Efficacy and Toxicosis of VELCAP‐C Treatment of Lymphoma in Cats

Abstract

Background: Lymphoma is the most common malignancy affecting cats. A protocol employing vincristine, L-asparaginase, cyclophosphamide, doxorubicin, and prednisone (VELCAP-S) is effective and well tolerated in dogs with lymphoma. A 24-week variation of this protocol (VELCAP-C) was developed for treatment of cats.Hypothesis: That VELCAP-C will result in survival times for cats with lymphoma that are similar to those obtained when cats are treated with a protocol that includes fewer chemotherapy agents.Animals: Sixty-one cats with lymphoma. Methods: Retrospective study. Outcomes evaluated were response to VELCAP-C therapy, toxicosis, and survival time. The effect of signalment, staging, CBC, and serum chemistry profile and dosage on these outcomes was examined.Results: Six cats (10%) completed the protocol with a median survival of 1189 days. Forty-three percent (23 of 61) of the cats achieved complete response (CR) with a median survival time of 62 days. Cats that required a dose reduction of any drug during induction were more likely to achieve CR. Weight loss and hepatomegaly at diagnosis were negatively associated with response to treatment. Increased lactate dehydrogenase (LDH) serum activity at the time of initial treatment correlated with decreased survival times.Conclusions and Clinical Importance: This multi agent protocol did not provide improved survival over historical data using protocols with fewer agents. Serum LDH activity levels might provide useful prognostic information for cats with lymphoma.

Prospective Clinical Trial to Compare Vincristine and Vinblastine in aCOP‐Based Protocol for Lymphoma in Cats

“…The use of chemotherapy drugs that are less likely to cause substantial GI toxicity, such as vinblastine, may help decrease the risk of chemotherapy‐associated weight loss during treatment, particularly in cats that are responding to treatment. Anemia at baseline was significantly negatively associated with LSS, which has been inconsistently reported previously for cats with lymphoma …”

“…Given the internal location of lymphoma in most cats, it is reasonable for body weight to be a marker of severity of disease. In fact, weight loss before treatment has been reported as a negative prognostic factor for cats with lymphoma . Body weight also may be a marker for response to treatment and tolerance of chemotherapy during treatment, because weight loss early during treatment is associated with shorter survival time in cats with large cell lymphoma .…”

“…If this difference were detected, the study hypothesis that the 2 drugs have equal efficacy would be rejected. Based on prior literature, the probability of gastrointestinal toxicity in the control group (ArmVCR) was estimated to be 0.4, and a 75% reduction in that risk (probability of 0.1 in the experimental group [ArmVBL]) was considered clinically relevant. Therefore, a minimum of 38 cats would be required in each arm to detect a difference in the proportion of cats that changed treatment groups because of gastrointestinal toxicity with power = 0.8 and α of 0.05 …”

“…In addition, vincristine was associated with 47% of the episodes of neutropenia and 56% of the episodes of gastrointestinal toxicity in 23 cats receiving a CHOP‐based protocol . In another study, the dose of vincristine was reduced in 20 of 61 cats receiving a CHOP‐based protocol . Vincristine was the most commonly dose reduced drug, and 19 of these dose reductions were because of gastrointestinal toxicity.…”

Clinical relevance of serial determinations of lactate dehydrogenase activity used to predict recurrence in dogs with lymphoma

“…13 Additionally, elevated serum LDH activities in patients without clinical signs may precede the onset of the clinical stage for occult lymphoma. [13][14][15] Measurement of LDH activity in small animals with lymphoma has gained attention [16][17][18][19] ; however, little information is available on the clinical importance of LDH activity in the canine species regarding prognosis or follow-up monitoring. [13][14][15] Measurement of LDH activity in small animals with lymphoma has gained attention [16][17][18][19] ; however, little information is available on the clinical importance of LDH activity in the canine species regarding prognosis or follow-up monitoring.…”