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Cyclophosphamide (=cytoxan) vs Chlorambucil (=leukeran)
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New Haven, CT
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24 July 2013 - 2:58 pm
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After being on cytoxan (10mg, 1x/day) for nearly 5 months, Jackson finally developed urinary cystitis (this is his metronomic protocol and it’s proactive; he doesn’t have any mets…that we know of yet).  At first, the volume of each pee varied; that’s weird for him, as typically each pee would decrease in volume, with his final stops being almost nothing.  It’s gotten a little worse: his first pee will pretty much empty his bladder, but he’ll continue to try to pee SO many times along our route.  Fortunately, he doesn’t seem bothered by it.  No weird behavior issues inside, although he recently peed in the onco’s waiting room!  I mopped that up, and there was blood.  His onco collected more urine (via catheter! Poor guy…OUCH!) and cultured it.  We just got the culture back and there were no bacteria.  This means Jackson’s system is “simply” inflamed.  To help him, we’ve doubled his anti-inflammatory med (now: rimadyl, 50mg, twice/day) and doubled his MSM (now: 400mg, twice/day).  I’m going to look into an herbal supplement, too.  Apparently this problem can take WEEKS to heal.  We’re a week out since his last cytoxan and there’s no sign things are getting better (they’re not getting worse, though).

Because of the cystitis, Jackson will no longer EVER take cytoxan.  His onco feels that Jackson’s bladder is sensitive to its side effects, so just merely going off cytoxan, waiting for it to heal, and then restarting it will only cause the problem again.  Makes sense to me.  The solution is to replace cytoxan with leukeran.  Leukeran is the brand name and Chlorambucil is the generic name.

Jackson was, for a 60lb pup, on 10mg cytoxan daily.  Now, he’s going to start on 1.5mg leukeran every day, but can go up to 4mg.  NOTE: we’re starting at the VERY low end, because he’ll be starting this new drug while we’re away.  We don’t want any side effects while we’re gone.  It’s great his onco recognizes this and realizes we’ll bump it up when we return.  Plus, Jackson is still dealing with cystitis!

About leukeran:

  • Leukeran has been around a LONG time.  Perhaps as long as cytoxan.  It’s pretty darn near as effective.  Plus it has fewer side effects than cytoxan.  So why is cytoxan preferred?  Well, in the studies looking at metronomic therapies in dogs, cytoxan simply has more studies and more stats.  Onco’s love stats!  Cytoxan is also cheaper than leukeran.  So, if your pup handles cytoxan well, you’re set: it’s effective, it’s cheap, and it’s got some good stats.
  • It’s not necessary to keep Jackson on MSM while on leukeran.  Leukeran simply doesn’t have that same side effect in the bladder as cytoxan.  MSM helps the bladder (also), so it’s not needed while on leukeran but is helpful when on cytoxan.  But, since his MSM is in his joint and hip supplement, he’ll still get daily MSM.  He’s a tripawd, after all!  I want to preserve all his joints as best as possible!
  • Leukeran can be given any time of day unlike cytoxan.  Cytoxan is usually given in the morning, thus allowing your pup to pee throughout the day vs letting it sit in his/her bladder overnight.
  • Jackson was getting 10mg of Cytoxan.  Soon, he’ll be on a max dose of 4mg (see above story) assuming all is well and he handles it fine.  This doesn’t directly mean leukeran is more powerful than cytoxan.  Leukeran simply has a different mode of action and the dose is appropriate for its mode of action.
  • The bad news is that leukeran is pricey.  Or it can be.  See this article posted by Jackson’s friend, Jill: http://catexper…..ine.html  This article was written in Jan 2013.  When we got the word Jackson’s medication was switching, I made phone calls.  I called the following pharmacies: Diamondback Drugs (where we have been getting his cytoxan from = 30 pills, 10mg were ~$40), RoadRunner, Stokes, BestPetRx, Wedgewood, Apex (a local, compounding pharm near me in CT), and my local Walmart.  For 45 pills, 1.5mg each, here are the prices: Diamondback = $85, Roadrunner = $144 pills OR $57 for a liquid suspension (this may be UBER helpful for kitties!), Stokes = $125, BestPetRx = $140, Wedgewood = $158, Apex = $48, and Walmart = $684.
  • Yes, Walmart is $684.  Yes, Apex is $48.  I had all about given up until Apex got back to me.  I had a discussion with the pharmacist about this price and she mentioned how crazy the markup is.  Well, THAT’S reflected in the prices I got!  Wow.  Apex may be a registered pharmacy in your state and they do ship.  Give them a call, if you need to and are interested.  They may be able to ship to your state!  Their website is: http://www.apexpharm.com/
  • If you want to or need to call other pharmacies I didn’t call, see this other article I wrote for Tripawds: http://www.nutr…..me-from59/  This article details how to find good, safe meds for your pet.  It provides links to where you can find compounding pharmacies in your state.  It’s entirely possible that the smaller pharms don’t mark up this dug (as was my experience).  Shop around for this medication!  The savings are immense!

~ Katy & Jackson

ACL tear in right hind leg 12/5/12 and scheduled ACL repair surgery 12/21/12. Pre-op xrays revealed osteosarcoma. Amputation 12/28/12.  Chemo (carboplatin) started Jan 10, 2013 and ended on April 5, for a total of 5 doses. He handled carbo like a champ!  No side effects.  We started metronomic therapy at his third chemo and have been also doing some holistic treatments.  He's a lively, playful 10 year old huskie-boarder collie and a very proud member of the Winter Warriors!  Our love. Our funny little guy!

New York, NY
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24 July 2013 - 3:11 pm
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Awesome post Katy.  When I was given the choice (yes I was given a choice) between Leukeran and Cytoxan, I really didn’t find much info out there on Leukeran being used metronomically.  It is used a LOT for kitties with lymphoma, but no articles/studies/information could be found about using it metronomically.

 

Jill’s oncologist did tell me, as I’ve mentioned, that Leukeran and Cytoxan are “chemical cousins”.  One thing I did like about Leukeran is that I could give it at any time during the day.  I was also told by Jill’s oncologist (and this was the reason we chose leukeran) was that leukeran is, to quote her, “very easy on the bone marrow” and as we all know, Jill has issues with chemo and her neutrophil levels.

 

So far, Jill has been on Leukeran for close to 6 weeks.  She was a bit lethargic for the first couple of weeks, but that is all better now.  She has been a bit nauseous lately, throwing up a few times, but I just started giving her pepcid a half hour before the leukeran and it seems to be helping.

 

As far as price goes, for what its worth, I get Jill’s 1mg (30 day supply) pills from Diamond back for $39.

Jill is a 9-year-old tuxedo kitty. She was diagnosed with Osteosarcoma in June 2012 on her toe in her right hind leg. Her leg was amputated on 12/12/12 and she completed four rounds of chemo (2 of Carbo, 2 of Doxy) in April 2013. "Like" Jill's facebook page: https://www.fac.....tty?ref=hl Proud member of the WINTER WARRIORS!!!! Her blog can be read at http://jillsjou.....ipawds.com. xoxo

Virginia




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24 July 2013 - 5:07 pm
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How on earth do you simply just say “thank you” for this INCREDIBLE, INVALUABLE iformation? This is crazy good stuff you…and Jill have provided us!

Katy, your relati ship with our oco. is cleary very special. I’m sure it’s because she vaues you as the great persn you are…..full of so much humanity and compassion.

I’m going to show this to my onco. and look at maybe…maybe switching Happy Hannah over. The main reason is that Happy Hannah…like Atlas…just loves to nold ner pee! Big dog..equals big bladder holding tank!

Oh…that’s right….I don’t have a printer!! Oh …that’s right…….I wouldn’t even k ow how to use one if I had one!! :-) :-)

That’s alright…..I still k ow how to write…..and a lot better than I type!! I’ll write out the key points.

Katy and Jackson—THANK YOU! At least you can put a very powerful and positive meaning to him having to deal with this “pee” issue!!

Love and appreciation,

Sally and Happy Hannah

Happy Hannah had a glorious additional bonus time of over one yr & two months after amp for osteo! She made me laugh everyday! Joined April's Angels after send off meal of steak, ice cream, M&Ms & deer poop!

Fort Wayne, IN
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24 July 2013 - 7:27 pm
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Awesome information, Katy!  Thank you so much.  You are a wealth of information.  We are so far so good with the Libby on cytoxan.  We’re keeping our paws crossed it stays that way!

Liberty (Libby) was diagnosed with OSA on 1-22-13.  Right front amputation on 1-31-13. No IV Chemo. Metronomic Therapy started 2-19-13 along with supplements and some home cooking. Lungs clear until 1-06-14.  She's still her happy, hoppy, bossy self.  Living the dog life to the fullest and a proud Winter Warrior. :) RIP my Libby 4-21-03 to 3-19-14

The Rainbow Bridge



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24 July 2013 - 8:00 pm
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Katy, thanks a bunch for this super valuable information! You are so good at digging for the real scoop, we can’t tell you how much we appreciate it.

It's better to hop on three legs than to limp on four.™
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24 July 2013 - 8:46 pm
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Thanks Katy.  We will be switching drugs too.  Had another vet visit today.  But I am not sure what pharmacy we will be using.  I told them just to get the cost & order it at diamondback drug as that was what we have been using.  but my vet will call it anywhere.  I just figure since we have been using them & that is where Bosch’s meds are at too that it might just be easier to keep them at the same pharmacy so I don’t lose my mind.  LOL (not that I haven’t done that)

 

Dr Boyer will be getting the exact dose for sassy then I will post that info.

 

Hugs

Michelle & Sassy

sassymichelle-sm.jpg

Sassy is a proud member of the Winter Warriors. Live long, & strong Winter Warriors.
sassysugarbear.tripawds.com
07/26/2006 - Sassy earned her wings 08/20/2013

05/04/2006 -  Bosch, Sassy's pal, earned his wings 03/29/19  fought cancer for 4 months.

"You aren't doing it TO her, you are doing it FOR her. Give her a chance at life."

New Haven, CT
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12 September 2013 - 6:56 am
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Another detail for the thread: Jackson’s onco did move him up to a stronger dose of leukeran.  He’s 60lbs.  Officially he should be on 3.7mg/day, but for compounding ease and price we went with 3mg/day.  Diamondback Drugs would charge $70.88 for 30 of these (then add $6 shipping) and my pharmacy nearby (Apex) charges $72.95.  Tomorrow will be his first dose of 3mg.  We’ll be watching for changes and in a month he’ll get his blood and urine checked.

~ Katy & Jackson

ACL tear in right hind leg 12/5/12 and scheduled ACL repair surgery 12/21/12. Pre-op xrays revealed osteosarcoma. Amputation 12/28/12.  Chemo (carboplatin) started Jan 10, 2013 and ended on April 5, for a total of 5 doses. He handled carbo like a champ!  No side effects.  We started metronomic therapy at his third chemo and have been also doing some holistic treatments.  He's a lively, playful 10 year old huskie-boarder collie and a very proud member of the Winter Warriors!  Our love. Our funny little guy!

Virginia




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12 September 2013 - 8:49 am
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Thanks dor the update Katy. We’ll be looking forward to following Jackson’s continued success!

Happy Hannah FINALLY got a good Free catch pee” cleared as of yesterdayclap . Onco wouldn’t order it until she saw first hand report faxed from my regular vet. As of this morning, my vet faxed a second copy just to be sure and called her to tell her directly everything looked good! And guess who won’t be back ’til Monday?? $&%## Grrrrrrrrrrrrrrrrrrr &%%#%& Grrrrrrrrrrrrrugh
ugh

Happy Hannah had a glorious additional bonus time of over one yr & two months after amp for osteo! She made me laugh everyday! Joined April's Angels after send off meal of steak, ice cream, M&Ms & deer poop!

The Rainbow Bridge



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12 September 2013 - 10:07 am
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Good to know Katy, thank you for continuing to keep us posted.

It's better to hop on three legs than to limp on four.™
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