What’s new with oral malignant melanoma?
Updated: October 8th, 2018
I was not planning on my next blog to be about oral malignant melanoma (or OMM) in dogs, but I just attended a really great meeting on the topic in New York City. It cut into my weekend family time, so I am happy that the meeting was so informative.
This meeting was VECOG, or Veterinary Eastern Cooperative Oncology Group. It’s a group of local oncologists from the Northeast who meet one to two times a year. Recently we changed the format and decided to dive into a specific tumor topic in depth. The meeting is attended by oncologists, residents, surgeons, pathologists, and a few radiation oncologists. Like my recent meeting in Paris, this is not a review of the basics but a chance to see what is current and discuss the challenges in diagnosing, grading, staging and treating these tumors.
Let’s touch on the highlights. I will do this in 2 parts, because there is was a lot of interesting info to share.
Topic 1: Melanoma Immunotherapy in people
Dr. Margaret Callahan spoke on the “Future of Melanoma Therapy at Memorial Sloan Kettering Cancer Center.” Dr. Callahan reviewed an immune therapy called ipilimumab (IPI) that when combined with dacarbazine chemotherapy improved overall survival in people. We also discussed the interesting toxicity associated with immune therapy. It’s different than the chemotherapy side effects (which is typically nausea and vomiting). With this immune therapy, they see skin rashes, diarrhea, liver and endocrine disorders, due to immune inflammation.
In the clinics, the response can take 3 to 4 months, with only about 15% of the patients responding. That may sound small, but those who responded also had long-term durable responses. Basically, this therapy is beneficial for some people, and not for others. One of the things that needs to be discovered: is there a biomarker that is common to those for whom this is effective? If there is, we can look for that biomarker in future candidates and more accurately predict who will benefit from the treatment.
Topic 2: Melanoma Immunotherapy in dogs
Dr. Rowan Milner from the University of Florida Melanoma reviewed the development of a research melanoma vaccine used at his facility. This vaccine has a different antigen or target (GD3, ganglioside-3) than the commercially available Merial melanoma vaccine. After Dr. Milner reviewed the survival times based on different sites (oral, foot, skin), he reported an unexpected result – new tumors were triggered.
The example Dr. Milner gave us was a dog with OMM (oral malignant melanoma). Two years after receiving the treatment, the dog was diagnosed with skin MCT (mast cell tumor). When the MCT was treated with an oral chemotherapy, the MCT responded, but then the oral tumor got larger. When dog was re-vaccinated, the oral melanoma got smaller — but sadly, the dog developed lung metastasis.
This effect is something we will need to closely monitor in patients with multiple tumors, especially when immunotherapy is involved. Dr. Callahan contributed at this point that people treated with other immune modulators are also monitored for skin squamous cell carcinomas.
Dr. Phil Bergman also updated us on the commercially available Merial melanoma vaccine, which is available through medical oncologists. This xenogeneic DNA melanoma vaccine is effective for digit melanomas, as well as oral MM. This study was published last year, and is reviewed in my chapter on melanoma in the Dog Cancer Survival Guide. So check out the guide and come back next week to read more about my great meeting and what’s new for oral melanoma.
Also please check out my new FB page, Dr Sue Cancer Vet and if you stop by, show me some love with a “like!” Thanks!!
All my best,
Sue Ettinger, DVM. Dip. ACVIM (Oncology). Dr. Sue is a boarded veterinary medical cancer specialist. As a Diplomate of the American College of Veterinary Internal Medicine (Oncology), she is one of approximately 400 board-certified veterinary specialists in medical oncology in North America. She is a book author, radio co-host, and an advocate of early cancer detection and raising cancer awareness. Along with Dr. Demian Dressler, Dr. Sue is the co-author of The Dog Cancer Survival Guide: Full Spectrum Treatments to Optimize Your Dog’s Life Quality and Longevity.
My 13 year old male Chow/Lab mix was just diagnosed with oral malignant melanoma under his tongue. The Dr. removed 80% of the mass but said the only possible survival option was to remove a part of his lower jaw and he did not think this would be good for a dog his age. He has given him a couple months and offered no treatment except prednisone. He said the cancer will move to his lymph nodes and lungs. We live in Tallahassee and I was going to contact Dr. Milner about the Vaccine Trials. I am not sure if the trials are a good option if an option at all so my question to you is – should I be asking our doctor for some sort of treatment to help his immune system in the meantime? He offered nothing but based on what I have read there are medications and treatments to help extend his survival and make the time he does have left better. I don’t know why my vet would not offer anything.
I am sorry to hear of this – it is common in chow type dogs.
Get to an oncologist so you can use the vaccination which is now in the market and consider the chemo/surgery/radiation options too.
Another post you should read: https://www.dogcancerblog.com/blog/an-overview-of-what-else-can-i-do/
And of course diet too!
might be time for you to read the Guide if you have not done so.
Hope this helps
How about narcotics? Why is everybody shying away from opioids? Our doggie also suffers from oral melanoma..and the vet offered nothing to relieve his misery. Eventually now, he is on Gabapentin, Prednisone and Hydromorphone (more potent than Morphine). He did have surgery but the cancer recurred. Let’s not worry about addiction at the end of life!! You want humans and animals comfort!!
I cannot speak for why no other options were discussed. But it’s great that you are getting more info. A second opinion is always an option. If you need to find an oncologist, check out http://www.acvim.org to find a specialist. Good luck!
All my best, Dr Sue
Cheryl, ask the vet for a narcotic. Our doggie also suffers from recurring melanoma. He has terminal cancer. Forget the experimental drugs. Your animal is suffering. He needs Hydrocortisone for inflammation and narcotics for pain and misery. I finally managed to get a Morphine -like narcotic for our dog and he is so much more comfortable. My daughter couldn’t afford a second surgery, chemo, radiation etc. We’re also against euthanasia. It’s called palliative care, hospice (at home) care!! Your vet should be able to manage end-of-life care.
[…] you read part one, you remember I was all excited after a recent weekend meeting in New York City on the topic or […]
My six years old beagle (about 50 pounds ,neutered) was diagnosed in (early July,2011) oral squamous cell carcinomas.
He has been taking these supplement : Natural Yunzhi and AUREO for pet(beta-glucan).
After reading your book, I would like to give him two more supplement but I’m not sure whether it is suitable or not! These supplement are:(by CATALO )
1.High Concentration of Catechins GREEN TEA Extract : Natural Decaffinated Green Tea Extract, Pullulan(Water-soluble Vegetable Polysaccharide), Maltodextrin, Magnesium Stearate.
2.Natural Feverfew Extract : Natural Feverfew Extract 250mg(Standardized 0.2% Parthenolide), Natrual Gelatin.
Thank you for your work, it is really useful for me! Thank !!!!
Sorry about your beagle.
I am a little confused however- have you read the book? There are many more supplements that have much more merit than the ones you have proposed. I don’t see the need for Yun Zhi with the aureo product. The beta glucans are good, but I prefer the blend from K-9 immunity. There is some merit to the green tea extract but I have grown away from it in place of what I believe are better combinations. Have you discussed Apocaps with your vet? Diet? Artemisinin? Neoplasene? I assume surgery, radiation and so on are not options?
Hope this helps
My Lucy has MCT metastasis. With all of the research I have been doing I am wondering if it originated from melanoma. When she was about 2 she had a strange patch on her back about the size of a quarter. At age 3 she had her first MCT malignant. After her 4th MCT removal she metastasis and the oncologist gave a poor prognosis even with treatment. Lucy at age 8 will be gone soon, says the doctors. If the original site was melanoma and it had been treated maybe she never would have got MCT? I am considering another Boston Terrier when Lucy is gone and hope to never go through this again. It’s like losing my child and a bit of me is dying. I have photos if anyone is interested I am happy to share for free, so others will know what to look for.
Hi Heidi, I am a little confused. Was Lucy ever diagnosed with melanoma? And in dogs, most skin melanomas are benign (different than people). It’s the oral melanoma and digit ones in dogs that are so malignant.
It sounds like you Lucy had an aggressive MCT, and I am sorry for everything you have gone through.
All my best, Dr Sue
I learned that most people on melanoma vaccine is also on a human form of Prozac. She works with cancer patients and notice that mostly all the patients that were receiving this kind of treatment was on Prozac wonder if he is just fatigue and need a anti-depressant for dogs. What do you think.
Hi Jay, If your dog’s energy has not picked up, I would discuss these concerns with your oncologist, The vaccine is typically quite well tolerated. Sometimes there is a transient fever but it does not last more than a day or 2 in most cases. If your dog has not had recent lab work, I would start there and also consider imaging to check for metastasis or spread. Again, please discuss with your oncologist!
I would also consider an aspirate of the chest mass.
All my best, Dr Sue
I have my dog on Merial melanoma vaccine, There are some things going on that I do not understand. He is very moving very slow and I notice there is a small mass on his chest that is getting larger. He is still eating, drinking and using the bathroom, but looked and acted better before surgery and before starting the Merial melanoma vaccine.