Prednisone for Dogs: When to Start with Lymphoma
Sue Ettinger, DVM. Dip. ACVIM (Oncology). Dr. Sue is a boarded veterinary medical cancer specialist. As a Diplomate of the American College of Veterinary Internal Medicine (Oncology), she is one of approximately 400 board-certified veterinary specialists in medical oncology in North America. She is a book author, radio co-host, and an advocate of early cancer detection and raising cancer awareness. Along with Dr. Demian Dressler, Dr. Sue is the co-author of The Dog Cancer Survival Guide: Full Spectrum Treatments to Optimize Your Dog’s Life Quality and Longevity.
Updated: June 2nd, 2020
Summary
Prednisone for dog lymphoma may be recommended. It’s true, it treats lymphoma, and is used a lot in chemo. BUT … using it too soon could be a mistake.
Using prednisone for dog lymphoma too soon happens all the time, so don’t beat yourself up if you’ve done it. But if you can, avoid the use of steroids (such as prednisone) before chemotherapy, and also before you have a confirmed lymphoma diagnosis.
Why? This common steroid is used in lymphoma protocols … and can also interfere with lymphoma protocols.
This is a little weird, so let me explain.
Prednisone’s Uses
Now, I’m not bashing prednisone across the board. Steroids are used for many things in veterinary medicine.
For example, your dog has probably been on prednisone. It’s a great anti-inflammatory for use with itchy skin, allergic reactions, and allergies.
Prednisone is also immunosuppressive at higher doses, which means it is great for immune disorders. That’s why it is used for things like inflammatory bowel disease and immune-mediated diseases like anemias and platelet disorders.
Prednisone is also part of most lymphoma treatment protocols because prednisone actually kills lymphoma cells. In fact, it can be a standalone treatment: if a pet Guardian decides against chemo, I recommend prednisone. Survival times for lymphoma without chemotherapy treatment are about one month, but using prednisone increases median survival times about two to three months, with about 50% response rate.
Sounds great, right? Why not start prednisone for dog lymphoma right away?
Mistake: Using Prednisone Right Away
It’s tempting for a lot of general practice veterinarians to start dogs on pred immediately if they see lymphoma on an aspirate. But this is a mistake if you are going to consult with an oncologist or use chemotherapy. Why?
Our current lymphoma protocols can be very effective. The median survival time for dogs receiving chemotherapy is thirteen to fourteen months. Compare that to one month with no treatment, or two to three months with prednisone alone, and you see why we oncologists are keen to use UW CHOP for your dog’s lymphoma.
They are definitely worth a chance if you choose chemotherapy.
Which means you should avoid the use of prednisone for dog lymphoma until AFTER you have confirmed the diagnosis, and ONLY if your oncologist prescribes it.
Why? Prednisone complicates diagnostics, and interferes with chemotherapy treatments. Let’s look at diagnostics first.
Prednisone for Dog Lymphoma Complicates Diagnostics
If you start prednisone (often shortened to “pred”) before we complete other tests like chest X-rays and abdominal ultrasound, those tests will now be less accurate. Why? Because you’re already treating cancer, so we don’t know as much about the illness your dog has.
Staging Lymphoma Is Affected
For example, if your dog is already on prednisone before a liver and spleen ultrasound, that ultrasound image is not very useful. We can’t tell if lymphoma has invaded those organs or not. The lymphoma may have been there before the prednisone, or may not have been. We just can’t tell.
Why is this important? Well, how much lymphoma has spread tells us what stage cancer we’re dealing with. And knowing the stage helps us to determine treatment, monitor response, and make a more accurate prognosis about the probable outcome of treating your dog.
Side Effects Are Affected
Here’s another fact: if your dog is on prednisone before we finish testing and staging his or her cancer, he or she is probably having few side effects from the lymphoma. Of course, that’s great for the dog’s comfort, but if symptoms and side effects pop up later after we start treatment, it may be difficult for me to distinguish whether those are due to the chemotherapy or to the cancer itself. (This is one reason to see an oncologist RIGHT AWAY if you find out your dog has lymphoma!)
SubType Diagnostics Are Affected
And another thing: prednisone can affect the test for the lymphoma phenotype, also known as the subtype. There are two subtypes of lymphoma: B-Cell, which means the lymphoma is in the B-cells, and T-Cell, which means the lymphoma is attacking the T-cells. Whether your dog’s lymphoma is B-Cell or T-Cell matters, a lot: B-cells usually respond better to chemotherapy and have a longer survival time. If I can’t tell whether your dog has B-Cell or T-Cell lymphoma, I’m not going to be as accurate in my prognosis, and it will be harder for you to make a decision about whether and how to treat.
For this reason, I don’t test for the subtype if a dog is already on pred and the lymph nodes are already in remission. The subtype test is the very best predictor we have for lymphoma: it helps us predict both the cancer’s likely response to treatment and the likely survival time we’re working with.
Lymph Node Aspirates Can Be Affected
In order to confirm your vet’s diagnosis, I take an aspirate of a lymph node. But if your dog is on pred, and the aspirate is inconclusive, we have to delay confirmation while I re-aspirate or actually biopsy a lymph node to confirm the diagnosis. This happens often when a dog has already started on prednisone before they arrive in my office.
Once again, starting prednisone before getting a diagnosis confirmation, makes getting a diagnosis a challenge.
And if diagnosis is a challenge, and I don’t have the good data I need to make a protocol choice, it can interfere with treatment.
It’s Harder to Choose a Chemo Protocol with Confidence
Knowing all of the above, particularly the B-Cell or T-Cell subtype of your dog’s lymphoma, helps me to choose which protocol to use. The UW CHOP multi-agent protocol (the best protocol we have) does not work as well for T-cells as is does for B-cell lymphomas, so the protocol has to be adjusted, and our expectations have to be adjusted, too.
I’m really flying blind — and therefore less accurate in terms of my advice — if your dog is already on pred and we can’t test for the subtype.
So, we’ve established that prednisone can really complicate diagnostics. But what about what it does to chemo treatments themselves?
Prednisone Used Too Soon Can Trigger MDR
Unfortunately, steroids like pred potentially make treatment with chemo less effective.
Prednisone can trigger a mechanism in the cells called Multi-Drug Resistance (MDR). I cover this at length in The Dog Cancer Survival Guide, because it’s an important concept for you to understand if your dog is undergoing chemotherapy for any cancer.
There’s a bunch to know, but in short, MDR is something some cancer cells can do to evade chemotherapy. Basically, some sneaky cells turn on pumps that literally eject chemotherapy agents OUT of the cell. No matter how much chemo we throw at them, they just keep throwing it back.
For more helpful tools and information, get a copy of the Dog Cancer Survival Guide
MDR can develop during normal chemo treatments, but just using prednisone alone can also trigger MDR.
As you can imagine, dogs with lymphoma who have MDR have a much worse prognosis than those who don’t.
The use of pre-treatment prednisone has been demonstrated to be a strong negative-predictor for dogs with lymphoma. In plain English: dogs who are on pred before they start chemo don’t respond as well.
Bottom Line: Wait to Use Prednisone for Dog Lymphoma
Lymphoma is a very aggressive dog cancer, and the pressure to start treatment right away is (and should be) enormous.
Every day you delay treatment is a day lost, and time is really short with lymphoma. (Most cancers do NOT have such tremendous pressures!)
However, that urge to treat does NOT mean you should start prednisone immediately.
Wait to see what the test results are. That way, you can choose from ALL of the relatively good options we have for treatment.
Jumping right in with prednisone can take options off the table.
Live longer, live well,
Dr. Sue
Sue Ettinger, DVM. Dip. ACVIM (Oncology). Dr. Sue is a boarded veterinary medical cancer specialist. As a Diplomate of the American College of Veterinary Internal Medicine (Oncology), she is one of approximately 400 board-certified veterinary specialists in medical oncology in North America. She is a book author, radio co-host, and an advocate of early cancer detection and raising cancer awareness. Along with Dr. Demian Dressler, Dr. Sue is the co-author of The Dog Cancer Survival Guide: Full Spectrum Treatments to Optimize Your Dog’s Life Quality and Longevity.
Good morning,
I’ve come across this post in my mounds of research and am hoping you can offer some clarification. While waiting for test results, the vet recommended we begin treatment right away as he was fairly certain lymphoma would be the diagnosis and placed Maggie on prednisone 20 mg BID. My dog, who had previously been completely asymptomatic with the exception of the lymphadenopathy, became extreme heat and activity intolerant within 2 days. After 4 days total of prednisone, I stopped because of reading this article and a multitude of other corroborating research. I am wondering if there is a window where the prednisone affects the efficacy of chemo and what that window would be. Pretty much, since it’s only been a few days, I want to know if there has already been irreversible damage to further potential treatments or if we might be in the safe zone since it was only 4 days. We are still awaiting some test results and a consult appointment right now. Thank you.
Becky & Maggie
Hi Barbara andindeed Julie,
Everyone here at the Dog Cancer Support Team knows what it’s like to go through this diagnosis. PLEASE be careful about what you find on the internet. Many things claim to cure or successfully treat cancer and that’s what we want to hear. But few of them have actual proof outside the lab, that is to say proof in a living body. Many things will kill cancer in a petri dish (in vitro). Our dogs however have to take most things by mouth and it all goes through the digestive tract. For something to retain it’s usefullness through digestion itis considered to be “bioavailable”. When you find a site that gives good claims, ask their customer support and ask if they have actual documentation about successful results “in vivo” in a living body, beyond testimonials. This goes for even things like turmeric, which is hands-down one of the items that has loads of proof. You still have to get it into your dog. I really recommend The Dog Cancer Survival Guide, which Dr Dressler and Ettinger wrote specifically for dogs with cancer. It explains the bioavailability issue and recommends genuine substances you can get and get into your dogs to help. I certainly reached for everything I could find when my first dog was diagnosed, and Shadow patiently did his best to put up with me. Fortunately I discovered Dr D’s work and got Shadow on the best list of quality support and supplementation he could have. He was much happier, and he was with us 10 times longer than his prognosis. Good luck.
I have been using the colloidal silver and I saw a 100% improvement within the first 24 hours. Hennessey couldn’t walk and hadn’t been eating and within 24 hours she was up and walking…going up and down stairs and eating and even “playing” on the couch. It looked to be a miracle. The problem is…I dont know how much to give her and I dont know how to find the right brand of silver and how hard to hit her with it and when?? I know I have to get agressive with it and quick or she will still die. She has to kill it not the other way around!!. I also researched it more and I’m thinking she should be taking vitamin D and just a small amount of prednisone. The prednisone just gives you more time to kill the cancer. Any ideas or constructive help here? Thank you. Ps I forgot to mention that the tumors shrunk to one third of their original size in 24 hours and one side is almost completely gone
Has anyone looked up unconventional methods of treating cancer? I have, and I found colloidal silver is being called the cure for cancer! Anybody else know of anything else that might save my sweet Boxer, Hennessey?
How much colloidal silver do you give Hennessey? I am giving Buddy, our Pit, Vitamin D3, Omega 3, fish oil, turmeric, C, E, and digestive enzymes. I have baking soda is good for cancer but I haven’t tried it. I am willing to try most anything.
Hello Jason,
Prednisone is an anti-inflammatory which is why it can be so effective in treating cancer. As cancer creates inflammation in and around a tumor, reducing it often makes your dog more comfortable. Dr. Dressler comments on page 407 in the Dog Cancer Survival Guide, so I’m drawing from that to help answer your questions.
Just like us, when our dogs have medication that produces a change in the body, it can have a knock-on effect such as the body itself does not respond the way it normally would, because this other substance is doing a job for it, like inflammation control in this case. So we may see some side effects like blackened stools, increased appetite and thirst, etc.
Dr. Dressler further explains “Another consideration, when using prednisone, is the potential necessity to taper off usage. After seven days of using prednisone, the body significantly decreases its own corticosteroid production. If prednisone is stopped abruptly, the body can be thrown into a kind of shock, with symptoms like nausea, vomiting, weakness, pain and fever. Tapering the use of prednisone, however, allows the adrenal glands (which produce corticosteroids) to gradually increase steroid production. This helps your dog’s hormones to stay in balance. The longer you have used prednisone, the longer the tapering period, so check with your vet or oncologist.”
So I hope that makes sense, and goes some way to answering your questions. You asked why preds stops being effective after a time. Like many things, the body responds to a point, then balances out with the agent or medication being used. Just because preds is not a permanent or continuous treatment doesn’t mean it doesn’t have it’s place. You could consider using Apocaps, which has anti-inflammatory properties as you balance your dog’s treatment. http://www.apocaps.com Please don’t change your dog’s dosage or frequency of the preds without your vet’s advice, because you don’t want your dog’s system to be thrown into chaos as it tries to balance it all. Wishing you and your dog all the best. Get that nutrition as optimum as you can too, so your dog’s body has every available tool to stay strong!
I can’t seem to find an answer on this anywhere, but wondering if anyone knows. What is the scientific reason why prednisone stops being effective after a time? Also would a therepy such as 3 days on, 3 days off prednisone possibly increase the length of effectiveness, before cancer becomes prednisone resistant? I see a lot of info out there that says, once you start prednisone, you shouldn’t stop abruptly, but I don’t see any info on the reason why.
Hello,
To help respond to your question I’m taking an excerpt from Dr Ettinger’s views in Dog Cancer Survival Guide:
“Prednisone tends to activate a protein in the walls of cancer cells, called a multidrug resistance (MDR) pump (check out page 130 of the Dog Cancer Survival Guide). This protein pump kicks toxins out of cells on contact. For cancer cells, chemotherapy drugs are the toxins. If the dog is already on prednisone, this pump may be active, which means that it could interfere with the effectiveness of chemotherapy protocols.The problem is use prior to starting chemotherapy.”
But don’t panic, Dr. Ettinger goes on to say:
“Despite this negative predictor, I recommend starting treatment, even if your dog is on prednisone already, as any delay in treatment worsens the overall prognosis.”
So if you’re comfortable in this discussion with your vet, you’re covering the bases. Well done for being proactive and protective of your pup.
Regarding the MDR concern, you can discuss with your vet the possibility of testing for the mutated gene through Washington State University College
of Veterinary Medicine. If chemo is already scheduled and you want to do this, act fast. More info can be found at http://www.vetmed.wsu.edu/depts-VCPL I hope this helps. Good luck to you both!
Hi Dr Ettinger, My vet prescribed prednisone before chemo but she said if we start chemo within a week it will not affect it. Now I am worried that I have started her on it 4 days before we start her on chemo. She is also an Aussie mix so I am worried about the MDR mutation. I think she will be tested for that before she starts chemo in a couple of days. Can you clarify if the amount of time they are on pred before chemo treatment begins will alter the effectiveness of treatment?
I’m confused. My dog’s oncologist also said that taking prednisone prior to therapy makes chemo less effective, but used prednisone after chemo was initiated. Are you saying that prednisone at any time during chemotherapy is not a good thing to do?
Thanks!
Mary, Sorry for the confusion, but the issue is ONLY USING PRED PRIOR to chemo. Using pred with chemo is not an issue and pred is included in many chemo protocols for lymphoma.
Wishing your dog a great response to chemo and a long complete remission!
All my best, Dr Sue
Please help me understand why they started my dog on prednisone a week before chemo started he immediately went into remission but last day of chemo they said it was back and he has been on prednisone ever since. None of the rescue drugs are helping and the last most expensive drug has lowered his platelet count and his lymph nodes are like baseballs and he is very sick now. It was B cell and all that was checked before chemo but why is he so sick? Is it just CHOP that it affects?
Hello Candi, thanks for writing, and we’re so sorry to hear about your guy feeling so sick. We’re not vets here at the blog, but we’re answering just because we know how you feel and Dr. Sue might not see this right away. Just like in human oncology, no one can ever really predict whether any one protocol is going to “work” or for how long it will work if it does. Each case is different, and there are SO MANY things that cancer can do to survive and thrive. As they write in the book, it’s a truly tricky, nasty, deviant disease. Having side effects from chemo like you describe isn’t unheard of, unfortunately, but the likelihood is that the reason he’s so sick is because of the cancer.
Prednisone is often used as PART of chemo protocols, so it’s not that it should never be used — in fact, the “P” in CHOP stands for prednisone! As Dr. Sue points out in the article, the first reason not to use prednisone before starting a formal chemo protocol is because it can make it harder to really figure out how bad the cancer is. Prednisone is SO STRONG and quick! The second reason to not use it before starting the formal chemo protocol is because if it’s used FIRST, it can make the C, H, and O drugs less effective. This doesn’t always happen, of course. And sometimes, people can only afford prednisone, anyway — so it’s not like pred should never ever ever ever be started earlier. It’s just that in general, Dr. Sue recommends that it be used as part of the chemo protocol, rather than right away when they’re still figuring things out.
The sad fact is that there is no silver bullet when it comes to cancer. Vets try what seems to help, but it’s not like a broken bone, or even diabetes or heart disease. The CHOP protocol has tremendous success in general with lymphoma, but remember that oncologists consider slowing tumor growth a “success” … while to us laypeople, “success” would be our dogs don’t have cancer anymore. You’ve done a great job by your boy, and it’s clear you’ve taken wonderful care of him. We hope that he recovers from this bout of yuckiness. Call your veterinarian or oncologist and see if there’s any other protocol that can be tried, and in the meantime, feed him the cancer diet and give him all the love and attention you can. That’s what he treasures most of all. Many hugs and cuddles to you from all of us here.
Candi sorry to read your sad news my little girl been diagnosied with lymphoma on Friday I’m deverstaed, I have been givien prednisone, I don’t know how bad the cancer is as her stroke are little weight loss and her glands are up in her jaw everything else is normal she don’t stop eating. I want a ct scan to see where this cancer is, or how bad, just don’t know what to do really surely there is more than just drug. I have a chihuahua xx
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