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Help with possibly final chemo decison
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Forum Posts: 38
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24 November 2008 - 11:20 pm
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Udate: Cody’s amp was on Aug. 29th. He went through 2 rounds of Carboplatin. He developed lung mets and they continued to progress. He was then accepted into a clinical trial which he had his first treatment 3 weeks ago. He was supposed to have his second treatment today but sadly his lung mets are continuing to grow and multipy so our vet felt the clinical chemo drug was not working and took him out of the study today. I am faced with 3 choices. If anyone is familiar with any of these forms of treatment or has any opinions I would love to hear them. I have to decide by tomorrow afternoon. I just need to step away for a night emotionally and hope I can gain some new strength from you guys! BTW…Cody is still doing great physically and emotionally. He’s very happy. He’s eating, he’s playing, he’s playing hide and seek and giving kisses. His mets although increasing, are still small enough that we are not seeing symptoms yet.   Here are the choices we were given today:

1. Doxorubican chemo once every 3 weeks- IV treatment

2.Metronomic chemo as pallative care only: NSAID and Cytoxn given orally

3. Rapamycin Study. This is another new clinical program. Rapamycin is a MTOR inhibitor that has  shown some promice. This is a first phase trial like the one Cody was just in so doses would be at the lower levels. This one entails pawrents to give IM injections once daily for 5 days followed by a 2 week break and then another 5 day cycle. X-rays  and lab work are done at 1 month intervals to check on progress.

With the lung mets growing the way they are I think this may be my final choice in choosing chemo. I am always optimistic but I also have to be realistic. So again, if anyone has any opinions or experience of the treatments listed above I’d love to hear them.

Cody and Cathy

The Rainbow Bridge



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25 November 2008 - 12:48 am
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Cody and Cathy,

We know you’re in a ruff spot, and we hope we can help somehow. It’s great to hear that Cody is still himself and loving life. Try to stay focused on that. Live in the moment. He sure is. That’s all that matters.

Ok, so as far as the options go, the only one we are familiar with is the Metronomic protocol. When I started it, I had one, possibly two, small lung mets. After two months of being on it, the chemo shrank the most obvious tumor by ten percent. After six months, the tumors had grown and it wasn’t doing much to help anymore, so my oncologist said "time to pawty!" and took me off of it.

We understand your dilemma about balancing the act of being realistic, with the promise of being hopeful. It’s a tough line to walk.

The thing we asked ourselves when first dealing with my lung mets was; what option would allow me to embrace life, and not fill my time with intrusive medicine? For us, because we lived on the road, the choice was the metronomic protocol. For Cody, it may be entirely different.

That’s one way of looking at it, and we hope that it helps. 

Give our love to your boy, and let us know what you decide. We are thinking of you and sending pawsitive energy your way.

P.S. Next Tuesday we are having a Live Chat with my oncologist, Dr. Mullins, at 5pm Pacific, so if you have questions about whatever option you chose, be sure to chat with us then, she’d be happy to help!

 

 

 

It's better to hop on three legs than to limp on four.™
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25 November 2008 - 1:12 am
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Hello Cody & Cathy,

   I am sorry to hear the news. Whatever decision you make will be the right one. So don’t second guess yourself. I have never had to deal with these options. If you need a medical opinion you can also post this under ask the vet. Perhaps some medical advice would guide you. I have heard of doxorubican being used on humans for lung cancer but it has possible side effects.
  Please keep us updated. I am glad that Cody still feels fine and has no obvious symptoms. Stay in the moment and listen to your heart.
  Kim&Buster

Kim & Angel Buster

"Until one has loved an animal, a part of one's soul remains unawakened."
–Anatole France


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25 November 2008 - 9:55 pm
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I am so sorry that Cody’s lung mets have progressed!  At least he is still feeling fine.  Here is my two cents:

 I would probably forego the Adriamycin, since it often causes nausea and vomiting, and has the potential to hurt the heart muscle.  Also, if carboplatin failed then this drug probably won’t help.

I would find out more about the new drug and see what the reported side effects are.  It is the same drug class as Adriamycin but I am not familiar with it to know if it also could damage the heart.  I have heard that this is the next best hope for dogs with OSA who have failed other chemo protocols.

I think the Metronomic protocol is at least worth a try as long as your dog can handle an NSAID daily.  Possible side effects are GI ulcers and liver or kidney problems but these are rare.

So I would try the new drug and if that fails then consider Metronomics.  Maybe the Vet School would give you until 12/3 to decide so that you could get the opinion of Jerry’s oncologist.

Pam and Tazzie

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25 November 2008 - 10:39 pm
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Cody and Cathy,

We are so sorry to hear that the mets are progressing.  Our prayers are with you. 

As far as your choices, I agree with Pam on the Adriamycin.  Bonnie went through 5 courses of alternating chemo with Adriamycin and Paraplatin.  The Adriamycin hit her the hardest.  It is a really harsh drug.  In spite of 5 courses given only two weeks apart, Bonnie showed 2 mets yesterday prior to her last course.  We did not do the last course because the vet felt that if the escalated treatment he had done did not stop them, then one more would not help.  SO…. we are in line for a clinical trial of Rapamycin.  I have copied their description below.  Hope this helps some.  The doctor told me that the dosage is lower and therefore the side effects are less.  Either way, we hope for the best for you and know that any decision you make is the right one and Cody knows you love him. 

1. This clinical trial evaluates the safety and effectiveness of rapamycin when given to dogs with visible lung OSA nodules seen on x-rays. Rapamycin is a drug currently approved human patients receiving organ and bone marrow transplant. Early work with rapamycin suggests that this drug may also have anti-cancer properties by inhibiting or blocking an important pathway in cancer progression known as mTOR. Preclinical studies of rapamycin suggest that mTOR blockade may be effective in the treatment of several cancers including osteosarcoma. In a recently completed study of rapamycin in dogs, the injection of rapamycin under the skin and into the muscle for seven consecutive days was well tolerated. There have been no studies yet performed to evaluate the effects of administered rapamycin in dogs with cancer for longer than 7 days. Prior to entry in this study, your dog must have a confirmed diagnosis of visible lung metastasis on x-rays and staging tests (physical examination, complete blood cell count, chemistry profile and chest x-rays) to ensure his/her general health and to assess how advanced the disease is prior to treatment.

2. Therefore in this study, we ask that you permit either daily or every other day rapamycin subcutaneously (SQ) dosing in your dog for 30 days. The treatment schedule will be assigned to each eligible dog by randomization (like flipping a coin). If your dog shows a response or has stable disease with rapamycin, your dog will continue on his/her assigned rapamycin treatment schedule until the cancer progresses.

chris-bonnie

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27 November 2008 - 11:31 pm
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First off, I would like to say I am sorry to hear about Bonnie’s mets. It’s always sad news to hear and forces us back into the decision making/balancing quality of life mode. Also, thank you to Jerry and Kim for your support and Pam & Chris for your two cents. I needed it!!!! I was personally leaning toward the Rapamycin clinical study. Cody is a good candidate. I will know more Friday after talking with my vet again. Thanks for the additional info on Rapamycin Chris. You had extra info beyond what I had been given that was very helpful and I know that was a bunch to type up up for us. Thanks for taking the time to do that! Cathy

The Rainbow Bridge



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28 November 2008 - 6:59 pm
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We’re anxiously awaiting to hear what you decide Cathy. Many hugs.

It's better to hop on three legs than to limp on four.™
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1 December 2008 - 8:18 pm
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Hi Cody and Cathy,

 We hope the best for you.  Ivan was diagnosed in late September, and had his amputation October 2.  He has gone through two rounds of chemo, starting with Doxorubicin October 22, then Carboplatinum last week.  He had no side effects whatsover from the Doxorubicin (he had a heart scan prior to treatment to make sure there were no irregularities).  Likewise, he had no side effects from the Carboplatinum.  His next chemo is scheduled again with Doxorubicin for December 17. the next round 3 weeks later will be Carboplatinum. Depending on how he does, he will stop there or go on for two more treatments, for a total of 6 treatments.

Ivan is tolerating the chemo very well, no loss of appetite, a little tired the day of and the day after, but no effects that diminish his quality of life.   Our best to you and Cody.

 Ivan and Kate

Ivan and Ivan's mom

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1 December 2008 - 8:56 pm
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Hello Cody and Cathy, the only thing I can add to all the advice above is that I had my chemo with carboplatin and had no side effects and went on my merry way.  My treatments were supposed to be every 3 wks but to make sure my CBC were good they stretched them to every 4 wks.  I did well during treatment. 

As for the Adriamycin, we are with Pam. Not from my personal experience but from my Mom and my Auntie Ivette (mom’s sister).  Luckily for my mom her chemo was just preventive so adriamycin was not part of her treatment but my auntie did and boy did she have a hard time with the drug.  It is a very strong drug and very harsh.  So, if you can avoid it and choose something else…….go for it. 

Like Jerry said, choose something that will not interfere with your quality of life.  Definitely join in the chat tomorrow and ask Dr. Mullins for advice, she is a great person.  Even though she never treated me, she was great in answering my Mom’s email when my mom needed advice.  Best of luck to you and whatever you choose it will be the right thing for you.  Lots of licks, Kellie.

Kellie

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