Helping More Dogs with Lymphoma

•Cornell

•Oncology

•Interventional

•1 Location

Lymphoma is one of the most common cancers in dogs with few treatment options available. Traditional injectable chemotherapeutic drugs have been used to extend quality of life, achieve clinical remissions, and slow cancer progression, but are not feasible options for many families. Additional safe, low cost therapies are needed for canine patients. Multi-agent chemotherapy plus prednisone (an oral steroid pill) is the standard treatment. However, this is not a viable option for many families with affected dogs. Cyclophosphamide is also given by mouth, inexpensive, and part of the standard of care chemotherapy protocol for dogs with lymphoma, but it's effectiveness as a single agent has not been well-studied or reported. We want to learn about what happens when prednisone, an antibiotic, and cyclophosphamide are used together. Our goal is to develop a well-tolerated, effective, oral chemotherapy protocol as an alternative for families that want to avoid injectable chemotherapy.

About Lymphoma

Background

Canine lymphomas are a diverse group of cancers, and are among the most common cancers diagnosed in dogs collectively representing approximately 7-14% of all diagnoses. There are over 30 described types of canine lymphoma, and these cancers vary tremendously in their behavior. Some progress rapidly and are acutely life-threatening without treatment, while others progress very slowly and are managed as chronic, indolent diseases. Lymphomas may affect any organ in the body, but most commonly originate in lymph nodes, before spreading to other organs such as the spleen, liver, and bone marrow.

Causes

Unfortunately, the cause of lymphoma in dogs is not known. Although several possible causes such as viruses, bacteria, chemical exposure, and physical factors such as strong magnetic fields have been investigated, the cause of this cancer remains obscure. Suppression of the immune system is a known risk factor for the development of lymphoma in humans. Evidence for this includes increased rates of lymphoma in humans infected with the HIV virus or are on immune-suppressing drugs following organ transplantation surgery. However, the link between immune suppression and lymphoma in dogs is not clearly established.

Diagnosis

The best way to diagnose lymphoma is to perform a biopsy. A biopsy is a minor surgical procedure to remove a piece of lymph node or other organ affected by cancer. The most common methods for lymph node biopsy are Tru-cut needle biopsy, incisional wedge biopsy, or removal of an entire lymph node (excisional biopsy). The larger the biopsy sample, the better the chance for an accurate diagnosis of lymphoma. In addition to biopsy, several staging tests are also performed for dogs with lymphoma. The purpose of the staging tests is to determine how far the lymphoma has spread throughout your dog’s body. In general, the more places the lymphoma has spread to, the poorer the dog’s prognosis. However, dogs with very advanced lymphoma can still be treated and experience cancer remission (see more on treatment below). Staging tests also help us assess whether your dog has any other conditions that may affect treatment decisions or overall prognosis. The staging tests we typically recommend include blood tests, a urinalysis, x-rays of the chest and abdomen, an abdominal sonogram, and a bone marrow aspirate. Organs that appear abnormal on sonogram can be sampled with a small needle (fine needle aspirate) to confirm the presence of lymphoma.

Treatment

No preventative measures are currently available but it is recommended that breeds at a higher risk of developing lymphoma being screened by their veterinarian on a regular basis in an attempt to identify the disease at the earliest stage possible.

The most effective therapy for most types of canine lymphoma is chemotherapy. In some cases, surgery or radiation therapy may also be recommended. There are numerous chemotherapy treatment protocols for dogs with multicentric lymphoma. As discussed below, most dogs with lymphoma experience remission of their cancer following treatment, and side effects are usually not severe. Currently, the protocols that achieve the highest rates of remission and longest overall survival times involve combinations of drugs given over several weeks to months. The median length of survival of dogs with multicentric lymphoma treated with UW-25 chemotherapy is between 9-13 months. (The term “median” implies that 50% of dogs will survive beyond this time point and 50% of treated dogs will die before this time point.) Various other factors, such the type of lymphoma your dog has or its stage of disease, may affect your dog’s overall prognosis.

Eligibility

Dogs seen by the Cornell University Hospital for Animals who have been diagnosed with large cell lymphoma or cutaneous lymphoma who are not already on oral prednisone. Diagnosis can be confirmed at the initial study visit if needed. Dogs must have at least one enlarged (>2cm diameter), peripheral lymph node for large cell lymphoma.

Compensation

This study is sponsored by the Cornell Richard P. Riney Canine Health Center. All testing related to this study is covered by the sponsor. This includes the costs of medications, diagnostic testing, and evaluation pertinent to the study. Any tests or procedures unrelated to the study are your responsibility.

Owner Responsibilities

You are responsible for administering study medications as directed and must return your dog to CUHA for follow-up appointments according to a specific timeline. We may take a small amount of extra blood and lymph node aspirates at time points where these procedures are already occurring (so your dog will not have an extra needle poke). You will be asked to complete an extra questionnaire about your dog's health at study-related visits. All study procedures, time requirements, and responsibilities will be provided to you in a project outline.

Location

1. Cornell University Hospital for Animals (CUHA)

930 N Campus, Ithaca, NY 14853

(607) 253-3060

Study Team

Carol Frederick

Clinical Trials Coordinator

Carol graduated from SUNY Delhi in 1994 and became an LVT. She spent 2 years in private practice, then moved to the emergency and critical care department at Cornell University Hospital for Animals. She obtained her technician specialty in ECC in 2007. After 21 years in ECC she moved to clinical trials, and now is the lead trials coordinator at Cornell.