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T Cell Lymphoma In A Dog

by Debbie - October 20, 2018 View Case Report

Sundae is an 8 yr old FS Gordon Setter (not one of my breeding for a change) who after developing an acute episode of vomiting and diarrhea was diagnosed with an intestinal tumor and had a large amount of her upper bowel ressected. No mets were seen at the time of surgery and I believe she had an otherwise clean CT scan. The tumor was classified as a T-cell LSA and given 2-4 month prognosis. The clients didn't want to put her through the CHOP protocol because at best they were told she would get 6 months and they didn't want her to spend what time she had left undergoing chemo. They decided they would like to use a single chemo agent (Lomustine) + prednisone as a sort of rescue protocol that has shown some promise.

I have suggested they consider adding chinese herbal formulas for support knowing how liver toxic and immunosuppressive we can expect these agents to be. Sundae has received her first dose of Lomustine 1 week ago and her blood work looks pretty darn good, except we have wiped out her lymphocytes as expected. Kidney and Liver function are so far normal. I had planned on starting her on Modified XCHT but was wondering when to start? If I start her now should I discontinue them for a few days before or after her next dose of Lomustine which is scheduled in 2 weeks. I'm also wondering how to prioritize which additional supplements to recommend... eg medicinal mushrooms, VitA/D, IP6, ApoCaps, Rx ImmunoSupport etc.

I'm also planning to talk to them about Ketogenic diets but was hoping to stage introduction of these products as tolerated. She seems quite well at this time and eating quite normally though is underweight after everything she has been through.

Thank-you in advance for any insights you can offer.

Debbie

by naturevet

October 22, 2018

Hi Debbie,

One of my favourite formulas for GI lymphoma is Si Miao San, especially if there were signs of colitis. It can be used with XCHT. You can start low and ensure it is well tolerated. I would expect at least the same survival as they were mentioning for the CHOP protocol.

I use XCHT if the pulse is responsive to GB points

When dosing herbs, Erin Bannink stops a day or two before chemo, and continues a day or two after. I don't stop, personally, as there is abundant research showing synergy between drugs and herbs, so I like to have herbs in the system when the drugs are given. Erin is more conservative, and also ensures the herbs aren't started until the adverse events of the drug have had a chance to materialize after dosing, so the herbs aren't mistakenly blamed.

I think we both are fans of polypharmacy. I don't know that I would stage introduction of supplements. I'd just get on with whatever you think you're going to use. Erin is not as much of a fan of vitamin A and uses more mushrooms. I'm more of a vitamin A fan and use less mushrooms. Vitamin D supplementation is probably mandatory, and IP6 likely has no downside.

A real food diet is a very good idea, even if you don't decide to go ketogenic, Just lowering insulin levels by stopping canned or kibble diets is bound to be at least somewhat helpful

Steve

Si Miao San

by bannink

November 2, 2018

Hi Debbie,

I'd just like to clarify a little on timing of herbs. I only recommend stopping the herbs before and after chemo, as Steve mentioned, if the oncologist administering and managing the chemotherapy is nervous about doing them with the Chemo. So your timing will depend somewhat on how best to work together respectfully with their comfort level and concerns. What I typically do when I'm managing the case is to start herbs after the first cycle of chemotherapy. The reason I do this is so I know if the patient has an adverse reaction to the chemo whether it is due to the chemo alone: i.e.: vomiting, diarrhea, anorexia. And in the case of CCNU, severe neutropenia. This is the same reason (GI upset) I don't recommend major diet changes at the start of chemo. I do not stop herbs through the course of chemo after introducing them as long as the patient continues to fit, and is responding well to, the herbal prescriptions. I will tell you that I generally don't see herbs exacerbating neutropenia, after 11 years using them together, EXCEPT for with CCNU if the patient is starting out blood deficient and this is not directly addressed. I'm not sure what your patient looks like, as I don't see a TCM assessment in your case assessment. So just keep this in mind...you'll want to have a blood tonic on board if you are seeing signs of Blood deficiency.

I agree with Steve's comments about Si Miao San and Xiao Chai Hu Tang with Gastric Lymphoma.

Keep in mind that true Ketogenic diets for cancer therapy are extremely high fat, and also must be fed raw (heating that high fat diet is not recommended)...both of which I would advise avoiding in a dog with Damp Heat in the GI tract and who is receiving chemotherapy. A fresh food diet would be a better way to go at this point, at least until you are through chemo.

Erin

by naturevet

November 2, 2018

Thank you for the clarification, Erin! Sorry if I misrepresented you a little

S

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