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Is CCNU (lomustine) valuable for treatment of cutaneous epitheliotropic lymphoma in dogs? A critically appraised topic.

Abstract CCNU and other treatment protocols are commonly offered to owners for the treatment of dogs diagnosed with cutaneous (epitheliotropic) T-cell lymphoma (CTCL). Chemotherapy protocols provide variable benefits; they have different side-effects, and they typically require monitoring to detect drug toxicity at a non-negligible cost to the owner. At this time, even though CCNU is most often recommended to treat dogs with CTCL, there is no clear consensus on the benefit of this drug. Knowing which chemotherapy protocol yields the highest rate of complete remission and longest survival times would help veterinarians and pet owners select treatment options based on the best evidence available. Our objective was to review the literature to compare the complete remission rates and survival times of CCNU-based protocols to those of other interventions. We critically assessed the data included in articles reporting treatment outcome in at least five dogs with CTCL. Single case reports and case series with less than five patients were not reviewed to avoid anecdotal evidence of lower quality.
PMID
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Authors

Mayor MeshTerms
Keywords

Canine

Chemotherapy

Dog

Epitheliotropic

Lomustine

Lymphosarcoma

Mycosis fungoides

Neoplasia

Journal Title bmc veterinary research
Publication Year Start




PMID- 28222789
OWN - NLM
STAT- MEDLINE
DA  - 20170222
DCOM- 20170306
LR  - 20170306
IS  - 1746-6148 (Electronic)
IS  - 1746-6148 (Linking)
VI  - 13
IP  - 1
DP  - 2017 Feb 21
TI  - Is CCNU (lomustine) valuable for treatment of cutaneous epitheliotropic lymphoma 
      in dogs? A critically appraised topic.
PG  - 61
LID - 10.1186/s12917-017-0978-7 [doi]
AB  - BACKGROUND: CCNU and other treatment protocols are commonly offered to owners for
      the treatment of dogs diagnosed with cutaneous (epitheliotropic) T-cell lymphoma 
      (CTCL). Chemotherapy protocols provide variable benefits; they have different
      side-effects, and they typically require monitoring to detect drug toxicity at a 
      non-negligible cost to the owner. At this time, even though CCNU is most often
      recommended to treat dogs with CTCL, there is no clear consensus on the benefit
      of this drug. Knowing which chemotherapy protocol yields the highest rate of
      complete remission and longest survival times would help veterinarians and pet
      owners select treatment options based on the best evidence available. Our
      objective was to review the literature to compare the complete remission rates
      and survival times of CCNU-based protocols to those of other interventions. We
      critically assessed the data included in articles reporting treatment outcome in 
      at least five dogs with CTCL. Single case reports and case series with less than 
      five patients were not reviewed to avoid anecdotal evidence of lower quality.
      RESULTS: The search for, and review and analysis of, the best evidence available 
      as of February 8, 2017, suggests that CCNU and pegylated liposomal doxorubicin
      appear to yield the highest rate of complete remission in approximately one-third
      of dogs with CTCL. Other treatment protocols did not report usable information on
      remission rates. Without any treatment, the mean/median survival time in dogs
      with CTCL varied between 3 and 5 months. With CCNU protocols, the median survival
      time was 6 months and the one with retinoids (isotretinoin and/or etretinate),
      PEG L-asparaginase or prednisolone monotherapy was 11, 9 and 4 months,
      respectively; all these durations were obtained from small numbers of dogs,
      however. CONCLUSIONS: CCNU leads to a complete remission of signs in
      approximately one-third of dogs with CTCL, but such remissions are of short
      duration. The median survival time after CCNU appears longer than that without
      treatment, but other drugs appear to provide a better long-term prognosis.
      Further studies are required to investigate the effect of CCNU, alone or in
      combination, on remission rates, survival times and impact on quality of life.
FAU - Laprais, Aurore
AU  - Laprais A
AD  - Department of Clinical Sciences, College of Veterinary Medicine, North Carolina
      State University, Raleigh, NC, USA.
FAU - Olivry, Thierry
AU  - Olivry T
AUID- ORCID: http://orcid.org/0000-0003-1399-0034
AD  - Department of Clinical Sciences, College of Veterinary Medicine, North Carolina
      State University, Raleigh, NC, USA. [email protected]
AD  - Comparative Medicine Institute, College of Veterinary Medicine, North Carolina
      State University, Raleigh, NC, USA. [email protected]
LA  - eng
PT  - Journal Article
PT  - Review
DEP - 20170221
PL  - England
TA  - BMC Vet Res
JT  - BMC veterinary research
JID - 101249759
RN  - 0 (Antineoplastic Agents, Alkylating)
RN  - 7BRF0Z81KG (Lomustine)
SB  - IM
MH  - Animals
MH  - Antineoplastic Agents, Alkylating/*therapeutic use
MH  - Dog Diseases/*drug therapy
MH  - Dogs
MH  - Lomustine/*therapeutic use
MH  - Lymphoma, T-Cell, Cutaneous/drug therapy/*veterinary
MH  - Remission Induction
MH  - Treatment Outcome
PMC - PMC5320629
OTO - NOTNLM
OT  - *Canine
OT  - *Chemotherapy
OT  - *Dog
OT  - *Epitheliotropic
OT  - *Lomustine
OT  - *Lymphosarcoma
OT  - *Mycosis fungoides
OT  - *Neoplasia
EDAT- 2017/02/23 06:00
MHDA- 2017/03/07 06:00
CRDT- 2017/02/23 06:00
PHST- 2016/11/12 [received]
PHST- 2017/02/15 [accepted]
AID - 10.1186/s12917-017-0978-7 [doi]
AID - 10.1186/s12917-017-0978-7 [pii]
PST - epublish
SO  - BMC Vet Res. 2017 Feb 21;13(1):61. doi: 10.1186/s12917-017-0978-7.

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