Dr. Venable: Welcome to the Veterinary Cancer Pioneers podcast, the show where we delve into groundbreaking work of veterinary professionals who are dedicated to advancing the field of veterinary oncology. I'm your host, Dr. Rachel Venable, and I'm thrilled to embark on this journey with you.

I'm your host, Dr. Rachel Venable, and today I am so excited to introduce our guest, Dr. Andy Flory. If you've been listening to conferences or webinars, you've probably heard her name in the last year or so. She's been great about talking about the new company that she co-founded, as well as the chief medical officer at PetDx. They also have OncoK9, which we'll talk about today. But I also want to talk more about where Dr. Andy Flory started. So she's been in oncology for almost two decades. She went to vet school at Ohio State and then did more training in Florida and Cornell, and she is a boarded oncologist. And she was in charge of residency programs. And I remember we talked once at a conference, and you told me you never thought you would leave clinical practice. So I definitely wanna hear a little bit about that transition that you've gone through. The other thing I think that's really interesting, you have a certificate that says you're not going to leave clinical practice. genomics from John Hopkins University. So certainly still learning, which is also really interesting. And also you have persistent oncology and genetic testing and sequencing technology from Harvard. So very impressive schools. And you certainly are quite the lecturer. As I said, I feel like a lot of people probably heard your name now over the last couple of years. I'm so excited to get to learn more about you and just hear some more of the backstory. So thank you so much, Dr. Flory, for being on this podcast. 

Dr. Flory: Thank you, Rachel. It's so great to be here. Thanks for having me.

Dr. Venable:  Oh, definitely. Our pleasure. So, you know, as I mentioned, you know, you've been in clinical practice for a long time and you trained residents and worked with interns. And so how has that process been, or I guess what was that final thing that made you switch now that you're more into research and industry?

Dr. Flory: Yeah, so I mean, I think it kind of started with a love of animals, of course, that was instilled in me in a very early age by an animal-loving mom. And then, you know, just kind of from the very get-go, there were animals in my life that kind of, of helped me make decisions at different time points. And I think a lot of us in the veterinary space have those stories, right? Like, there's a specific event or there's a specific animal that kind of made our path go one way or the other. When I was about six years old, I got a kitten. And when I held her for the first time, and I felt her little heart beating, it was like this aha moment, like, oh my gosh, cats have hearts, like tell me more like I want to know all about this science and it kind of created this fascination for me and so looking back it kind of felt like this meant to be sort of happenstance of already loving animals, but like being exposed to kind of the medicine and the science and having that desire to know more. And then when I was a third-year vet student going into clinics our family dog got really sick and he was hypercalcemic and very very ill, and he was ultimately sent to Ohio State whereas a vet student and you know the workup led to a diagnosis of lymphoma and he was very young dog so this was completely heartbreaking right to be like in love with this young puppy and then now all of a sudden he has lymphoma. But you know when my family and I met with young the oncologist, which was Dr. Jeremon Coto, and the oncology resident, just Carrie Kasarek, just the, you know, the, the care that they provided, and the hope that they gave us, it was like, Oh, that's what I want to do. And then when I kind of rotated through oncology, and I got to learn again about all the science, it was this again, this aha moment of, Oh, my gosh, tell me more like I want to know everything that I can do and looking back again it felt like London who was my dog was kind of put in my life for that reason to kind of show me like this is this is the path and this is your path. And so you know fast forward through many years of clinical practice and you're right. I didn't think that I would, you know, I thought that clinical practice was kind of how my life was going to go but I met another little dog that really changed the path of my career, which was my little patient named Poppy. And her, you know, as it turned out, her owner is an MD, and he has a background in genomics and in liquid biopsy. So, you know, as we went through her treatment, he let me know that he had helped to develop the technology that developed liquid biopsy for people. And, you know, this was a time in my life where I was already kind of really investigating whether there was a different way. Because I was seeing so many patients in clinical practice I'm sure you see the same where it's like, you just find them at a point where it's so late in the clinical course that there's not a lot of options that we can provide. And I was just like, I wish there was something else else. I kept seeing these cases where it was like, I wish that I had found this case sooner that we could have intervened and kind of offered something earlier. And so this happened right at this time, that this kind of perfect time point in my career. And he said to me, do you think that veterinarians could use a blood test for cancer? And it was like, this is the answer. And so we really bonded over this kind of shared desire. He, you know, we weren't able to kind of provide that for Poppy. We only, we lost her in like seven weeks, but he said, I really would love to be able to help other families that are going through this by detecting cancer earlier. And we just kind of bonded over that shared desire to find cancer earlier.

Dr. Venable: Well, I love that story. 'Cause it is such a good story. story, right? Starting when you were a little kid, picking up a kitten, how many of us, you know, growing up doing that and then your experience with cancer in animals even when you were a vet student and going through clinics and then how another dog, like he said, changed your life, right? And I'm thinking about the cancer blood test 'cause I feel like throughout my career, I couldn't even tell you how many times owners have said, well, the blood work was normal. All of there was no, cancer in the blood and we're like well that doesn't really tell us much of anything you know and so but now it it actually can there really is a cancer blood test so I really kind of enjoy that paradigm shift at least, you know, from talking with owners like okay now now they're not crazy there really is a test that we could do. 

And now so how did you go about because it I mean there had to be so many many steps to go from being in clinics. I mean, as it, you know, in your bio, you had to go to, you know, John Hopkins, Harvard. I mean, I can't imagine the leaps that you had to do to go from clinics to co-founding a company, learning more about genomics. You know, I mean, we learn about it a bit, but not enough, you know, for like what you had to know. So what kind of big steps did you have to go through? 

Dr. Flory: I mean, so, you know, know, when we initially co-founded the company, I really kind of got a very rapid lesson in learning what being part of the startup world is like, which is like, hang on to your hat. This is gonna go super fast. It's pretty much like a roller coaster. And, you know, it went from idea to company in like days to weeks. And then it went from idea to company. From company to clinical trials in just a few months. And so it meant that like the pace is fast and furious. And I was still working full-time as a clinical oncologist in two hospitals. I was overseeing internship programs at both of them and I had two preschoolers. So it was a really, really busy time in my life. But I was so passionate about this and we encountered a really good problem which I think hits on what you just said, which is that as we were starting to recruit our clinical study sites, it really started with reaching out to friends and then additional contacts too. But the good problem was that everyone said yes, because I think they had all heard that question, "Isn't there a blood test for cancer?" for their entire careers. And so they're like, we want to be part of helping to answer that question. 

And I think also, dog owners really love the idea of paying it forward for future dogs with cancer. So dog owners really wanted to help with this study too. And so it meant that we ended up doing the study at 41 sites on four continents. We had over 1700 dogs ultimately enrolled in the program, which is just it's those are mind boggling numbers coming from the world of veterinary oncology where we're used to studies that are like, you know, 100 would be a big study. Yeah, we do like, you know, here's a case series of five or like, here's something that we base practice on and it's in 15 dogs. So these are I mean, it was just kind of so overwhelming, but so exciting that that first step of it was just like, oh my gosh, I'm so like pinching myself that I get to do this and work with these amazing people and get to work on something as important as that.

Dr. Venable: Yeah, I mean, you mentioned clinical trials because you're right, yours is quite impressive. That's one thing I've always loved. Not only do you guys publish, but you publish with real numbers, right? I mean, as you mentioned, in veterinary, we have a tendency to make a lot of decisions on a very small number. I mean, for pulmonary carcinoma, I think forever we were using Vinorelbine from four dogs, you know, that was the one study for years. Now there's slightly more information, but still not great. I mean, you guys, you know, the Candid study was 1,100 dogs, right? Somewhere, so yeah, that's just huge and amazing. How did you guys manage that? I mean, 'cause I feel like there's a reason, a lot of our vet studies are so small and some of it comes down to just the structure, you know, personnel, finances, that kind of thing. So how are you guys able to coordinate something to that magnitude? 

Dr. Flory: I mean, I think that it just started with the priority of knowing that this test that we were developing is a multi-cancer test, right? And so we're not talking about one disease at a time. We're talking about all cancer. And so when you think about that, and you put that in a perspective, it means that you really have to have a lot of tests done to be able to capture a pretty good number of all of the different types of cancer. And so we knew that we had to make it big. And we knew that we had to have a very large control population of the cancer-free dogs, and so we knew that we had to have decent numbers of both and really helped to develop the algorithm and develop the test using a very large set of dogs as well, so meaning we knew that we wanted to have an independent training and testing set, which is really important in diagnostic test evaluation that you make sure that your test is going to perform in the real world the same way that it does in your clinical validation study where the status of the dog is known at the time of testing. You want to make sure that it's going to perform the same way in the real world for veterinarians that are using it in dogs where they're trying to figure out if they have cancer. So we knew that those things were really important, so we knew that sample size was really, really important to us, and I have the benefit of working with people that are coming from the human medicine side, where large studies are the norm. So to them, it was like, well, of course, we're going to do a really big study. And so for me, convincing veterinarians with large sets of data was important for them. It was kind of the norm to show the power of this technology. And it meant that it was just a really exciting kind of project to be able to work on together and we just prioritized that we knew that we needed to have a really big sample size. 

Dr. Venable: We were talking about clinical trials and all of the dogs that you guys have been able to enroll. Can you kind of discuss a little bit more detail, what did that trial look like? What exactly, how did you guys do that?

Dr. Flory: Yeah, so we started enrolling sites in late 2019. And then patients started enrolling that same kind of timeframe. And we started the study at multiple clinical practice settings. So these were patients that were enrolled at general practices, as well as academic sites and specialty private practice clinics as well. So there were 41 sites, they were on four continents actually, and dogs were enrolled into one of three protocols. They either were presumably cancer-free, meaning that these were dogs that were being enrolled at their general practitioner. They had no history or current suspicion of cancer based on thorough history or physical exam. Or they were enrolled into one of the two cancer studies where they were either having surgery as part of their treatment or medical therapy as part of their treatment. And what's important to know about all three of these sets of dogs is that these dogs was very much a real world population of dogs because dogs of any age over the age of one were allowed to enroll and dogs with any type of cancer were allowed to enroll. And dogs with any comorbidities were allowed to enroll. So these were real world populations of dogs that had acute and chronic medical conditions. They were allowed to have common skin and subcutaneous benign tumors like lipomas, sebaceous adenoma, skin tags, things like that. like that. So we wanted to make sure that this was a real-world kind of population that any general practitioner or specialist would typically see, which is we tend to see dogs that have lots of diseases by the time they're older. So when they're at risk for cancer, they generally have a risk for other kind of concomitant conditions as well. And so in these the cancer patients, all of the patients were staged, meaning they had to work up to find out where cancer was in their body. And what we found at the end of that when we looked at the performance of the test is that we found that in the all-commerce group, which was over 40 types of cancer, the detection rate or sensitivity of the lipid biopsy test OncoK9 was 55%, but in the most common cancers that we see, in dogs, it was 62%. So 62% in the most likely cancers that you commonly manage in practice. But for what I like to call the big three, which are lymphoma, hemangiosarcoma and osteosarcoma, the detection rate was 85%. And all of this at a very, very low false positive rate of only 1.5%, meaning a specificity of 98.5%. It means you know this is a really good test to look for a wide variety of cancers and it's got a really low false positive rate so it's also a very good test as a screening test in asymptomatic but high-risk dogs.

Dr. Venable: You know that it's really interesting you said that this was you know you tried to make it as real world as possible because again a lot of times it's older dogs that get cancer but they also have a lot of other issues so did you find that those other issues affected the test result at all? 

Dr. Flory: So no, I mean, with a test, you know, specificity as high as 98.5%, it's pretty clear that false positives are uncommon and those comorbidities don't affect this. I mean, really the only thing that's gonna cause a change in your DNA and those genomic alterations is really cancer. So conditions like inflammation, infection, autoimmune disease, things like that, they don't cause a false positive on this test. 

Dr. Venable: That's really interesting, especially I can think of multiple times as an intern working on emergency. You know, I don't do emergencies so much anymore, but there would be so many cases where pets would be really sick and we were trying to decide cancer or infection or, you know, what autoimmune, you know, all those different things. So that is really interesting that you would know if you do this test that you got a positive, you know, strong likelihood of cancer. I know you guys also talk about doing more testing to confirm, but that is that is nice. I guess as a vet I feel like it's kind of that extra reassurance that a false positive, well possible nothing's 100% right but it's pretty low on that list. 

Dr. Flory: Exactly. Yeah, that's really important to have in a test like this. 

Dr. Venable: You know, one of the things that I, you know, we've talked about it at conferences and things, and that I do admire with PetDx is you guys keep publishing. I think we're starting to get more papers in the veterinary world from some of the startups, but I know a lot of them still can struggle or even resident projects just or, you know, just in our profession in general, but you guys definitely do a good job. What do you recommend for people that maybe they're wanting to do something else with their career or even academia and things like how do you guys do kind of just all sit around and brainstorm different ideas? How would you recommend like keep publishing on the data you know looking and showing people what you have.

Dr. Flory: I mean I think that it's a really interesting question I think that the only way that veterinary medicine is going to continue to get better is making sure that we are that we have great science right and that we we back it up with great data and so it really starts starts with making sure that the data is collected responsibly and that you're collecting the kind of data that you need and that, you know, you report on what is important, I think, to veterinarians, but also for us, it was really important to kind of show that this isn't just a test where we were gonna publish this one large clinical validation. We also really wanted to show them how it's working in the real world. So for example, like earlier this year, we published in JAVMA an analysis of 1,500 consecutive samples that were sent to our lab early last year, where we then obtained outcome to find out not only how veterinarians are using the test and kind of what use cases they use it in, but also what happens after testing. Like what kind of results do they get and what happens when they work those patients up? And it just was so gratifying to see that the performance of the test really mirrored what we set forth in the clinical validation study. And that veterinarians when they do have a positive, they're able to get to a cancer diagnosis easily using tests available in their own clinic. In a short period of time, the median was 11 days. So these aren't, you know, cancer hunts that take forever or it's like some that's hard to find. It's generally, you know, very straightforward to then go ahead and find cancer and confirm cancer in those patients. 

Dr. Venable: So how would you recommend that that's used OncoK9 or even when to use it?

Dr. Flory: So yeah, you know, I think just kind of starting with a summary of what this really is OncoK9 nine is a liquid biopsy test. So it's blood based test. It's in a category of tests called an MCED test or multi-cancer early detection. This is a category of tests that is used in people and it detects 30 different types of cancer with a simple blood draw. It uses next-generation sequencing to evaluate a biomarker called cell-free DNA. So cell-free DNA are essentially fragments or short bits of DNA that are free-floating in the bloodstream, which are released by cells, and this is normal cells in cancer cells when they die, so cells are constantly turning over, and when they die, they release their DNA into the bloodstream, and in the blood that DNA gets broken down into pieces or fragments, and those fragments that are circulating outside of any cell are called cell-free DNA, and the subset that comes from cancer cancer cells is called circulating tumor DNA or CT DNA. And so what we're able to do with next generation sequencing is evaluate those fragments and look for the genomic alterations that are, you can think of those like spelling mistakes that are the underlying cause of cancer and that are present in the blood of a patient with malignant tumor cells in the body. And so if that's detected with next generation sequencing and bioinformatics, which is the computer science that looks for the presence of those genomic alterations, then that's called a cancer signal. So the result here, it's like, it's a yes/no. It's a binary answer. It's a cancer signal detected or cancer signal not detected. And then additionally, in a subset of cases, we also can determine the specific type of cancer that's likely to be present. And that's called the cancer signal origin prediction. That means that not only do you get that yes/no answer, so you get a yes answer, but you also get a CSO prediction. And right now that's available for hematologic malignancy like lymphoma or leukemia. That specific signal is present in about half of cases, but additional cancer types will follow. So that's really exciting. And, you know, this is a field that's always evolving and always changing. And so it's exciting to kind of see what new developments are constantly happening.

Dr. Venable: It is so amazing to me to just think about, you know, your DNA in the blood that we can actually read that, like not to sound too nerdy, but it reminds me of like Star Trek, right? Like it just, it's so exciting to see sort of just where science is going, right? And as you said, like, like they're having this technology on the human side. And so it's just really neat to see where all this is heading. And it also just sounds really confusing. Like you just said it very simply, but I know there's a lot of science. And it's actually quite complicated, right? I can only imagine trying to read DNA in the blood that sounds quite complicated.

Dr. Flory: It is complicated, but I think that, you know, we can boil it down to a few uses of where the veterinarians can use it and kind of break those down into pre-diagnosis and post-diagnosis. So like pre-diagnosis is for dogs that don't yet have a cancer diagnosis where it can be used as a screening test in an asymptomatic dog, but a dog that's maybe at higher risk because of age or breed. And then it also can be used as an aid in diagnosis. So this would be a patient in which you suspect cancer or maybe because of their clinical presentation something you can see on imaging or something you see on lab work. And so those are the pre-diagnosis use cases. Then it also can be used on the post-diagnosis side. This is, I think, what oncologists get the most excited about. This is like for a patient that has cancer, where it can be used to monitor some aspect of their cancer therapy. So for example, it can be used to detect residual disease remaining in the body after excisional surgery. and it also can be used to monitor for evidence of cancer recurrence after therapy.

Dr. Venable: Now, to use it for monitoring in that kind of scenario, it's still just blood tests, right? Are there serial blood tests or how do you recommend, especially oncologists, using the OncoK9 for monitoring?

Dr. Flory: So for cancer monitoring, it actually starts kind of before the tumor is removed or before the treatment is started. Because it really, you're gonna get the most use out of it if you know that there is a signal present at baseline before treatment. Because then it means that test interpretation is a lot easier, the results will mean more if you know that this is a cancer that is detectable by this test. So it can be really helpful to have that conversation with the client kind of ahead of time before treatment to know that this is an option, that there's a cancer monitoring blood test, and that we should submit a sample prior to surgery. And I think that the cases where it certainly makes the most sense to do this are anything that's going to you think is going to have a high chance of either recurrence or metastasis internally, that's going to be more difficult for you to monitor easily. This could be an additional kind of layer on top of like helping you interpret the imaging to look for metastasis or to look for recurrence. We also, so you and I just got back from the Veterinary Cancer Society meeting and we had a panel discussion of oncologists, three oncologists that are using this across the country in different practices but in their clinical patients and one thing that they all said is that for patients that have insurance, insurance is generally covering this test for any patient that has a diagnosis or suspicion of cancer. So when you're using this either for monitoring, or if you're using this as an aid in diagnosis, it seems to be covered. So that can kind of give you a little bit of a clue of like, well, which clients do you kind of prioritize talking about this with. But also kind of those, you know, those owners that are asking. for like, what's the best we can do? What are the most kind of tests we can do or the best kind of tools that we have to manage cancer? 

Dr. Venable:  Yeah, that is really interesting. Because sometimes, as we know, especially ultrasound, it's not as sensitive as we would like, you know, there's all kinds of studies showing that, you know, it really doesn't pick up mast cell as well as we think or hemangiosarcoma, where we might think it is. And then when they do histo, it's not. And so that is really neat, especially those cases with those organs. It makes me think of a case that I actually am working on with a friend, of course, her little dog has got quite the complicated case, but it's something where it had a neck mass, which actually came back as hemangiosarcoma. So anyone that's not an oncologist, nodal hemangiosarcoma is very rare, not something we know much about. And that's it for today, thank you so much for watching. spleen in her dog is also a bit abnormal, and it's changed over time. But on cytology, they're not seeing anything. And of course, also her little dog is done horrible under anesthesia and has had all kinds of complications. So, you know, just removing the spleen isn't that simple. So that's something where I think, you know, I think this could really be a good use for her because I I know she's really scared of surgery 'cause just the last surgery her little dog had, she's just had a lot of complications afterwards. So this might be, it's making me think, it's getting the wheels turning. 

Dr. Flory: Yeah, I think those aid and diagnosis situations are, sometimes you're just like, what other tools do I have in my toolbox to help answer this question of, "Is this a case where concern is being raised?" management is okay, or is this a case where I need to convince the family that this is more urgent and we need to proceed with treatment? And sometimes that's kind of what that conversations comes down to. And it can mean that the getting to the diagnosis actually takes a long time, especially if they wanna go kind of stepwise and they are a little hesitant or they're not sure, or like in this case where the patient is maybe just not a candidate and they you know they want to get to the answer but they are not sure if they want to proceed. Those aid and diagnosis situations are some of the I think most intriguing where I really see it helping so many veterinarians and families because it's really helping to cut short that path to diagnosis like getting to the answer faster getting to the kind of being able for the veterinarian to kind of counsel more confidently and more directly about what is taking place. For aid in diagnosis, the settings where I'm seeing veterinarians are getting the most use out of this are when they, like you mentioned, when they're presenting with changes on imaging like an aggressive bone lesion or a mass in the spleen or changes in the lungs or or we're seeing something on lab work, like cytopenias, or hypercalcemia, or it's like an inconclusive cytology, like you've tried cytology, but you're just not getting kind of to the answer, or even clinical presentation, like chronic weight loss or lethargy, a unilateral four limb or hind limb lameness, that's kind of a confusing case. These are the cases where it's like another tool in the toolbox that can be another layer on top of imaging to help you interpret what's going on. 

Dr. Venable: Yeah, I think that's right, just that next tool, because you know, in the little doggie I was mentioning, you know, the spleen keeps changing on ultrasound, so we're worried, but we still just don't know. So yeah, and it is nice to have some non-invasive tools, right? I feel like so often our tools are quite invasive. And so it's nice to have that non-invasive option. 

And then just to switch gears a little bit, I do wanna know kind of going as an oncologist and most of us, the clinical oncology, we know sort of what that looks like the day to day, but now co-founder, chief medical officer, what does that look like for you? How would you describe that role and kind of how things are different, certainly compared to clinics? 

Dr. Flory: Yeah, I mean, as chief medical officer, I kind of oversee all of this. clinical and medical affairs parts of the organization. So I oversee our clinical studies team. So we are the team that writes the studies, gets studies approved, finds the study sites, works with the study sites to enroll patients, manages all of the data, reports out the results, all of that sort of thing. And then the clinical support team. So these are board-certified specialists that reach out to veterinarians and when they receive a positive result and help walk through next steps, but they're also available for case consultation as well. So that has been hugely popular with veterinarians that have a specialist available to help walk them through their case. And then kind of on the other side is like medical affairs and a science side of things. So this is like, you know, writing papers. developing education, giving webinars or planning out our webinars, doing studies with partners, developing studies, doing the data crunching, you know, writing the manuscripts, all of that sort of part of the organization too. So I get to do a lot of very, very exciting things in all of these different areas.

Dr. Venable: Right? It sounds like you're wearing lots of different hats. hats. And I'm sure managing lots of people. What would you say is the most challenging thing with all that? 

Dr. Flory: You know, I think that it's just that there's not enough of me. Like if I could clone myself, then it probably would be a good thing because I really like what I do. And so it means that it's very exciting to get to do all of the things, like go to all of the meetings and share our science. And you know, come up with new ideas. But all of those projects take a long time, right? And they take a lot of hours. And so, if, yeah, if I could clone myself, that would be really, really good. 

Dr. Venable: Nice. I love it, especially as a mom, you know, you mentioned you had preschoolers. I feel like there's just never enough time, you know, personally, that's how I feel. There's just never enough time.

Dr. Flory: Exactly. 

Dr. Venable: Now, since you've been in both clinical practice and now industry, do you have any advice for veterinarians if they're thinking about making that switch over to industry? 

Dr. Flory: Yeah, absolutely. You know, I think that I kind of fell into industry in sort of a non-traditional way, I think probably, but I think that there's some tips I can give you. I think for me, transitioning into industry was was kind of a little bit tough in the beginning because I kind of felt like in my mind, I trained my whole life to do this one thing. And then I was considering not doing that one thing my whole life. And it was a hard decision. And so for me, it was, I knew that I had to ask for help. And so that's kind of one tip I would say that if you need help, ask for it. For me, it came in the manner of a career coach to help me kind of, you know, I think as veterinarians, we're like really data-driven. So I needed to just kind of like understand what are all the data points and the pros and the cons. But my career coach really helped me to understand, like what's the best and worst thing that could happen if you do this or don't do this and pursue your passion and leave clinical practice and the understanding that you can help more animals and more families and more veterinarians by doing something like this. 

At the end of the day, you're always a veterinarian, you're always an oncologist, and there are no shortage of jobs you can go back to if it doesn't work out for some reason. So, I think that's first is ask for help. But I think also if you are considering industry, you kind of have to think about the parts of your job that you really love, the things that you're passionate about and that give you joy and try to pursue that. Like really try to see if there's anything that aligns with what parts of your job that you're really excited about because if you don't love genomics and you end up in a genomics company, that's gonna be hard. And if you don't love flea preventives and you end up in a company where you're selling flea preventives, that's gonna be hard, right? So it needs to be something that you're excited about. You mentioned before that I did certificates and I think that's another tip is, consider getting more education. For me, I did those certificates in genomics and sequencing. One, because I was excited to learn, but also to help me feel as confident as possible around the topic. And I think anyone that's considering a move to industry might consider additional learning in whatever field you're considering. And I think that one of the additional things is get really comfortable speaking because a big part of industry is educating and being a speaker. And I personally love speaking. I love everything about it. I love writing talks. I love shaping the storyline of a talk. I love figuring out how to educate. And I think taking courses or reading up on how to give presentations can be really helpful. And that's part of what I love about industry is that it's always leveling up. Like every talk that I give is a little bit better than the last one. And people always say to me like, "Oh, I bet you've given this talk 500 times, you could do this in your sleep. And that's actually not true. Anytime I give a talk, it's almost the first time I've given it because it's always different than the last time. And I love that we constantly have that chance to make it better and tweak the message and tweak the, you know, anything from like just how the message lands and how veterinarians perceive even and understand it. I really love that concept. So I think that those are kind of some tips of things that you could consider. And if there's any trainees out there listening, one of the most important things I think is that you do need clinical experience first to be as big of an asset as you can be in industry. Like having those three or five years of clinical practice means that not only are you an expert in your field and in veterinary medicine, but you're also an expert in how clinics work. And that's hugely valuable in industry. So I would say definitely if you are interested in industry, go out and get your clinical chops first and then ask around about jobs. A lot of industry jobs seem to come down to contact. So a lot of it is who you know, but reach out to anybody that you know in industry to find out what's available and what's happening. 

Dr. Venable: There are so many good points. I liked the career coach. I think a lot of times we don't really think about that in veterinary medicine, so that's great. And to keep learning, it sounds like that's really what's driven you through the whole process, you know, getting more education, learning more, because you mentioned about presentations, clearly the science and the technology. But I liked what you said about presentations, because I think sometimes people forget that there's a whole market on that and they're really are skills to learn how to be better at presenting and I'm sure writing, talking with people, all of those things. So that is really cool. Are there any presenting books or anything like that that you recommend to people? Do you have a special or a podcast or something you like on that topic?

Dr. Flory: No, but there's like tons of free resources like TED Talks and all kinds of stuff, where you can where you can learn like there are people that do this for their whole careers right is just teach people of how to make presentations better. So there's lots of again coaches out there that you can get that can really help you understand, you know, how to really connect with the audience. And there I mean, there's so many little tips and tricks about helping making sure that you're prepared and making sure that that everything from your message to the way you practice to your eye contact in a talk. I mean there's so many little factors that go into the audience getting your message and remembering what they're going to take away and those things are really important, so in the industry being a good speaker is a huge part of that.

Dr. Venable: Right yeah and I love all those tips. 'cause I do think it, you know, I like to speak as well and I agree with you. I think there are just lots of little things you can do that make a big impact. You know, we all remember sometimes maybe the teacher or if we've gone to conferences where they just looked down and never looked up and just read the whole slide, you know, you just, you don't wanna be that person if you can at all, you know, all avoid that. And, you know, before we get things really wrapped up, I am curious, what are some new technologies coming out? I always like to ask everybody this, you know, new technologies, obviously, I know we talked about OncoK9, but is there anything else in the veterinary field or maybe the human field that you're kind of excited about that has been, you know, gradually coming together? 

Dr. Flory: Um, I mean, I think on the the liquid biopsy side and what I do, I think that the most exciting part of this is just the big data part of it. You know, like we mentioned before, like we're used to these very small studies and we just published a study in over 4,800 dogs. That is enormous for what we do. And, you know, something like that, when you deal with a data set that's really large, it means that you can find, for example, things that occur very infrequently. That particular paper that I'm mentioning was looking at potential evidence of something called clonal hematopoiesis of indeterminate potential or CHIP. This is a change that happens in people. It's a somatic, so an acquired genomic alteration that occurs in hematopoietic cell lines, and it doesn't indicate the presence of cancer, but it's associated with an increased risk of developing. cancer, and it happens in older individuals. And this paper that we publish is the first potential population level evidence of CHIP-like findings in dogs. That to me is so exciting. Getting to find things that happen infrequently, but because we're able to look at such large population level data sets, is that simple. incredibly exciting. So that's kind of on the liquid biopsy side. I mean on the veterinary side, I think that probably a lot of oncologists would agree that the fourth pillar of cancer therapy is immunotherapy and I just think that huge strides are being made in immunotherapy and they will continue to be. So that's completely separate from the lipid biopsy stuff but I think that that's really going to be a great novel tool for therapy that we oncologists have in our toolbox. 

Dr. Venable: Right, I think there's a lot of exciting stuff coming out both in animals and people. I feel like we usually a lot of times hear more people but it is exciting to hear all the new stuff coming out with animals. And yeah, it'll be exciting to keep watching. Certainly love seeing the papers you guys produce and your posters and things. So again, thank you guys for really, you know, delving into your research and looking for that stuff. 'Cause I do feel like sometimes people are sitting on this gold mine and they don't even realize it. So definitely excited that you guys teased through all that. And then Dr. Flory, before we wrap up, is there anyone that you would recommend to be on this podcast? 

Dr. Flory: Yeah, I mean, I think that one of the things that I've been really lucky to have in my career and in my journey is great mentorship. Sometimes a nudge from a great mentor can tell you right at the right time that you have what it takes and that you should believe in yourself. And for me, I had a great mentor.

I had great mentors in vet school and internship and residency, but one of my mentors in my internship was Dr. Amy LeBlanc. She's the director of comparative oncology program at the NCI now. And I think in veterinary oncology a lot of us look to what they do in human medicine to understand how best to treat our patients and we also understand the benefit of being able to learn things from animals that can benefit people and vice versa. And I think comparative oncology is so important for research that benefits individuals on both sides for both animals and for people and someone that's really paving the way and leading the charge there is Amy LeBlanc, so I think she would be a great guest. 

Dr. Venable: Yeah, that's a great idea. Thank you so much. We'll certainly reach out to her. And Dr. Flory, again, thank you so much for being on this podcast. And how would you recommend people get a hold of? I'll let you say that, you know, PetDx website and things. What's the best way if they have questions about your products or even want to know more about your research and things? What's the best way to get that information? 

Dr. Flory: I would say that just check out our website. It's petdx.com. We have lots of resources there in terms of our peer-reviewed publications and posters. So lots of our science for all of you data-hungry veterinarians out there. I know us the veterinarians are show me the data kind of people. So please just check that out to find out all of the data. And if you're interested in being able to perform OncoK9 in your clinic, clinic, you can reach out to us at sales@petdx.com or you can discuss with your IDEXX or your Antech rep and they will have more information because it's available through them as well.

Dr. Venable: Awesome, well, thank you. And that's a pretty simple website. So, I mean, as far as the address, right? It's not complicated. So that's perfect. Well, again, thank you, Dr. Flory, for being on this podcast today. I know I learned a lot. And so I know the other listeners will too. So again, thank you so much. 

Dr. Flory: Thanks for having me.

Dr. Venable: Well, that's it for this episode of the Veterinary Cancer Pioneers Podcast. If you enjoyed this episode and gained valuable insight, we would be so grateful if you could mention our podcast to your friends and colleagues. And it would be so wonderful if you could leave a five-star rating, positive review, or any kind of feedback on Apple Podcasts or wherever you listen. The Veterinary Cancer Pioneers Podcast is presented to you by ImpriMed.