The Madison Wisconsin Protocol (also known as “The Madison Protocol,” “The Wisconsin Protocol,” “The University of Wisconsin Madison Protocol,” “The Madison Wisconsin Chemotherapy Protocol,” “UW-25,” or “CHOP”) is a combination therapy, combining 3 chemotherapy drugs traditionally used for Canine Lymphoma care, plus Prednisone for a portion of the treatment cycle. It is considered the “gold standard” of current conventional Canine lymphoma Care, and is by far the most commonly recommended conventional treatment for Canine Lymphoma care. In fact, regardless of the type or stage of Lymphoma, this is the treatment that Dr. Freeman generally recommends for almost all of her high grade (lymphoblastic/acute) Canine Lymphoma patients to the extent they can afford it.
What you need to know about the Madison Wisconsin Protocol
Madison Wisconsin Protocol – Treatment Details
The Madison Wisconsin Protocol is a 25 week protocol that combines 3 of the most popular chemotherapy drugs traditionally used for Canine Lymphoma care: Vincristine, Doxorubicin, and Cytoxan (or cyclophosphamide). In addition, during the first 4 weeks of the Wisconsin Protocol, the patient is also given Prednisone as part of his care. Under this protocol, chemotherapy treatments are given weekly for the first 2 months, and then every other week for the remaining 4 months of treatment. At the end of 6 months, if the patient is in remission, you take them off therapy and monitor them for relapse (with the hope that this relapse won’t occur for another 6 to 8 months following completion of the treatment).
Once the patient falls out of remission, a new cycle of treatment (using either the Madison Wisconsin Protocol or some other treatment protocol) can begin again. Because of the potency and danger of the chemotherapy medicines themselves – and the manner in which certain of the chemotherapy medicines must be given (i.e., intravenously) – most chemotherapy treatments (including most of the treatments used for the Madison Wisconsin Protocol) must be given in the Oncologists clinic. However, some of the chemotherapy treatments can be done at home, and in some cases vets like Dr. Freeman encourage home care for the portions of the treatments that can safely be delivered in the patient’s own home.
Madison Wisconsin Protocol – Treatment Advantages:
- From an outcome/success standpoint, the Madison Wisconsin Protocol provides the best results of any conventional Canine Lymphoma treatment in the vast majority of cases;
- The nice thing about the Wisconsin Protocol is that it’s a 6 month (25 week) treatment plan, compared to other protocols that require ongoing chemotherapy treatments throughout the course of the treatment;
- Under the Wisconsin Protocol, the risk of side effects from the chemotherapy is relatively small – and in the vast majority of cases, dogs will suffer only very minor side effects as a result of this care;
- As many as 80% to 90% of all dogs receiving this treatment will go into remission (depending on the type and stage of the Lymphoma diagnosis), and dogs that do will go into remission very early during the treatment process, and will generally stay in remission for many months following the end of these treatments.
Madison Wisconsin Protocol – Treatment Disadvantages:
- Because it combines 3 different chemotherapy treatments, the Madison Wisconsin Protocol can be one of the more expensive treatments for Canine Lymphoma care. In some cases this expense may prevent the caregiver from undertaking this treatment option;
- Unfortunately, even though the Madison Wisconsin Protocol is the best conventional chemotherapy treatment option for virtually all types of Canine Lymphoma today, there are certain Canine Lymphoma types that the Madison Wisconsin Protocol does not have great success in treating. In particular, for dogs diagnosed with T-Cell Lymphoma, Stage V Lymphoma, or any “substage b” designation (i.e., showing significant symptoms of the disease), the Madison Wisconsin Protocol may not work well enough to justify the expense of this treatment.
- As with all chemotherapy treatments, some side effects, small and large, may come along with this treatment. Although the risk of these side effects tends to be small (and manageable), they do still occur in a small portion of the cases. For more information, see Canine Lymphoma Chemotherapy Side Effects.
- Because the types of chemotherapy used for this protocol require intravenous treatment, caregivers will have to travel with their dogs to the vet’s office for treatment for many weeks during the course of this treatment. Also, because of the dangerous toxic potential of the chemotherapy drugs used, this protocol is generally given only in a Veterinary Oncology specialists office, so depending on the area where you live, the drive to this office may be significant;
Madison Wisconsin Protocol – Treatment Cost:
For the Madison Wisconsin Protocol, for the average dog, over the course of the full 6 months of treatment, the cost at Dr. Freeman’s office is approximately $5,000 to $7,000 depending on size of the dog being treated. That estimate includes the cost of all of the drugs, blood tests, visits, exams, etc.
During the period after the 6 month Madison Wisconsin Protocol treatments (during the remission period), expenses will be minimal, just to cover follow up check ups. Dr. Freeman generally has her patients come in about once per month for follow up check ups, for as long as the dog remains healthy and symptom free. But then once caregivers start seeing signs that their pet is falling out of remission, the quicker you can notice this and get started on follow up treatments the better. For this reason, vets generally teach caregivers how to feel for lymph nodes and know what they’re looking for, and encourage them to bring their dog to their vet as soon as they suspect the Lymphoma has returned.
Prognosis from Treatment Using the Madison Wisconsin Protocol
The effectiveness of the Wisconsin Protocol will vary (of course) with the type of Lymphoma the patient has, the grade of the cancer, etc. – but for most average Canine Lymphoma cases (e.g., a healthy “Substage a” patient with Grade 3 or 4, B-cell Lymphoma) the expectation is that the first round of Madison Wisconsin Protocol will help the patient get and stay in remission for about 12 to 14 months (6 months during the course of the treatment, plus another 6 to 8 months after the treatment has ended).
(Note: The reason vets talk about the length of the remission period as lasting for both the time of the treatments itself plus the time that follows the end of treatment, is because patients often go into remission within a few weeks of the start of therapy. You have to continue the full 6 months of therapy to ensure that the remission lasts as long as possible, but the disease should become unnoticeable pretty quickly once the treatments have begun.)
And then once the patient has fallen out of remission, vets will generally recommend a second round of treatment, which will allow most dogs to enter a second remission, only this time for a shorter period of time. Third remissions are possible with additional treatments as well, but these third remissions are for a small percentage of dogs and for a shorter period of time than the first or second remission.
For example, say there’s a patient that had 12 to 18 months of remission as a result of the Madison Wisconsin Protocol or other conventional Canine Lymphoma care (6 months during the Madison Wisconsin Protocol treatment, followed by 6 to 12 additional months of remission after the end of those treatments), they probably have about a 70% chance of going into remission a second time, and the length of that second remission will generally last for about one-half to two-thirds of the duration of their first remission.
For dogs who were treated using the Madison Wisconsin Protocol the first time, the recommended treatment is to repeat the same Madison Wisconsin Protocol a second time, with of course the same cost and time issues faced during the original Madison Wisconsin Protocol treatment. For that reason, cost and timing issues sometimes affect the caretaker’s decision regarding whether to go through this treatment protocol for a second remission again. However, if the first remission lasted only 3 to 4 months, then the chance of the patient going into a second remission is much smaller.
This makes sense, since the Madison Wisconsin Protocol itself is a 6 month treatment plan, and if the patient falls out of remission prior to the end of the treatment protocol, the only options remaining will be alternative rescue protocols that have a smaller chance of remission, and for a lesser period of time. In most cases, these are dogs who have T-Cell Lymphoma and who probably weren’t going to respond well to the Madison Wisconsin Protocol treatment anyway.
Under the Madison Wisconsin Protocol, about 50% of dogs who receive this treatment will survive to 12 months from the start of therapy. And of those dogs who survive to 1 year, 20% of those patients make it out to 2 years, and of all the dogs who survive for 2 years, 5% make it longer than that. In other words, for 1,000 dogs who are treated for Canine Lymphoma using the Wisconsin Protocol, about 500 will survive for at least 1 year, 100 will survive at least 2 years, and about 5 will survive for significantly longer than 2 years.
Note: While this may not feel like a tremendous amount of time to extend a dog’s life, consider that the average life expectancy for most dogs only extends into their early teen years and that many dogs are diagnosed with Canine Lymphoma in their middle or later years (age 7 to 10+). Thus this extra time, especially for the more successful patients, can actually help them recover a good portion, if not all, of their natural life expectancy. Again, that’s why most cancer treatment programs don’t fight for more aggressive treatment protocols that seek to “cure” the cancer and extend life expectancy even further, but at more risk of significant side effects and other health risks to the patient.
Madison Wisconsin Protocol – Additional Notes:
In general, most vets recommend using the Madison Wisconsin Protocol for any type of high grade Canine Lymphoma as long as money, time, location, etc. allow, because statistically, in most every case this protocol will have the most successful outcome. Of course the expected outcome of using the Madison Wisconsin Protocol will vary from case to case, depending on the type and stage of the cancer, etc., but in virtually any Canine Lymphoma case, using the Madison Wisconsin Protocol will provide a better chance of success, for a longer period of time, compared to any other conventional Canine Lymphoma treatment protocol. The limitations that argue against using the Madison Wisconsin Protocol come down to:
- the cost of the treatment (which can cost as much as $5,000 to $7,000);
- whether or not the patient can travel to the veterinary oncologist’s clinic once a week for several months to receive the treatments; and
- factors related to the type and stage of cancer which may argue against undertaking the effort and expense of the treatment. For example, while the Madison Wisconsin Protocol generally provides the best possible results of the available conventional treatment options, for certain types and stages of cancer (for example Stage 5 Canine Lymphoma, T-Cell Lymphoma, and “Substage b” cases where symptoms are strongly visible) the results still may not be very effective, and therefore it may not be worth the expense and effort for just a few short months of relief.