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.
11 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