Treatment Options

The treatment options for Histiocytic Sarcoma are limited. Based on our discussions with various dog oncologists it pretty much came down to two paths of chemotherapy treatment. One option was a drug called CCNU  the other a combination of Adriamycin & DTIC. The three different oncologists we spoke with were divided as to which method they use as a first line of treatment, but they all agreed the statistical information currently available does not show one treatment type as more successful over the other.  The study sample sizes also include a very small number of cases which is also unhelpful when determining the success of a treatment method.

Adriamycin & DTIC (Dacarbazine)
The combination of Adriamycin and DTIC was presented as a first protocol of treatment. DTIC (Dacarbazine) is a chemotherapy agent used in the treatment of sarcomas, metastic melanoma and Hodgkin's Disease. It is often given in conjunction with other chemotherapy agents in a multidrug regimen, in this case with Adriamycin. DTIC is an alkylating agent which work to prevent cell division. Cancer cells are rapidly dividing cells and chemotherapy aims to stop the rapid division of cancer cells as well as irradicate them when possible. This treatment type is administered intravenously over a 4-6 hour time frame depending on the ppet and dosage required. Side effects include:

• Nausea
• Diarrhea or vomiting
• Loss of appetite
• Picky about food choices
• Fatigue
• Drop in white blood cell count
• Vulnerable to infections
• Changes in the texture of paw pads
• Changes in the skin on dog's nose
• Hair loss
• Whiskers may fall out
• Change in hair texture
• Possible organ damage if administered to fast or too long
• Possible heart damage

Doxorubicin (Adriamycin)
It is used against a variety of tumor types, but also has some of the broadest range of side effects and can only be used for a limited number of doses before it poses a risk of organ system damage.  Possible side effects include:

• Possible organ damage
• Damage to the heart
• tissue damage if the drug gets outside the vein on injection
• Diarrhea
• Nausea
• Drop in white blood cell count

CCNU Lomustine
Is primarily used for central nervous system cancers and resistant lymphomas. CCNU, as offered for Gracie's treatment, can be given orally in tablet form so the actual "treatment"' time is very short, but it's typically accompanied by regular testing and monitoring with the treating oncologist.

• Nausea
• Vomiting
• Possible significant liver toxicity/damage
• Possible significant impact on bone marrow
• Low white blood cell count (can be marked, cumulative and delayed up to 6 weeks)
• Low platelet count (can be marked, cumulative and delyaed up to 6 weeks)

How we decided on our treatment choice
Since there was no clear evidence to support one drug choice over the other we tried to approach it from a different way and look at other factors like how the treating team felt about Gracie's case and if we had to switch from one drug option to another would it be harder one way over the other.  We looked at the possible side effects and how they might impact switching to the other drug choice if needed. Based on the possible side effects, even though there is no way to know if in fact any of the side effects will happen, we decided the damage to the liver and bone marrow would be a side effect that could delay the start of the changing to the other drug choice if needed, for that reason we decided to go with the other drug combination with NNCU as the back up alternative. We had two teams we were equally comfortable with treating Gracie, but it ultimately came down to the first protocal drug choice, accessability to the treatment location and a team that is willing to try and beat the odds.

It's important to make a decision that you feel comfortable with and it's not easy when there are no clear answers. We appreciate all the candor of the oncologists we saw while getting treatment opinions on Gracie's condition. All presented as relatively good options for us under the circumstances, a good problem to have in the very difficult situation we were in.