This article is all about cats with lymphoma and chemotherapy protocols.if you are having a pet that is going through chemotherapy, you should definitely read my chemotherapy safety Article.
This is all about home safety if you have a pet going through chemotherapy in your home. It is definitely safe to have a pet that is receiving chemotherapy in your home with your family member, with your children, with other pets. But there are some common sense precautions that you should know about and we highlight that in the article So, I’m gonna break this down into four overall categories of different chemotherapy options. And these are first line options. Well, actually, there are gonna be three options and then no therapy. Because that is what some people choose and that’s okay. I just want you to have all the options laid out for you. Okay,
so the first option is going to be a combination chemotherapy protocol. And there’s more than one combination chemotherapy protocol. But overall this is gonna give you the highest possibility of a complete remission rate. And as we went through the last set of videos, and this is true for dogs and cats with lymphoma. A complete remission is so important. So, the lymphoma being undetectable. So, for cats, remember their lymphoma tends to be internal and gastro-intestinal, the GI tract, the lymph nodes and the abdomen is going to be the most common form. So, those lymph nodes, that GI mass resolves and usually, as I talked about in my last video when we do a follow up ultrasound, we can’t detect that lymphoma anymore. So, to get the highest possibility or the highest likelihood of a complete response rate that’s going to be a combination chemotherapy. Where you’re giving different drugs that each have a different mechanism of action against the lymphoma and usually we cycle through the different drugs. So, overall, when you look at the different combination chemotherapy protocols, we see about a 50 to 80% complete response rate and in general, most cats are going to be in remission for about five to nine months.
As I talked about in the last article, cats are less predictable than dogs so, there’s a sub-set of kitties that don’t respond that, unfortunately, will have shorter overall remissions and shorter survival times. But, again, those cats that go into complete remission tend to be our cats that have longer survival times and usually a median survival time of about one year. So, again, about 50% of those cats are alive out one year. There’s a few combination chemotherapy options out there and there’s a couple of variations of how often you’ll come in and how long the different protocols are. My personal preference is the University of Wisconsin CHOP chemotherapy protocol and it’s a 25 week protocol. Again, there are other different protocols out there so when you meet with your oncologist, and again we’ll put a link on where you can find a vet specialist or an oncologist in your area, hopefully. So, talk to your veterinarian, talk to your Pets Ductor about the combination chemotherapy protocol that they recommend. But again, I use the University of Wisconsin 25 week CHOP chemotherapy protocol. I know, that’s a lot of words. So, again, the C-H-O-P. is an acronym and it stands for the different drugs in the protocol.
The C is cyclophosphamide. The H is, actually, the chemical or the name for doxorubicin or adriamycin. The O is vincristine, which is oncovin. Again, the trade name for that. And the P is the steroid, prednisolone is what I recommend. Overall, again, we see about 40 to 70% remission rate for this protocol and median remission rates are about seven to nine months. Again, the cats who go into complete remission are going to do better. The cats that have those complete remission rates, usually, we have a median survival time of about one year. This protocol can be used for cats with other anatomic forms of lymphoma. So if your cat has nasal lymphoma, renal lymphoma, spinal lymphoma, liver lymphoma so it’s not just recommended. So any of the high-grade lymphomas will be using this protocol.
Again, it is very well tolerated and if you watch some of my other videos, my other cat lymphoma videos and the chemotherapy side effect videos, I definitely wanna remind you that chemotherapy is better well tolerated in cats than dogs and dogs and cats as a group tolerate chemotherapy better than people alone. So, definitely check out other article where I talk about that in detail. I do wanna just comment there are some recent studies looking at shorter versions of the CHOP protocols and there are still some studies where there’s maintenance phases where it will go beyond the 6th month protocol. I personally, and most studies do not support using that maintenance phase. That would be the place they come in at regular intervals after the convention to get normal chemotherapy. Again, the shorter protocols are trying to see if we give less chemo, will they do just as well? So, the jury is still out on that. There will be continue to see some studies.
Again, what continues to show in study after study is again those cats that go into complete remission tend to do better. So that’s going to be really important. And if your cat is not going into complete remission just as in dogs, we recommend switching the protocol to something else. Another combination chemotherapy protocol that is pretty well known and commonly used is the COP chemotherapy protocol. This one don’t have the H in it so it does not have doxorubicin. There are some studies that show that doxorubicin is really essentiable for that durable remission so to keep your cat in remission. Another big difference with the COP chemotherapy protocol it’s only weekly for a month then it’s every three weeks but it’s a maintenance protocol and it keeps going for about a year. The CHOP protocol is six months and then you’re done. So, it’s weekly for about the first 2 1/2 months and then every other week for six months and then you’re done. So, again my preference is the CHOP six month protocol but the COP would be an alternative protocol. Again, you wanna talk to your specialist about what they recommend for your cat. But again the CHOP multi-agent chemotherapy protocol is my multi-agent chemotherapy protocol of choice. Okay, category number two is going to be a single-agent protocol. And if you Read my dog Article and hopefully you haven’t had to deal with this in a dog and a cat but that usually becomes a more economical option because you’re not having to come in quite as often and you’re giving one drug as opposed to multiple drugs very frequently.
So the next best option after a combination chemotherapy protocol in cats and this is different than in dogs is gonna be single agent oral lomustine. In the intro, I refer to this as CCNU which is an abbreviation of its chemical name. And this is based on a study done by Dr. Rowell in 2017. And so this is an oral pill, in my practice, you would come in, I would examine your kitty, we would run a CBC and a chemistry panel to check the liver panels because this can be affect the liver. After we check the white blood cell count and all of the blood work including the liver values, in my practice, we usually administer the pills for the owner there and then you go home. The nice thing about this protocol is its given usually monthly every four to six weeks, so you’re not going in that often not weekly or every other week like you are with the combination chemotherapy protocols. So, in advantages, it’s a lot less expensive the practice doesn’t have to deal with all the chemotherapy safety that we have to deal with with the hood, if you’ve watched any of my other videos, you see that we gown up, we make chemotherapy up in a hood, you know that we have to use a closed system to keep everything safe.
So it’s much more practical to be giving oral chemotherapy in a practice. But how does it work, Dr. Sue? Well, that’s a great question. So, it’s not as effective but its very reasonable. Has reasonable cost, we give it with steroids to cats. It seems to be well tolerated and effective. Not as effective as the multi-agent combination chemotherapy protocols but again it does seem to be a reasonable option. Let’s break it down. So, in the study, half of the cats got low white blood cell counts but none of those cats were hospitalized or got septic from the low white blood cell count. In this study that I quoted, only 22% of cats had a complete remission. So that’s pretty low, about 30% of the cats had a partial response. But the median duration of response was about 10 months and it ranged from two months to four years. So that’s pretty respectable. The median survival time of the cats in this study was about 3 1/2 months but it ranged from four days to a little bit over four years. So there’s definitely a range that we were seeing in this. So it was very well tolerated, it seemed to be effective it definitely is gonna be significantly less expensive. You’re gonna be visiting the veterinarian less often than these multi-agent chemotherapy protocols and its much easier to administer than the injectable chemotherapy protocols. So its a good plan B if the cost and the frequent visits of a multi-agent combination chemotherapy protocol are not in the cards for you. So I think it’s a really good option to know about. Again much shorter median survival time for this.
But again there were some cats that had really good quality of life on the protocol and with a median duration of response of about 10 months. And there was a good range on that. So something to consider in my opinion.
What’s the best?
Combination chemotherapy, but I think this is a best plan B. I wanna mention there are some other single agent chemotherapy protocols that we can use in dogs that are not as effective in cats. So single agent doxorubicin, which I told you is in the combination chemotherapy protocol really seems to make a difference. And the difference between COP and CHOP not a good choice as a single-agent protocol in cats. So I really like single agent doxorubicin if a family doesn’t wanna do a multi agent protocol in dogs, its not a good choice in cats. Its just really not effective. I’m gonna go to lomustine in cats if a family doesn’t wanna do a multi-agent chemotherapy protocol. Tanovea, which is a brand new drug that we have for dogs, that was just approved about a year and a half ago is not labeled for cats so we’re not using that in cats. Not an option at this point. So again lomustine would be another good option. There are some other protocols, there’s the MOP multi-agent protocol and a couple other variations, but again I’m just trying to break it down for you some of the basic protocols that I would recommend as first line options. The third category that I’m gonna recommend is steroids. So if you decide that chemotherapy is not the option for you, whether its cost, having to go to the vet frequently, or an oncologist frequently, I would definitely talk to your veterinarian or oncologist about the addition of steroids. I recommend prednisolone in cats over prednisone. So its estimated about half of cats don’t have the enzyme to convert prednisone to the active form which is prednisolone. That’s why I recommend prednisolone. I have two Article that review steroids and their different uses, so you can check those out. But steroids, we’re not just putting them on just as an anti-inflammatory, which they are but they actually have an anti-lymphoma property so they do kill the lymphoma cells and so if you decide against chemotherapy, I recommend if there’s no other reason that your cat shouldn’t be on steroids, that your cat start prednisolone. And that is definitely something that you should talk to your veterinarian about going home with at that appointment. Unlike dogs, it does not seem to increase resistance so you can start steroids while you’re thinking about starting chemotherapy.
So what it does to the survival time, so usually cats with no therapy for high-grade lymphoma is about a month and steroids can increase that to about two to three months. Remember anytime I give you numbers there will be ranges on both sides of that and I always hope that I’m wrong and that your kitty is living longer than the statistics predict. And finally the fourth option is no therapy at all. And that is always an option. In my opinion, for lymphoma in dogs and cats if you’re not going to treat and there’s no reason not to put your pet on steroids, so talk it over with your veterinarian. You know I can’t be your veterinarian through YouTube. Please talk to them about going home on steroids. Again I recommend prednisolone in cats because not only can it kill those cancer cells but it is palliative so it does make them feel better.
Usually we see about a 50% response rate in some cats depending on what their response would be. So I think it is really a good option. But again you’re not obligated to do anything and that is always an option to do no treatment. I didn’t forget about those kitties with low-grade small cell lymphoma. Those kitties are usually treated differently than cats with high grade lymphoma. Those kitties are usually treated with a combination of steroids, the prednisolone with an oral chemotherapy called leukeran or chlorambucil which is treated chronically. There are always gonna be exceptions to the rule and so that’s why I think its great to talk to a medical oncologist like myself. I do have some cats that come in quite sick very cachectic, they’ve lost a lot of muscle, a lot of body mass. There are some cats that I will start with some injectable chemotherapy just to kinda get the cancer a little bit under control more quickly, but then I will transition them over to the combination of steroids with chlorambucil. But just to recap, in general the therapy for small cell low-grade lymphoma is going to be steroids with leukeran and chlorambucil which is an oral chemotherapy drug that you are going to be administering at home under the care of your oncologist, your veterinarian. That does require routine blood work, usually for me I recommend every two weeks for about two to three visits so usually about six weeks and then we go to monthly appointments and then every six week appointments. Why? We’re monitoring weight, we’re monitoring for side effects but we do need to monitor for low white blood cell counts, low platelets, and liver issues. Those are some of the side effects that we can see with chronic chlorambucils. hank you so much for reading !