![]() ![]() This typically resolves with drug discontinuation and supportive therapies. There are 2 toxicities specific to Tanovea: a cumulative dermatopathy characterized by local superficial erythema and pruritus, most often in the periauricular region, dorsum, and inguinal region. Incremental dose reductions or dose delays may be used to manage adverse reactions. Common side effects include gastrointestinal and hematologic changes similar to those seen with other chemotherapy agents. Tanovea is given as a 30-minute IV infusion once every 3 weeks at a dose of 1 mg/kg for up to 5 consecutive doses. It is not a substrate for P-glycoprotein and therefore should not be subject to the multidrug resistance that commonly develops in dogs treated with doxorubicin-based chemotherapy. It is indicated for the treatment of lymphoma without specification as to immunophenotype, anatomic site, stage/substage, or degree of pretreatment. Tanovea (rabacfosadine for injection, Elanco) became the first fully FDA-approved drug for canine lymphoma in 2021. Several rescue protocols exist and can be employed in the event of a relapse during or following CHOP-based chemotherapy. In select cases, less intensive alternatives to standard CHOP-based chemotherapy may be chosen: single-agent doxorubicin or lomustine (CCNU) +/- L-asparaginase, and prednisone for palliative care. 3 To date, no prospective head-to-head studies have demonstrated what protocol performs best for T-cell lymphoma. Because T-cell lymphoma has a poorer response to doxorubicin-based chemotherapy, many oncologists will modify the protocol by substituting it with alkylating agents. Afterward, patients are monitored every 4 to 8 weeks. ![]() These authors currently treat dogs with a 16-week protocol that is broken down into four 4-week cycles. Typically, protocol length varies from 12 weeks to more than 2 years and is often driven by efficacy, cost, and owner convenience. 2 There are well over a dozen published protocols that differ in the number of drugs used and the timing of each drug. The acronym comprises the names of the 4 drugs that make up the protocol: cyclophosphamide, hydroxydaunorubicin (doxorubicin), Oncovin (vincristine), and prednisone. 1 Treatmentįor many years, the standard of care for most canine lymphomas has been doxorubicin-based combination chemotherapy, or CHOP. T-cell disease is associated with certain anatomic forms, including cutaneous, mediastinal, hepatic, and gastrointestinal. B cell is the most common intermediate to high-grade form, whereas T-cell lymphoma is less common but more frequently seen in breeds like Boxers, Golden Retrievers, and Siberian Huskies. Of additional importance is immunophenotype, which can provide prognostic information and guide therapy. Clinically ill (substage b) dogs and dogs with advanced (stage V) disease typically have a poorer long-term prognosis. Stage IV involves hepatosplenic involvement, and stage V refers to the presence of bone marrow infiltration or involvement of extranodal sites like the kidneys, lungs, CNS, or eyes. Most patients present with at least stage III disease, with generalized peripheral lymphadenopathy. This allows them to be categorized by disease stage (I-V), substage (a or b), cell size/grade (large cell, intermediate grade, high grade, or small cell/low-grade/indolent), and immunophenotype (B cell or T cell). Upon diagnosis or suspicion of lymphoma, patients typically undergo a series of staging tests, including lab work (CBC and chemistry panel), fine needle aspiration cytology and/or biopsy, imaging (ultrasound and/or thoracic radiographs), and molecular diagnostics (immunohistochemistry, immunocytochemistry, PCR for antigen receptor rearrangement, flow cytometry, and genomic profiling) to determine the nature and extent of disease. Most dogs diagnosed with lymphoma have the intermediate or high-grade form of the disease, but given recent advances in molecular diagnostics, other previously underrecognized subtypes, like indolent lymphoma, are being more frequently diagnosed. Lymphoma, a cancer that originates in white blood cells, is one of the most common cancers in canines. ![]()
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