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Hollis AR. What Is the Evidence Behind Sarcoid Treatments? Vet Clin North Am Equine Pract 2024:S0749-0739(24)00055-5. [PMID: 39183073 DOI: 10.1016/j.cveq.2024.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/27/2024] Open
Abstract
Despite the ubiquitous nature of sarcoids, robust data regarding the selection of treatment modalities are scarce, with many treatments having little or no published data to support their use. Treatment options are numerous and vary with the location and type of sarcoid, treatment accessibility, and the financial status of the owner. Many treatments are expensive and time-consuming, and some have health and safety implications. It is this author's belief that, based on the limited evidence base, appropriate treatment options vary with the location and type of the sarcoid, and no one treatment is universally appropriate.
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Affiliation(s)
- Anna R Hollis
- Department of Veterinary Medicine, University of Cambridge, Madingley Road, Cambridge CB3 0ES, UK.
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Malalana F. Chemotherapeutics in Equine Practice. Vet Clin North Am Equine Pract 2024:S0749-0739(24)00053-1. [PMID: 39155164 DOI: 10.1016/j.cveq.2024.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/20/2024] Open
Abstract
Chemotherapy is the treatment of cancerous cells through the use of cytotoxic drugs. Whilst the use of systemic (intravenous) chemotherapy in equine practice is generally limited to the management of lymphoma, cytotoxic drugs are commonly used in the treatment of accessible skin tumors, either by topical application in the form of ointments or injected intralesionally. These drugs should be employed with caution due to the risk of serious adverse effects. In addition, extreme caution should be followed when preparing, handling, administering, and disposing them, due to their carcinogenic, mutagenic, and teratogenic properties.
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Affiliation(s)
- Fernando Malalana
- Philip Leverhulme Equine Hospital, University of Liverpool, Leahurst Campus, Chester High Road, Neston CH64 7TE, United Kingdom.
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Beermann A, Clottu O, Reif M, Biegel U, Unger L, Koch C. A randomized placebo-controlled double-blinded study comparing oral and subcutaneous administration of mistletoe extract for the treatment of equine sarcoid disease. J Vet Intern Med 2024; 38:1815-1824. [PMID: 38529853 PMCID: PMC11099770 DOI: 10.1111/jvim.17052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 03/08/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND Equine sarcoids (ES) are the most common cutaneous tumors in equids. Systemic treatment options are sparse. Subcutaneous (SC) injections of Viscum album extract (VAE) demonstrate efficacy as a systemic treatment directed against ES. OBJECTIVES/AIM To critically assess the therapeutic efficacy of orally administered VAE. ANIMALS Forty-five ES-affected, privately owned, 3-12 year-old horses. METHODS A 3-armed randomized placebo-controlled, double-blinded study was conducted in a double-dummy design. Horses were subjected to oral administration and SC injections of either VAE or placebo (VAE oral/placebo SC, VAE SC/placebo oral, placebo oral/placebo SC) over a 7-month treatment period. Primary endpoint was the change of baseline of a composite index of ES number and ES area after 14 months. Second endpoint was the clinical response. RESULTS No statistically significant difference in the composite endpoint between the 3 study arms was found. The primary endpoint showed 4 (27%) horses in the VAE oral group with complete ES regression, 3 (21%) in the VAE SC injection group, and 2 (13%) in the placebo group. The clinical response revealed complete or partial regression in 6 horses of the oral VAE group (40%), 4 of the SC injection group (29%), and 4 of the placebo group (25%). Direct comparison of oral VAE and placebo showed an odds ratio, stratified for prognosis of 2.16 (95%-CI: 0.45-10.42) and a P-value of 0.336. CONCLUSION AND CLINICAL IMPORTANCE Oral administration of VAE is well tolerated. No statistically significant difference in the effectiveness of systemic VAE versus placebo against ES was found.
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Affiliation(s)
- Anke Beermann
- Research Institute of Organic Agriculture (FiBL), Department of Livestock SciencesFrickSwitzerland
| | - Ophélie Clottu
- Research Institute of Organic Agriculture (FiBL), Department of Livestock SciencesFrickSwitzerland
| | - Marcus Reif
- Society of Clinical Research e.VBerlinGermany
| | - Ulrike Biegel
- Research Institute of Organic Agriculture (FiBL), Department of Livestock SciencesFrickSwitzerland
| | - Lucia Unger
- Department of Clinical Veterinary Medicine, Swiss Institute of Equine Medicine (ISME)University of BernBernSwitzerland
| | - Christoph Koch
- Department of Clinical Veterinary Medicine, Swiss Institute of Equine Medicine (ISME)University of BernBernSwitzerland
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Offer KS, Dixon CE, Sutton DGM. Treatment of equine sarcoids: A systematic review. Equine Vet J 2024; 56:12-25. [PMID: 36917551 DOI: 10.1111/evj.13935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 03/09/2023] [Indexed: 03/15/2023]
Abstract
BACKGROUND The sarcoid is the most common equine cutaneous neoplasm. Evidence-based treatment of this condition is often lacking, and selection of treatment modality based on clinical experience or anecdotal evidence. OBJECTIVES To assess the quality of the currently available best evidence regarding the treatment of the equine sarcoid. STUDY DESIGN Systematic review. METHODS In compliance with PRISMA guidelines, literature searches were performed in PUBMED, Web of Science, CAB Abstracts, EMBASE (Ovid) and Scopus in April 2021. Included papers were required to describe an interventional study examining sarcoid treatment strategy, of level 4 evidence or greater. The case definition required confirmation of at least some included lesions on histopathology, and a minimum of 6 months of follow-up was required on treated cases. Studies were assessed by two independent reviewers (KO, CD). Data extraction was performed manually, followed by risk of bias assessment. Methodological quality was assessed using the GRADE system. RESULTS In total, 10 studies were included in the review. Case definition was confirmed via histopathology in all included lesions in 60% of papers. Time to follow-up was variably reported. Overall risk of bias ranged from 'some concerns' to 'critical'. Reported sarcoid regression rate ranged from 28% to 100% on an individual sarcoid level, and 9%-100% on a whole horse level. Transient local inflammation was reported following most treatment strategies, with further adverse events reported infrequently. MAIN LIMITATIONS Review methodology excluded a large proportion of available literature regarding the equine sarcoid. Significant heterogeneity between included studies prevented quantitative synthesis and most included papers were at significant risk of bias, indirectness, and imprecision. CONCLUSIONS There is insufficient evidence currently available to recommend one sarcoid treatment over another. There is an urgent need for sufficiently powered, randomised, placebo-controlled trials in order to allow more definitive comparison of the efficacy of different treatment strategies.
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Affiliation(s)
- Katie S Offer
- School of Biodiversity, One Health and Veterinary Medicine, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Claire E Dixon
- Tufts Equine Center at the Hospital for Large Animals, Cummings School of Veterinary Medicine at Tufts University, North Grafton, Massachusetts, USA
| | - David G M Sutton
- School of Biodiversity, One Health and Veterinary Medicine, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
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Curnow B, Rich AF, Ireland J, Correa DC, Dunn J, Jenkins D, Carslake H, Ressel L. Histological evidence of superficial inflammation is associated with lower recurrence of equine sarcoids following surgical removal: A follow-up study of 106 tumours in 64 horses. Vet J 2023; 292:105953. [PMID: 36775186 DOI: 10.1016/j.tvjl.2023.105953] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 01/31/2023] [Accepted: 02/08/2023] [Indexed: 02/12/2023]
Abstract
Although the equine sarcoid is the most common skin neoplasm in domesticated horses, histopathological characteristics have not previously been evaluated for association with recurrence. The aim of this retrospective cohort study was to investigate clinical and histopathological features of excised equine sarcoids and to evaluate their association with recurrence at the original surgical site and at new sites. Clinical records and excisional biopsies from 106 equine sarcoids from 64 horses referred to Leahurst Equine Hospital, University of Liverpool, between March 2010 and February 2015 were retrieved. Biopsies were re-evaluated histologically. Clinical data were obtained from hospital records, and owner-reported follow-up data were obtained by telephone questionnaire. Associations between clinical and histopathological features of sarcoids and their recurrence at the surgical site were determined using uni- and multivariable mixed effects logistic regression. Recurrence of sarcoids at the surgical site occurred in 30 horses (46.9%). Sarcoids developed at a distant site in 21 horses (32.8%). In the final mixed effects logistic regression model, only superficial inflammation was associated with reduced odds of recurrence at the surgical site (adjusted odds ratio, 0.32; 95% confidence intervals, 0.10-0.96; P = 0.04). This suggests that the inflammatory process may play a role in protecting horses against the recurrence of sarcoids.
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Affiliation(s)
- B Curnow
- Department of Equine Clinical Science, University of Liverpool, Leahurst Campus, Neston CH64 7TE, UK.
| | - A F Rich
- Department of Veterinary Anatomy, Physiology and Pathology, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Leahurst Campus, Neston CH64 7TE, UK
| | - J Ireland
- Department of Equine Clinical Science, University of Liverpool, Leahurst Campus, Neston CH64 7TE, UK
| | - D Cubillos Correa
- Department of Veterinary Anatomy, Physiology and Pathology, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Leahurst Campus, Neston CH64 7TE, UK
| | - J Dunn
- Department of Equine Clinical Science, University of Liverpool, Leahurst Campus, Neston CH64 7TE, UK
| | - D Jenkins
- Department of Equine Clinical Science, University of Liverpool, Leahurst Campus, Neston CH64 7TE, UK
| | - H Carslake
- Department of Equine Clinical Science, University of Liverpool, Leahurst Campus, Neston CH64 7TE, UK
| | - L Ressel
- Department of Veterinary Anatomy, Physiology and Pathology, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Leahurst Campus, Neston CH64 7TE, UK
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Hollis AR. Management of equine sarcoids. Vet J 2023; 291:105926. [PMID: 36334801 DOI: 10.1016/j.tvjl.2022.105926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 10/19/2022] [Accepted: 10/29/2022] [Indexed: 12/12/2022]
Abstract
Sarcoids are the most common cutaneous neoplasm of the horse, arising as a result of a neoplastic proliferation of fibroblasts associated with infection with bovine papillomavirus, most notably types 1 and 2. Although they do not metastasise, they are locally invasive and aggressive, and can lead to important welfare concerns, interfere with tack and therefore impede athleticism, and undoubtedly lead to a reduction in the value of affected horses. This review discusses the evidence behind the most commonly used treatments for equine sarcoids. The most commonly used treatments are discussed. No one treatment is universally successful, and there are many treatments with varying level of scientific evaluation and reported success rates.
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Affiliation(s)
- Anna R Hollis
- Cambridge Equine Hospital, Department of Veterinary Medicine, University of Cambridge, Madingley Road, Cambridge CB3 0ES, UK.
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Ferrari G, Pang LY, De Moliner F, Vendrell M, Reardon RJM, Higgins AJ, Chopra S, Argyle DJ. Effective Penetration of a Liposomal Formulation of Bleomycin through Ex-Vivo Skin Explants from Two Different Species. Cancers (Basel) 2022; 14:cancers14041083. [PMID: 35205831 PMCID: PMC8870439 DOI: 10.3390/cancers14041083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 02/09/2022] [Accepted: 02/14/2022] [Indexed: 01/25/2023] Open
Abstract
Bleomycin is a chemotherapy agent that, when administered systemically, can cause severe pulmonary toxicity. Bleosome is a novel formulation of bleomycin encapsulated in ultra-deformable (UD) liposomes that may be applicable as a topical chemotherapy for diseases such as non-melanoma skin cancer. To date, the ability of Bleosome to effectively penetrate through the skin has not been evaluated. In this study, we investigated the ability of Bleosome to penetrate through ex vivo skin explants from dogs and horses. We visualized the penetration of UD liposomes through the skin by transmission electron microscopy. However, to effectively image the drug itself we fluorescently labeled bleomycin prior to encapsulation within liposomes and utilized multiphoton microscopy. We showed that UD liposomes do not penetrate beyond the stratum corneum, whereas bleomycin is released from UD liposomes and can penetrate to the deeper layers of the epidermis. This is the first study to show that Bleosome can effectively penetrate through the skin. We speculate that UD liposomes are penetration enhancers in that UD liposomes carry bleomycin through the outer skin to the stratum corneum and then release the drug, allowing diffusion into the deeper layers. Our results are comparative in dogs and horses and warrant further studies on the efficacy of Bleosome as topical treatment.
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Affiliation(s)
- Giulia Ferrari
- Roslin Institute, The Royal (Dick) School of Veterinary Studies, University of Edinburgh, Edinburgh EH25 9RG, UK; (G.F.); (R.J.M.R.); (D.J.A.)
| | - Lisa Y. Pang
- Roslin Institute, The Royal (Dick) School of Veterinary Studies, University of Edinburgh, Edinburgh EH25 9RG, UK; (G.F.); (R.J.M.R.); (D.J.A.)
- Correspondence: ; Tel.: +44-13-1651-9164
| | - Fabio De Moliner
- Centre for Inflammation Research, The Queen’s Medical Research Institute, University of Edinburgh, Edinburgh EH16 4TJ, UK; (F.D.M.); (M.V.)
| | - Marc Vendrell
- Centre for Inflammation Research, The Queen’s Medical Research Institute, University of Edinburgh, Edinburgh EH16 4TJ, UK; (F.D.M.); (M.V.)
| | - Richard J. M. Reardon
- Roslin Institute, The Royal (Dick) School of Veterinary Studies, University of Edinburgh, Edinburgh EH25 9RG, UK; (G.F.); (R.J.M.R.); (D.J.A.)
| | | | - Sunil Chopra
- The London Dermatology Centre, London W1G 8AS, UK; (A.J.H.); (S.C.)
| | - David J. Argyle
- Roslin Institute, The Royal (Dick) School of Veterinary Studies, University of Edinburgh, Edinburgh EH25 9RG, UK; (G.F.); (R.J.M.R.); (D.J.A.)
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Knottenbelt DC. The Equine Sarcoid: Why Are There so Many Treatment Options? Vet Clin North Am Equine Pract 2019; 35:243-262. [PMID: 31097356 DOI: 10.1016/j.cveq.2019.03.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
This article discusses the main treatments for sarcoid and the specific difficulties of these. It explains to some extent why the frustrations of a condition for which there is no single treatment option have led to the burgeoning of an industry of irrational treatments. The factors that need to be considered before selecting an option for treatment are wider than is the case in most other disease entities as a result of the complexity of the condition, its variable phenotypes, and the individual perceptions and experiences of both veterinarians and owners.
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Affiliation(s)
- Derek C Knottenbelt
- Equine Medical Solutions Ltd, STEP Building, Kildean Business & Enterprise Hub, 146 Drip Road, Stirling, Scotland, FK8 1RW, UK.
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