The Toxicity of Potent Dog Chemo Drug Doxorubicin
ByVets and veterinary oncologist use Doxorubicin (also called Adriamycin) in many different chemotherapy plans.
Common dog cancers treated with this drug include lymphosarcoma, hemangiosarcoma, other sarcomas, and carcinomas.
This is not a mickey-mouse drug. It is one of the main players in conventional dog cancer chemo treatments. It also has corresponding side effects that, from time to time, are heavy duty and should be taken into account.
Doxorubicin is given as an injection in the vein at the vet hospital. If the tip of the catheter used to deliver the drug is not in the vein (but still under the skin), the drug will end up in the tissues around the vein.
Doxorubicin is very toxic to living tissue when given in this way and will cause this tissue around the vein to die.
It can also cause stomach upset, inflammation of the colon, and delay the regrowth of hair. Some dogs will develop allergic reactions during doxorubicin injections. It can bone marrow suppression (anemia and low white blood cell and platelet counts).
It is known to cause damage to the muscle in the heart, in some dogs, which can be quite serious.
Check out this abstract for more info on doxorubicin toxicity.
The reader should be advised that the purpose of this content is not to crucify doxorubicin. It has helped many dogs. Rather, this is information that should be in your head as an informed advocate of your dog’s health.
In the next post, I will discuss the use of common, over-the counter-supplements that should be considered to help alleviate a big toxicity with this drug: heart damage…
Best to all,
Dr D
About the Author
Dr. Demian Dressler, DVM is known as the "dog cancer vet" and is author of Dog Cancer Survival Guide: Beyond Surgery, Chemotherapy & Radiation. Visit his blog and sign up free to get the latest information about canine cancer. Go to http://DogCancerBlog.com.
27 Comments
December 29th, 2008 at 4:32 am
It should be noted that when giving Doxorubicin, a Benadryl injection before administering chemo may prevent allergic reactions. Also, pre-treat meds for possible nausea and diarrhea can be prescribed to start on chemo day and continue for 5 days. The idea is to beat the cancer, not the dog. It may be better to pre-treat to prevent, as it can be much harder to get possible side effects under control once they start.
Ask your Onc about CoQ10 to promote heart health when giving Doxorubicin. Milk Thistle should also be discussed with your Onc to promote liver health. (Before starting any supplements, check with your Onc to make sure they do not interfere with the chemo’s effectiveness or have interactions between the supplements)
Blood tests between each treatment will help monitor your dog’s response to this chemo and may determine the timing of the next treatment. Fasting the night before chemo can give more accurate blood test results and may also help ward of chemo anemia.
Exercise may good after treatment to encourage drinking water, which may help flush the toxins faster. Always keep a chemo diary during treatments so you can let your Onc know of any reactions. Tweaking the protocol or even reducing the dosing of the Doxorubicin may be discussed to reduce side effects.
The above are just a few things we did when Mali got her Doxorubicin every 2 weeks for her hemangiosarcoma, which she handled beyond my expectations.
Always consult your Onc, each dog, each cancer and each protocol is different.
December 29th, 2008 at 7:13 am
Hi Ilene,
Thanks for your comments and great to hear things are going well!!
One question for you about the milk thistle. Milk thistle does some very interesting things, very good things for dog cancers. These are totally independent of the liver “support” it provides. I was wondering first about what your oncologist thought of using a supplement with known antioxidant effects with doxorubicin, whose mechanism of action is pro-oxidant. Thus from an “onc’s” viewpoint there would be interference.
Another question I was wondering about is that the liver is not a site for doxorubicin toxicity. I am not saying that milk thistle is inappropriate, I was just wondering about the rationale you gave.
Finally, has your oncologist been informative with you about options outside chemo, radiation and surgery? The areas outside these three realms of conventional oncology seem to be lacking, as many readers have stated their oncologist have not provided much input in areas outside chemo, radiation and surgery. What are your thoughts?
D
December 29th, 2008 at 8:43 am
We didn’t start the Milk Thistle until 2 weeks after the final Doxorubicin tx. At that time, we also started Vits. C & E, Fish Oil, IP6, Turmeric, Artemisinin, Yunnan Paiyao and her chemo maintenance meds of Cytoxan, Doxycycline, and Piroxicam (with a daily antacid to protect the GI from the Piroxicam). The Milk Thistle is given to promote liver health, as HSA can spread to the liver, thus another reason for the CoQ10, as HSA can spread there as well.
Mali’s spleen ruptured, so she had an emergency splenectomy. No evidence of spread was evident on chest x-rays and abdominal ultrasounds or seen during surgery. No further surgery or radiation was required. We started her Doxorubicin 2 weeks after splenectomy, given every 2 weeks.
She is 4yrs post her splenic HSA dx as of 12/24/08. While this survival success is not typical, anything is possible given the unpredictable nature of HSA. Who knows if the splenectomy alone removed the threat of the HSA or the chemo and/or chemo maintenance, and/or the supplements. We wanted to do everything for Mali, however everything may not have been right for her. I worked with her Vet and Onc to get an integrative approach of traditional meds and supplements that suited/complimented her overall health and her cancer protocol.
To answer your last question, our Onc was very open and informative about supplements. I emailed almost daily about alternative therapies (PawPaw, Neoplasene, SAHA, L-MTP-PE, Essiac) that I had read about and always got an answer or experience about them and reason for whether or not we used them for Mali. We also discussed acupuncture and hydrotherapy. I am very lucky to have great support from our Docs.
December 30th, 2008 at 8:27 am
That is fantastic!!
It is really great to hear. You are very lucky to have such a team. If every dog with cancer had access to this type of care we would be so much ahead of the game.
Congrats
D
January 9th, 2009 at 2:32 pm
I was wondering what your doctor said about Essiac?
Our 13 yr old Panda had surgery for Hemangiosarcomas on Dec 31, 2008 when her spleen ruptured. We are giving her IP-6 Max with Inositol, Maitake & Cats Claw along with Essiac, Vit E, Echinacea/Golden Seal, Flax Oil & Fix Oil. She is also getting a liver detox that contains Milkthistle. Her diet is Chicken breast with steam viggies.
We are choosing not to do chemo, because everything I read indicates it degrades the immune system which is what we are trying to up to fight the cancer. She had black spots on some organ that they removed with the spleen that the vet said floats like a jelly fish. Right before this, they were treating her for Pancreatitis so we are trying to be carefull with her diet.
January 13th, 2009 at 9:58 pm
Dr. Dressler-
I had posted this comment on a different article, but thought this one would be more appropriate.
Our dog Griffy was diagnosed with Lymphoma this past December. He has had four treatments on the Madison protocol and is up for Doxorubicin this coming Thursday. I am very concerned about the potential side effects of this drug, especially possible heart damage, and want to do everything I can to try prevent and/or alleviate them. Coenzyme Q10 has been recommended to us via a telephone conversation with a cancer vet; but my wife has read about never using any antioxidants while a dog is being treated with chemo. Do you have any suggestions regarding this issue?
Patrick
January 14th, 2009 at 11:37 pm
I am sorry about Griffy’s diagnosis. My opinion is that the benefits of CoQ with doxorubicin outweigh the theoretical negative of it’s antioxidant effect. My opinion only here, and this is debated.
February 1st, 2009 at 6:51 am
Dr. Dressler and Ilene,
I was wondering; do you give the Yunnan Paiyao daily? My almost 10 yr old Jinn has HSA with no rupture, but a splenectomy. No visible spread through x-rays and ultrasound. We tried two rounds of Chemo. with the second making making her very sick, for 10 days despite anti nausea meds given prior to and during recovery. We stopped Chemo after that. She is not on any meds now. I find the doxycycline, cytoxan and piroxicam interesting, as I was never told about it. Must you complete all of the chemo before gettng these drugs? What are their purposed? Jinn also has a grade 3 heart murmur that was first observed at the Dx of HSA. She gets a multiple vitamin, CoQ10, 1000 mg of Vit 3 and 800 mg of VitE and 5000 of Fish oil daily along wth 12 mg of Calcium (She is on a cooked diet of pureed veggies, and a variety of meat sources and offal)
Thanks for your input
Michelle
February 1st, 2009 at 6:56 am
So Sorry for all of the typos. I type fast and there is a delay on this screen when typing. The vitamins my Jinn receives are 1000 mg of Vit C, 800 Vit E, and a multiple Vit/Mineral supplement She also gets DMG and Tasha’s Immune Support for dogs. How much milk thistle do you give. Jinn is 75 lbs.
Thanks again
Michelle
February 7th, 2009 at 5:40 pm
Dr. Dressler,
Jinn passed on Feb 6, 2009 after hemmoraging. God bless her, she was my girl and will always have a huge part of my heart
February 8th, 2009 at 11:05 pm
Oh, Michelle, I am so sorry. Sending you and Jinn’s spirit all my best in this hard time.
D
August 28th, 2009 at 8:10 am
Dr. Dressler,
My 10 year old golden, Bailey, was diagnosed with Hemangiosarcoma on July 25th after an emergency surgery to remove her ruptured spleen. The ER vet did not see any other visible lesions and her xrays and liver biopsy came back clean. We did one round of chemo 3 weeks ago and Bailey is scheduled for her second session on Monday, August 31st. I’ve having a dilemma on what to do as Bailey was also diagnosed with Valley Fever (we live in AZ) and started meds this past week. Although her titer is low, I worry the chemo/cancer and meds/valley fever will work against one another and wear her down. She also had a small run in with Pancreatitis two weeks ago, but since seems to be doing better. Would we be better off with homeopathic treatment vs. chemo? My worry is her lifespan as I’ve read that those dogs that do not get chemo only live an avg of 2-3 months vs those with chemo that can survive approximately 9 months. Would appreciate your advice.
B
August 30th, 2009 at 9:19 am
Dear Bridget,
this is an excellent question. The summary statement is no, in my opinion relying on hemeopathy by itself would be inadequate for what you want. I would treat both the infection and the cancer and monitor more frequently than normal. I would like to answer this question more fully in this month’s webinar, which will be recorded so you can listen on demand-
http://www.mydogvet.com
Best,
Dr D
August 30th, 2009 at 10:36 pm
Dear Bridget,
the webinar went overtime, so:
I would treat both at the same time and not rely on the homeopathy. Instead, make sure that your veterinarian or oncologist monitors the white blood cell count more frequently than normal. The suppression of the white count may make fighting the infection more difficult due to the chemo. Also consider taking your Bailey’s temperature on a daily basis so you can see if a fever develops. In the end the cancer has to be dealt with. Another option would be to delay the chemo about 2-3 weeks while you treat the Valley Fever, then resume. Supplementation with immune stimulants (K-9 immunity, Beres drops, Avemar, plus or minus Ehinacea) are some other ideas.
Best,
Dr D
September 10th, 2009 at 4:31 pm
Dr. Dressler,
On August 18 my 9 year old Staffordshire Terrier Oliver was diagnosed with a mass on his spleen through xray. We were quickly sent to Denver, two hours away, and it was seen on ultrasound that there was hemmoraging. The spleen and the mass (which was extremely large) were removed, and thankfully there really was not that much blood from the hemmoraging. All other organs apparently looked good during surgery.
His post-op went really well. While waiting for biopsy results I had of course been online researching anything I can do to save my Ollie. I feel so overwhelmed with everything out there and want to make sure I am doing this correctly. I changed his food to a grain free diet of Wellness Core Ocean formula, with Young at Heart supplement. I am not sure about the Young at Heart. I worry about the amount of carbohydrates. I have also started him on K-9 Immunity with the Transfer Factor and Fish Oil gel tablets.
At Ollie’s Dr.’s request he was seen at Colorado State University last Tuesday as results indicated the tumor was grade 3 myxosarcoma. An entire day spent there resulted in the decision to start chemo using doxorubicin through Ollie’s Dr. in the mountains. They want to do five treatments.
His first treatment was yesterday. He has vomited once today, and his appetite is a little less, but otherwise he seems well. Follows us everywhere, wants to play ball and go for walks.
I guess I am looking for any guidance that you might have as far as what I doing now and what more I could be doing. Should he be getting any anti-nausea medications before or after treatment? I am concerned about the effects to his heart and am interested in the Coenzyme Q10. Do you recommend that he should be getting that? We do not have a lot of resources where I live so it has been difficult. Neither CSU or Ollie’s Dr. seem to have much insight outside of the conventional approaches and I am looking for more! Ollie is everything to me and I would greatly appreciate any advice that you could offer.
Thank you in advance!
Jenn
October 2nd, 2009 at 6:51 am
Is anyone reading these posts? Does anyone get notified when there is a new one? It seems like past posts were answered and I am looking for some kind of a response to my post left on September 10!
October 2nd, 2009 at 4:08 pm
Hi Jenn, I’ve been looking at the blog a lot since my dog got sick. I don’t think the Dr. has time to answer all these questions. It’s just a blog. I had a very specific question so I signed up for his monthly seminar to get it answered directly. http://www.mydogvet.com is how I found it. Hope that helps.
October 5th, 2009 at 4:53 am
Thanks Sarah! I know he is probably very busy, I was just curious because it does look like he had answered other posts so I wasn’t sure what to expect!
October 22nd, 2009 at 3:30 am
Dr. Dressler,
Our dog is a 5 yr old rotweiler.Our vet suspected that he has a leg tumor because his front leg (right) swell and he said that there’s no treatment for that but since I am an oncology nurse here in our place i will try to treat him same as for human treatment.Would you mind telling what is best remedy for our dog and what is the best drug for him coz it’s very hard for us to look at him suffering.Thank you and God Bless
Nicole
October 22nd, 2009 at 7:32 am
Our 10-year-old Golden retriever was just diagnosed with a Grade III Hemangiosarcoma in her speen. She had a splenectomy, and pre-op no other tumors were visible in her lungs (3-views via xray), liver, abdomen, heart, or kidneys (viewed via ultrasound). The splenic tumor, however, had hemmorhaged, though not fully ruptured. The liver biopsy came back clean except for evidence of some white blood cells that were a result of the spleen hemmorhaging. We were told her prognosis was 2-3 months with surgery alone, and 6-8 months with chemo.
yesterday, Maggie started her first dose of Doxorubicin. Our vet told us that we could not give Maggie ANY supplements or antioxidants except fish oil. Prior to the dox. I had her on a laundry list of 11 or so supplements, ranging from I’m-Yunity to K9 Immunity, Transfer Factor, CoQ10, Milk Thistle, IP6+Inositol, Colostrum, and an antioxidant “power pill” that has a list of about 20 different herbs and Vitamins.
My question: what can I give Maggie that isn’t contraindicated with chemo / doxorubicin? I read a study which stated that I’m Unity / Colous Versicolor mushroom (also in K9 Immunity) can help doxorubicin’s effectiveness not hinder it, with some cancers. My vet isn’t too keen on anything holistic, but I would like to try whatever i can. Please advise!
October 22nd, 2009 at 5:11 pm
my boxer was diagnosed with stage II hemangiosarcoma much like your dog Maggie and my oncologist,as well as the k-9 immunity rep (MD) i spoke to stated that there is no harm in giving both at the same time. He just finished his third round of chemo today and has been taking the supplements at the same time and has been doing wonderfully. if i were you i would just make sure you arent over doing it. If a vet isnt too keen on anything holistic, you should provide him with the printout for vets off of the k-9 immunity web site. immunomodulation therapy is done world wide and the principles make sense. There isnt a large subject pool for studies like there are for humans so noone truly knows. I would call aloha medical and ask to speak to the doctor (John) i believe is his name..
October 22nd, 2009 at 5:18 pm
in addition it stands to reason that the same way every person has different genetics and body responses to the disease process, so may each dog respond differently. The majority of people out there dont have thousands of dollars to spend on their dogs, follow through with a better diet, and keep to protocol. So it would suggest that the more things that you can change that are within your control., just as with a human, the better the chance for recovery. An oncologist for a human can never truly say someone is cancer free, they can ony say with regard to remission that there are no visible signs of cancer. So never give up hope, there are cases where dogs have lived for a few years with this, so even if it is a small percentage, why cant our dogs be the ones that are fortunate. Diet is super important as is positive energy.
October 25th, 2009 at 8:20 am
Dear Nicole,
well, you are correct. First you need a diagnosis, or at least a presumptive diagnosis. One contender would be osteosarcoma, very common in Rottweilers. You need a second opinion, big time. You need to have X-rays of both the leg and the chest. If it looks like a tumor without obvious spread, amputation is the first step. They do fine on three legs assuming no other major orthopedic issues. Then diet, supplements, maybe chemo…this is a very complex issue. You may want to tune in to this weeks webinar on the most common kind of bone cancer (osteosarcoma):
http://www.mydogvet.com
Best,
Dr D
November 5th, 2009 at 11:15 am
My 10 yr old golden has been diagnosed with hemangiosarcoma but it was in her rt front leg in the muscle belly. The vet questioned the lab due to the unusualness of this location but they feel they are 90% correct. We amputated and her cath site was a mess and the incision was not only ugly but developed necrotic tissue and tomorrow she has to be put under again to have the tissue removed and restitched. We are living in London now and I have shaken confidence in her doc as a result of this, and a bad experience with the biopsy. the biopsy site burst and was weeping and the dog in intense pain and the vet dismissed it and i had to pay another more local vet to come to the house and change her pain killer, clean the site, place her on antibiotics and even call the next day to assess hospitalization. Now these vets are suggesting dox as a treatment and checked with a friend about the protocol instead o bringing in an oncologist liason. would love and input as i am drained after all this to date and really need good info and peopke who will talk to me inteligently vs dismiss me so i can make good choices for my dog.
November 8th, 2009 at 12:05 pm
Dear Jill, Doxorubicin is an accepted choice for chemo for HSA. You should go to a university or specialty center. Get your dog’s heart checked out first. Read about chronotherapy to time the treatments if possible. Also I would use the supplements in the Dog Cancer Guide, in particular curcumin/luteolin….as well as the CoQ and acetyl-L-carnitine (and diet, etc…)
Best,
D
December 28th, 2009 at 9:03 am
A side note about Doxorubicin AKA Adriamycin)
>>Doxorubicin is given as an injection in the vein at the vet hospital. If the tip of the catheter used to deliver the drug is not in the vein (but still under the skin), the drug will end up in the tissues around the vein.<<
During my dogs first chemo treatment on October 28th, 09- the syringe slipped while being flushed. Unfortunately the Doxorubicin mixture was deposited around the surrounding tissue. Her skin has sloughed off down to her muscle. (inside area of upper front leg)
The four remaining chemo treatments have been shelved until further notice.
She had several laser treatments and clinical study Platelet Rich Plasma PRP Treatments. Last Wednesday her veterinarian preformed a surgical flap procedure that covered about 85% of the exposed muscle. We are now working with antibiotics to ward off infection. We have been to the vet between four and six times a week for the last five weeks.
Please take time to educate yourself on the risks of cancer procedures and how they may effect you and your family pet.
January 10th, 2010 at 3:46 am
My great dane that I love was told that she migth have cancer in her leg after an x-ray done, chest x ray was clear. Still waiting on the blood result but at this point I don’t want to get a biopsy done, what are my options?