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  1. Consider Giving Hope This Year to a Pet in Need

    Dear fellow Animal Lover, Everyone who walks into this practice loves their pet, of that we are sure. Despite this, some pet parents do not have the resources to treat their beloved pets. The Veterinary Cancer Center has been a major supporter of a non-profit organization called the Riedel & Cody Fund. This 501(c)3 organization enables pets whose owners cannot afford cancer therapy to receive treatment. The Riedel and Cody Fund has already helped hundreds of pets and pet parents around the country. We at The Veterinary Cancer Center have partnered with the Riedel and Cody Fund to raise money for the local pets and pet owners who need our help. The people of Fairfield and Westchester counties are among the most generous in the world; please join us in helping our neighbors this holiday season. Our pets are part of our family and we would love for everyone who has a pet in our community to be able to do something if their pet is diagnosed with cancer. Riedel and Cody can’t do this without our help.

    Please consider making a donation to The Riedel and Cody Fund and The Veterinary Cancer Center will match a portion of every dollar donated. Please mark on your check or online donation that it is to be used for “The VCC Neighborhood”. Please mail your check to: Riedel and Cody Fund, 129 Glover Avenue, Norwalk, CT 06850. For your 100% tax deductible online donations, please visit www.riedelcody.org. We guarantee that at minimum 90% of your donation will be used to treat pets in need as administrative costs are generously covered by Riedel and Cody Fund co-founder Mark Tillinger. Thank you from the bottom of our hearts for helping and Happy Holidays, The doctors and staff of The Veterinary Cancer Center.

     

  2. Innogenics – Genomic Profiling for Pets: What information can it provide

    Innogenics is a specialty genomics reference laboratory that helps veterinarians and owners of pets with cancer by providing state-of-the-art molecular diagnostic analysis of tumor tissue at costs affordable to the pet owner. We provide a molecular profile of a dog’s tumor that details the cancer type and subtype and provides biomarker information useful in guiding decisions about current and novel therapeutic options.

    At its core, cancer is a genetic disease. Unregulated growth, inappropriate growth signals, blunted or absent response to “death” signals—all of these characteristics are regulated by genes.  For this reason, the promise of genomics in oncology is huge. The expectation of improved diagnostics, prognostics and therapeutics is shared by patients and oncologists alike.

    Gene expression analysis is widely used in human oncology.

    In the diagnostic phase of oncology, we certainly understand that an accurate diagnosis is necessary in order to prescribe the optimal therapy. A fantastic paper published in the Proceedings of the National Academy of Sciences (http://www.pnas.org/content/98/26/15149.short) reported that gene profiling was incredibly accurate in determining the type of cancer spanning 14 of the most common cancers. In addition, gene expression analysis showed that undifferentiated cancers based upon histology had gene expression patterns unlike their tissue of origin. The dramatically different gene expression accurately predicts the aggressive, abnormal biologic behavior of these tumors, similar to what most oncologists observe in the clinic.

    Gene expression patterns can also aid in the prognostic phase of oncology. Accurate prognostication is important, as it allows the clinician to identify patients who will likely do well or those who will do poorly. In a highly cited paper in Nature (http://www.nature.com/nature/journal/v415/n6871/full/415530a.html) the authors evaluate the gene expression pattern of 117 patients and they were able to conclude that “This gene expression profile will outperform all currently used clinical parameters in predicting disease outcome. Our findings provide a strategy to select patients who would benefit from adjuvant therapy.” The number of genes that need to be evaluated does not have to be large. In one paper (http://www.sciencedirect.com/science/article/pii/S1535610804001412) the authors prove that the ratio of only TWO genes was prognostic in breast cancer patients. As a clinician, the question of how will MY pet do is one I hear every day. Wouldn’t it be wonderful to be able to accurately answer these pet owners?

    When it comes to the cancer that is most treated in the veterinary world, lymphoma, can gene expression analysis help? The answer is a resounding yes. Diffuse large B-cell lymphoma (DLBCL) is the most common type of lymphoma in dogs and is very similar to DLBCL in humans. Gene expression analysis has proven useful in this disease for BOTH dogs and people (http://cancerres.aacrjournals.org/content/73/16/5029.abstract and http://www.nature.com/nature/journal/v403/n6769/full/403503a0.html). By routinely performing gene expression analysis on the lymphomas that we diagnose in dogs, it is possible, indeed expected, that therapy will be more effective. And at the end of the day, isn’t more effective therapy what we all want?

  3. Monoclonal Antibodies and Canine Lymphoma: A huge leap forward

    Comparison of a Standard Regimen (CHOP) with Three Intensive Chemotherapy Regimens for Advanced Non-Hodgkin’s Lymphoma:

    Lymphoma is one of the most common cancers in both dogs and cats and one of the most commonly treated cancers in veterinary medicine. As a veterinary oncologist, I cannot remember a more exciting time in this field, as there are now some wonderful new therapeutic options available, including monoclonal antibody therapy for both T and B cell lymphoma in dogs.

    Antibodies are proteins produced by plasma cells (mature B cells) used by the immune system to identify and neutralize foreign antigens like bacteria, viruses, parasites, and cancer cells. Each antibody recognizes a specific antigen and monoclonal antibodies are identical antibodies that each recognize a single, specific antigen. The scientist who discovered monoclonal antibodies shared the Nobel Prize in Medicine in 1984, signifying how important this discovery was to the world.

    The immune system attacks foreign proteins (parasites, viruses, bacteria) in your body, but it doesn’t always recognize cancer cells as foreign. Therapeutic monoclonal antibodies can be directed to attach to certain parts of a cancer cell, and therefore allow the immune system to more easily detect and eliminate the cell. Monoclonal antibodies do this through a variety of mechanisms: activating Antibody Dependent Cellular Cytotoxicity (ADCC); blocking growth factor signaling; stopping new blood vessels from forming; delivering radiation to cancer cells; and delivering chemotherapy to cancer cells

    As canine lymphoma is incredibly similar to non-Hodgkin’s lymphoma (NHL) in people, it is helpful to look at the “human” experience with monoclonal antibodies. In the late 1990’s a large group of oncologists tested the various chemotherapy regimens for NHL and found that the standard CHOP regimen was just as good as the other more intense chemotherapy regimens.  (see chart #1)

     

    Fisher RI et al. N Engl J Med 1993;328:1002-1006 (chart #1)

    It wasn’t until the development of Rituximab that there was any significant advancement in the treatment of NHL in people (see chart #2). The monoclonal antibody drug rituximab (Rituxan) attaches to a specific protein (CD20) found only on B cells, one type of white blood cell. Certain types of lymphomas arise from these same B cells. When rituximab attaches to this protein on the B cells, it makes the cells more visible to the immune system, which can then attack.
Rituximab lowers the number of B cells, including your healthy B cells, but your body produces new healthy B cells to replace these. The cancerous B cells are less likely to recur.

    “The most substantial advancement in the treatment of B-cell malignancies, since the advent of combination chemotherapy, has been the addition of the monoclonal anti-CD20 antibody rituximab (Rituxan).” -Pharmacy and Therapeutics 2010 Mar; 35(3): 148–157.

    PMCID: PMC2844047

    Impact of Rituximab (Rituxan) on the Treatment of B-Cell Non-Hodgkin’s Lymphoma

    Efrat Dotan, MD, Charu Aggarwal, MD, MPH, and Mitchell R. Smith, MD, PhD

    JCO, Feugier, et al, 2005 (chart #2)

    (chart #3)

    The veterinary oncology community has also been testing an anti-CD20 monoclonal antibody, also from Aratana. In the first trial, dogs were treated with either 1 cycle of CHOP along with the anti-CD20 MAb or 1 cycle of CHOP alone. The results are quite impressive (see chart #3) in that the median progression free survival times and the median overall survival times of the dogs treated with MAbs were 167 and 325 days, respectively, compared to 93.5 and 177 days for the placebo arm.  In the second trial dogs were treated with either single agent doxorubicin and the anti-CD20 MAb or single agent doxorubicin alone. The number of dogs achieving a complete remission was greater in the group receiving the MAb than in the group receiving doxorubicin alone.

    Monoclonal antibody therapy for T cell lymphomas in dogs is also available. T cell lymphomas are typically more aggressive than the B cell lymphomas in both dogs and people. There are however, indolent forms of T cell lymphoma that dogs can survive with for years. Not all T cell lymphoma are “terrible”. For those T cell lymphomas that are not indolent, the response to chemotherapy alone is not robust. In people, the addition of monoclonal antibodies to chemotherapy for T cell lymphomas has increased survival times and response rates. Clinical responses to the anti-CD52 antibody, alemtuzamab, were observed in over 33% of people with chemotherapy-refractory or relapsed peripheral T cell lymphoma.  The canine (“caninized”) monoclonal anti-CD52 antibody developed by Aratana was granted a conditional license in Jan 2014. Since that time there have been 3 clinical programs involving the antibody—T-CHOMP, T-LAB and T-CEP.

    T-CHOMP was a clinical study evaluating the anti-CD52 antibody in conjunction with a multi-agent chemotherapy protocol. T-LAB is the clinical trial in which the monoclonal therapy is used in addition to a short protocol involving single agent CCNU. Final results regarding the efficacy of the drug has not been published, but in our experience, the drug was well tolerated and safe.  The T-CEP or Clinical Experience Program is the third piece in this program. This program is designed to determine in what scenario or scenarios this therapy is most effective—at the start of chemotherapy, after chemotherapy, when the pet has achieved minimal residual disease status, as maintenance therapy or as induction therapy.

    The fact that monoclonal antibody therapy for canine lymphoma is now available is hugely important to veterinarians and pet owners alike.

    Gerald Post, DVM, MEM, DACVIM (Oncology)

    The Veterinary Cancer Center (www.vcchope.com)