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.
Our almost 11 year old “lethal white” sheep herding mix was diagnosed with thyroid cancer in Oct. We did 5 radiation treatments and now the oncology vet feels the tumor is slightly larger but not as large as before the radiation. She is recommending the Palladia since we don’t want to put her through more radiation or traditional chemo. I realize that Palladia is for Mast Cell cancer, what about thyroid cancer?
Dear Marcy,
If you are seeing a board certified oncologist, they are the most qualified to make chemotherapy decisions. They are very good at what they do. Dogs on chemotherapy plans benefit tremendously from the expertise of oncologist input.
Best,
Dr D
Thank you everyone for your feedback and advice. I truly appreciate it. Teresa, your quote sounds similar to other people I have seen post regarding dogs this size. I’ve already made a phone call to Dr. Meleo’s office and let my regular vet know we would like a second opinion on how to manage the cancer care. Thank you so much again everyone and best wishes to all of you.
Has anyone tried using Palladia to fight bladder TCC or any other cancer than MCT? Our onc vet is recommending replacing our current chemo, Mitoxanthone, with Palladia because our lab’s bladder tumor has re-grown (after surgical removal and 5 chemo treatments). I thought it was only effective for MCT?
Thanks,
JoAnn & Jake
(10-yr-old black lab, bladder TCC dx’d 10/09, toe melanoma dx’d 12/09)
I have an 8-year old Golden Retriever who had a grade 2 mast cell tumor between her toe removed and then her toe removed. She has been given vinblastine chemo and now the oncologist has been recomending to follow up with Palladia. Is this necessary based on the the history of the drug? Is there anyone who has had this or a similar experience? We don’t know what to do.
Thank You Becky–that is helpful information!
And I think you are right about the walks and my dog knowing that i am sad–she follows me everywhere lately..more so than before(she’s always been mama’s little girl) (-: I am more stressed than she is , it seems–so great idea.(-:
Dear Lisa,
I thought maybe you would like this post and possibly it could help:
https://www.dogcancerblog.com/blog/escaping-dog-cancer-days/
Best,
Dr D
Jennifer,
There is an Oncologist in Seattle that you may want to call for a consult. Her name is Dr Keri Meleo and she works at Animal Cancer Care Specialists. She is terrific and is very well known within her profession.
My dog has an extremely stubborn grade 2 recurrent mast cell tumor. He’s been through surgery, radiation and we’ve been administering Palladia at home for the last three weeks. I have to admit, my dog has been experiencing unpleasant side effects from the drug and we are still struggling to get the correct dosage for him. It’s been very, very frustrating.
At this point in time, there is still no word on a definite price for Palladia. I was charged a dispensing fee of $19 at our last visit. However, I was warned to expect to pay approximately $600 (my dog is 75 lbs) per month for Palladia alone. I was quoted an estimate of up to $1500 for the first 6 weeks, of which would include bloodwork and checkups on a weekly basis. Thereafter, we will need to go in for bloodwork every 6 weeks, of which may cost around $200 per visit. If my dog is able to tolerate Palladia, then his treatment is expected to continue for 6 months.
Good luck,
Teresa
Hi Lisa,
Because your dog is on Prednisone and Palladia, it will be prone to infections, mainly urinary tract infections. We had to continually check my dog’s urine, sometimes we had to run a culture to find out exactly what kind of bacteria was involved in order to get her on the right antibiotic. Several times our local vet would look at the urine and say there was no visible bacteria, but I knew she had an infection so I had to insist on a culture, and sure enough it showed an infection. When she had an infection, she would leak pools of urine when sleeping. The bed pads they sell for humans greatly helped to keep it off the couch and her bed. Also the Prednisone will make them urinate more.
I preferred the Masitinib because it was every day (leaving no room for the drug to wear off between doses), and she didn’t have to be on Prednisone with all it’s side affects.
I had great luck with Pepcid (Famtamodine) for stomach upset. Also you need to get anti-nausea and anti-diarrhea drugs from your vet to help with GI upset so you don’t take a break from the Palladia or Masitinib, any time you go off either cancer drug, the cancer has a chance to become resistent.
It is also important to take walks and enjoy being happy with your dog as Dr. D. says, your dog knows how sad you are, it’s a great stress reliever for you both. Good luck and enjoy every minute.
Dear Becky
Great advice!
Dr D
Hi Jennifer,
and all others on the difficult but soul enriching journey of dog cancer:
I had a little more advice since I’ve been through this if you will indulge me.
The only cure for mast cell cancer is total surgical removal. If the site is inoperable or Grade III with high miotic index, your only option is cancer care. But this is actually a good thing, it gives you time to adjust to the idea that your beloved pet’s time is near. If the treatments work to hold back the cancer, and you can control the side affects with drugs and supplements, then you have quality time to spoil your dog and go for more walks together. You don’t have to take it to the very end like I did, but you can use it for a while. That will also help with costs, you choose when you are done.
You can also help with costs by using a regular vet to do the blood, urine and fecal tests, sending the results to the oncologist. Regular vets are usually cheaper. I had to follow the strict weekly protocol because I got help through the test program, hopefully the protocol can now change. The tests are very important, they will not only help your vet check your dog’s health, but you will get peace of mind knowing the liver, kidney’s, heart and lungs are okay.
Hang in there and enjoy every minute.
I have a question about another kind of therapy (don’t know where to put it instead) After losing my dog 8 weeks ago, I remain questionning if I took al the right steps. Palladia wasn’t available yet in Europe, and we tried Masivet (Kinavet) (which did something, but not enough) we tried vinblastine, lumustine (ccnu), tagamet and prednison.
I cannot stop learing about all kinds of treatments and I have read a lot about b17 laetrile. Dr. D, have you considered trying injections with b17????
Esther
Dear Reader,
I think maybe you would like this post, and possibly it would help:
https://www.dogcancerblog.com/blog/escaping-dog-cancer-days/
And yes, I have investigated b17 and I have not yet found clear evidence for supporting it’s use (in my opinion of course).
Best
Dr D
Hi Jennifer,
I had a 60 pound Weimaraner with mast cell tumors Grade III, miotic index 10, surgery not an option once it matastized elsewhere. After going through this myself – first and best option is to surgically remove it with wide margins, if Grade I or II, should cure it. If not I feel it is better to skip the chemo and go straight to Palladia. If it works for your dog you may only get 6 months to a year, which in dog time is a lot of time, and really helped me to have her a little longer. The cost of Palladia itself is only part of it, the weekly blood tests to check for low white cell count, urine tests and fecal tests can run up the bill. They also have the dog on Prednisone which is cheap, but causes infections, usually UTI’s which can also add to the cost. The Palladia is given at home by the owner every other day. Another option is a similar drug called Masitinib, maybe since you are in Canada you can get this easier than here in the US. You don’t have to give Prednisone with it and saves those side affects. The Masitinib is given at home daily by the owner. The Masitnib was $140 for a 3 month supply through AB Science who is dispensing it on a “compassionate basis” until it gets FDA approval here. The Palladia was free as we were still on the test program which ended December. It sounds like your vet is being honest with you preparing you for the expense. With 2 $1,000 surgeries, and 6 months of treatments, blood work, etc. I spent $10,000, then the cancer became resistent to all treatments and I had to put her down. You have to decide if you want to go through all this, the dog will go through boughts of nausea, vomiting and diarrhea, but supplements and drugs mentioned in the Cancer Care Book and on this free blog will help with that.
I know I will have to go through it again with my dog’s daughter who has had Grade II mast cell tumor disease if some day she gets Grade III or high miotic index, so for now I’m following the wonderful information from Dr. Dressler for her: surgery as soon as she gets a lump which needle aspirate shows to be mast cell tumor, supplements and tagamet and a low histimine diet to help with the histimine overload which causes problems. If she does get advanced cancer I will go straight to the Palladia or Masitnib. My vet here in Montana was very reasonable but the weekly blood work & tests which are very important in the beginning to check for white cell count and liver and kidney function, still ran $100 – $200 each time, but after the first month your vet should go to a biweekly then monthly protocol, which will help the expense. Find a good oncologist and develop a relationship with them, then they will help best they can. Most vets are not doing this just to line their pockets. Treating cancer is expensive.
Good luck, enjoy every day.
Dear Becky,
very helpful comment, thank you
Dr D
Eric
For us it was 3 weeks before the tumor shrunk about 20% . She has been stable since the middle of September. We have not had any problems with accidents in the house. We had a long spell where she would not drink any water, would only eat snow. We have not had any problems with kidney function, but her ALT and BUN levels have been consistently rising. Her last blood, she was slightly above the normal levels. She goes in again next week for another check-up, so we will see where her levels are at that point. The first three months were extremely hard, her appetite decreased, her personality changed, she developed diarrhea, and wouldn’t drink. After taking a break from the Palladia and starting up again at a lower yet therapeutic dose things are going much better. We also give Pepsid twice a day to help with the stomach upset and diarrhea. By looking at her you would not believe she has cancer. She has lots of energy goes for two long walks daily and plays in the park. . She does have a good quality of life, better than when she was first diagnosed. Palladia is a hard drug to work with but for us it was the best option we had. If you try Palladia don’t be afraid to ask question and keep the vet informed of any changes you notice in your pet. You know your pet better than anyone else go with your heart and you will never be wrong. Please keep my updated.
Carolyn
Dear Carolyn,
Thanks for sharing your story,
Best,
Dr D
I wonder if the accidents are their way of telling us they are sick?
My 20 yr terrier mix recently diagnosed with oral melanoma and 4 weeks was given vaccine treatment and tomorrow I am to begin 2 tab Palladian 15 my every other day. His vitals are better than most 10 yes or half his age but I want to be as humane to my best buddy as can be. Today before the vet visit he walked 4 miles without a problem. I have a stroller but he is very athletic and has always been on a low fat diet with fish as the mainstay. My question is am I doing the right thing administering this drug? Please give me your opinion.
Dear Beth,
the truth is there is no right or wrong answer for canine cancer.
as long as you have been advised by your oncologist about the odds of success in your dogs (and what the odds of side effects are, and what they could be, and how long the benefit of the drug might be estimated at lasting), I would encourage you to be in charge of your dog’s well being. You are in the information stage at this point. Gather this data for your pooch. Asking the right questions is critical in being your pet’s number one health care advocate. You might want to read the Guide, which is written to help you though this process, and also discusses diet, supplements, and so on.
Best
D
Amanda–Hi
Zoe had swelling too and the prednisone and benedryl helped almost immediately–within days of starting it…but after a week thats when the accidents started in the house…i guess they drink so much water and just gotta go—We saw the oncologist today and she gave us something called Prion to help with the incontinence…my sisters dog also has cancer and she experienced the same thing (accidents, etc) with the prednisone but said after a while it just evens out and accidents dont happen…we’ll see if this drug helps in the meantime.
Not so good news with the Palladia–it didnt seem to help as the bumps actually got a little bigger just in a week..so our vet decided no sense paying money for something that probably might not work..We decided to try CeeNU (Lomustine)instead…oral drug, 2 pills only every 3 weeks…Zoe is still taking prilosec, prednisone, the prion and benedryl…She is cheerful, energetic, and you wouldnt suspect that she has cancer just by looking at her…we shall see how this CeeNU works…
good luck! (-: think positive..
lisa
Thank you Dr. D. Some of the challenges we are facing are because the drug is only on Emergency Release program here in Canada, so I believe there is a strict protocol for the Oncologist to follow. As you know they are specialists and the rate is close to $800 a week just to visit them, and for them to do full testing, this does not include the cost of the drugs.
We have had a lot of experience visiting various specialists over the years because our dog is an English Bulldog, and they are notoriously plagued with interesting conditions. At one point we had to see the Neurologist because his mouth was hanging open, (turned out to be something to do with his ear). In the past (unrelated) we have been through ultrasounds, allergy injections (trial), several operations to remove (benign) tumours,one on his back,one on his foot, one cancerous tumour removed on his head, his ear was enclosed (due to allergies). We have a great relationship with our Vet, and have always given our Bulldog the best care no matter the cost.
With a price tag of a potential: $4000+ a month for the visits and the meds est. for Palladia, we must take this into consideration, especially based on the rate of success.
Also, I believe for my family, (and that includes our Bulldog) any time you are diagnosed with something as serious as this, you always ask for a second or even third opinion. This not only gives you options, but allows for time to process and discuss the information. Over the years and speaking to so many different vets, it really depends on their experience, perspective, values, etc. a combination of these qualities.
I have nothing but the deepest respect, gratitude and admiration for all of the wonderful things that Vet’s do all over the world. Thank you Dr. D, for this useful blog/forum and everyone who participates to help support each other.
Thanks again, I am very grateful for all of the feedback. It has helped me tremendously.
Dr. Dressler,
My 7-year-old greyhound mix has osteosarcoma. She has just had her hind leg amputated after a spontaneous fracture of the upper long bone, above the knee. My vet is recommending Palladia as a valid new option for treatment of osteosarcoma in dogs. Treatment with Palladia is giving even non-amputee dogs and their owners 7 quality months, and that’s not too shabby. From an owner’s perspective, the numbers are very encouraging. Palladia might not be the way to go with the mast cell tumors, but it does seem to yield some very encouraging results with osteosarcoma. I’m definitely going to continue to look into this drug, and I am currently leaning toward it as a valid option when she starts chemo in the next couple weeks.
If you have any evidence that it’s a poor choice for this situation, I’d appreciate some links to the relevant data.
Thanks–
Ivy
Dear Ivy,
there’s some initial evidence (I don’t believe published yet) that indicates palladia may help stabilize disease for around 6 months or so with metastatic osteosarcoma. Many of the dogs in the study were also on cyclophosphamide and non-steriodial anti inflammatory drugs.
I would discuss these options with your oncologist…
Hopefully we can get your pooch the benefits of the additional supportive measures discussed in the Guide too (diet, apoptogens, immune support, and so on..)
Best,
D
My dog just started taking prednisone, benedryl and pepcid on Sunday for a mast cell tumor that has only just starting bothering her. We are thinking about starting the Palladia though after reading the comments on this site I am a little leary of the side effects. She has been having accidents in the house too and I am not sure but maybe its from the steriods? She also has quite a bit of swelling in the leg with the tumor. The tumor is on her thigh but the leg is swollen down to her foot. Walking and massaging it seems to help. The area inside her thigh is very red. All of these symptoms started this past weekend. The emergency vet says Lady Rage had a massive histamine release from the tumor. Until that time the tumor never caused any problems and she has had it for many years. Any suggestions on how to relieve this? I have an appt with the oncologist on Monday the 15th and am trying to keep her comfortable until then.
Paladia equals death….don’t be fooled. My perfectly healthy golden retiever developed a mass cell tumor at age 9. She had surgery and was fine. Vet recomended paladia just in case of tumor coming back. Bailey…. My dog was dead in 2 months…. Didn’t even have time to put her down it went so fast the last few days…. Stay away from this drug. DO NOT USE
Hi,
My 7 year old pug was diagnosed with MCT about 3 months ago. She had two surgeries to remove the masses…but within the past month she has developed 5 new little masses. The oncologist started her on Palladia–every other day..and on the off days, she takes Prednisone..SHe also takes benedryl and prilosec to ease her tummy..she does vomit on occasion.. She has been doing this combination for only a week…in the last two days she has been having accidents in the house–which never has happened before…she will just be walking around and suddenly there is pee on the floor…i dont think she realizes its happening… could this be problems with kidneys and the Palladia–as Eric mentioned above—so soon after starting the Palladia?
thanks–
Lisa
Dear Dr. Dressler,
I have a 12-14 year old male neutered indoor cat that was diagnosed with oral squamous cell carcinoma. I am trying to figure out a treatment plan after most doctors have told me to aim for pain management until euthanasia. I am truly not ready to give up on him. I see you mentioned neoplasene and was considering that treatment option myself (topical application and per os route). However, I have serious reservations about trauma and pain caused by this agent in the mouth. Also considering Palladia or Gleevec. In the meantime I plan to start piroxicam for pain and antineoplastic properties. Do you have any input or recommendations or experience with any of these modalities? Thank you, Virginia
Hi,
Has anyone seen any kidney problems with the use of Palladia?
Thanks,
Eric
Oh and by the way…. Her counts were great so the mast cell tumor did not kill her. It was the drug! Do not use this drug. My local vet (not the oncologist who prescribed this) gave me all the blood work. This drug will kill your dog and not in a kind way.