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metronomics.. cant decide when or what to use..
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25 July 2018 - 10:42 pm
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I have been lax in deciding on Simons metronomics regimen.. this study shows no difference in those that did metronomics and those that didn't .  Unless I'm not grasping this correctly... thoughts??   Fyi.. I do have input on treatment in this case ie there are many options and " it is a crapshoot."  ( quote from my onco rad vet)

Abstract
June 1, 2018, Vol. 252, No. 11, Pages 1377-1383

Evaluation of metronomic cyclophosphamide chemotherapy as maintenance treatment for dogs with appendicular osteosarcoma following limb amputation and carboplatin chemotherapy
Arata Matsuyama DVM; Courtney R. Schott DVM; Geoffrey A. Wood DVM, PhD; Danielle Richardson DVM; J. Paul Woods DVM, MS; Anthony J. Mutsaers DVM, PhD
Department of Biomedical Sciences, Ontario Veterinary College, University of Guelph, Guelph, ON N1G 2W1, Canada. (Matsuyama, Mutsaers); Department of Pathobiology, Ontario Veterinary College, University of Guelph, Guelph, ON N1G 2W1, Canada. (Schott, Wood); Health Sciences Centre, Ontario Veterinary College, University of Guelph, Guelph, ON N1G 2W1, Canada. (Richardson); Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, ON N1G 2W1, Canada. (Woods, Mutsaers)
Address correspondence to Dr. Mutsaers ().

OBJECTIVE To determine the effectiveness of metronomic cyclophosphamide (MC) chemotherapy (primary treatment of interest) with adjuvant meloxicam administration as maintenance treatment for dogs with appendicular osteosarcoma following limb amputation and carboplatin chemotherapy.

DESIGN Retrospective case series with nested cohort study.

ANIMALS 39 dogs with a histologic diagnosis of appendicular osteosarcoma that underwent limb amputation and completed carboplatin chemotherapy from January 2011 through December 2015.

PROCEDURES Dogs were grouped by whether carboplatin chemotherapy had been followed with or without MC chemotherapy (15 mg/m2, PO, q 24 h) and meloxicam (0.1 mg/kg [0.045 mg/lb], PO, q 24 h). The Breslow rank test was used to assess whether MC chemotherapy was associated with overall survival time (OST) and disease progression-free time (PFT) after limb amputation.

RESULTS 19 dogs received carboplatin and MC chemotherapy, and 20 dogs received only carboplatin chemotherapy. No differences were identified between these groups regarding age, reproductive status, body weight, serum alkaline phosphatase activity, tumor location, or histologic grade or subtype of osteosarcoma. Median duration of MC chemotherapy for dogs in the carboplatin-MC group was 94 days (range, 7 to 586 days); this treatment was discontinued for 11 (58%) dogs when cystitis developed. Overall, 11 (28%) dogs survived to the time of analysis, for a median follow-up period of 450 days (range, 204 to 1,400 days). No difference in median PFT or OST was identified between the 2 groups.

CONCLUSIONS AND CLINICAL RELEVANCE Maintenance MC chemotherapy following limb amputation and completed carboplatin chemotherapy was associated with no increase in PFT or OST in dogs with appendicular osteosarcoma. Cystitis was common in MC-treated dogs, and prophylactic treatment such as furosemide administration could be considered to reduce the incidence of cystitis in such dogs.

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The Rainbow Bridge

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26 July 2018 - 10:53 am
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Thanks for sharing this, it's pretty recent and good food for thought.

this study shows no difference in those that did metronomics and those that didn't

You are correct, that's what I'm reading as well. However, keep in mind that this is a very small sample size and it's just one study. Another study could come out that concludes the opposite. That's cancer (and the scientific process) for ya. It's terrific that scientists are looking at this regimen for its effectiveness, but it's not the last word on it. 

In the end, it's another tool to keep cancer at bay. You go with your gut, and what you can afford. There are no right or wrong choices here.

It's better to hop on three legs than to limp on four.™
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26 July 2018 - 10:57 am
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This is my onco vets reply to the study:

The study you referenced is seriously underpowered and not randomized, therefore the results difficult to interpret. Regardless, your thoughts are appropriate. We give the metronomic therapy in the morning and allow the patient to have appetime to urinate. Any metabolites and therefore where they have any bladder issues. Furosemide could be done for safety.

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26 July 2018 - 11:02 am
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Thanks for sharing.

I thought it was interesting that such a high percentage of dogs developed cystitis in that study. Based on our members' experiences here, it doesn't seem like that high of a percentage develop the condition. I could be wrong since I don't know every story but that's my gut feeling.

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26 July 2018 - 3:02 pm
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Yup, there is just no way of knowing how well treatments can work against osteosarcoma ...

Eurydice did metronomics (and Palladia briefly) and that did not stop her developing lung mets but others did metronomics extensively, some for years and their babies did not develop mets ...

I think following our gut and listening to as many professional and personal opinions/experiences is the best one can do.

Hugs and cuddles 😘🐮💫✨🌟🌹

Eurydice 77kg/170lb Great Dane limping end of April 2016, amputation (right front leg/osteosarcoma) 4 May 2016 6 courses of carboplatin followed by metronomic therapy, lung mets found 30 Nov 2016. 3 courses of doxorubicin, PET scan 26 Jan 2017 showed more mets so stopped chemo. Holistic route April 2017. Lung X-ray 5 May 2017 showed several tennis ball size mets, started cortisone and diuretics. Miss Cow earned her XXL silver wings 12 June 2017, 13 months and 1 week after amputation and 6 1/2 months after lung mets, she was the goofiest dawg ever and is now happily flying from cloud to cloud woof woofing away :-) 

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4 August 2018 - 10:54 pm
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Need to decide on my metronomics regimen soon.. Has anyone used all three of these?  this is what I will ask for... thoughts?

   cytoxan  cyclophosphamide

  piroxicam

  lasix  ( to prevent cystitis) 

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5 August 2018 - 12:32 pm
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All but lasix are the most common ones around here as far as I know. Jerry only had cytoxan and the NSAID (Metacam), as well as Doxycycline.

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5 August 2018 - 1:04 pm
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I'm going to advocate for lasix,..  Dr Phillips,,, the onco vet that does the trial in san diego.. often  gives cytoxan and lasix... without an nsaid. Since Simon has some hip dysplasia and now uses galliprant.. it seems an easy reach to switch to an nsaid like piroxicam that helps the cytoxan do it's job... 

  I've read recent reports and seen talks from vets that the cystitis is under reported... so I want to avoid this problem, hence adding lasix to the regimen...  I think my onco vet will dose every other day.. perhaps rotating the lasix with the cytoxan and giving the piroxicam daily. 

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