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Cisplatin biodegradeable beads save Gretta from amputation

gretta cancer dog cisplatin beadsLast 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. An article in the Annals of Surgical Oncology describes the treatment.

Jami wrote to tell us about her dog, Miss Gretta, who underwent the implant surgery at age 12. Jamie has generously offered to explain the procedure, and wanted to share Gretta’s progress with Tripawds.

August 26, 2008

Cisplatin biodegradeable beads have recently been approved for use in smaller animals (see Royer Biomedical).

The cisplatin beads are useful for solid mass tumors in tissue (such as nerve sheath, muscle, skin) which can be surgically removed, and then the beads prevent the regrowth of the cancer at that site. The beads have been tested specifically in spindle cell tumors (nerve sheath), sqamous cell (skin), melanoma (skin) basal cell ( skin), and a handful of other solid mass tumors.

Gretta had spindle cell tumor (the originating tissue was likely a nerve sheath)… the tumor was about the size of a grapefruit at the time it was removed.

Previously used in horses, these beads can be surgically implanted after removal of certain types of cancers, and provide release of chemotherapeutic agents directly into the tissue. Since this allows the concentration of drug to be highest at the site needed to attack the remaining cancer cells, this is an effective way to treat cancer without exposing the dog’s entire body to high concentration of chemotherapy.

Ultimately, there may be less side effects related to the chemotherapy, and a greater reduction in cancer cells at the site of the tumor removal.

There is little publicly available related to dogs, either on their website or on the internet. I do understand that they have just recently been approved for the smaller animals, and their representatives are starting to talk with veterinarians. It is an expensive treatment, but for certain types of neoplams, it is life and (in our case) limb-saving. We hope, at least.

Here is a technical presentation on their website, related to horses.

August 28, 2008

Gretta came through the surgery just fine….we’ll bring her home later this morning. She required 32 beads, which is a record right now. I spoke with Dr. Royer himself yesterday morning (he is the PhD who invented the Cisplatin bead), and he gave me some information that I will summarize.

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 release of the capsules is 4-6 weeks, just to add to the safety picture.

Dr. Royer mentioned that they have just completed the small mammal study and will be taking this information out in this seasons’ round of veterinary medical meetings, and this fall to the Vet schools. He personally had come to the Surgical clinic where my dog was to undergo amputation because it is one of the larger and more reputable centers on the East coast. I did know before I had called him, but he had personally consulted on my dog with the surgeon. What a stroke of luck!!!

She is a record… 32 beads implanted in a dog. The most that has ever been done in total is 40 in a horse. (Gretta is a petite Rottie at 82 pounds…still not the size of a horse!!!). My surgeon has another Great Dane scheduled tomorrow, so he’s getting a handful of experience this week!

Lets see how Gretta recovers… she’s still got some recovery over the next 2-3 weeks.

September 13, 2008

Just a quick update. Gretta is recovering from the surgery, but has some post-op complications with infections. She is 16 days out, stable. Her prognosis is good, but right now she is still limited in her mobility, and we are challenged by managing her with the open wounds and infections from the surgery. Still, a huge difference from loss of a limb, but it has been challenging.

November 17, 2008

We had a bit of a set back. Gretta had pretty serious infections following the surgery, and about day 14 she became immobile and non-responsive. With all that said, we were able to pull her through just fine. She did develop MRSA (which is an antibiotic-resistant infection). She required 30 plus days of antibiotics, and Day 14-28 she was on 4 antibiotics, including treatment for the MRSA. Dogs don’t get MRSA very often, so I had to convince my vet to treat the MRSA (he wanted to wait to get cultures for 5 days). I believe if we had waited for the culture to come back, we would not have Gretta with us right now.

With all that said, she is now post-op 90 days, and is recovered from the surgery. The next test will be whether the tumor comes back.

February 10, 2009

We’ve been holding off to see what the real outcome of the surgery will be…. while it saved her leg, the real issue is whether the tumor comes back.

She has follow-up in a few weeks. We do think there is already something that might be growing back, however, we should have the vet check it before we say it is the cancer.

The overall surgery and follow-up cost about $4,000.00…. not too much for a dog you love, but if the beads don’t prevent regrowth, then we are back to the reality of removing the leg. She almost died once in the post op period (as my note says below). If I weren’t a medical person, with access to high end infectious disease consultation, she would have died.

The real outcome is prevention of regrowth, and we are still watching her closely.

Jami, thanks for sharing your story. We wish Miss Gretta a full recovery, and give she and Jame “paws up!” for participating in this new treatment, which we hope will continue to help more dogs affected with osteosarcoma.

29 Responses to “Cisplatin biodegradeable beads save Gretta from amputation”

  1. I have a 8 year shephard mix with myxosarcoma had surgery once but came back in 2 months,thinking of second surgery with up to 30 beads I have been told. Does anyone have information on side effects to the dog being treated,and on secretion exposure to other dogs, and humans from the release of the chemo in the beads.

    Thank You

  2. Polenka’s leg is doing fantastic–the debulking nine months ago went as well as could be hoped for. She can run full speed and walks without a limp. The only sign of chronic pain in the leg is when I feel on the area Polenka’s tail will move down. She doesn’t cry out or anything though. Every now and then she’ll kick like a mule. Nerve damage? The vet said the tumor doesn’t show any sign of returning. So far it looks like a good decision to have avoided the amputation.

  3. Thanks much for replies. Will continue researching and hope for the best. Btw, Polenka is a Siberian-Husky/German Shepherd mix and it sounds like those are the two breeds at highest risk for spindle cell tumor.

    • Update on Gretta…..

      she fought a long and difficult battle, and gracefully left this earth yesterday. We miss her terribly, but know she is waiting for us in a better place. Her treatments brought her two additional years of a good life… thats 15% increase in years of her total life. All together, she lived 3 years with the cancer diagnosis, and was pain free all the way up to the end. Regrettable, the tumor became inoperable and became ulcerated so there was little option for treatment for her.

      These spindle cell tumors march up the leg, and once they invade the chest wall, there is little that can be done. I wished the cisplatin had been effective against the tumor, but it could only do so much. The most advice I would offer to anyone would be seriously consider the removal of a leg before the tumor gets too high, and if the dog is young enough to recover. Gretta was 12 at her first surgery, and we are very proud that we were able to give her two wonderful years of life (and a new baby to play with!)

      God Bless to all of you for your thoughts and prayers over these years. We hope Gretta’s story has helped others. She was an amazing dog, and an amazing friend. She will be missed.

      • We are saddened by this news but thank you for the update. And bless you for giving Gretta such a beautiful life. By sharing her story here you are certain to help many others going down the same difficult road. Peace.

      • Sorry to hear of Gretta’s passing. I mentioned the part about spindle cell tumors possibly spreading following debulking, but the vet replied it’s a locally invasive tumor and that he didn’t beleive it would spread. He was confidant he could remove it without resorting to amputation. It’s does seem a risk going this way (debulking), but again, hopefully this has a positive outcome since the vet staff reported much confidance in the removal of her tumor today.

      • Hello,

        I am so sorry to hear about Greta’s passing. I hope you were able to enjoy the years she gained after treatment.
        My dog Cocoa is 12 years old. He had a mass removed from his right hip 2 weeks ago. We are now considering having the beads implanted. He is 115 lbs and only having 18 beads done. Why did Greta have so many?

      • Thanks for asking. If we do not hear from Greta’s people with an answer here, please post in the discussion forums for more feedback from others.

    • Polenka had the tumor removed from her leg today (debulking). They sounded very happy and confidant the surgery was successful when I went in to pick her up. Hopefully it won’t grow back since they commonly recur when not completely “excised with wide margins”. Will wait and see. Numerous vets had advised amputation, and that may have been the best solution anything short of a best case scenario. But hopefully Polenka’s surgery fits best case scenario and all will be well.

      • Bruce, thanks for the update. We hope for a long, healthy tumor-free “best case” life! Please keep us posted on how she’s doing OK? We’re here to help. Good luck!

      • Thanks for checking in Bruce, and best wishes for Polenka! Please consider sharing future updates in the discussion forums.

      • Thanks….I’ll look for the discussion forum to continue with updates. Last note here….the vet said the tumor will most likely grow back (due to the location being on the leg joint and unable to completely get it all), but since it was a slow growing tumor hopefully it will take a long time to grow back. I’ve read somewhere that due to immunosuppression resulting from the surgery, the tumors growth may accelerate. Hope not. It took 2-1/2 years to become the size of a baseball. Which evidently made for a gruesome debulking. They want Polenka back in should the tumor grow (back) to the size of a golfball.

  4. RE: Kim’s message about Kona (from February 20 above): My dog Polenka’s spindle cell tumor is about the size of a baseball now, and began to bleed (ulcerate) about 10 days ago. She’s on antibiotics; trying to determine if a debulking will save her from leg amputation. Numerous consultations, numerous opinions. How is Kona? Hope to hear more…thanks much.

    • Bruce, we’re so sorry about Polenka, and hope that the debulking measures work. To chat with others who have gone through spindle cell, please visit our forums, we have a few members there who can help too. Good luck.

    • Hi Bruce. I am so sorry to hear about Polenka. It is a difficult ordeal and I know first hand. Kona has unfortnuately passed. I had her tumor debulked in January and the beads put in. She had another good 5+ months and then the last few weeks were tough. The tumor did grow back and over took the leg and began to ulcerate. She had also torn her ligament in her other leg so was using her bad leg most of the time. On the last day (which I had already made the appointment) she couldn’t even really walk. Even though I only got another 6 months with her, it was the best decision I ever made. I still haven’t event paid off my family that I had to borrow money from to do the surgery, but would never go back and change a thing. I wish you the best. Just know that what ever decision you make is the right decision for you and Polenka. You cannot let the “what if’s” get to you. Believe me, from personally experience. Make a decision and stick by it and enjoy whatever time you do have with Polenka. I’ll be thinking about all of you. And yes, I miss Kona terribly but know that she is not in pain anymore.

    • We’ve heard from many new members who put their dogs through multiple painful expensive surgeries only to proceed with amputation anyway. But every dog is different. Best wishes for you and Polenka. Please start a topic in the forums for more advice and support from this community.

  5. It has now been nearly 6 months since Mufasa’s nerve sheath tumor excision with cisplatin implants. He is doing very well! Dr. Donnor had removed a generous amount of muscle around the tumor which is not even noticeable beneath his fur and the function of his limb is nearly 100%. There is no sign of re-growth to date (still saying my prayers though!). He is 14 yrs old and is still as energetic and playful as a “bear cub”! Both Mufasa and his sister Boo are still hiking in the cliffs, swimming in the ocean, playing in the snow covered mountains of Big Bear on vacations and enjoying their lives to the fullest. We were extremely fortunate to have found Dr. Donnor in our own “backyard” and we cannot thank Dr. Royer (who we’ve never met) for his work on cisplatin bead implants. Looking back at the experience including the initial shock of the diagnosis, I can’t stress enough to pet owners the importance of doing your own research. The articles, research papers and treatment options we found on-line proved key in our decisions towards Mufasa’s care plan. All of this information enabled us to interview several specialists and assess with some level of knowledge the best approach for the most beneficial outcome. Again, the fact that we have pet insurance was a lifesaver. Even in this economy, the cost of monthly payments ranging from $55.00 to $75.00 per month to protect the lives of our beloved pets is well worth the investment.

    • Great advice Rachel, and thanks for the update about Mufasa! What an amazing boy! If you would like to write a blog post about this experience, please contact us OK? We’d love to hear more. Keep us posted.

  6. I just wanted to add that we were blessed to have had pet insurance for the last 5 years and Mufasa (my male Malamute) as well as his sister littermate has $6000.00 in each system category (skin, heart, lungs, cancer). I would encourage anyone who has a young dog to invest in this type of coverage which costs about $52.00 a month per dog. It is well worth it.

  7. My 12 year old Malamute mix was diagnosed with nerve sheath tumor on his mid upper hind leg. It was about the size of a walnut. The first surgery was done by our local vet who did not know at the time that it was nerve sheath tumor and had only excised about a 2mm margin around the growth. We were referred to a radiation oncologist who suggested radiation vs. re-excision but not both. After researching hundreds of articles regarding best and available treatments, I learned that the first and most important treatment is surgical removal with adequate and clean margins of about 3 cm. So we then consulted with an oncology surgeon, Dr. Gayle Donnor of Southern Ca Vet Specialty Group who re-operated on the site to remove larger margins and then implanted cisplatin beads. Although there was not extensive definitive efficacy results available on-line for cisplatin beads in dogs, she said she has had very good results with horses and dogs with the beads, so much so that she is involved with putting out new statistics on this treatment soon. I am hoping that since the growth was small when we caught it and that adequate margins were obtained during the second surgery the tumor will not recurr. If it does, we will immediately surgically remove it and go for the radiation.

  8. ANOTHER GRETTA UPDATE!

    Gretta continues to be her spunky, lovey-dovey self…. however she has experienced another recurrence. This time, the tumor regrowth has been anterior (above) the previous mass. In a sense, the tumor growth is ‘marching’ up her leg and has now infiltrated her chest wall. The only option now is yet another surgery, and the cancer is now is her core so the probability of metastasis (spreading) is higher with each intervention. At this time, we are considering our options.

    So…. the full of this story is the surgery of 8/28/08 has given her at least 18 months more functionality (although minus the surgical recovery times). I understand from our surgeon that this type of tumor can be removed, without the implantation of the cisplatin beads, and will always come back ‘with a vengeance’. I think our example shows a slower pace of recurrence, but never the less, recurrence.

    After her 10/2009 surgery, she lost her hearing, so we have been learning to adjust with that disability. How glad I am that my husband had trained her to hand signals!!! She clearly is cognitively intact, and probably is wondering what happened that everyone is being so quiet.

    So, for those who are considering the procedure, and experience, here is the sum of our experience, and where we stand now….

    13.5 y.o. neutered female Rottweiler, currently experiencing third recurrence of solid mass spindle tumor in chest wall; s/p surgical resection and implantation of cisplatin beads x2 (8/08, 10/09). Past surgical complications include MRSA infection (s/p 8/08 sx), hearing loss (s/p 10/09 sx). Currently healthy, asymptomatic; fully ambulatory. No apparent pain/discomfort; no behavioral problems, other than those expected with hearing loss. Moderate risk surgical candidate due to age and location of tumor. Prognosis: good, however tumor mass will continue to grow and may require debulking within next 6 months, at which time surgical candidacy will be reassessed. At this point, amputation of limb would not remove cancer primary site, so that is not an option. Current recurrence has grown to 3 cm in 3 months, indicating rapid growth. Without additional surgeries, tumor is likely to become disabling in 12-18 months, based on animals past experience and location of tumor. Dog would be 14-15 years old at that point in time, so surgical risks need to be considered carefully.

    And the million dollar question…. what will we do? Another surgery, more beads? Watch and wait? Debulking surgery in a few months, just to spread out the surgeries? Honestly, at this point I am not sure…. every surgery has had complications, and post-op has required a lot from our family with small children. In the last 10 months, I have had a baby and been laid off from my job; my husband is also in a job transition. A lot to think about for Gretta, and our family…

    I will let you know, but for right now I wanted to add to the post…. the experience has given Gretta the opportunity of FOUR LEGS for all this time…that is an absolute truth, and our ultimate hope for her. However, if we had allowed the amputation in 8/2008, the recurrences most likely would not have occurred as the original tumor was so far down her leg. She might still have her hearing, and not needed additional surgeries. As much as we would like to say hindsight in 20-20, it is important to weigh both the positive and negatives.

    So if you find yourself in a similar position, this story might help you.

    On a separate note, thanks to everyone for their prayers and support. I know we made the right decisions for Gretta up to now, and will continue to weigh our options. We love her, she is our first baby, and she has been an incredible inspiration for us. And so have all of our friends, family, and newly found friends… thanks for all your support and love!!

    Best regards-
    Jami & Gretta

    • Jami, we can’t thank you enough for such a detailed, thoughtful update, thank you so much. I’m certain that Gretta’s story has already helped others, and will continue to do so. It’s great to hear that she continues to thrive and overcome challenges as only a dog can do. What an inspawration!

      The technology that is developing to help dogs keep their spare leg is amazing, and we thank you for sharing it with us here!

      Many hugs to you both, keep us posted.

      -Rene, Jim, Wyatt Ray & SPirit Jerry

  9. Thank you for sharing your story. My 8 year old Shepard mix, Kona (she’ll be nine in March) just had around 10 beads placed on Thursday. Her spindle cell tumor was also the size of a large grapefruit. Thankfully it was not attached to any muscle and only fatty and connective tissue needed to be removed. This is our first morning home. She is doing ok, not good but not bad. She is eating good and actually went down the stairs on her own this morning.

    I wish I would have known more about the beads because I spend 2 agonizing weeks contemplating amputation (without much support from my husband) and when I fianlly saw a surgeon he said we didn’t need to amputate that the beads was a much better way to go.

    Please keep us updated on Gretta.

  10. We are happy to pass along this great update from Gretta’s pack …

    Hi there! I wanted to give you another follow-up on Gretta; please add to website if you would like.

    Gretta is still doing well, and turned 13 y.o. on September 15th. However, we noticed some nodules on her leg in late August, and last she underwent surgery again last week. She had 2 sites of recurrence of the cancer, at both the bottom and top margins from the original tumor. Keep in mind, her original tumor was huge (the size of a grapefruit) so the recurrence might be expected in her case. The two new tumors have successfully been removed, and she has received another batch of the cisplatin beads (8 this time).

    This is still a success, in that she has kept her leg, and continues to live a healthy life. I do believe that if the cisplatin beads had not been implanted, the recurrence would have been sooner, and more severe. However, a consideration for anyone thinking about doing this type of intervention; this surgery was almost as expensive as the first one, and all together we have invested about $6K in the treatment. Well worth it in our mind (and budget), ut certainly a consideration for anyone who may believe they only need to do the procedure once.

    Best regards-
    Jami Earnest & Gretta (Cancer Survivor!)

  11. Nice story! Very informative…

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