Lomustine, methotrexate and cytarabine chemotherapy as a rescue treatment for feline lymphoma

Abstract

Objectives The aim of this study was to assess the efficacy and tolerability of lomustine, methotrexate and cytarabine chemotherapy as rescue treatment for feline lymphoma. Methods The medical records of 13 cats treated with lomustine, methotrexate and cytarabine for relapsed high-grade feline lymphoma, at a single institution between 2013 and 2018, were examined. All anatomical types were included. Data were analysed using descriptive statistics. Results Nine cats received all three drugs and four cats received only two drugs owing to progressive disease. In cats that received (or in which there was intention to treat with) all three drugs, 6/13 (46%) demonstrated a complete or partial response to chemotherapy. Treatment was generally well tolerated, although two cats experienced Veterinary Comparative Oncology Group (VCOG) grade 3 neutropenia and one cat experienced VCOG grade 3 thrombocytopenia. The median progression-free survival was 61 days (range 16–721 days). Conclusions and relevance CHOP-(cyclophosphamide, doxorubicin, vincristine, prednisolone) and COP-based protocols are established first-line chemotherapy for feline lymphoma, but standard rescue protocols are lacking. Lomustine has become a popular single-agent option, but prolonged or cumulative myelosuppression can result in treatment delays, risking relapse. Therefore, a multidrug lomustine-based protocol may be advantageous, and, from first principles, should also better overcome resistance. This study suggests that lomustine, methotrexate and cytarabine may represent an efficacious and well-tolerated protocol for feline lymphoma rescue.

Renal histiocytic sarcoma in a cat undergoing nephrectomy and adjuvant chemotherapy

“…In the present case, nephrectomy was performed and adjuvant chemotherapy with CCNU started at the standard dose of 50 mg/m 2 , as previously reported 32 . The time interval between lomustine administrations in cats is reported to range between 3 and 6 weeks, depending on the study 10,33–36 . Albeit in a phase I trial the authors suggested to use lomustine in cats every 6 weeks due to a late onset of neutropenia (up to 28 days), a subsequent study showed that the drug could be safely administered every 21 days, considering high‐grade haematological AEs were infrequently reported 32,37 …”

“…32 The time interval between lomustine administrations in cats is reported to range between 3 and 6 weeks, depending on the study. 10,[33][34][35][36] Albeit in a phase I trial the authors suggested to use lomustine in cats every 6 weeks due to a late onset of neutropenia (up to 28 days), a subsequent study showed that the drug could be safely administered every 21 days, considering high-grade haematological AEs were infrequently reported. 32,37 In our case, treatment was well tolerated even though it was administered every 3 weeks, with no development of haematological AEs.…”

Successful rescue treatment using chlorambucil for presumed recurrence of sinonasal lymphoma in a cat

“…Although the use of several chemotherapeutic agents such as lomustine, mechlorethamine, methotrexate, cytarabine, actinomycin D and melphalan has been reported for relapsed feline lymphoma in various sites (including the nasal cavity), response rates were typically poor with median progression-free survival ranging from 14 to 61 days. [13][14][15][16] Chlorambucil is most commonly used to treat low-grade gastrointestinal lymphoma in cats and is well tolerated. [17][18][19][20] Adverse effects associated with chlorambucil are generally mild relative to those of the aforementioned rescue protocols.…”

“…Although the use of several chemotherapeutic agents such as lomustine, mechlorethamine, methotrexate, cytarabine, actinomycin D and melphalan has been reported for relapsed feline lymphoma in various sites (including the nasal cavity), response rates were typically poor with median progression-free survival ranging from 14 to 61 days. 13–16…”

Investigation of the Oncolytic Properties of Newcastle Disease Virus on Feline Lymphoma Cells

“…Lymphoma is one of the most common types of cancer in cats, and chemotherapy is often the treatment of choice for this disease [1][2][3][4][5][6]. The expected survival rate in animals treated with multidrug chemotherapy protocols is 6-9 months, and the remission rate is approximately 65-75% [7].…”