Read The Dog Cancer Survival Guide Online
Authors: Susan Ettinger Demian Dressler
I use this approach with Palladia, often combined with oral cyclophosphamide to treat dogs. I am seeing early, promising results with osteosarcoma, anal sac carcinoma and thyroid carcinoma. The effectiveness of this approach needs to be monitored in further studies.
This new approach is less expensive (because you’re using less drug), easier to administer and, certainly, less toxic. However, oncologists are still learning which drugs work best with this method. There is a lot to learn about dosing, schedules and types of tumors, which respond best to metronomic chemotherapy. It’s certainly worth checking with your vet about the possibilities for your own dog’s case.
Here’s something that surprised – flabbergasted – me, when I first discovered it: certain drugs are more effective and have lower toxicity at certain specific times of day.
I spoke to the American expert on chronotherapy, Dr. William Hrushesky, about the efficacy and safety of chemotherapy drugs in relation to when they are given. According to him, cisplatin, an extremely potent and sometimes extremely toxic drug, is most effective and least toxic between 4 and 6pm.
Doxorubicin (Adriamycin) – another potent drug – is best in the early morning, right after waking. It’s more potent then, with fewer side effects, than if given at any other time of day.
Timing drug administration to the time of day – chronotherapy – is just about unheard of in the United States (although it’s not in Europe, where it has been the subject of some intense study in French human cancer trials).
All life forms (dogs, people, worms, plants, algae) share a similar “biological clock,” or circadian cycle. As the sun rises in the morning and sets in the evening, certain enzymes turn on and off at appointed times, hormones surge in and out, and organ systems accelerate or slow down.
These processes can all influence the way the body handles drugs. Perhaps, an enzyme that is very active at 10am is helpful in activating a chemotherapy drug – and helpful in suppressing nausea at the same time. Perhaps, a cocktail of hormones is released at that time, which facilitates the drug’s absorption into the cancer cells (the mechanisms are not all understood or mapped out yet).
Giving a drug at a time when it is most effective and least toxic can really help us to boost a treatment’s safety and efficacy. On the other hand, giving it when it is most toxic and least effective can have a serious impact on your dog’s health.
If the drug is more effective and less toxic, a bigger dose can be delivered – which means a bigger impact on the cancer, longer life expectancies and maybe, even a cure.
I asked Dr. Hrushesky if I could use his findings about chemotherapy drugs to help dogs in my practice, and he graciously agreed to share them with me. I am going to share them with you, too, and I want to be very clear that these results are his findings, based on studies in rats and humans (not dogs). Although these times may not yet be published in peer-reviewed journals, they represent the best, most up-to-date findings from a researcher who spends his life examining the use of circadian rhythms in administering medications.
Here are his findings:
DRUG: | BEST TIME BEST TIME TO ADMINISTER*: |
CCNU (Lomustine) | 4 pm +/- 2 hours |
Doxorubicin (Adriamycin) | early morning |
Platinum Drugs (Cisplatin, Carboplatin) | 4-6 pm |
Corticosteroids (Prednisolone, Prednisone, Dexamethasone, Triamcinolone) | early am (after waking) |
5-FU | middle of the night |
Cyclophosphamide | early morning (after waking) |
Vinca Alkaloids (Vincristine, Vinblastine) | mid-day |
*based on human and rodent studies
No matter which conventional treatment you use – surgery, radiation, or chemotherapy – managing side effects will be your first priority. Symptoms like nausea, vomiting, diarrhea, decrease in appetite, weight loss, anemia and immune suppression can cause a downturn in your dog’s quality of life – whether they are caused by the cancer or by the treatments. Managing these side effects can help to keep your dog’s spirits high, which is one of the most loving (and therapeutic) things you can do for your dog. We’ll talk about both conventional and alternative treatments in this section.
If your dog refuses food completely (anorexia), drools or approaches food, but doesn’t eat it, he may be nauseous. If you’ve ever been nauseous (and who hasn’t?), you know just how uncomfortable it can be. Most vets will give you some instructions on how to manage nausea at home; here are some tips:
In addition to these measures, you can also use ginger and cimetidine, an “old-fashioned” conventional nausea medication, which has evidence for helping to slow cancer spread. These are discussed below.
Vomiting is one of the most distressing symptoms guardians confront. Most of us are familiar with how painful throwing up can be; seeing a sick dog vomit is just plain awful. Most vets will give you detailed instructions on how to handle vomiting, and here are some tips:
Ginger and Cimetidine can also both help with vomiting, as discussed below.
Diarrhea is both messy and irritating – both for you and your dog. If your dog’s feces are runny and smelly, and he can’t seem to control when or where he goes, here are some tips: