NEWPORT NEWS — A few minutes past noon, Chloe lies almost motionless on her side on the examining table as Dr. Christina Long administers a vaccine on the tender inside of her upper thigh. Gently, she turns her over and injects the other thigh in the same spot.
"She's the best patient ever," says Long of the 51/2 -year-old Boston terrier, who was diagnosed with a glioma, a cancerous brain tumor, in February. Tenderly, she traces the barely visible scar that runs the length of Chloe's skull, the result of surgery three weeks ago in Minneapolis to remove a 2-by-2-by-11/2 centimeter tumor from the right occipital lobe. "It's amazing. She hasn't shown any residual deficit since the surgery," says Long. "Her quality of life is much better — before she was having seizures and vision problems."
Chloe in vaccine trial
Chloe, who lives in Kiln Creek in Newport News with her owners Carrie and Eric Chi, is one of 70 dogs and eight people who have participated in a canine/human clinical brain cancer trial run by the University of Minnesota Veterinary Medical Center since 2008. There, veterinarian Dr. Liz Pluhar performed the surgery on Chloe with a pediatric neurosurgeon in attendance. The first participant and poster dog for the trial, Batman, lived 18 months after the surgery, dying from heart failure — but cancer-free — at age 12.
In Chloe's case, all but a sliver of the tumor was removed, leaving her eyesight unaffected. The specially mixed vaccine, part packed on dry ice and part frozen, is shipped to Kiln Creek Animal Care each day of the series of six treatments; it is thawed just before injection. The unusual site of the injection is the farthest away from the tumor, explains Long, and close to healthy lymph nodes for rapid processing.
The immunotherapy uses proteins from Chloe's tumor to make a vaccine that is as genetically similar as possible; it should cause her immune system to recognize and kill any tumor cells that were not removed during surgery. John Ohlfest, head of the Minnesota neurosurgery gene therapy program, oversees the vaccines for dogs and has started similar treatments for humans; the latest application is in children when surgery is not an option. Long likens it to how flu vaccines are customized to tackle particular strains.
Deciding on treatment
A week after the removal of her sutures, Chloe appears the picture of health, with a glossy black and white coat and an alert, engaging personality. "I did notice she got tired yesterday when we went for a walk," says Carrie Chi, who stumbled across the clinical trial while reading online about canine cancer. Until then, she and her husband, Eric, had decided to pursue palliative care only in light of the aggressive nature of the diagnosed cancer — the same as the late U.S. Sen. Ted Kennedy had, she notes.
At the end of January, Chloe woke the young couple with a grand mal seizure in the middle of the night. "She was flailing and I thought perhaps she needed some oxygen," said Eric, 31, who removed the bed covers to free her. She then skewed off the bed on to the floor. "Then I knew it wasn't right," he says. Her symptoms included foaming at the mouth, shaking violently, and lying on her side disoriented. A local emergency vet took a full panel of blood tests and X-rays and started her on anti-seizure medications. (Chloe must still take anti-seizure meds four times a day — "we hide them in meatballs. She gets a lot of treats these days," says Carrie, 30.)
More seizures followed. Then the Chis took Chloe to Bush Veterinary Neurology Service in Richmond, where they saw Dr. Martin Young, who changed Chloe's medication. On Super Bowl Sunday, Feb. 5, Chloe had two more seizures, so they rushed her back to Richmond where she had an MRI — the closest veterinary office with that capacity — that revealed the tumor. She was given between three and six months to live. Their options were to pursue radiation therapy at North Carolina State, which would require a long separation, or to try experimental electrical treatment (electroporation) offered at Virginia Tech. They rejected both.
Chloe goes to Minnesota
Two weeks later, Carrie happened on Pluhar's clinical trial, which is open to dogs with meningiol and glioma tumors. She called and left a message on a Friday; by Tuesday, after sending Chloe's records, she learned that Chloe was an excellent candidate and the surgery date was set for March 1. "Eric and I had to decide really quickly," says Carrie. They were impressed by the researchers' qualifications, the many successes recorded, and that Pluhar had not lost any dogs in the surgery phase. And perhaps, most of all, they liked the idea of contributing to cancer research.
"Even if Chloe doesn't make it, at least we've contributed to cancer research while benefiting the dog," says Carrie. "Perhaps more people will donate to cancer research when they see where their money goes." Funding for the trial comes from several sources, including the Children's Cancer Research Fund, the National Institutes of Health and the American Cancer Society.
On Feb. 28, two days early to avoid a storm that never materialized, Eric boarded a Delta flight to Minneapolis with a sedated Chloe. They flew first class to allow the 23-pound pooch enough room and they stayed at a Days Inn near the clinic. On March 1, Chloe had a three-hour surgery with three doctors in attendance. Her glioma proved to be Stage 4, or advanced — Pluhar advised them, honestly, that she has not had a cure at this stage — and it was determined she would participate in the vaccine therapy rather than the gene therapy that's also part of the trial.
Chloe comes home
Within 24 hours Chloe was back at the hotel with Eric, who waited three days before flying home in order to give her more recovery time before subjecting her to air pressure changes. "She's just back doing her normal doggie things," says Carrie, who's thankful that Eric had the flexibility to take the time off work. The extended family also provides day care for Chloe and her canine companion, Coco, a pug.
"If we didn't do anything how would we feel when she died? The rate it was growing we wouldn't have had three months," she says.
Altogether the couple has spent about $7,000. "We don't have children. … We're really good at saving," says Carrie. Of the $4,500 in vet expenses, the MRI at $1,850 took the biggest chunk, with travel accounting for the rest.
Chloe is due for a follow-up MRI on May 1 in Richmond. Both the Richmond vet and Kiln Creek Animal Care, where Carrie worked as a teenager, are working to minimize the costs of her care. "It's exciting to be part of it. It really is a collaboration; it's really nice to see vets and doctors working together," says Long.
The vaccine could be administered at home by Chloe's "parents," but the Chis opted to rely on the vet's expertise.
"We don't trust ourselves. We'd hate to mess it up after investing so much time and money," says Eric, handing the leash over to Debbie Wright, a licensed vet tech.
Wright helps flip Chloe on her side and holds the dog steady for the minute or two it takes Long to give the shots.
"Chloe has the benefit of not knowing what she's going through," says Long. "She's not dwelling on it. Stress has a huge effect on the immune system and healing."
For Chloe, it's just another day, another outing, another treat at the end of a veterinary visit.
Ready to go, she takes the proffered biscuit bone and holds it in her lips with what can only be described as a grin.
Learn more about the clinical trial
For dogs that qualify for the clinical trial, Immunotherapy for Canine Glioma, NIH R21, all treatment (approximately $15,000) is covered by the University of Minnesota Veterinary Medical Center. Transportation and housing costs as well as follow-up care at other vets are the responsibility of the owners. For information, go to http://www.braintumorlab.com and click on "For Dog Owners"; http://www.cvm.umn.edu/vmc, or call 612-624-2485.Copyright © 2014, The Baltimore Sun