I'm Dr. Sue, Cancer Vet, and I'm here to share another story of one of my Stelfonta cases.

我是癌症獸醫 Sue 博士，在此與大家分享我的一個 Stelfonta 案例。

I think it's really helpful to see a case go from treatment to week four for follow-up, just to see what goes on with him, because those pictures, what to expect, are hopefully gonna help you make the decision whether or not Stelfonta is the right treatment option for you if your veterinarian tells you that your dog is a candidate for Stelfonta.

我認為，看到一個病例從治療到第四周的隨訪情況真的很有幫助，因為如果獸醫告訴您，您的愛犬適合接受斯通塔治療，那麼這些圖片和預期結果有望幫助您做出決定，斯通塔是否是適合您的治療方案。

So be sure to check out Vlog 130, because it has so much information about Stelfonta.

所以一定要看看 Vlog 130，因為裡面有很多關於 Stelfonta 的資訊。

So let me tell you about beautiful, gorgeous Teddy.

讓我來給你們講講美麗動人的泰迪吧。

He is one beautiful dog.

它是一隻漂亮的狗。

He is a six-year-old golden retriever, and I met Teddy to find out some treatment options for his mast cell tumor.

它是一隻六歲大的金毛獵犬，我見到泰迪是為了瞭解它的肥大細胞瘤的治療方案。

He originally had a mast taken off the top of his head in August of 2020.

他最初是在 2020 年 8 月從頭頂上取下一根桅杆的。

Unfortunately, it was not submitted for biopsy, so we didn't know what it was at the time.

不幸的是，它沒有被送去做活檢，所以我們當時並不知道它是什麼。

It did grow back a couple of months later and was taken off.

幾個月後，它又長了出來，並被取了下來。

He had a second surgery in December of 2020, so about four months later, and at that time, it was determined that it was a grade two, high-grade mast cell tumor.

他在 2020 年 12 月進行了第二次手術，也就是大約四個月後，當時確定這是一個二級、高級別肥大細胞瘤。

So there's those two grading systems for the mast cell tumor.

是以，肥大細胞瘤有兩種分級系統。

Be sure to check out, I'll put the link below for my mast cell tumor vlog, where I talk about the different grading systems.

請務必查看我的肥大細胞瘤視頻博客，我將在下面附上鍊接，在那裡我將講述不同的分級系統。

So it grew back a month later in January, kind of at the edge of the incision, sort of right over the ear pinna, the base of the ear pinna.

一個月後的一月，它又長了出來，長在切口的邊緣，就在耳廓上，耳廓的底部。

And then she came to see me in the beginning of January, and this was a big mast, and it measured about seven centimeters.

然後，她在 1 月初來找我，這是一根很大的桅杆，大約有 7 釐米長。

When I did a preliminary assessment of his tumor volume,

我對他的腫瘤體積進行了初步評估、

I knew that it would be too big for Stelfonta.

我知道它對斯特豐塔來說太大了。

It was greater than 10 cubic centimeters, which again, in vlog 130, I talk about as the requirement is the cutoff for being a candidate for Stelfonta.

在第 130 期視頻中，我再次提到了這一要求，即成為 Stelfonta 候選者的分界線。

But I thought maybe I could use steroids to shrink the mast cell tumor and get it into that size requirement.

但我想，也許我可以用類固醇來縮小肥大細胞瘤，讓它達到那個尺寸要求。

So I started him on steroids and I had him come back,

於是我開始給他服用類固醇，然後讓他回來、

I think about eight or 10 days later.

我想大概是八到十天之後。

It had a really good response to the prednisone.

它對強的松的反應非常好。

And when he came back in and we measured it, it was about two and a half centimeter diameter, and the tumor volume on the day of treatment when he came in was 4.2 cubic centimeters, definitely below the 10 cubic centimeters.

當他再次來就診時，我們測量了一下，腫瘤直徑約為 2.5 釐米，治療當天的腫瘤體積為 4.2 立方厘米，絕對低於 10 立方厘米的標準。

So let me show you his treatment, because his treatment, Teddy's such a good boy, was beautiful.

讓我給你看看他的治療，因為他的治療，泰迪是個好孩子，非常漂亮。

You know, if you're a veterinary professional, you know, we talk about you wanna use a lure lock syringe, you're gonna use a 23 gauge needle, and you wanna put, when you inject, it's a single injection and you're gonna fan it throughout the tumor, because you wanna distribute the Stelfonta throughout the entire tumor in one injection.

如果你是獸醫專業人士，你知道，我們說過，你要使用誘餌鎖定注射器，你要使用 23 號針頭，注射時，你要一次注射，在整個腫瘤內扇形注射，因為你要在一次注射中將 Stelfonta 分佈到整個腫瘤內。

Teddy, just wonderful patient.

泰迪，真是個好病人。

So let me show you his injection.

讓我給你看看他的注射劑。

I'll be right back.

我馬上回來

Hi, Teddy.

嗨，泰迪。

Are you ready for Stelfonta?

您準備好了嗎？

Hi there, we're here with Teddy.

你好，我們是泰迪。

He has a recurrent mast cell tumor in a very challenging location to be able to get margin.

他患有複發性肥大細胞瘤，而且腫瘤位置非常難以切除。

So we're treating him with Stelfonta.

所以我們用斯特豐塔治療他。

His tumor volume length times width times height times a half was 4.2, and so they get half that of the Stelfonta, so he's getting 2.1 ml.

他的腫瘤體積長乘以寬乘以高乘以半是 4.2，是以他們得到的是施特豐塔的一半，所以他得到的是 2.1 毫升。

We're gonna do a single injection.

我們要進行一次注射。

We're doing a 23 gauge needle with a lure lock syringe.

我們使用的是 23 號針頭和誘餌鎖定注射器。

It does sting a little, so we recommend that it goes up to room temperature.

它確實有點刺痛，是以我們建議將其加熱到室溫。

All right, ready, buddy?

好了，準備好了嗎，夥計？

All right, here we go.

好了，我們開始吧。

And then we're just gonna take it and fan the dose throughout the tumor to get it.

然後我們就把它吃下去，把劑量分散到整個腫瘤裡，這樣就能得到它。

All right, here we go.

好了，我們開始吧。

Good boy.

好孩子

All right there, buddy.

好了 夥計

Good boy.

好孩子

Good boy.

好孩子

You want a treat?

你要請客嗎？

Yes, that was so good.

是的，太好吃了。

So I keep in close touch with my patients following Stelfonta.

是以，我在斯特豐塔之後一直與我的病人保持密切聯繫。

I ask them to send me pictures, especially these early cases.

我請他們把照片寄給我，尤其是這些早期病例。

I wanted to document them.

我想把它們記錄下來。

And Teddy's mom and I follow each other on Instagram.

泰迪的媽媽和我在 Instagram 上互相關注。

So she was sending me some direct messages.

所以她給我發了一些直接資訊。

And you know, he's having some swelling as we expect in the area.

你知道，他有一些腫脹，我們預計在該地區。

And I actually had her come in a couple of days earlier.

實際上，我讓她幾天前就來了。

And remember for Stelfonta, we expect inflammation and we expect oncolysis, so rupture of these cancer cells.

請記住，對於 Stelfonta 來說，我們期待的是發炎，我們期待的是腫瘤溶解，所以這些癌細胞會破裂。

But what with him is we were noticing that there was sort of a pocket under the side of his face.

但我們注意到，他的臉側下方有一個口袋。

And when he came in, when I pressed on that, we noticed that there was some pus purulent discharge.

他進來的時候，我按了一下，發現有一些膿性分泌物。

And I told you that most dogs, we take a hands-off approach.

我跟你說過，大多數狗，我們都是放手不管的。

We don't use antibiotics.

我們不使用抗生素。

We don't flush and things like that.

我們不沖水，諸如此類。

But I did make an exception to the rule.

但我確實破例了。

So, you know, we have to use our assessment.

所以，你知道，我們必須使用我們的評估。

We have to use our judgment as clinicians.

作為臨床醫生，我們必須做出判斷。

And I did flush his out because I was worried that as his tumor was dying and necrosing that it was getting trapped under there.

我確實把他的腫瘤沖洗出來了，因為我擔心隨著他腫瘤的死亡和壞死，腫瘤會被困在下面。

And I did do a short course of antibiotics for Teddy.

我還為泰迪做了短期抗生素治療。

So an exception to the rule there.

是以，這是一個例外。

So again, we usually check at day seven and then at day 28.

是以，我們通常會在第 7 天和第 28 天再次進行檢查。

He, mom was very happy.

他，媽媽非常高興。

Things dried up.

一切都乾涸了。

He was really, really improving.

他真的真的在進步。

Hi everyone.

大家好

So we're here with Teddy.

我們和泰迪在一起

He's about four weeks after his Delfonda treatment.

他接受 Delfonda 治療大約四周後。

Oh, he's so perfect.

哦，他太完美了

Looks great.

看起來不錯。

Look how beautifully he healed up.

你看，他的傷口癒合得多好。

He has this little area right here that I just did an Asper trying to determine if he had a complete response.

他這裡有一小塊區域，我剛給他做了阿斯佩爾檢查，想確定他是否有完全反應。

When he came in on day 28, there was a 0.8 centimeter mass.

他在第 28 天前來就診時，發現了一個 0.8 釐米的腫塊。

When you see a mass, you know, little different than Tucker, who's in the one of the other previous vlogs that I have as a case study.

當你看到一個大塊頭時，你就會知道，他和塔克沒什麼不同，塔克在我之前的其他視頻錄像中也有一個案例。

You don't know if it's just some scar tissue or if it's residual mast cell tumor.

你不知道這只是一些疤痕組織，還是殘留的肥大細胞瘤。

So what do you think I'm going to do to figure out whether there's tumor there or if it's just healing scar?

那麼，你認為我該怎麼做才能弄清那裡是否有腫瘤，還是隻是疤痕癒合？

Of course, we're going to Asperate, collect some cells and look at them under the microscope.

當然，我們要進行透析，收集一些細胞，在顯微鏡下觀察它們。

And so on day 28, we did determine that there was residual tumor there.

是以，在第 28 天，我們確實確定那裡有殘餘腫瘤。

I looked at it myself, saw mast cells, also sent it out to the lab and the cytologist confirmed it as well.

我自己看了一下，看到了肥大細胞，還把它送到了實驗室，細胞學專家也證實了這一點。

With Delfonda, we have a 75% complete response rate with one treatment.

使用 Delfonda 一次治療後，我們的完全應答率達到 75%。

For dogs that get one or two treatments, the complete response rate goes up to 87%.

對於接受一到兩次治療的狗來說，完全應答率高達 87%。

And we want to wait a full four weeks before we do a repeat treatment.

我們希望等滿四周後再進行重複治療。

So I set Teddy up to come back in next week for a repeat treatment.

於是我安排泰迪下週再來複診。

They need to start their steroids at least two days before treatment.

他們需要在治療前至少兩天開始服用類固醇。

And when he came back in after being on steroids for two days,

當他服用類固醇兩天後回來時

I felt around, felt around, felt around and I could not find his mast cell tumor.

我摸了又摸，摸了又摸，就是找不到他的肥大細胞瘤。

And if you can't find a mast cell tumor and you can't measure tumor volume, you can't inject Delfonda.

如果找不到肥大細胞瘤，無法測量腫瘤體積，就無法注射德方達。

So we're going to taper Teddy off of his steroids.

所以我們要讓泰迪逐漸停用類固醇 So we're going to taper Teddy off of his steroids.

He did not get a repeat Delfonda injection.

他沒有重複注射德豐達。

I'm apprehensive that there, you know, his mast cell tumor is going to grow back, that there's still some cells there, but he didn't get a repeat treatment and mom was pretty happy about that.

我擔心他的肥大細胞瘤會再長出來，因為那裡還有一些細胞，但他沒有接受重複治療，媽媽對此非常高興。

His also was a subgrade high, was that high grade, grade two high mast cell tumor.

他的也是一種亞高分級，是高分級，二級高分級肥大細胞瘤。

So I do think he has more risk for metastasis.

是以，我認為他有更大的轉移風險。

So for him, unlike some of the cytologic low grade mast cell tumors, for Teddy, we are considering chemotherapy as well.

是以，對他來說，與一些細胞學低級別肥大細胞瘤不同，對泰迪來說，我們也在考慮化療。

Again, I have more information about the overall how we manage mast cell tumors in my mast cell tumor vlog.

同樣，在我的肥大細胞瘤視頻博客中，我還會介紹更多有關我們如何管理肥大細胞瘤的整體資訊。

There's a two part vlog and we'll put links below so you can follow up on those.

我們將在下面放上兩部分視頻的鏈接，以便您跟進。

But again, I hope this was helpful to kind of see a patient go through the process, see their treatment, see their injection.

不過，我還是希望這能幫助大家瞭解病人的治療過程，瞭解他們的治療方法，瞭解他們的注射情況。

And like I said, most dogs, very hands-off approach.

就像我說的那樣，大多數狗都很聽話。

We are not going to use e-collars, not going to do antibiotics.

我們不會使用電子項圈，也不會使用抗生素。

Their wounds are going to be left untouched and just really minimal management.

他們的傷口將不做任何處理，只做最簡單的處理。

Teddy's an exception to a rule.

泰迪是個例外。

So again, if you have questions or concerns about how your dog is doing after Stelfonta, reach out to your veterinarian.

是以，如果您對您的愛犬在服用 Stelfonta 後的情況有任何疑問或擔心，請再次聯繫您的獸醫。

Thanks so much for watching.

感謝您的收看。

I'm really excited.

我真的很激動。

I will continue to share these cases with you as we treat them.

我將繼續在治療過程中與大家分享這些病例。

I've treated a handful, a good number of cases so far.

到目前為止，我已經治療了不少病例。

And as I capture the videos, I will share them with you.

當我拍攝到這些視頻時，我將與你們分享。

Thanks so much for watching.

感謝您的收看。

I'll see you at the next video.

我們下次視頻再見。

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