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

Low Dose Chemotherapy Better for Canine Hemangiosarcoma?

Updated: January 24th, 2019

Low Dose Chemotherapy & Dog Cancer

What is the difference in using low dose chemotherapy to treat hemangiosarcoma?

Chemotherapy in dogs is normally given at doses that are as high as possible without causing too many side effects.  This is to try to rid the body of as many cancer cells as we can, although some dogs will have occasional side effects related to the use of conventional chemotherapy.

For this reason, there is interest in using lower doses of chemotherapy to simply try to control spread of the disease, and perhaps increase lifespan, while also reducing the odds of side effects.

Canine hemagiosarcoma is a tough cancer.  This cancer grows from the walls of blood vessels, and is often found in the spleen, although sometimes can occur in the liver, heart, eye, skin, and other sites in the body.  Hemangiosarcoma in the dog tends to resist the effects of chemotherapy generally, although there are chemo protocols that exist to try to increase lifespan.  These usually contain the drug doxorubicin.

However, the use of high doses of doxorubucin for dogs with hemangiosarcoma may only increase life span by a few months, in comparison to dogs who did not receive chemotherapy at all.  Additionally, there are occasional cases where doxorubicin may injure the heart, as well as other side effects.

Recently, a new protocol has been developed that does not use high dose doxorubicin, and has some real promise for dogs with this disease. The strategy is called metronomic chemotherapy, which is covered in The Dog Cancer Survival Guide in detail.  However, the short story is this: metronomic chemo uses low doses of chemo, given at home (pills or capsules), which are meant to help the immune system and lessen the growth of blood vessels that aid cancer growth.  Although these beneficial effects can also be seen with the use of certain botanicals, the research for these pharmaceuticals in dogs is strong.

A paper came out in 2011 which looked the effects of a cocktail of 3 different oral medications (cyclophosphamide, piroxicam, and etoposide) on hemangiosarcoma in the dog.  The amazing thing was that these dogs could be medicated at home, instead of requiring an IV infusion in the veterinary hospital.  The side effect rates were low.  And the results were better than the normal protocol using doxorbucin.  The disease-free interval (the time where there are no more signs of the disease) using the low dose protocol was 178 days, compared to 126 days on the traditional doxorubicin protocol!

It is true that there were not many dogs in the study, but nonetheless, this is a very encouraging result, and can be an option for guardians who are coping with hemangiosarcoma dog cancer.

I hope this helps,


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  1. Robert Barton Price, M.D. on October 17, 2018 at 3:30 am

    Recently discovered a small lump in Dukes side. 3cm. Had it removed within a week. Grossly removed. No margins. Did not want an abdominal mesh for tradotional3 cm margins. Thought it was low grade sarcoma came back Hemangiosarcoma. W/U no Mets yet. Put him on I’m Yunity 3600mg/ day immediately. K9 immunity plus. changed diet to include meat, fish oil, brocolli, garlic, vit c etc. they want to do palliative rad rx( visited this morning) then IV chemo. Assume doxorubicin but unsure. Any suggestions. DNA showed ha 40% great fame, 49 Akita the rest Golden Doberman etc. new territory for us. Any suggestions welcome. This soulDUKE would make one of histories great stories if he were human. Thank you.

  2. Amber Drake on October 9, 2017 at 4:35 pm

    Hello, Patrick. There is a different time for every chemotherapy drug, some of the most common ones are listed in this blog post with the best times associated.

  3. Patrick on September 29, 2017 at 11:16 am

    Hi. I would like to know when is the best time to give your dog the low dose chemotherapy medication?

  4. Hemangiosarcoma: Low Dose Chemotherapy Protocol | Dog FYI: Dog Health Information Library on April 7, 2014 at 5:41 pm

    […] Full article Dog Cancer Blog: Low Dose Chemotherapy Better for Canine Hemangiosarcoma? […]

  5. Penny on August 13, 2013 at 5:21 pm

    Hi Dr Demain,
    My 11 year old staffy had an emergency spleenectamy in May last year. In Oct they discovered she had Hemagiasocoma & lymphoma cells combined that has mettasized to when her spleen used to be, her intestines, stomach & in her abdomen (this was discovered in open surgenry to remove the “masses”on her stomach. They told me I would be extremely lucky if I had her at Christmas. I started her immediately on the K9 Immunity Plus, Artemism, Butrex & tramadol for pain. She is on a diet of cooked chicken, carrots, broccoli, beans, cauliflower & sardines. Im very happy to say she is still doing very well & they believe the cancer may have stopped. They had offered chemo but thought it would buy her only a short amount of time.
    Kind Regards

  6. Kris on May 11, 2013 at 2:28 pm

    My almost ten year old golden retriever was diagnosed with cardiac hemangiosarcoma on September 15th, 2012, after collapsing on his walk. He was given anywhere from a day to a couple of months to live. Needless to say, we were devastated. We took him to an oncologist who prescribed metronomic chemotherapy and he has not had one sick day since and this week will mark his eighth month of treatment. We know that in his case, this was the right treatment.

    • Dr. Demian Dressler on May 30, 2013 at 4:24 pm

      thanks for sharing this info!!
      Great that your golden is doing well!

  7. Eric Lagin on April 5, 2013 at 10:10 am

    With the recent study out of Penn indicating that the use of certain mushroom products, specifically “turkey tail” mushrooms, can produce results superior to any existing chemo protocol, would this not be a preferred treatment even over the metronomic for dogs?

    • Dr. Demian Dressler on April 10, 2013 at 5:47 pm

      Dear Eric,
      The use of medicinal mushrooms, including coriolus and other species, is one of the core strategies we advise in the Guide. However, it should be noted that the information from the penn study does not really state that the use of this mushroom is superior to any existing chemo protocol. Different cancers have different chemo protocols, and in some cancers we get good results fro the use of conventional options including chemotherapy. It would be nice if turkey tail or other natural therapies were always better, but as one who routinely uses these therapies i can say that yes, they certainly help, but are not always the best or only tool in the toolbox for all dogs and all cancer types. For example, lymphosarcoma seems quite resistant to the effects of these mushroom extracts, although I still use them to aid in immune support.
      I hope this answers your question,
      Dr D

  8. Joan F on April 5, 2013 at 5:37 am

    What do you think of I’m-Yunity (Coriolus versicolor mushroom) that was used in a trial at U of PA and resulted in median survival time of 199 days in the group given the highest dose (100 mg).

  9. Lynn Hopkins on April 2, 2013 at 5:04 am

    What type of therapy would you use for a 10 old black lab who was in excellent health prior to his diagnosis of hystiocytic sarcoma in the left rear leg and some lymph node affected in the anal gland. He has severe arthritis and an old tear of the cruciate ligament in the same leg as the cancer.

    • Dr. Demian Dressler on April 10, 2013 at 6:07 pm

      Hi Lynn
      the conventional approaches for histiocytic sarcoma are oral chemo with Loumustine (CCNU) and removal with surgery. I’m not certain what is happening in the anal gland- that is not a very common place for a metastasis. The lymph node is common though. So normally we would be considering removal of the tumor (wide excision) and likely the lymph node with the Lomustine. The published median survival is about a year with both the chemo and the surgery, but all dogs are different:
      Also, this is an important post for you to read:
      I hope this helps,
      Dr D

  10. jackie nolen on March 20, 2013 at 3:11 pm

    has this low dose three chemo drug been tested on any other types of canine cancers?

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