The Toxicity of Potent Dog Chemo Drug Doxorubicin
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: January 4th, 2021
Summary
Is your dog on doxorubicin? Here’s what you need to know about this potent, common chemotherapy agent.
Vets and veterinary oncologists use Doxorubicin (also called Adriamycin) in many different chemotherapy plans.
Common dog cancers treated with this drug include lymphosarcoma, hemangiosarcoma, other sarcomas, and carcinomas.
This is not a mickey-mouse drug. It is one of the main players in conventional dog cancer chemo treatments. It also has corresponding side effects that, from time to time, are heavy duty and should be taken into account.
NOTE: The reader should be advised that the purpose of this content is not to crucify doxorubicin. It has helped many dogs. Rather, this is information that should be in your head as an informed advocate of your dog’s health.
How Doxorubicin Is Given
Doxorubicin is given as an injection in the vein at the vet hospital. If the tip of the catheter used to deliver the drug is not in the vein (but still under the skin), the drug will end up in the tissues around the vein.
Doxorubicin is very toxic to living tissue when given in this way and will cause this tissue around the vein to die.
Doxorubicin Side Effects
In addition to injuries caused by bad injection technique — which are NOT common, but can occur — doxorubicin may also cause stomach upset, inflammation of the colon, and delay the regrowth of hair. Some dogs will develop allergic reactions during doxorubicin injections. It can also cause bone marrow suppression (anemia and low white blood cell and platelet counts).
It is known to cause damage to the muscle in the heart, in some dogs, which can be quite serious. Check out this abstract for more info on doxorubicin toxicity.
How to Mitigate Side Effects
In the next post, I will discuss the use of common, over-the counter-supplements that should be considered to help alleviate a big toxicity with this drug: heart damage…
And of course, you can find out more about this drug and every other chemo agent, in The Dog Cancer Survival Guide. Dr. Ettinger and I also cover multiple ways to support your dog with and without chemotherapy.
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.
My dog is being treated with vincristine and I have small dogs that like to lick in her mouth should I isolate her from them ? Is this dangerous to them? She is also started taking cyclophosphamide.
Hello, You’re wise to have concerns and to ask. Vincristine and Cyclophosphamide are powerful tools and you want to keep your other dogs safe. The Dog Cancer Survival Guide, page 134 lists tips for safe handling of chemotherapy, and states in part “Avoid direct contact with urine, feces, vomit and saliva for at least five days.” So please make sure your other dogs are isolated from the saliva and all the other discharges from both ends for at least that amount of time! This may mean your dog has to toilet in a separate area and you’ll have to take special cautions to clean up after it, with gloves and a good cleanse as well. I hope you have The Dog Cancer Survival Guide book, as it is packed full of vital information. If you do, please read page 403 about Vincristine, 395-6 about cyclophosphamide and 134 about the cautions. I hope this helps.
all these anti-neoplastic drugs are immune suppesor but why the is give in canine lymphoma ?
Dr. Dressler,
I have a 5 year old Italian Greyhound that has been diagnosed with lymphoma. She has received 3 chemo treatments and has tolerated them well. She is due for her Doxorubicin treatment next. I am concern because she was found to have a heart murmur which appears to be only detectable when excited. Her primary vet never noticed this before. The vet administering her chemo gave us the option to use another drug if we decide to. He does not feel that the Doxorubicin would be an issue. I was wondering what your thoughts are regarding this.
LuAnn
LuAnn,
A heart murmur does not exclude a dog from receiving doxorubicin, but a better way to evaluate the heart function and safety to continue doxorubicin is to have the heart evaluated with an ultrasound, or echocardiogram. During this, the cardiologist measures the fractional shortening, or how effectively the heart is contracting with each beat. If this is abnormal, I would recommend switching drugs.
But a heart murmur alone does not tell you what the fractional shortening is. So is may be safe to continue. Most dogs do not experience heart toxicity until 6 to 8 doses of doxorubicin, but an abnormal rhythm or fractional shortening may be reason to stop and switch. Discuss it with your oncologist, and try to get the echocardiogram.
Also check out the section on chemotherapy and doxorubicin in the Guide!
Good luck, Dr Sue
Dear LuAnn,
personally I would NOT be dismissing this as insignificant.
Dox toxicity is cumulative over time. Those doing chemo frequently would not be ignoring this. Get an ultrasound done of the heart.
I would read the Guide for additional ways to support your dog.
Meanwhile discuss with your oncologist
https://www.dogcancerblog.com/blog/chemotherapy-toxicity-in-dog-cancer-acetyl-l-carnitine-alc/
“Further, the protective effects of silymarin and its major active constituent, silibinin, studied in various tissues, suggest a clinical application in cancer patients as an adjunct to estabilished therapies, to prevent or reduce chemotherapy as well as radiotherapy-induced toxicity. ”
from:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2612997/
Apocaps has silymarin in it as well as other beneficial items. Discuss with your oncologist/vet…
Best
Dr D
Dear Dr Dressler, thank you so much for the time and expertise you have given to help our beloved pets have a maximum quality of life and the best chance for long-term survival.
Our ‘Angel’ is a 8 to 9 yr old medium sized Jack Russell mix. She was diagnosed with Hemangiosarcoma (not sure if spelling is correct), which necessitated removal of her spleen that had a large hard mass, but it did not rupture. She had developed very pale gums during a 2 or 3 wk period prior to the surgery and her red blood count was a little low (not enough to require transfusion), but the surgeon made the choice to give her a small transfusion so that she would have maximum strength to assist her recovery. During the splenectomy they did not see any heart issue or visible spread, but the mass looked suspect for malignancy plus there were 3 small nodules noted on her liver which they biopsied. The vet stated she did not remove the liver lobe just in case it turned out benign.
Our Angel-girl did very well during the surgery, came home in one day, and at 12 days out she is doing excellent, her welbeing has returned, she has a huge appetite, good energy level, plays with the other two dogs, and no more vomiting (prior to the surgery she had trouble holding her food down and had developed extreme weakness).
Today we were told by the referred vet oncologist that her tumor biopsy came back grade lll, and apparently both the spleen mass and the liver nodule(s) are malignant. We are devastated. To look at her zest, renewed spirit and energy level right now it is hard to believe the estimate that without chemo treatments this type of cancer only has a 4 to 8 week survival rate.. and 6 mo to a year if she undergoes the chemo, which seems to be the primary route they recommend. My concern is that with chemo she will be again made miserable with loss of appetite, vomiting, fevers, immune system depression… and ultimate death from either the disease or the treatments.
We want to do everything possible to keep her around as long as we can, but only IF she is not miserable, overly-stressed or made additionally sicker by the side-effects of the treatment. My question is which treatment approach is the least toxic way to extend her quality of life, and for as long as possible? She gets stressed going to the vet.. and she’s not very tolerant of poking and proding.
In addition to Angel’s cancer my husband is being treated for metastatic protate cancer, and is extremely upset over her prognosis, as he loves this special dog dearly. The bad economy has wiped out our savings and investments, so we are currently relying on social security which means treatment cost is part of the consideration as well – but certainly not the primary one.
For the last 6 months she and our other dogs were and still are on a no-grain combo roll of meat, veggie and brown rice diet, along with a multi-vitamin, some flax seed sprinkled in, pre-biotics/pro-biotic powder, plus a small amount of meat-based no-grain kibble to satisfy her crunch need. I ordered an immune booster called ES Clear that has various herbal ingredients, but it has not arrived as yet. I have also been told that Milk Thistle and/or coenzyme Q are helpful, but am rather confused as to how and when the coenzyme Q is used. I will be downloading your Guide later today, which I hope might help shed light on that.
Your professional opinion and any treatment suggestions or alternatives would be welcomed, especially those not involving immune depression or toxicity. I really appreciate your time, and I am sorry for the length of this plea! I just wanted to be sure you have all the mitigating facts. Thanks again, on behalf of Angel and her human parents too.
Hi Dr. Dressler,
My family and I just rescued a labrador from the humane society 9 weeks ago. 8 weeks ago, I noticed enlargement of the popliteal LNs and one of the submand LNs. First aspirates were “atypical reactive lymphoid hyperplasia” – – dog also had Lyme disease — we treated the Lyme with Doxycycline and reaspirated to find the dx was consistent with lymphoma (all LN are now prominent except for the axillary nodes – – all nodes go and and down but never down to normal). I did chest and abd films today (I am a vet tech) and they all were basically normal. Our dog is somewhere between 8 and 10 years old according to the Humane Sociey but they found him as a stray – -he has two scars on his throat as if from some sort of collar when found.
Here are my questions and concerns – – we want to do what we can for him b/c even though we have only known him for 2 months, we have fallen in love with this most awesome dog!! I have started him on Welactin (Omega 3s and DHA), changed his diet to Taste of the Wild non grain/low carb and Hill’s n/d. My boss has a call into a local vet oncologist who I believe uses a multi chemo approach – -my family and I can not afford this treatment and I honestly don’t want my dogs last year of life to be about running to the vet for IV catheters, injections, bloodwork, etc. – – I have read that Doxorubicin alone can be used in conjunction with oral Pred to provide better results than just pred although not as good as multi dose chemo – – -What do you know about using Doxorubicin only (as it may be more affordable for us and it is only one injection q 3 weeks for about 5 txs). Additionally, I have children and I understand that Doxorubicin is excreted in the U and BM of dogs for several days after tx so caution is advised for dealing with eliminations – -what are the consequences of accidental contact with the urine say should the dog accidentally urinate in the house or something like that since on pred also? Just want to consider the issues since I have children (one of which will be undergoing surgery soon).
If we choose to go with pred only, what else can I do to maximize our time with our beloved new pet and keep him as happy/healthy as possible – – I saw an earlier post where you mentioned alternatives – – -I am open to hearing about that please. Thanks so much – – any info you can give is greatly appreciated – -what successes are there with alternatives?
thanks so very much!!!
Dear t.rheam,
there’s a lot of information needed to answer your questions…so many it could fill a book (it did, actually, The Dog Cancer Survival Guide…a good investment for you on the “what else can I do” question. Also see: https://www.dogcancerblog.com/blog/an-overview-of-what-else-can-i-do/
One can do doxo as a single agent with pred. Median life expectancy is vaguely 6 months…but don’t forget you will be adding in all the good stuff you read in the Guide.
As to effects of low concentrations of doxorubicin on kids, check with your pediatrician. During the 4 days after treatment you will have most of the dog’s excretion of the drug. Usually though if waste disposed of in sealed bags and the urine is cleaned with gloves using a detergent several times you and yours are likely safe- but that is a human medical question that I am afraid I am not fully qualified to answer. Oh yeah, don’t forget saliva, poop, and vomit.
I hope this helps
Dr D
My sweet Mugs is going to have her 1st round of radiation & chemo this monday. Thank you so very much for the insight, info & support.
Dear Dr.Dressler,
My English Bulldog buddy is 8 yrs old and just Dx with a grade 1 hemangiosarcoma
He had a uneventful splenectomy without rupture, spent 3 days in ICU in the UGA
VTH…no problems with his heart noted during his stay, 10 days later he was started on doxirubicin and after his dose they did an echo which they said showed ventricular premature contractions. I had noted a very tiny lump on his side which they did an aspirate and Dx him with a mast cell tumor as well. He had a halter monitor for 24 hrs after, we have not heard the results. We are 4 days out and he has gotten I’ll, vomiting, diarrhea and very quiet, tired. He was given SQ lactated ringers , cerina and benedryl . It’s 24 hrs and I’m not seeing a noticible improvement…my big concern of course is his heart, did one dose do damage?
Should I give supplements, once his N/V subsides? I’m just so worried…before chemo he was a very happy active boy, who bounced back well from surgery..
If it is determined that the chemo did indeed cause damage, what treatment is possible then?…thanks, devastated and confused..cheryl
Dear Cheryl
sorry to year about your Buddy.
I’m wondering something- have you taken a bit of time and read the Guide? If not, this would be a very wise choice for you. There, you would learn about using coenzyme Q as a supplement that may help animals on doxorubicin, as well as the pharmaceutical dexrazoxane for the same purpose. Also you will learn about apoptogens, antimetastatic supplements, immune support, diet, and other methods to help both from a supplement standpoint and also for a complete care standpoint. There is also a section on treatment plan analysis which sounds like it would be good to become informed on.
Hopefully the cardiac issue will be reversable with time. Talk to your vet about the use of Coenzyme Q-10, dexrazoxane, and possibly Acetyl-L-carnitine to help with this.
I hope this helps
D
Dear Dr Dressier, my name is Anna, I am an haematologist from Italy, based in NY. My dog was recently diagnosed with T cel lymphoma, CD3+, with no signs of epiliotrophism. No systemic involvement, only one big tumor on his cheek and 3 smaller behind his ear. Literature reports that the best treatment for epiliotrophic lymphomas is lomustine, however this is not an epiliotrophic lymphoma. My dog had MOPP and did no respond to it. When he started the treatment two weeks ago, he was still very energetic and full of life. He now lost appetite and he is quite weak. He is scheduled to start lomustine tomorrow. However, the second doctor I met for a second opinion, suggested me to treat him with CHOP rather, since the response rate for non epiliotrophic lymphomas is higher with CHOP versus lomustine (at least in his experience). I am now very confused and dont know how to proceed. Could you please give me some help on this matter? My dog had an ecocardiogram 8 months ago for other reasons and it was fine. I was thinking I could maybe start the CHOP with doxorubicin and in case he doesnt respond to doxorubicn after the first week of treatment (we would start the CHOP with doxorubicin) switch to lomustine? I am concerned to start lomustine rightway because once I start it I will have to wait 4 weeks before I can switch to any other therapy in case he doesnt respond. Also, would you recommend to use the K9 pack to help him during all this process? Thanks a lot for your time, I really hope to hear back from you. I am very confused on how to proceed and time is unfortunately a constraint right now. Thanks!
my dog was dg with osteosarcoma in midshaft of rt rear leg he weighs 40 lbs. is it safe to have a regular vet. we he have a better chance getting his treatment at a veterinary school ?
Dear Jane
I always advocate getting the most highly trained expertise you can, as long as the people in charge of the case are willing to listen to you and use all the tools available to help treat your dogs cancer. Often a team approach is best. I would read the Guide here if you have not as this and other issues are discussed-
Dr D
Our 5 yo labradoodle Lola was diagnosed with a fibrosarcoma, high grade, on her tail. She had a large portion of her tail removed, above the tumor by at least an inch and probably more, but the margins weren’t sent for pathology, so we don’t know if they were clear.
She has now undergone two courses of doxorubicin, 3 weeks apart, and is supposed to get 3 more.
She has lost a lot of hair (in spite of the fact that we were told this wouldn’t happen) but otherwise is doing well in terms of energy, spirit and appetite.
Because it is a cold winter, we are considering stopping the chemo after two courses so her hair can grow back, and we were wondering whether there is any data suggesting that 5 is the correct number of courses of chemotherapy to undergo, and that 2 or 3 is worse. We were told that there is about a 70% chance that the surgery alone was curative.
We don’t want to torture the poor thing, but we want to do what is best.
Any advice would be appreciated.
Thanks and happy new year.
Dear Liz,
So sorry to hear about Lola.
The chemo protocols usually do not have these types of comparisons available, including this one. Her hair regrowth though, to be honest, seems less life threatening than cancer growth. Doggy sweaters can help a lot.
Have you read the Guide? If so, you will encounter:
low dose palladia (used with a metronomic chemo protocol)
combination apoptogens
dog cancer diet
Neoplasene
as some options to discuss with your vet. You can also discuss with your vet implantation of Matrix 3 cisplatin impregnated beads available from Wedgewood pharmacy.
I hope this helps
Dr D