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Adverse Events (AE): GI side effects were most common AES, >10% Palladia dogs (during blinded phase). Neutropenia was the most common lab abnormality. From the study the recommended dose for MCT is 3.25 mg/kg EOD. It is recommend to give with or without food (I recommend with food), give in evening, and adjust dose based on biweekly assessments for 1st 6 weeks, then every 4 to 6 weeks. Dose reductions of 0.5 m/kg are recommended with a minimum dose of 2.2 mg/kg EOD. If AE occur, drug holidays for up to 2 weeks. It is important to not be complacent in monitoring. Clients must be educated if any side effects are noted, STOP medication, start just in case medications, and contact
a veterinarian. Early recognition if side effects are critical when using Palladia!!
TKI combination protocols are starting to be evaluated. Palladia given with vinblastine caused myelosuppression, and the dose of vinblastine was reduced significantly. The ORR of 71% is encouraging.
In conclusion chemotherapy should be considered for: High grade/grade 3, dogs with distant metastasis, lymph node metastasis, C-kit positive dogs, dogs with high proliferation scores, and for non resectable MCT in the neo-adjuvant setting. Dogs with multiple MCT in a short time period may also be considered for chemotherapy. Dogs with low grade/grade 1 or grade that have low proliferation scores and are c-kit negative can typically be managed with local therapy (surgery +/- radiation).
An Urban Experience
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