In veterinary clinical oncology, we use clinical trials to test new chemotherapeutics for efficacy, compare new treatments to the current "standard of care", and to test new procedures.
In some cases we are testing to determine if a treatment is safe, in other cases we are testing to determine if a treatment is effective (does it help dogs live longer than if they're not treated?), and in other cases we're testing to determine if the new treatment is better than our current "best" treatment for a certain type of cancer.
Where Are Trials Conducted?
Clinical trials are typically conducted at a veterinary teaching hospital and are funded by competitive grants that the researcher (investigator) must apply for. In some cases, private practices may also participate in studies, or a study may involve many academic and private practices (in order to collect as many cases as possible).
Note: Participating in a clinical trial typically involves traveling to your nearest veterinary teaching hospital for the study. As mentioned, there are some veterinary oncologists in private practice that also run their own trials or participate in nationwide trials.
Who Pays For The Treatment?
If you participate in a clinical trial at an academic institution, the trial will typically pay for most aspects of the treatment. This is sometimes the case with trials run in the private practice setting as well and is often one of the main incentives for dog owners to participate. Not all trials are funded, but this information will be clearly stated up front.
Who Is A Good Trial Candidate?
Every trial is looking for a different type of patient. Some trials are testing a new drug in "naive" patients (patients that have cancer but have not begun treatment for that cancer yet), but in others it doesn't matter if they've received treatment. In some cases the researchers are specifically looking for dogs with metastatic disease (cancer that has spread) and in other cases, a dog will only be accepted to the trial if their cancer has not spread.
All trials will have some sort of stipulation that they are looking for a dog that is expected to live X number of weeks. This means that if a dog is very sick from his cancer, and might die within the next few days to weeks, he would not be a candidate.
This is for logistical reasons (it takes some time to schedule the appointment, start all of the necessary testing like chest x-rays, abdominal ultrasound, blood work, evaluate results, decide if the patient is a candidate, then initiate treatment) and logical reasons. Patients that are already feeling very sick from most cancers (lymphoma is an exception) are unlikely to have a meaningful response to any treatment.
In Which Situations Would Participating In A Trial Make Sense?
Whether or not to participate in a clinical trial is a very personal decision. We have to remember that a trial is no guarantee (that's why the treatment is being tested) and we may not fully appreciate the possible side effects of the new treatment at the time of the trial.
So, in which cases might participating in a trial make the most sense?
- If the trial is studying the addition of a new treatment to the current standard of care (these patients would still be receiving the "best" treatment, plus they would be receiving an extra treatment that may help them do better than the current standard)
- If the trial is studying a new treatment for metastatic disease and your dog has already failed the currently available treatments
- If the trial is studying a new treatment for metastatic disease (we don't have many great options for metastatic disease for most types of cancer; you would have to discuss the likelihood of efficacy of what we currently have with your oncologist and decide whether you prefer the odds of trying what we have or the new trial)
- You cannot afford treatment for your dog's cancer and a new trial offers funding for a new treatment
How To Find The Latest Clinical Trials
The most comprehensive resource for veterinary clinical trials is the AVMA Animal Health Studies Database. This database includes studies for all species in the US and Canada. You select the species, topic (nutrition vs oncology, etc.) and location (US or Canada). You then select the keyword (ex "osteosarcoma" or "mast cell"). Other countries will have their own database.
I would say the main drawbacks to using this search are that you cannot search by state/region and if you include the keyword "tumor" (example: mast cell tumor) it will populate results with other types of tumors, so you have to have patience and be very specific with your search.
This is what the site looks like:
The search for osteosarcoma in dogs in the US reveals 57 results. I copied the first result below. It names the title of the study, the location (it also mentions that other locations are available), and how long the study is open (sometimes this is listed and sometimes the study is open for as long as it takes to obtain enough patients).
If you want to learn more about the study, click the "Find out more" button. It will pull up specifics about the study such as whether there is funding, where you would need to travel, who you would contact for more information, what would make a dog a good candidate (inclusion and exclusion criteria), what is involved in the study, etc.
Other options to find clinical trials include (1) searching the clinical trials page of your nearest veterinary teaching hospital and (2) searching the Morris Animal Foundation Trials Database. This database is not as comprehensive as the AVMA database, but can still be very helpful (I would recommend searching both to make sure you're not missing anything).
Every veterinary teaching hospital will have a list of their current/ongoing clinical trials. This can typically be found by navigating to their veterinary teaching hospital website and looking for a "clinical trials" link from one of the dropdown menus listed towards the top of the homepage. From there you can search (as above) for the type of trial (oncology/cancer) and species (canine).
Trial investigators are typically very motivated to fill their trials with the right patients. If you feel like your dog might be a candidate for one of the trials you read about and you're willing to travel to the trial location, don't hesitate to reach out to the investigator and get the ball rolling. Just be certain to carefully read through the information sheet provided about the trial - trials do not make exceptions with exclusion and inclusion criteria. Make sure it seems like your dog might be a candidate prior to contacting the investigator.
And don't forget, there are new trials listed frequently, so don't hesitate to continue to check the databases for new trials!
Dr. Lori Cesario
Board Certified Veterinary Oncologist
PS: I'm happy to now offer online oncology consultations. Learn more about how this service can help by visiting the Vet Cancer Consultants site.
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