Lit Oncology Flashcards
Differences in clinical outcome of carboplatin vs doxorubicin-based chemo protocols to treat dogs with stage I-II splenic HSA?
Negative prognostic indicator?
Faulhaber JVIM 2021
Similar MST - 160d (48->559d) for carbo dogs & 139d (54-975d) for doxo dogs.
Increasing post-splenectomy peripheral monocyte counts (shorter MST 66d vs 265d for dogs with decreased post-op Mc counts).
Which dog breeds were overrepresented in CNS histiocytic sarcoma (either primary or disseminated)?
Which clinicopathological variables were discriminatory between primary CNS vs disseminated HS?
Toyoda JVIM 2020
Breeds overall = BMD, Rotties, GRs, Corgis, Shetlands.
Rotties - exclusively disseminated HS. Corgis & Shetland Sheepdogs - primary CNS HS.
CSF analysis - marked inflammation in primary CNS HS.
Overall CSF is useful - also can detect neoplastic cells (52% cases).
Utility of M-protein measurement in prognostication & monitoring dogs with multiple myeloma?
Moore JVIM 2020:
Overall correlates to OST & clinical findings.
Px: MST longer if achieve ≥90% densitometric M-protein reduction (630d). Shorter MST if <50% reduction in M-protein (284d).
Monitoring:
- Dz progression - M-protein increase >25% & at least 0.5 g/dL from nadir –> correlated with clinical deterioration.
- Complete response to chemo - detectable M-protein by SPE & IF.
M protein - mostly IgM (big molecule)
Survival time for dogs with localized splenic histiocytic sarcoma treated with splenectomy +/- adjuvant chemo?
What adjuvant chemo was used?
Latifi JVIM 2020
Survival times can be >1yr (MST 427d).
CCNU
What were the effects of toceranib in the treatment of canine AGASACA in regards to:
- Progression-free survival (PFS)
- Overall survival time
- Clinical response rate (partial response vs stable disease)
Name 1 prognostic factor in AGASACA dogs, and if positive/negative?
Heaton JVIM 2020
- PFS 313d
- OST 827d
- CRR 69% - PR 20.7%, SD 48.3%
(remember 70% CR, 20% PR, 50% SD)
HyperCa, negative
Most common tumor location for lower urinary tract TCC in cats?
Incidence of metastatic disease?
Overall MST?
Treatment factors associated with longer survival?
Griffin JVIM 2020
Trigone
21.2%
155 days
NSAID treatment + partial cystectomy (> NSAID alone > no tx)
What were the differences in survival between dogs with OSA that received autologous cancer vaccination & IL-2 SQ injections post-amputation, and dogs treated by amputation alone?
Flesner JVIM 2020
Amp + vax/IL2 - MST 415d, 5 dogs survived >730d.
Survival >2x longer cf amp alone (MST 134d in prev case series).
Which circulating microRNA markers were useful as diagnostic and/or prognostic biomarkers in dogs with mammary carcinoma compared to healthy dogs?
Fish JVIM 2020
- miR-19b – biomarker for diagnosis (sig higher in MC dogs vs controls)
- miR-125a also sig higher in MC dogs vs controls
- miR-18a – biomarker for prognosis (sig higher in MC dogs with histo evidence of lymphatic invasion)
Which form of lymphoma are Boxers predisposed to, and median age of onset?
MST?
List 1 non-significant and 2 significant risk factors that were identified in Boxers with lymphoma.
Craun JVIM 2020
T- cell LSA. Median onset 7yo (high grade), 10yo (low grade).
MST 8-9mths with multimodal chemo.
Significant risk factors = aggregate exposures to environmental chemicals & industrial waste
- Proximity to nuclear power plants (living within 10miles)
- Proximity to chemical suppliers & crematoria (living within 2 miles)
Non-significant: known canine glutathione S-transferase (GST) variants (no difference in endogenous DNA damage between Boxers & non-Boxers)
Concurrent rabacfosadine & L-aspar tx in dogs with relapsed/refractory LSA:
- Response rate (complete & partial)
- Progression-free survival
- Negative prognostic factors (list 2)
Cawley JVIM 2020
- 67% overall response rate. 41% complete response
- PFS 63d, 144d in CR dogs
- Failure to achieve CR, previous L-aspar tx.
What novel treatment option could be considered for dogs with incompletely excised hepatocellular carcinomas?
Yang JAVMA 2021
Imaging-guided intensity-modulated radiotherapy - SRT
- What imaging modality was sensitive in detecting lesions in dogs with cutaneous lymphoma (CCL)?
- What were the most common imaging features in dogs with CCL?
- Which LNs were most commonly affected?
Watton JAVMA 2021
- CT scan - detected lesions (including affected LNs) that were not detected clinically.
- Well-defined, diffusely distributed, contrast-enhancing, cutaneous or subcutaneous nodules.
- Axillary & mandibular LNs.
Which 2 clinicopathological features in dogs with soft tissue sarcomas should prompt performing imaging for pulmonary staging?
Villedieu JAVMA 2021
1) Grade 3 STS - OR 10.8 for presence of pulmonary nodules vs grades 1 or 2
2) STS duration >3mths - OR 3.14 for presence of pulmonary nodules vs <3mths
(A) …… at time of initial diagnosis may be a negative prognostic indicator in dogs with multicentric LSA treated with CHOP.
MST for these dogs was (B) ….. days compared to (C) …. days for dogs without (A).
Overall response rate for dogs with (A) were significantly lower at (D)……% compared to (E)….% in dogs without (A).
Veluvolu JAVMA 2021
A) Neutrophilia
B) 70 days
C) 184.5 days
D) 75%
E) 97%
What rare complication can potentially occur in dogs with obstructive TCC that undergo SUB device placement?
Merickel JAVMA 2021
SQ/cutaneous seeding of TCC at site of SUB device access port
- What % of cats with appendicular or scapular OSA develop a) local recurrence, b) LN & c) distant metastasis after limb amputation?
- Any predilection site(s) for distant mets?
- Overall MST was …. days.
- Tumor location was significantly associated with survival time (T/F).
Nakano JAVMA 2021
1.
a) 9%
b) 3%
c) ~40%
- Humerus OSA (86% cats with humeral lesions had distant mets)
- 527 days
- F
Overall MST for dogs with untreated peripheral, nodal, intermediate or large cell LSA treated with prednisolone alone was …..
Which factors were associated with poorer survival time?
Rassnick JAVMA 2021
50 days.
Substage b (vs a), immunophenotype - B cell worse (vs T cell)
Based on a histopathologic study of canine oral melanomas, lymphatic invasion could be confidently ruled in for tumors …….. in diameter with ……. specificity, and ruled out for tumors ……. in diameter with ……sensitivity.
List 5 other histologic parameters assessed in these tumors.
Carroll JAVMA 2021
≥ 24.5mm, 100% specificity
< 6.5 mm, 100% sensitivity
Mitotic index, nuclear atypia, junctional activity, ulceration, degree of pigmentation.
Dogs undergoing surgical removal of functional thyroid
tumors without additional treatment had a ….(good/bad) prognosis with an MST of ….., despite ……% tumors being malignant.
Predominant clinical signs included …..(..%). and ……(…%).
What significant prognostic factors were identified in this study?
Frederick JAVMA 2021
Good, MST 1072d.
85%
PUPD (56%), weight loss (44%).
No significant prognostic factors identified.
What technique used frequently in people has been trialled to treat retroperitoneal neoplasia in dogs?
What tumor features would prompt considerations for using this method?
Culp JAVMA 2021
Percutaneous microwave ablation (MWA).
Small masses (<4cm in diameter in people)
Can be targeted with image guidance (CT or US)
Accessible via direct visualization (on imaging or physically), or palpation (through open or endoscopic surgery, or
or percutaneously).
- What treatment option is strongly recommended for dogs with parathyroid carcinoma?
- Top 3 most common clinical signs?
- Cervical US most commonly detects …..(single/multiple) PT nodules.
- What was the survival outcome for these dogs in the 1st 3 years following treatment listed in (1)?
- What is a major complication following treatment listed in (1) and the survival outcome for dogs that developed this complication?
Erickson JAVMA 2021
1. Surgical excision (parathyroidectomy).
2. PU (44%), PD (43%), HL paresis (22%) - effects of hyperCa.
3. Single nodule (~70% dogs), 2 or 3 in others.
4. Excellent long term px. HyperCa resolved in 93% dogs within 1wk post-op. MST 2yrs. Survival rates - 1yr 84%, 2yrs 65%, 3yrs 51%.
5. Hypocalcemia - 34% dogs, of which 8% (3/34) were euthanised for refractory hypoCa.
Which 2 clinicopathologic features were negatively associated with progression-free interval (PFI) & overall survival time (OST) in dogs with splenic HSA treated with splenectomy & chemotherapy?
Masyr JAVMA 2021
- Stage 3 HSA (HR 6.6 for PFI, HR 4.5 for OST).
*Recap: stage 3 = distant LN or other tissue mets.
- Peri-operative thrombocytopenia (HR 2.2 for PFI, HR 2.0 for OST).
In dogs with appendicular OSA undergoing limp amputation, what timeframe post-op has been recommended to initiate chemotherapy?
What impact does this recommendation have on prognosis?
Marconato JAVMA 2021
Within 5 days post-op.
Confers significant survival benefit vs dogs receiving chemo >5d post-op. Median PFI 375d (vs 202d), median OST 445d (vs 239d).
- Top 4 most common pulmonary neoplasms in dogs?
- Differences in MST between
McPhetridge JAVMA 2021
1. Pulmonary carcinoma (87.1%) > sarcoma (7.6%) > adenoma (3.2%) > neuroendocrine tumors (1.5%). 5.9% sarcomas were primary pulmonary histiocytic sarcoma.
2. MST: neuroendocrine tumors (498d) > pulmonary carcinomas (399d) > histiocytic sarcomas (300d).
4. For dogs grouped in each stage of pulmonary carcinoma, no sig diff in MST following lung lobectomy with/without adjuvant chemo.
- What was the overall complication rate for female dogs undergoing mastectomy for mammary gland tumor removal?
- Risk factors associated with complications?
Evans JAVMA 2021
1. 17% complication rate; 35% of this required hospitalisation.
2. Higher BW, bilateral mastectomy, post-op abx administration (variable according to mastectomy type - highest complication rate in dogs undergoing chain mastectomy), previously spayed (concurrent OVH/ovarectomy DECREASED odds of complications).
What 4 treatment options can be considered for dogs with prostatic carcinoma? What was the outcome of dogs following 1 of this interventional treatment option?
Culp JAVMA 2021
Prostatectomy, radiotherapy, chemotherapy, prostatic artery embolization (PAE).
PAE significantly reduced clinical signs within 30d (tenesmus, stranguria, lethargy) + significantly reduced prostatic volume by ~40%. Need more studies to evalhuate longer term benefit on survival.
In dogs undergoing mandibulectomy or maxillectomy, what was the:
1. Overall complication rate
2. Time post-op where complications predominantly occurred
3. Major complications described
4. Risk factors for post-op complications
Cray JAVMA 2021
1. 37.3%
2. Within 3 months post-op (90%)
3. Incisional dehiscence, oral fistula formation
4. Pre-op RT or chemo (OR 3), maxillectomy (vs mandibulectomy) (OR 1.8), increased sx time (OR 1.36)
List 8 clinical variables which may be useful in predicting splenic malignancy when evaluating splenic masses based on a multivariable model & online decision-support calculator.
Burgess JAVMA 2021
Serum TP
Presence of ≥ 2 nRBCs/100 WBCs
Splenic mass diameter on AUS
Presence of multiple splenic masses/nodules
Moderate-marked splenic mass inhomogeneity
No. of liver nodules (0, 1, or ≥ 2)
Mesenteric/omental/peritoneal nodules
Moderate-marked abdominal effusion
What surgical margins was determined to be non-inferior to current recommendations in achieving tumor-free histo margins during the excision of grade I & II cutaneous MCT in dogs?
Chu JAVMA 2020
Conservative lateral sx margins - equal to tumor diameter for tumors <2cm, 2cm for larger tumors.
(Current recommendations = 3cm lateral margins)
How does PET/CT work in quantifying tumor activity?
How can PET/CT findings be useful to prognosticate canine appendicular OSA?
Griffin JVIM 2019
Fluorine18 flourodeoxyglucose positron emission tomography/CT (18F-FDG PET/CT) combines nuclear medicine with resolution of 3D imaging. FDG is a glucose analog that is taken up by metabolically active cells (both healthY=y & diseased) - neoplastic lesions have the potential to exhibit increased uptake of FDG (ie increased avidity) due to uncontrolled cell growth. Analysis of avidity on an 18F-FDG PET/CT includes evaluation of a unitless semiquantitative factor called a standard uptake value (SUV). Maximum SUV (SUVmax) is the most commonly reported value and is indicative of the highest pixel of metabolic activity in a tumor. Maximum standard uptake value is proportional to the growth rate of a tumor cell (in line with Ki-67 labelling index).
Increased SUVmax = negative px indicator.
MST 284d for dogs with SUVmax ≥7.4, 680d if SUVmax <7.4.
Which Doppler ultrasonographic & sonoelastographic features may be useful to distinguish malignant superficial LNs?
Belotta JVIM 2019
Mixed vascular distribution on Doppler colour flow mapping, higher resistivity & elasticity scores
(Also pulsatility score but less useful)
What is the MST for thyroid carcinoma post unilateral thyroidectomy in dogs?
What is the post-operative complication rate in these dogs, and the most common post-operative complications?
Reagan JAVMA 2019
98% survived to discharge. Common for long term survival. MST 911d.
20% complication rate. Most common - haemorrhage (7.72%, of which 3.2% total dogs needed transfusion), aspiration pneumonia (3.2%).
Are canine mammary masses usually benign or malignant? Do the number of masses impact probability of malignancy?
Litterin-Kaufman JAVMA 2019
85% benign.
No - consider similar management for single vs multiple mammary masses.
- What is the incidence of clinical cardiotoxicity in dogs receiving doxorubicin?
- What are risk factors for developing DOX-induced cardiotoxicity in dogs?
- What clinical changes can predict cardiotoxicity?
Hallman JVIM 2019
1. 4%
2. High risk breeds for developing DCM (Boxers etc.) - 15% developed vs 3%, higher BW, higher cumulative DOX dose.
NOT duration of DOX infusion.
3. Decreased FS% after 5 doses, development of VPCs.
What is the accuracy of cytology for canine OSA when compared to histology?
Sabattini JVIM 2017
Cytology - accuracy 83% (Sn 83.3%, Sp 80%). Similar to histology - accuracy 82.1% (Sn 72%, Sp 100%) though histo had higher Sp.
Also similar accuracy in determining tumor type (correctly identified in 50% cases for cytology, 55% for histo).
Cytology appears to be a reliable diagnostic method, as did not misdiagnose benign lesion as malignant in this study (most important error to prevent, as tx for malignant bone tumors includes aggressive sx).
Note: study included OSAs, chondrosarcomas, fibrosarcomas, poorly differentiated sarcomas, carcinoma metastases & non-neoplastic lesions.
How may osteosarcoma evade the immune system in dogs?
Tuohy JVIM 2016
Peripheral blood monocytes in OSA dogs have significantly downregulated cell surface chemokine receptor expression (CCR2 & CXCR2) & reduced monocyte chemotactic function.
Also increased pro-inflammatory substances (PGE2 & TNF-α) in OSA monocytes.
Immunotherapy may reverse monocyte dysfunction & improve survival in OSA dogs.
