Top Cancer Care Tools for the Primary Care Setting
Sponsored by Dechra
Approximately one-third of deaths among adult dogs can be attributed to neoplasia, making cancer the leading cause of death in dogs.1 Clients typically expect primary practitioners to be well-versed in cancer diagnostics and treatment, and their willingness to pursue specialty referral can be impacted by personal preferences, emotional attachment to the patient, physical capabilities, and availability of financial resources.2 Presented are 4 tools general practitioners can utilize to aid in the care of cancer patients in primary practice.
1. BRAF Testing for Transitional Cell Carcinoma/Urothelial Carcinoma
Up to 80% of canine urothelial carcinomas have a mutation in the BRAF protein, making detection of this mutation an indication of cancer.3 BRAF testing identifies cells harboring the BRAF mutation via free-catch urine samples, allowing for a noninvasive method of cancer detection.4 This tool should be utilized in animals suspected of having neoplasia of the urinary tract, including those with recurrent urinary tract issues, in cases in which diagnostic imaging indicates there may be a bladder mass, for early detection in high-risk breeds, and to monitor for success of chemotherapy protocols. A positive test confirms diagnosis, and results are not affected by hematuria, glucosuria, proteinuria, and/or bacteriuria.
2. Cytologic Grading of Mast Cell Tumors
Mast cell tumors make up ≈20% of canine skin tumors.5 Although histologic grading requires a biopsy, which can come with several challenges, cytologic grading is a less invasive, faster, and less expensive way to grade mast cell tumors.5 Cytologic grading can provide important prognostic information that helps guide treatment decisions. These findings can be especially beneficial when tumors are in a difficult surgical location or when the owner wishes to pursue intratumoral treatment.
Primary care practitioners can perform 2-tier grading in house using cytology from a fine-needle aspirate sample.5 In a study, the cytologic grading scheme had 88% sensitivity and 94% specificity relative to histologic grading.5 Using this cytologic grading system, about one-third of tumors will falsely be classified as high grade, but very few will be considered low grade that are actually high grade.5 If a mast cell tumor is determined cytologically to be low grade, it may be a good candidate for marginal excision or intratumoral treatment.
3. Cancer Biomarker Blood Tests
These noninvasive tests utilize a patient’s blood to detect biomarkers that are commonly associated with cancers. Although cancer biomarker blood tests can be used to screen for the presence of cancer, they do not replace other staging and diagnostic modalities. False-positive and false-negative results can occur, and the sensitivity and specificity of each available test can vary.6 For breeds with a higher risk for cancer, routine use of biomarker testing as a screening test in healthy pets can be considered.
4. Laverdia®-CA1 (Verdinexor Tablets) Treatment for Lymphoma
Laverdia®-CA1 (verdinexor tablets) is the first oral tablet conditionally approved by the FDA for lymphoma treatment in dogs. Conditional approval is based on the FDA Center for Veterinary Medicine’s assessment that Laverdia®-CA1 has been demonstrated to be safe when used according to the label, that there is a reasonable expectation of effectiveness for the treatment of canine lymphoma, and that the drug is manufactured in accordance with full approval standards. Laverdia®-CA1 is an orally bioavailable, selective inhibitor of nuclear export (SINE) that exhibits antitumor activity against lymphoma in dogs.7 Although CHOP chemotherapy (cyclophosphamide, doxorubicin hydrochloride [hydroxydaunorubicin], vincristine sulfate [Oncovin], and prednisone) remains the gold standard for lymphoma treatment in dogs, it is not a feasible option for many pets and their owners and most tend to decline treatment.
Laverdia®-CA1 may be an option for clients who do not wish to pursue CHOP chemotherapy with an oncologist or whose dogs have experienced their first relapse. Laverdia®-CA1 can also be initiated while a patient’s owner waits to discuss CHOP therapy with an oncologist, unlike prednisone, which should not be started before chemotherapy due to the potential decreased response rate.8 Laverdia®-CA1 is administered orally at home twice weekly.9 Laverdia®-CA1 also offers an option for managing lymphoma.
Conclusion
Primary practitioners are well-equipped to make a difference for patients and their owners as they face a cancer diagnosis. Several diagnostic tools exist for primary practitioners, including BRAF mutation testing for transitional cell carcinoma/urothelial carcinoma, cytologic grading of mast cell tumors, and blood biomarkers for cancer screening. Laverdia®-CA1 is an oral chemotherapeutic agent primary practitioners can consider for the treatment of lymphoma. Primary practitioners are often on the front lines of a cancer diagnosis, and being aware of these available cancer tools can help guide pet owners to make the best decisions for their pets.
IMPORTANT SAFETY INFORMATION
For use in dogs only. Laverdia®-CA1 (verdinexor tablets) is conditionally approved for the treatment of lymphoma in dogs. NOT FOR USE IN HUMANS. KEEP THIS AND ALL MEDICATIONS OUT OF THE REACH OF CHILDREN. CHILDREN SHOULD NOT COME INTO CONTACT WITH LAVERDIA®-CA1. Pregnant women, women who may become pregnant, nursing women and children should not handle or administer Laverdia®-CA1 or come into contact with the feces, urine, saliva, or vomit of treated dogs for 3 days following treatment. Laverdia®-CA1 can affect male fertility based on animal studies and studies in humans. Wear protective disposable chemotherapy resistant gloves when handling Laverdia®-CA1 to avoid direct exposure to moistened, broken or crushed tablets or biological waste from the treated dog (feces, urine, saliva, or vomit). Do not use in dogs that are pregnant, lactating or intended for breeding. Laverdia®-CA1 is a possible teratogen and can affect female and male fertility. Dogs should be frequently monitored for hematologic and serum chemistry abnormalities. The most commonly reported adverse reactions in dogs include anorexia, weight loss, vomiting, diarrhea, lethargy, polyuria, polydipsia, elevated liver enzymes and thrombocytopenia. Please see package insert or visit dechra-us.com for full prescribing information.
Dechra is a registered trademark of Dechra Pharmaceuticals Limited.
Laverdia® is a registered trademark of Dechra Limited.
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