Cisplatin Beads to cure Squamous Cell Carcinoma in horses. A happy ending for Aponi!






I don’t have a light colored horse, so this type of skin cancer wasn’t even on my radar… I mean, I’d heard of it, but really didn’t take note because I thought it was rare.  It isn’t…

Squamous cell carcinoma came to my attention via my wonderful vet who has battled Tess’s canker cure, Aladdin’s rare disease, Norma’s severe laminitis/abscesses — and several other equine maladies — with me.  We were sitting in the barn observing Norma and chatting.  He said, “Y’know, I think I have a really great story for your blog…”

I get excited when THE VET says he has a great story… I know it is going to be good!  So, with excitement, I urged him on.

“OK, well, there is this really sweet, totally blind Appy mare that we know.  And…”

APONI’S STORY

Aponi is an 18 year old, totally blind Appy mare who was rescued 6 years ago by her devoted new owner, Veronica.  This mare was so sweet and so congenial, Veronica couldn’t help but take her in.  At that time, Aponi still had sight in one eye.  However, within two years, she lost sight in the other eye.  According to Veronica, Aponi is still the same happy mare.  She uses her nose and ears quite well and with the aid of her pasturemate Annie, Aponi didn’t miss a beat.  From all accounts, (including my vet and his tech) Aponi is just about the sweetest and most affable mare in the county.

Beautiful and blind, Aponi

BUT ONE DAY

This is the stuff that makes your scoobydar peak…  You notice something and you figure it is nothing but you call the vet out anyway.  When the vet arrives he cocks his head and says, “Hmmmmmmm”.

Ugh.  We’ve all been there.

“Wha?  Isn’t it just a little thing?”

No, it isn’t.

Here is the way Veronica told the story:

I originally had my vet out to check her in July for what I thought at the time was an abrasion/laceration from rubbing on the fence and/or trees that had gotten infected.  There was a thumb sized opening near the left side of her vulva and she’s such a butt scratcher that I assumed that must have been the cause.

However, when my vet came out to check her, the opening was actually deeper and larger than it had appeared.  When he examined the inside of the opening the tissue felt odd so he took a sample and sent it to the lab for testing.  When the test results came back, the diagnosis was cancer (squamous cell carcinoma.)  My vet indicated that due to advanced stage of the cancer, he was not sure that I had a lot of options other than trying to make her comfortable and he did offer to assist with what ever I needed.  However, he recommended that I check with UC Davis or other nearby Vet Hospitals to see if they thought it might be treatable.

The problem...

BUT SHE’S BLIND AND SHE CANNOT TRAILER

And then the thoughts that make owners bang their head against the wall…

“If you could get her to the Specialists…”

But she doesn’t trailer!  Arrgh.  What to do?!  Exasperation.

Here is how Veronica explained it:

The problem with taking her somewhere like UC Davis to be examined was that I had not trailered her since she lost her sight and wasn’t sure how well she would do.  She was blind in one eye when I adopted her six years ago, and had lost her sight completely in her other eye a couple of years later.  She has adjusted well to her lack of vision and gets around in her pasture using her nose and ears and her pasture mate, but I didn’t want to traumatize her by taking her away from her home if I could avoid it.

Up to this point, I wasn’t sure what to do. I wanted to do right by this 18 year old blind Appaloosa mare that I loved to pieces, but I wasn’t sure how I was going to make that happen.  About this time, she was due for her regular trimming from the farrier. When he came to see her, he noticed the S.W.A.T that I had applied around the affected area and asked what was wrong.  When I explained her situation, he almost cried.  I was not the only one that had a soft spot for this mare. After we spoke a bit more, he told me that I should contact Mario Dinucci and have him come out and do an exam.  He said that Mario had worked with some of his other clients in similar situations and that he might be able to help me as well.

IN COMES MARIO, MY VET

So, as Mario was relating this story, he filled in the medical blanks for me.  He said that these tumors grow rapidly and are nasty.  As a vet, he runs the risk of removing the tumor and in that process “angering it” (his words).  The tumor could come back with a vengeance.  But, sometimes tumors are removed and they don’t reappear.

This particular tumore was deep and large and scary.

But the mare was so nice…  Mario said that he decided that he wanted to try a new procedure on this sweet mare — as long as the owner understood the risks and agreed.

THE TREATMENT

Mario said that he read that Cisplatin beads had worked in a clinical trial of several horses, donkeys, and a zebra.  Cisplatin beads are tiny beads that contain the cancer medicine, Cisplatin.  The idea is that these beads can be placed exactly in the hot area and do their work with minimal intrusion upon the rest of the animal.  These concentrated measures of medicine are fixed and don’t spread around the rest of the body as Cisplatin liquid can when used orally.  So, less stress on the animal and more directed intervention.

The HOPE, Cisplatin Beads

CISPLATIN BEADS

I found this article that gives a bird’s eye view on the beads.

Click to enlarge

THE STUDY

There are several articles written on Cisplatin beads. However, I wanted to show you the study so you could read about it from a clinical standpoint:

At the Marion duPont Scott Equine Medical Center in Leesburg, Va., 40 of 48 horses (83%) treated with this approach were relapse-free two years later. Hewes reported the following success rates from an article published in the Nov. 15, 2006, issue of the Journal of the American Veterinary Medical Association:

Use of cisplatin-containing biodegradable beads for treatment of cutaneous neoplasia in equidae: 59 cases (2000–2004)

Christina A. Hewes, DVM, Kenneth E. Sullins, DVM, MS, DACVS
Marion DuPont Scott Equine Medical Center, Virginia-Maryland Regional College of Veterinary Medicine, Leesburg, VA 20177. (Hewes, Sullins)
Dr. Hewes’ present address is Peninsula Equine, PO Box 7297, Menlo Park, CA 94028.
The authors thank Lea Ann Hansen of the Virginia Commonwealth University School of Pharmacy for technical assistance.
Address correspondence to Dr. Hewes.
Objective—To determine outcome for equids with cutaneous neoplasms treated with cisplatin-containing biodegradable beads, alone or in conjunction with debulking.
Design—Retrospective case series.
Animals—56 horses, 1 zebra, 1 donkey, and 1 mule.
Procedures—Medical records were reviewed. Follow-up information was obtained through telephone conversations with owners and trainers of the animals.
Results—22 tumors were sarcoids, 6 were fibrosarcomas, 1 was a fibroma, 2 were peripheral nerve sheath tumors, 11 were squamous cell carcinomas, 14 were melanomas (13 gray horses and 1 bay horse), 1 was a lymphosarcoma, 1 was an adenocarcinoma, and 1 was a basal cell tumor. Forty-five (76%) animals underwent conventional or laser debulking of the tumor prior to bead implantation. Forty of 48 (83%) animals for which long-term follow-up information was available were relapse free 2 years after treatment. This included 20 of 22 animals with spindle cell tumors (including 11/13 horses with sarcoids), 6 of 10 animals with squamous cell carcinomas, 13 of 14 animals with melanomas, and 2 of 3 animals with other tumor types. Adverse effects were minimal.
Conclusions and Clinical Relevance—Results suggest that implantation of cisplatin-containing biodegradable beads, with or without tumor debulking, may be an effective treatment for equidae with various cutaneous neoplasms.

•                91% (20/22) of cases with spindle cell tumors (sarcoids and fibrosarcomas) were relapse-free after two years. Three cases with regrowth at one, two, and three years resolved after one additional treatment.

•                Squamous cell carcinomas had the greatest tendency to recur (60% success rate), likely due to the duration of these cases and the increased metastatic (spreading) potential of this tumor type.

•                93% (13/14) of melanoma cases were relapse-free after two years, including all affected gray horses. The one failure was a bay horse with malignant melanoma.

•                The sole cases of basal cell sarcoma and adenocarcinoma were relapse-free after two years.

•                One horse with lymphosarcoma showed metastasis after nine months.

•                Flat sarcoids don’t respond well to this treatment; growth stops, but the tumor doesn’t regress.

Complications included swelling, erythema (capillary congestion), wound drainage, subtle scarring, and a corneal ulcer requiring eye removal in one horse (following treatment of an upper eyelid tumor).

“Cisplatin beads are a simple and effective cutaneous (skin) neoplasia treatment,” Hewes concluded. The beads are affordable for the average horse owner and are sold in three-packs.

HOW VERONICA SAW THE OPTION OF SURGERY

As an owner, we have to make difficult decisions… Here is what Veronica said:

I contacted Sierra Equine that same day and requested a ranch call.  Mario came out the following week and conducted the exam and commented on Aponi’s good nature about the whole thing.  I told him that was why I adopted her in the first place.  After he finished the exam he told me that he couldn’t guarantee the cancer would be cured, but he did think that Aponi was a good candidate for the procedure and cisplatin beads and most importantly that he could do the procedure on site.

He provided me with worst and best case scenarios where the worst case would be to perform the procedure and cancer would come back but at least her quality of life would improve greatly while she was still around to enjoy it and of course the best case scenario where the cancer is cured completely.

MARIO’S TAKE ON THE SURGERY

Mario was very excited and nervous to do the surgery.  Clinically, he wanted to find something that worked, of course.  But, he was also frightened that he might exacerbate the problem and contribute to the decline of this lovely mare.

Bottom line, she was such a good mare, Mario felt that he could perform the surgery in the field and it was worth it.

He said that he only used local anesthetic and the mare was a dream…  The tumor was even larger than he thought and very deep.  Getting it all was a challenge.  As he went along, he inserted the tiny beads and stitched them in place.  5 in all.  He sewed it all up and prayed a bit.

THE RESULT

Mario was so enthusiastic about this because it worked (so far so good) and also because he really felt a pang of “gotta fix her” for this very sweet, blind mare.  it has been almost 5 months now and there is no regrowth.  Mario felt that there would be regrowth by now if he had aggravated the tumor or hadn’t removed it all.

Mario smiled and said that the mare helped him do his job because she was such a good girl throughout the entire ordeal…

His tech nodded her head in agreement, “She is an awesome mare!”

Here is Veronica’s conclusion:

As of today, it has been almost 4 months since her surgery and she seems to be doing great.  In fact, I rode her recently for the first time since the cancer was discovered and we both enjoyed it tremendously.  That would not have been possible without Mario and Sierra Equine’s innovative approach.

4 months later... still gone!

Up close...

A HAPPY ENDING

So, a happy ending for this mare!  Please pass this onward to any owners of light colored horses!

A happy ending! A cancer-free Aponi receives some lovin'!

MARIO AT SIERRA EQUINE

If you want to learn more about Mario Dinucci and Sierra Equine, please see the Sierra Equine FaceBook Page or go to the Sierra Equine website.

DOGS AND CATS

The beads are just starting being used for small animals with squamous cell carcinoma.  They are also being used to help with bone cancer.  Evidently, in some cases, no amputation has to occur after using these beads.  Good to know.  I’ve attached a story:

Apparently, there has been a large study in California; 80-100 small animals (mostly dogs, cats) that have received the treatment with tumor removal. They have had a 90-95 percent success rate, with only one case of tumor regrowth. In general, these are results that are typically not seen in clinical trials, so with that said, it is a very viable option.
While the Cisplatin is a very potent anti-tumor drug, the delivery system places it right on the tumor site and thus requires a fraction of the medication that would be given through more traditional methods (by mouth or through injection).
To put it in perspective, if every bead released every drop of medication at once, it would be less than *one* oral/intravenous dose of cisplatin previously used in treatment for animals. The rel
Last summer, our friend Jami told us about about “cisplatin biodegradeable beads,” an experimental type of chemotherapy treatment being tested in dogs with bone cancer, who are undergoing limb-sparing procedures instead of amputation.
These biodegradeable beads are being implanted at the time of the limb-sparing surgery, with the goal of preventing tumor regrowth in the leg, through a gradual release of cisplatin, a chemotherapy drug. This type of treatment can possibly reduce the recurrence of tumors in dogs who have had limb-sparing surgery instead of an amputation.



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4 comments have been posted...

  1. Veronica Purvis

    Just wanted to update everyone that Aponi is still here and still the sweetest mate I have ever had the pleasure to know.

  2. Pingback: Nasal Squamous Cell Carcinoma - Page 7 - Pet Forums Community

  3. meredith misakian

    dear mario,

    I have heard this story from you many times, but it still brings tears to my eyes. It is such a wonderful story, but it doesn’t surprise me, because you are such a remarkable vet. You are a very special person Mario…

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