(upbeat music) – Hey, everybody, welcome back to the vlog, I’m Dr. Sue Cancer Vet. I just got home from work, and it is the summer, and I’ve decided that I wanna get my next vlog in. This is a vlog I really wanted to do for a while, because this is one that I would love to refer my clients to. I give them a ton of information, but this is not one that I’ve done yet. I wanna talk about the different chemotherapy protocol options for dogs with lymphoma. The good news is there’s a lot of different options. The bad news is that can be really overwhelming. There’s some cancers where there’s really just one standard chemotherapy protocol, and that’s really it. The good news, like I said, is there’s lots of different protocols, so if you don’t wanna do the most intense and expensive chemotherapy protocol option, we have plan B and plan Z, plan B and plan C, which is great, but like I said, it can be really, really overwhelming.So I wanna break it down. Just remember this is an overview. I cannot make specific recommendations for your pet. Even if you comment, even if you send me a direct message, I’ve never examined your pet. So you need to talk to your veterinarian, and ideally, it would be great if you could see a cancer specialist. So we always have links on how to find a cancer specialist, and you can always talk to your veterinarian about seeing a cancer specialist as well. And just remember these are very, this is a broad overview. There’re gonna be things that may not apply, or you’re gonna talk to your veterinarian or your cancer specialist and they’re gonna say, “Yeah, Dr. Sue recommended that, “but it doesn’t apply to your dog.” For example, in the CHOP chemotherapy protocol, we’re gonna talk about Doxorubicin. Doxorubicin can also be a single-agent protocol. But we don’t use that drug if your dog has some pre-existing heart conditions like a arrhythmias, dilated cardiomyopathy.Not heart murmurs. So you’re gonna need to talk to your veterinarian. So if your dog has one of those conditions that we can’t use it, we’re gonna need to swap it out for another chemotherapy drug. Lomustine is something that we often will use for dogs with T-cell lymphoma, but you have to have pretty normal liver values ’cause it can cause hepatotoxicity, liver toxicity. So you may wanna do that protocol because it’s less expensive, every three weeks, but it might not be a safe medical option. So just remember this is a broad overview to give you a general idea of what the best chemotherapy, what are the plan Bs, what is the plan C options, general overview of the different response rates and survival times. And then what’s most expensive, what’s medium expensive, and what’s least expensive. We can’t give you estimates, ’cause different parts of the country, chemotherapy has different, just the cost of living is different. I often lecture with my colleague, Dr. Chad Johannes, who works at the University of Iowa, and we’ll talk about what the cost of CHOP chemotherapy is for a golden retriever, and it’s really different if you live in the Metro New York area versus Iowa.So you’ll get that estimate when you go and talk to the cancer specialist after they’ve examined your pet. All right, that was a really long introduction. It’s kinda hot and humid, so I’m gonna go inside where the air conditioning is, little less background noise, and we’re gonna break down the different chemotherapy protocols for dogs with lymphoma. As always, guys, thanks for watching. I hope you found this useful. I usually do this at the end, but please comment, please let me know, and again, thanks for watching.Chemotherapy is definitely the main way, or the mainstay of treatment for dogs with lymphoma. There are a couple of different things, we’re not gonna cover them in this video, but they’re worth mentioning. Radiation can be used to treat dogs with lymphoma. Often for big lymph nodes, maybe around the neck, sometimes we’ll do radiation, it does work really well. And some protocols have incorporated something called half-body radiation. Something else is bone marrow transplants or something that’s called stem cell transplants, which is more common in people. There’s about four places at the time of this video that are doing that, pretty involved.Again, not gonna be covered in this video, but something if you’re interested in, please talk to your oncologist about. You will have to travel to get that done. Usually chemo, then the bone marrow transplant. And then finally, immunotherapy. There’s not a standard immunotherapy yet available in dogs like there is in people, like Rituximab, which is a monoclonal antibody that’s combined with chemotherapy in people. There were some monoclonal antibodies that were temporarily available for dogs for B and T-cell lymphoma, but they’re no longer available ’cause they weren’t really shown to be effective. There is a lymphoma vaccine. It’s been on the market for a couple years, but there’s some studies showing that it might be more effective if we give it earlier in the chemotherapy protocol. So you might be hearing more about that. But really for the rest of this video, what I wanna focus on is comparing the chemotherapy protocols, but I do think it is worth thinking about radiation, stem cell transplants, and immunotherapy.They do have an important part in the treatment of lymphoma, but chemotherapy is definitely the mainstay of treating dogs with lymphoma. So let’s do it, let’s talk about chemotherapy for dogs with lymphoma. Okay, so what is the goal of chemo? The goal is obviously to get these dogs into remission, and folks will say that the goal is to get them into remission for a minimum of six months.I don’t know, maybe I’m an overachiever. I’m never happy if it’s just six months, but that’s technically what a lot of the oncology textbooks will say. The most successful chemotherapy protocol is going to be a CHOP multi-agent chemotherapy protocol. So multi-agent, multiple drugs in the protocol. CHOP is an anacronym or an abbreviation for the different drugs that are combined in the protocol.And the way that I like to think about it is the different drugs have a different, each of them have a different mechanism of action. So they kind of attack the cancer cells, so that’s gonna be more successful than if we just use one drug with a single mechanism of action. So again, in general, if you can show that each drug is individually effective and you can find a protocol that’s gonna be safe and tolerable, multi-agent protocols are going to be more successful than single-agent protocols. Makes sense, right, good. Okay, so CHOP is an abbreviation for basically three drugs, plus prednisone, so cyclophosphamide, Oncovin, which is vincristine, the Oncovin is a trade name. The P is prednisone, and the H is actually, believe it or not, Doxorubicin. It comes from the chemical name. So that is a CHOP protocol. Sometimes there will be L-aspariginase given in the beginning as well when you’re getting them in remission. You can talk to your oncologist. Sometimes we give it, sometimes we don’t. But the main chemotherapy protocol is the CHOP chemotherapy protocol. Typically we have 90 to 95% remission rates.The first remission is usually about 10 months, nine to 10 months. The median survival time is about one year when followed by a rescue protocol, and about 25% of dogs are alive at two years, and those will be considered long-term survivors. So that is definitely by and far considered the best chemotherapy protocol for dogs with B-cell lymphoma. So how do we determine B versus T-cell lymphoma? That is usually, that’s not something, just as a side note, that we can figure out from your dog’s aspirants, from their lymph node cytology.That’s going to be a separate test that your veterinarian or your oncologist is going to talk to you about doing, usually determined by something called flow cytometry or PARR, I usually do flow cytometry. That is one of the most important tests to me is figuring out whether or not a dog has B or T-cell lymphoma, for two very important reasons. One, it’s the most single important prognostic factor, so it really, we know that dogs that have B-cell lymphoma do better than dogs that have T-cell lymphoma. Do I still treat dogs that have T-cell lymphoma? Yes, I do, and I do have dogs that have T-cell lymphoma that do better than dogs I have B-cell lymphoma. So I know it’s confusing, but in general, dogs with B-cell lymphoma do better. They have higher complete remission rates, longer, they stay in remission longer, and they have longer survival times. But I do modify the protocol based on whether or not your dog has B or T-cell lymphoma.So I do think that test is really, really important, and I prioritize that test as the top of the list in the things that I’m gonna do. And guys, I have lots of other videos. Please check out the chemotherapy playlist where we talk about that chemotherapy is so well-tolerated. But if you’re watching this video, you really need to watch those, because I know it’s really scary, right? Chemotherapy, we think about chemo and people and hair falling out and getting sick, but chemotherapy is so well-tolerated in dogs.And most of my clients, I have so many clients that come to see me, that their veterinarian calls me and says, “I’m sending over Jack, and they’re not gonna “treat, but I just want them to talk to you.” And then they come over and we talk about it, and the owners decide to treat. Because I know when you hear that your pet has chemo, it’s so overwhelming. But what I tell people is, it’s not a contract. Give a dose or two of chemo, see how your pet does. And so many clients are so shocked how well their pet does during chemo, that they keep coming back, because they’re so happy. I have dogs that still do agility, still run on the beach. They have such a great quality of life. So I’m not saying there’s no side effects, but chemo’s really well-tolerated. And most of my clients that choose to treat their dogs for lymphoma are so happy that they did. Not everybody, I’m sure there’ll be some comments, someone said, “I wish I never did.” But most of the people do, and that’s how I can really, honestly recommend chemo for dogs, I really, really can.I feel so strongly and passionately about it. So with that said, guys, just think about it. I know it’s scary and there’s a lot of stuff that you’ll read on the internet about it, but this is why I’m here, like I said, after work. I’m kind of getting hungry and I want to eat some dinner, but I’m here because I wanna give you guys information, and then I want you to talk to your veterinarian and hopefully go see a cancer specialist. Okay, so high response rates. 90 to 95% of dogs will achieve a complete remission. Their lymph nodes go back to normal, and any of their symptoms that they had if they were sick resolve. More than 50% of dogs are asymptomatic when they come in with lymphoma, and they have a really good quality of life. So 80% of dogs have no side effects or mild side effects. Very preventative, please, please watch my video about medications that you should go home with. If you are starting chemotherapy for your dog with lymphoma, you should have your preventative medications, your Cerenia, your Entyce, your probiotic, your metronidazole, and you can also talk to your veterinarian or your oncologist about some supplements as well.And we’ll put the links, as always. So I hope you can see how passionately I feel about this. It’s a very rewarding cancer to treat, why? ‘Cause they go into remission, and they go back to their quality of life. People often say to me, “I don’t want my dog to feel sick. “I don’t wanna poison them.” And you know what, the cancer’s what’s making them feel unwell. And if they were feeling well when they came in, they’re gonna start to feel unwell from lymphoma pretty quickly, because this is the crappy part about lymphoma, the survival time, on average, without treatment is one month. It’s quick, guys. So this is the cancer that you need to make a decision quickly. It’s not one that you wanna go home and think about for a long period of time.So, okay, one month with no treatment, median survival time with a CHOP multi-agent chemotherapy is about 13 to 14 months. I’m gonna talk math, median, guys, median is different than averages. So that is if in the study they line all the dogs up in the middle, all the dogs up, so over here is the dog that succumbed to the cancer pretty quickly, didn’t respond well to treatment, and here’s the long-term survivor. Median is the dog in the middle. That’s what we’re giving you. Because if we give you a mean or an average, it’s gonna get skewed by the dogs at each end. I had one dog, Jabba the Mutt, best name ever, treated him when I was in private practice in California in San Jose. When I moved out back East, they messaged me. Jabba the Mutt lived 7 1/2 years. He would throw off the average, the mean, right, ’cause he was a really long-term survivor. So we give you the median.Just remember, that means half the dogs live longer and half the dogs live shorter. Both in human and veterinary oncology, that’s gonna be a better representative of what what you can expect with your dog. So again, it’s really rewarding, I think, for most veterinarians and oncologists to treat, and I think for pet owners. And like I said, most dogs tolerate treatment very well, and very few experience significant toxicity. I talk about it in other videos, but I think it’s worth mentioning again, less than 5% of dogs will be hospitalized due to chemotherapy side effects. And I take a very preventative approach. So please make sure you talk to your veterinarian or your oncologist about going home with those preventative medication.And remember, many clients that initially think they might not treat will often decide to treat and are very satisfied and happy that they did. Okay, so CHOP chemotherapy is gonna be the best protocol if your dog has B-cell lymphoma. What does that entail? So there’s a couple of different versions, but it’s a 19-week or a 25-week protocol. So it takes about five or six months to do. It’s usually weekly for that five-month period. I do the 19-week version, so it’s weekly for about four weeks, and then you get a week off, and then you repeat the cycle, week off, repeat the cycle, get another week off. So takes about five months to do the 25-week protocol. It just has a couple weeks spread out in there. So I do the 19-week protocol. There’s also a 15-week protocol. But most oncologists are doing the University of Wisconsin CHOP multi-agent protocol.So it was the vet school at the University of Wisconsin that kind of fine-tuned this multi-agent protocol with those drugs that we talked about. So the hard part is you’re bringing your pet in weekly for injectable chemotherapy. The only hard part about that is the time, right? So you gotta get your pet in, which means coordinating that with all the other things that you have going on in your life, so I get that, and also the cost. So it’s gonna be the most expensive of the chemotherapy protocols. So you’re gonna need to talk to your veterinarian or your oncologist about the cost. Chemo is, in general, based on weight. So an exam and blood work’s gonna be the same whether you’re a Chihuahua or a Great Dane. But a Great Dane is gonna get a heck lot more chemo than a little Chihuahua, and a 40-pound dog versus a 70-pound dog, also gonna be different.So chemotherapy costs are based on the weight of the dog ’cause they get more or less chemo. So again, when you go in and talk to your cancer specialist, they’re gonna figure out what your dog’s chemotherapy cost is. So we can usually ballpark it based on weight and the part of the country that you’re in. Like I said, more expensive if you’re in New York or California or Hawaii or something like that versus if you’re in other parts of the country, like Iowa with my good friend Dr. Chad Johannes. So again, best, you know, there’s always trade-offs. So it’s more frequent, more drugs in the protocol, higher response rates, longer survival times, higher remission rates.That is the good, you know, the good that you get with the CHOP multi-agent chemotherapy protocol. I’ve decided to make this lymphoma protocol video two-part. It was just too much information to make into one video. So be sure to subscribe so you will know right away when the next video comes out. At this point, new videos come out on Wednesday. But in the next video, we will talk about the alternative protocols if your dog has B-cell lymphoma and T-cell lymphoma. We’ll also be talking about the new lymphoma protocol called Tanovea. So be sure to join me, be sure to comment, tell me what you liked about this video, what questions that you have.Thanks so much for joining. My goal is to always make these videos helpful for you, to help you get through this horrible time. If you know somebody that you think this information could be helpful, be sure to share this video with them, and don’t forget to subscribe. Thanks so much for watching, and I’ll see you at the next video. (upbeat music) .