My husband posted several months ago asking for advice after our dog’s osteosarcoma diagnosis, and I thought it might be helpful to provide an update and a little more information about the course that we chose. Tucker was diagnosed with TPLO-associated osteosarcoma (most likely caused by the metal plate in his leg) in June.

After Tucker’s diagnosis, we debated between stereotactic radiation, amputation and chemo, or amputation and the Elias vaccine/immunotherapy. It was very difficult to find information, and this forum was such an incredible resource. Thank you to everyone who replied or took the time to create posts in the past. We also got a lot of information from Bill (rileyfan11), who was incredibly kind and generous with his time. That was our first chance to correspond with someone who was in the process of the Elias vaccine, and it was very helpful to us.

After much debate, we ruled out stereotactic radiation, because our dog is quite active (even at 11) and we were afraid of a break. It was especially concerning to think that we might not be home at the time, and I knew that I would feel nervous traveling, or even being gone for the day. Also, we live in a somewhat rural area and there is not a great emergency vet nearby. If he had a break, we’d have to drive 2 hours to get him treatment, which sounded terrible for him.

We were very intrigued by the Elias vaccine, but there was so little information to be found. Initially, we planned to amputate at UGA (where Tucker was diagnosed) and then explore the Elias vaccine. However, we learned that the amputation must be done at a facility that works with Elias and we began exploring those options. Unfortunately for us, no one in the Atlanta area is currently working with Elias. The nearest veterinary hospital was in Charleston, SC. Because we were willing to travel, and mentioned to the Elias coordinator that we’d even considered going to Colorado State for stereotactic radiation, she also referred us to an “excellent” facility in Colorado, CASE. Most veterinary hospitals wouldn’t talk to us until we came in person, which was very frustrating, but we made two appointments in Charleston for consultations and also set up a (paid) phone consult with Dr. Fowler at CASE. We were so grateful that Dr. Fowler was willing to do this because we learned so much. We later found out that both of the hospitals in Charleston had signed up for the program, but had never actually completed the  Elias treatment. CASE had, at the time we spoke to them, completed the treatment on over 50 dogs. Although we felt very comfortable with Dr. Fowler and CASE, and would have loved to work with them, we ultimately decided that was just too far to travel for such an extended period of time. However, we were able to use many of our learnings with the hospital that we chose to work with in Charleston.

Dr. Wall at Blue Pearl in Charleston was fantastic. She answered our questions thoroughly and was willing to hear our suggestions and work with them (very different from the other vet that we “interviewed” in Charleston). She really went above and beyond to track down information and ensure that we were doing everything in the best possible manner to help Tucker.

So, here’s a little more about the treatment itself as well as what is required of you as pet parents. Please keep in mind that I am not in the medical field, so this is my layman’s understanding of all of this. The amputation must be done at a facility that is working with Elias, because they harvest cells from the amputated limb to create the vaccine. Elias works closely with the facility to ensure it’s being done properly (including zoom calls/tutorials). The harvested material is overnighted to Elias and they create the vaccine. The vaccine is a series of 3 weekly injections. These are not as simple as something like a flu vaccine – they’re performed at multiple injection sites around the dog’s body (at the lymph nodes). It’s very important that this is done properly, and Elias also works with the doctor on this portion of the treatment. For us, that meant traveling to Charleston 4 times – once for the amputation and three times for the vaccines.

One interesting item that came out of our conversation with CASE in Colorado, is that their preferred protocol is to hold off on the vaccine and fist complete two rounds of chemo. Of course, because this treatment is new and still experimental, no one is sure of the “right” way to proceed, but they believe that this is a good combination of treatments. The chemo works immediately to knock back the cancer, and then the vaccine portion of the treatment begins. We also learned through CASE and other research we performed, that most of the latest data seems to suggest that early chemo is ideal. From what we were able to gather, that meant within 72 hours of the amputation. We chose to go this route and added two rounds of chemo to Tucker’s treatment plan.

The final step in the process is the immunotherapy portion of the treatment. Using apheresis, the dog’s T cells are collected. We had to travel to New Orleans (MedVet) for this procedure. When we began the Elias journey, we were told this could happen in North Carolina at NC State, but apparently, they stopped offering this. This was the hardest day for Tucker. He was hooked up to the apheresis machine (which cycles blood out of the body, separates the T cells, and puts the blood back in the body) for 5 hours. He had to stay overnight and was still very tired the following day. It took a good 36-48 hours for him to recover. Exactly one week later, those T cells are re-infused in mass. Elias describes their process as taking the collected T cells and using them to create an “army” of T cells to go in and attack the cancer. There is some risk with this that the dog could have too strong of an immune response, known as a cytokine storm. Apparently, the risk is quite low. The re-infusion was also difficult for Tucker. The clinic seemed to think it would be fine to head home the next morning (he’d stayed overnight again) after monitoring him and not observing any issues. We had been in New Orleans for over a week, so we were ready to get him back home. Unfortunately, he had terrible diarrhea in the car the whole way home. It was obvious that he felt very sick. Luckily, it resolved in about 24 hours, but we were getting very nervous about the severity of it.

To summarize Tucker’s treatment plan, he had one round of chemo 24 hours after his amputation, and another 3 weeks later. Following the second dose, we began the first vaccine three weeks later. Two weeks after the last vaccine, he had the apheresis performed to collect his T cells. One week after T cell collection, he had his re-infusion and completed the treatment.

*I’d begun writing this summary after Tucker’s re-infusion and was optimistic about the prognosis. Unfortunately, at Tucker’s first re-check appointment, 4 weeks after the re-infusion, we learned that the cancer had already metastasized to his lungs. We discussed starting Palladia, but Elias ended up advising our vet to hold off and x-ray again in another month. They thought it was possible (from previous cases) that the radiographs might be highlighting inflammation from the Elias treatment attacking the cancer. I also asked if Palladia would potentially interfere with the immunotherapy, in case it was still working to fight the cancer and was told that it would not. I asked why we wouldn’t just start the Palladia to get everything going to fight this, but our oncologist (I should add, this was not Dr. Wall – we’d begun working with a closer oncologist for Tucker’s post-treatment care), said that she would hold off. She said we wouldn’t know which was working if we started both and his next x-rays showed improvement. Also, she liked the idea of keeping Palladia in our “back pocket”. I am still a little angry with myself for not pushing to start Palladia. As I discussed with my husband after that call, I didn't care if we knew which was working, I just wanted him to get better. I can understand that they want to know from a scientific perspective, but he's not their dog. I’ll never know how much time that might have bought him, and perhaps it wouldn’t have helped. Around three weeks later, he began knuckling on his remaining back leg. It gradually progressed over the next few days, to the point that his leg seemed completely paralyzed in that leg. We went to an emergency vet, and they suggested it was either a slipped disc or a tumor pressing on his spine. We went back to the oncologist and had more X-rays and a physical exam. We were told that there were now more nodules in his lungs, and they were larger. She also felt what she thought was a large tumor in his abdomen. She told us it was time to think about euthanasia. Tucker passed away on November 18^th.

This has been incredibly hard to finish writing, but I wanted to post this in case it helps anyone else considering this treatment. Would I do it again? Probably. If the data continues to match the early results, I think I would. We continually heard (even from CASE, who had done this procedure ~50 times), that most dogs lived close to 18 months. Some dogs had lived longer than that. We were told the conservative number was 12-18 months. MedVet echoed the same thing and said every dog they’d done this for lived well over a year. They went so far as to say Tucker could be “cured” because we caught this early. We also knew that it didn’t work for every dog, and we knew the risk. But hearing those numbers, we had it in the back of our mind that we’d have Tucker for at least another year. We got around 5 months. Less than two months after the treatment was completed.

I would probably do this again for another dog, but I wish I hadn’t done it for Tucker. He hated the vet (he was always a very nervous dog), and this caused more visits than any of the other treatment options. Also, the last two visits (for the apheresis and re-infusion) were stressful. He had to be sedated for both appointments. He had to stay overnight. I hated this for him. But we told ourselves that we were doing this to get more time, and it would be worth it. He’d forget all of this and we’d have many more happy memories. But that didn’t happen for us. The one upside is that I think Tucker enjoyed all of our travel during this time. We called it “Tucker’s Big Adventure”. Both my husband and I work a lot, and this forced us to slow down and take road trips together that we might never have done otherwise.

Elias was great to work with. One note is that they most likely won’t communicate much with you – I think they primarily want to talk to the veterinary team. That can be a little frustrating for someone who is very involved in the treatment and has questions. But they’re very responsive and very thorough. And I can’t recommend Dr. Wall in Charleston highly enough. It’s obvious that she cares about her patients (which can’t be easy to let yourself do in this field). She’s also very up-to-date with the latest treatments and protocols. It seemed like she was traveling nearly every weekend to some educational panel or seminar. 

I’m happy to answer any questions for anyone considering the Elias procedure, or anything else related to our learnings. Thank you all again for this incredible resource that you’ve created.