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Factors associated with the development of gastrointestinal adverse events in dogs with multicentric lymphoma treated
E Treggiari1, E Catania1, P Valenti2,3
1Oncology Service, Istituto Specialistico Veterinario, Milan, Italy.
Objectives:
Canine multicentric lymphoma is treated with multidrug protocols that include an anthracycline, namely doxorubicin, epirubicin or mitoxantrone. Both epirubicin and doxorubicin are known to cause gastrointestinal adverse events; however, very few reports have focused on comparing adverse events of the two drugs. The aim of this study was to report the frequency and severity of gastrointestinal adverse events in dogs with lymphoma treated with a multi-agent protocol including either doxorubicin or epirubicin, and to identify clinical and treatment-related factors associated with the development of adverse events.
Materials And Methods:
The medical databases of four institutions were retrospectively searched for dogs with a confirmed diagnosis of lymphoma that had received a multi-agent protocol including either doxorubicin or epirubicin. Dogs with detected gastrointestinal involvement, suspected gastrointestinal lymphoma or that did not undergo abdominal imaging at presentation were excluded. Variables included breed, sex, age, body weight, clinical stage, substage, immunophenotype, use of corticosteroids, chemotherapy dosing strategy and remission status following the first administration of anthracycline.
Results:
A total of 178 dogs were included, 114 dogs (64%) received epirubicin and 64 (36%) received doxorubicin. Dogs treated with doxorubicin had a significantly higher incidence of gastrointestinal adverse events compared with those receiving epirubicin (56.3% vs. 34.2%, OR 2.47, 95% CI 1.33 to 4.67; P = .005). In multivariable analysis, doxorubicin was independently associated with an increased risk of gastrointestinal toxicity (OR 2.70, 95% CI 1.39 to 5.38; P = .004) as were increasing age and female sex. Stage V disease was associated with a reduced risk.
Clinical Significance:
These findings suggests that treatment with doxorubicin, when administered as part of a multi-agent protocol in dogs with lymphoma, is associated with a significantly higher risk of developing gastrointestinal adverse events compared with epirubicin. Prospective studies are warranted to further investigate differences in gastrointestinal toxicity between epirubicin and doxorubicin, and to better define the toxicity profile of each drug.
