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- 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.

(upbeat music)

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,

traditional chemotherapy.

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.

(musical beat)

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,

Leukeran, Chlorambucil,

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.

(upbeat music)

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