To Chemo Or Not To Chemo

Had cancer so plagued Shakespearean times like it does ours, perhaps that would have been his question: To Treat or Not to Treat.

That is the question before me.

Hudson is healing well after his recent surgery to remove a Mast Cell tumor although he sneaked his E-Collar off briefly and that set post-op recuperation back a bit. I wanted to take some time to update everyone about his treatment plan and share my decision making process as that may benefit other pet parents.

Recently we pulled a tumor from his right hind leg, the largest of his previous six mast cell tumors but unlike the rest, the pathology and genetic markers reveal a much more aggressive one.

In the words of his surgeon, Dr. Fish, 'We got a clean cut', and yet the decision still remains. Do we do follow on with prophylactic and preventative chemotherapy since all scans seem to be clear of any metastasis?

As pet parents, we make medical decisons on behalf of our companions and often with a lack of scientific certainty. And that the onus is on us to be correct makes it infinitly harder.

Lessons from Murphy's Cancer

Perhaps the most important lesson I learned from Murphy's nasal adenocarcinoma was a critical cancer cellular phenomenon known as Autophagy.

After Murphy's initial IMRT had not only failed to slow the progression of his nasal tumor, a new sarcoma developed on his nasopharynx thereby severely shortening whatever prognosis he had. You could already hear Murphy's 'death rattle' - a frighteningly distinct sound of air trying to pass through an obstructed pathway that gets louder and louder until becoming silent. It haunts me still.

Having few options, I then made the decision to do another round of radiotherapy but this time in massive doses over 3 days rather than the 4 week treatment regimen he had previously received at CSU.

Still, I was unsatisified and I wanted to do more, try more. I pressed my team of thought leaders for research or studies for chemo done on nasal cancer and the only one published was from an Australian clinical trial of 8 dogs, the results of which were mixed.

It's a question I have asked researchers and oncologists on my travels many times before - 'What can we learn that's scientifcally relevant from such a small sample size?'. And it's an industry problem that drives much of the solution based scientific philosophy of The Puppy Up Foundation. Our goal has been to continuously fund larger clinical trials across more sites.

And yet I still had to make a split second decision and having survived 4k miles on the road, that's second nature to me. We were traveling in Texas at the time so I took Murphy to TAMU for a course of chemo. Within days, his WBC count crashed and he spent a few nights in ICU.

Murphy's levels normalized eventually although he never fully recovered and after that, his cancer was merciless spreading through the sinus cavity into his eye socket with an unstoppable resolve to consume its host. That is both a philosphical and evolutionary biological enigma that I often think on.

Why would cancer evolve into such an effective parasite - if you will - only to more rapidly kill the very host - its counterpart - that it lived off and biologically depended on? Where, and into what cancer is evolving is a conversation for another time but here's what I did learn.

It's my belief that the follow-on chemo compromised Murphy's system in such a way that it created the perfect microenvironment for the cancer to spread more virulently and that brings me back to Autophagy.

To quote and paraphrase the textbook Small Animal Clinical Oncology, 'It has been shown that radiation & chemo may promote autophagy in later stages by allowing the cancer cells to survive in severe cellular distress'. As we all know, both chemo and radiation are cytotoxic and this can create a microenvironment for cancer to spread like wildfire.

My bad decision hastened Murphy's demise. No doubt about it.

I have learned so many lessons from my travels and I always try to light my way forward from them. And that's how I arrived at my decision about Hudson.

Eight treatments of Vinblastine were recommended by Kathy Mitchener as a potential therapeutic course but after adding all of the other variables into this complex equation - that Hudson turned twelve this year and that all of his other health indicators are fine, we all agreed the best decision is: Not to Chemo.

'That Hudson is still Hudson is of great comfort and assurance to me although this is the first year I've noticed he's become an Old Puppy.

Still he has to wear his Sonar/E-Collar contraption (pictured above) for a few more weeks and that's why we decided to decorate it for the holidays. You can see how amused Hudsy is just in time for the holidays and on that note....

Happy Christmas from The InFamous Fuzzybutts & Yer Big Dog

Make the Most with Your Companions This Christmas!