CCNU chemotherapy.

Dr. Marie replied:

Aw, sorry to hear that Maggie is dealing with this.

I did some research for you on using CCNU (lomustine) for malignant melanoma of the mouth as it is not something that I have experience with.

I found one report where six dogs with oral malignant melanoma were treated with CCNU. Some of them had tumors that weren't completely removed (likely due to their size and location). The shortest survival time of the six dogs was 4 months. The rest of the dogs lived between 18 and 22 months.

Another study that I found showed that dogs who had surgery to remove oral melanoma and then had chemotherapy (i.e. CCNU) lived an average of 12-14 months.

Here is some information about the side effects of CCNU:

• Many dogs will have low neutrophils (white blood cells) when getting this kind of chemotherapy. This is very serious and puts the dog at risk for infection. However, when it happens it usually happens by the 7th day or treatment and then the dog recovers by the 10th to 14th day. This means that Maggie may feel a little crummy for a few days, but if she avoids infection she should eventually do just fine.


• A less common side effect is something called thrombocytopenia (low platelets). If this happens to the dog then it is often irreversible. When platelets are low this can be life threatening. It means that dogs are unable to clot their blood and are at risk for serious internal or external bleeding. There is more chance of thrombocytopenia if the CCNU is given every 3 weeks as opposed to every 4 weeks.


• CCNU can also affect the liver. You will likely need to have blood tests done a few times to make sure that Maggie's liver is handling things ok.

So, now I don't know if I have helped or if I have made the decision harder. :) Here is how I approach decisions like this:

First, let's look at the cost. Is it financially feasible for you to do chemotherapy and some repeated blood tests? If you feel that the expense is worth it in the hopes that you get an extra year or more of life from Maggie, then this is good.

Next, the biggest concern from most owners that I hear is how bad the side effects of chemotherapy going to be. I have found that most dogs handle chemotherapy extremely well. We all know people who have had a difficult time going through chemo, but most dogs that I know live very happily while they are on chemo.

What I tell my clients is that we can stop at any time. So, if we start Maggie on CCNU and she is not doing well, then we can make the decision to euthanize. I often will have my clients make a list of criteria that will help them in making that decision. So, if Maggie doesn't eat for a few days, or if she no longer wants to (go for a walk, play with her favorite toy, etc.) then we make the decision.

Most clients that I have who have put their pets on chemotherapy have not regretted it.

I pray that she does well, whatever you decide.

Dr. Marie.





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Dr. Marie replied:

I'm thinking that if your vet has suggested CCNU, they may have access to more information than I do about its use with melanoma. The cases I mentioned above are ones that I am aware of. But I am not an oncologist (cancer specialist) and I am guessing that there are a good number of other studies out there.

It's really a tough call because chemo can be a gamble. There are some cases where pets get side effects that are not good. But, we wouldn't be using chemo if that was always the case. Rather, we suggest chemo when the stats tell us that there is a good chance that the chemotherapy will give the dog a longer, good quality life than without it.

The best option for treating melanoma (once surgery is done), is indeed the melanoma vaccine. Next, what is recommended is chemotherapy with either CCNU or a drug called carboplatin. Carboplatin would have its own set of possible side effects. Most likely, if your vet has suggested CCNU then this means that they are more comfortable with using this drug and feel that it is going to be the most helpful.

Another possible route is radiation therapy. There are only so many places where this is available, and it can be expensive.

It is also an option to do nothing, but then you are more likely to lose the battle faster than with chemotherapy.

It's really a hard decision.