here - The Small Animal Medicine Society (SAMSoc)

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Treatment of Canine Gastrointestinal
Stromal Tumours with Tyrosine Kinase
Inhibitors-Patient Enrolment.
Your name
Date
Your practice name
Your work telephone number
Your e-mail address
Patient name
Unique case number
Patient species
Dog (please confirm)
Date of birth
(if known otherwise
write ‘not known’)
Patient age at
diagnosis (OK to leave
blank if entries above
are complete)
Neuter status (entire,
neutered or unknown)
Please note
presenting clinical
signs (record yes, no
or unknown)
Breed
Date of diagnosis
Gender
Body weight/kg (ideally at
treatment start)
Y/N/U
Space for comments
Vomiting
Diarrhoea
Weight loss
Abdominal pain
Anaemia
Palpable abdominal
mass
Loss of appetite
Melaena
Other
Y/N/U
Please note clinical
stage evaluations
performed
Thoracic x-ray
Thoracic CT
Abdominal x-ray
Abdominal
ultrasound
Abdominal CT
Please describe findings including
dimensions of primary tumour and
lymph node secondaries
Please tick to confirm
you are happy to
request that a wax
block containing your
patients tumour
specimen is forwarded
to Gerry Polton at
NDSR
Please describe
surgery by circling
most appropriate term
Date of surgery
Please tick to confirm
you have requested
that a wax block
containing your
patients tumour
specimen is forwarded
to Gerry Polton at
NDSR
Incisional biopsy
Tyrosine kinase
inhibitor (TKI) used
(please circle)
Masitinib
Date TKI treatment started
Burden of tumour at
treatment start
Complete remissionno detectable tumour
Excisional biopsy
Toceranib
Wide local excision
Other: please also
state which agent used
Starting dose in mg
Same as reported on
clinical stage
evaluations above
Different from above:
please describe
Please e-mail your completed or partially completed enrolment form to me on [email protected]
Further information regarding response to therapy, disease progression and adverse events will be
gathered by direct communication between you and me. Ideally prospectively enrolled patients will
be re-evaluated by their attending clinician for evidence of disease progression after one month,
three months and then quarterly. The nature of the re-evaluations performed and the findings will
be recorded. Changes in clinical signs and any adverse events will similarly be recorded. It is the
intention to recruit twenty patients. There will be no funding for treatment or investigations of
affected animals. Funding will be sought for immunohistochemical and possible mutational analyses
of the collected histology specimens once recruitment of cases has closed.
With thanks for your interest and (hopefully) participation.
Gerry Polton MA VetMB MSc(Clin Onc) DipECVIM-CA(Onc) MRCVS
European Veterinary Specialist in Oncology
RCVS Recognised Specialist in Veterinary Oncology (Small Animals)
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