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Lymphoma is the canine tumor most frequently treated with chemotherapy. It is the most common hematopoietic neoplasia of dogs (see Canine Lymphoma) and cats and is also among the most responsive to chemotherapy. Four antineoplastic agents, vincristine, cyclophosphamide, doxorubicin, and prednisone, form the basis for many lymphoma treatment protocols. Treatments based on these 4 drugs are often abbreviated as CHOP (cyclophosphamide, hydroxydaunorubicin [doxorubicin], Oncovin® [a trade name of vincristine], and prednisone) protocols (see Antineoplastic Agents: Multidrug Chemotherapy for Treatment of Canine Lymphoma (sample induction protocol) a ).
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Table 2
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Multidrug Chemotherapy for Treatment of Canine Lymphoma (sample induction protocol) a
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Drug
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Dosage
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Schedule
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l-Asparaginase
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10,000 IU/m2, SC
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Wk 1
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Vincristine
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0.5–0.7 mg/m2, IV
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Wk 1, 3, 6, 8, 11, 13. 16, and 18
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Cyclophosphamide
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250 mg/m2, IV or PO
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Wk 2, 7, 12, and 17
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Doxorubicin
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30 mg/m2, IV, for dogs >10 kg; 1 mg/kg for dogs <10 kg
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Wk 4, 9, 14, and 19
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Prednisone
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2 mg/kg, PO, sid
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For 1st week, then 1.5 mg/kg, PO, sid for 7 days, then 1 mg/kg, PO, sid for 7 days, then 0.5 mg/kg, PO, sid for 7 days, then discontinue
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a This table is intended to provide a typical treatment approach; however, there are nearly 40 published protocols for the management of lymphoma in dogs.
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A discontinuous chemotherapy protocol is used more commonly in veterinary oncology than maintenance or continuous chemotherapy. Discontinuous chemotherapy in dogs appears to lead to the same or similar remission and survival time as a traditional maintenance protocol. In this approach, all chemotherapy is discontinued for patients that are in complete remission at the end of the treatment protocol. At the first signs of recurrence of lymphoma, reinduction using the original chemotherapy protocol should be used. Studies have suggested that dogs receiving a discontinuous protocol were more likely to achieve a second remission when they relapsed than dogs that received longterm or maintenance chemotherapy. If reinduction fails, use of rescue protocols should be considered.
Other lymphoma protocols include a non-doxorubicin based combination protocol (COP) or a protocol consisting solely of doxorubicin administered every 3 wk. These protocols are generally well tolerated, less expensive, and easy to administer but are considered to be less effective than a CHOP protocol.
CHOP protocols also are the most common lymphoma chemotherapy protocols in cats, although there is no consensus treatment protocol recommended for this species. In general, fewer studies document the clinical effectiveness of various CHOP combinations in cats than in dogs.
Last full review/revision March 2012 by Deborah T. Kochevar, DVM, PhD, DACVCP; Lisa G. Barber, DVM, DACVIM (Oncology); Kristine E. Burgess, MS, DVM, DACVIM (Oncology)
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