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Dose Intensive CHOP Protocol for Canine Multicentric Lymphoma
PAG E 6
A D VA N C E S
prednisone), are the most effective treatment for canine lymphoma. However, there has been no substantial improvement in patient outcome since the addition of DOX to these protocols nearly 2 decades ago. Canine lymphoma is highly chemoresponsive, with reported remission rates of greater than 85% and survival times ranging from 8 to 12 months for most protocols. Despite high remission rates, these protocols are rarely curative. Half of the dogs treated will relapse and succumb to their disease within 1 year of diagnosis, and less than 25% of patients will experience remissions greater than 2 years. Because treatment of lymphoma is largely palliative in nature, many pet owners are reluctant to commit the financial resources and time necessary to treat their pet with a weekly multidrug protocol. Dose intensity (DI) is defined as the amount of chemotherapeutic agent(s) delivered over a unit of time. It has been demonstrated that human patient outcome for many malignancies is improved with administration of more dose-intense chemotherapy regimens.
Objectives To determine if a 15-week dose-intense CHOP protocol would have shorter treatment duration with similar efficacy to other doxorubicin-based multidrug protocols.
Procedure Thirty-one client owned dogs with multicentric lymphoma were treated with a 15-week CHOP chemotherapy protocol.
Results There was an overall response rate of 100% and a median progression-free interval (PFI) of 140 days. Dogs that had 2 or more treatment delays had significantly prolonged PFI and overall survival. Dose intensity did not correlate with patient outcome.
Author Conclusion
DOSE INTENSIVE CHOP PROTOCOL FOR CANINE MULTICENTRIC LYMPHOMA Background Doxorubicin (DOX)-based, multidrug chemotherapy protocols, such as CHOP (cyclophosphamide, DOX, vincristine, and
Dogs experiencing multiple treatment delays secondary to adverse events may receive their individual maximally tolerated dose, while dogs with no adverse events may be underdosed.
Inclusions Five tables, 21 references.
Editor Annotation People undergoing chemotherapy for various types of cancer have improved outcomes when they receive more aggressive, dose-intense chemotherapy for their disease. The purpose of this study was to see if a similar benefit exists for dogs with lymphoma. Unfortunately, neither one of the 2 dose-intense CHOP protocols studied resulted in improved outcomes compared to those historically documented in dogs treated with standard CHOP protocols. However, these investigators did make one intriguing observation that dogs in their study that had 2 or more treatment delays during the course of therapy enjoyed significantly longer remission and survival times. This observation was hypothesized to reflect more aggressive and therefore more effective treatment in this subset of animals. Ultimately, it seems possible that optimal chemotherapy for canine lymphoma will incorporate individualized, incremental increases in drug doses for animals that will tolerate them, similar to the individualized, incremental decreases that are commonly implemented to address treatment-related toxicity. In the meantime, the results of this study strongly suggest that veterinarians managing dogs with lymphoma should not hesitate to delay a scheduled treatment to permit recovery from legitimate complications of therapy. They should also avoid arbitrarily decreasing recommended drug doses when they encounter clinically insignificant adverse effects. (GEM) Burton JH, Garrett-Mayer E, Thamm DH. Evaluation of a 15-week CHOP protocol for the treatment of canine multicentric lymphoma. Vet Comp Oncology 2012;11:306-315.
A D VA N C E S
prednisone), are the most effective treatment for canine lymphoma. However, there has been no substantial improvement in patient outcome since the addition of DOX to these protocols nearly 2 decades ago. Canine lymphoma is highly chemoresponsive, with reported remission rates of greater than 85% and survival times ranging from 8 to 12 months for most protocols. Despite high remission rates, these protocols are rarely curative. Half of the dogs treated will relapse and succumb to their disease within 1 year of diagnosis, and less than 25% of patients will experience remissions greater than 2 years. Because treatment of lymphoma is largely palliative in nature, many pet owners are reluctant to commit the financial resources and time necessary to treat their pet with a weekly multidrug protocol. Dose intensity (DI) is defined as the amount of chemotherapeutic agent(s) delivered over a unit of time. It has been demonstrated that human patient outcome for many malignancies is improved with administration of more dose-intense chemotherapy regimens.
Objectives To determine if a 15-week dose-intense CHOP protocol would have shorter treatment duration with similar efficacy to other doxorubicin-based multidrug protocols.
Procedure Thirty-one client owned dogs with multicentric lymphoma were treated with a 15-week CHOP chemotherapy protocol.
Results There was an overall response rate of 100% and a median progression-free interval (PFI) of 140 days. Dogs that had 2 or more treatment delays had significantly prolonged PFI and overall survival. Dose intensity did not correlate with patient outcome.
Author Conclusion
DOSE INTENSIVE CHOP PROTOCOL FOR CANINE MULTICENTRIC LYMPHOMA Background Doxorubicin (DOX)-based, multidrug chemotherapy protocols, such as CHOP (cyclophosphamide, DOX, vincristine, and
Dogs experiencing multiple treatment delays secondary to adverse events may receive their individual maximally tolerated dose, while dogs with no adverse events may be underdosed.
Inclusions Five tables, 21 references.
Editor Annotation People undergoing chemotherapy for various types of cancer have improved outcomes when they receive more aggressive, dose-intense chemotherapy for their disease. The purpose of this study was to see if a similar benefit exists for dogs with lymphoma. Unfortunately, neither one of the 2 dose-intense CHOP protocols studied resulted in improved outcomes compared to those historically documented in dogs treated with standard CHOP protocols. However, these investigators did make one intriguing observation that dogs in their study that had 2 or more treatment delays during the course of therapy enjoyed significantly longer remission and survival times. This observation was hypothesized to reflect more aggressive and therefore more effective treatment in this subset of animals. Ultimately, it seems possible that optimal chemotherapy for canine lymphoma will incorporate individualized, incremental increases in drug doses for animals that will tolerate them, similar to the individualized, incremental decreases that are commonly implemented to address treatment-related toxicity. In the meantime, the results of this study strongly suggest that veterinarians managing dogs with lymphoma should not hesitate to delay a scheduled treatment to permit recovery from legitimate complications of therapy. They should also avoid arbitrarily decreasing recommended drug doses when they encounter clinically insignificant adverse effects. (GEM) Burton JH, Garrett-Mayer E, Thamm DH. Evaluation of a 15-week CHOP protocol for the treatment of canine multicentric lymphoma. Vet Comp Oncology 2012;11:306-315.