Hill vet offers holistic option for cancer patients

by LAUREN FRITSKY

When you first meet Dexter, a black Rottweiler who belongs to Nick and Elizabeth Tellie of Elkins Park, you would think that he is a normal, healthy dog. Actually, as he bounded toward me while sitting in the office of the Chestnut Hill Veterinary Hospital, I thought that he was even a bit friendlier and more active than most dogs. You would never guess that Dexter suffers from osteosarcoma, a type of cancer that most commonly affects t he leg bones of larger breeds of dogs.

It took me a full 15 minutes to realize that Dexter is missing a leg. Osteosarcoma spreads very rapidly and metastasizes very early, leaving few effective treatment options. Dogs are tested for the disease with radiographs and biopsies, but once the bone is involved, it quickly becomes very painful. Amputation of the limb is the most effective way to stop the pain, and as evidenced by Dexter, does not have as much as a handicapping effect as it does on humans.

Dexter's cancer was discovered when he went to the veterinarian because of a torn anterior cruciate ligament (ACL), which connects the tibia to the femur in the leg. He had been limping since the summer of 2003 and shortly after the cancer was diagnosed, it spread to his chest. He started chemotherapy for the osteosarcoma in mid-January, but the side effects were so severe that the oncologist recommended they stop the treatment.

"We asked if there was anything else we could do," said Nick.

The answer was angiogenesis treatment.

The Tellies found Dr. Sheldon Gerstenfeld of the Chestnut Hill Veterinary Hospital through the American Holistic Veterinary Medical Association. According to the organization's Web site, holistic medicine means, "Taking in the whole picture of the patient — the environment, the disease pattern, the relationship of pet with owner — and developing a treatment protocol using a wide range of therapies for healing the patient." Treatments can range from behavior modification to acupuncture, the common goal being to remedy ailments more humanely and effectively.

Angiogenesis, which is the growth of new blood cells, falls under  the umbrella of holistic medicine because it has little to no side effects, unlike harsher treatments like chemotherapy. In the 1970s, Judah Folkman, a researcher at Children's Hospital at Harvard Medical School in Boston, found that tumor growth is reliant on the natural process of angiogenesis. People originally thought that Folkman's findings were heresy, but more research revealed that angiogenesis does play a significant role in the development of cancer. Anti-angiogenic therapy involves drugs called "angiogenesis inhibitors" that stop new blood vessels from forming and stop a tumor's blood supply. There are no side effects with anti-angiogenic  treatment because it is concentrated only on the cancer site and not other areas of the body. The field just recently began exploring the possibility of treating animals with this type of therapy.

"This and gene therapy are the future," said Gerstenfeld, who has been a veterinarian for 30 years. "We want to get  the word out that these types of treatment are available."

The type of anti-angiogenic therapy used on Dexter is called OLCAT-007, also referred to as the "Navy Protocol," named for a two-year-old Golden Retriever who was the first canine patient to be successfully treated with antiangiogenic therapy. The protocol was created by the Angiogenesis Foundation, a nonprofit organization based in Cambridge, Mass. whose mission is to improve global health by facilitating the development and use of medicines that control blood vessel growth. Navy's cancer disappeared after only three months of treatment using a cocktail of FDA approved drugs — Celebrex, tamoxifen and doxycycline.

According to an article on angiogenesis titled "Dog's tale of survival opens door into cancer research," featured in USA Today in July 2002, each drug in the protocol focuses on a different angiogenesis  growth factor. These growth factors are the catalysts for angiogenesis and cause the body to generate new blood vessels that feed the tumors. If the growth factors cannot signal the rest of the body, angiogenesis will not take place.

Gerstenfeld agreed with a statement made in the article that anti-angiogenic therapy is not a cure, but a way to make cancer a more "chronic, manageable disease," like diabetes. Human and animal cancer patients have poor quality of life when they undergo chemotherapy. Anti-angiogenic therapy is a less harsh treatment that avoids negatively affecting other areas of the body and causing more problems.

"It's easy to give Dexter his pills," Nick said. "We just hide them in his food. He seems himself. People say they can't tell that he has cancer. There are no major side effects with the anti-angiogenic treatment. He's comfortable."

The first anti-angiogenic drug to be FDA-approved for human cancer was Avastin, developed by the biotechnology company Genentech. "It is approved specifically for use in colorectal cancer in combination with standard chemotherapy," said Dr. William Li, president and medical director of the Angiogenesis Foundation. According to Li, there are more than 70 other anti-angiogenic drugs being tested in human cancer patients, but those are not yet FDA-approved. "Nine of them are in Phase 3, the final stage of testing," said Li. "Some are given by injection, others by mouth and one even as a drink." The USA Today article said that as of the summer of 2002, 10,000 human cancer patients had been treated with anti-angiogenic drugs.

Gerstenfeld, who studied at the University of Pennsylvania, combines allopathic and alternative medicine when treating animals. Soon after he began practicing, he became dissatisfied with the traditional treatment for animal ailments.

"After so many years we are still treating things the same way," said Gerstenfeld. "We are trained to look at diseases in one way. Alternative medicine looks at trying to balance the animal or person before they get sick."

Dexter was the first animal Gerstenfeld has treated with anti-angiogenic therapy. Dexter's lungs will be checked to see if the tumors have grown. For the time being, he will continue to live a dog's life with the Tellies, who are also expecting their first child in July.

(Since this article was written one month ago, Dexter passed away; Dr. Gerstenfeld is currently using the same treatment for another cancer patient, Zoe, a six-year-old  female Golden Retriever. Her owner, Linda Levinson of Spring House, insists the dog has made significant progress since the treatment began.)

The Chestnut Hill Veterinary Hospital is located on 903 Bethlehem Pike in Erdenheim. It can be reached at 215-836-2950. To find out more information on the Angiogenesis Foundation, contact them by phone at 866-54-ANGIO or through e-mail at patienthelp@angio.org.