Featuring Demian Dressler, DVM and Susan Ettinger, DVM, Dip. ACVIM (Oncology), authors of The Dog Cancer Survival Guide.

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Hit The Bull’s Eye With Dog Cancer Drugs

One of the problems with chemotherapy, in addition to cost and trips in and out of the hospital is toxicity.  It can be especially difficult to handle a toxic event when the whole point of chemo in treating dog cancer is palliation.

Palliation is defined as a reduction in the signs or symptoms of a disease.  Note that nowhere is the word “cure” used.

This is something many may have not heard before.  Chemotherapy in dogs, unlike in some cases of human medicine, is not geared towards a cure.  The toxicities resulting from “cure” doses delivered by vein or as pills are too high for our dogs.

So, it makes a lot of sense to do everything we can to lower toxic events, since  we are simply trying to make something better for a period of time.

In previous blogs I focused on things like chemotherapy timing (chronotherapy), which got very little response from readers (I found this puzzling).   We are talking about simply changing the time of day for the chemo treatment and getting much better outcomes.  Higher margins, less toxicity, no increase in cost or life quality reduction.  What more could one ask for?

Everyone likes the idea of supplements to help lower toxicities (L-acetyl carnitine, coenzyme Q-10, beta glucans, ginger, milk thistle, and others..).  Supplements are a hit.

Here’s another one that will need the cooperation of your vet or oncologist:

Suppose we want to get a chemo drug in high concentrations to the lungs.  Why the lungs?  Well, the lungs are the site of many secondary tumors which have spread from a primary location.  These are called pulmonary metastasis.

If your dog had, for example, a malignant melanoma in his toe, it could easily end up sending melanoma cells to the lungs to grow.  These cells are said to have metastasized to the lungs.

Sometimes tumors start in the lungs.  These are called primary lung tumors.  They are not especially common, much less common than pulmonary metastasis.

At any rate, it would seem logical to get the chemo drugs right to where the tumors are for a couple of reasons.  First, if you cluster all drugs, only about 5% of what is taken as an IV injection and only about 2% of what is taken as a pill actually gets to the lungs.  So very little ends up where you want it.

From a conventional medical standpoint, the more anticancer substance that arrives at the site of the tumor, the higher the desired  effect in that area.

Second, if you can target your potentially toxic chemo drug so it acts as a “silver bullet”, and avoids contacting non-cancerous (healthy) body parts, you can limit toxicity to those healthy body parts.

If a veterinarian or oncologist is presented with a dog having a lungful of cancer, one way to get the cancer fighting substance to the tumor would be to aerosolize it.   This is commonly done with asthma inhalers in human medicine (which we use sometimes in veterinary medicine too).

Aerosolization is simply making a substance able to travel in the air, as a vapor.  You mix your drugs in some liquid, dump it in a machine called a nebulizer, and out comes a moist mist with your drugs in the mist. Neat.

Lots of things can be aerosolized.  Antibiotics, antifungals, anti inflammatories, and more.  And yes, chemotherapy drugs have been aerosolozed too.

And we see results.  Here, here, here and here are a few of publications for you (and your oncologist) to check out if you are interested.  The results of the aerosolized chemo drugs were clearly better than those given by traditional routes.

The main barrier to entry? Equipment for delivery simultaneous with prevention of aerosolized chemo drugs in room air.  Nobody wants to be inhaling chemo drugs themselves.  However, if you or your oncologist is industrious, you can use the schematic provided in this link and build a set-up,  or have someone else make one for you.

Another possible resource is the use of a compressor set up described in the article about IL-2 and osteosarcoma metastasis.  A  Bunn 400A compressor from the John Bunn Company in Happauge, New York, was used with a Puritan Bennet Twin Jet Nebulizer from Puritan Bennet in Carlsbad, California.  A polyethylene rebreathing bag was used to cover the dogs’ muzzles.  These dogs were trained to receive the IL-2 administration via this route.

Please, if any have success with this information, let me know so it  can be shared with others.

Best to all,

Dr D

About the Author: Demian Dressler, DVM


Dr. Demian Dressler, DVM is known as the "dog cancer vet" and is author of Dog Cancer Survival Guide: Full Spectrum Treatments to Optimize Your Dog's Life Quality and Longevity. Visit his blog and sign up free to get the latest information about canine cancer. Go to http://www.DogCancerBlog.com.

  • Lori Sieben

    Hi Doc, Interested in your comment about chronotherapy – my dog gets Piroxicam – right before bedtime because she’s also on Neoplasene twice a day. Where can I get more info?
    Thank you!
    Lori

  • Carol

    Dr. D

    I applaud your objective and earnest efforts with helping owners help their dogs through the scourge of cancer.

    My dog has an advanced osteosarcoma which we have opted to treat naturally, albeit aggressively. It’s complicated and all-consuming when you are trying to save someone’s life–I went through it with 2 parents too.

    I tried to fill in your survey, but it wouldn’t ‘send’ because I’m already a subscriber to your newsletter. I’d like to offer this suggestion for your book title: “Cancer Answers for Canine Caregivers.”

  • Judy

    I just lost my GSP Gunnar to lymphoma. He was diagnosed last October and had 6 months of chemo (CHOP protocol). He did extremely well with that protocol, having almost no side effects. I did read your blogs on chronotherapy and scheduled all of his subsequent treatments based on that information. Maybe that’s why he did so well with the treatments. He came out of remission in June, only 7 weeks after finishing chemo. I then started naltrexone and bombarded him with many of the supplements in your book. He also got homemade meals as well as all the exercise he wanted which was lots of hikes and short runs. He had an abdominal ultrasound in mid October which did reveal some enlarged lymph nodes. He also had a chest X-ray which was clean. He had great quality of life until the 3rd week in October 2009 (wow . . . cancer can move like a cheetah) when more labored breathing began and it was clear he was also starting to lose muscle mass. On Halloween night I took him to emergency because of his breathing and suddenly weakened condition. The doctor said there was air in his chest cavity and there was a shadow on his left lung; she conjectured that the cancer had metstasized to his lung. It was too much for Gunny. He died the following morning. But your info on aerosolization is fascinating. I wish we could have tried it on my Gunnar. But after an incredibly valient fight, I think it was probably too late for him and he chose to leave us on Nov. 1. Thank you, Dr. Dressler, for your riveted focus on treating cancer in dogs. Your book was so valuable and helped with a number of issues, esp. nutrition and supplements. May your work continue. . . forever!

  • Sheila

    My 14yo 43 pound Brittany has non-small cell lung cancer (bronchogenic adenocarcinoma), a recurrence from 2.5 years ago, resectable except surgery would kill him. No one can tell me how he got this. Jake is on low dose daily Lomustine & arthritis meds. I asked the head oncologist at WSU about nebulizing Farnesol, she said the tumor was large enough that more of the drug would actually make it to the tumor through the blood than through the airway, and that for Farnesol nebulizing was more of a theoretical way to administer it.

    Can you think of anything I should be trying for Jake? Or change something I’m doing? Can you recommend dosages, I’m unsure of all my doses, I attempt to do 30% of a human dose for his size. In addition to Lomustine and Duracoxib he is getting:

    * 6 mg Melatonin before bed
    * Multivitamin (1/3 human dose) with recommended amounts of selenium, Vitamin D, Calcium, and just about everything else (no iron) 2x daily.
    * Additional amounts of vitamins C, E, D/Calcium (perhaps I shouldn’t be doing this?)
    * Jarrow Artichoke Extract (supposedly high in Luteolin) 3x daily w/food.
    * Mushroom Science Coriolus Super Strength (supposedly this is the same as polysaccharide-K, the most prescribed adjunctive cancer therapy in Japan)
    * Additional standardized mushroom powders from Mushroom Harvest (Cordyceps, Reishi, and Maitake which I add vitamin C to). Mushrooms all taken on empty stomach.
    * Astragalus, Ashwagandha, Milk Thistle 80%, olive leaf extract, and coenzyme Q10 3x daily w/food.
    * Curcumin C3 (standardized curcuminoids w/bioperene) 2x daily w/food, but not with his anti-inflammatary arthritis med. I understand this stuff is metabolized by the liver into different forms so not very effective, and there’s also a Taiwanese study that says not much makes it into bloodstream; should I stop using this?
    * Artemisinin 100 mg, given with Salmon Oil and Butyrex (Calcium-Magnesium Butyrate). I’m giving this 2x daily for a week, and then quit giving for about 10 days.
    * Salmon Oil, 3/4 Tablespoon 3x daily.

    Things I am considering, but unsure of are:
    * Artusenate. An alternative form of Artemisinin, used with Artemisinin. Oncologist doesn’t seem to think I need this. UW Artemisinin researcher thinks it’s a good addition to Artemisinin.
    * Farnesol, I would get from Sigma Aldrich in same form as studies and give orally.
    * AHCC (Active Hexose Correlated Compound). This is yet another mushroom extract, and I’m told it is the most commonly used OTC cancer aid purchased in Japan. Why is it that everything immune boosting seems to be mushroom??? Do we really need all these different mushrooms and mushroom fractions, or would a couple of them be enough?
    * Genistein. Is this for hormonal cancers? Any cancer?
    * I’ve had to quit exercising Jake; I’m told that with the chemotherapy his body isn’t repairing itself well enough to be breaking it down with exercise…???
    * There is a study in England that recommends specific amino acids to help with cachexia, and I was considering supplementing Jake’s diet with the specific amino acids from that study. (It was not an amino acid in the study, but I used to use L-glutamine for Jake after his surgery as it supposedly helps recovery from surgery, since then I have seen that L-glutamine supposedly can help fuel cancer).

    I have always been told by herbal types that a dog with cancer should be on grain free food (low in simple carbohydrates). Since my dog needed to gain weight back I had put him on Nutro puppy chow (not grain free). I asked my oncologist about grain free, her answer was, “I would not recommend a grain free dog food. There is no data to support this. The only study to date on diet and cancer was the development of a diet to help animals gain weight that were losing weight due to cancer. A low carbohydrate diet is best in these situations. This information has been somehow now interpreted as grains and carbohydrates cause cancer and grain free diets help fight cancer. There is no truth to this.”

    I saw your article on timing of medication. It was interesting, yet I don’t really know how to do more than what my doctors tell me to do. And, I don’t think they really know more than what they tell me to do. There are so many little questions about what can be taken together, time of day, with or without food, with fat or water, used like a medicine or like a food, it all gets very confusing. And, when I’ve gone to herbal practitioners for advice, the advice has usually been extremely basic. What I wanted for advice would have been much more on top of current studies, by someone with extensive and diverse training like this TCM/biochemist…

    Dr. Subhuti Dharmananda (wikipedia profile) http://en.wikipedia.org/wiki/Subhuti_Dharmananda

    I downloaded a pdf presentation for herbal doctors, which I can no longer find online. I would have attached it if I could attach a file here. It seems too complicated and difficult to use myself, but if you would like to check it out, send me an email so I can attach the file and send it to you. It’s the kind of herbal help I’ve always tried to find for my dog, though I don’t know enough to know how accurate all of the TCM/naturopath stuff is.

  • Deana

    My 12 year old Golden Retriever has melanoma in the mouth. The tumor was successfully removed. I am considering the canine Melanoma vaccine; however, she has other issues i.e. a small benign tumor in her rectum, another one (golfball size) under one arm and arthritis. She had large splematic turmor about the size of a basketball removed this summer which was benign. With all these tumors growing, her age and the fact that she has arthritis, would the vaccine be a good idea?

    THanks,

    Deana

    • Dr. Dressler

      Deana,
      the short answer is yes, it would be a good idea, depending of course on what your vet or oncologist thinks…
      Best,
      Dr D

  • http://Dogcancerblog.com Lynda warringer rd,ld

    I have your latest book can not find anything on naltrexone
    Sammy black lab malignant melanoma start in toe in lungs since march
    Had the vacine cannot have booster until march
    Had carboplantin
    Now on chemo 2 nd round take home gets for 5 days
    Getting artemisinin with cottage cheese fish oil and mg,cal and vit d3 b/t meals
    And naltrexone at midnight
    When should I give the chem drug dr mallott could not give me ant specifics since she is not in favor of the supplements just tx
    Your help on the timing of these supplement would greatly be appreciated
    Sammy’s wt is holding at 72 #’s eats 3cups salmon or chx organic and 2cups no starch veg plus ~12000 mg fish oilnpureencapsulations his labs are all normal
    Did have low white count before naltrexone now labs wnl
    Dr. Connlly my holistic vet has rx these supplements as Sammy has done well on them but timing of everything is questionable and to be determined