Cytoxan

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chriscleo

chriscleo

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vet's recommending we switch to cytoxan for cleo. she has small cell low grade multicentric lymphoma (plus diabetes and liver disease). leukeran made her really sick and she couldn't tolerate the taste (the pills were too big for her so she fought me hard, so they're out). she's been on ccnu but it isn't strong enuf. so our choice is to go back to leukeran, which has been the best chemo protocol for her kind of cancer but made her vomit constantly, or go to a stronger chemo agent, which is cytoxan.

biggest problems with cytoxan are having to give it every other day (ccnu was monthly and leukeran was EOD) and potentially bad GI issues. just when her vomiting has been more under control now we're talking GI issues again (grrr). plus she periodically gets anemia so i'm worried about that again.

anyone else's kitty been on cytoxan? anything to say about it, what to expect, and how to handle it?
thanks.
 
Cytoxan alone? Aren't they planning to use it along with vincristine?

Abbey was on the COP protocol for the entire time she was treated for lymphoma until she came out of remission. The only other thing we tried at that point was Elspar.
 
I am so sorry for your beautiful kitty they should not have to deal with all this stuff I hate cancer....Angels coming to help with her recovery prayers and lots of beautiful green light Hugss Kath
 
thanks, kath.
good point, deanie. i forgot to ask about vincristine. for some reason my brain latched onto the cop protocol right at the beginning when we started chemo but so far we've just done leukeran then ccnu (plus pred of course).
 
chriscleo said:
anyone else's kitty been on cytoxan? anything to say about it, what to expect, and how to handle it?
thanks.
Click to expand...
meowzi has. i don't remember watching for GI issues, but it's listed in the book i just looked up. she did have horrible non-stop vomiting after the first round when cytoxan/cyclophosphamide was given together with adriamycin/doxorubicin via IV, but we don't know if it was one or the other or the combination that was the factor. i wrote about that in jess/elliott's thread on community.

our biggest concern with cytoxan was sterile hemorrhagic cystitis; increase water intake, and give her soupy meals as much as she'll tolerate. i've even seen references to giving pred on cytoxan days to encourage drinking, but i don't know how common that approach is.

is cleo getting it in pill form? i learned later that an oncologist we did a phone consult with prefers not to use cytoxan IV to avoid toxicity esp for older patients. it was partly our fault that meowzi got it by IV the first time; we asked for that since she was at that time unpillable, and she was going to be sedated anyway - but i sure wish they would have tried to discourage us. we ended up taking her to our local hospital for the subsequent 2nd, 3rd and 4th cytoxan pills - they were given at three week intervals in her case.

eta: http://www.veterinarypartner.com/Conten ... C=0&A=1429
 
if cleo got cytoxan it would be every other day in pill form (she's hell to pill).
other option is continue ccnu monthly and augment with elspar. if that helps, go on to the COP protocol (cytoxan+vincristine). or go back to leukeran altogether.

just sent vet an email with a bunch of questions but deferring to her on chemo choice.
cleo's already on pred daily as part of lymphoma treatment protocol.

what worries me most is how hard controlling her vomiting has been. can't think of anything we haven't tried and they all work only for a short time. vet says she's seen more foaming at the mouth with cytoxan than GI issues but she has seen GI issues too.
 
i don't remember meowzi throwing up at all for the 2nd, 3rd and 4th treatments, when we used the pill form. inappetance, yes, maybe queasiness too, but no outright vomiting. but then we had a whole arsenal of tools by then - she had on board the morning of (before) the chemo meds: centrine shot (i would use cerenia now), to continue 3-4 days after (not sure about duration for cerenia, but max is five, i believe?), mirtz for inappetance, and for good measure, we had a local reiki practitioner stop in around the day we expected the side effects to peak. but ECID.
 
WCF and Meowzi said:
is cleo getting it in pill form? i learned later that an oncologist we did a phone consult with prefers not to use cytoxan IV to avoid toxicity esp for older patients.
Click to expand...

I haven't heard this and I've done a lot of research on it recently as I was debating whether or not to go IV or PO. If anything, with IV cytoxan you can also give a dose of Lasix to make them pee and you can also give the perfect dose (rather than being restricted by tablet size). FWIW, however, cats do not seem to have the same susceptibility to hemorrhagic cystitis that dogs do--it's really not a concern with them.

I can't think of why the onco would prefer PO rather than IV. You're sure it's not the other way around? Some oncologists strongly prefer IV because of more precise dosing and to avoid owner exposure to chemo drugs.
 
Jess & Earl said:
I can't think of why the onco would prefer PO rather than IV. You're sure it's not the other way around? Some oncologists strongly prefer IV because of more precise dosing and to avoid owner exposure to chemo drugs.
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yes, i'm sure, it's in her book. we discussed it too during our phone consult, and e-mail exchanges. i think she did emphasize that was her preference (no IV cytoxan) for geriatric patients. this isn't a boarded oncologist btw, afaik - probably graduated before the boards existed but she's been an oncologist for donkey's years. i guess i'll chalk it up to lots of differing opinions in the field?
 
i think she did emphasize that was her preference (no IV cytoxan) for geriatric patients.
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Ah so she just uses it for the puppies and kittens that need chemo? ;-) I'm teasing, a little. There are unfortunately some young animals that get cancer (mostly purebred dogs like Golden Retrievers and Boxers) but the vast majority are senior citizens.

WCF and Meowzi said:
i guess i'll chalk it up to lots of differing opinions in the field?
Click to expand...

Except maybe she's the only one that thinks that :) Seriously, I did a lot of research on this and didn't come across this. I can ask Elliott's oncologist (ugh, it hurts my heart to write that) what she thinks, she has been an oncologist for a long time. One of her residents did the research showing that IV cytoxan and IV furosemide given together reduces the changes of hemorrhagic cystitis in dogs, actually. She thought it was pretty funny when I told her that I was considering just doing the cytoxan IV because there was a paper showing that IV cytoxan and furosemide given together ...
 
hi chris.
winnie was on COP. the cytoxan doses can be broken up in different ways -- depends on vet. (in pill form -- and I have only heard it being given to cats in pill form on the L board. )

I have my original protocol here-- which is pretty standard and can recheck for you.
I frankly have no idea why your vet would only do cytoxan and not add the vincristine and do the full COP ( she is already on the pred part right? ) Please ask. The meds are much more effective when working together.
in the mean time I will be happy to look up our protocol for you .
no sleep here yet--- that needs to come next ;-)

sending good wishes for you and cleo.
 
Re: Cytoxan, + test results out of range

she said she didn't plan to add vincristine because cleo has small cell low grade lymphoma, not a worse grade.

but she said if i wanted we could continue the ccnu and add elspar this month and if in one week it helps her that tells us we can go to the COP protocol.


might as well show her latest numbers out of range [#s in brackets=normal range; prior month's #s are at right]:

Aug 2.................................................July 19...............................June 23
ALT 174 [10-100] HI...........................Not Checked.........................Not Checked
BUN 45 [14-36] HI.............................Not Checked......................... 50 HI
i don't worry about BUN as much coz of hi-protein diet. creatinine + USG normal
WBC 16.2 [3.5-16.0] HI..........................27.8 HI.............................24.4 HI
RBC 5.6 [5.92-9.93] LOW.........................6.4.................................6.2
HGB 8.4 [9.3-15.9] LOW........................10.6..................................9.3
HCT 25 [29-48%] LOW............................32..................................28 LOW
-- Per lab note: Antech offers a feline hemoplasma PCR panel for detection of M. haemofelis, M. haemominutum, and M. turicensis, if we want to look for one or more species of hemoplasma.

Neutrophils 9234 [2500-8500] HI..............15290 HI...........................12688 HI
Lymphocytes 6156 [1200-8000].................7228...............................9272 HI
Monocytes 0 [0-600]...............................278................................732 HI
Eosinophils 810 [0-1000]........................5004 HI............................1708 HI


they ran a reticulocyte count (reflex) for me, too:

total reticulocyte 0.5 [0-1%] (Aug 2) ................... 0.7 (July 19)
absolute reticulocytes 28,000 [<45,000] (Aug 2).....44800 (July 19)

so her numbers are more normal despite last month's scare.
possibly anemia tied to sneaking dog's food last week (onion) but anemia's an issue periodically.
 
Jess & Earl said:
WCF and Meowzi said:
i guess i'll chalk it up to lots of differing opinions in the field?
Click to expand...

Except maybe she's the only one that thinks that :) Seriously, I did a lot of research on this and didn't come across this. I can ask Elliott's oncologist (ugh, it hurts my heart to write that) what she thinks, she has been an oncologist for a long time. One of her residents did the research showing that IV cytoxan and IV furosemide given together reduces the changes of hemorrhagic cystitis in dogs, actually. She thought it was pretty funny when I told her that I was considering just doing the cytoxan IV because there was a paper showing that IV cytoxan and furosemide given together ...
Click to expand...
I would be curious to hear Elliott's oncologist's thoughts on IV cytoxan, if you get a chance to ask her :) I've wondered why Meowzi's reaction was so severe the first time and why she tolerated it so much better the the 2nd, 3rd and 4th time - not that those didn't bother her, they did, but there was no non-stop vomiting and utter misery.

The only factors I can think of are
(1) cytoxan IV the first time;
(2) cytoxan and adriamycin given by IV on same day the first time (the rest of the time, they were spaced about 48 hours apart);
(3) anti-emetics on board for rounds 2, 3, and 4; and/or
(4) having reiki before the side effects got really bad. But she didn't get reiki at the 4th round until a day or two later than the other rounds, and she was already starting to feel bad. Yet she didn't throw up at round 4.

Elliott's oncologist's answer may help rule out (1), or not ... It's not an urgent matter, but if you ever get a chance to ask, I'm interested in her response.
 
WCF and Meowzi said:
[
I would be curious to hear Elliott's oncologist's thoughts on IV cytoxan, if you get a chance to ask her :)
Click to expand...

Sorry, I meant I'd ask her if she'd heard of that idea or anything specific with cats. I know she's ok with the IV cytoxan for geriatric cancer patients because she gave it to my very sick, elderly dog.

The only factors I can think of are
(1) cytoxan IV the first time;
(2) cytoxan and adriamycin given by IV on same day the first time (the rest of the time, they were spaced about 48 hours apart);
(3) anti-emetics on board for rounds 2, 3, and 4; and/or
(4) having reiki before the side effects got really bad. But she didn't get reiki at the 4th round until a day or two later than the other rounds, and she was already starting to feel bad. Yet she didn't throw up at round 4.
Click to expand...

Numbers 2 and 3 are pretty darn good reasons for the difference you saw.
 
Re: Cytoxan, + test results out of range

chriscleo said:
she said she didn't plan to add vincristine because cleo has small cell low grade lymphoma, not a worse grade.

but she said if i wanted we could continue the ccnu and add elspar this month and if in one week it helps her that tells us we can go to the COP protocol.
Click to expand...

ccnu and elspar are traditionally considered "rescue" drugs.
Although, it seems more and more ccnu is being used earlier for it's ability to be given orally at home.
Are they trying to knock it back hard before going on COP?

and to note -- elspar is hard on the pancreas. Since Cleo has pancreatitis, its use would be contraindicated.
I would have a long hard talk w/ your vet before adding that one in.

Winnie's protocol, that I said I would dig up was
for the induction period ( 4 weeks ) -- Vincristine 1x a week , cytoxan weeks 1 and 4 , and pred daily ( was a loading dose for one month then reduced-- which we didn't do, it was not working for her. Eventually, we switched to dex)
then both vincristine and cytoxan every 3 weeks.
i stand corrected re the IV cytoxan and cats per my previous comment -- as i see on her sheet it was an option. It was also an option to give one large dose of cytoxan PO. we opted to spread the dose out over several days. We also, after the first week, never gave them both on the same day as it was too harsh for her.

best -
 
cool, cheryl.
thanks for the help.
i just wrote the vet again so i'll add your pancreatitis note to my email. :)

i think she chose ccnu because cleo is so hard to pill, and it was once a month versus every other day. plus cleo's lymphoma appeared well managed. but now that the numbers worsened last month and because of her continuing weight loss we have to do something different.

i don't know the actual mechanics of elspar but she wanted to try it once and check again in a week to see if the numbers continue to improve. if they do, it gives us the go ahead to do the COP protocol. otherwise, i gather she thinks it's too aggressive for small cell lymphoma.

she still thinks of leukeran as the "gold standard" for small cell lymphoma, and if cleo hadn't gotten so sick on it that's what we'd be doing. her ultimate goal is to get cleo back on the leukeran.

the pred is always part of the equation. she gets 5 mg a day.
 
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