Mast Cell Tumors Flashcards
1
Q
In a multi-center, placebo-controlled, double-blind, randomized study evaluating the efficacy of Palladia in recurrent grade II or grade III MCTs, Palladia was given at 3.25mg/kg EOD for 6 weeks and compared to placebo. Following placebo, patients who were eligible received open-label Palladia. The overall objective response rate was ___% with a CR rate of ___% and PR rate of ___%. The blinded phase ORR was ___%. The median duration of response was _____, and the overall TTP was ____. The odds of an objective response were ___ times higher in
Palladia-treated dogs compared with placebo-treated dogs. The ORR for Palladia treated dogs with c-kit mutation was ___% compared to those without ___%. The observed biologic response rate was ___%, including stable disease.
A
- overall ORR: 43%; CR 14%; PR 28%
- blinded ORR: 37%
- Median duration: 3mo
- overall TTP: 5mo
- OR: 6.5 times higher
- c-kit RR: 60%
- c-kit RR: 31%
- biologic response rate: 60%
2
Q
In a case series of dogs with primary GI MCT, ___% were alive at 30 days after first admission and fewer than ___% were alive at 6 months.
A
- 40%
- 10%
3
Q
GI ulceration is seen in ___-___% of dogs at necropsy.
A
~35-85%
4
Q
_________ secreted by mast cell tumor cells may mediate hypotensive effects observed in humans with MC disease, particularly during surgery.
A
Prostaglandlins in D series
5
Q
Metastatic rates for undifferentiated MCTs in dogs are ___-___% with most dying of disease within _______.
A
- 55-96%
- 1 year
6
Q
Name the criteria of the Kiupel grading system to be classified as “high grade.”
A
At least one of the following:
- at least 7 mitotic figures per 10 HPF
- at least 3 mutlinucleated cells per 10 HPF
- at least 3 bizarre nuclei per 10 HPF
- Karyomegaly
7
Q
What proliferation markers correlate with histologic grade and post-surgical outcome?
A
- Ki67
- AgNOR
- PCNA
8
Q
In one study, dogs with tumors possessing a MI < / = 5 had a MST of ____ compared to _____ for dogs possessing MI > 5.
A
MST MI <5: 6.7 yrs (Withrow) or 5.8 yrs (paper)
MST MI >5: 2-3mo
9
Q
Approximately ____-___% of dogs with MCTs located on the muzzle presented with regional lymph node metastasis, but this finding interestingly did not indicate worse prognosis. The overall MST was ____, _____ for dogs without metastasis, and ___ for those with metastasis.
A
- 50-60%
- oMST: 30mo
- MST no mets: 52mo
- MST with mets: 14mo
10
Q
In a study of 306 dogs with SC MCT, metastasis was reported in ___%, local recurrence in ___%, and 5-year survival rate was ___%. Decreased survival was linked to what factors? ____% died of MCT related disease and MST was _____.
A
- 4%
- 8%
- 5 year survival: 86%
- MI >4, infiltrative growth pattern, and presence of multinucleation
- 9%
- MST not reached
11
Q
For poorly differentiated tumors, the presence of LN metastasis resulted in MST of ____. Dogs with NO LN metastasis had a MST of _____. Treatment of LN improved MST to ____ compared to those dogs left untreated at _____.
A
- MST LN met: 7mo
- MST No LN met: 17mo
- MST treated met: 8mo
- MST untreated met: 1mo
12
Q
In one study 83% of dogs with mast cell tumors present for longer than ____ prior to surgery survived for at least 8 months compared with only 25% of dogs with tumors present for less than ______.
A
> 7mo
< 7mo
13
Q
Name 18 negative prognostic factors for MCTs. I’ll wait.
A
- Grade (undifferentiated/high grade)
- MI > 5 OR >/= 7
- Increased proliferation markers (Ki67, AgNOR, PCNA)
- DNA ploidy
- Increased CNVs
- Microvessel density
- C-kit mutations
- Breed (Sharpei)
- Location (prepuce, scrotum, MC junction, oral, subungual, visceral, BM, +/- muzzle, +/- inguinal)
- +/- Single vs. multiple masses
- +/- LN mets/stage
- +/- tumor ulceration, erythema, or pruritus
- Larger tumor size
- Male
- +/- Older age
- Systemic signs
- Rapid growth/length of time present (<7mo)
- Recurrence of MCT
14
Q
Name 6 IHC markers for canine MCT.
A
- Vimentin
- Tryptase
- CD117 (KIT)
- Chymase
- MCP-1
- IL-8
15
Q
In a study of 56 healthy beagles, approximately ____% of LN aspirate contained mast cells with a mean of 6.4/slide.
A
24%
16
Q
In dogs with cutaneous MCT and STS, the extent of local tumor margins was upgraded in ___% and ___% of cases, respectively, when imaged by US and CT.
A
- MCT: 19%
- STS: 65%
17
Q
Peripheral mastocytosis in a dog is most likely related to _______. Name all possible causes.
A
- most likely to occur in diseases other than MCT
- Possible causes: acute inflammatory disease (Parvovirus), inflammatory skin disease, regenerative anemia, neoplasia other than MCT (ie, LSA), MCT, trauma
18
Q
In a study of 157 dogs with MCT, the incidence of bone marrow infiltration was ____%
A
2.8%
19
Q
In dogs that present with visceral MCT, ___% of buffy coat smears are positive for mast cells. Bone marrow involvement is confirmed in ___%.
A
- buffy coat: 37%
- bone marrow: 56%
20
Q
In 100 dogs with 115 resectable MCTs of low or intermediate grade, no local recurrence or metastasis was noted for greater than _____ after excision with lateral margins of ________ and deep histologic margins __________.
A
- 2 years
- lateral: 10mm or greater
- deep: 4mm or greater
21
Q
In a study of 31 dogs managed with second-intention healing after excision of soft tissue sarcomas with 2cm lateral margins, ____% of resulting wounds healed completely after a median of ______.
A
- 94%
- ~2mo
22
Q
2-year control rates of ____-___% can be expected with adjuvant RT for stage 0 tumors of low and intermediate grade.
A
85-95%
23
Q
____-___% of MCTs with histologically confirmed incomplete margins recurred in some studies.
A
10-30%
24
Q
A VCOG study on efficacy of single-agent prednisone therapy for intermediate/high grade MCTs in 21 dogs reported an objective response rate of ____%. More recent studies report ____-___%.
A
- 24%
- 70-75%
25
Objective response rates of measurable canine MCTs to cytotoxic chemotherapy are as high as ___%.
64%
26
What is the ORR and CR rate of canine measurable MCT treated with vincristine?
ORR: 7%
CR: 0%
27
What is the ORR and CR rate of canine measurable MCT treated with CCNU single-agent therapy?
- ORR: 44%
- CR: 6%
28
What is the ORR and CR rate of canine measurable MCT treated with vinblastine and prednisone in 2 studies? What is the median response duration? What is the MST of dogs with grade 3?
- ORR: 43-47%
- CR: 4-33%
- 5 mo
- MST grade 3: 5mo
29
What is the ORR, CR rate, and median response duration of canine measurable MCT treated with prednisone, Cytoxan, and vinblastine?
- ORR: 63%
- CR: 18%
- 3mo
30
What is the ORR, CR rate, and median response of duration of canine measurable MCT treated with multi-agent COP-HU (cytoxan, vincristine, prednisone, and hydroxyurea)?
- ORR: 59%
- CR: 23%
- 2mo
31
***What is the ORR, CR rate, and median response durations of canine measurable MCT treated with prednisone, vinblastine, and CCNU combination therapy in 2 studies?
- ORR: 57-64%
- CR: 24-29%
- ~5 (CR) - 13mo
32
What is the ORR and CR rate of canine measurable MCT treated with single-agent hydroxyurea?
- ORR: 28%
- CR: 4%
33
What is the ORR, CR rate, and median response duration of canine measurable MCT treated with chlorambucil and prednisone?
- ORR: 38%
- CR: 14%
- 18mo
34
What is the ORR and CR rate of canine measurable MCT treated with single agent Toceranib in 2 studies? What is the median response duration reported in one of those studies?
- ORR: 43-63%
- CR: 14-17%
- 3mo (shorter response one)
35
What is the ORR and CR rate of canine measurable MCT treated with masitinib in 2 studies?
- ORR: 55-82%
- CR: 26-38%
36
What is the ORR, CR rate, and median response duration of canine measurable MCT treated with Toceranib/CCNU combination therapy?
- ORR: 46%
- CR: 10%
- Not reached (CR), 4mo (PR)
37
What is the ORR and CR rate of canine measurable MCT treated with Toceranib/vinblastine combination therapy? ____% required dose reduction.
- ORR: 71%
- CR: 14%
- >50%
38
One study evaluated the use of post-operative prednisone and vinblastine for dogs with high-grade MCT and reported a MST of _____. A second study reported a ___% 1-year and 2-year DFS in high grade tumors treated with adjuvant vinblastine and prednisone.
MST 3.8 years
70%
39
What is the PFST and overall ST reported for dogs with high-risk MCT treated with surgery and adjuvant prednisone, CCNU, and vinblastine?
- PFST: 9mo
- Overall ST: 12mo
40
What is the PFST and OS for dogs with "high-risk" MCT treated with adjuvant combination therapy with Cytoxan, vinblastine, and prednisone?
- PFST: 2.5 yrs
- OS: > 5.7yrs
41
Palladia-treated c-kit MCTs had inferior PFS compared with c-kit wild type MCTS in one study with a hazard ratio of ____.
2.34
42
A clinical trial evaluating masitinib in dogs with recurrent or uresectable MCTs were compared to placebo controls. Outcome was improved in dogs with MCTs harboring activating _______ mutations. There was an increased number of patients with long-term disease control compared to placebo. For the treatment group, ___% were alive at 2 years, and for the placebo, ___% were alive at 2 years.
- c-kit
- treatment: 40%
- placebo: 15%
43
***A study evaluating the combination of Palladia, prednisone, and hypofractionated RT in dogs with unresectable and/or metastatic MCTs reported an ORR of ___%, CR rate of ___%, PR of ___%, PFI of ____, and oMST of ____.
- ORR: 76%
- CR: 59%
- PR: 18%
- PFI: 11mo
- oMST not reached (follow-up 12mo)
44
In one study, ___% of cutaneous and splenic/viscera MCT in cats had c-kit mutations.
67%
45
***c-kit mutations in feline MCT are primarily present in exons ___ (___%) and ___ (___%), which encode the 5th immunoglobulin domain of KIT.
- exon 8 (45%) and 9 (15%)
46
One study found that ___% of cats with cutaneous MCTs also had splenic disease.
3%
47
What are the IHC markers for feline MCT?
- vimentin, alpha-1 antitrypsin, and KIT
48
A MI cutoff of _____ has been suggested for feline cutaneous MCT to predict risk for local recurrence and metastasis.
5/10HPF
49
In recent studies evaluating the prognostic value of histologic and IHC features in cats with cutaneous MCT, _______ and _______ were the strongest predictive variables.
MI and KIT immunoreactivity score/localization
50
In a series of 32 cats with cutaneous MCTs treated with surgery, ___% developed local recurrence but none died of disease.
15%
51
In a recent series of cats with MCTs of the eyelids, local tumor control was achieved with surgery alone in ___%, MST was ____, and while only ___% of tumors were reported to be completely excised, NO cats developed recurrence or metastasis.
- 83%
- MST 32mo
- 50%
52
Some reports have demonstrated a local recurrence rate after excision of cutaneous MCT in cats to be ____-___%.
0-24%
53
The frequency of systemic spread after surgery in cats with cutaneous MCT is ___-___%.
0-22%
54
In one study of feline cutaneous MCT in microscopic disease setting after surgery, ___% control rate was achieved with strontium-90 with a MST of ______.
- 98%
- MST > 3 years
55
For cats with cutaneous MCT treated with CCNU, what is the ORR, CR, and PR?
- ORR 50%
- CR: 10%
- PR: 40%
56
Necropsy on 30 cats with splenic MCT revealed dissemination in what organs in descending order and their %?
- Liver (90%)
- Visceral LN (73%)
- Bone marrow (40%)
- Lung (20%)
- Intestine (17%)
57
Peripheral bood mastocytosis is seen in ____-____% of cats with splenic MCT.
40-100%
58
In a clinical report of 43 cats with splenic MCT, ___% had BM involvement.
23%
59
In a report of 43 cats with splenic MCT, ___% had an abnormal coagulation profile.
90%
60
Cats with splenic MCT treated with splenectomy in the face of metastatic disease report long-term MST of ____-_____ while in one study a MST of _____ was reported after splenectomy.
- MST 12-19mo
- MST 4mo
61
What are 3 negative prognostic indicators in cats with splenic MCT?
- Hyporexia, significant weight loss, and male sex
62
For feline intestinal MCT, prognosis has been reported to be poor because metastasis is common at presentation. Two recent studies totaling 48 cats suggest a more favorable outcome where MSTs after surgical and/or medical (TKIs/steroids) management were _____. _______ and ______ were prognostic whereas _______ was NOT prognostic. _____ KIT patterns were associated with a lesser differentiation. ____% of cats died from unrelated cause.
- MST ~1.5yrs
- Histologic differentiation and MI > 2
- c-kit mutation status = NOT
- cytoplasmic KIT patterns
- 26%
63
Surgery is the treatment of choice for feline intestinal MCT with wide margins of _____ - _____.
5-10 cm
64
What is the metastatic rate in dogs with SQ MCT with MC > 4/10hpf?
56%
65
For Patnaik grading of MCTs, list % alive at 48 months post surgery for each grade.
- low (grade I): 83%
- intermediate (grade II): 44%
- High (grade III): 6%
66
An average of ____ to ____ AgNORs per nuclease is associated with a less aggressive biologic behavior in canine cutaneous MCT while an average of ____ AgNORs per nucleus is associated with poor survival.
- Favorable: 1 to 3
- Poor: >4
67
Ki67 value of ______ is associated with a favorable prognosis in canine cutaneous mast cell tumor while a value of _____ is associated with a poor prognosis.
- favorable: 23
68
Cross sectioning (half and radial sections) combined with ______ of tumor margins is the preferred method to determine surgical excision of canine MCTs with a ___% higher sensitivity in detecting dirty margins when combined.
- tangential
- >20%
69
Describe HN1, HN2, and HN3.
- HN1: > 3 individualized MCs in sinuses in minimum of 4 HPFs
- HN2: aggregates of MCs (early metastasis)
- HN3: effacement (overt metastasis)
70
According to a recent review article, the incidence of grade 1/low grade MCT ranges from ___-___%, incidence of RLN metastasis at staging is __% and distant metastasis at staging is ___%, MCT related deaths is ___%, median survival time is ____, and 1-year survival rate is ___%.
- Incidence: 14-24%
- RLN: 6%
- Distant: 2%
- MCT-related deaths: 0%
- MST: not reached
- 1 year survival: 100%
71
According to a recent review article, the incidence of grade 2/low grade MCT ranges from ___-___%, incidence of RLN metastasis at staging is __% and distant metastasis at staging is ___%, MCT related deaths is ___ - ___%, median survival time is ____, and 1-year survival rate is ___%
- Incidence: 54-58%
- RLN: 16%
- Distant: 2%
- MCT related deaths: 3-17%
- MST: Not reached
- 1 year survival: 94%
72
According to a recent review article, the incidence of grade 2/high grade MCT ranges from ___-___%, incidence of RLN metastasis at staging is __% and distant metastasis at staging is ___%, MCT related deaths is ___ - ____%, median survival time is ____ - ____, and 1-year survival rate is ___%
- Incidence: 18-26%
- RLN: 15%
- Distant: 2%
- MCT related deaths: 14-56%
- MST: 8-23 mo
- 1-year survival: 46%
73
According to a recent review article, the incidence of grade 3/high grade MCT ranges from ___-___%, incidence of RLN metastasis at staging is __% and distant metastasis at staging is ___%, MCT related deaths is ___ - ___%, median survival time is ____ - ____, and 1-year survival rate is ___ - ____%
- Incidence: 11-18%
- RLN: 46%
- Distant: 21%
- MCT related deaths: 67-83%
- MST: 4-7mo
- 1-year survival 16-46%
74
According to a recent review article, the incidence of subcutaneous MCT is _____%, incidence of RLN metastasis at staging is ___% and distant metastasis at staging is ___%, MCT related deaths is ___ - ___%, median survival time is ____, and 1-year survival rate is ___ - ___%
- Incidence: 15%
- RLN: 1.5%
- Distant: 2.5%
- MCT related deaths: 8-9%
- MST: not reached
- 1 year survival: 91-95%
75
According to a recent review article, high risk breeds for high grade MCT are: (n=9)
1. Sharpei
2. Staffie
3. BMD
4. Cocker spaniel
5. Dachshund
6. Poodle
7. Maltese
8. Shih-tzu
9. Rottie
76
According to a recent review article, high grade MCT has a ____ greater odd of recurrence vs. low grade regardless of margin with ___% recurrence rate vs. ___% for low grade.
- 13.7 greater odd
- 36% vs. 4%
77
An older paper (2004), reported an ORR of ___%, a PFST of ____, and 1-year and 2-year PFS of ___% and ___%, respectively, for hypofractionated RT for measurable MCT in dogs.
- ORR: 89%
- 1 year PFS: 60%
- 2 year PFS: 52%
- PFS: 2.8 yrs
78
In a recent article, CCNU and prednisone for high grade microscopic canine MCT reported a local recurrence rate of ___%, ___% metastatic rate, and MST of ____.
- LR: 13%
- Met: 13%
- MST: 30 mo
79
A retrospective study evaluating the prevalence of malignancy in cats undergoing a splenectomy found that ___% of splenic masses were malignant with ____ and ____ being the most common types of neoplasia.
- 81%
- MCT (42%) and HSA (40%)
80
What was the reported MST of splenic MCT and splenic HSA in a retrospective study evaluating the prevalence of malignancy in cats undergoing splenectomy for a splenic mass?
- MST MCT: 12mo
- MST HSA: 3mo
81
In a recent retrospective study evaluating outcome of 17 dogs with high grade, stage 2 MCT undergoing local therapy (surgery +/- RT) and adjuvant cytotoxic chemotherapy, the MST was reported to be _____.
MST: 9 mo
82
In a recent retrospective study evaluating outcome of 17 dogs with high grade, stage 2 MCT undergoing local therapy (surgery +/- RT) and adjuvant cytotoxic chemotherapy, what 3 factors were associated with shorter survival times?
- local recurrence
- tumor location (head)
- ulceration
83
Correlation between CT and histologic evaluation of nodal metastasis in dogs with MCT was assessed. Sensitivity of CT was ____%, specificity was ___%, and accuracy was ___% for nodal metastasis.
- Sensitivity: 36%
- Specificity: 97%
- Accuracy: 60%
84
A recent retrospective study evaluating the behavior of canine mast cell tumors of the pinna in 39 dogs reported ___% were high grade. Of the 46% dogs that had SLN mapping, ____ was the most common SLN seen in ___%. ___% had LN metastasis and all were the ____ lymph node. The TTP was ____, the TSS was ____ for high grade and ____ for low grade.
- high grade: 49%
- Prescapular (superficial cervical): 94%
- 56% LN mets: all prescap
- TTP: 9mo
- TSS (high grade): 12mo
- TSS (low grade): not reached
85
*** c-kit mutation and localization status as response predictors for canine macroscopic mast cell tumors treated with prednisone and toceranib or vinblastine was prospectively evaluated in 88 dogs. There was NO significant difference in ORR, PFS, or OS between the two groups. C-kit mutation status did NOT predict treatment response. The ORR of toceranib/prednisone was ___% and ___% for vinblastine/prednisone. The PFS for toceranib/pred was _____ and ____ for vinblastine/pred. The OS for toceranib/pred was ____ and _____ for vinblastine/pred.
ORR
- Toceranib/pred: 46%
- Vinblastine/pred: 30%
PFS
- Toceranib/pred: 3mo
- Vinblastine/pred: 3mo
OS
- Toceranib/pred: 5mo
- Vinblastine/pred: 8mo
86
The pathological aspects of cutaneous mast cell tumors with metastases in 49 dogs was recently assessed. _____% of dogs with metastases were high grade. List the site of metastases in decreasing frequency and their %.
- 100% high grade
1. LN (96%)
2. Spleen (67%)
3. Liver (59%)
4. Bone marrow (41%)
5. Kidneys (33%)
6. Heart (29%)
7. Lungs (18%)
87
Longitudinal LN step-sectioning for identification of metastatic disease in canine mast cell tumor was recently evaluated. Evaluation of first section plus step-section produced an accuracy of ___%. First step sectioning had a ___% accuracy for HN3 LNs and ____% for HN2. It was concluded that step sectioning may increase accuracy.
- 100%
- 98% HN3
- 74% HN2
88
Describe the cytologic grading scheme for canine mast cell tumor. What is the sensitivity and specificity? High grade on histology had a ___ x more likely chance to die within 2 years and high grade on cytology has a ____x more likely chance to die within 2 years.
Cytologic grading scheme:
poor granulation
~ OR ~
2 of the following:
- mitotic figures
- >50% anisokaryosis
- binucleated/multinucleated cells
- nuclear pleomorphism
- Se: 88%, Sp: 94%
- High grade histo: 39x
- High grade cyto: 25x
89
A recent paper evaluated lymph node metastasis in feline LOW grade cutaneous MCTs in 17 cats. ___% had metastasis.
59%
90
*** Describe the proposed grading criteria for cutaneous high grade MCT in CATS. High grade using this criteria showed a significant reduction in MST. Cats with high grade MCT had a MST of _____ vs. cats with low grade at _____.
High grade criteria:
> 5 MC/10hpf
~ AND ~
At least 2 of the following:
- Nucleolar prominence/chromatin clusters
- Irregular nuclear shape
- Tumor diameter >1.5cm
MST
- high grade: 12mo
- low grade: not reached
91
A systematic review of surgical margins utilized for removal of cutaneous MCT in dogs was recently performed. Resection of canine cutaneous MCTs that are _____ in size and grade I and II with ____ lateral margins and ___ fascial plane deep result in low rates of incomplete excision and local recurrence.
- <4cm
- 2cm lateral
- 1 fascial plane deep
92
The feasibility and utility of optical coherence tomography (OCT) directed histopathology for surgical margin assessment in canine mast cell tumors recently reported a ___% sensitivity and ___% specificity.
- Se: 90%
- Sp: 56%
93
*** Intranasal mast cell tumors were recently evaluated in 20 dogs. The metastatic rate was ___% with ____ being the most common site. Of the dogs with available outcome, ___% died from MCT within 1 year.
- 55%: mandibular LN
- 43%
94
A recent systematic review and meta-analysis of histologically low-grade yet biologically high grade canine cutaneous MCTs was recently performed. The MST for dogs with distant metastasis was ____ and ____ for regional lymph node metastasis. An increased risk of death was associated with _____ (HR ___) and _____ (HR ____).
MST
- distant: 7mo
- RLN: 21mo
Increased risk of death
- distant met: HR 2.6
- not receiving surgery: HR 3.79
95
A recent retrospective study of mast cell tumors in dogs less than 12 months of age was performed. Despite the common presence of various negative prognostic factors and a ___% regional LN metastatic rate, the DFI rate at 3 years after diagnosis was ___%, even without extensive treatment.
- 33% RLN
- DFI 3 year: 100%
96
A recent retrospective analysis out of Italy evaluated prognostic factors and outcome of subcutaneous MCTs in dogs undergoing surgery +/- adjuvant therapy. The recurrence rate was ___%. ____% of evaluated lymph nodes had early or overt metastasis. The TTP and MST were ______ and _____.
- LR: 15%
- RLN: 63%
- TTP and MST not reached
97
A recent retrospective study evaluating dogs with high grade MCT, clinical stage I, was performed in 49 dogs. The oMST was ____ with 1-year and 2-year survival rates of ____% and ___%, respectively. Local recurrence occurred in ___% and lymph node metastasis occurred in ___%. Increasing MC and tumor diameter were negative prognostic factors. For dogs who developed LN metastasis, MST was ______ vs. those who did not develop metastasis at _____.
- oMST: 35mo
- 1 year survival: 79%
- 2 year survival: 73%
- LR: 18%
- LN met: 12%
MST
- LN met: 15mo
- No LN met: 4.5 years!!
98
A recent retrospective study of 60 dogs with low and high grade cMCTs AND at least one overtly metastatic sentinel LN undergoing standardized treatment consisting of surgical excision of cMCT, lymphadenectomy, and chemotherapy was performed. The TTP for high grade tumors were ____ and ____ for low grade. The MST for high grade tumors was ____ and ___ for low grade. _____ and ____ were negative prognostic factors. The authors concluded histologic grade has a higher-weighted value than nodal status as a predictor of outcome.
TTP:
- high grade: 7mo
- low grade: not reached
MST:
- high grade: 18mo
- low grade: not reached
Negative prognostic factors:
- grade
- incomplete margins
99
A recent systematic review and meta-analysis for the prognostic value of IHC markers in canine cMCTs was performed. _____ and ____ were found to be suitable prognostic factors with an OR of ____ and ____, respectively.
- Ki67 (OR 11.2)
- BAX (OR 9.9)
100
A recent retrospective study evaluating prognostic indicators and clinical outcome in 43 dogs with subcutaneous MCTs treated with surgery alone reported a PFS of _____, DFI of _____, and MST of _____. ____ was a negative prognostic factor for PFS.
- PFS: 49mo
- DFI and MST: not reached
- AgNOR
101
A recent retrospective study evaluating factors affecting prognosis in 45 dogs with subcutaneous mast cell tumors was performed and concluded that these tumors may be a more aggressive disease than previously reported. Local recurrence rate was ___%, metastatic recurrence was ___%, and lymph node metastatic rate was ___%. DFI for dogs with lymph node metastasis was _____ vs. those without at _____. MST for dogs with lymph node metastasis was ____ and ____ for those without. An infiltrative pattern was associated with a significantly shorter DFI of _____ vs. ____ without. _____ and ____ significantly decreased survival.
- LR: 18%
- metastatic recurrence: 11%
- LN met: 27%
DFI
- LN met: 7mo
- No LN met: not reached
MST
- LN met: 18mo
- No LN met: not reached
DFI
- Infiltrative pattern: 9mo
- Absent pattern: not reached
- Local recurrence and LN metastasis significantly reduced survival
102
A recent prospective study of 82 dogs with high-risk mast cell tumors evaluating ultrasound as a predictor for early or overt liver or spleen metastasis. What was the sensitivity, specificity, PPV, and NPV of ultrasound for spleen and liver metastasis? The TTP for dogs with no metastasis was ____, ______ for early metastasis, and _____ for overt metastasis. The MST for dogs with no metastasis was ____, _____ for early metastasis, and _____ for overt metastasis.
Spleen:
- Se: 67%
- Sp: 68%
- PPV: 21%
- NPV: 94%
Liver:
- Se: 29%
- Sp: 93%
- PPV: 56%
- NPV: 82%
TTP
- No met: not reached
- early met: 10mo
- overt met: 2mo
MST:
- No met: not reached
- early met: 11mo
- overt met: 3mo
103
***The utility of spleen and liver cytology in staging of canine mast cell tumors was recently evaluated in 205 dogs. The OR for spleen cytology correlating with liver (positive or negative) was ______. ______ spleen cytology had an improved predictive value over _____ spleen cytology in predicting liver status. The predictive value for negative spleen cytology in predicting negative liver cytology was ____, and the predictive value for positive spleen cytology in predicting positive liver cytology was ____.
- ORR 233.49
- predictive value for negative spleen cytology: 0.99
- predictive value for positive spleen cytology: 0.54
104
CT features of subcutaneous, intermuscular, and intramuscular MCT in dogs was recently evaluated. What was the sensitivity and specificity in CT predicting correct location? CT was insufficient for curative-intent surgical planning in ___% of cases.
- Se: 86%
- Sp: 56%
- 81%
105
***Biopsy of sentinel lymph nodes after injection of methylene blue and lymphoscintigraphic guidance in 30 dogs with mast cell tumors was recently performed. The SLN differed from expected regional LN in ___% of cases and metastasis of "normal" appearing SLN was found in ___% of cases.
- 63%
- 56%
106
The therapeutic impact of regional lymphadenectomy in canine stage II cutaneous mast cell tumors was recently evaluated. The risk of tumor progression was _____ in dogs NOT undergoing lymphadenectomy for metastatic LN's and the risk of tumor-related death was _____.
- tumor progression: 5.47
- tumor-related death: 3.6
107
A recent prospective observational study evaluating CT features of cutaneous and subcutaneous canine mast cell tumors and the utility of conventional and indirect lymphography to detect clinically unknown mast cell tumors and to map SLNs was performed. CT had high/low accuracy in distinguishing cMCT from scMCT (___%)? Additional incidental MCTs were found in ____% using CT, and indirect lymphography detection rate of SLN was ___%.
- LOW accuracy: 57%
- 32% incidental MCTs
- 97% detection rate
108
A recent prospective clinical study of 20 dogs with cutaneous mast cell tumors compared indirect CT lymphography and near-infrared fluorescence SLN mapping. Combining techniques yielded high SLN detection rates. Technique agreement was ___% (including complete and partial). 95% of the population had low grade/grade II MCTs, but ___% were found to have HN2-3 LNs, suggesting lymph node metastasis may be more common than previously reported for intermediate to low grade MCT.
- agreement: 80%
- 95% HN2-3 LNs
109
A recent study evaluating STA-1474, which is a pro-drug of HSP90 inhibitor, _______, was performed in murine models and canine mast cell tumors. In dogs with canine mast cell tumors, dosing on day 1 and day 2 was associated with sustained _____ downregulation, ___% ORR, and ___% clinical benefit rate.
- ganetespib
- KIT
- ORR: 50%
- Clinical benefit rate: 100%
110
A recent study evaluated histological, IHC, clinical, and genetic prognostic factors associated with response of canine mast cell tumors to glucocorticotherapy in 60 dogs. Prednisone was given for 7-14 days prior to surgical biopsy (incisional or excisional) . PR was reported in ___% with the remainder having no response. Response correlated with favorable prognostic factors.
- PR: 63%
111
Hematologic toxicity in dogs with mast cell tumors treated with vinblastine/prednisolone chemotherapy with or without radiotherapy was recently evaluated in a retrospective study. RT and vinblastine concurrent therapy was well tolerated with NO increase risk in myelosuppression. Neutropenia was ___% in RT group and ___% in control group.
- RT: 18%
- Control: 23%
112
Safety and efficacy of intralesional triamcinolone administration for treatment of mast cell tumors in 23 dogs was performed. Triamcinolone was given alone or in combination with other therapies. The ORR was ____%, the CR rate was ___%, PR was ____%, and the TTP was ____.
- ORR: 67%
- CR: 17%
- PR: 50%
- TTP: 2mo
113
***The benefit of RT for high grade MCTs in 42 dogs was recently retrospectively evaluated. Prophylactic lymph node RT significantly improved PFS. Dogs with stage 0 high grade MCT who received prophylactic lymph node RT had a PFS of _____ compared to dogs with stage 0 that did not receive prophylactic lymph node radiation at _____. LN treatment with RT in dogs that were previously stage 2 (lymph node bed) had significantly improved survival of _____ compared to dogs that were stage 0 and did not receive prophylactic radiation at _____.
PFS
- prophylactic LN RT: 6.5 yrs
- Stage 0 no LN RT: 7mo
OS
- LN bed RT for prior stage 2: 5.2yrs
- Stage 0 no LN RT: 10mo
114
Pre-operative neoadjuvant vinblastine - prednisolone in 43 dog with mast cell tumors was recently evaluated. The ORR was ___%. Wound dehiscence occurred in ___% and complete excision occurred in ___%. LR occurred in ___% and ___% of completely excised MCT recurred.
- ORR: 40%
- Wound dehiscence: 17%
- Complete excision: 47%
- LR: 20%
- Completely excised LR 27%
115
A recent retrospective study evaluated outcomes of adjunctive radiation therapy for treatment of mast cell tumors in 300 dogs. Local recurrence was similar regardless of protocol. Local recurrence was ___% at median of ____.
LR: 7%
Median: 18mo
116
A multicenter, open-label, uncontrolled, non-randomized dose de-escalation design was used to assess tigilanol tiglate (Stelfonta) for treatment of canine MCTs. A ___% CR rate was found at dose _____.
- CR 90% at 1 mg/ml
117
A randomized controlled clinical study evaluating the efficacy and safety of tigilanol tiglate in 123 dogs with mast cell tumors was performed. After 1 treatment, the CR rate was ___% by 1 month. A second treatment increased CR rate to ___%.
- 1 tx: CR 75%
- 2 tx: CR 88%
118
Recurrence-free interval of 12 months after treatment with tigilanol tiglate in dogs with mast cell tumors was recently performed. At 12 months, ___% were tumor free and ___% had LR. LR predominantly occurred when?
- 12mo tumor free: 89%
- LR 11%
- LR predominantly occurred within first 3 months
119
The impact of lymphadenectomy on outcomes in 49 dogs with high grade MCT and overt regional lN metastasis was recently evaluated. TTP for dogs that underwent lymphadenectomy was ____ vs. those without at ____. The MST for dogs that underwent lymphadenectomy was ____ vs. those without at _____. It was concluded that regional lymphadenectomy may improve outcome in dogs with biologically aggressive cMCTs.
TTP
- Lymphadenectomy: 8mo
- No " ": 5mo
MST
- Lymphadenectomy: 12mo
- No " ": 8mo
120
***A large retrospective study evaluating 9,000 feline cutaneous tumors was performed. The majority of masses were neoplastic with ____% of neoplastic masses being malignant. The 4 most common tumor types were _____, ______, _____, and _____ in decreasing frequency. ____ and _____ had increased odds of developing skin tumors. Several breeds had decreased odds of developing skin tumors (n=4) and malignant tumors (n=8). Try to name them. Several breeds had increased odds of developing MCT. ***Name these breeds (n= 7).
- 53% malignant
- Basal cell tumor (23%) > FSA (20%), SCC (11%), and MCT (7%)
- Increased odds of skin tumors: British Blue and Himalayan
- Decreased odds of skin tumors: Siamese, Burmese, oriental breeds
- Decreased odds of malignant tumors: Persian, Siamese, Burmese, Ragdoll, British Blue, Birman, Norwegian Forest cat
- Increased odds of MCT: Siamese, Burmese, Main Coon, and Ragdoll, Oriental, Russian Blue, and Havana
121
Retrospective evaluation of Palladia in cats with mast cell neoplasia revealed a clinical benefit of ___%, including ___% for cutaneous, ___% with visceral, and ___% with intestinal involvement. A majority of cats received glucocorticoids during treatment. Treatment was generally well tolerated with ___% experiencing AEs, mostly _____ and ____.
- oCB: 80%
- CB cutaneous: 86%
- CB visceral: 80%
- CB intestinal: 76%
- AEs: 60% (mostly low grade GI or hematologic
122
Retrospective evaluation of Palladia toxicity in cats was performed. _____ (__%) and _____ (____%) were most common hematologic toxicities. _____ (___%) and ______ (___%) were most common biochemical alterations. GI toxicity was seen in ___% of cats.
- Thrombocytopenia (16%) and neutropenia (9%)
- Azotemia (15%) and ALT elevations (7%)
- GI toxicity: 22%
123
A retrospective evaluation of Palladia toxicity and response in 14 cats with neoplasia (mostly mast cell tumor or epithelial neoplasms) was assessed. ___% developed toxicity, mostly _____ and _______. Severe _____ toxicity was seen in ___%. Overall biologic response was ____% with cats achieving PR or CR having mast cell disease. Overall median duration of response was ____. None of the cats with _____ achieved a response.
- 71% toxicity: mostly GI and hematological
- 2 cats developed severe hepatotoxicity (14%)
- Overall biologic response: 57%
- Median duration of response: 3 mo
- SCC
124
A 3+3 dose escalation study in 21 cancer-bearing cats evaluating low-dose meloxicam and Palladia was performed. When combined with Palladia, a meloxicam dose of ______ was well tolerated.
0.02 mg/kg q24
125
High-dose oral calcitriol (DN101) was assessed in an older study of dogs with MCT. ORR was ___% with ___% achieving CR and ___% experiencing PR, although majority experienced toxicity, necessitating discontinuation of the trial. Calcitriol exhibited synergistic, antiproliferative activity when used in combination with ____, _____, _____ or ______ in vitro. The concentrations required for 50% growth inhibition were generally ___ - ___ - fold lower when the drugs were used in combination than when used individually.
- ORR: 40%
- CR: 10%
- PR: 30%
- CCNU, vinblastine, toceranib, imatinib
- 2 to 6 fold lower
126
***To evaluate the consistency of microscopic grading among veterinary pathologists and the prognostic significance of the Patnaik grading system, 95 cutaneous MCTs from 95 dogs were graded in a blinded study by 28 veterinary pathologists from 16 institutions. Concordance among veterinary pathologists was ___% for the diagnosis of grade 3 MCTs and less than ____% for the diagnosis of grade 1 and 2 MCTs. According to the novel Kiupel grading system, high-grade MCTs were significantly associated with shorter time to metastasis or new tumor development, and with shorter survival time. The median survival time was _____ for high-grade MCTs but _____ for low-grade MCTs.
- 75%
- 64%
- <4mo
- > 2 years
127
What is the response rate for measurable MCT in dogs treated with vinorelbine?
13%
