatic cancer
spread throughout his lungs.
He also was not feeling well when he came in
and he also had something called hypercalcemia,
so high blood calcium,
which is a negative prognostic factor
for dogs with anal sac cancer.
He had seen another oncologist
and they had tried maximum tolerated dose,
I had met him two months later and we had done some things,
I'm not gonna go through all the details,
but we had used steroids to try to get his calcium down,
increase his appetite,
but eventually, I switched him over
about two months into that, onto Palladia.
We're gonna talk about the different drugs
that I use in the protocol coming up.
But, eventually I got him on Palladia
and lose dose cyclophosphamide
and again, we'll talk about those different drugs
and we did a series of x-rays and followed him
and so, we started him on Palladia.
He was diagnosed around Christmas in 2009.
I started him on Palladia in March of 2010.
Again, he had been on some traditional chemo before that.
We had used steroids to lower his calcium
and improve his appetite
because as I talked about in the last video,
it's really important that they're eating pretty well.
We had used Cerenia and things like that
to get his appetite up.
Entyce was not yet on the market.
And then, I took x-rays two months later
and I was pretty excited with his x-rays.
One, his quality of life had improved two months on therapy,
the radiologist actually thought that some of the nodules
was smaller and less defined,
so we talked about in the last video
how we can have a slow response.
So again, we were seeing some improvement,
but he was gaining weight, his appetite was improving,
he was having more energy.
This was a really sick dog when I first met him.
His coughing was improving.
When you look at those x-rays, those radiographs,
you're not surprised that you know,
he was not feeling well when he came in.
So, when he was on the protocol for about,
you know, week 25, so now, in September,
so about six months into the protocol,
some of the nodules were cavitated,
but he did have more nodules
and they were a little bit larger,
so his quality of life sadly started
to deteriorate the following month,
so in October,
the end of October in 2010 and so,
and he was humanely euthanized at that time.
But, this was a dog that lived 10 months
with metastasis, pretty significant metastasis,
high blood calcium, and had a really poor quality of life
when I first met him
and during the six months that we had him on Palladia
with you know, all the other things that we did,
he had a really improved quality of life
and the owners were really, really satisfied with that.
And you know, if you had told me before that
that this dog was gonna have
a great quality of life 10 months with those x-rays
that originally were taken in, you know December,
right around Christmas in 2009,
I would not have believed it, so pretty remarkable.
The second case that I had a really good response was Oprah
and she was, when I first met her,
an eight year old female spade, recently spade Doberman
that had history of mammary tumors
and so she, her chest x-rays were a little bit different,
but she had two very large nodules in her lungs
and then, some smaller nodules that we saw on CT.
So, we determined that they were not resectable,
not gonna be, you know, able to remove
'cause she had two big masses plus other ones.
We did aspirate the the bigger one and it was carcinoma.
We never were able to figure out,
was it primary lung cancer that had spread to her lungs
or mammary cancer that had spread to her lungs.
You know, there was no point of going to surgery
with these two very large masses.
So, in December of 2013, she has a very huge mass
in front of the heart and then, a very,
a second large mass behind the heart.
We decided to put her on this Palladia based protocol
with low dose cyclophosphamide.
She was on some supplements, as well.
As I talked about, this was a slow acting protocol,
so I usually do not take chest x-rays or follow up imaging
for about two to three months.
We did take follow up imaging in March of 2014.
So, she had been on the protocol
for about two to three months
and things were pretty status quo
when you look at the images that we'll show you.
Our next set of films that I'm gonna show you
are in September of 2014,
so about six months later
and we were pretty surprised, as well,
so the mass in front of her heart,
towards the front of her body was pretty much resolved
and the mass behind her heart,
basically over the time period that I treated her,
kind of waxed and waned in size,
a little bit bigger, a little bit smaller,
so, you can see Oprah's continuing to come in,
so now, we're about a year after her diagnosis
and she's in her Christmas sweater
and you can see her images as well,
so again, mass in front of the heart remained gone
and the one behind her heart, closer to her diaphragm
to the abdomen, pretty stable.
Oprah definitely got dressed up for many, many holidays
when she came in and that was always so much fun.
She comes in for Halloween, you know, all dressed up.
She actually won the Halloween basket,
so just a fabulous, fabulous dog.
She remained status quo over the period of time.
She was a dog that did have sero-hemorrhagic cystitis,
one of the few dogs,
I talk about that as we go through the drugs
that we did have to stop that.
That was a side effect,
so she was one of the few dogs over the years,
but this was a dog who lived almost three years
with those chest x-rays,
which was pretty amazing and Mom was very grateful
for the time that she had and again,
just a pretty amazing response.
So, let me tell you about the drugs that we have
and it's just nice to know that they are options
for dogs with you know, images like Reeses and like Oprah,
and like I said, I had other dogs like Goliath
and other ones.
I've used this for other cancers, as well,
so it's pretty amazing in my humble opinion
and let me tell you about the drugs
and then, we'll wrap it up.
(musical beat) Okay,
finally I'm gonna wrap up with what are the different drugs
that we use in this protocol.
So typically, we're gonna use a low dose oral chemotherapy,
an alkylating agent.
The most common one that I'm using
is low dose cyclophosphamide.
It's a drug that we use in higher dosages,
commonly in the lymphoma chemotherapy protocols
for dogs and cats.
It's usually gonna be compounded into a size
that fits specifically for your dog,
usually given every other day, or three times a week,
but, it can cause bladder irritation,
so you're gonna give it in the morning.
So, that's typically well tolerated.
And then, there are some other drugs, as well,
that's one that has recently gone up in price.
If your dog's having urinary side effects
that can be one that will be used
or relapses on cyclophosphamide
and then, low dose compounded Lomustine is another option.
I don't typically that one, but it has been reported
as another alternative option.
So, that's gonna be your lose dose chemotherapy.
Then, you need something to target those blood vessels.
That's often a non-steroidal anti-inflammatory or Palladia.
Palladia, and I just saw a dog, today, guys,
that had metastatic cancer to the lungs.
This actually, we knew where the primary was.
The dog had a recurrent soft tissue sarcoma
over the wrist, over the carpus.
Was originally removed almost two years ago,
grew back about a year and a half later
and then, had a second surgery and then,
just grew back about a month ago.
We think, that's what the reason it has metastasized
to the lungs, that's the lung nodules
and the owner was Googling,
he was like, why am I using Palladia,
this mass cell tumor drug?
So, it is a drug that does target a certain mutation
in skin tumors called mass cell tumors,
but also has this anti angiogenic effect,
so it inhibits some other growth factors
that are involved in blood vessel formation,
so anti angiogenic.
So, for dogs that have measurable metastasis, nodules,
chest or abdomen, I usually will combine
Palladia with cyclophosphamide.
I don't start them together.
I want to make sure they're tolerant,
the Palladia and then, I add the cyclophosphamide.
They're on a stomach protectant, as well,
and you're gonna go home with just in case medication,
as described in vlog number 93.
In come cases, you may be on Doxycycline depending
on the protocol.
Yes, that is a tick antibiotic.
At low doses, it is thought to have an anti cancer
and anti inflammatory effect.
The exact protocol is something
that's gonna be discussed with you and your oncologist.
We'll put links below on how to find an oncologist
or talk to your veterinarian
to see if they're comfortable managing this protocol.
So, that's really my summary, guys,
about metastatic disease and metronomic chemotherapy.
Like I mentioned, there are some other uses for it,
those incompletely resected soft tissue sarcomas.
I've used it in incompletely resected pato selo carcinomas
where none of the chemotherapy options work
and this has seems to work in some of the patients.
So, it's definitely a good option to be considered.
There are definitely side effects
that you are gonna wanna talk to your oncologist about.
Please find an oncologist.
Remember, I can't make specific recommendations
through YouTube, through Facebook, through Instagram.
This is to give you an overview,
so you have a basis of information.
I have found the majority of patients on this protocol
with proper monitoring, with their just in case medications,
can really tolerate this protocol quite well.
Some dogs will need dose modifications.
They will need their Palladia to be adjusted.
Some dogs will need Cerenia before Palladia
on you know, it's given three days a week,
some dogs will not, so every dog is an individual
and that's what I do with my patients,
is modify everything to make sure they have
a great quality of life.
Like I said, I've had patients on it for three to four years
where we've been able to stabilize their metastatic disease
and stabilizing metastatic disease for that long
is pretty phenomenal, in my humble opinion.
So, it's an option worth considering.
I hope this information was helpful.
Please leave me comment.
Don't forget to subscribe.
I'm sorry that you were here
and you know, researching metastatic disease.
I know it's a crappy time.
Again, I hope you found this information helpful.
Oh, guys, one more thing.
I also do have an information sheet,
a printed, a sheet,
that I would be giving you if you were able
to come see me in my practice.
It's on my website, Dr Sue Cancer Vet,
we will but a link below,
so that's a printed out sheet
about metronomic chemotherapy, as well,
if you wanted to print that out, just to have something
to read after you're done with this video.
Thanks again for watching.
I'll see ya at the next video.