There is Hope. Part 2: New Personalized Cancer Treatment Leads to Long-Term Remission in Dogs
*This article has been reprinted in part with permission from the Canine Cancer Alliance.
Wouldn't it be wonderful if remission from osteosarcoma meant years of ball-chasing, tail-wagging, and the good life? Osteosarcoma is the most common type of bone cancer and is very aggressive. Even with today's gold-standard treatment of amputation and chemotherapy, survival after diagnosis is typically less than a year. Having lost our dog, Gus, to osteosarcoma, I've been particularly interested in research for new treatments for this disease.
A new cancer treatment based on immunotherapy is currently available
for osteosarcoma (aggressive bone cancer) in canine patients.
Like many dogs, Gus's cancer spread to his lungs roughly 12 months after his diagnosis, and my big disappointment was not being able to enroll him into a promising immunotherapy clinical trial for a shot at long-term remission. Immunotherapy engages the immune system to fight cancer, unlike chemotherapy, which tries to kill cancer cells directly and has produced outstanding results in some human patients.
After losing Gus, I wanted to find ways to support canine cancer research for dogs, started a nonprofit organization, and began attending veterinary cancer conferences to learn about the latest treatments under development.
I first met the team from ELIAS Animal Health at the Veterinary Cancer Society meeting in 2018 and began to follow their work. The ELIAS team stood out from other companies and researchers because they were actively sharing their most recent findings from their clinical evaluations.
At the end of 2019, they published a summary of their pilot trial results. To get the most recent update, I reached out to Tammie Wahaus, the founder and CEO of ELIAS Animal Health and their Chief Medical Officer Noel Reyes, DVM.
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Here is a summary of what I found out.
ELIAS Cancer Immunotherapy (ECI®)
ELIAS Cancer Immunotherapy (ECI) is a form of immunotherapy called "Adoptive Cell Therapy" or Adoptive T-cell Therapy. A patient's cancer-fighting T-cells are removed and activated in the laboratory and infused back into the body so they can better kill cancer cells.
A form of Adoptive Cell Therapy called CAR-T Therapy has met with spectacular successes with some human patients with blood cancer. ELIAS has been evaluating ECI for several years by partnering with different veterinary teaching hospitals and clinicians.
According to their summary, a total of 14 dogs with osteosarcoma were enrolled in their trial. For all dogs in the trial, the observed side effects of the treatment were mild to moderate and transient, in other words they didn’t last long.
Two-Step Treatment Process
ECI treatment is administered over 6-8 weeks and consists of two steps.
First, the patient dog undergoes amputation surgery of the affected limb. A tumor sample is sent to ELIAS's lab, where they make a vaccine. This patient-specific vaccine is injected under the skin weekly for three weeks. This step primes the immune system to recognize the unique proteins that are associated with the dog's tumor cells. Hence this therapy is personalized to each dog. But this step alone does not activate enough T-cells to fight cancer effectively.
In the second step, the patient's white blood cells are removed in a procedure called “apheresis” and sent to ELIAS's lab. There, mononuclear white blood cells are stimulated to produce many activated T-cells that can attack cancer cells. This T-cell infusion is then given to the dog. The dog also receives 5 injections of IL-2. IL-2 is a substance that stimulates and helps keep the T-cells growing.
Survival Times Extended
Standard-of-care treatment for many osteosarcoma canine patients consists of amputation surgery followed by chemotherapy. Based on prior studies, the median survival times for dogs receiving surgery and chemotherapy is 308 days. (This means that half the dogs survived beyond 308 days.)
According to published trial data, roughly half of the ten dogs that completed the therapy became disease-free and experienced long remission.
ELIAS reported a median survival time of 415 days. Out of fourteen patient dogs enrolled in ELIAS's trial, ten dogs completed the entire treatment protocol. Out of these ten dogs, five dogs were still alive and disease-free at the time of paper was published at the end of 2019. Both the survival times and quality of life have been impressive, according to ELIAS team.
ROSCOE'S STORY
Roscoe is a Great Dane and one of the dogs who received ELIAS's immunotherapy treatment. He was diagnosed with osteosarcoma in May 2017 when he was only six years old. His leg was amputated, and he received ELIAS' immunotherapy instead of chemotherapy. Soon after the infusion, he developed a subcutaneous mass that was confirmed to be metastatic osteosarcoma.
The researchers assumed that he was not going to survive, but when they followed up with Roscoe's parents several months later, they were happily surprised to learn that Roscoe was still alive.
Roscoe experienced full regression and is still alive today,
almost three years after his diagnosis.
According to Dr. Noe Reyes DVM, "It is important to note that not all dogs will respond this well as there is a complicated interaction going on that is dependent on the patient's immune system health and the aggressiveness of cancer, among other things. But when we do see a response, it has been quite substantial and sometimes complete. Some of the results seen are similar to those observed in human CAR-T patients (for example, when it works, it can have dramatic results)."
How can I get this treatment for my dog?
Today, ECI is designated as an experimental product by the US Department of Agriculture and is available at slightly over thirty clinics in the United States. To receive the treatment, a canine patient needs to have a diagnosis of osteosarcoma, should not be on any immunosuppressive drugs, and, other than cancer, should be in good health.
ELIAS is planning new studies with different types of cancer later this year.
In Washington state, three veterinary specialty clinics
in Bellingham and Tacoma offer this treatment
to dogs confirmed with osteosarcoma diagnosis:
Boundary Bay Veterinary Specialty Hospital, Bellingham, WA,
Phone: (360) 982-0166
BluePearl Pet Hospital, Tacoma, WA, Phone: (253) 474-0791
Summit Veterinary Referral Center, Tacoma, WA, Phone: (253) 983-1114
If you cannot find a clinic near your location listed on their website, I recommend contacting ELIAS directly to ask. New clinics are being added, and the site may not reflect the most up-to-date information. For example, Blue Pearl Seattle Veterinary Services Clinic in Kirkland WA will be offering the treatment soon.
The treatment is not inexpensive and costs slightly more than chemotherapy. The actual cost will depend on the clinic, and a number that I heard mentioned is $10,000+.
If I had to choose today, I would most likely select immunotherapy over traditional chemotherapy because I believe my dog would get a chance at a more durable remission.
But each pet owner's situation is different; we all face difficult choices, especially since this is still an experimental treatment, and there is no guarantee that the dog will respond with long-term remission, especially since the pilot trial consisted of small number of dogs.
But unlike today's standard-of-care treatment, this therapy does give big hope to pet owners. And with additional much-needed research, I hope that a new generation of immunotherapy treatments will improve, and more dogs will live many more tail-wagging good years.
Notes:
The Canine Cancer Alliance welcomes questions or comments. You can connect by visiting their website or sending an email to Mari Maeda, mmaeda@ccralliance.org.
Mari Maeda is the director of the Canine Cancer Alliance, a Bellevue-based nonprofit organization supporting cancer research to help pet dogs. To learn up-to-date information on new treatments, we encourage you to check out their blog pages.