Apoquel for Dogs and Cancer │ Dr. Nancy Reese #111

>> Dr. Nancy Reese: [00:00:00] On paper Apoquel looks great because you think it only affects the itch cycle and the animal stops itching. And everybody's happy. Unfortunately, those enzymes that it hits are not only used for itch cycle. There's other cell processes that are also potentially affected. So that's where we start worrying. "Well now what are we doing to the immune system? Is it having problems?" 

>> Announcer: [00:00:27] Welcome to Dog Cancer Answers, where we help you help your dog with cancer. Here's your host, James Jacobson. 

>> James Jacobson: [00:00:36] Hello friend. And thank you for joining us today. Today's show is inspired by a Listener Line question about Apoquel. Apoquel has been out for about 10 years now and it is really great at keeping allergic dogs from itching, but some folks think that it may actually cause cancer. Could that be true? Joining us once again for a Question and Answer Episode is Dr. Nancy Reese. Dr. Nancy is a practicing veterinarian with over 30 years of experience and she's got a PhD in epidemiology, Dr.
Nancy. Thanks. So much for being with us today. 

>> Dr. Nancy Reese: [00:01:19] Well, it's a nice day to be here. 

>> James Jacobson: [00:01:21] We are going to take a call from Kelly who has a question about Apoquel and its side effects. Let's listen and get your answers on the other side. 

>> LL Caller - Kelly: [00:01:30] Hi, this is Kelly from Houston, Texas. I have a question about allergy medication and cancer.

So I have three dogs. One of them has lymphoma currently being treated in the CHOP chemo protocol, and she's doing really well. Um, but one of my other dogs is experiencing, seeing some severe skin allergy. We're having trouble diagnosing what's causing them whether it's food or environmental. But my vet has given her a medication called Apoquel, which is the only thing that seems to work for her.

She immediately has stopped itching, feels much better, et cetera. However, I've been reading a lot about the drug and there seems to be some concern that it could cause cancer and being that I have a dog with cancer now, I really want to avoid any of my other beloved animals to get it as well. So I was curious what your opinion was on this drug or any allergy medication drugs, or what do you recommend for maybe helping dogs with skin allergies?

Thank you very much.

>> James Jacobson: [00:02:38] Dr. Nancy, what do you think about Apoquel and allergy medicines in general and their risks to cancer? 

>> Dr. Nancy Reese: [00:02:44] So Apoquel has been somewhat of a revolutionary, I hate to use that word, so somewhat of a  surprising drug to come out because its popularity went skyrocketing. When it first came out, it was so hard to get a hold of because allergies are an extremely frustrating condition to live with.

Owners are miserable. Dogs are miserable. The veterinarians are miserable because this animal keeps coming in for the same thing. So we all look for that magic thing that makes the allergies go away. So when Apoquel came out, and it really seems to work very well for stopping the itch so it's definitely been a blessing for lack of a better word for these really itchy animals in terms of not having to put them on something like prednisone or steroids, which have significant side effects over the long-term.

Apoquel works fairly specifically by targeting a particular set of enzymes that are involved in the itch cycle. So it's not as widespread of a medication as something like prednisone that really hits a lot of different targets. So on paper, Apoquel looks great because you think it only affects the itch cycle and the animals stop itching.

And everybody's happy. Unfortunately, those enzymes that it hits are not only used for. Itch cycle. There's other cell processes that are also potentially affected. So that's where we start worrying. "Well, now what are we doing to the immune system? Is it having problems?" In the very initial studies, they were at very high doses.

So there may be some more side effects when they're used at particularly high doses, but in young dogs, they develop demodex which is a type of mange. So those dogs got demodex more frequently. And again, they recommended it not be used in dogs under 12 months of age because those dogs are more susceptible to that particular mite anyhow. Then there's also the concern that, more so with dogs that already have established cancer, that because this drug is affecting something that's affecting the immune system, we really don't want to use anything that might damp down the immune system. If we're trying to fight cancer at the same time.

So there hasn't yet been really good studies that show Apoquel causing cancer, but certainly in dogs with cancer, I would be much more hesitant to use it. And I think as we mentioned in another question, having an animal itch all the time and itch and scratch, it's not too healthy either because their system is going to be prone to getting secondary skin infections, which might result in needing antibiotics and other drugs.

So there's always that balance of stopping the itch, but not causing problems with the immune system. Certainly we think that cancer seems to be on the rise. I mean, more and more animals are coming down with cancer and we seem to see cancer at an alarming rate, but this was happening well before Apoquel hit the market.

So when people suddenly think that Apoquel is a big cause, we know that it's been going a long time and any animal that suddenly develops cancer, we do try to say, well, what could have been the cause having an association of being on Apoquel versus something else causing it is really hard to prove. So again, if an animal doesn't need it, I wouldn't give it, or they may not need to be on it year round, or they might just have a seasonal allergy where you could give it for two months and then keep them off the rest of the year.

Some animals are so darn itchy that again, weighing that risk of quality of life, not itching, versus possible later side effects has to be carefully considered. A couple of alternatives. There is a Cytopoint injection, which is a monoclonal antibody injection. Again, it's early in the process. So it may end up having its own set of potential side effects.

>> James Jacobson: [00:06:41] So Cytopoint is relatively new, right. What do you think  about it?

>> Dr. Nancy Reese: [00:06:45] That is an injection so that it makes it easier for people that don't want to shove a pill down or have to do something regularly. So I think that's one of its main benefits is that convenience wise, you go in once every four to eight weeks, depending on how long it lasts for your animals for the injection.

Again, it targets one very specific chemical that's involved in itching. So for some animals, that's an alternative to Apoquel and maybe it's a little less prone to effect the rest of the immune system, but that's a newer product. So I think the jury is still going to be out about the long-term effects of that.

But for some animals it will last four to eight weeks. But, again, anytime we inject something into the body, we started have to wonder, you know, what potential things we're having to cause later. So far, the reports seemed good, but I always, you know, say that with new products, we don't know what will happen later.

Other things in general to help allergies. I think having a cleaner diet, something like home cooked diet, like even The Dog Cancer Survival Guide. Any diet that isn't as highly processed, might reduce allergy symptoms a little bit. Dry dog foods have potentially a grain mite that cross reacts with house dust mites, which a lot of dogs are allergic to.

So switching a dog's diet can actually reduce their exposure to some allergens and things. Bathing out allergic animals frequently can help to reduce the pollens and things that they're allergic to and from their coat that they're either being exposed to in their skin or breathing in when they're grooming and licking themselves.

Cool water for bathing provides a little bit of more anti-itch properties than warm water. It's hard to do in the winter, but it does help to decrease the itch by doing cool water. And then there's a lot of dogs that lick their feet from their allergies a lot and they'll get yeast infections in their feet.

And then that gets itchy. So for some of those dogs, I'll do things like little vinegar soaks for their feet, because it doesn't matter if they lick it off. And vinegar is a very good anti yeast type of agent. So. There are a lot of things you can do that take a lot of work, but that you can do to try to decrease the exposure to pollens in general, or oak trees or whatever it is they're allergic to.

And a good clean diet, I think does help reduce that. 

>> James Jacobson: [00:09:08] I like the tips just about things as simple as vinegar, Dr. Nancy, thank you so much for being with us today. 

>> Dr. Nancy Reese: [00:09:15] Thank you. 

>> James Jacobson: [00:09:18] Well, that is it for today's show friend. And speaking of friends, if you're looking for, I mean, for a like-minded community of dog lovers figuring out how to help their dogs with cancer, I think you should join Dog Cancer Support, which is our private Facebook group.

A link is in the show notes for this episode. And of course joining is free, because it is a Facebook group. I'd like to thank Dr. Nancy for being here. And thanks to Kelly from Houston for your Listener Line question. Now, if you have a question that you would like one of our veterinarians to answer, we'd love to hear it.
I'll tell you how to do that. Right after this short break.

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