metronomic chemotherapy – Jabba-Bear's Blog

Jabba starts metronomic therapy….again…

Three weeks after Jabba’s lobectomy to remove a large portion of his metastatic osteosarcoma, he was given a “bill of good health”, at least a temporary one. At this point, we decided to put Jabba back on metronomic therapy (i.e., frequent, low doses of chemotherapy) since he had tolerated it well for such a long time (almost 2 years!).

We started giving him cyclophosphamide (9 mg), the primary chemotherapy drug, first, since we still had a full bottle of it leftover from January. Note: Jabba’s doctors told us to withhold chemotherapy until he had sufficiently recovered from his surgery because these potent drugs that attack rapidly dividing cancer cells may prevent or limit wound healing (at the cellular level, the active ingredients in the pill cannot distinguish between a growing tumor and healthy tissue regeneration-it kills them both).

We debated putting Jabba-bear back on Palladia (50 mg) because of the sheer expense ($323.85 for 30 pills), but we eventually gave in and ordered the pills. Note: Jabba had previously been taking 70 mg of Palladia, but, since he lost a significant amount of weight prior to the lobectomy, we adjusted his dose accordingly. Although it should have been slightly higher (closer to 60 mg), we decided that we would start with the 50 mg capsule.

Because indigestion is one side effect of the metronomic therapy, Jabba-bear also receives 10 mg Pepcid or a generic anti-acid 2x daily. We still catch him eating grass occasionally though, which suggests that his stomach is not entirely settled.

In summary, Jabba-bear currently receives cyclophosphamaide and Palladia after breakfast on alternating days. He also takes 10-20 mg of Pepcid per day depending on his symptoms. In addition, Jabba-bear is still taking Prednisone (20 mg), which serves two purposes: (1) to help reduce any residual swelling in his joints from the lobectomy and/or systemic inflammatory reaction to the metastatic osteosarcoma, and (2) to keep his temperature in the normal range (it is currently hovering in the high 102 degrees Fahrenheit).

As you can probably imagine, Jabba-bear has accumulated quite the extensive collection of drugs in his “medicine cabinet”. In addition to his metronomic therapy, he also has a stash of pain medicine (Tramadol), various antibiotics, metronidazole (for diarrhea), heartworm medicine, flea medicine, etc.

Jabba-bear's medicine cabinet. Also shown in the above image is his thermometer which we used frequently to monitor his persistent fever and his jar of Royal Treats. — Jabba-bear’s medicine cabinet. Also shown in the above image is his thermometer which we used frequently to monitor his persistent fever and his jar of **Royal Treats**.

Jabba-bear is very good about taking his medicine. We have a nice system worked out. Every morning after breakfast, Jabba’s mom says, “time for your medicine, sweet prince”, and Jabba runs to the kitchen, drool spilling from his bottom lip, because to him, medicine = a tablespoon of peanut butter.

Jabba-bear medicine delivery system-edited — Jabba-bear’s **drug delivery system**. Peanut butter, disposable knife, and medicine!

The disposable, plastic knife is a good tool for delivering the chemotherapy drugs because it is not a good idea to touch them with your bare hands (as they are toxic!!!), and the knife is not too sharp, so Jabba can successfully lick off the peanut butter without hurting himself.

Jabba getting his daily dose of medicine after breakfast. He gobbles it up with delight!

Overall, Jabba-bear seems to be doing pretty well on metronomic therapy. However, it is important to acknowledge that we are fighting a losing battle. The metronomic therapy will not cure Jabba-bear. His metastatic disease is serious and quite aggressive. . . At best, this combination of medication will slow the progression of his cancer. Maybe it is working? Today marks 6 weeks since his lobectomy! We are blessed to have had him so long. We are not in denial about the gravity of Jabba-bear’s situation, and we recognize that the choices we made to prolong his life may not be viable options for everyone (we have accumulated a significant amount of debt over the past 3 months). Nevertheless, we hope that some people may find this information useful. Thank you, once again, for your support.

Jabba’s lobectomy

On Monday, February 18th, Jabba-bear was admitted to Carolina Veterinary Specialists (CVS) upon referral from his primary veterinarian (Oldtown Veterinary Hospital). By that point, Jabba’s condition was critical. It was clear that if we didn’t act fast, he would die…soon. That day, the doctors at CVS performed an ultrasound of his abdomen, to try and visualize the mass in his lung for a biopsy.

Jabba-bear at CVS during visiting hours. The small patch of shaved skin on his side shows where the doctors attempted to do a blind biopsy of the mass in his lung (following the ultrasound).

Jabba-bear loves to push on our feet as we rub his belly! This was the most energetic he had been in 3 weeks. We felt that he was showing signs of improvement.

This procedure was, in some ways, a gamble because lungs are ill-suited for ultrasonographic examination given that they are typically full of air (and ultrasound doesn’t work well through oxygen). As such, the doctors were unable to get a good look at the mass. The next viable option was lung surgery. As detailed in a previous post, Jabba-bear spent nearly one week at the “hotel” (CVS), receiving ample IV fluids and pain medicine, as he bravely withstood test after test after test. Eventually, it was determined that Jabba was healthy enough to sustain surgery (no organ failure, no noticeable masses in his liver, etc.), although there was still some risk involved as Jabba-bear had been so sick for such a long time, and we were not sure what was causing his illness. On Thursday, Februrary 20th, Jabba-bear had a lobectomy. Specifically, the surgeon removed the caudal lobe of Jabba’s left lung.

We were not allowed to visit Jabba-bear the day of his lobectomy, but we went to check on him Friday morning. This was a very difficult visit for us. As soon as the technician left us alone with Jabba, he starting crying…Loud, wailing, cries. We had never heard him make those sounds before. We didn’t know what those vocalizations meant. Was he in pain? Was he suffering? Was he yelling at us for putting him through yet another major surgery? We felt helpless. We looked at each other and wondered if we had made the wrong decision. The technicians assured us that Jabba was not in pain, that he had spent the whole day resting comfortably (and quietly). However, he was still not very interested in food. We asked if we could try to feed him. The technician brought us quite a selection of wet and dry food. To our surprise, Jabba-bear ate it all! This lifted our spirits. We stayed there petting Jabba-bear as long as possible, until it was time for him to go back on his IV fluids.

The next day, February 23rd, we checked Jabba-bear out of the “hotel” and brought him home!

Jabba on the way home form the vet (after the lobectomy). The blue bandages covered the incision site.

Jabba-bear was happy to see the car. He had never been boarded before, and this was the longest he had ever gone without seeing his pawrents. When we got close home (turning onto our street), Jabba-bear perked up. He lifted his head, looked at the road, and started smiling!

The doctors sent us home with pain medicine (Tramadol) and steroids (Prednisone) and told us to limit Jabba’s physical activity for at least two weeks (no jumping, climbing stairs, running, etc.). We weren’t too worried about this since Jabba-bear is an extraordinarily lazy dog. Even though his sister, Beyonce, was waiting for him, we knew that they would be OK. Honestly, Jabba-bear and Beyonce do not interact much, save for the occasional forced cuddling on Beyonce’s part.

We spent that whole day laying on the floor with Jabba-bear, scratching behind his ears, petting his backside….letting him know how proud of him we were. He is such a brave boy!

Jabba resting on his pillow. Beyonce give him a concerned look. — Jabba resting on his pillow. Beyonce giving him a concerned look.

By Sunday morning, Jabba-bear seemed to have improved significantly. His appetite had returned, and he seemed more energetic. Jabba kept rolling onto his back, begging for more belly rubs. As a result, he wiggled out of his bandage and exposed the incision site of his lobectomy. Although the below picture might look gruesome, the incision site was neat and clean. We thought the doctors did an excellent job!

Jabba's incision site exposed! — Jabba’s incision site exposed! Beyonce stayed close to her brother, making sure he was OK.

We took Jabba-bear back to CVS to replace the bandages, since it was recommended that they remain on for one week.

Jabba's new threads! — Jabba’s new threads!

The following Thursday, Februray 28th, we took Jabba’s bandages off to allow the incision site to “breathe”. By this time, Jabba-bear had figured out how to jump on the couch again, and well….we let him.

There's that goofy smile again! (one week after the lobectomy) — **There’s that goofy smile again!** (one week after the lobectomy)

Brother and sister on the couch. Jabba loves to look out the front door.

Jabba's idea of resting comfortably. — Jabba’s idea of resting comfortably.

All things considering, Jabba-bear is doing very well. He started the high protein diet (Hill’s prescription) a few days ago, which we will write more about soon.

He is no longer taking pain medicine, and he is tapering off the steroid treatment. We are still thinking about the next step for Jabba-bear (i.e., whether to put him back on cyclophosphamide and/or palladia).

Thank you so much for all of your support over the past few weeks.

Jabba starts metronomic therapy

This was back in April, sorry for the delay but at least we still have the pictures. Jabba started his metronimic therapy regimen which involves low does of cyclophosphamide and piroxicam every other day. This dose and frequency is supposed to prevent angiogenesis, thus preventing a metastasized tumor from being able to take hold and grow (presumably in the lungs). We met some other dogs in the trial that morning, though they were still there for the high dose chemo (Jabba was the first in this study!). One lady, the owned of the Irish Wolfhound made the trip all the way from Washington DC. It is good to see people so committed! Interestingly, we noticed the Wolfhound’s front leg was amputated mid-bone, and apparently is being fit for a prosthesis, something new they are doing at NCSU CVM.

Later that day Jabba stayed at his grandparents house and played this his big sister Xena the Italian Greyhound:

Updates- halfway done with chemo

Jabba has had 2 of his 4 “high dose” chemotherapy treatments at North Carolina State College of Veterinary Medicine. He has these every 3 weeks for 4 months. He needs a complete blood count every week to make sure he is handling it alright. We had a small scare when in the 2nd week his neutropil level was low, and there was a chance if it got lower he would have to stop. Luckily next week it was back to normal.