poorly differentiated transitional cell urothelial carcinoma help

Re: poorly differentiated transitional cell urothelial carcinoma help

Tim Charlesworth — Wed, 09 Jul 2014 16:08:31 GMT

Hi Andrew, surgeons are starting to look again at surgery on these due to the relatively poor response rates from chemo regimes commonly given but in this dog I suspect that it would be nothing more than a debulk. There is the option of placing a urethral stent across the TCC. This should be able to be placed via the urethra in a decent sized dog and can resolve symptoms of urinary tenesmus but are associated with an approx 25% risk of urinary incontinence. Not for everyone I'm sure but they can work well and extend survival for a number of months. They aren't cheap, I think that the stents are $1200 to us so costs would be stent + flouro setup/time to place etc,

Tim

Re: poorly differentiated transitional cell urothelial carcinoma help

Gerry Polton — Wed, 09 Jul 2014 10:03:54 GMT

There is good evidence that use of an NSAID can reduce the symptoms with which the patient presents in approximately 75% of cases. However, true measurable tumour reduction probably only happens in about one case out of six. Piroxicam is used by many people. There remains a complete uncertainty about the importance of COX inhibition over other potential molecular interactions. Many oncologists use other NSAIDs. Meloxicam was the most commonly used in a straw poll of experts a few years back. I choose firocoxib as my first line.

The combination of a NSAID and a chemotherapy treatment achieves a better probability of a response and a greater durability of that response if one is seen. Some combinations are nephrotoxic (platinum drugs plus NSAID).

There is a report of the use of chlorambucil and piroxicam. I am deeply uncertain about the conclusions drawn. But it is certainly out there. The paper can be found here:

J Am Vet Med Assoc. 2013 Jun 1;242(11):1534-8. doi: 10.2460/javma.242.11.1534.

Metronomic administration of chlorambucil for treatment of dogs with urinary bladder transitional cell carcinoma.

Schrempp DR¹, Childress MO, Stewart JC, Leach TN, Tan KM, Abbo AH, de Gortari AE, Bonney PL, Knapp DW.

I would read it with a critical mind before deciding whether to jump in.

Best wishes

Gerry

Re: poorly differentiated transitional cell urothelial carcinoma help

Stephen Courtney — Tue, 08 Jul 2014 21:52:45 GMT

I have had some success with feldene (piroxicam) - if it works, you get spectacular remission , once lasted a year. Other cases didn't respond , and some cases cannot tolerate the drug . I'd say about 50% chance of good results.

There are also proper chemo protocols which are probably better reviewed and may have longer remission times - i expect an expert or two to be along shortly!