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Aglepristone  

New treatment for frustrating feline
mammary disorder

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by Arnold Plotnick MS, DVM, ACVIM, ABVP

 

Disorders of the mammary glands can be worrisome in cats.  Mammary gland cancer is the third most common cancer in the cat.  Unlike dogs, in which only half of all mammary tumors are malignant, mammary cancer in cats has a much worse prognosis, with 80 to 90% of mammary tumors being malignant.  While most cases of mammary cancer occur in older cats (most commonly 10 to 12 years of age), mammary cancer has been reported in cats as young as 9 months of age. 

 

There is another condition of the mammary glands called mammary hyperplasia, which is characterized by rapid growth of mammary tissues.  Although the condition is considered to be benign, the condition can mimic mammary cancer, which has a much worse prognosis. Mammary hyperplasia, however, tends to occur in young, unspayed female cats instead of older cats. It is important to differentiate mammary hyperplasia from mammary cancer, as the ages of affected cats with these conditions can overlap.  Mammary hyperplasia occurs as a result of the influence of progresterone on the mammary glands.  When a young cat becomes pregnant (ovulation followed by fertilization) or pseudo-pregnant (ovulation, but no fertilization), progesterone levels begin to rise.  Mammary tissues in cats have many progesterone receptors, and the binding of progesterone to these receptors can stimulate mammary gland development.   Although the condition is generally regarded as benign, in some cats, this stimulation can lead to severe swelling, pain, ulceration, and infection of the glands.  Treatment involves removing the source of the progesterone, although frequently, removal of the progesterone doesn’t result in regression of the swelling.  In the case of unspayed females, removal of the progesterone source is best accomplished by spaying.  The extent of the mammary gland swelling, however, can make a relatively simple surgery like spaying much more difficult.  The swollen mammary glands tend to be very painful, and in my experience, the incision site often becomes bruised and very tender afterward, causing a lot of discomfort for the cat.  My last case of mammary hyperplasia was a disaster.  The client had unfortunately waited several days before bringing in the cat for examination, and by the time I had a chance to examine the cat, several of the glands had ulcerated and had become seriously infected.  When this happens, it is sometimes necessary to surgically remove the swollen and infected gland(s).  Unfortunately, this cat, with a high fever and severe dehydration, was in no condition to be anesthetized for any type of surgery.  Emergency care with intravenous fluids and antibiotics was unsuccessful, and the cat developed septic shock followed by cardiac arrest.  She could not be resuscitated.  She was only 7 months old.  

 

The presence of progesterone receptors on feline mammary tissue offers the potential for targeted endocrine therapy with drugs that block progesterone receptors.  Recently, the results of a study evaluating the use of aglépristone, a progesterone blocker, in 22 young cats (aged 3.5 to 19 months) with mammary hyperplasia were reported in the November/December 2002 issue of the Journal of Veterinary Internal Medicine.  Weekly injections of aglépristone successfully treated nearly all cats in the study.  A marked and lasting response was seen in all cats after 1 or 2 doses.  Complete remission was observed in all but one cat.  Side effects were minimal and consisted of short-term skin irritation at the site of injection.  Two of the cats were pregnant when they were treated, and as expected, those cats aborted their kittens 2 to 5 days after the first injection. (Progesterone is necessary to maintain pregnancy.)  Those two cats eventually developed endometritis, a uterine infection, and had to be spayed as part of their treatment. They did fine afterward.

 

Questions as to why only a minority of cats develop mammary hyperplasia after exposure to high levels of progesterone, and why only young cats seem to develop the condition have yet to be answered, and the pathogenesis of this condition requires further study. 

Unfortunately, aglepristone is commercially unavailable in the United States.  Hopefully, this will change in the future.

Although mammary hyperplasia is an uncommon and relatively benign condition, many cats develop significant clinical signs of illness, including lethargy, loss of appetite, and painful, uncomfortable mammary glands.  Despite the benign description, most of the cases that I’ve encountered have been fraught with complications.  The use of aglépristone as a simple weekly injection now makes treatment of this condition much easier.

         

Updated 2/9/06