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  Discussion on Research Summary: Long-term outcome associated with intratumoral chemotherapy with cisplatin
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Moderator:
DrO

Posted on Monday, May 21, 2007 - 11:10 am:

Though cisplatin has shown efficacy against a number of tumors in small studies, the size of the studies, the many varied ways of preparing the cisplatin, dosages, and a myriad of other problems makes evaluation difficult. Here is a very large study that standardizes preparation and administration. Using much of the recent research to maximize effectiveness and minimize reactions the results are a surprisingly successful long term results against the most common yet sometimes difficult to treat tumors of horses.

But there are 2 flies in the ointment here. The first is the particular formulation used here (Matrix Pharmaceuticals a division of Novartis) is not readily available and as near as I can research, it is still in the approval process with the FDA and would be difficult to formulate. The second fly is the safe handling of cisplatin requires education. That said I would hope the tremendous results here spur development of this product and in tough tumor cases might well be worth pursuing.
DrO


J Am Vet Med Assoc. 2007 May 15;230(10):1506-13.
Long-term outcome associated with intratumoral chemotherapy with cisplatin for cutaneous tumors in equidae: 573 cases (1995-2004).

Theon AP, Wilson WD, Magdesian KG, Pusterla N, Snyder JR, Galuppo LD.
Departments of Surgery and Radiology, School of Veterinary Medicine, University of California, Davis, CA 95616.

Objective-To determine outcome associated with cutaneous tumors treated via intratumoral chemotherapy with cisplatin and identify risk factors affecting local tumor control and complications in equidae. Design-Retrospective case series. Animals-573 equidae with 630 cutaneous tumors. Procedures-Medical records of horses, mules, donkeys, and ponies with cutaneous tumors treated via intratumoral chemotherapy with cisplatin were analyzed. Results-549 horses, 13 mules, 8 donkeys, and 3 ponies with 630 histologically confirmed cutaneous tumors were included. Tumors included sarcoids (n = 409), squamous cell carci nomas (151), soft tissue sarcomas (28), cutaneous lymphomas (26), and melanomas (16). Overall cure rate, defined as local control at 4 years, was 93.3%. For all tumor stages combined, cure rates after 1 course of treatment were 96.3% for sarcoids, 96% for lym-phomas, 88% for squamous cell carcinomas, 85% for soft tissue sarcomas, and 81% for melanomas. Treatment protocol, tumor stage, and prior treatment were significant prog nostic factors for tumor control. Treatment efficacy was lower for large tumors, those with gross postoperative residual disease, and those that had been treated previously with other modalities. Treatment was well tolerated. Local reactions were more likely to occur and to be more severe after the third and fourth treatment sessions. Conclusions and Clinical Relevance-Results confirmed the value of intratumoral chemotherapy with cisplatin for treatment of cutaneous tumors in equidae.The results cannot be extrapolated to other formulations of cisplatin or other protocols that might be used.
Member:
corinne

Posted on Monday, May 21, 2007 - 7:54 pm:

I thought tumors were not made up of rapidly dividing cells therefore making a chemotheraputic less effective and cancer cells that are rapidly dividing are most susceptible so this is very interesting that there are great results with equine tumors and with those statistics I would say Cisplatin seems to be very effective, even if there are variables that make treatment prognosis, well variable and availability difficult at the current time.
I have given Cisplatin and it does require special handling such as gloves and gown and special disposable containers to discard the medication bags etc. but the American Cancer Society who certifies licensed health care workers such as nurses to give chemo can provide information to vets who choose to try this as a therapeutic modality. Very nice to know that regardless there are treatments on the forefront for those of us with horses who suffer from such if less invasive treatments such as cryotherapy doesn't work. So far I have dealt with three or four different vets due to our moves and each had only limited knowledge on efficacy of the treatment of tumors in horses besides excision and perhaps freezing which is still not a guarantee and only a few who used H2 antagonists primarily because of the lack of information out there in the field and scientific studies available. Thanks Dr. O, even if there are flies in the ointment as with any advances in medicine it's nice to know that there are potential options for those of us who have equine who might need them one day. I am passing this on to my vet to have him file away in his library.

Thanks!

Corinne
Moderator:
DrO

Posted on Tuesday, May 22, 2007 - 7:36 am:

The term "tumor" is pretty nonspecific for firm circumscribed swelling but the ones described in this article are neoplastic cells so are essentially cancer. However they range from very slow growing to the rapidly enlarging.

I am putting together an article based on this paper, further research including general handling principles,and trying to find where you can buy the ingredients to put together this particular concoction. So far I cannot find a commercial source of lypholized cisplatin. In the body of the paper they state they believe this form is important as it makes a better suspension than other forms.
DrO
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