Palladia, First Dog Cancer Drug FDA Approved But Not Great
Dr. Demian Dressler is internationally recognized as “the dog cancer vet” because of his innovations in the field of dog cancer management, and the popularity of his blog here at Dog Cancer Blog. The owner of South Shore Veterinary Care, a full-service veterinary hospital in Maui, Hawaii, Dr. Dressler studied Animal Physiology and received a Bachelor of Science degree from the University of California at Davis before earning his Doctorate in Veterinary Medicine from Cornell University. After practicing at Killewald Animal Hospital in Amherst, New York, he returned to his home state, Hawaii, to practice at the East Honolulu Pet Hospital before heading home to Maui to open his own hospital. Dr. Dressler consults both dog lovers and veterinary professionals, and is sought after as a speaker on topics ranging from the links between lifestyle choices and disease, nutrition and cancer, and animal ethics. His television appearances include “Ask the Vet” segments on local news programs. He is the author of The Dog Cancer Survival Guide: Full Spectrum Treatments to Optimize Your Dog’s Life Quality and Longevity. He is a member of the American Veterinary Medical Association, the Hawaii Veterinary Medical Association, the American Association of Avian Veterinarians, the National Animal Supplement Council and CORE (Comparative Orthopedic Research Evaluation). He is also an advisory board member for Pacific Primate Sanctuary.
Updated: March 14th, 2019
Palladia, the first drug officially approved for use in treating dog cancer has arrived. This was described in the Dog Cancer Survival Guide by it’s pre-market name, SU11654. Now it’s finally ready for release.
Palladia, made by Pfizer, has been approved by the FDA. It is expected to be available next year. This drug is approved for treating mast cell tumors in the dog.
The fact that this is the first drug approved for dog cancer may be odd for many. What about all those chemotherapy drugs that are used? They are not FDA approved?
Well, the facts are that vets and veterinary oncologists have been using human drugs the whole time. As a matter of fact, many of the drugs we use generally are not FDA-approved for use in the canine.
Why?
It turns out that FDA drug approval is allowed for one species at a time. On top of that, approval is for one disease or problem. In veterinary medicine, we have cats, dogs, birds, rabbits, monkeys, snakes, and so on…many different species, and they all need treatment.
It would take hundred of years and staggering amounts of money to get all our drugs approved for all these different species and diseases.
So vets have “off-label” drug use privileges. Off-label drug use means we can use drugs approved for one species (including humans) freely in other species.
Let’s take a look at some of the facts around Palladia.
Like most of the conventional treatments we use in treating dogs with cancer, the numbers for Palladia are a bit disheartening.
The median duration of objective response (meaning how long the Palladia’s effect lasted on mast cell tumors) was 12 weeks. Yes, 3 months of tumor shrinkage or disappearance is what you can expect. This number is taken from the original study.
After 3 months the cancer came back.
On top of this, not all dogs with mast cell tumors even responded. It turns out that roughly 40% of dog with mast cell tumors will actually respond to the drug, while the majority do not.
This means that while about 40% of the time the cancer either went away or shrank, in the remaining 60% of dogs Palladia had no effect.
Get a copy of the Dog Cancer Survival Guide for more information and tools to help your dog with cancer
Sigh.
If you would like to look at the original data for yourself, here is the link.
This highlights important points.
First, there is a big to do about Palladia. But, the actual statistics are depressing. Interesting contrast between hype and reality.
Second, I think most guardians of dogs afflicted with mast cell tumors would not be jumping for joy at these numbers, in spite of the festivities at Pfizer.
Lastly, this shows how important it is to leap sideways in our efforts to really treat canine cancer.
The more I think about dog cancer, and disease in general, the more I believe early choices are key, long before old age.
I will start addressing how dog cancer does not start in old age, in future posts. Instead, it starts many, many years before hand. We need to start taking steps earlier, much earlier.
Best to all,
Dr D
Dr. Demian Dressler is internationally recognized as “the dog cancer vet” because of his innovations in the field of dog cancer management, and the popularity of his blog here at Dog Cancer Blog. The owner of South Shore Veterinary Care, a full-service veterinary hospital in Maui, Hawaii, Dr. Dressler studied Animal Physiology and received a Bachelor of Science degree from the University of California at Davis before earning his Doctorate in Veterinary Medicine from Cornell University. After practicing at Killewald Animal Hospital in Amherst, New York, he returned to his home state, Hawaii, to practice at the East Honolulu Pet Hospital before heading home to Maui to open his own hospital. Dr. Dressler consults both dog lovers and veterinary professionals, and is sought after as a speaker on topics ranging from the links between lifestyle choices and disease, nutrition and cancer, and animal ethics. His television appearances include “Ask the Vet” segments on local news programs. He is the author of The Dog Cancer Survival Guide: Full Spectrum Treatments to Optimize Your Dog’s Life Quality and Longevity. He is a member of the American Veterinary Medical Association, the Hawaii Veterinary Medical Association, the American Association of Avian Veterinarians, the National Animal Supplement Council and CORE (Comparative Orthopedic Research Evaluation). He is also an advisory board member for Pacific Primate Sanctuary.
Hi doctor
Do you have any thoughts regarding Palladia and transitional cell carcinoma? My 13 (now 13.5+) year old sheltie had surgery back in December 2011 to remove two masses from her bladder. Chemo (Mitoxantrone) and Piroxicam ended in April but masses are back and oncologist has given us the option of Palladia or just using metacam to ‘manage’ it. Any insight is appreciated.
Palladia is being used for the bladder carcinoma an anti-angiogenic medication, to target tumor blood vessels. It is believed that the mechanism of action is similar for piroxicam. If your dog has progression on piroxicam, Palladia is a reasonable option. I typically do not recommend Palladia with NSAIDS, like piroxicam or Metacam, together due to the potential for GI irritation or ulcers. Good luck.
All my best,
Dr Sue
Hello, My 12 year old Wheaten Terrier, Frankie has been diagnosed with tibial hermangiosarcoma. His left hind leg was amputated about a month ago after it broke- which is when he was diagnosed with the cancer. He had one round of Docorubicin(Adriamycin) with bad reactions- diarrhea, vommiting, and very low white blood count causing him to have to be hospitalized for two nights and put on IV fluids. His white blood count recovered thankfully and he has recently started acting more like himself. We saw a holistic vet who started him on Yunnan Baiyao (chinese medicine supplements) twice a day; new chapter lifeshield immunity activated mushrooms; and 4 drops of liquid vitamin A. We also add fish oil to his food. The vet oncologist is now suggesting trying him on oral chemo- Leukeran for 2 weeks, then combing it with Palladia for 2 weeks. We are so torn about what to do for our boy. We want him to have a good quality of life for as long as he can. Dealing with the amputation has been a challenge for him, but he’s doing pretty well. We are doing some hydro therapy to increase his muscle strength. Any suggestions out there or advice from experiences of others is welcome.
Dear Ronna,
so sorry to hear about your Frankie. 🙁
Here are some posts that I think will give you some initial info.
https://www.dogcancerblog.com/blog/low-dose-chemotherapy-better-for-canine-hemangiosarcoma/
https://www.dogcancerblog.com/blog/metronomic-chemotherapy/
https://www.dogcancerblog.com/blog/an-overview-of-what-else-can-i-do/
https://www.dogcancerblog.com/blog/beta-glucan-containing-mushrooms-in-the-news-again/
https://www.dogcancerblog.com/blog/chinese-herb-for-bleeding-dog-cancers/
There is a lot more in the Guide, which I think might be good for you to read.
Hope this helps
Dr D
I just got biopsy results for my 9 year old Akita…she has metastatic adenocarcinoma of the liver that originated from her thyroid cancer 4 years ago. She has several nodules and they are suggesting Palladia. She has not one clinical sign but was found on a routine examine by my vet. I am so scared of making her sick. I am just starting your book but want to know if there are any other new drugs to date I should be looking at. Everything at this point is so overwhelming. Thank you
Julie
Julie,
I am sorry that your Akita’s tumor has spread. Palladia is a good option for metastatic thyroid carcinoma. There has been evidence of anti-tumor efficacy for this tumor with this medication. I also personally have had some great response. If you are concerned about the side effects, discuss it again with your oncologist.
I am glad you have the book. I do discuss Palladia in the Dog Cancer Survival Guide. It’s under metronomic chemotherapy.
I personally think Palladia can be well-tolerated and used chronically with good monitoring under the guidance and supervision of an oncologist. I am glad you are considering it.
All my best,
Dr Sue
Dr. Stringer. I looked up the abstract on the article and it was interesting. But I notice that most studies are watching response from an existing tumor that can be measured. What about when there is no current tumor to measure and pt is already on an agent to try to kill any remaining cancerous cells? How do you know if it is doing any good? At this point are there any studies or data showing prevention of recurrence? Or am I throwing more stress to a system already stressed with the Carboplatin tx?
Hi Dr. D,
My dog (6.5 years old, 64 lb. Goldendoodle) just had a malignant (non mast cell) be-be sized tumor removed along with one of his anal sacs. The vet said that she felt she got everything because none of the sac/tumor seemed to be attached to anything. The lab results backed that up. The margins indicated that everything “bad” was removed. He had a follow up x-ray of his lungs which was clear and an ultrasound of his entire abdomen. His lymph nodes were clear and his organs appear to be in great shape. Despite this, the veterinary oncologist (he did the ultrasound) seems to feel that we should give our pup Palladia. We cannot see the advantage of doing this though. If he was on the med for 6 mos. and then came off, his chances of getting another tumor are equal to if we had not medicated him. We feel the better course of action would be to bring him into the vet quarterly for a rectal exam. Am I missing something here? Thanks for any advice you can give.
Dear Patty,
we need a diagnosis (name of cancer) to predict bahvior instead of the area where it occurred.
Perhaps the onc is worried about micrometastasis:
https://www.dogcancerblog.com/blog/dog-cancer-what-is-micrometastasis-and-why-do-we-care/
You should read the Guide which will give you important information concerning how to deal with this. Cancer is not just a lump somewhere- it is a systemic derangement that needs systemic intervention of many types:
https://www.dogcancerblog.com/blog/an-overview-of-what-else-can-i-do/
I hope this helps
D
Dr. D. – I have a very active 12 yo Australian Shepard who was diagnosed with anal sac adenocarcinoma with mets to the sub lumbar lymph nodes two months
ago. All other areas looked clear. He underwent surgical removal of the tumor and lymph nodes without any complications. As expected not all margins were clear,so he was started on a 5 dose course of Carboplatin. He has been on DHA for years but the dose was increased and Piroxicam was added. He is tolerating all well and no current evidence of active tumor recurrence. Now the vet wants to add Palladia, but after reading some of the reviews, and not having a known active recurrence I am wondering what the info is on using this for his type of cancer.
Hi Pam,
Great question. There is early evidence of the use of Palladia for anal sac adeocarcinomas. It was published in the Journal of Veterinary and Comparative Oncology on Jun 1, 2011. (I was one of the oncologists who contributed cases to this study which included 32 dogs with this tumor – other tumors included too.) The name of the paper was: Preliminary evidence for biologic activity of toceranib phosphate (Palladia) in solid tumours(*).
And I think Palladia is well-tolerated with good monitoring and guidance. I have many patients on Palladia long-term. So I think it is something to consider in dogs with anal sac adeocarcinomas.
All my best, Dr. Sue
Our oncologist put our dog on Palladia for 3 weeks. He was diagnosed with mesothelioma 4 weeks ago. We are now trying chemo.
I know no one has posted on this since last year, but a friend just sent it to me. I wanted to share my experience with Palladia because it is so different from the statistics described and very positive. I consider it a miracle drug so far!
My 7 year old border collie/lab mix (45 pounds) got sick in March 2011 with listlessness and vomiting and then within a day or two developed two large lumps on her stomach and within 24 hours of those, developed a bright red skin rash and little lumps all over her body. It was incredible. She had the two largest lumps removed with clean margins at her normal veterinary hospital and was diagnosed with MCT (I can’t remember the stage or grade, but was told they were aggressive and likely to return even if we did treat them). We were sent to Oradell Animal Hospital in NJ where we saw oncologist, Dr. Dennis Bailey, and he went through our options with us (radiation and surgery were not among them because of the widespread rash and tumors all over her skin – it had not spread to other organs though). He said if we did not treat her, she would have probably weeks to live. We chose to use Palladia 3 times a week along with steroids and benadryl. Within 24 hours of the first dose, her tumors were shrunk to about 50% and drying up and her rash was gone. After the second dose, the tumors and rash were gone with very little flakiness left at any of the tumor sites. It was amazing. She was like new again and feeling much better, acting more herself.
We continued this treatment until July 2011 when the Palladia was reduced to once every three days due to some diarrhea issues and nothing recurring in the skin. She continued the Palladia until October 2011 when all medications were stopped.
The only negative side effect that occurred was some protein in the urine which was corrected with medication and as soon as all medication was stopped, her urine came back with no protein.
She remained in remission for 8 months following the stopping of all medication. This month, June 2012, the MCT did return and just as quickly and widespread as the first time. Knowing what it was this time, she was put on Palladia and steroids the same day and has responded again as quickly and well as the first time. We are hoping for another full remission and to be able to keep it in remission for six months or more again.
Palladia saved my dog’s life and gave us hope and so much more time with our angel. It is absolutely worth trying if the cancer is Mast Cell and the dog is young. I would never hesitate to use it again (I am now!) even with the extraordinary cost of her care.
There is also now a new drug that is in the same family but attacks a different part of the cancer cell receptor that is available if or when her body becomes resistant to the Palladia. I am very hopeful with the new research and drug developments in dog cancer and pray that others have as wonderful experience as we did with treatment even though the statistics suggest otherwise.
Hi Jill,
Thanks for sharing your story. I agree that Palladia is well-tolerated, but you need to be under the direction and monitoring of a good oncologist. Dr Bailey is a colleague and friend of mine. You are in great hands.
Again, thanks for sharing and good luck with your dog!
All my best, Dr Sue
Obviously there’s a lot of different results going on but I can say that my bosses dog has been on Palladia for about a year for a massive intertwined tumor in her intestines. They had given her 3-6 months but since then the tumor has gone down about 1/2 in size twice over and she’s doing really well. Obviously things can take a turn for the worse at any time but so far so good. I just had her over to my cube giving me licks and jumping around, so it’s certainly been a great thing for her so far.
Hi, my chihuahua(mixed) Niko is 10 years old about a month ago I realized a lump on his face, I took him to the bet they said he had an infected tooth. So he had surgery to remove it, while he was under they realized he had more than 1 tooth infected so they removed 3. Then they saw some suspicious tissue and sent it out for biopsy. They called me and told me he had oral cancer I immediately started crying, he is like my son & I can’t picture my life without him I am so scared and sad for him. I just want him to be happy & healthy. I got referred to an oncologist they informed me about the 3 different types of treatment. Palladia is the only option I can really afford. The way the vet presented it to me I came home very optimistic & eager to start. But nw after reading all these comments & doing my research online I am a bit hesitant and concerned if this is the best choice for him. They made it seem like lameness & diarrhea are the only major side affects but now I am reading otherwise. Also there is only a 40% chance eh wil respond? I read somewhere else that it was a 60% chance does anybody know the correct percentage? Also I care more about his quality of life than dragging his life on if he’s going to be miserable. I’m scared of making him more sick, I ‘d rather be happy than wimpering or cryign throughout the night, because right now he is perfectly happy & active. I’d hate to have the Palladia change him and make him lazy and sad all the time:( So I really am torn if anyone can help me? I just wonder how long more he can be around without the treatment…
Hi Doctors,
I have a 7 1/2 year old Boxer/Pit mix (Tux) that recently had a stage 3 MCT removed from his right hind leg. They were able to remove all of it and we were referred to an oncologist in our area who is recommending Palladia.
The thing that concerns me most is that Tux also has a rare condition – Ciliary Dyskenesia. Unfortunately, this is limiting the options for treatment for us. He’s already on Clavamox and Doxycyclene for the rest of his life, and he’s doing really well. I’m absolutely devistated that he now has to go thru this and I can’t help but wonder if I should do any additional treatment since the margins removed with the tumor were clean. I can’t believe there isn’t some kind of blood test to see if this cancer is floating around looking for a new place to land!! It’s so frustrating and I don’t know what to do! I know you can’t answer that question for me, but everything I’ve read seems 50/50 and isn’t helping me lean one way vs. the other. It seems people either think it’s a miracle drug or is nothing but poison.
Do either of you have any opinion, based on the limited information I’ve just given you, which way we should go?
Thank you!
Hi Katie,
sorry to hear about this!!
In the guide we talk about grade 3 mct. This is aggressive! You want all the tools at your disposal. Might consider Kinavet which may (depends on who you talk to) have a higher safety margin than Palladia.
You need to be thinking about all the tools…diet, apoptogens, immune stimulation, chemo…even possibly radiation to prevent recurrence.
Please read the Guide.
Load up on the beta glucan containing supplements to stimulate immunity with this condition (Apocaps, K-9 immunity, BioBran, ADCC, Astragalus, etc) under veterinary supervision.
I hope this helps
Dr D
Hi Dr. D!
My dog started Palladia, but the side effects were too severe do I stopped treatment. This was four days ago. She still won’t eat, she still vomits, she has lameness in her hind legs, and she is very lethargic. Any advice as to when this poison is out of her body so she can be normal again?
Dear Tricia
please be in touch with your vet/oncologist so your pet gets the needed care ASAP.
Best
Dr D
Hi Dr. D,
I have a 9 year old female Golden Retriever diagnosed in December 2011 with hemangiosarcoma. She had a tennis ball size tumor rupture away from her liver. Her oncologist and I decided to start her on 5 treatments of doxorubicin every 3 weeks. I am wondering if a drug called Palladia has ever been used in treating hemangiosarcoma in dogs?
Thanks!
Dear Lisa
I am sure your oncologist will be giving you the best information concerning chemo. Palladia does have some merit in treating these cancers but would likely be lower on the list than doxo and also usual metronomic chemo drugs (cyclophosphamide and piroxicam).
I hope also your Golden is getting the other steps you can use to help her cancer discussed in the Guide…
Best
Dr D
Palladia does hit the digestive trac hard. In the over two years Gracie has been on it though we’ve learned how to manage it pretty effectively. In the past whenever she’d get a bout of upset she’d stop eating and she’d have diarrhea and everyone would panic. We quickly learned to stop the palladia, let her recover which typically took only a couple of days and then she was back to normal as quickly as it started. Once however she did have a serious GI issue, we quit the Palladia and put her on an antibiotic and a GI med (like an Imodium), she cleared up in a couple of days and was fine there after. Finding the right Palladia dose and a steady diet of prilosec (generics not recommended) has minimized the occurrences of GI issues.
Dear Dr. Dressler.
There is a new clinical trial underway for treatment of osteosarcoma through conventional chemotherapy in conjunction with Palladia (the other drugs are Peroxicam and cyclophosphamide). It is thought that Palladia, with this combination treatment protocol may help prevent tumor recurrence. I have a close friend who has a wonderful dog who eras just diagnosed with bone cancer.
After I contacted the principal investigator of the trial my friend will be able to enroll his dog in this trial (after further condemnation of it being osteosarcoma). Enrolling in a clinical trial is his only option for affording treatment. However, there is also an alternate clinical trial that uses a be drug that is injected directly into the affected area/tumor. It is not chemotherapy but some other sport of anti infection or anti inflammatory, or something like that.
(don’t know yet exactly what it is).
What are your thoughts on these clinical trials, and Palladia being used in such a “cocktail”?
Thanking you in advance for your kind and wise response.
– Karin
Nice Article Dr. Dressler, Well said.
In Mar 2008, my 4 yr 10 mo old boxerlab mix was diagnosed with kidney cancer by Washington State University Vet Hospital. She was at the hospital for a knee surgery when they discovered the cancer. At that time we had her kidney removed. WASU was very pleased with the surgery but explained that renal cancer is terminal and that the surgery would extend her life from 1 to 1/2 yrs. Two years later we did a follow-up. They were surprised she was still alive. Tests showed her remaining kidney, liver, etc. were all clean. However, the cancer metastasized to one lung. There were 3 very small sites. WASU told us about Paladia which they felt could extend her life by maybe 1 year, without the drug she had 2-3 months to live. We decided to use Paladia. At 60 lbs she took 80 mg on a Monday, Wednesday, Friday schedule. She tolerated it very well, especially when we switched to giving her the drug at night with her dinner, rather than in the morning. Kali recently passed away after 18 months of using Paladia. We had a very positive experience. In the end she lived 3 1/2 years from the time she was first diagnosed. They were wonderful years which my husband and I are so grateful to have shared with her.
Thanks for sharing your experience Jennifer
Best
Dr D
Hi Dr. D:
I have been stalking the forums for months and I have learned so much from the forums and your book.
I just lost one boxer to a brain tumor last month. She had 19 radiation treatments and was not improving even after the treatments :(. She was only 9 years old. My other boxer is 13 years old and has had multiple grade 2 mast cell tumors over the years. She had her first one removed when she was 7. When she was around 11 years old I decided to stop with the surgeries. All together she has had 5 mast cell surgeries. So I figured that she had been through enough. After the decision to stop the surgeries we put her on chlorambucil for about a year and a half. The chlorambucil worked great for a long time up until a few months ago. She developed a big tumor on her throat. This might have caused her vomiting and diarrhea or it was from getting off the chlorambucil.
The next step was Palladia. While on Palladia she experienced lameness in her back legs so I took her off of it. Then she went on Kinavet (Masitinib) which seemed to have the same effect. So we took her off these and she went on prednisone. She is doing fantastic (like a puppy) with more strength and energy. She is also on a grain free diet and tons of supplements prescribed by a holistic vet.
My concern is that the tumor and other lumps are getting larger. I am tempted to put her back on Kinavet since I didn’t give it much of a chance and the oncologist said that lameness is not a side effect. Can Kinavet be given with Prednisone?
At one point she got a cortisone shot in the tumor which shrunk it tremendously. But when I brought her back to the oncologist they said that they didn’t remember giving it to her in her throat and they couldn’t do that especially since she is already on prednisone. They just wanted to up the Prednisone dosage which I am afraid has stopped working.
Since I still have kinavet and palladia which one would you recommend? Can I continue with prednisone, benadryl, pepcid, and tramedol if she goes back on palladia or kinavet?
Thank you for your help and the great information,
Kristin
Dear Kristin
so sorry to hear about all of this. Yes, many dogs tolerate kinavet with pred. This should be done under veterinary supervision. In my opinion I encounter fewer side effects with kinavet than palladia. Yes, you may continue those other meds too…but these are all questions for your oncologist, not me, as this is the person who knows what is going on with your individual dog. If you cannot communicate properly with your oncologist there is nothing wrong with a second opinion.
I am wondering about the other supplements. Apopotogens, including luteolin? waveco.com/mast-cells-and-luteolin-in-cancer-treatment-part-1/
Neoplasene? https://www.dogcancerblog.com/blog/neoplasene-as-a-dog-cancer-treatment/
These are conspicuously absent from the discussion. Have you read the Guide? There is much to do that I am not sure is being done…
Hope this helps
D
My service dog has been on Palladia for nearly 12 weeks. He is on 80 mg every other day with 40 mg then 20mg of Prednisone on the other days with Sundays off of all chemical therapy. He responded very well during the 1st month with his MCT decreasing from 4.6 cm to 3.0 cm. His initial Palladia dosage was higher but the diarhhea proved too much for him and I to handle so the dose was lowered. He is also on Prilosec, Benadryl and Cimetadine for the MCT histamine effects. He is doing really well. When he was diagnosed he was almost 6.6 years. Now he will be 7 in April. I think and I hope that your prediction of reversal of good progress after 12 weeks is untrue as pertains to my service dog. I think every dog is different in their response.
Dear Elaine,
I am glad your dog is doing well. Don’t worry- I have made no “prediction” for a given dog, including yours. We are forced to deal with large populations of dogs and use these numbers as if they applied to a single dog, but they don’t.
If you are interested in learning more about these numbers, you will like these posts:
https://www.dogcancerblog.com/blog/using-dog-cancer-statistics/
https://www.dogcancerblog.com/blog/the-oncologists-perspective-on-statistics-part-three/
Best
Dr D