Oncology Flashcards
Rescue therapy for feline LSA:
–Lomustine, methotrexate, cytarabine
–Mustargen, vinc, melphalan, and pred (MOMP)
–Mustargen, vinc, procarbazine, pred (MOPP)
For each protocol:
–% responders?
–Adverse effects?
–PFS?
LMC and MOMP were similar
– ~half
–Occ neutropenia, thrombocytopenia
MOPP:
–70%
–Occ GI, neutropenia
Median PFS:
LMC 2mo (up to 2yrs)
MOMP 3wks (up to 1yr)
MOPP 5.5mo (up to 2yrs)
**Note – MOPP was the largest paper and was mostly GI LSA. LMC and MOMP were much smaller and more heterogenous.
JFMS 2021 Smallwood
JFMS 2019 Martin
JFMS 2020 Maloney
What proportion of cats with GI SCLSA go on to develop large cell LSA?
On average, what is the time interval between the two diagnoses?
9%
1.5yrs
JFMS 2019 Wright
For cats with FeLV associated multicentric or mediastinal LSA treated with the novel LOPH protocol (lomustine, vinc, pred, doxo):
–% with partial or complete response?
–MST? Better or worse than previous studies of non-FeLV large cell LSA?
–Frequency and severity of bone marrow suppression?
95%
6mo – better
100%, usually mild or moderate
JFMS 2021 Horta
What is Tanovea’s generic name and MoA?
Overall response rate for LSA (studies included naive and relapsed dogs)?
Tanovea has the usual chemo “BAG” AEs. Name two additional more peculiar AEs, their frequency, and timing of when they show up.
Rabacfosadine
Nucleotide. Cell cycle specific (S phase). Inhibits DNA polymerase.
75-100%
Derm >50%, usually later in tx (prob cumulative effect)
Pulmonary fibrosis 4%, by mean 3mo, usually fatal
JVIM 2021 Weishaar
How does mitoxantrone compare with doxorubicin in terms of efficacy (as part of an LSA protocol) and cardiotoxicity?
Equal efficacy, less cardiotoxic
JAVMA 2019 Marquardt
What is the importance of the ATP-binding cassette transporter?
Expressed in high levels in T cell and hypercalcemic lymphomas. Associated with chemo resistance.
JSAP Angelo 2019
Are the following at the time of LSA diagnosis positive, negative, or not prognostic indicators for response rate and survival in dogs:
Neutrophilia
Neutrophil:lymphocyte ratio
Neutrophilia – negative
Neutrophil:lymphocyte ratio – not prognostically significant
JAVMA 2021 Veluvolu
How do the following affect prognosis in dogs with B cell CLL?
Breed
Ki67
Lymphocyte count
CS at presentation
What is the overall MST?
Worse px if:
–Boxer
–High (>40%) Ki67
–High (>60K) Lymphs
–CS at presenation
MST 10mo
JVIM 2021 Rout
Answer the following about ALL in cats based on a small study (N=6).
–CS?
–Common CBC findings?
–MST?
Nonspecific
Anemia, thrombocytopenia, variable WBC count, variable numbers of circulating blasts. TAKEAWAY – always consider ALL if there are blasts, even if just a few!
MST 2mo
JSAP 2018 Tomiyasu
Answer the following regarding cutaneous LSA in dogs.
–Difference between epitheliotropic and nonepitheliotropic?
–Proportion with LN or visceral involvement?
–Prevalence of T vs B cell?
–Are dermal lesions consistent or variable?
–Is clinical course consistent or variable?
Epith –> just in dermis, more common.
Nonepith –> diffuse throughout dermis and SQ.
Most have LNs affected, half visceral
Half T, half B
Lesions and clinical course are highly variable, can mimic other dermatopathies, can do well (>3yrs) or horrible (1 week) with chemo
JAVMA 2021 Watton
MST for canine CNS LSA that received any kind of tx (chemo, sx/radiation, etc)?
6mo (range 1d - 4.3yr)
JSAP 2018 LaRue
What proportion of cats with discrete intermediate or large cell GI LSA will perforate post starting chemo (no sx)?
Approximate timing?
Any risk factors?
17%
2mo
Higher magnitude of weight loss at dx
JFMS 2018 Crouse
What is the MST for feline renal lymphoma using pred vs L-CHOP?
Pred 2mo, L-CHOP 6mo. BUT both had extremely wide ranges (some of the pred only cats did well for years).
JFMS 2021 Williams
How dose LN cytology perform in the following areas?
–Ability to rule in/out LSA in LNs aspirated for any reason
–NPV for cases suspected of LSA
–More detailed classification (high vs low grade, T vs B cell)
–Good – high sens/spec/PPV/NPV
–Low – so don’t rely on a neg cytology alone if you think it’s LSA
–Worse for this
JVIM 2021 Martini
What are the most common findings in dogs with renal LSA?
–Clinically well vs sick
–RBCs low, normal, high
–One vs both kidneys affected
–Presence of abdominal lymphadenopathy
MST with chemo?
Sick, erythrocytosis, bilateral renomegaly, abdominal lymphanopathy
MST 6 wks
JSAP 2019 Taylor
How does PARR perform for differentiating LSA vs non-LSA in dogs for bx, flow cytometry pellets, and FNA?
Fairly high sens/spec for all – so any sample type is fine
JVIM 2019 Ehrhart
What does CHOP stand for?
Cyclophosphamide
Doxorubicin (hydroxydaunorubicin)
Vincristine (Oncovin)
Pred
You have a patient hospitalized with a new diagnosis of lymphoma. You recommend L-asparaginase to stabilize him pending onco transfer. The owner is concerned because they have a family member who received that drug and became encephalopathic.
In basic terms, how does this complication happen? What can you tell the owner about this complication in dogs? Any known risk factors?
L-asparaginase –> incr breakdown of asparagine and glutamine –> incr deamination and ammonia production –> overwhelms urea cycle –> hyperammonemic encephalopathy
Rare complication in people. In a canine study, subclinical hyperammonemia was common (no apparent risk factors) but none became encephalopathic.
JVECC 2019 Sepas
You are treating a dog with high grade lymphoma. He is clinically doing well. You submit a serum TK1 level as routine monitoring and it returns much higher than it was last month. What is the significance?
TK1 is associated with cellular proliferation and is higher in dogs with LSA vs healthy.
A significant increase of TK1 during LSA tx is predictive of early relapse.
JVIM 2019 Boye
Chemotherapy commonly causes bone marrow suppression. Your LSA patient is thrombocytopenic prior to his scheduled vincristine dose. Should you postpone it?
No – vinc increases plt count in LSA dogs, not contraindicated
JSAP 2019 Campbell
Answer the following regarding T-zone LSA.
–Characteristically lacks which cell surface marker?
–High levels of which two markers? What does this imply about potential risk factors?
–Overrepresented breed?
–Do omega-3 FAs increase, decrease, or not affect risk?
CD45
CD21, CD25 - activated phenotype. A study showed association with a handful of inflammatory conditions. Inflammation may potentiate T-zone LSA.
Goldens
Decrease
JVIM 2019 Labadie
How do disease stage and plt count affect prognosis of HSA?
Stage 3 (distant mets) and thrombocytopenia –> worse px
JAVMA 2021 Masyr
Compare the MST for periarticular histiocytic sarcoma vs non-periarticular vs hemophagocytic.
Two studies found that pred tends to help or hurt?
Periarticular 1yr
Non-periarticular 4mo
Hemophagocytic 1-2mo, no effective tx
Using pred –> worse px
2019 VCNA Mullin
Thalidomide has been shown to be beneficial in treatment of what type of cancer?
What first line drug is typically used? MST with this?
HSA
Doxorubicin 5-8mo
2019 VCNA Mullin
True or False: Studies support that Yunnan Baiyao is beneficial for HSA patients.
False
2019 VCNA Mullin
True or False: Dermal carries a favorable prognosis and wide surgical excision is generally curative.
True
2019 VCNA Mullin
Answer the following regarding skeletal muscle metastases (SMM) in dogs with HSA.
–Prevalance?
–Sex predilection?
–Usually one or multiple mets?
–% lameness in SMM vs non-SMM dogs?
25%
Male
All had multiple mets
60% SMM lame, none of the non-SMM dogs were lame
JVIM 2019 Carloni
True or False: HSA dogs treated with carboplatin have worse survival than with doxorubicin.
False – was comparable
JVIM 2021 Faulhaber
A study in HSA dogs treated with carboplatin evaluated monocyte count as a potential prognostic indicator. What did they find?
Incr monocytes post splenectomy –> worse px
JVIM 2021 Faulhaber
MST for feline mammary neoplasia overall? MST if it has metastasized?
1.5yrs overall
If mets –> 6-8 weeks depending on the chemo protocol
CS at diagnosis –> worse px (2 weeks)
JFMS 2021 Petrucci
JSAP 2023 Price
8yr FI lab with multiple mammary masses. Is she more likely to have benign tumors or malignant tumors?
Overall odds are in favor of benign. More than one mass does not incr prevalence of malignancy.
JAVMA 2019 Litterine-Kaufman
What is the local recurrence rate of dermal MCT in dogs treated with adjunctive chemo? SQ MCT?
7%, 0%
JVIM 2021 Mason
2yr FS Sphinx cat with chronic, raised red spots on the front half of her body, esp head/neck and axillas. She is itchy on exam.
–Her age, signalment, and CS should put what cancer on your ddx list?
–What form would this be? What are the two other presenations?
–One other predisposed breed?
–How does this disease typically respond to tx?
Maculopapular cutaneous mastocytosis
–Monomorphic (this cat): small lesions, crusts, moderate pruritus
–Polymorphic: bigger lesions, wheals, moderate pruritus
–Chronic pigmented: pigmentation, lichenification, severe pruritus
Devon rex
Variable
JFMS 2019 Ngo
What are four basic features of MCT histopath that would be consistent with high grade disease?
What are two IHC markers of prognostic value?
High grade has lots of:
–Mitotic figures
–Multinucleated cells
–Bizarre nuclei
–Variation in nuclear diameter
Worse px if incr markers of cell growth:
–Kit expression and c-Kit mutation
–AgNOR x Ki67 index
VCNA 2019 Kiupel
For dogs with MCT treated with vinblastine, does concurrent radiation increase, decrease, or not change the risk of neutropenia?
No change
JSAP 2019 Stiborova
True or False: Oral malignant melanoma and oral SCC have unpredictable LN metastases (site and side relative to the tumor). Thus, proactive removal of both mandibular and medial retropharyngeal nodes should be part of the tx plan.
True
JAVMA 2019 Grimes
Stereotactic body radiation therapy (SBRT) delivers a high dose of radiation to a small target.
In a small study of cats with advanced facial SCC, what was the relative safety and efficacy?
Safe – acute and late effects were common but mild and easy to medically manage
Effective – all cats had complete response.
JFMS 2021 Swan
What is the gold standard treatment for oral SCC or oral fibrosarcoma?
Which tumor type carries a better px?
If gold standard tx is insufficient, would either tumor type benefit from a follow up therapy?
Gold standard = aggressive sx to achieve clean margins
SCC better px (MST not reached) vs fibrosarcoma (MST 1.5yrs)
If dirty margins, SCC benefits from radiation (MST without 6mo vs with 5.5yrs) but fibrosarcoma does not (with 10mo, without 2yrs)
JAVMA 2018 Riggs
What is photodynamic therapy?
What is it used to treat?
What two characteristics would make a tumor a poor candidate for this treatment?
Noninvasive tx for feline SCC using a photosensitizer, light, and endogenous molecular oxygen to kill cancer cells.
84% of cats respond, mean PFI 3yrs, OST 3.3yrs.
Contraindicated if large or invasive tumor
JFMS 2018 Flickinger
In cats with SCC treated by radiation, how does fractionated vs single dose affect response rate and survival time?
Three prognostic factors?
No difference
Worse px:
–Larger/more advanced tumor (esp if nasal planum tumor extended to upper lip)
–Comorbidities
–Partial or incomplete response to tx
–Male
JFMS 2019 Berlato
JFMS 2019 Lino
Which two markers are found in >95% of feline injection site sarcomas?
c-KIT
COX-2
Desmin
DOG1
E-cadherin
FeLV viral particle
S-100 protein
Vimentin
Vimentin, S-100 protein
JFMS 2019 Carneiro
In cats with injection site sarcoma treated with surgery, which cats would benefit from definitive radiation vs palliative?
First time sx –> definitive (median PFI 4yrs)
Multiple sx –> palliative is fine, no additional benefit from definitive (median PFI 1.5yrs)
JFMS 2019 rossi
What percentage of STS grade 3 vs grades 1 and 2 have pulmonary mets?
STS grade 3: 38%
STS grade 1, 2: 6%
JAVMA 2021 Jan
Regarding giant cell pleomorphic sarcoma (aka malignant fibrous histiocytoma) in cats:
Do these tend to be large (>2cm) or small (<2cm) at the time of diagnosis?
Three cell types on cytology and histopath?
Which of the following IHC markers are useful?
–Desmin
–DOG1
–E-cadherin
–Iba-1
–S-100
–Vimentin
Large
Cyto: spindle cells, small round cells, multinucleated giant cells on dense eosinophilic stroma
All bx in the study were positive for Iba-1 (confirms histiocyte origin) and vimentin (spindle cells), neg for S-100. Variable Desmin – not helpful.
**Note – very similar findings to a tumor type in people
JFMS 2021 de Cecco
in dogs with osteosarcoma tx with amputation, does prompt initiation of chemo post op affect DFI and/or MST?
Chemo within 5d of sx –> SHORTER DFI and MST. So give it a week!
JAVMA 2021 Marconat
True or False: Carboplatin SQ is better tolerated than IV and achieves a longer MST in dogs with OSA.
False. Well tolerated but no difference in MST, recc use carbo IV.
JAVMA 2019 Santamaria
You are seeing an OSA patient for a routine visit. You detect a new skin mass on physical exam. It doesn’t bother the dog.
Do you monitor or recommend testing? Why?
If the latter, what test do you do for the mass?
Test it – if cutaneous or SQ met, add’l mets are likely already present or soon to follow and px is poor (sx+chemo 3mo, chemo 2mo, no tx 1.5 weeks).
Can usually dx via FNA/cyto. ALP staining may be helpful.
JVIM 2019 Parachini-Winter
Flourodeoxyglucose is a glucose analogue taken up by active cells. This can be measured via PET/CT scan to identify tumors and mets. How does SUVmax (max standard uptake value) inform prognosis for OSA dogs?
Higher SUVmax –> shorter survival
JVIM 2019 Griffin
True or False: Amiloride (K+ sparing diuretic) is synergistic with doxorubicin in tx of canine OSA.
True
JVIM 2019 Poon
Regarding PTH carcinoma treated with sx:
–How long til resolution of hypercalcemia?
–Frequency of hypocalcemia? How many required rehospitalization for it? How many were euth’d for refractory hypocalcemia?
–Any predictors for PTH carcinoma vs adenoma, or post op hypocalcemia?
–How many had mets post op? How did clean vs dirty margins affect this risk?
–75% normal iCa within 2d, most of the rest within a week
–24% mild hypocalcemia, 6% severe –> rehospitalize, 3% refractory –> euth
–PTH carcinomas tended to be slightly larger but lots of overlap. No predictors for post op hypoCa (incl preop iCa).
–Mets 1% (1 dog). At least 50% of dogs had dirty margins. So, cancer on paper but behaviorally benign.
JAVMA 2021 Erickson
Regarding canine thyroid tumors:
–What proportion of palpable thyroid masses are malignant?
–Overall complication rate? One risk factor?
–Most common periop complication?
–At least two post op complications?
–% that died prior to discharge?
–MST?
–Any benefit in surgery for dogs with mets?
90%
20%, higher risk if fixed (and thus more invasive) tumor. Periop - hemorrhage. Post op - asp pneumonia (most common), lar-par, Horner’s, hypothyroidism.
2%
MST 2.5yrs
Mets are rare and dog may still benefit from sx
JAVMA 2018 Reagan
JVIM 2023 Enache
In dogs with confirmed gliomas, which of the following affect survival time:
Tumor type
Tumor grade
Tumor size
Tumor location
Definitive vs palliative tx
How does this compare with other studies that include several different tumor types (presumed based on imaging, no bx) treated with radiation?
Glioma: Only definitive vs palliative tx affected MST (3mo vs 1mo). Overall, px is poor.
Other more general studies have conflicting results. Depending on the study, tumor size and/or location, type may be prognostic. Overall MST with radiation ~1-2yrs.
JVIM 2021 Jose-Lopez
JVIM 2021 Carter
JVIM 2018 Schwarz