A Practical Guide to Clinical Studies in Veterinary Oncology.

This article explains the authors' experiences about opportunities, perspectives, and considerations required to initiate clinical studies in a veterinary oncology practice. These details include the infrastructure required for appropriate study training for all staff. Negotiation of scope of work and fees for service with study sponsors is also discussed. Finally, although generally similar, the article also describes management of clinical studies in academic and private practice settings.

Novel genomic prognostic biomarkers for dogs with cancer.

BACKGROUND: Growing evidence from dogs and humans supports the abundance of mutation-based biomarkers in tumors of dogs. Increasing the use of clinical genomic diagnostic testing now provides another powerful data source for biomarker discovery. HYPOTHESIS: Analyzed clinical outcomes in dogs with cancer profiled using SearchLight DNA, a cancer gene panel for dogs, to identify mutations with prognostic value. ANIMALS: A total of 127 cases of cancer in dogs were analyzed using SearchLight DNA and for which clinical outcome information was available. METHODS: Clinical data points were collected by medical record review. Variables including mutated genes, mutations, signalment, and treatment were fitted using Cox proportional hazard models to identify factors associated with progression-free survival (PFS). The log-rank test was used to compare PFS between patients receiving and not receiving targeted treatment before first progression. RESULTS: Combined genomic and outcomes analysis identified 336 unique mutations in 89 genes across 26 cancer types. Mutations in 6 genes (CCND1, CCND3, SMARCB1, FANCG, CDKN2A/B, and MSH6) were significantly associated with shorter PFS. Dogs that received targeted treatment before first progression (n = 45) experienced significantly longer PFS compared with those that did not (n = 82, P = .01). This significance held true for 29 dogs that received genomically informed targeted treatment compared with those that did not (P = .05). CONCLUSION AND CLINICAL IMPORTANCE: We identified novel mutations with prognostic value and demonstrate the benefit of targeted treatment across multiple cancer types. These results provide clinical evidence of the potential for genomics and precision medicine in dogs with cancer.

Client perceptions improve with collaborative care when managing dogs with cancer: a Collaborative Care Coalition study.

OBJECTIVE: Collaboration between primary care veterinarians (pcVets) and veterinary oncologists is common for dogs diagnosed with cancer, but no data exist that explore dog owner utilization and perceptions of collaborative care. The objectives were to describe dog owner perceptions of the value of collaborative veterinary cancer care and identify drivers of a positive collaborative care experience between the pcVet and oncologic specialists. SAMPLE: 890 US dog owners who had pets diagnosed with cancer in the past 3 years. PROCEDURES: Online contextual survey. Data were analyzed using group comparisons and multiple regression analysis. Significance was set at P < .05. RESULTS: 76% of clients sought specialty care following cancer diagnosis in their dog. Seventy percent of owners across all income brackets indicated that referral to a specialist was a very good value based on money spent and outcomes. Delayed referral resulted in lower client satisfaction scores for pcVets. Top predictors of client satisfaction with pcVets were as follows: responsiveness to questions, staying involved with their dog's care, and willingness to work with other veterinarians and specialists. For specialists, top predictors were as follows: providing accurate cost estimates, cancer knowledge, and effectiveness of care. Client perceptions of pcVets were 6 times more likely to improve following referral to a specialist. All were significant predictors of owner advocacy (P < .0001). CLINICAL RELEVANCE: Dog owners perceived early collaboration between pcVets and specialists favorably, fostering client satisfaction and positive perceptions of the value for service provided for dogs diagnosed with cancer.

Comparison of resident and intern salaries with the current living wage as a quantitative estimate of financial strain among postgraduate veterinary trainees.

OBJECTIVE: To compare resident and intern salaries with current regional living wages as a quantitative estimate of financial strain. SAMPLE: 152 residency programs and 141 internship programs listed with the Veterinary Internship and Residency Matching Program for the 2021-2022 training year. PROCEDURES: Data were collected for program annual salary and location. Regional living wage for each location was determined with the Massachusetts Institute of Technology Living Wage Calculator, and annual salary was compared with living wage to estimate income surplus before and after taxes. Results for programs in academia and private practice were compared. Spearman correlation was used to determine whether program annual salary was significantly associated with regional living wage. RESULTS: Mean ± SD income surplus before taxes was $7,786 ± 9,426 for clinical residency programs, $16,672 ± 5,105 for laboratory animal programs, and $5,829 ± 8,119 for internships. Academic residencies and internships offered salaries significantly lower than those offered in private practice, and income surpluses before and after taxes were significantly lower for academic programs than for private practice programs. There were weak and moderate, respectively, correlations between program annual salary and regional living wage for residency (r = 0.369) and internship (r = 0.570) programs. CLINICAL RELEVANCE: Postgraduate training prolongs financial instability, and annual salaries generally do not meet the minimum income standard of a living wage. Financial stress has implications for mental health and diversity, and these findings invite deeper consideration of current remuneration practices for veterinary residents and interns.

Immunoglobulin G4-related disease in a dog.

Immunoglobulin G4-related disease (IgG4-RD), which affects many organ systems, has been recognized as a distinct clinical entity in human medicine for just over a decade but has not been previously identified in dogs. In humans, IgG4-RD is characterized by diffuse IgG4-positive lymphoplasmacytic infiltrates that commonly lead to increased serum concentrations of IgG4 and IgE, peripheral eosinophilia, tumorous swellings that often include the parotid salivary glands, obliterative phlebitis, and extensive fibrosis. Herein we describe the diagnosis, clinical progression, and successful treatment of IgG4-RD in an 8-year-old female spayed Husky mixed breed dog. Immunoglobulin G4-related disease should be considered as a differential diagnosis for dogs with vague clinical signs, lymphoplasmacytic swellings, restricted polyclonal gammopathy, eosinophilia or some combination of these findings.

Post-surgical outcome and prognostic factors in canine malignant melanomas of the haired skin: 87 cases (2003-2015).

The medical records of 87 dogs treated with surgery for cutaneous malignant melanoma (CMM) of the haired skin were retrospectively reviewed for overall survival time (OST), progression-free survival time (PFS), and prognostic factors. The post-surgery median PFS and median OST were 1282 days and 1363 days, respectively. The post-surgery metastatic rate was 21.8% with a local recurrence rate of 8%. Increasing mitotic index (MI) was predictive of a significantly decreased OST and PFS on multivariable analysis [hazard ratio (HR): 1.05, 95% confidence interval (CI): 1.02 to 1.07 and HR: 1.04, 95% CI: 1.02 to 1.06, respectively]. Increasing age was likewise predictive of a significantly decreased OST and PFS on multivariable analysis (HR: 1.39, 95% CI: 1.17 to 1.65 and HR: 1.33, 95% CI: 1.14 to 1.54, respectively). These results confirm clinical impressions that long survival times are likely in dogs diagnosed with malignant melanoma of the haired skin when treated with surgery alone.

Résultat post-chirurgical et facteurs de pronostic pour les mélanomes malins canins de la peau poilue : 87 cas (2003­2015). Les dossiers médicaux de 87 chiens traités à l'aide d'une chirurgie pour le mélanome malin cutané (MMC) de la peau poilue ont été évalués rétrospectivement pour le temps de survie global (TSG), le temps de survie sans progression (TSSP) et les facteurs de pronostic. Le TSSP médian après la chirurgie et le TSG médian étaient de 1282 jours et de 1363 jours, respectivement. Le taux métastasique après la chirurgie était de 21,8 % avec un taux de récurrence local de 8 %. L'augmentation de l'indice mitotique (IM) était prédictive d'un TSG et d'un TSSP réduits à l'analyse multivariable (ratio de risque [RR] : 1,05, intervalle de confiance [IC] de 95 % : 1,02 à 1,07 et RR : 1,04, IC de 95 % : 1,02 à 1,06, respectivement). La progression de l'âge était aussi prédictive d'une réduction importante du TSG et du TSSP à l'analyse multivariable (RR : 1,39, IC de 95 % : 1,17 à 1,65 et RR : 1,33, IC de 95 % : 1,14 à 1,54, respectivement). Ces résultats confirment les impressions cliniques que des longs délais de survie sont probables chez les chiens diagnostiqués avec le mélanome malin de la peau poilue lorsqu'ils sont uniquement traités à l'aide d'une chirurgie.(Traduit par Isabelle Vallières).

Retrospective evaluation of toceranib phosphate (Palladia) use in cats with mast cell neoplasia.

Objectives The purpose of this study was to solicit and compile data from practicing veterinary specialists regarding their use of toceranib in cats with mast cell neoplasia and to provide initial assessment of possible clinical benefit and adverse events. Methods The American College of Veterinary Internal Medicine and Oncology listservs were used to solicit data pertaining to cases in which toceranib was used in the treatment of feline mast cell neoplasia. Cases were included if the following data were received: signalment (age, sex, breed), diagnosis of mast cell neoplasia by either cytology or histopathology, anatomic classification of disease (cutaneous, splenic/hepatic, gastrointestinal, other), previous and concurrent treatment, toceranib dose (mg/kg) and schedule, duration of therapy, best response and documentation of adverse events. Results Case data from 50 cats with cutaneous (n = 22), splenic/hepatic (visceral) (n = 10), gastrointestinal (n = 17) or other (n = 1) mast cell neoplasia were received. Clinical benefit was seen in 80% (40/50), including 86% (19/22) with cutaneous, 80% (8/10) with visceral and 76% (13/17) with gastrointestinal involvement. A majority of cats (n = 35) received glucocorticoids during toceranib treatment. Median duration of treatment in cats experiencing clinical benefit was 36 weeks (range 4-106 weeks), 48 weeks (range 12-199 weeks) and 23 weeks (range 13-81 weeks) for cutaneous, visceral and gastrointestinal cases, respectively. Toceranib was administered at a median dose of 2.5 mg/kg (range 1.6-3.5 mg/kg); in 90% (45/50) the drug was given three times per week. Treatment was generally well tolerated with 60% (30/50) of cats experiencing adverse events. The majority of these events were low-grade (grade 1 or 2) gastrointestinal or hematologic events that resolved with treatment break and/or dose adjustment. Conclusions and relevance Toceranib appears to be well tolerated in feline patients with mast cell neoplasia. Biologic activity of this drug is evident in the studied cats; however, further prospective studies are needed to elucidate fully its role in treatment of this disease.

Predictors of outcome in dogs with subcutaneous or intramuscular hemangiosarcoma.

OBJECTIVE: To identify prognostic factors in a large group of dogs with subcutaneous or intramuscular hemangiosarcoma (HSA) or both. Design-Multi-institutional retrospective cohort study. Animals-71 dogs with subcutaneous or intramuscular HSA. PROCEDURES: Medical records of affected dogs were reviewed. The following factors were evaluated for an association with outcome: dog age and sex, clinical signs, anemia, thrombocytopenia, neutrophilia, tumor stage at diagnosis, achievement of complete excision, intramuscular involvement, presence of gross disease, tumor recurrence, and treatment. RESULTS: Of the 71 cases identified, 16 (29%) had intramuscular tumor involvement. For all dogs, median time to tumor progression and overall survival time (OST) were 116 and 172 days, respectively; 25% survived to 1 year. Univariate analysis identified presence of clinical signs or metastasis at diagnosis, dog age, tumor size, use of any surgery, and presence of gross disease as predictors of time to tumor progression and OST. There was no significant difference in survival time between dogs with respect to type of HSA. Multivariate analysis confirmed that adequate local tumor control, tumor diameter ≤ 4 cm, presence of metastasis at diagnosis, and presence of gross disease were significantly associated with OST. CONCLUSIONS AND CLINICAL RELEVANCE: Subcutaneous and intramuscular HSA remains a heterogeneous group of tumors that generally carries a poor prognosis. Adequate local control of smaller tumors with no associated clinical signs or metastasis may provide the best chance of long-term survival.