How Long Can Dogs Live With Metastatic Cancer and Metronomic Chemotherapy? Vlog 105

How Long Can Dogs Live With Metastatic Cancer and Metronomic Chemotherapy? Vlog 105

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– Once a cancer has spread
we often tell owners one to two to three months. And I’ve had patients
live six to eight months, I’ve had some live over a year, I’ve had some live over two years, and I’ve had some live
three and four years. (percolating synth music) Today’s vlog is about
metastatic lung cancer and metronomic chemotherapy. And if you were searching
for different videos you may have come across two videos of when we’re talking about lung cancer. So a recent video that I just did was about primary lung cancer in dogs, which is very uncommon in dogs. And guys, I’ve actually seen
a lot of appointments recently and when in my appointment book, which is actually a computer nowadays, lung cancer, lung cancer,
lung cancer is listed as the reason that the pets are coming in. But usually those patients
have metastatic lung cancer ’cause, as I was saying,
that is way more common than primary lung cancer. If you’re looking for information
about primary lung cancer, we’ll put the link below
because, like I said, I just did a recent video about that. So there is information here for you. And again, I’ll put links below. But today’s video is about
metastatic cancer to the lungs and how I typically recommend treating it with something called
“metronomic chemotherapy.” So let’s break it down, let’s talk about what metronomic chemotherapy is, what are the chemotherapy
drugs that we typically use, and how we will often see responses. So what is metronomic chemotherapy? So, you will often hear that term or low-dose oral chemotherapy, which explains what it is. Remember the metronome? Which is what keeps the beat, if you ever took piano lessons
when you were a little kid. I did. So again, it’s meant to be pulse, low-dose oral chemotherapy. So that’s where the phrase
“metronomic” comes from. So it’s uninterrupted
administration of oral chemotherapy, done at home by the pet owner. It’s usually associated
with less toxicity, but that can vary from
pet to pet depending on which drugs that we’re using. And classically less expense, but again, depending on which drugs we’re using and some of the drugs that we use in the metronomic chemotherapy protocols have changed in the recent years. So not always less expensive,
but that is the idea. So it’s oral, so ease of administration. You don’t have to bring your
pet in to a specialty clinic. The hospital doesn’t have to
have all of the, you know, chemotherapy hood and gowns
and specialty-trained nurses to administer chemotherapy,
so that is helpful. One of the key differences is there’s no breaks in treatments. So if your pet is going
in for lymphoma treatment, it’s weekly. Or bone cancer, osteosarcoma treatment, they’re getting chemo either weekly, every two weeks, every three weeks. This is, there’s no
breaks between treatments. So we’re giving it at lower doses, but at very frequent, regular intervals, which is usually daily or every other day as we’ll go through. So that is sort of the gist of what metronomic chemotherapy is. Now, let’s talk about how it’s different than the other chemotherapy, what I’m gonna call,
“classic chemotherapy,” which is that maximum-tolerated
dose chemotherapy. And when I think about that, you know, most of the other chemotherapy protocols that I talk about in most of the videos. So again like osteosarcoma, where your dog is going
in every three weeks. Or lymphoma, where we’re
giving high doses of chemo. It doesn’t have to be injectable, it can also be oral as well, like lomustine and things like that. So classic chemotherapy
is maximum-tolerated dose, where we’re giving the dog or cat maximum-tolerated doses. And again, this is that
low-dose oral chemotherapy. When we’re giving maximum-tolerated
dose chemotherapy, the goal is to directly
kill those cancers cells. So you know sort of zap,
kill the cancer cells. It’s a little bit more technical than that and different chemotherapy drugs have different mechanisms of action. But the reason that we space
the chemotherapy treatments out either weekly, every two
weeks, every three weeks, is to give the normal
tissues time to recover. Like the gastrointestinal tract. The white blood cells, which
is usually what we call the “dose limiting toxicity.” During that time those
tumor cells repopulate, they repair the damage that
the chemotherapy has caused and it allows those
cancer cells to grow back. But again, the goal of
maximum-tolerated dose chemotherapy, like doxorubicin, vincristine, lomustine, and things like that is direct tumor kill. With metronomic chemotherapy, with that low-dose, pulse chemotherapy, we are not directly
killing the cancer cells. We are actually targeting
the blood vessels, so the endothelial cells that line the actual tumor blood vessels. And the goal is often that the tumor will stay the same size, I’m very happy, more
happy when it shrinks, or completely goes away. But stable disease is often a success as long as the pet is
tolerating the protocol well and you know, they’re having
a good quality of life. So it’s really different
than how we think about like, lymphoma where we want those patients to go into a complete remission. And it’s really changed
the way that I’ve thought about treating patients
over the last 10+ years that I’ve been using
metronomic chemotherapy. And we’ll talk about which
are the cases that are ideal. But dogs and cats that come to
see me with metastatic cancer that has spread to the lungs, for example, is really to me an ideal case where I’m often using
metronomic chemotherapy. There are some other situations as well, like soft-tissues sarcomas that have been incompletely removed and radiation is not an
option for other reasons. That would be another place for some of the metronomic chemotherapy protocols. And that’s why you’ll hear
it called antiangiogenic, which is a fancy doctor word for targeting the blood vessels. For the purpose of this video, I think that’s a good comparison in that maximum-tolerated dose chemo directly kills the cancer cells. And this is targeted to
cut off the blood supply. So the way that I often describe it is that we’re trying to
starve the cancer cells by cutting off their blood supply so they’re not gonna get the
nutrients, the blood sugar, the glucose that they need to grow. And sometimes these tumors
will regress over time and sometimes they will just stabilize and we can maintain the
patient’s quality of life and hopefully prolong how
long that patient is with us with that great quality of life. Immunology was not my strong
point in vet school at all. But there are some cool immune responses that some of these drugs,
specifically cyclophosphamide and then palladian cyclophosphamide
together can cause. And so they can change
the T regulatory cells and that can help the host,
which is the dog or the cat that’s on these chemotherapy
protocols fight the cancer. So, there is also some
cool immune responses. Again, I’m not gonna
dive too deep into that. If you’re a veterinarian or
a veterinary professional, I do talk about that in my
metronomic chemotherapy lecture. So pretty cool stuff,
it’s actually been studied in the last couple years that these protocols have been used. Cyclophosphamide does down-regulate
the T regulatory cells and that allows the patient, the host, to identify these cancer cells and then hopefully destroy
the cancerous cells. And then we have seen when
you use cyclophosphamide and palladia together there’s
a cool, synergistic effect. So even though I don’t
like the immune system, I like when it helps our patients. So again, hope that was a good
enough explanation for you. Let’s move on to to the next thing ’cause immunology, not my favorite. You know, I’m honest. Okay, let’s go on. And the last major difference
with metronomic chemotherapy. In addition to not a major direct effect on the cancer cells, like I said, we’re cutting off their blood supply, tends not to effect the skin cells and it also tends not to really effect the neutrophils, the white blood cells. So in general, we tend not to see drastic low white blood cell counts, the way that we do with some
of the other chemotherapy, the maximum-tolerated dose. We still do watch the white blood cells, sometimes with chronic usage, and I have had some of these patients successfully on these
protocols for six months to four-plus years. We will have to give them
a little bit of break if we see progressive, low
white blood cell counts. Just to kind of give the bone
marrow some time to recover. But in general, we don’t
see a lot of side effects to the cells that I just mentioned. So that really summarizes
how metronomic chemotherapy is different than classic,
conventional chemotherapy. The other thing that I think
is really important to know is that it’s slow acting. What I find when you put
patients on these protocols is it’s not gonna melt
tumors away in the lungs or in the abdomen, if they
have metastatic disease there. It takes time because
you’re, again, starving them by cutting off the blood supply. So often I will not do follow-up imaging, whether it’s chest x-ray or ultrasound, for two to three months
after starting the protocol and usually space it out there. But I will see the patients back. In beginning, every two weeks. But once they’re on
their maintenance dose, usually every four weeks and then eventually every six weeks. But it does require
consistent, you know, visits with your oncologist, with
your veterinarian to monitor. So you’re not just gonna go home with three-months worth of medication, at least under my
direction, and not see me. Because it requires close monitoring of weight and things like that. So that’s really the
palladia-based protocol. Some of the other less
intense metronomic protocols that are, if you’re just on like, cyclophophamide and a non-steroidal. I may be doing every six weeks. So the point of this video is not give you the exact protocol that I do, it’s just to let you
know there are options using metronomic chemotherapy for dogs with metastatic disease. Dogs that have measurable
metastatic disease, in my opinion, typically, so nodules in the abdomen, in the lungs, typically do not responds well
to injectable chemotherapy. Like a dog with metastatic osteosarcoma, metastatic anal sack tumor,
metastatic mammary tumor. We wanna use those injectable chemotherapy after primary tumors have been removed, before the cancer has spread. I have found more success
with these protocols in patients when their cancer has spread. Once their cancer has spread, we often tell owners one
to two to three months, And I’ve had patients
live six to eight months, I’ve had some live over a year, I’ve had some live over two years, and I’ve had some live
three and four years. So I’ll be honest, I’ve had some patients where
the protocol has not worked. Requires close monitoring,
working with a specialist because there are side effects. We have to make sure they’re eating, that they’re not losing weight, and they’re getting pills everyday. So one of the things to be aware of when you’re going through this protocol is you have to be able to pill your dog. You have to be able to give them diarrhea medications at times. You have to be able to use
the just-in-case medications. So we’ll put links to vlog number 93 and the video, I think it’s
number 70, on how to pill a dog. Also, if your dog’s not
eating to start with, I’ve found that these
protocols tend to be harder because we’re giving medications that could effect the appetite. So, I’m a little less
optimistic if we’re having a dog that comes in completely not eating. We’re gonna work really hard
with the appetite stimulants, like Entyce and Cerenia to get them eating before we add some of these medications. If the masses are causing a lot of pain and discomfort for the patient, that makes me worried
about putting them on this type of protocol. So now I hope you really
have an understanding of how this chemotherapy
protocol is different than traditional chemotherapy. And to me, it’s really been a game-changer for some of my patients
with metastatic cancer. And like I said, to have patients
live six months and years, one, two, three, even four
years with metastatic cancer has just been phenomenal. And it’s really different
than how I think about some of the cancers like lymphoma, where we want them to get
into a complete remission. If they can have stable
disease and a quality of life, to me, you know, that is phenomenal. So I hope that this has been helpful. You know, to hear that your
pet has metastatic cancer, I know it’s crushing, it’s heartbreaking. I hope that this is a protocol
that will work for your dog and for your cat as well. So please, talk to your veterinarian. Hopefully you can see a specialist. There will be links below with lots of different
information about chemotherapy. My chemotherapy information sheets. But come on back for the next video, we’ll talk about the different drugs. Thanks for watching and I look forward to seeing you at the next video. (percolating synth music)

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