Hi all. Thanks for the support and thanks for the research Jerry.  Yes-our Onco is awesome and cutting edge.  Very fortunate!  Even if this doesn't help Rosie I am so glad that they are trying new things instead of giving up. 

Jerry-I posted an excerpt from her report below. 

Patient: Rosie​
Species: Canine
Sex: Spayed Female​
Age: 7 years
Weight: 31.60kg

Recheck for Rosie Monahan

01-23-17

History:
Rosie presented to the Oncology department for a recheck examination, CBC, thoracic radiographs and her fourth dose of Carboplatin. Despite the reduced dose she received last time she had a grade 2 and then grade 3 neutropenia 2 and 2.5 weeks post carboplatin. She was mildly lethargic.

Exam:
T: 101.6 °F​P: 114 bpm​R: 40 rpm​CRT: 1 sec​MM: pink​BCS: 6/9
Rosie was BAR on presentation. No concerns on physical exam. She ambulates well on three legs. Oral exam is unremarkable. peripheral lymph nodes all palpate normally. Abdomen is soft and non-painful.

Diagnosis:
Proximal humerus chondroblastic osteosarcoma- right forelimb amputation 10.26.16, Src +ve
Pulmonary metastatic disease diagnosed on radiographs today

Diagnostics:
Complete Blood Count: WBC's 18,560 /uL(5,500-16,900), Neutrophils 15,580 /uL (2,000-12,000), Platelets 143,000 /uL (175,000-500,000), Lymphocyte 2,140 (1.05-5.10), HCT 41.9 (37.3-61.7%)

Thoracic Radiographs - Three view radiographs were taken today to monitor for disease progression prior to Rosie's chemotherapy. Unfortunately numerous pulmonary nodules were observed in all lung lobes totalling at least 20 total metastatic lesions ranging in size from 1mm-5.8cm with the largest masses located in the left cranial and caudal lung lobes. No effusion noted.

Discussions/Treatments:
Dasatinib is a tyrosine kinase inhibitor that has shown efficacy in dogs with metastatic osteosarcoma. When this medication works it can successfully shrink these metastatic nodules over time. It can take several months to see the effect of this drug. However if we repeat her radiographs in one month and her disease seems fairly stable, this is a good sign. Dasatinib can be well tolerated by most dogs when an appropriate dose and schedule is found that works for that individual pet. Many dogs will develop some degree of GI upset (decreased appetite, diarrhea, vomiting, nausea, gas, stomach cramping) or restlessness. We do not want to cause Rosie any discomfort in our efforts to help her, so we are going to give her anti-nausea medications concurrently with this medication to minimize her risk of side effects. We have started her at the low end of the dose range, which for Rosie is ^^mg. I would like you to give her this dose every other day for 1 week. If you notice any changes please discontinue the medication right away and give is a call so we can recommend the appropriate changes to make. Dasatinib is a fairly new drug in veterinary medicine and so new previously unreported side effects could occur. If you notice any changes in Rosie behavior discontinue Dasatinib and give us a call. Possible but infrequent side effects seen with similar drugs in dogs include a mild decrease in the white or red blood cell counts, increase in kidney or liver values, loss of protein through the kidneys and into the urine, coat color changes, and lameness. Routine monitoring of the blood and urine is recommended at least every 4 weeks while taking this medication.

Dasatinib (Sprycel)
Dasatinib is an oral anti-cancer medication that belongs to a class of drugs called tyrosine kinase inhibitor (TKI). Tyrosine kinases are normal proteins found throughout the body that serve as messengers to relay critical information to our cells from the cells environment. Dasatinib targets the tyrosine kinase receptors, “c-kit”, “PDGFR”, and “Src”. Src is over-expressed by a number of tumors and can promote growth, survival, and motility of the cancer cells. Dasatinib can inhibit growth and spread of some tumors that rely on these pathways for their survival.

What do you treat with Dasatinib?
Dasatinib is being investigated for a number of canine and feline cancers including mast cell tumors (skin cancer), osteosarcoma, hemangiosarcoma, and histiocytic sarcoma. Dasatinib has a role in the treatment of human melanoma and its use is currently being explored for canine melanoma as well. A study in dogs has shown significantly increased survival time and even regression of metastatic disease in those tumors most sensitive to dasatinib.

How is Dasatinib administered?
Dasatinib is intended for once daily administration, but the frequency of administration can be lowered if side effects are encountered. Wear disposable gloves when handling dasatinib as repeated handling of the tablets could affect the individual handling the medication. These types of medications may impair fertility and fetal development. Please avoid handling this medication if you are pregnant, trying to become pregnant, nursing, or taking immunosuppressive medications for a medical condition.

What are the potential side effects?
The most commonly reported side effects are gastrointestinal upset such as decreased appetite, nausea, vomiting, soft stool, increased flatulence, or diarrhea. If GI side effects are encountered the drug should be discontinued immediately until the symptoms resolve. Nausea can manifest with drooling or frequent licking of the lips. Anti-nausea medications can be sent home to help minimize gastrointestinal side effects should they occur. Diarrhea can be treated as well with a prescription from your veterinarian upon request.

Additional but less common side effects include anxiety, restlessness, weight loss, dehydration, protein loss in the urine, coat color changes, anemia, low white blood cell counts, low platelets, increased ALT or bilirubin (liver enzyme), or creatinine (kidney enzyme), or lethargy. If any side effects are suspected STOP administering dasatinib and contact your veterinarian.

How are patients monitored while on dasatinib?
A blood cell count and biochemistry analysis are recommended every 4 weeks to detect anemia, decreased white blood cell counts, and to monitor healthy organ function. A monthly urinalysis will detect any protein loss through the kidneys, which may necessitate a dose modification or additional supportive medication.

Client Instructions:
Rosie has been diagnosed with metastatic disease to the lungs as a secondary site from the primary tumor. Many pets can co-exist normally with some degree of metastatic disease, and most do not show symptoms of lung disease when the metastatic disease is found. Unfortunately for most cancers, the disease can double rapidly (within 30 days) once it reaches the lungs and secondary sites are typically more resistant to chemotherapy.

As the metastatic nodules become larger and more numerous, clinical signs of disease will start to occur. Many times these symptoms are directly related to the loss of healthy lung tissue and therefore an inability to appropriately exchange oxygen for waste. The first signs will be exercise intolerance where Rosie will tire easily and maybe unwilling to perform demanding activities like long walks, fetch, jumping, stairs. Many pets will no longer sleep laying on their side because when pets sleep on their sides the lower/gravity dependent lung lobes collapse from their body weight further limiting the amount of lung tissue available for oxygen exchange. So many pets will try to stay upright/sternal. You may see Rosie trying to stretch out their neck or broaden their stance in attempt to expand the rib cage as much as possible. Since they are so focused on breathing, they will try not to fall asleep, and their appetite will likely suffer. Shallow breathing, coughing, an abdominal component (abdominal lift) can also be seen. These are all signs that their quality of life is suffering as they are no longer able to meet their basic needs.

Additional information about assessing quality of life and emotional support can be found at http://csu-cvmb.....fault.aspx
and http://www.lapo.....ty-of-Life

Medications:
1. Dasatinib 12mg capsules #12 & 3mg capsules #10: Please give 12mg by mouth every other day for 2 doses, if no GI upset increase dose to 15mg (12mg + 3mg) every other day

2. Ondansetron 8mg tabs: Please give 1 tablet 30-60 minutes prior to dasatinib and every 8-12 hours thereafter

Diet: Rosie can have her normal diet.
Activity: Rosie can dictate her own activity level.

Plan for re-evaluation of Rosie: Please keep us posted on Rosie's condition (energy, breathing) as well as call right away if you think she is having side effects to the medications. We will plan to recheck her radiographs in 3-4 weeks.

Thank you for bringing Rosie to the AMCS. Please call our Oncology Service if you have any questions or concerns about Rosie at (206) 204-3366. They can also be reached by email.

The Oncology Dept. is available Monday thru Thursday, from 9am to 7pm. Please allow 24 hours for all prescription refills. To request a refill, please call 206-204-3366. Thank you.

Thank you for bringing Rosie to Animal Medical Center of Seattle. We appreciate your trust in our care.

Krystal Harris, DVM, MS
Practice Limited to Oncology

14810 15th Ave NE, Shoreline, WA 98155 | P: 206.204.3366 | F: 206.204.3858 | www. animalmedicalspecialists.com