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Marley's prognosis 4-6 months
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Forum Posts: 104
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18 February 2009 - 8:23 pm
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Hi Pam, 

Yes, that's it – it's the sublumbar lymph node. 

Do you think that the fact that Marley has liver issues – to be specific “moderate to marked portal fibrosis” and some scarring from previous inflammation I've been told – would increase that risk? So if a dog with a normal liver would have a 6% chance of a failure then hers would be higher? And when you say “liver issues” are some in that 6% ok after the drug is stopped i.e. elevated liver levels that will then go down – or is the 6% number fatal do you think? 

I will definitely ask re: opting out of chemo what the prognosis will be. When I reminded him of her liver issues he said we'd alternate with cytoxin – are you familiar with this drug? I wonder if we could use ONLY cytoxin and no CCNU. I will have to ask him that as well. 

Thanks so very very much for your help AGAIN! 

Holly and Marley

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18 February 2009 - 8:44 pm
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Pam, 

I just found this online.. do you know anything about denamarin ? sorry to keep bugging you – I so appreciate the help!!

Study: Evaluation of denamarin in preventing liver toxicity during CCNU chemotherapy treatment in
dogs.
Location: University of California Veterinary Hospital Davis, CA
Phone: (530) 752-1393, ext 431
http://www.vetm…..ology.html

Eligibility: To qualify for this study, the canine patient must have a confirmed diagnosis of Lymphoma, Mast Cell Tumor or
Hystiocytic Sarcoma. Patients beginning CCNU as chemotherapy with normal blood ALT levels and are not on any other
anti-oxidants, are eligible for the study.

Summary: Dogs with cancer that will be receiving CCNU as part of their chemotherapy protocol will be asked to
participate in a randomized study. CCNU is a commonly used chemotherapeutic drug used to treat dogs with lymphoma,
mast cell tumors, histiocytic sarcoma, and other cancers. CCNU is known to be hepatoxic and most dogs receiving the
drug will experience some changes in blood liver values, although clinical signs of liver failure are rare. In some cases,
these changes require treatment adjustments and, occasionally, treatment may be discontinued to avoid severe liver
damage. denamarin is a combination of two nutraceuticals, S-adenosylmethionine and Marin, both of which have proven
hepatoprotective effects. The purpose of this study is to determine whether denamarin prevents blood liver value
elevations in dogs with cancer that are being treated with CCNU. Dogs will be randomized to start denamarin treatment
at the time CCNU is first prescribed.

Requirements and incentives: The owner is responsible for the cost of the initial tests and most treatment costs to
insure eligibility to participate. Additionally, the client will be required to fill out a questionnaire on their pets progress
once a week. Once the patient is enrolled, the study pays for the cost of regular bloodwork to evaluate liver health at
each visit and for the DenomarinTM that will be provided at no cost to the owner. For more information regarding this
clinical trial, please contact our Clinical Trials Coordinator at 530.752.0125.

Here and Now


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18 February 2009 - 8:49 pm
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Thanks for posting this clinical trial info! I haven't heard of it, but here are some search results for Denamarin where it has been mentioned elsewhere in the forums.


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19 February 2009 - 1:24 pm
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Marley,

Tazzie has been taking denamarin for over 2 years to protect her liver.  She also is on the “sister drug” Marin which furthur boosts her levels of milk thistle, Vitamin E, and zinc. I think that any dog with chronic hepatitis (inflammation) should be on these drugs (there are also other brands that your vet might carry like Zentonil) even if they are not on chemo.  These drugs are really called “neutraceuticals” which means that they are not drugs but nutritional additives much like glucosamine.  They help the liver to clear toxins and repair damage in a natural way.  Tazzie's liver values remain normal on these drugs but without them her ALT runs about 300 or so.

Since your dog also has periportal fibrosis she might also benefit from a drug called Actigall (there is also a generic available). This helps with biliary stasis (flow of bile through the bile ducts) and can reduce the fibrosis.

Cytoxan is also called cyclophosphamide and will not hurt the liver.  I doubt that it would be strong enough alone to fight a sarcoma.  Maybe if they added Adriamycin they could drop the CCNU?  I personally would try to avoid CCNU because a dog with a weakened liver is more likely to have issues with it.  Odds are probably higher than 6% of irritating the liver in Marley but I have no idea of fatality rates.  The dogs that I have seen die from this drug have been related to the bone marrow suppression.  Maybe the oncologist can share his experiences with you.

This is a hard choice becasue the CCNU might give her extra time but she is doing well now and it could also prematurely end her life or make her very sick, maybe within a few weeks!  Knowing how sensitive Tazzie's liver is I would avoid it and see how she does or try other chemo but Marley has not been on the Denarin yet so that might help her quite a bit.

Pam and Tazzie


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19 February 2009 - 1:48 pm
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Marley,

I did a quick search on VIN (Vet Info Network) for you regarding histiocytic sarcoma.  CCNU is the treatment of choice but other dogs with elevated liver values were given Adriamycin alone every 2 -3 weeks.  I only saw one mention of CCNU plus Cytoxan (from a doc at Red Bank Oncologists) and he was less than impressed with this combo.  I could not find any stats on the Adriamycin alone but it usually does not affect the liver, just the bone marrow and sometimes the heart but the Lab is not a breed that is predisposed to cardiomyopathy.  I think that this would be a safer option, but once again I would defer to your oncologist.

Hope this helps,

Pam and Tazzie

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19 February 2009 - 7:22 pm
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Pam, 

You are just amazing. thank you so much for taking the time to help us out on this!! I have hope that we will find another drug that will be safer. I also had her blood drawn today when she was getting her staples out – so we can see what her numbers are now… Once I get the results I'll talk to the oncologist again as well as my local vets.  I also will get her on the denamarin and Marin asap!! 

Thank you thank you thank you! 

Holly and Marley

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