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Axiak‐Bechtel SM, Leach SB, Newton‐Northup JR, Milner RJ, Fox‐Alvarez SA, Fagman LI, Young KA, Tate DJ, Wright ZM, Chretin JD, Allen JW, Yoshimoto SK, Selting KA, Flesner BK, White CR, Mills T, Aherne M, Bergman PJ, Qi L, Gruber KA, Callahan MF. Safety of TCMCB07, a melanocortin-4 antagonist peptide, in dogs with naturally occurring cachexia. J Vet Intern Med 2023; 37:2344-2355. [PMID: 37897303 PMCID: PMC10658582 DOI: 10.1111/jvim.16915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 10/13/2023] [Indexed: 10/30/2023] Open
Abstract
BACKGROUND The melanocortin 4 antagonist TCMCB07 is safe and effective in reversing cachexia caused by sepsis or cancer in rodents. The safety and pharmacokinetics of TCMCB07 are demonstrated in healthy beagle dogs. HYPOTHESIS/OBJECTIVES The objectives of this study were to investigate the safety, peak plasma concentrations, and potential for efficacy of TCMCB07 in pet dogs with naturally occurring cachexia over a 4-week time period. ANIMALS Fourteen dogs with cachexia of any underlying cause, except cancer of the oral cavity or gastrointestinal tract, were eligible for enrollment with informed client consent. METHODS This study was a prospective, 1-armed open-label trial. Physical examination, complete blood count, chemistry panel, and owner-assessed quality of life surveys were checked at weeks 1, 2, and 4. Due to potential for bradycardia and hypotension, Holter monitoring and blood pressure evaluations were scheduled at pre-enrollment and week 4. RESULTS Fourteen dogs completed the trial. Significant changes detected included increased mean body weight (18.6-19.5 kg, P < .02), increased body condition score (median Tufts 5-point thin dog scale score P < .004 and WSAVA muscle condition score P < .02) and increased mean blood urea nitrogen (21.79-30.43 mg dL-1 , P < .004). On quality of life surveys, pet owners perceived their dog appeared to be panting less (P < .002) and that the general health improved (P < .03). Four dogs had a change in coat pigmentation. The peak plasma concentration of TCMCB07 in cachectic dogs was similar to that in healthy beagle dogs. CONCLUSIONS AND CLINICAL IMPORTANCE TCMCB07 was safe and has potential efficacy in pet dogs with cachexia.
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Affiliation(s)
| | - Stacey B. Leach
- Department of Veterinary Medicine and SurgeryUniversity of MissouriColumbiaMissouriUSA
| | | | - Rowan J. Milner
- Department of Small Animal Clinical SciencesUniversity of FloridaGainesvilleFloridaUSA
| | - Stacey A. Fox‐Alvarez
- Department of Small Animal Clinical SciencesUniversity of FloridaGainesvilleFloridaUSA
| | - Lana I. Fagman
- Department of Small Animal Clinical SciencesUniversity of FloridaGainesvilleFloridaUSA
| | - Kaylee A. Young
- Department of Small Animal Clinical SciencesUniversity of FloridaGainesvilleFloridaUSA
| | - Deborah J. Tate
- Department of Veterinary Medicine and SurgeryUniversity of MissouriColumbiaMissouriUSA
| | | | - John D. Chretin
- VCA West Los AngelesLos AngelesCaliforniaUSA
- Present address:
VCA Veterinary Specialists of the ValleyWoodland HillsCaliforniaUSA
| | | | - Sean K. Yoshimoto
- VCA West Los AngelesLos AngelesCaliforniaUSA
- Present address:
VCA Animal Specialty and Emergency CenterLos AngelesCaliforniaUSA
| | - Kimberly A. Selting
- Department of Veterinary Medicine and SurgeryUniversity of MissouriColumbiaMissouriUSA
- Present address:
Department of Veterinary Clinical Medicine, College of Veterinary MedicineUniversity of Illinois Urbana‐ChampaignUrbanaIllinoisUSA
| | - Brian K. Flesner
- Department of Veterinary Medicine and SurgeryUniversity of MissouriColumbiaMissouriUSA
- Present address:
Department of Clinical Sciences and Advanced Medicine, School of Veterinary MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Carrie R. White
- VCA Family and Oahu Veterinary Specialty CenterPearl CityHawaiiUSA
| | - Tracy Mills
- VCA Clinical StudiesLos AngelesCaliforniaUSA
| | - Michael Aherne
- Department of Small Animal Clinical SciencesUniversity of FloridaGainesvilleFloridaUSA
| | | | - LeAnn Qi
- TCI Peptide TherapeuticsColumbiaMissouriUSA
| | - Kenneth A. Gruber
- TCI Peptide TherapeuticsColumbiaMissouriUSA
- Department of Medical Pharmacology & Physiology and the Dalton Cardiovascular Research CenterUniversity of MissouriColumbiaMissouriUSA
| | - Michael F. Callahan
- Department of Medical Pharmacology & Physiology and the Dalton Cardiovascular Research CenterUniversity of MissouriColumbiaMissouriUSA
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Intile JL, Rassnick KM, Al-Sarraf R, Chretin JD. Evaluation of the Tolerability of Combination Chemotherapy with Mitoxantrone and Dacarbazine in Dogs with Lymphoma. J Am Anim Hosp Assoc 2019; 55:101-109. [PMID: 30653362 DOI: 10.5326/jaaha-ms-6878] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Combination chemotherapy can be an effective option for treating resistant lymphoma in dogs. This retrospective study examined the tolerability and efficacy of the combination of 5-(3,3-dimethyl-1-triazeno)-imidazole-4-carboxamide (dacarbazine) (DTIC) in a population of dogs with lymphoma resistant to a doxorubicin-containing chemotherapy protocol. Mitoxantrone was administered at 5 mg/m2 IV over 10 min followed by DTIC at 600 mg/m2 IV over 5 hr, every 3 wk. All dogs were treated with prophylactic trimethoprim-sulfadiazine and metoclopramide. The frequency of grade 4 neutropenia was 18%, and 5% of dogs were hospitalized from sepsis. Gastrointestinal toxicity was uncommon. The overall response rate was 34% (15 of 44; 95% confidence interval 20-48%) for a median duration of 97 days (range 24-636 days, 95% confidence interval 44-150 days). Fourteen of 15 dogs who received mitoxantrone and DTIC as first rescue responded to treatment. Dogs who achieved complete remission to their initial L-asparaginase, cyclophosphamide, doxorubicin, vincristine, and prednisone chemotherapy protocol were more likely to respond to mitoxantrone and DTIC (23 versus 11%, P = .035). The combination of mitoxantrone and DTIC is a safe treatment option for resistant lymphoma in dogs.
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Affiliation(s)
- Joanne L Intile
- From the Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina (J.L.I.); Veterinary Medical Center of Central New York, Syracuse, New York (K.M.R.); Animal Emergency and Referral Associates, Fairfield, New Jersey (R.A-S.); and VCA West Los Angeles Animal Hospital, Los Angeles, California (J.D.C)
| | - Kenneth M Rassnick
- From the Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina (J.L.I.); Veterinary Medical Center of Central New York, Syracuse, New York (K.M.R.); Animal Emergency and Referral Associates, Fairfield, New Jersey (R.A-S.); and VCA West Los Angeles Animal Hospital, Los Angeles, California (J.D.C)
| | - Renee Al-Sarraf
- From the Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina (J.L.I.); Veterinary Medical Center of Central New York, Syracuse, New York (K.M.R.); Animal Emergency and Referral Associates, Fairfield, New Jersey (R.A-S.); and VCA West Los Angeles Animal Hospital, Los Angeles, California (J.D.C)
| | - John D Chretin
- From the Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina (J.L.I.); Veterinary Medical Center of Central New York, Syracuse, New York (K.M.R.); Animal Emergency and Referral Associates, Fairfield, New Jersey (R.A-S.); and VCA West Los Angeles Animal Hospital, Los Angeles, California (J.D.C)
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Abstract
The purpose of this study was to evaluate the prevalence of serum alanine transaminase (ALT) increases in cats treated with 1-(2-chloroethyl)-3-cyclohexyl-1-nitrosourea (CCNU, lomustine). The medical records of 95 cats treated with CCNU were reviewed, 29 of which met study criteria (at least one treatment with CCNU as a single agent, and at least one pretreatment and one post-treatment complete biochemical profile). Cats that received concurrent prednisone or dexamethasone were included, but those that received concurrent hepatoprotective or hepatotoxic medications were excluded. Cats included in the study were diagnosed with hepatic carcinoma, mammary carcinoma, lymphoma, mast cell tumor, plasma cell tumor and gastrointestinal leiomyoma. CCNU was given as a single agent at 31-60 mg/m(2), once every 4-8 weeks. Serum alanine transaminase (ALT) activity was measured after at least one dose of CCNU. Four cats (13.7%) had increased ALT activity above the reference interval before starting treatment. Two additional cats (6.8%) developed increased ALT activity above the reference interval 1 month after treatment with CCNU. One cat developed clinical signs potentially associated with hepatotoxicity, without a concurrent increase in ALT, 3 weeks following the final dose of CCNU. No association between dosing frequency, cumulative dose, initial starting dose or concurrent medications, and increases in ALT were found. Clinically significant hepatic injury is seemingly uncommon in cats treated with CCNU.
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Flory AB, Rassnick KM, Erb HN, Garrett LD, Northrup NC, Selting KA, Phillips BS, Locke JE, Chretin JD. Evaluation of factors associated with second remission in dogs with lymphoma undergoing retreatment with a cyclophosphamide, doxorubicin, vincristine, and prednisone chemotherapy protocol: 95 cases (2000–2007). J Am Vet Med Assoc 2011; 238:501-6. [DOI: 10.2460/javma.238.4.501] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Payne SE, Rassnick KM, Northrup NC, Kristal O, Chretin JD, Cotter SM, Kintzer P, Frimberger AE, Morrison-Collister KE, Wood CA, Moore AS. Treatment of vascular and soft-tissue sarcomas in dogs using an alternating protocol of ifosfamide and doxorubicin. Vet Comp Oncol 2009; 1:171-9. [PMID: 19379178 DOI: 10.1111/j.1476-5810.2003.00024.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A retrospective analysis was done to assess the toxicity and efficacy associated with an alternating chemotherapy protocol of ifosfamide (375 mg m(-2)) and doxorubicin (30 mg m(-2)) for adjuvant treatment of 39 dogs with sarcomas. Twelve dogs had various soft-tissue sarcomas and 27 dogs had hemangiosarcoma (HSA). Complete blood counts were evaluated 7 days after the first dose of ifosfamide and doxorubicin. One dog had grade 4 neutropenia (<500 microL(-1)) after treatment with ifosfamide and one dog had grade 3 neutropenia (500-1000 microL(-1)) after treatment with doxorubicin. One dog treated with doxorubicin was hospitalized for 24 h due to vomiting. The median survival time (ST) for the 27 dogs with HSA treated by surgery and with doxorubicin/ifosfamide was 149 days (mean 366 days). Although the protocol of alternating ifosfamide and doxorubicin was well tolerated, it failed to result in a statistically significant improvement in the ST when compared to a historical population of dogs with stage 2 splenic HSA treated by surgery alone.
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Affiliation(s)
- S E Payne
- Harrington Oncology Program, Tufts University School of Veterinary Medicine, North Grafton, MA 01536, USA.
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Intile JL, Rassnick KM, Bailey DB, Al-Sarraf R, Chretin JD, Balkman CE, Flory AB, Kiselow MA, Wakshlag JJ. Evaluation of dexamethasone as a chemoprotectant for CCNU-induced bone marrow suppression in dogs. Vet Comp Oncol 2009; 7:69-77. [PMID: 19222832 DOI: 10.1111/j.1476-5829.2008.00175.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
In mice and people, administering corticosteroids before chemotherapy can reduce the severity of myelosuppression without reducing antitumour effects. This study investigated whether pretreatment with dexamethasone would reduce the incidence of grade 4 neutropenia in dogs receiving CCNU. Twenty-five dogs received dexamethasone [0.1 mg kg(-1) per os (PO) every 12 h] for 5 days and on the sixth day received CCNU (90 mg m(-2) PO). Historical dogs (n = 67) received CCNU alone (90 mg m(-2) PO). Forty-five percent of historical dogs had grade 4 neutropenia, while 64% of dogs pretreated with dexamethasone had grade 4 neutropenia (P = 0.16). Dexamethasone plasma levels were quantified by enzyme-linked immunosorbent assay in three healthy dogs. Peak plasma concentrations after a single oral 0.1-mg kg(-1) dose were <80 ng mL(-1), the minimum level associated with chemoprotective effects of dexamethasone in people. Pretreatment with dexamethasone did not reduce the incidence of grade 4 neutropenia in dogs receiving CCNU.
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Affiliation(s)
- J L Intile
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853, USA
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Chretin JD, Rassnick KM, Shaw NA, Hahn KA, Ogilvie GK, Kristal O, Northrup NC, Moore AS. Prophylactic trimethoprim-sulfadiazine during chemotherapy in dogs with lymphoma and osteosarcoma: a double-blind, placebo-controlled study. J Vet Intern Med 2007; 21:141-8. [PMID: 17338162 DOI: 10.1892/0891-6640(2007)21[141:ptdcid]2.0.co;2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The administration of chemotherapy is associated with risk for morbidity. Management of chemotherapy-related morbidity in veterinary oncology has been primarily supportive. HYPOTHESIS The purpose of this study was to evaluate the effect of prophylactic antimicrobial use on chemotherapy-associated morbidity in dogs with lymphoma or osteosarcoma. ANIMALS Dogs presenting with histologically confirmed osteosarcoma or lymphoma were eligible. METHODS Patients were randomized to receive placebo or trimethoprim-sulfadiazine for 14 days after their first doxorubicin chemotherapy. Both owner and clinician were blinded with respect to treatment. Patient assessment included CBC, physical examination and performance, and toxicosis grading on days 7 and 14. Investigated outcomes were hospitalization, suspicion of infection, gastrointestinal toxicity, neutropenia, nonhematologic toxicity, and quality of life. RESULTS Seventy-three dogs were enrolled; 34 had osteosarcoma, and 39 had lymphoma. Dogs receiving trimethoprim-sulfadiazine (n = 36) had a significantly reduced hospitalization rate (P = .03), nonhematologic toxicity (P = 0.039), grade 2-4 nonhematologic toxicity (P < .0001), grade 2-4 gastrointestinal toxicity (P = .007). and altered performance (P = .015). By group, dogs with osteosarcoma (n = 34) that received the antimicrobial experienced fewer occurrences of nonhematologic toxicity (P = .02) and less severe nonhematologic toxicity (P = .038). Dogs with lymphoma (n = 39) had significant reductions in the occurrence of hospitalization (P = .035), severity of nonhematologic toxicity (P = .036), and alterations of performance (P = .015). CONCLUSIONS The use of prophylactic trimethoprim-sulfadiazine has benefit in reducing morbidity in dogs with osteosarcoma or lymphoma during the first 14 days after treatment with doxorubicin.
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Affiliation(s)
- J D Chretin
- Harrington Oncology Program, Tufts University, North Grafton, MA, USA
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Wright ZM, Chretin JD. Diagnosis and treatment of a feline oral mast cell tumor. J Feline Med Surg 2006; 8:285-9. [PMID: 16616568 DOI: 10.1016/j.jfms.2006.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2006] [Indexed: 10/24/2022]
Abstract
A cat was diagnosed with an oral mast cell tumor following incisional biopsy. The location of the tumor, possible metastasis, financial restraint and patient disposition severely limited therapeutic options. The patient was treated with six doses of 1-(2-chloroethyl)3-cyclohexyl-1-nitrosurea (CCNU) and methylprednisolone acetate. Complete remission was obtained after the third dosing regimen. This is the first documented case of feline oral mast cell tumor and one of a small group of cats with various cancers to be responsive to CCNU treatment.
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Affiliation(s)
- Zachary M Wright
- Small Animal Clinic, Texas A&M College of Veterinary Medicine, 4474 TAMU, College Station, TX, USA.
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Kristal O, Rassnick KM, Gliatto JM, Northrup NC, Chretin JD, Morrison-Collister K, Cotter SM, Moore AS. Hepatotoxicity associated with CCNU (lomustine) chemotherapy in dogs. J Vet Intern Med 2004; 18:75-80. [PMID: 14765735 DOI: 10.1892/0891-6640(2004)18<75:hawclc>2.0.co;2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
One hundred seventy-nine tumor-bearing dogs were treated with 1-(2-chloroethyl)-3-cyclohexyl-1-nitrosourea (CCNU) between 1995 and 2001. CCNU was given as a single dose of 50-110 mg/m2 body surface area PO. Treatment interval varied, but the minimal interval between CCNU doses was 3 weeks. After treatment, 11 dogs (6.1%) developed hepatic toxicity. The median number of CCNU doses and the median total cumulative CCNU dose were significantly higher in dogs that developed hepatic toxicity (4 doses; 350 mg/m2) than in dogs without hepatic damage (3 doses; 230 mg/m2). Median duration to detection of hepatic toxicity from the last dose of CCNU was 11 weeks (range 2-49 weeks). Common biochemical abnormalities were abnormally high serum liver enzyme activities and hypoalbuminemia. Six dogs with CCNU-associated hepatic toxicity had ascites, and 3 dogs had concurrent pleural effusion. Serum concentrations of bile acids were abnormally high in 4 of 5 dogs tested. Percutaneous ultrasound-guided liver biopsies were performed in 10 dogs, and findings were nonspecific and chronic in nature. Seven dogs were euthanized because of progressive liver failure, and their median survival from diagnosis of liver disease was 9 weeks. Three dogs died of other causes and 1 dog of unknown cause. Although clinical signs resolved in 3 dogs, biochemical abnormalities and histopathologic lesions persisted 4 to 38 months from the time of diagnosis of liver disease. Our findings suggest that CCNU can cause delayed, cumulative dose-related, chronic hepatotoxicity that is irreversible and can be fatal.
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Affiliation(s)
- Orna Kristal
- Harrington Oncology Program, Tufts University School of Veterinary Medicine, North Grafton, MA, USA
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Kristal O, Rassnick KM, Gliatto JM, Northrup NC, Chretin JD, Morrison-Collister K, Cotter SM, Moore AS. Hepatotoxicity Associated with CCNU (Lomustine) Chemotherapy in Dogs. J Vet Intern Med 2004. [DOI: 10.1111/j.1939-1676.2004.tb00138.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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