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Aggressive Facial MCT

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Dear Steve,
It's been awhile. Hope you are well.

I saw a 10 yr FS lab yesterday for a follow-up exam for a MCT involving the left upper lip, with metastasis to the local draining nodes as determined by CT scan and histopathology. The owner is a proprietor of a local health food/supplement store, and is very well informed on herbal treatment options, and so has held off on the recommended vinblastine chemotherapy since diagnosis 1 month ago. Radiation is not an option due to LN involvement, and Neoplastene not an option due to location. Medications for the last month: Reishi, cod liver oil, prednisone tapered to 10 mg QD currently, 20 mg Pepcid QD, 75 mg benedryl TID, 300 mg vitC, Transfer Factor, probiotic, dig NZ, and 2 gm modified XFZYT BID. Her diet is home-prepared mostly meat and vegetables, with <10% low glycomic index carbs.
The mass has doubled in size over the last month, and now is the size of a medium grape just rostral to the commissure on the left upper lip. The owner feels it was stable on higher pred doses (20 mg QD). The tongue is red, large, dry body with cracks and a large tip slightly wet. The dog lays on the floor with her head slightly extended, like she wants to get away from the mass, and has a slightly worried or anxious expression. the left submandibular LN is only slightly enlarged to me. The owner reports that the mass is bleeding a slight bit this morning. TCVM diagnosis: Toxic Damp Heat/Phlegm entanglement with local Blood stagnation. Blood Heat?
This is the second facial MCT I have treated that just seems to grow despite what I do. They are aggressive, and the first one rapidly progressed despite the addition of Si Miao San to address the Damp Heat component.
We discontinued the Reishi in case it had any MC stimulatory activity, increased the prednisone back to 40 mg QD, increased the vit C to 500-700 mg QD, and added kelp, artichoke hearts and chrysanthemum for a source of luteolyn. I am thinking that giving Si Miao San 2 gm QD in the evening, and adding Xiao Feng San 2 gm QD in the am will add some anit-histaminic and mast-cell inhibiting action to the treatment protocol with the cicadia and Jing Jie. Do you have any other ideas for these?
Thank you,
Jodi

by naturevet

January 29, 2010

Hi Jodi,

It seems you need an anti-inflammatory kind of approach to succeed here. SMS is helpful. Also Hoxsey should be rolled in there, given its considerable anti-neoplastic and anti-inflammatory effects. I would even wonder about trying an NSAID, both for pain relief and to double up on the anti-inflammatory (which means anti-angiogenic) properties of the tumor. Off-the-cuff, that's what I'd recommend. If the client desires pred for now and feels they are reliant upon it, then I guess I'd let that be my anti-inflammatory for the next week or two. But if you gain better control, then trying to wean may once again be feasible.

Hope that helps. Remember also Tan Yu Tang for facial tumors. For me, if things were out of control, I'd try all three. I'd even look at topical applications, perhaps using DMSO (which is anti-inflammatory) as a carrier. I've had good results with Xian Fang Huo Ming Yin in that vein, while Dr. Fougere has had good results with Xue Fu Zhu Yu Tang.

Good luck,

Steve

by bannink

January 29, 2010

Jodi,

Mast Cell Tumors on the muzzle do have a more aggressive biological behavior than those on other parts of the body. I had a similar case which presented with metastasis to the right submandibular and prescapular lymph nodes and a lot of facial swelling. Radiation and chemo were declined due to cost. No response to Prednisone and XFZYT after 1 week so I tapered the pred and added high doses of milk thistle (20mg/lb daily) and vitamin E (800IU daily) after which time we got a complete remission until owner discontinued herbs about 2 months later and tumor recurred. Not sure how much the milk thistle played into regression (versus tincture of time on herbs) but I would recommend adding that into the mix for its antineoplastic, antioxidant and hepatoprotective properties.

Also, if disease is really out of control, radiation can be given for palliation and they can treat the local site and the lymph node. With metastasis, I would not recommend a full course protocol. Palliative protocols (a few large doses) will have minimal side effects and have resulted in significant responses in mast cell tumors. If the owner is open to radiation and not put off by the cost, this will buy you more time and decrease the tumor burden you are working against with the herbs.

â€¢ The disease-free interval for 35 dogs treated with radiation therapy (course fraction/palliative protocol) and prednisone for non-resectable Mast cell tumors was 1031 days, with one and two-year progression free rates of 60% and 52% respectively. Overall, 4 dogs eventually developed local recurrence, 5 developed distant metastasis and 2 developed both local recurrence and metastasis (Dobson. Vet Comp Oncol Sept â€™04).

Good luck,

Erin

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