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Dogs and cats
May Be Prescribed by Veterinarians for:
Lymphosarcoma, mast-cell tumors, cutaneous T-cell lymphoma, mycosis fungoides, histiocytic sarcoma, brain tumors.
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Lomustine is a chemotherapeutic alkylating agent. It also commonly is referred to as CCNU. Alkylating agents disrupt DNA transcription and RNA replication. They are not cell-stage specific. Lomustine is metabolized in the liver and excreted in the kidneys. It is highly lipid-soluble and crosses the blood-brain barrier into the CNS. Lomustine is absorbed rapidly from the GI tract. In order to decrease nausea, lomustine should be given on an empty stomach. There is some topical absorption of lomustine.
Lomustine is used commonly and considered efficacious in rescue protocols for relapsed canine lymphoma. Numbers regarding remission vary but complete or partial remission may be achieved in as many as 25% - 50% of dogs with drug-resistant lymphoma. Results with the use of lomustine as a first-line treatment for canine lymphoma are less promising, although it may be used as a first-line treatment when finances and or owner compliance limit the treatment options. Lomustine also is used in relapsing lymphosarcoma in cats.
Lomustine is used as a first-line drug to treat cutaneous lymphoma of dogs with a response rate of 80 - 90% and 26% achieving complete remission. The duration of treatment to response is reported to be about three to four months.
Lomustine is helpful for chemotherapy of mast cell tumors in both dogs and cats. Complete surgical removal is the most-effective treatment for canine mast cell tumors; multiple authors emphasize the importance of clean margins. In tumors that are not completely resectable due to location or size, radiation and chemotherapy have both proved useful. Chemotherapy usually is used in tumors that are grade II or above. Lomustine is safe to use with prednisone and has provided complete or partial remission in a number of cases. One study gave the overall response rate in cats with mast cell tumors as 50%. Lomustine was found not to be beneficial in dogs with advanced mast cell tumors that had bone marrow involvement.
The most-common primary intracranial tumor of dogs is astrocytoma (glial cell tumor). Because active metabolites of lomustine are found in the CSF it has been used in the palliative treatment of intracranial tumors. There also is a favorable report of the use of lomustine within a multiple-drug protocol to treat optic neuritis secondary to granulomatous
Side effects include bone-marrow suppression, including anemia, thrombocytopenia, and leucopenia. Approximately 40% of treated dogs will have neutrophil counts of <1,000 cells/uL at seven days after treatment. GI effects can include vomiting, anorexia, and diarrhea. Hepatotoxicosis, alopecia, corneal de-epithelization, and renal and pulmonary damage also may be experienced.
Lomustine has a narrow effective-dose range prior to toxicity. Overdose should be treated aggressively with gut-emptying protocols.
Dr. Barbara Forney is a veterinary practitioner in Chester County, Pennsylvania. She has a master's degree in animal science from the University of Delaware and graduated from the University of Pennsylvania School of Veterinary Medicine in 1982.
She began to develop her interest in client education and medical writing in 1997. Recent publications include portions of The Pill Book Guide to Medication for Your Dog and Cat, and most recently Understanding Equine Medications published by the Bloodhorse.
Dr. Forney is an FEI veterinarian and an active member of the AAEP, AVMA, and AMWA.
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