Small Animal/Exotics 20TH ANNIVERSARY Compendium October 1999

Highlights and Horizons in

Veterinary
Oncology
E. Gregory MacEwen, VMD, Diplomate
ACVIM (Internal Medicine, Oncology)
Professor, Department of Medical Sciences
School of Veterinary Medicine
University of Wisconsin
Madison, Wisconsin
he field of veterinary oncology has grown considerably over the past 20 to

T 30 years. Today, cancer treatment in companion animals continues to

undergo a substantial evolution within clinical veterinary practice. It is
estimated that 15% to 20% of mature animals presented to a veterinary practice
will have a neoplastic process. Following diagnostic workup, 20% to 25% of
those patients will receive cancer treatment.

History
In the late 1960s and early 1970s, veterinary oncology was dominated by
pathologists and, to a limited degree, academic veterinary surgeons. The ad-
vances made during this time were predominantly pathologic classification
schemes and tumor grading systems. The development of traditional surgical
management of solid tumors served as the basis for gaining information on the E. Gregory MacEwen, VMD
biologic behavior and sites of metastasis for many common cancers.
When I entered the field of veterinary oncology in the early 1970s, the prima- olina State University), radiation ther-
ry objective for most aggressive cancers was to establish a diagnosis and obtain a apy advanced because of the potential
complete necropsy. In the late 1970s, clinical staging systems were established for using companion animals as mod-
under the leadership of the World Health Organization. These staging systems els for human cancer. Over the past
were essential for the development of prospective clinical trials, for valid compar- 20 years, there have been significant
isons among treatment modalities and studies performed by various investiga- technical refinements in radiation
tors, and for maintaining consistency in the presentation of data in the litera- therapy in humans as the result of ex-
ture. Surgical oncology advanced significantly in the 1980s; the most notable perience gained in veterinary practice.
contributions included advances in the aggressive treatment of oral tumors (e.g., For example, investigators at Colo-
mandibulectomy, partial maxillectomy) and limb-salvage procedures. rado State University obtained substan-
Slowly, the field of nonsurgical cancer therapy began to develop. Particularly at tial grant support from the National
a few schools of veterinary medicine (e.g., Colorado State University, North Car- Cancer Institute in the mid-1970s

1968 1974 1978 1980

ENDIU
MP 1980 1983
19
The seminal paper on The Veterinary The World Health Purdue University hosts the first

1985
cancer incidence data Cancer Society Organization VCS Clinical Veterinary
M’

20th

CO

for dogs and cats is (VCS) is publishes the TNM Oncology Workshop

1981
S

published in the established (tumor, node,

1 9 7

ANNIVERSARY
9 - 1
9 9 9

1979Journal of the
National Cancer
Institute
1982 metastasis)
classification of
tumors in domestic

1984
animals
The National Institutes of Health
publishes the first and only
monograph on the occurrence of
tumors in domestic animals
19
 Compendium October 1999
and early 1980s for the study of ani-
mal models and obtained new data
on tumor response, tumor hypoxia,
fractionation techniques, and normal
tissue toxicity in companion animals.
The field of veterinary medical on-
cology struggled in the 1970s because
of the lack of veterinary centers fo-
cusing on medical oncology. Initially,
the major challenges were to identify
available chemotherapeutic agents,
determine dose levels that were well
tolerated, establish frequencies of ad-
ministration, determine appropriate
monitoring for drug toxicity, and
conduct clinical trials to determine
efficacy. In the late 1970s and early
1980s, a number of available chemo-
therapeutic agents (e.g., L-asparagi-
nase, doxorubicin, vincristine, cyclo-
phosphamide, melphalan) tested in
prospective clinical trials were shown
to have antitumor activity in animals
for lymphoma, chronic leukemias, mye-
loma, and a few solid tumor types.
Following the identification of the
best agents, such as those listed above,
the next challenge was to combine
these drugs into combination chemo-
therapy protocols. In the mid-1980s,
combination chemotherapy protocols
had become the standard of care for
medical oncology in human and vet-
erinary medicine. Since the late 1980s
and early 1990s, combined-modality
therapy, which includes surgery, ra-
diation, and chemotherapy, has be-
come more common in the general
practice of veterinary oncology.
The use of immunotherapy and
biologic therapy has its roots in the
mid-1970s; however, the results of a
number of clinical trials yielded only
minimal benefit in treating a few se-
lected solid tumors, such as osteosar-
coma, melanoma, and lymphoma. None
98719901992 1985
1995
The American Veterinary
1987
The American College
1998
Medical Association of Veterinary Internal
1991
publishes a brochure entitled Medicine recognizes
1994
Warning Signs for Cancer oncology as a specialty,
19891993 1997
in Pets and the certification
986
process is established
The Veterinary Cooperative
Oncology Group is founded
20TH ANNIVERSARY
of the targets of current anticancer
drugs are cancer-specific; DNA and
RNA synthesis, microtubule assem-
bly and function, and topoisomeras-
es are common targets for anticancer
drugs but are also required by nor-
mal cells, especially those that grow
rapidly (e.g., in bone marrow and
the gastrointestinal tract). However,
as our understanding of the molecu-
lar biology of cancer and the role of
the tumor microenvironment or tu-
mor–host interaction increases, en-
thusiasm for biologic therapy, gene
therapy, organ-specific targeting, and
immunotherapy will intensify. Some
of the most exciting advances in can-
cer therapy, such as antiangiogenic
agents, tumor vaccines, growth factor
receptor inhibitors, and liposome-en-
capsulated chemotherapy, are based
on a better understanding of the bi-
ology of cancer and the selection of
agents with defined mechanisms of
action.
Organizations
The advancement of veterinary
oncology is also based on organized
veterinary medicine. The most no-
table impact on clinical veterinary
oncology was the establishment of
the Veterinary Cancer Society (VCS)
in 1974. The VCS grew from a small
group of approximately 20 to more
than 600 members today. This orga-
nization has played a major role in
the dissemination of new knowledge
through its annual scientific meet-
ings and the publication of the Vet-
erinary Cancer Society Newsletter.
The VCS has also helped to devel-
op veterinary oncology into a recog-
nized specialty within the American
College of Veterinary Internal Medi-
cine (ACVIM). In 1987, the ACVIM
1990
The European Society
The American College
of Veterinary
Oncology (ESVO)
holds its first annual
congress
Small Animal/Exotics
OWNERS’ OUTLOOK
■ Family Ties. Studies conducted
by Barker and Barker showed
that some dog owners are as
emotionally close to their dogs as
to their closest family member.
More than one third of owners in
the study felt closer to their dogs
than to any human family
member.1,2
References
1. Barker SB, Barker RT: Investigation
of the construct validity of the Family
Life Space Diagram. J Ment Health
Couns 12:506–514, 1990.
2. Barker SB, Barker RT: The human-
canine bond: Closer than family ties?
J Ment Health Couns 10:46–56,
1988.
established oncology as a subspecial-
ty within its organization. Today,
there are more than 90 board-certi-
fied ACVIM diplomates in oncolo-
gy. In 1994, the American College of
Veterinary Radiology established ra-
diation oncology as a separate board,
and there are currently 30 board-cer-
tified veterinary radiation oncolo-
gists.
An additional significant contribu-
tion to veterinary oncology was the
establishment of the Veterinary Co-
operative Oncology Group (VCOG)
in 1985. This group was established
to enhance interactive collaboration
and multicenter trials to broaden the
generation of clinical data and thera-
peutic studies. The VCOG has con-
ducted a large number of retrospec-
tive and prospective clinical studies,
most of which have been published
in the veterinary literature.
1994
1999
The VCS and the
of Radiology ESVO hold their
establishes the first combined
subspecialty of international meeting
radiation oncology
1999
Small Animal/Exotics 20TH ANNIVERSARY
Private Practice
Although the majority of contributions made to veteri-
nary oncology have originated from oncology programs at
academic veterinary institutions, the field has extended
greatly into the private sector. The rapid development of
specialty practices in almost all major metropolitan areas
has moved cancer management from academic centers to
private practice. Not only has medical oncology expanded
to private practice, but radiation therapy is now becoming
readily available in private specialty practices. Based on the
economics and demographics of veterinary practice, the
greatest expansion of the delivery of veterinary cancer care
in the future will most likely take place in private referral
practice. The academic centers will still play a major lead-
ership role in resident training, research, and conducting
prospective clinical trials. For academic programs to re-
main viable and competitive, however, close collaboration
will be needed with the private sector.
Client Attitudes
Concurrent with the rapid expansion of clinical veteri-
nary oncology, clients’ attitudes toward cancer and cancer
therapy for their companion animals have changed at a
similarly rapid pace. Much of this is a direct result of the
awareness and appreciation by veterinarians of the strong
bond that develops between owners and their pets. In ad-
Compendium October 1999
dition, veterinarians now have a more positive attitude and
philosophy regarding cancer therapy. Finally, veterinary
care has shifted toward life extension and the improvement
in quality of life. General veterinary practice has eliminat-
ed many juvenile diseases, and pets are living to a ripe old
age. Pet owners are generally knowledgeable, and many
have a strong appreciation for the various modes of cancer
therapy, related toxicities, and potential benefits.
The Future
The next 20 years will bring a phenomenal number of
exciting changes to veterinary oncology. There will be a
greater shift toward cancer-specific therapies and less re-
liance on traditional chemotherapy and radiation. These
therapies will include gene therapy, targeted chemotherapy,
antiangiogenic therapy, focused radiation, and cancer-spe-
cific drugs. Furthermore, the availability of reliable and fac-
tual information via the Internet will allow pet owners to
have immediate and up-to-date information, which may
give them as much knowledge as practitioners have about a
particular cancer or treatment modality. This will create a
major challenge for practicing veterinarians. The availabili-
ty of current information and access to veterinary specialists
via the Internet and telemedicine will play an even greater
role in expanding oncology into the private sector.