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The Ralph CPD Digest – Medical Oncology

This is an educational blog post for our veterinary colleagues.

Having launched our Oncology Service toward the end of last year, our Oncologist, Stefano Zago, shared the latest information on cancer treatments and what this means for our patients and clinical practice during one of our free CPD events. The session, titled “Medical Oncology: the good, the new and what to do,” covered topics such as metronomic chemotherapy, Tanovea and immunotherapy. Below you can find a summary of the key points from the presentation, or you can click here to see recordings of the whole session.

Metronomic Chemotherapy (MC):

Conventional Chemotherapy VS Metronomic Chemotherapy:

Used in human oncology:

  1. Once conventional therapies have been exhausted
  2. For frail patients or those with co-morbidities
  3. Countries where conventional therapies are too expensive
  • The most common drugs used in veterinary oncology are cyclophosphamide and chlorambucil associated with an NSAID
  • Published studies include the treatment of canine haemangiosarcoma, osteosarcoma, transitional cell carcinoma, soft tissue sarcoma and mammary carcinoma. Unfortunately very little is published in feline oncology.

When do I use MC?

  1. Following conventional chemotherapy
  2. Palliative setting when definitive treatment is not an option


  • Newly licensed drug for naïve and relapsed canine lymphoma
  • Rabacfosadine is a pro-drug that is preferentially loaded into lymphoid cells where it is transformed into the active compound
  • The dose is 1 mg/kg IV administered over 30-minutes every 3 weeks for 5 treatments
  • Comparable results with CHOP protocols in B-cell lymphoma
  • Can be used alternating with doxorubicin every 3 weeks
  • Adverse effects:
    • Mild gastrointestinal upsets
    • Neutropaenia (nadir around 7 days)
    • Dermatological (alopecia, erythema, crusting and ulceration of ear pinnae and canals and dorsum)
    • Pulmonary fibrosis. Delayed event. Use is contraindicated in dogs with pre-existing pulmonary problems and the West Highland White Terrier
  • Ongoing trials:
    • Multiple myeloma
    • Leukaemia
    • Feline lymphoma
  • Shipped from the USA with VMD certificate


  • Exploiting the ability of the immune system to recognise and eliminate cancer
  • IL-2 (human recombinant interleukin-2)
      • Intratumour administration
      • Several human studies (TCC, HCC, melanoma, ovarian carcinoma, mesothelioma)
      • Minimal side effects
      • Few veterinary studies (bovine ocular SCC, canine fibrosarcoma and TVT, equine sarcoids)

Tonsillar squamous cell carcinoma:

  • Melanoma vaccines
    • Oncept (Merial)
      • Commercially available from the USA
      • Licensed for use in the microscopic setting
      • Several studies with mixed results
    • Second vaccine used in Italy but not commercially available
      • Delivered by electrovaccination
      • Very promising initial results
  • Lymphoma vaccine
      • Commercially available from France
      • Used in conjunction with chemotherapy
      • Improved survival over CHOP protocols
  • Osteosarcoma vaccine
      • Used in conjunction with chemotherapy
      • Very encouraging initial results
      • Not commercially available but has conditional licence in USA

Did you know that we offer free, catered CPD events every month? For more details on our upcoming CPD events, please visit our Events page.

Thank you for reading!

Take care,

Team Ralph.

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