RE: Mast cell tumour LN and oedema.

Tony Knapp — Wed, 22 Jul 2015 04:33:02 GMT

Thanks for your reply, I thought this would be the case, but I thought I'd best throw the question out there in the hope of a more positive answer.

RE: Mast cell tumour LN and oedema.

Gerry Polton — Tue, 21 Jul 2015 08:19:40 GMT

As you surmise, the oedema is a consequence of the lymphadenomegaly. Assuming there is no valid reason to suspect an additional trigger for enlargement of this lymph node, there is simply one problem here, the cancer is no longer sufficiently responsive to therapy to achieve the desired effect. Options are to increase the prednisolone dose, to give prednisolone alone (higher dose or same dose), add chemotherapy, switch TKI to masitinib, remove lymph node or to pursue radiotherapy. Decisions are made based upon an assessment of the probability of a durable beneficial effect and the likely adverse impacts, including cost, of the chosen option. If cost is an issue, as you state, then I would consider withdrawing the toceranib and simply managing the patient with prednisolone alone. We can't cure them all but we can ensure that owners understand when their financial and emotional investment is or is not likely to give a decent return. Without the benefit of seeing the patient, I suspect the tide has turned on this case, unfortunately.

Yours

Gerry