Lomustine treatment for feline MCT

Re: Lomustine treatment for feline MCT

Andrew Kent — Mon, 28 Oct 2013 20:35:50 GMT

I wouldn't say first line but we have been using it in some cases and been impressed with the response on the whole.

Re: Lomustine treatment for feline MCT

Christopher Saul — Mon, 28 Oct 2013 10:40:22 GMT

[quote user="Andrew Kent"]masivet for epitheliotropic lymphoma[/quote]

So Andy, do you guys use masivet first line for Epitheliotrophic LSA then? Or second line after lomustine?

Re: Lomustine treatment for feline MCT

Andrew Kent — Sat, 26 Oct 2013 20:16:56 GMT

[quote user="robloxley"]

[quote user="Andrew Kent"] using tyrosine kinase inhibitors, masivet being the first line[/quote]

What's your thinking on Masivet vs Palladia, in general?

[/quote]

what Chris said.

there is a role for both in mast cell tumours but we tend to use masivet first and switch to Palladia when it stops working (in people they work through them in turn), mainly due to incidence of side effects.

in terms of 'other uses' Palladia more often for various carcinomas etc, masivet for epitheliotropic lymphoma.

Re: Lomustine treatment for feline MCT

John Flynn — Sat, 26 Oct 2013 18:16:08 GMT

That's a really helpful rundown of Masivet vs Palladia - thanks for that, Chris!

Colleauge told me of dog started on masivet recenty that developed diabetes 2wks later (also on antihistamines and 0.25mg/kg pred once daily, the pred starting at same time as masivet) - I'm guessing that the masivet had nothing to do with the diabetes, but thought I'd ask here just in case there's a reason not thought of why this might be linked?

Re: Lomustine treatment for feline MCT

Christopher Saul — Sat, 26 Oct 2013 16:58:19 GMT

[quote user="robloxley"]What's your thinking on Masivet vs Palladia, in general?[/quote]

This is the way I think of it. This explanation is very over-simplifed however and in reality there are many other factors which might dictate your choice........

Palladia is broader spectrum ( also targeting PDGF and VEGF as well as KIT) whereas masivet is narrower - Mainly just KIT (also VEGF but much more weakly than does palladia). I'm prepared for one of our diploma holding colleagues to correct me on this though!!

Palladia is generally more commonly associated with severe (especially GI) side effects than is Masivet, which is generally much better tollerated.

I would chose masivet if you're targeting KIT (so basically a MCT) because of its better side effect profile

I would use palladia if you're trying to utilise an anti-angiogenic effect ( so you want to target VEGF or PDGF) - for instance second line therapy for an anal sac carcinoma or maybe a haemangiosarcoma after you've reached the cumulative maximum of doxorubicin, or a soft tissue sarcoma. However if you're trying to use anti-angiogenic effects, another way to do this is metronomic chemotherapy, but that's another arguement,

In a v old frail dog I would always choose masivet over palladia, again for reasons of side effects.

Hope this helps

Chris

Re: Lomustine treatment for feline MCT

Rob Loxley — Sat, 26 Oct 2013 16:07:26 GMT

[quote user="Andrew Kent"] using tyrosine kinase inhibitors, masivet being the first line[/quote]

What's your thinking on Masivet vs Palladia, in general?

Re: Lomustine treatment for feline MCT

Christopher Saul — Sat, 26 Oct 2013 13:55:06 GMT

[quote user="Tanya Fielding"]did they suggest how you divide a 40 mg capsule?[/quote]

Never divide a capsule. You can get 10mg capsules (or other sizes at a premium) from reformulating pharmacies - well one reformulating pharmacy to be honest - novalabs

Re: Lomustine treatment for feline MCT

Tanya Fielding — Sat, 26 Oct 2013 12:39:58 GMT

did they suggest how you divide a 40 mg capsule?

Re: Lomustine treatment for feline MCT

Martin Atkinson — Sat, 26 Oct 2013 10:55:49 GMT

Not used Lomustine my first instinct would have been to use Masivet. But TKIs have lost a lot of their shine with oncologists, they're proving not to be the holy grail we hoped for even in dogs. My first stop for oncology advice these days is Gerry Polton at NDSR - he did after all help develop Masivet in the UK.

Re: Lomustine treatment for feline MCT

Busybee — Sat, 26 Oct 2013 10:35:06 GMT

I've already had a lot of very helpful advice from the AHT who have helped to formulate the treatment plan, and we have decided the best course of treatment (if the owners will go for it) would be lomustine. I'm just after people's personal experiences of using lomustine.

The cat had a skin mass removed a couple of weeks ago, but more deeper masses were found at the surgery that were deemed inoperable. The mass removed has a mitotic index of 23, is poorly granulated and we obviously haven't got it all. The prognosis given was very guarded to poor. There are also signs of spread to other areas of the skin and possibly systemical spread too - further investigations will go ahead next week depending on if the owners are amenable to treatment. After initially reporting the initial mass had been present for only a few weeks, the owner has now admitted it's been growing for a few years so unfortunately systemic spread is likely.

Re: Lomustine treatment for feline MCT

Andrew Kent — Fri, 25 Oct 2013 23:31:34 GMT

I would second the idea of using tyrosine kinase inhibitors, masivet being the first line. And the cost has fallen a lot recently! Can you tell us more about the presentation? Cutaneous or visceral?

Re: Lomustine treatment for feline MCT

Stephen Courtney — Fri, 25 Oct 2013 23:07:57 GMT

Best thing to do is ring an oncologist.

my last feline MCT ( unusually aggressive dermal presentation) went to the VRCC. they treated with Masivet then palladia, then PTS. the cat tolerated the meds well, but improvement was short lived, hence the switch. Each drug worked noticeably well, but incompletely, for a few weeks before the tumour recommenced spreading and metastasizing.

We have however had great success in canine MCT treatment with masivet, albeit in a limited number of cases. At least three inoperables still alive up to 2 years later. don't ask about the cost.....