National Pet Cancer Awareness Month: Pet Cancer Treatment Options, Part II

November 12, 2014

dog receiving chemotherapyNovember has been designated National Pet Cancer Awareness Month to raise awareness about the causes, prevention and treatment of dogs and cats with this terrible disease. To raise awareness of the possible treatments for pet cancer, this second part of my two-part blog on cancer treatments for pets discusses three additional treatment therapies: chemotherapy, immunotherapy and targeted therapy. Part I focused on surgery and radiation therapy.

Chemotherapy
Although the use of radiation therapy in humans preceded the use of chemotherapy, chemotherapy was more widely used in pet cancers before radiation therapy. Chemotherapy is administered when a biopsy indicates a tumor has spread or might spread, such as in feline breast cancer.

Chemotherapy can also be administered when a tumor is too widespread for either surgical removal or radiation therapy. At the top of the veterinary list of pet cancers treated with chemotherapy is lymphoma.

Veterinary oncologists treat both dogs and cats for lymphoma using a variety of chemotherapy drugs. Most commonly used is the CHOP protocol. CHOP is an acronym representing the first letter of each chemotherapy drug in the protocol and is repurposed from human oncology. Despite the bad reputation chemotherapy has, both cat and dog owners report a good quality of life in their pets receiving chemotherapy.

Immunotherapy
The concept of harnessing the cancer patient’s own immune system to fight cancer is an idea that has been around a long while. The idea came to fruition when a vaccine to treat melanoma in dogs was approved in 2010.

Dogs suffering from melanoma are given four vaccinations over two months and then boostered every six months. This treatment protocol prolonged survival by 300 days or more in dogs receiving the vaccine. In people with lymphoma, treatment using monoclonal antibodies like Rituxan® has dramatically improved patients’ survival time. In a similar vein, AMC oncologists are currently studying a monoclonal antibody against T cell lymphoma and a monoclonal antibody against B cell lymphoma is also available.

On the horizon for the treatment of lymphoma is a new cancer vaccine for a particular type of lymphoma in dogs called large B cell lymphoma.

Targeted Therapy
In 2009, toceranib phosphate, known as Palladia®, became the first targeted therapy approved for use in dogs diagnosed with mast cell tumors.

A second targeted therapy, mastitinib, known as Kinavet®, has conditional approval for the treatment of the same tumor. Targeted therapies exploit a physiologic abnormality in tumor cells, not present in normal cells. Targeted therapies commonly work by turning on or off a cellular process critical to cancer growth and metastasis, halting tumor growth. In the future, expect to see more targeted drugs used in dogs and cats.

Because cancer is diagnosed in over six million pets each year, you may be faced with this diagnosis in your favorite furry friend. But treatment of cancer in pets is possible. You and your pet have more treatment options and more specially trained veterinarians than ever before to help you achieve a good outcome if your pet is diagnosed with cancer. To find a board certified veterinary cancer specialist in your area, visit the American College of Veterinary Internal Medicine website and use their search function.


The [Veterinary] World is Flat

February 26, 2014

digital x-raysThe title of this blog takes its name from author and New York Times columnist, Thomas Friedman’s bestselling book, The World is Flat: A Brief History of the Twenty-First Century. The book’s thesis explains globalization in the 21st century as a result of wide accessibility to personal computers and fiber optic cables which make communication via email and information gathering via the internet nearly instantaneous. This form of globalization renders geographic divisions between countries irrelevant.

Friedman describes “ten flatteners” including: the collapse of the Berlin Wall, Netscape and workflow software. My own observations of the world of veterinary medicine indicate that it is not much different than the global economy Friedman describes in his book. Paying tribute to the Pulitzer Prize winner Friedman, here are my veterinary flatteners.

A New Workflow
Digital radiography has changed the workflow of daily veterinary practice. In the pre-computer days, each x-ray was a piece of film, not easily copied and very easily misplaced. Now The AMC and many other veterinary hospitals have switched to using digital radiography, using a machine that looks like a regular x-ray machine but which takes digital images similar to those taken with your smart phone. These x-rays can’t be lost because the images are stored in a picture archiving and communication system (PACS). The image files are very large, but can be transported by burning them onto a CD or transferring them through any number of file sharing systems.

Electronic Medical Records
As it has revolutionized the global economy, the personal computer is revolutionizing veterinary practice. Electronic medical records systems (EMRS) allow rapid dissemination of medical information between specialists and primary care veterinarians. I can write a letter to a patient’s primary care veterinarian after I have completed my consultation with their patient. Through the magic of the EMRS, I can have the letter in that veterinarian’s inbox for his/her review before the pet has returned home.

Board Certification
Twenty-five years ago when I started the process of becoming a board certified veterinary oncologist, there were only about 25 veterinary oncologists in the world. The American College of Veterinary Internal Medicine now has certified over 300 oncology diplomates and there is a European College of Veterinary Internal Medicine which certifies oncologists as well. Board certified specialists all over the world form a healthcare network that trades patients back and forth when pet owners relocate or go on vacation, just as I described in a previous blog: “Clea’s International Healthcare Team.” Since veterinary oncologists and other specialists have expanded their reach worldwide, specialist veterinary care no longer has geographic boundaries.

Multinational Veterinary Companies
Specialists are not the only international flatteners. Because international companies provide veterinary products and services, veterinary specialists can access information about pets seen by a veterinarian practicing on a different continent! Take for example my patient Gigi. She came to The AMC from Kuwait, but because the biopsy of her tumor was sent to the European branch of the same laboratory used by The AMC, I was able to ask additional questions about the biopsy result. The biopsy sample was retrieved from storage and then reviewed by a pathologist in Europe. The answers to my questions were sent via email.

Real Time Communication
The internet has changed the face of veterinary education. Today, veterinarians no longer have to travel to earn continuing education credits necessary to maintain their licenses. Continuing education comes to them though their computers. This year, the keynote speaker addresses at the annual Veterinary Cancer Society Meeting were streamed live to members unable to attend. Additionally, several internet based companies offer on-demand veterinary continuing education opportunities.

The veterinary world is indeed flat and that means your pet can get excellent veterinary care from a veterinarian in your neighborhood or from a specialist somewhere a long way from home!


Five Medical Tests Your Cat Can’t Live Without

June 20, 2013

kittens in pink bedThis blog is written in honor of our furry feline friends. Remember, June is Adopt-a-Cat Month, so visit your local animal shelter to add a feline to your family.

Last week was the annual meeting of the American College of Veterinary Internal Medicine in Seattle. This meeting is a beehive of educational activity for board certified veterinarians in oncology, internal medicine, neurology and cardiology. Veterinarians from The AMC attended. Some took tests leading to board certification, some attended educational talks and others presented new scientific information to their colleagues. One of the most important abstracts presented changed my way of thinking about feline health. The results of the study were presented by one of The AMC’s board certified cardiologists, Dr. Philip Fox.

Dr. Fox and his international team of researchers evaluated over 1,300 cats from 20 countries across five continents. Two groups of cats were studied: cats with hypertrophic cardiomyopathy, the most common form of feline heart disease, and cats that were believed to be healthy and not have heart disease. The cats were studied for five years and the results demonstrate cats with heart disease have a shorter lifespan than cats without heart disease. The healthy group of cats did not stay healthy forever and the investigators found the most common causes of death in cats without heart disease were cancer, kidney failure and intestinal disease.

So what does this mean to the diligent cat owner? Talk to your veterinarian about how the following tests might help your favorite feline furball:

  1. Have a heart-healthy feline checkup at least once a year. Cats with heart disease frequently have a heart murmur that can be detected using a stethoscope. A routine physical examination can detect feline heart disease early. But if your cat never goes to the veterinarian, the murmur can’t be heard.
  2. Prevent cancer in your cat by keeping them indoors and having them tested for feline leukemia virus and feline immunodeficiency virus. These viruses increase your cat’s risk for cancer, one of the common causes of feline fatality. If your cat tests negative for these viruses and you keep her indoors, she can’t get infected as the infection comes from other cats.
  3. Have your cat weighed. Weight loss is a common clinical sign associated with intestinal disease, cancer or kidney failure. If your cat loses weight and your veterinarian recommends additional testing, please agree for your cat’s sake.
  4. A simple urine test can help determine if your cat has early kidney disease. Collect a urine sample and take it to your cat’s next visit with his veterinarian. The results of a urine test plus a blood test gives your veterinarian a more complete picture of your cat’s health. Here are some helpful hints for collecting urine.
  5. Older cats lose weight from overactive thyroid glands and this disease is diagnosed with a routine blood test. Treatment of hyperthyroid cats can restore them to their optimal weight.

Big News in Cancer Treatment for Dogs!

July 21, 2009

Palladia

Just last month, veterinary oncology had a first and as a board certified veterinary oncologist, this news just made my day. Until now, all chemotherapy agents administered to dogs were human drugs adapted for use by veterinarians. In June, the Food and Drug Administration’s Center for Veterinary Medicine approved the use of Palladia® (toceranib phosphate) which was specifically developed for use in dogs and has safety and efficacy data from canine studies backing its use. Palladia is licensed for the treatment of recurrent mast cell tumors.

mast-cell-tumorVeterinary oncologists have effective therapies for some dogs with mast cell tumors.  These treatments include surgery, human chemotherapy agents and radiation therapy.  But not all dogs have tumors amenable to surgical removal, not all tumors are in a location where radiation therapy can be safely administered and currently available chemotherapy agents do not cure every dog. So the first drug specifically developed for canine mast cell tumors is big news. 

Mast cell tumors are one of the most common skin tumors in dogs and are one of the most important cancers veterinary oncologists treat. Some dogs are unlucky enough to have multiple mast cell tumors or a mast cell tumor that keeps coming back in the same location. So a drug to help manage this common tumor is big news, redux.

Palladia belongs to a class of drugs known as tyrosine kinase inhibitors. The presence of abnormal tyrosine kinases in tumors results in the proliferation of tumor cells and the growth of new blood vessels to the tumor. These blood vessels provide nutrients to the growing tumor. Inhibition of tyrosine kinases by drugs like Pallada (or for humans, Gleevec®, another tyrosine kinase inhibitor) stops both cell proliferation and new blood vessel growth. Without nutrients and without cell proliferation the tumor shrinks. More big news.

Pfizer Animal Health is working with veterinary specialists to help them use Palladia effectively and safely. It is currently available from board certified veterinary specialists in oncology, internal medicine and dermatology. To find the specialist nearest you go to http://www.acvim.org/ for oncologists and internists and at http://www.acvd.org/ for dermatologists. Pricing for Palladia has not yet been announced.

Click here to download an information sheet about Palladia from The AMC.

______________________________________________
The Oncology Team at The Animal Medical Center

At The Animal Medical Center, specialists certified by the American College of Veterinary Internal Medicine in the sub-specialty of Oncology and the American College of Veterinary Radiology in the sub-specialty of Radiation Oncology provide dedicated care for pets with cancer Monday through Saturday.  We take a team approach to cancer care, collaborating with specialists in the fields of diagnostic imaging, pathology, surgery and internal medicine to create a customized plan for the care of your pets .

You can reach The AMC Oncology staff by email or phone:

• Ann Hohenhaus, DVM, DACVIM (Oncology, Small Animal Internal Medicine)    
(212) 329-8612, Ann.Hohenhaus@amcny.org   
• Nicole Leibman, DVM, DACVIM (Oncology)
(212) 329-8696, Nicole.Leibman@amcny.org   
• John Farrelly, DVM, DACVR (Radiation Oncology), DACVIM (Oncology)
(212) 329-8794, John.Farrelly@amcny.org  
• Andrea Flory, DVM, DACVIM (Oncology)
(212) 329-8687, Andrea.Flory@amcny.org


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