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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 and Cancer

Updated: May 15th, 2024

Over the last few years, there has been much work in attempting to improve canine cancer treatment.

One strategy has been to use lower, continuous doses of oral chemotherapy drugs.  The goal in this is to lessen chemotherapy toxicity, reduce trips to the oncologist for IV injections (the medications are pills), and hopefully gaining life span and life quality gains.

This is approach is called metronomic chemotherapy.  Here, lower doses of drugs such as cyclophosphamide and piroxicam have been used with some success.  Initial trials show promise with cancers such as hemangiosarcoma and soft tissue sarcomas.

One of the ways this treatment works is by acting on an enzyme found in higher levels in some cancers, called COX-2.  This enzyme is “turned on” during inflammation. When this enzyme is activated, cancerous cells are able to suppress the immune system and create new blood vessels to feed tumors (angiogenesis).

Many think of metronomic chemotherapy as an attack against angiogenesis.

Perhaps most importantly however, when COX-2 is active, cancer cells are able to avoid apoptosis.  Apoptosis is a naturally occurring process which is coded for in normal body cell genes.  When these cells become pre-cancerous, damaged, old or infected, the apoptosis genes create what is called “cell suicide”.  Apoptosis is the name for this genetically programmed cell suicide directed towards clearing out unwanted cells.

Cox-2 has been found in a variety of dog cancers, such as transitional cell carcinoma, some mammary carcinomas, prostate carcinoma, squamous cell carcinoma, and carcinomas of the nasal and intestinal lining.

One of the common metronomic chemotherapy drugs is piroxicam.  This drug is able to help block the effects of the COX-2 enzyme.

There are plant-derived substances that are capable of having similar effects on COX-2.  These include luteolin, apigenin, and curcumin (among others).  It was for this reason that these constituents were included in the Apocaps formulation.

Metronomic chemotherapy, and the use of substances that fight COX-2,  are still in their early stages, and has not yet had large scale studies completed to assess its effectiveness on a wide variety of cancers.  However, oncologists are using these promising strategies today for canine cancers.


Dr D



One of th

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  1. Silvana C. on October 29, 2011 at 6:38 am

    Hi Dr. Dressler:

    I have a female chow lab mix who will be 11 years old in February. She was diagnosed with a very aggressive melanoma on her tongue in Sept. The vet removed a 5cm tumor which grew back in 10 days! In those 10 days, we already started with the vaccine and radiation treatments. By the 3rd radiation treatment the tumor stopped growing. At the 5th treatment, it had jumped to her lymphnode and the oncologist administered Chemo (carboplatin), and it shrunk both tumors on her tongue and lymphnode in a few days. At the 6th and last radiation treatment it has gone down even more. She has received 4 vaccinations and completed her radiation treatment. I have started her on Apocaps along with K9 Immunity in the last 10 days. We decided to do another chemo treatment to ensure we keep the tumors at bey. However, when I brought her in today, the melanoma has spread to the lungs showing 6 nodules. Recommendation is to try another chemo and check in 3 weeks if they shrink or go away. At this point, do you have any other recommendations besides the Cancer diet and the Apocaps? Should it kick in shortly where it would boost her immune system and finally kill off all of these nodules that are starting to pop up? Shay Shay is a beautiful, healthy dog and should not pass on this way. She should live out her natural life.


  2. Ivan Dryer on October 13, 2011 at 7:07 pm

    Yes, I am giving Apocaps and K-9, along with cottage cheese, oatmeal, EPA/DHA, pectin and a powder mix called Super Daily Greens, with intemittent broccoli and cauliflower. He also gets a number of meds and supplements, including COQ10 and L-carnitine for his heart condition. I think I am going to proceed with the cytoxan/piroxicam, but I wonder if I have to stop any/all of the above steps before/during the treatment, or can they augment the metronomic?
    Thanks again for your responses!

    • Demian Dressler on October 14, 2011 at 9:28 am

      Dear Ian,
      the only thing I have a question about is perhaps the Super Daily Greens. I worry about the free radical scavenging effects of antioxidants may hinder some of the pro oxidant effects of the other therapies without a significant advantage as the trade off. In other words, CoQ10 can scavenge free radicals, but the benefit in my view outweighs this potential interference.
      For more:

  3. Ivan Dryer on October 12, 2011 at 8:30 pm

    Just read about EBC-46. Is it for real and worth waiting for even while the tumor continues to grow? Or should we sart metronomic in the meanwhile?


    • Demian Dressler on October 12, 2011 at 9:08 pm

      Dear Ivan
      It looks like studies done are proprietary (I can’t find anti cancer references aside from blogs and online magazine articles) so we dont know what the real story is. Sorry. I would do the metronomic under oncologist’s supervision. Are you doing the other steps too?

  4. Ivan Dryer on October 10, 2011 at 3:27 pm

    My Cocker’s sarcoma has grown slightly in the last 6 weeks, and I’m now considering at least one course of metronomic with either cytoxan/pyroxicam alone or in combo with palladia. The problem is, I may not be able to afford more than a month or two. Is it worth trying on that basis, and if so should I go with just the pair first and maybe add palladia later (it’s a lot more expensive), or do all 3 at the outset for the best chance of a good result? His heart is still a major concern, and I’ll be making sure this would be Ok with his cardiologist when she returns.
    Thanks very much!

    • Demian Dressler on October 12, 2011 at 9:00 pm

      Dear Ian,
      one problem we are faced with is a limited amount of published data concerning the various metronomic protocols. so we are all shooting in the dark here. I feel it would be reasonable to try the pair first and work in the palladia next, or perhaps a lower dose of palladia? Best to also voice your concerns with your oncologist, who has hands on the dog.
      Don’t forget the other steps in the Guide too- they are also tools that can help-

  5. Vichuta on October 6, 2011 at 3:52 am

    Bow , my dog has removed her tumors 3 times in less than a year.Now , she has cancer in her shoulder too.I do home cook food for her , follow from your book and give k-9 immunity plus , artemisinin , selenium , milk thistle , garlic ,omega 3 , shark cartridge and fresh herbs.

    (I live in Thailand so I can not buy Apocaps.But I can buy K-9 immunity plus and other supplements from and you can delivery the survival kit internationally , please ship Apocaps too.Or at least , supply it to

    My vet wanted to remove her leg then changed to chemo every 3 weeks.For the first 2 therapies , Bow was doing well.She had no side effect from chemo.

    She just came back from her 3rd chemo yesterday.This time she gets worst!She lost appetite and she can not walk.She suffers a lot.Is it because she didn’t have K-9 plus immunity for over a week?(I had 2 months supply for Bow but my maid gave to my other dogs as a snack!And the new supply has’nt arrived yet.)

    Her blood test is stable as last chemo.Is it good?My vet didn’t explain much about her condition.I don’t know which type of cancer she has.
    My vet just said Bow has 6 months to live.Last month , he also said 6 months.

    Unfortunately , there is no acupuncture for cancer dog in Thailand.Thai vet think it will spread cancer.I don’t know what should I do to help her relief from her painful.Any suggestion?(I still want to fight for her life!)


    • Demian Dressler on October 12, 2011 at 8:48 pm

      Dear Vichuta,
      I would be suprised if the lack of K-9 immunity was the definite culprit- I think more likely the additive effect of the chemo. I would see if your vet can get things like ondansetron or cerenia or mirtazapine along with metoclopramide for the stomach. Maybe these would help?

  6. Diane Barnhart on October 4, 2011 at 7:49 pm

    Please subscribe me to “Dog Cancer News”.

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  8. Terri Lohman on September 26, 2011 at 8:32 am

    My dog, Bari, was diagnosed with Lymphoma a week ago. We took him to the ER because he had stridor. We certainly were not prepared for the diagnosis. He also had an infection.
    He started Vincristine and prednisone today (Wisconsin protocol). He has been on omega 3’s for 3 days. His appetite has always been good. The swollen sub-maxillary glands have made the mechanics of eating a little difficult. Changing his diet gradually. The hunters in my family are supplying venison.
    He is a Golden (of course). When we got him from rescue, 2 years ago, he had heart worm and we made through that very scary therapy. Hope he does as well here. Will start Apocaps when they arrive. Not ready to loose him yet.

    • DemianDressler on September 28, 2011 at 5:19 pm

      Dear Terri,
      don’t forget diet, antimetastatics, and very important, deliberate life quality enhancements every day!!
      Keep us posted.
      Dont’ forget to drop the dose of Apocaps with the pred use (use 1/4 to 1/2 the labeled dose with food). Keep your vet informed of medical steps for your Bari as always…

  9. Ivan Dryer on September 22, 2011 at 2:05 pm

    Thank you Dr. Dressler. I decided not to proceed at this time and see how he does for a couple months. If the tumor size increases, I’ll have to reconsider, but so far it doesn’t seem to bother him. Dr. Turner at Vet Cancer said he might live 8 or 9 months without treatment, and his cardiologist said she’d be happy if he lived a year. Maybe his current regimen will better those odds. He is a tough little guy, having previously survived being hit by a minivan and taken down by a coyote, which bit his neck before I chased it off. He doesn’t like the new food/supplement combination, so I have to spice it up with Cesar. And he did vomit up the ApoCaps yesterday, so I made a bigger pill-pocket pouch and also gave him a jerky strip; this worked, as there wasn’t a repeat today.

    • DemianDressler on September 28, 2011 at 5:03 pm

      Dear Ivan,
      you might want to give the Apocaps with a small meal to help buffer the stomach…

  10. Ivan Dryer on September 19, 2011 at 4:30 pm

    I have an urgent question relating to my dog’s life and health. I have purchased the book and am following the nutritional guidelines, including Apocaps and K9 Immunity, for my 14-year-old Cocker whose soft-tissue sarcoma has recurred after surgery 2 years ago. He now also has an enlarged heart that was acute until recently stabilized by meds. Nevertheless, the cardiologist has given provisional approval for him to be entered into a clinical trial at Cancer Veterinary Group in L.A. that uses a bacterium to shrink tumors, but the oncologist said most dogs in the study still require surgery to remove the tumor due to potential side effects from the bacteria.

    My question is whether Dr. Dressler has heard of this study, and if so what does he think of it. I can’t afford any more treatment options, such as metronomic chemo, but I’m concerned that in the fairly likely event he would survive a surgery, the cancer might still persist and/or he would be debilitated. He is acting just fine and apparently doesn’t know he’s sick–taking me for a brisk walk every night. I would hate to either suddenly lose him or our walks unnecessarily, but I know the cancer could ultimately worsen his condition.

    He goes in for prescreen tests tomorrow, and if he passes they want to begin treatment as soon as Thursday, with surgery generally coming, if required, within 72 hours thereafter. So time is of the essence, and the doctor’s opinion would be highly appreciated and valued! Below is the intro to the study.

    Thank you very much for your consideration of my urgent request!

    Funded Clinical Trial for Dogs with Solid Tumors
    A new clinical trial option is now available for dogs with melanoma, osteosarcoma, soft tissue sarcoma or squamous cell carcinoma.
    Trial Summary
    A minimum of 100 dogs with solid tumors will be treated with modified anaerobic bacteria. Treated dogs will be monitored closely after treatment with follow-up required at 2,4,7, and 14 days. While the patient remains on study, there will also be rechecks at 1 and 2 months from the initial treatment.
    Trial Support and Funding
    Study drug, diagnostic tests, and follow-up exams will be paid for by the study sponsor. In the event that side effects are attributed to the study drug, the study will pay for medical management of the side effects.

    • DemianDressler on September 21, 2011 at 7:26 pm

      Dear Ivan,
      the Cancer Veterinary Group is a good group. However, I am not certain that the study will uncover the cure for cancer. You should be prepared for this reality- that your dog may still have cancer following the study treatments. We don’t know the outcome of the treatments (hence the study), and I would simply ask yourself if you are okay with the possibility that it may (or may not) cure your dog. If it does not, will you feel you made the wrong choice?
      I am sorry I cannot make that decision for you, but if you quietly ask yourself this question, I believe you will get your answer.

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