A wave of technological advancements in fighting cancer – as well as a new understanding for care – has given pet owners new hope
When it comes to cancer diagnoses for pets, the conversations between veterinarian and pet owners have changed in recent years. And that’s a good thing, says Dr. Barbara Biller, DVM, Ph.D., Diplomate ACVIM (Oncology).
“I see very few pet owners these days that say ‘My regular veterinarian said there was nothing we can do and we should just put our animal to sleep,’” says Biller, an associate professor of medical oncology at the Flint Animal Cancer Center, Colorado State University. “That was a statement I heard way more often in the first 10 years of my career rather than in the past 10 years – thankfully.”
Indeed, pet owners and general practice veterinarians are becoming increasingly aware of the fact that cancer can be treated successfully in dogs and cats, says Biller.
“Owners are coming to see the specialist more often and earlier in the course of the disease because they are better informed and aware of the potential treatment options – this information is coming from their family DVM and through other sources such as social media, the internet, etc.”
Prevalence and advancements
According to the National Cancer Institute, there are 65 million dogs and 32 million cats in the United States. Of these, roughly 6 million new cancer diagnoses are made in dogs and a similar number made in cats each year.
Cancer in the pet population is a spontaneous disease often similar to cancer seen in humans, according to the Animal Cancer Foundation. Some examples include non-Hodgkin’s lymphoma, prostate cancer, head and neck carcinoma, mammary carcinoma, melanoma, soft tissue sarcoma, and osteosarcoma.
Fortunately, the bar has been raised – and continues to be raised – in the care pets can receive. There are a range of treatment choices available that may balance quality of life, cost and owner goals, says Biller. Over the past few years the veterinary oncology field has witnessed the development of chemotherapy drugs that are specifically designed to treat particular kinds of cancer in dogs. “This is exciting because up until this time we have always used chemotherapy drugs that were designed for human cancer patients and then adapt them to use in dogs or cats.”
For example, VetDC’s TANOVEA-CA1 is a novel I.V. chemotherapy drug licensed specifically to treat lymphoma in dogs. It has been available as a treatment choice for about the past two years based on promising data from the initial clinical trials, says Biller. Veterinarians with the Flint Animal Cancer Center were key advisors as the Fort Collins-based VetDC refined Tanovea-CA1 for veterinary use, according to a CSU release.
Another example Biller points to is Zoetis’ PALLADIA®, an oral chemotherapy drug licensed for the treatment of mast cell tumors in dogs (a common type of skin cancer).
“It seems likely that other chemotherapy drugs will be developed to treat other kinds of cancer in dogs – and hopefully cats too – over the next few years,” says Biller.
In 2007, Merial (now part of Boehringer Ingelheim) released its melanoma vaccine Oncept for the prevention of spread of melanoma to the lungs and lymph nodes in dogs with stage 2 and stage 3 melanoma. In 2010, Merial gained full-licensure from the U.S. Department of Agriculture for ONCEPT™ Canine Melanoma Vaccine, DNA.
In December 2017, Aratana Therapeutics, Inc. received approval for conditional licensure from the USDA Center for Veterinary Biologics for its Canine Osteosarcoma Vaccine, Live Listeria Vector (AT-014), for the treatment of dogs diagnosed with osteosarcoma, one year of age or older.
Oncology advancements have been occurring in veterinary medicine at a steady pace for more than a decade, says Joyce A. Login, DVM, senior manager of veterinary specialty operations at Zoetis. Following those product introductions, there have been connecting trends of veterinary medicine moving forward, as well as clients understanding and expecting more state-of-the-art medicine. “That’s all kind of rolled up into having so many more oncology specialists that it’s all working together to move oncology forward, which is very encouraging.”
Login says that along with the veterinary approved chemotherapeutic and immunological agents that are coming to pass, there are oncology specialists and specialty hospitals providing amazing treatment options that wouldn’t have been thought of 15-20 years ago. Now, MRIs and CAT scans are routine. Veterinary specialists are doing more advanced procedures with technology such as CyberKnife (also called stereotactic radiosurgery) and other forms of radiation therapy. “These are amazingly forward treatments for oncology in animal health,” says Login.
Pain management should be a huge part of the oncology discussion, Login says. “I think we’ve been lax in perhaps not understanding how important it is. We know that pain in people with cancer can be excruciating, and it can be very debilitating.”
Perhaps it’s been different with animals because they don’t typically show signs of pain. It’s instinctive. Animals have to survive, so showing pain is not going to be conducive to survival. “What happens is they are hiding their pain, and we took that as them not having pain,” says Login.
Over the years, veterinary medicine has really progressed in terms of our understanding of animals’ pain, says Login. “To assume that they don’t feel pain, especially in a lot of these conditions that are very painful in people, would be wrong. Now we’re recognizing the pain, and many veterinarians and oncologists in particular, are treating the pain. Pain is detrimental to the healing and can affect their quality of life.”
The view of pain in animals has changed, Login says. “When I first graduated and was in practice, I was taught that pain was good. That it was protective – and in a certain sense it is – but that it was protective because it kept the animal from further injuring itself. We didn’t want to take the pain away, because that may make them run on a broken leg when they shouldn’t do that. That has changed thankfully, that we recognize that we can do both. Pain is a little bit protective, but it can also be detrimental to healing. The animals hide their pain and we’ve had to learn how to recognize it and interpret it.”
Room for improvement
Biller says the industry needs to continue to find ways to fund hypothesis-driven clinical research so that we are basing our treatment recommendations on information that better justifies whether a specific treatment works – or not. “For example, we sometimes recommend a particular chemotherapy drug (such as carboplatin) to decrease the chance that a metastatic cancer such as melanoma will spread – but the data that supports this recommendation is sometimes based on small (and not very current) studies that may lack the appropriate control groups,” she says. “In the human oncology field, most treatment recommendations come from much larger clinical trials that often provide better evidence for these sorts of decisions.”
Dr. Barbara Biller, DVM, Ph.D., Diplomate ACVIM (Oncology) is scheduled to speak on cancer care at VMX 2019:
- Let’s Wait and See: When It’s Right and When It’s Not in Managing Soft Tissue Sarcoma
- Recent Advances in Diagnosing and Treating Canine Lymphoma
For a full VMX 2019 agenda, https://navc.com/vmx
Setting a standard
Dr. Barbara Biller suggested a couple of ways that general practitioners and specialty practices can set a high standard of care for their clients.
General practice veterinarians should be aware of the fact that cancer CAN often be treated with a good quality of life, and that the offer of referral to an oncologist should happen sooner rather than later, Biller says. “And they should know how to consult with an oncologist by phone or email quickly so that they can provide the owner with enough information to make a decision about whether to go to a specialist or not.”
Specialty practices can set themselves apart by working closely with the GPs in their region to make themselves accessible, Biller says. “It’s important that a specialty practice be easy to refer to, easy to reach for a consultation prior to referral and provide follow-up from the visit to the GP in a timely fashion with the goal of always keeping the GP in the patient-client-doctor loop.”
Cancer Claims By the Numbers
In the last five years, Trupanion, a pet insurer company, has had over 80,000 cancer related claims, and paid out over $34 million in cancer claim reimbursements. The most commonly claimed types of cancer include Lymphoma, Mast Cell Neoplasm, Osteosarcoma, Carcinoma, and Adenocarcinoma.
The breeds who most frequently claim cancer: Boxer, Doberman Pinscher, Bernese Mountain Dog, Rottweiler, American Pitbull Terrier.
Cost of most common cancers per year:
- Lymphoma: $5,800
- Mast Cell Neoplasm: $2,400
- Osteosarcoma: $4,550
- Carcinoma: $4,200
- Adenocarcinoma: $4,950
According to Trupanion, a plan that does not rely on the traditional reimbursement model is the best for not only cancer treatment, but also for any other unexpected illness or injury. “Trupanion aims to pay veterinarians directly, within five minutes of the invoice being created, so our members don’t have to pay the entire veterinary bill out of pocket upon checkout and then wait to be reimbursed. We offer one simple plan that pays 90 percent of actual eligible veterinary costs (less deductible) for the life of the pet as long as they are members. Plus, Trupanion coverage has unlimited payouts.”