title: Combination of CCNU and DTIC chemotherapy for treatment of resistant lymphoma in dogs.
abstract: BACKGROUND
  Pleotropic-glycoprotein (P-gp)-mediated resistance is the usual cause of relapse in dogs with lymphoma. 1-(2-chloroethyl)3-cyclohexyl-1-nitrosurea (CCNU) and 5-(3,3-dimethyl-1-triazeno)-imidazole-4-carboxamide (DTIC) are alkylating agents that are not affected by P-gp and lack cross-resistance to each other. A combination protocol offers the advantage of improved summation dose and synergistic activity.
  
  
  OBJECTIVE
  A combination of CCNU and DTIC that is well tolerated can be used to treat dogs with lymphoma that developed resistance or failed to respond to previously administered chemotherapy.
  
  
  METHODS
  Fifty-seven dogs with lymphoma that were resistant to treatment with standard chemotherapy (L-CHOP; L-asparaginase, cyclophosphamide, doxorubicin, vincristine, prednisone).
  
  
  METHODS
  Prospective phase I and II trials were performed. CCNU was given PO immediately before a 5-h IV infusion of DTIC. Concurrent antiemetics and prophylactic antibiotics were used. Treatments were administered every 4 weeks.
  
  
  RESULTS
  Based on the results of 8 dogs in the phase I study, CCNU at 40 mg/m(2) PO combined with DTIC at 600 mg/m(2) IV was used to treat 57 dogs with resistant lymphoma. Thirteen (23%) dogs had a complete response (CR) for a median of 83 days and 7 (12%) had a partial response for a median of 25 days. The median L-CHOP CR duration of the dogs that did not respond to CCNU-DTIC was significantly longer than that of the dogs that did achieve remission with CCNU-DTIC (225 days versus 92 days, P= .02). The principal toxic event was neutropenia; the median neutrophil count 7 days after treatment was 1,275 cells/microL. Increases in alanine transaminase activity, possibly associated with hepatotoxicity, were detected in 7 dogs.
  
  
  CONCLUSIONS
  A combination of CCNU and DTIC can be an effective option to rescue dogs with resistant lymphoma.
authors.affiliation: Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853, USA.
authors.forename: A B
authors.initials: AB
authors.lastname: Flory
authors.forename: K M
authors.initials: KM
authors.lastname: Rassnick
authors.forename: R
authors.initials: R
authors.lastname: Al-Sarraf
authors.forename: D B
authors.initials: DB
authors.lastname: Bailey
authors.forename: C E
authors.initials: CE
authors.lastname: Balkman
authors.forename: M A
authors.initials: MA
authors.lastname: Kiselow
authors.forename: K
authors.initials: K
authors.lastname: Autio
mesh_terms: D000818:Animals; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D003606:Dacarbazine / Q000009:adverse effects / Q000627:therapeutic use*; D004283:Dog Diseases / Q000188:drug therapy*; D004285:Dogs; D004305:Dose-Response Relationship, Drug; D019008:Drug Resistance, Neoplasm / Q000187:drug effects*; D005260:Female; D008130:Lomustine / Q000009:adverse effects / Q000627:therapeutic use*; D008223:Lymphoma / Q000188:drug therapy / Q000662:veterinary*; D008297:Male
chemical_list: D000970:Antineoplastic Agents; D008130:Lomustine; D003606:Dacarbazine