Hello - I have a few questions regarding chemo.

Tazzie is scheduled for his 2nd chemo early next week. The original plan was to alternate adriamycin with cisplatin. However, I will be returning to a different area soon (a few days after the next treatment), so the vet thought it would be best for the clinic in that town to continue with carboplatin rather than cisplatin.

The logic is that the oncologist's clinic is well set up to mitigate side effects such as kidney problems, because they have the dogs go on diuresis the night before they give the cisplatin. They also give anti-nausea drugs before the cisplatin. I believe they will have me pick up Tazzie late in the day after he gets the cisplatin.

For background, I realize vet's opinions on the best chemo differ, but this oncologst suspects that cisplatin is more effective than carboplatin, an idea that seems to be backed up at least with some data on humans (I dug up some recent papers comparing the two drugs). On the other hand, this vet also says that the combo approach should be more effective theoretically than the single drug approach. The papers I dug up suggested that the single agent drug is as effective as the combined approach. In any case, I don't really want to give up the cisplatin if it is more effective (I think the cancer was diagnosed late, so am concerned it will show in the lungs early). However, the side effects are a big issue as well.

I did mention that Tazzie had acute kidney failure when he was 1 & 1/2 yrs old (8 & 1/2 now). But all of his kidney values (creatinine, bun, and no protein in the urine) have all been good since he was 2 yrs old. In fact, for some reason the creatinine value was better than ever two weeks ago. Even though I still consider him a 'kidney dog', there probably is no reason for me to do that. So that history might not affect the decision to use cisplatin.

- My first set of questions is whether this approach (diuresis ahead of the chemo) is truly able to mitigate the kidney issues. (The vet did not really indicate there would be many side effects for the adriamycin but we seemed to suffer every single one except for heart failure, thank goodness. They were not serious (nausea, loss of appetite, low blood counts, even the catheter slipped outside the vein but thankfully no drug escaped!), but it would have been easier to take them in stride if we had been prepared ahead.) Given these issues, which I do not feel the vet clinic managed all that well (I am not saying they handled them badly either, for they did send me off to get blood counts taken after a phone call), I am not entirely confident on their ability to mitigate the side effects of cisplatin. Tazzie does seem to be in very good form now.

- Also, if Tazzie had some nausea from the adriamycin, is that reason to expect him to have serious nausea from cisplatin?

A few days after the chemo, I need to drive with Tazzie to Manitoba, a 15 hr drive (probably split into two days). But I wonder whether he will be suffering side effects that could make such a trip difficult, and whether those are more likely to occur with cisplatin than with carboplatin. Once we are in Manitoba, we will have access to good vets, but not to an oncologist.

(2) The oncologist indicated that carboplatin would work as the follow-up to cisplatin as well as carboplatin typically works. Are the drugs similar enough for this to be true?

Unfortunately, I have had little opportunity (no opportunity) to talk directly to the vet since before the first chemo, so have not been able to ask her these questions. Because Tazzie is scheduled for a Monday afternoon admittance, I'd like to get some information before that. I don't mind saying 'just give him carboplatin' if that seems a more sensible way to go, all things considered. The papers suggest that cisplatin is a bit better, but certainly there are lots of dogs on this website that have done well following carboplatin.

Susan