Which chemotherapy protocol is most effective for alimentary versus mediastinal lymphoma in cats?

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Accepted Answer

For mediastinal lymphoma, COP (cyclophosphamide, vincristine, prednisolone) is the best-supported first-line protocol, with an overall response rate of 94.7–96.74% and median survival times of 338–484 days. For alimentary intermediate- to large-cell lymphoma, CHOP (cyclophosphamide, doxorubicin, vincristine, prednisolone) and its mitoxantrone-substituted equivalent CMOP (cyclophosphamide, mitoxantrone, vincristine, prednisolone) are the standard of care, with response rates of 66% and median survival times of 80–103 days — substantially shorter than mediastinal disease.141113 Mediastinal lymphoma responds exceptionally well to COP. Complete response rates reach 61.5–81.52% and partial response rates 15.22–34.0%, with an overall response rate of 94.7–96.74%.1113 Median survival with COP is 484 days in FeLV-negative UK cats and 338 days in FeLV-positive cats.1113 The Madison-Wisconsin (CHOP-based) protocol produces a statistically equivalent median survival of 211 days for mediastinal disease, with no significant difference in response rate (67% vs. 62% for COP).11 Cats achieving complete remission survive substantially longer than those with partial remission: 980 days versus 42 days.11 Young age (under 4 years) is a positive prognostic factor in FeLV-positive mediastinal cases.13 Alimentary intermediate- to large-cell lymphoma carries a worse prognosis regardless of protocol. CHOP and CMOP produce identical response rates of 66%, with median progression-free intervals of 59 days (CHOP) and 69 days (CMOP) and median survival times of 80 days (CHOP) and 103 days (CMOP) — differences that are not statistically significant.4 CMOP is a suitable substitute for CHOP: it can be administered as an intravenous bolus and carries less risk of catastrophic extravasation injury compared with doxorubicin.4 For cats achieving complete remission on CMOP, median survival extends to 1,176 days.2 The VAPC protocol (prednisolone, L-asparaginase, doxorubicin, vinblastine, higher-dose cyc