RE: Chemotherapic treatment in TCC

orik — Mon, 06 Jan 2020 21:20:42 GMT

In the end, there is no agreement to support one treatment or another. I asked a specialist and they told me that based on the evidence, they recommend following what the Purdue University suggests normally: vinblastine as the first line, then mitoxantrone. Every treatment needs to be tailored to the single patient though.

RE: Chemotherapic treatment in TCC

Lucy Fleming — Mon, 06 Jan 2020 18:04:03 GMT

When we have referred a couple of these to our local oncologists, they've used carboplatin (followed by toceranib in one case that didn't respond) but I'm not sure how effective it was. One showed no response to carboplatin, and was PTS shortly after starting palladia (about 4months after diagnosis).

RE: Chemotherapic treatment in TCC

Sarah Keir — Sat, 04 Jan 2020 11:48:06 GMT

I believe all carcinomas are poorly responsive to chemotherapy, radiotherapy often good for palliative.

RE: Chemotherapic treatment in TCC

Dinu Catilina — Sat, 04 Jan 2020 08:16:00 GMT

I also had better results with meloxicam than piroxicam, less GI side effects. None of our clients went for chemo when presented with the potential side effects and one of these bitches lived for another 18 months after diagnosis. Expect recurrent UTIs

RE: Chemotherapic treatment in TCC

Beats — Fri, 03 Jan 2020 20:23:05 GMT

Hi Orik, I'm unfortunately no expert, but as no-one else has commented i guess I can't do any harm.

1) Re choice of NSAID:

my understanding is that there are 2 schools of thought:

a) most relevant trials showing a benefit used prioxicam - therefore use piroxicam

b) benefit is likely to be COX2 inhibition and thus pick your favourite NSAID based on safety profile re GI problems [I fall into this school of thought and have always used metacam].

2) Other drugs:

I think this is a bit more speculative, and I personally generally don't.

Last time I did was in small dog with enthusiastic owner and after reviewing the options in https://www.ncbi.nlm.nih.gov/pubmed/25747698 (a good review on the topic) went for chlorambucil - monitoring was poor and euthanasia was only few months later and possibly due to drug effects of chlorambucil at least in part.

The following are more recent publications with other thoughts and suggestions:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5114733/

https://www.magonlinelibrary.com/doi/abs/10.12968/coan.2016.21.1.21

https://vetline.de/diagnostik-und-therapie-des-uebergangszellkarzinoms-des-unteren-harntrakts-beim-hund/150/3231/106618/

https://www.ncbi.nlm.nih.gov/pubmed/30246405

https://www.ncbi.nlm.nih.gov/pubmed/28217972

From the first link (the one I'd looked at from Vet Journal in 2015), here is a quote summarizing the limited knowledge on the drugs you mention:

"As summarized in Table 4, several different drugs have activity against TCC in dogs, and there are many acceptable treatment options. The most commonly used intravenous (IV) drugs have been mitoxantrone and vinblastine, with gemcitabine also showing recent promise (Henry et al, 2003a, Arnold et al, 2011, Marconato et al, 2011, Knapp, McMillan, 2013). These drugs result in remission in ~35% of dogs and in stable disease in ~45–50% of dogs, and are generally well tolerated. The platinum compounds (cisplatin, carboplatin) appear to be the most active agents, but are more likely to cause side effects (Moore et al, 1990, Chun et al, 1996, Chun et al, 1997, Knapp et al, 2000, Knapp et al, 2013b, Boria et al, 2005, Greene et al, 2007)."

I don't know that there is a lot to choose between these drugs, so if you are wishing to use one, then probably the drug you are most familiar with will be the best choice.

I was put off personally as the reported median survival times from the short case series did not seem obviously longer than my memory of the small number of clinical cases I've seen receiving only meloxicam.