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Dr. Karing
Dr. Karing, Veterinarian
Category: Dog Veterinary
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Experience:  General veterinarian with a special interest in internal medicine and emphasis on individualized care.
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I have a 1 1/2 yo female border collie/eskimo who weighs 18

Customer Question

I have a 1 1/2 yo female border collie/eskimo who weighs 18 lbs. She is diagnosed with TCC in her Urethra. She was prescribed a low dose chemo dosage (metronomics) of chlorambucil 1.5 mg
every other day alternating with metacam for 8 weeks.
Can you tell me if this is the proper dosage for metronomics? And what is the normal dosage (not metronomics) of chlorambucil?
I am a Pharmacist
Submitted: 2 years ago.
Category: Dog Veterinary
Customer: replied 2 years ago.
My dog is 11.5 yo
Not 1.5 yo
Customer: replied 2 years ago.
(Posted by JustAnswer at customer's request) Hello. I would like to request the following Expert Service(s) from you: Live Phone Call. Let me know if you need more information, or send me the service offer(s) so we can proceed.
Expert:  Dr. Emily replied 2 years ago.
ok, thank you for the clarification. I was very surprised at the age and was afraid we had a misdiagnosis here. were you seeing an oncologist or a general practitioner?
Customer: replied 2 years ago.
Expert:  Dr. Emily replied 2 years ago.
Did your oncologist discuss Piroxicam at all? This is what we typical use for a non steroidal because is has anti tumor properties as well. It is dosed at 0.3 mg/kg po q24h.
Expert:  Dr. Emily replied 2 years ago.
My choice would be piroxicam and either (or both) mitoxantrone or carboplatin. I can give more specific doses here. Just one moment. I am in and out of appointments this morning.
Customer: replied 2 years ago.
Can u just call me at **********
Expert:  Dr. Emily replied 2 years ago.
I am sorry, I cannot as I am at the office today. I can opt out and let another vet have time to talk with you so that maybe they can call
Customer: replied 2 years ago.
That would be best.
Preferably an oncologist
Expert:  Dr. Emily replied 2 years ago.
Ok, not a problem. I opened it back up but there are no oncologists on the site unfortunately.
Customer: replied 2 years ago.
Expert:  Dr. Karing replied 2 years ago.
Hi there,
I'mCustomerand would be glad to help with your question about your dog. I did find a journal reference for a metronomic dose of chlorambucil used at 4mg/m^2 once daily for TCC. This dose is also listed in the 8th edition of Plumb's Veterinary Drug Handbook.
An 18 lb dog is 0.4 m^2 so the chlorambucil dose works out to 1.6 mg once daily. Using 1.5 mg once daily is reasonable. In order to achieve this dose, the drug would need to be compounded: the manufactured (2 mg) tablets are not meant to be broken.
You may also dose in an alternative manner to avoid compounding. That is, if your dog needs 1.5 mg/day or 6 mg in 4 days, then you could give 2 mg once daily for three days, then take a day off. I would discuss this option with your vet to avoid the costs and possible efficacy issues of compounding.
Some additional information on monitoring and the journal article reference are pasted below:
Plumb's Veterinary Drug Handbook:
CBC, Platelets once weekly (or once stable, every other week) during therapy; once stable, dogs may require only monthly monitoring. If neutrophils are <3,000/microL hold drug until recovered and reduce dose by 25% or increase dosing interval. Other references recommend CBCs at 0, 1, 2, 4, 8, & 12 weeks and then every 3-6 months (Mueller 2000) or in cats, CBCs at 2 to 3 weeks after starting therapy and every 3-6 months thereafter (Ashley 2009). Also monitor liver enzymes; if warranted.
Client Information
Give this drug with food.
Chlorambucil is a chemotherapy (cancer) drug. The drug and its byproducts can be hazardous to other animals and people that come in contact with it. On the day your animal gets the drug and then for a few days afterward, all bodily waste (urine, feces, litter), blood, or vomit should only be handled while wearing disposable gloves. Seal the waste in a plastic bag and then place both the bag and gloves in with the regular trash.
Chlorambucil can be very toxic to the gastrointestinal tract and cause vomiting and gastrointestinal upset.
Contact your veterinarian immediately if you notice abnormal bleeding, bruising, depression, infection, shortness of breath, bloody diarrhea, etc.
Journal Reference:
Metronomic administration of chlorambucil for treatment of dogs with urinary bladder transitional cell carcinoma.
J Am Vet Med Assoc. June 1, 2013;242(11):1534-8.
Diane R Schrempp1; Michael O Childress; Jane C Stewart; Tiffany N Leach; Kean Ming Tan; Andrew H Abbo; Amalia E DeGortari; Patty L Bonney; Deborah W Knapp
1Department of Veterinary Clinical Sciences, Purdue University, West Lafayette, IN 47907, USA.
Companion Notes
Companion Notes are VIN generated expanded abstracts containing greater detail
Article Abstract
Objective-To determine the antitumor effects and toxicoses of metronomic oral administration of a low dose of chlorambucil in dogs with transitional cell carcinoma (TCC).
Design-Prospective clinical trial.
Animals-31 client-owned dogs with TCC for which prior treatments had failed or owners had declined other treatments.
Procedures-Chlorambucil (4 mg/m(2), PO, q 24 h) was administered to dogs. Before and at scheduled times during treatment, evaluations of dogs included physical examination, CBC, serum biochemical analyses, urinalysis, thoracic and abdominal imaging including cystosonography for measurement of TCCs, and grading of toxicoses.
Results-29 of 31 dogs had failed prior TCC treatment. Of the 30 dogs with available data, 1 (3%) had partial remission (≥ 50% reduction in tumor volume), 20 (67%) had stable disease (< 50% change in tumor volume), and 9 (30%) had progressive disease (≥ 50% increase in tumor volume or development of additional tumors); 1 dog was lost to follow-up. The median progression-free interval (time from the start of chlorambucil treatment to the day progressive disease was detected) for the dogs was 119 days (range, 7 to 728 days). The median survival time of dogs from the time of the start of chlorambucil treatment was 221 days (range, 7 to 747 days). Few toxicoses were detected; chlorambucil administration was discontinued because of toxicoses in only 1 dog.
Conclusions and Clinical Relevance-Metronomic administration of chlorambucil was well tolerated, and 70% of dogs had partial remission or stable disease. Metronomic administration of chlorambucil may be a treatment option for dogs with TCC
I hope that the information I provided has been helpful. Please remember to select REPLY TO EXPERT if you have more questions or would like additional information. It is my goal to provide you with the most complete information possible prior to you leaving a feedback rating. If you received all the information you needed, then kindly submit a rating.
Sincerely, Customer
Expert:  Dr. Karing replied 2 years ago.
Hi again Joe,
I see you also asked the typical chlorambucil dose:
From Plumb's:
As an immunosuppressant (extra-label): Dosage recommendations vary. Commonly dosed at 0.1 – 0.2 mg/kg (corresponds approximately to 2 – 6 mg/m2) once daily initially. Dosages are generally rounded to the nearest 2 mg. When remission occurs, attempt to dose every other day; use lowest dosage that will control condition. Often used in conjunction with prednisolone.
For adjunctive therapy of lymphoreticular neoplasms, macroglobulinemia, and polycythemia vera (extra-label): For first level treatment of dogs of canine lymphoma where clients cannot afford, or will not accept combination chemotherapy due to risks of toxicity: Prednisone alone 40 mg/m2 (NOT mg/kg) PO daily for 7 days then every other day or in combination with chlorambucil at 6 – 8 mg/m2 (NOT mg/kg) PO every other day. Perform a CBC every 2-3 weeks. (Ogilvie 2006)
For metronomic treatment of cancer (extra-label): 4 mg/m2 (NOT mg/kg) PO once daily. For dogs weighing >8 kg, the dose is rounded to the nearest 2 mg; dogs weighing ≤8 kg, dose is compounded to 4 mg/m2 (Leach et al. 2012; Schrempp et al. 2013). Note: In the second reference (Schrempp et al. 2013), dogs enrolled in the study had bladder transitional cell carcinoma. 70% of dogs either had a partial remission (1/30) or stable disease (20/30).
I hope this is helpful.
Thank you, Customer

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