Felis ISSN 2398-2950

Lymphoma: chemotherapy protocols

Contributor(s): Corey Saba

Induction protocols

Protocol 1: Modified UW-Madison (UW 25) (CHOP-based)Induction
Print table as supplied below for completion by veterinarian Chemotherapy protocol: modified UW-Madison (UW 25).

Week 1

  • Vincristine Vincristine : 0.5-0.7 mg/m2 IV.
  • +/- L-Asparaginase: 400 IU/kg SQ.
  • Prednisone Prednisolone : 2 mg/kg PO SID.      

Week 2:

  • Cyclophosphamide Cyclophosphamide : 250 mg/m2 IV or PO.
  • Prednisone: 2 mg/kg PO SID.    
      

Week 3:

  • Vincristine: 0.5-0.7 mg/m2 IV.
  • Prednisone: 1 mg/kg PO SID.      

Week 4:  

  • Doxorubicin Doxorubicin : 30 mg/m2 IV.
  • Prednisone: 0.5 mg/kg PO SID.   

Week 5:  CBC only. No chemotherapy. Discontinue prednisone.

Week 6Vincristine: 0.5-0.7 mg/m2 IV.    

Week 7Cyclophosphamide: 200-2550 mg/m2 IV or PO.

Week 8Vincristine: 0.5-0.7 mg/m2 IV.        

Week 9:  Doxorubicin: 30 mg/m2 IV.       

Week 10:

  • No chemotherapy.
  • If patient is in complete remission, continue with treatments at 2 week intervals on week 11.

Maintenance

Week 11Vincristine: 0.5-0.7 mg/m2 IV.     

Week 13Cyclophosphamide: 250 mg/m2 IV or PO.

Week 15Vincristine:0.5-0.7 mg/m2 IV.        

Week 17Doxorubicin: 30 mg/m2 IV.    

Week 19Vincristine: 0.5-0.7 mg/m2 IV        

Week 21Cyclophosphamide: 250 mg/m2 IV or PO.

Week 23Vincristine: 0.5-0.7 mg/m2 IV.       

Week 25Doxorubicin: 30 mg/m2 IV.      

Important considerations

  • For cats weighing <15 kg, consider using 0.5 mg/m2 of vincristine, 200 mg/m2 of cyclophosphamide, and 1 mg/kg of doxorubicin.
  • Myelosuppression and gastrointestinal toxicity (eg inappetance, vomiting, and/or diarrhea) are possible toxicities of vincristine, cyclophosphamide, and doxorubicin.
  • Additional toxicities of vincristine include:
    • Severe tissue necrosis and extravasation injury if given outside of the vein.
    • Peripheral neuropathies, most commonly manifested as paralytic ileus in cats.
  • Additional toxicities of doxorubicin include:
  • Severe tissue necrosis and extravasation injury if given outside of the vein. Doxorubicin should be administered through a "clean stick" catheter.
Careful monitoring of the patient is advised during administration to ensure the catheter remains in place.
  • Hemorrhagic colitis.
  • Anaphylactoid reactions secondary to mast cell degranulation. Premedication with 1-2 mg/kg of diphenhydramine Diphenhydramine IM approximately 30 minutes prior to treatment is recommended by some oncologists to prevent this toxicity.
  • Acute cardiac toxicity manifested as arrhythmias.
  • Nephrotoxicity in cats.
  • Acute toxicities may be minimized by administering the drug slowly (over 30 minutes or at 1 mg/min if <10 mg).
  • A complete blood count (CBC Hematology: complete blood count (CBC)) must be performed within 48 hours prior to chemotherapy administration. Ideally this should be done the day of chemotherapy administration. Delay chemotherapy by 3-7 days and then recheck CBS if:
    • Neutrophil count < 2500 cells/µl.
    • Platelet count < 50,000 cells/µl.
    • Patient is exhibiting GI signs secondary to previous chemotherapy.
  • Reduce chemotherapy dose by 25% in patients experiencing significant myelosuppression, GI toxicity and/or those requiring treatment delays during weekly administration.
  • If patient is in complete remission at week 25, discontinue all therapy and re-evaluate monthly with a thorough physical examination.
Print out owner factsheet on Cancer treatment - lymphoma chemotherapy Cancer treatment - lymphoma chemotherapy to give to your client.

Protocol 2: Combination cytotoxic therapy COP

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Further Reading

Publications

Refereed papers
  • Recent references from PubMed.
  • Milner R J, Peyton J, Cooke K, Fox L E, Gallagher A, Gordon P & Hester J (2005)Response rates and survival times for cats with lymphoma treated with the University of Wisconsin-Madison chemotherapy protocol: 38 cases (1996-2003). JAVMA227(7), 1118-1122PubMed.
  • Bronden L B, Rutteman G R, Flagstad A & Teske E (2003)Study of dog and cat owners' perceptions of medical treatment for cancer. Vet Rec152, 77-80 PubMed.
  • Fan T M, Kitchell B E, Dhaliwal R S et al(2002)Hematological toxicity and therapeutic efficacy of lomustine in 20 tumor-bearing cats: critical assessment of a practical dosing regiment. JAAHA38,357-363.
  • Teske E, van Straten G et al(2002)Chemotherapy with cyclophoshamide, vincristine, and prednisolone (COP) in cats with malignant lymphoma: new results with an old protocol. J Vet Intern Med10, 372-375PubMed.
  • Guillermo Couto C (2001)What is new on feline lymphoma? J Feline Med Surg3, 171-176.
  • Malik R, Gabor L J et al(2001)Therapy for Australian cats with lymphosarcoma. Aust Vet J79, 808-817PubMed.
  • Rassnick K M, Gieger T L, Williams L E et al(2001)Phase 1 evaluation of CCNU (lomustine) in tumor-bearing cats. J Vet Intern Med15, 196-199.
  • Zwahlen C H, Lucroy M D et al(1998)Results of chemotherapy for cats with alimentary malignant lymphoma: 21 cases (1993-1997). JAVMA213, 114-1149 PubMed.
  • Moore A S, Cotter S M et al(1996)A comparison of doxorubicin and COP for maintenance of remission in cats with lymphoma. J Vet Intern Med10, 372-375.

Other sources of information

  • Morrison W B (2002)Cancer in Dogs and Cats.2nd edition, p 662.
  • Tennant B (2002)BSAVA Small Animal Formulary, 4th edn. pp 280-281.


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