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Small Animal/Exotics 20TH ANNIVERSARY Compendium October 1999

Highlights and Horizons in


Veterinary
Oncology
E. Gregory MacEwen, VMD, Diplomate
ACVIM (Internal Medicine, Oncology)
Professor, Department of Medical Sciences
School of Veterinary Medicine
University of Wisconsin
Madison, Wisconsin
he field of veterinary oncology has grown considerably over the past 20 to

T 30 years. Today, cancer treatment in companion animals continues to


undergo a substantial evolution within clinical veterinary practice. It is
estimated that 15% to 20% of mature animals presented to a veterinary practice
will have a neoplastic process. Following diagnostic workup, 20% to 25% of
those patients will receive cancer treatment.

History
In the late 1960s and early 1970s, veterinary oncology was dominated by
pathologists and, to a limited degree, academic veterinary surgeons. The ad-
vances made during this time were predominantly pathologic classification
schemes and tumor grading systems. The development of traditional surgical
management of solid tumors served as the basis for gaining information on the E. Gregory MacEwen, VMD
biologic behavior and sites of metastasis for many common cancers.
When I entered the field of veterinary oncology in the early 1970s, the prima- olina State University), radiation ther-
ry objective for most aggressive cancers was to establish a diagnosis and obtain a apy advanced because of the potential
complete necropsy. In the late 1970s, clinical staging systems were established for using companion animals as mod-
under the leadership of the World Health Organization. These staging systems els for human cancer. Over the past
were essential for the development of prospective clinical trials, for valid compar- 20 years, there have been significant
isons among treatment modalities and studies performed by various investiga- technical refinements in radiation
tors, and for maintaining consistency in the presentation of data in the litera- therapy in humans as the result of ex-
ture. Surgical oncology advanced significantly in the 1980s; the most notable perience gained in veterinary practice.
contributions included advances in the aggressive treatment of oral tumors (e.g., For example, investigators at Colo-
mandibulectomy, partial maxillectomy) and limb-salvage procedures. rado State University obtained substan-
Slowly, the field of nonsurgical cancer therapy began to develop. Particularly at tial grant support from the National
a few schools of veterinary medicine (e.g., Colorado State University, North Car- Cancer Institute in the mid-1970s

1968 1974 1978 1980


ENDIU
MP 1980 1983
19
The seminal paper on The Veterinary The World Health Purdue University hosts the first

1985
cancer incidence data Cancer Society Organization VCS Clinical Veterinary
M’

20th
 CO

for dogs and cats is (VCS) is publishes the TNM Oncology Workshop

1981
S

published in the established (tumor, node,

1 9 7

ANNIVERSARY
9 - 1
9 9 9

1979Journal of the
National Cancer
Institute
1982 metastasis)
classification of
tumors in domestic

1984
animals
The National Institutes of Health
publishes the first and only
monograph on the occurrence of
tumors in domestic animals
19
Compendium October 1999 20TH ANNIVERSARY Small Animal/Exotics

and early 1980s for the study of ani- of the targets of current anticancer
mal models and obtained new data drugs are cancer-specific; DNA and OWNERS’ OUTLOOK
on tumor response, tumor hypoxia, RNA synthesis, microtubule assem-
fractionation techniques, and normal bly and function, and topoisomeras- ■ Family Ties. Studies conducted
tissue toxicity in companion animals. es are common targets for anticancer by Barker and Barker showed
that some dog owners are as
The field of veterinary medical on- drugs but are also required by nor-
emotionally close to their dogs as
cology struggled in the 1970s because mal cells, especially those that grow to their closest family member.
of the lack of veterinary centers fo- rapidly (e.g., in bone marrow and More than one third of owners in
cusing on medical oncology. Initially, the gastrointestinal tract). However, the study felt closer to their dogs
the major challenges were to identify as our understanding of the molecu- than to any human family
available chemotherapeutic agents, lar biology of cancer and the role of member.1,2
determine dose levels that were well the tumor microenvironment or tu-
tolerated, establish frequencies of ad- mor–host interaction increases, en- References
ministration, determine appropriate thusiasm for biologic therapy, gene 1. Barker SB, Barker RT: Investigation
monitoring for drug toxicity, and therapy, organ-specific targeting, and of the construct validity of the Family
conduct clinical trials to determine immunotherapy will intensify. Some Life Space Diagram. J Ment Health
efficacy. In the late 1970s and early of the most exciting advances in can- Couns 12:506–514, 1990.
1980s, a number of available chemo- cer therapy, such as antiangiogenic 2. Barker SB, Barker RT: The human-
therapeutic agents (e.g., L-asparagi- agents, tumor vaccines, growth factor canine bond: Closer than family ties?
nase, doxorubicin, vincristine, cyclo- receptor inhibitors, and liposome-en- J Ment Health Couns 10:46–56,
1988.
phosphamide, melphalan) tested in capsulated chemotherapy, are based
prospective clinical trials were shown on a better understanding of the bi-
to have antitumor activity in animals ology of cancer and the selection of
for lymphoma, chronic leukemias, mye- agents with defined mechanisms of established oncology as a subspecial-
loma, and a few solid tumor types. action. ty within its organization. Today,
Following the identification of the there are more than 90 board-certi-
best agents, such as those listed above, Organizations fied ACVIM diplomates in oncolo-
the next challenge was to combine The advancement of veterinary gy. In 1994, the American College of
these drugs into combination chemo- oncology is also based on organized Veterinary Radiology established ra-
therapy protocols. In the mid-1980s, veterinary medicine. The most no- diation oncology as a separate board,
combination chemotherapy protocols table impact on clinical veterinary and there are currently 30 board-cer-
had become the standard of care for oncology was the establishment of tified veterinary radiation oncolo-
medical oncology in human and vet- the Veterinary Cancer Society (VCS) gists.
erinary medicine. Since the late 1980s in 1974. The VCS grew from a small An additional significant contribu-
and early 1990s, combined-modality group of approximately 20 to more tion to veterinary oncology was the
therapy, which includes surgery, ra- than 600 members today. This orga- establishment of the Veterinary Co-
diation, and chemotherapy, has be- nization has played a major role in operative Oncology Group (VCOG)
come more common in the general the dissemination of new knowledge in 1985. This group was established
practice of veterinary oncology. through its annual scientific meet- to enhance interactive collaboration
The use of immunotherapy and ings and the publication of the Vet- and multicenter trials to broaden the
biologic therapy has its roots in the erinary Cancer Society Newsletter. generation of clinical data and thera-
mid-1970s; however, the results of a The VCS has also helped to devel- peutic studies. The VCOG has con-
number of clinical trials yielded only op veterinary oncology into a recog- ducted a large number of retrospec-
minimal benefit in treating a few se- nized specialty within the American tive and prospective clinical studies,
lected solid tumors, such as osteosar- College of Veterinary Internal Medi- most of which have been published
coma, melanoma, and lymphoma. None cine (ACVIM). In 1987, the ACVIM in the veterinary literature.

98719901992 1985

1995
The American Veterinary
1987
The American College
1990
The European Society
1994
The American College
1999
The VCS and the

1998
Medical Association of Veterinary Internal of Veterinary of Radiology ESVO hold their

1991
publishes a brochure entitled Medicine recognizes Oncology (ESVO) establishes the first combined

1994
Warning Signs for Cancer oncology as a specialty, holds its first annual subspecialty of international meeting

19891993 1997
in Pets and the certification congress radiation oncology

986
1999
process is established
The Veterinary Cooperative
Oncology Group is founded
Small Animal/Exotics 20TH ANNIVERSARY Compendium October 1999

Private Practice dition, veterinarians now have a more positive attitude and
Although the majority of contributions made to veteri- philosophy regarding cancer therapy. Finally, veterinary
nary oncology have originated from oncology programs at care has shifted toward life extension and the improvement
academic veterinary institutions, the field has extended in quality of life. General veterinary practice has eliminat-
greatly into the private sector. The rapid development of ed many juvenile diseases, and pets are living to a ripe old
specialty practices in almost all major metropolitan areas age. Pet owners are generally knowledgeable, and many
has moved cancer management from academic centers to have a strong appreciation for the various modes of cancer
private practice. Not only has medical oncology expanded therapy, related toxicities, and potential benefits.
to private practice, but radiation therapy is now becoming
readily available in private specialty practices. Based on the The Future
economics and demographics of veterinary practice, the The next 20 years will bring a phenomenal number of
greatest expansion of the delivery of veterinary cancer care exciting changes to veterinary oncology. There will be a
in the future will most likely take place in private referral greater shift toward cancer-specific therapies and less re-
practice. The academic centers will still play a major lead- liance on traditional chemotherapy and radiation. These
ership role in resident training, research, and conducting therapies will include gene therapy, targeted chemotherapy,
prospective clinical trials. For academic programs to re- antiangiogenic therapy, focused radiation, and cancer-spe-
main viable and competitive, however, close collaboration cific drugs. Furthermore, the availability of reliable and fac-
will be needed with the private sector. tual information via the Internet will allow pet owners to
Client Attitudes have immediate and up-to-date information, which may
Concurrent with the rapid expansion of clinical veteri- give them as much knowledge as practitioners have about a
nary oncology, clients’ attitudes toward cancer and cancer particular cancer or treatment modality. This will create a
therapy for their companion animals have changed at a major challenge for practicing veterinarians. The availabili-
similarly rapid pace. Much of this is a direct result of the ty of current information and access to veterinary specialists
awareness and appreciation by veterinarians of the strong via the Internet and telemedicine will play an even greater
bond that develops between owners and their pets. In ad- role in expanding oncology into the private sector.