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- [Sue] Hi everyone, welcome back to osteosarcoma.
Welcome back, you ask?
So if you're watching this video,
I want to make sure that you know about a couple
of other vlogs that I have on osteosarcoma.
So be sure to check out part one,
where I give you an overview of bone cancer in dogs,
and then be sure to check out,
I have a whole separate video about amputation.
This vlog, we're gonna be focusing on treatment.
(upbeat guitar music)
Clearly, she does not wanna be in her area.
Fallon!
(imitates kissing)
Crazy dog, what are you doin'?
Hi, ready for your exam?
Oh, I love her.
Muah, Fallon!
What?
Ready to go home?
We're almost there!
So Fallon finished chemo about a month ago,
and she obviously had osteosarcoma,
and she was amputated, and she did great on chemo.
And her x-rays look really, really good.
But we have to wait for the radiologist,
but I'm very pleased, I do not see any spread,
no spread allowed, and then hopefully
at your next appointment, we're gonna start
that new osteosarcoma vaccine, yeah?
So we have the battlefront of the tumor growing
in the bone, what I call the local battlefront,
and then we have that systemic battlefront.
So if we're thinking about curative intent,
we have to deal with both of those battlefronts.
Typically, for the local battlefront,
we're gonna be combining amputation
for the tumor in the bone, combined with something systemic,
which is most commonly chemotherapy,
and now we are gonna talk about some
of the new immunotherapies that are in clinical trials
right now, which is really super exciting.
There are some alternatives to amputation,
and so I do wanna touch on those as well,
because there are some limb-spare...
What does limb-spare mean?
It means we're sparing the limb for your dog,
and there are some surgical techniques,
specifically those typically are for the distal radius,
for the bone right above the carpus, the wrist in the dog,
where they'll remove that segment of bone,
there's some requirements, and they'll either plate it
and put in a replacement for that.
That's usually the best location for limb-spare,
and then sometimes we can do stereotactic,
so this very precise form of radiation.
Again, there usually can't be too much
bone destruction from the tumor.
So there are many people that used to come see me
when I was at a facility that had stereotactic radiation,
but the bone was too destroyed from the tumor that...
They wouldn't be good candidates for radiation,
'cause if we killed the tumor with the radiation,
they would still fracture.
So if you don't wanna amputate,
and you wanna investigate these limb-spare,
talk to your veterinarian about getting a referral
to a medical oncologist, or a surgeon,
or a radiation facility, usually starting
with a medical oncologist is gonna be a good place.
But again, most of the time it's gonna be the combination
of amputation plus chemotherapy,
is gonna be the treatment options.
And we're gonna come back to that.
But I do wanna touch on some of the palliative options.
What does palliative mean?
Palliative means for comfort,
and so palliative could be just amputation,
and that's still great, guys, because you're taking away
the source of pain for your dog.
It's not gonna cure them, because of that high spread rate,
because 90%, as I mentioned in the last video,
90% of dogs have micro-spread to the lungs.
So by doing amputation, great,
you're removing the source of pain for your dog,
but it will usually succumb to the cancer spreading.
How long will they live?
Usually with amputation alone,
the average median survival is about four to five months.
I've been posting about this all month on Facebook,
and someone just said, my dog's out a year,
and we didn't do anything after surgery.
Fabulous!
There will always be exceptions to the rule,
and I live for those statistic-busters
that do better than the statistics.
But again, statistically, amputation alone,
about four to five months.
Another option if you want palliative
is to do palliative radiation.
So not the stereotactic radiation,
but radiation, usually weekly,
for three or four treatments, once a week,
to a radiation facility, they give a type of radiation
that's gonna induce pain relief,
promote pain relief, allow your pet
to get off some of their oral pain medications,
which is great, and has been shown
to help strengthen the bone a little as well.
Some radiation facilities will do two treatments
on back-to-back days, we call that the boom-boom technique.
There are also these things called bisphosphonates,
really long word, the main one
that we're using in dogs is zoledronate.
It's a once-a-week pain injection
that you use on top of the other pain medications.
That has been shown to decrease their pain levels as well.
So I can do that in combination with their radiation
and chemotherapy as well, and then oral pain medications.
So four main things that I think about
as palliative options: amputation alone,
palliative radiation, the bisphosphonates,
specifically zolendronate, the trade name Zometa,
but it's now generic, which is nice,
'cause it's less expensive, and oral pain medications.
Remember, with oral pain medications, guys,
most of these dogs will need
multiple different pain medications
that have different mechanisms of action.
So often we'll use a non-steroidal anti-inflammatory
with something like gabapentin and sometimes with tramadol,
because again, these tumors hurt.
That's why if you can do amputation
as a palliative treatment option,
that often is a good thing.
Okay, so now let's talk about curative intent.
Remember, please watch the other video all about amputation,
because that's gonna really talk more
about the decision-making process.
There's lots of videos in there of my different patients
and how well they do, and how satisfied most owners are.
So that is to remove the tumor,
and then we're typically gonna follow that up
with chemotherapy, and the goal is to delay the metastasis,
again, with the most common place typically the lungs,
bone is the second most common location.
Chemotherapy is well-tolerated in dogs.
I encourage you to go
to the "Everything You Need to Know About" playlist,
and watch some of the videos about chemotherapy,
and some of the other videos about my patients,
and see these dogs wagging their tail,
and how well they do during chemotherapy.
Chemotherapy, specifically for osteosarcoma,
has been shown to increase their survival times
and their disease-free interval.
So it prolongs that period until we start to see metastasis.
My motto, guys, is live longer, live well.
So the goal is not just for them
to have a longer survival time,
but for them to be living well,
not only when they're done with chemotherapy,
but during treatment as well.
At this point, at the time of this video,
the current chemotherapy of choice
is a drug called carboplatin,
typically given every three weeks
for a total of six treatments.
Some, about four, to five, to six,
I personally give it six treatments.
So six doses of carboplatin every three weeks apart.
Typically chemotherapy is gonna be started
about two weeks after amputation,
so once that incision is healed.
We don't wait too long, we wanna get chemotherapy started.
So what I typically recommend is
when you book that appointment for amputation
and your dog is recovering, that is a great time
to call and get an appointment with an oncologist
if you haven't yet seen them, or if you have,
you wanna make that appointment with an oncologist.
'Cause sometimes we're booked a couple weeks out,
and you don't wanna call when the sutures are out,
and say, hey, I need an appointment to start chemotherapy.
So we kinda need to plan these things,
and that's one of the points of these videos,
is that you're gonna say, okay,
I know that I need to start chemotherapy
about two weeks after surgery,
I'm gonna get an appointment with an oncologist.
Or a couple days after surgery,
when my dog's recovering, let's go talk to an oncologist
and find out if chemotherapy's right for us,
maybe get some estimates about cost and things like that.
Because those are things that you really need to do
one-on-one with your oncologist,
and find out if it's something that works for your family.
What's really exciting is that there's some immunotherapy
that is being developed for dogs with osteosarcoma.
Chemo, carboplatin, the drug that I've been mentioning,
and the traditional chemotherapy that we use
to treat many cancers in dogs, and cats, and people,
that chemotherapy kills cancer cells,
which is great, that's the goal.
But immunotherapy's a little bit different.
What it's doing is it's gonna boost the immune system,
it is going to use the immune system
through some of the different immune system cells,
and then target something in the immunotherapy
that is hopefully going to kill the cancer cells.
So the immunotherapy that we're using
for the canine osteosarcoma vaccine is a listeria vaccine,
so it's a modified listeria vaccine that expresses HER2/neu,
and that's the target that we're using.
And this HER2/neu is something that's over-expressed
in dogs with osteosarcoma, and we're gonna manipulate
the immune system, and hopefully kill those cancer cells.
So it's really exciting, and there are some studies
that are being done by Dr. Nicola Mason
at University of Pennsylvania, and it looks like...
That dogs that had amputation plus chemotherapy
and then the immunotherapy, so they still get chemo,
but that it's very much improving their survival times.
So there's now multi-site clinical trials
going on in the U.S., about 20 sites.
One of the hospitals I previously worked at was there,
so I do have some personal experience with the vaccine.
You'll want to talk to your oncologist,
find out where they are, see if you can travel.
You do have to go to those facilities.
Looks like it's significantly improving the survival times.
And what I'm really hopeful is that
once these clinical trials come out, and we have more data,
this will be something that is approved for dogs,
and that we'll be able to get from all oncologists.
Couple of things, just sort of housekeeping things
when you talk to your oncologist.
So chemotherapy, dogs are at the clinic
maybe an hour, hour and a half,
depending on how your oncologist has it set up.
For the immunotherapy, they are there all day,
they get fluids before the infusions
of the immunotherapy is only over 30 minutes,
but then they are monitored all day,
sometimes around fluids, and their blood pressure
and everything, so they are there.
They can get a transient low-grade fever afterwards.
So it does look like the dogs that are getting it
are out over a thousand days,
which is really a significant improval in survival time.
All right, so let's wrap up with a common question
that I get for dogs with osteosarcoma.
Doc, what's the prognosis for my dog?
And so this is a very treatable cancer,
and dogs that are treated definitely live longer
than dogs who are not treated.
And the more treatment they get,
typically the better they do,
and treatment is very well-tolerated.
Sadly, most dogs will succumb to the...
The effects of the tumor, and typically the metastasis
if they have the amputation, again,
with lungs being the most common place that it spreads.
So here's a breakdown, and again,
these are statistics, and statistics will not predict
how your dog, individually, will do,
but they give you a general overview and a guideline.
For dogs that just have amputation,
the median survival time is about four to five months,
and only about 10% of dogs were alive out one year,
and about 2% of dogs will live two years.
So there are some dogs that are out two years,
long-term survivors.
Dogs that get amputation, in general, when I think local,
that could be stereotactic radiation or limb-spare,
but again, for what most dogs are getting,
so amputation plus platinum chemotherapy, carbo,
median survival is about a year, about 10 to 12 months.
50% of the dogs were alive at one year,
so significant improval than 10%,
and about 15 to 25% of the dogs are alive at two years.
So great, significant improvement.
I want dogs to do better, and again hopefully
that's where the immunotherapy will improve that.
Palliative therapy, so palliative radiation,
median survival time is about four to five months,
because again, that's only dealing with the pain
at the primary place that the tumor is growing.
You can talk to your cancer specialist
about adding chemotherapy and other pain medications,
like zolendronate, the bisphosphonates,
but there's limited reports on
how that will improve their survival times,
but I will do that on a case-by-case basis
with each individual family.
And finally, for some of the early studies coming out
on that canine osteosarcoma vaccine,
the reason that we're so excited, in the dogs
that were vaccinated, their disease-free interval,
so when they first started to see disease progression,
was about 600 days, so a little short of two years,
and the median survival time was 950 days.
78% one-year survival rate,
and a 67% two-year survival rate.
So again, this is based on small numbers of dogs,
and that's why it'll be very exciting
when we start to see some of the data come out
from the multi-site study of about 22 sites in the U.S.
But again, it's one of the reasons I'm really excited,
and I think it could be really great for dogs
to have amputation, chemotherapy,
and then the immunotherapy as well.
Maybe they'll be able to get less chemo,
and then the immunotherapy, but very, very exciting.
What I want you to think about osteosarcoma
is that it's a very treatable cancer.
I know that it is a very emotional cancer
for a lot of pet owners.
I think the decision to amputate is really traumatic.
I think that owners that do it are really happy
that they did, and a lot of owners that struggled with it
wished they knew how well their dog would do
at the time, because they really, really struggle
with the decision.
Chemotherapy tends to be very, very well-tolerated.
I find that most owners that treat
are very happy that they did.
I hope that you found this information helpful.
If you did, please comment, please share,
and remember, we're all here together.
Oh, guys, a couple of resources.
I mentioned this in the amputation video as well,
tripods.com is a great community of three-legged dogs.
I hope you can check out my Facebook page as well.
But I really hope this information has helped you.
Let's all kick cancer's butt together.
Thanks for watching, and I'll see you the next time.
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