Full Transcript

Dr. Venable: Welcome to the Veterinary Cancer Pioneers podcast, the show where we delve into the 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. All right. Hello, everyone, and thank you for joining us today. I'm honored to be here as we shine the light on remarkable individuals who are pushing the boundaries of veterinary medicine to combat one of the most formidable foes pets face, cancer.

In this podcast, we'll probe the minds of veterinary cancer pioneers, those who have dedicated their careers to unraveling the mysteries of this complex disease. We'll explore breakthrough research and discuss the latest advancements and diagnostic techniques that are paving the way for personalized treatment plans tailored to each individual animal.

Today, I have the pleasure of introducing our distinguished guest, Dr. Kevin Choy. Dr. Choy is a board-certified veterinary medical oncologist at Blue Pearl Veterinary Specialist in Kirkland, Washington. He completed his oncology residency at Washington State, and his professional interests include lymphoma, transitional cell carcinoma, and local treatment with electrochemotherapy, and translational cancer research. He has co-authored studies and published chapters in books. Without further ado, please join me in extending a warm welcome to Dr. Kevin Choy. Thank you so much for being here today.  We're truly honored to have you as our very first guest on this inaugural episode of the Veterinary Cancer Pioneers podcast.

Dr. Choy: Thank you for that great introduction, Rachel.  

Dr. Venable: Oh, you're welcome, Dr. Choy. So tell me a little bit more about yourself. Where are you from, and what got you into veterinary medicine?

Dr. Choy:  So that's a great question. I'm an only child, so I actually grew up with a lot of animals all the time. So they were kind of like my brothers and sisters. And the first time I was kind of exposed to veterinary medicine was actually in high school when a lot of our pets, you know,  needed vaccinations and general care as well. And I decided, you know, that's something I really wanted to get into in terms of being in medicine. And in Canada, they actually have a course called  Career and Personal Planning, where they match you with different medical fields so you can kind of see if that fits for you. So I volunteered, you know, at a human hospital, and I, you know, volunteered at a dental practice, and didn't really appeal to me. And when I went back and shadowed a veterinarian, it really resonated with me in terms of being able to see a lot of variety of different cases, a lot of different species as well.  And that's really what prompted me to go towards veterinary medicine.

 Dr. Venable: That's really fun.  You know, I had a little dog growing up that I would actually call my brother.  So I get, even though I did have an older human sister,  I did actually have a little dog brother. So I get what you're saying and can only imagine as an only child, right?  That you were probably pretty close to your pets growing up.  So you're from Canada.  What brought you to the States?

 Dr. Choy: Yeah. So I'm from Vancouver, British Columbia in Canada, and I did my undergraduate degree in animal sciences towards getting a veterinary degree. And my road to being an oncologist was actually one that circled the whole Pacific Ocean.  So I actually, once I did my degree, just like any other Canadian or most US, you know, veterinary aspirating students as well, it was very difficult to get into vet school. So after a few applications, I decided to expand my horizons and look overseas, and I was very fortunate to be accepted into the vet program at the University of Melbourne, Australia.  And after spending seven years there, four years in vet school, and three years in general practice, I decided that I wanted to do a lot more in terms of specialization. And that really came about due to two experiences. When I was in general practice, I really liked my interactions with my clients and caring for them.  But I felt like I was the jack of all trades and the master of none of them. And I started referring a lot of my patients when they were diagnosed with cancer to a local specialist clinic, the Melbourne Veterinary Referral Center. And I started actually calling over the phone to the oncologist. And she's a very good friend of mine, Dr. Maureen Cooper, who was a board-certified oncologist.  And she kept saying, you don't sound Australian. And I said you don't sound Australian either.  We both found out we were both from Canada, and we actually lived a few hours from each other. It was a very small world, and we both ended up in Australia. So I actually ended up learning a lot about oncology as a sub-specialty, actually, from her, and decided that it's something I wanted to pursue.  And to connect with that Australian sort of connection, I actually had a friend whose relatives were actually on faculty at different teaching hospitals, and a professor, Simon Turner, Colorado State University, was a large animal surgeon, but he actually helped me in terms of the application process, how to go through the match in terms of internships and residency.  And then, I ended up getting an internship at Oregon State and doing a residency at Washington State.  And I've been here at Blue Pearl Kirkland for the last 10 years.

Dr. Venable: That's an amazing story. How exciting that you're able to see the world as well as see lots of aspects of veterinary medicine. Yes, the whole process it's quite an event, right? Just trying to get into vet school. Then the match, as you mentioned, has somebody to help guide you.  I think that can be a real help because the whole internship residency thing it's a challenge. I think a lot of our younger vets are trying to decide where to go, right?  Do they specialize? Do they do internships?  So yes, it's quite the feat. Do you work with any interns there at the specialty hospital you're at now? 

 Dr. Choy:  Yes.  And that's a really big part of why I sort of came to the clinical practice as well at Blue Pearl Kirkland, really for the clinical aspects. But also, a big part of my draw to oncology was a lot of the newer cutting-edge research.  It seems like in both human and veterinary medicine, there are always new drugs being developed, new technologies, and also new research as well. So I really am very thankful for that.  You know, for me, you know, getting into a residency, having training as well.  Really a lot due to the part that, you know, I had a lot of mentors, very good mentors that supported me throughout the whole process.  And a big part of that was me now trying to be a mentor to the future generations of veterinarians as well. So our hospital actually has a pretty robust rotating internship program.  We have a residency program.  We used to have one in neurology. We still have one in surgery as well.  And I'm very fortunate to have the opportunity to have a specialty internship at our hospital.  And we're now in our fifth year of training specialty oncology interns.

Dr. Venable: Oh, that's amazing. It's I think it's so important to give back to your profession, right? That's how we can grow it and keep it going and make it strong. So that's amazing. I'm glad that you're doing that. And you also mentioned, you know, new technologies and keeping up with the different drugs and things.  So what is a new technology right now that you find particularly promising for oncology?  

 Dr. Choy: Yeah, I'm glad you asked me. I think there are really three main areas I feel like in both human and veterinary medicine where it's actually very exciting.  One, of course, is in the field of diagnostics. So not only are we getting better at diagnosing cancers, but also subtyping them, also looking at more of not just a traditional histologic. How does it look under the microscope, but also from a genetic or from pathway standpoint? So why did these cells become cancers in the first place?  And that could potentially guide things like prognosis and treatment.  A lot of that initially was really slow growing in human medicine. A lot of it was very done by, you know, or Ph.D., postdoc Ph.D., everything was done very, very step by step. You know, for example, look at the whole, you know, human genome project. Everything was sequenced manually and had to be put in manually. But now we can leverage the use of, you know, supercomputing, artificial intelligence. You know, there are some risks, as you know, in the news, but we're learning more and more about it to refine our knowledge and actually get more useful real-life clinical data. So the second thing would be the use of artificial intelligence and big data management as well to make sense of all the data that we're generating. And third, of course, would be newer treatment categories or therapeutics. So in the past, I tell people that in oncology, we're simple folk. We only have about three or four ways of treating things. Surgery, radiation, traditional chemo, and maybe immunotherapies are targeted biologics. And it's that last area that's getting really exciting where potentially newer and newer drugs are identified, not only to necessarily treat patients based on maybe genetic status or mutation status or pathway changes as well, but potentially maybe avoid certain side effects that traditional chemotherapies can have. So all three of those.  

Dr. Venable: Yeah, those are great. I agree with those. Those are really the areas that are really emerging. It's exciting. You know, we kind of follow behind human medicine so often in veterinary, and it is exciting as they're getting more advances in people,  you know, kind of how we can learn and take away from those things too. And I'm talking about AI and big data platforms. I understand that you contributed to some of the research platforms for ImpriMed when it was first starting.  So how did you find out about that?

 Dr. Choy: Yeah, I would say I always tell people I don't like to take any credit, but I maybe contributed a little bit. There are a few cases as well. And it was actually by happy circumstance that during my residency, the two big projects that I had, I was told by my mentor you always have a very easy project that you can complete because that's part of your training, but then you can always have big aspirations to have a more forward perspective trial that has more, let's say, clinical impact as well. And one of my big areas of interest in oncology is translational oncology. So things that not only can help other animals as well as how you and I  practice medicine on a day-to-day basis, but potentially it could help the parent as well. So maybe if the owner has cancer and how can that affect multiple species because everything's so similar as well? So one of my projects during my residency was with the Fred  Hutchinson Cancer Research Center here in Seattle. This is one of the biggest NIH-funded research cancers for humans in the US, in fact, in fact, the world as well.  So we were very fortunate to work with a lot of researchers there. And one of the big projects was developing an in vivo,  so inpatient lymphoma chemotherapy assay. And we basically had to inject chemotherapeutics into patients, into lymph nodes, and then have them retrieved. And they would analyze the lymph nodes for success or failure. And that was very interesting to me. And so, I already had a keen interest in research and also lymphoma drug  sensitivity assays.

So I think this was back in 2018 or 2019. I call it the before times. There was a conference in Las Vegas, actually. It is called the Veterinary Science of Oncology. So it's a very research-centered conference. And at one of those conferences, I actually met the ImriMed team when they were first developing their product. And we got chatting as well. And we found that we had a lot of similarities in terms of interest as well.  And because I think my background in lymphoma drug sensitivity research, they decided to reach out to me and see if I was willing to submit more samples. And at the time, I was very keen to support their research. And over time, that grew through many years, and it's culminated in them asking me to work as a consultant for them. And I've been working with them for the last two years as a consultant. 

Dr. Venable: Wow, that just shows how important networking is, right? You never know who you're going to meet or how things might intertwine. Because ImpriMed does some translational research as well, right?  As far as they have a human side where they're doing assays and different things,  I believe, as well as for the veterinary side. Is that correct?  

Dr. Choy: Yes. So this is what you were saying, humans always get the things, all the treatments, and all the new toys and the new drug therapies first.  I like to feel that this is one of the few areas we've kind of turned the tables where we get a lot of things first in animals. And not only am I seeing quite encouraging new results that help change clinical practice in veterinary medicine, but this is now starting to potentially trickle on into impacting how clinical practice is done in human oncology as well. So they've actually had some good collaborative research projects with actually major well-known hospitals on both the East Coast and the West Coast in the United States as well.

Dr. Venable: Wow, that's really exciting. We'll definitely have to keep up with that and see where everything's going.  Because I think a lot of us veterinary oncologists, we love translational.  We want to help everyone, right? The dogs and the people. So that's exciting that ImpriMed is involved with that.  And for the veterinary side, how are you using ImpriMed? 

Dr. Choy: Yeah, so back in around 2018-19, when the company was first starting, I feel like they did the research the proper way. They offered the test for free because it was still data gathering. We didn't really know the sensitivity, specificity, or reliability of the data. So it was more they were offering a service to both potentially help the clients, but also we would help further research.  And how I offered it to clients was that, hey, the price is right. It's free. It's no charge. And it initially offered two main benefits. One, it provided lymphoma phenotyping. So what type of lymphoma do you have. And that by itself was a really good prognostic indicator as well,  like B-cell versus T-cell, indolent versus more high-grade lymphoma.  So admittedly, I was actually using it for free phenotyping at the time. And I said, well, you could also get a potential side benefit in that you could actually potentially determine which drugs would be more effective. And that would really support do I use the standard of care like a Wisconsin, Madison, CHOP-based protocol, or should I potentially use something else? But I did tell clients you should take that with a really big grain of salt because it was still very developing. Over time, as they've gotten more case material, they've actually evolved their testing. They've gone through multiple generations of modeling and reports in terms of the formatting, how they present the data as well as how they interpret the data. I felt that their reliability and clinical epic ability have actually increased quite significantly.

And now, when I do offer it to clients, as a standard of care for my practice, I phenotype all my patients.  So I feel like really we should be moving away from the old way of we treat all lymphoma the same. They all get treated with CHOP.  And if they don't respond, then we'll move to something else.  And there are really good studies to show that if you don't put your first foot forward when you are in a rescue or relapse situation, a lot of the treatments really don't work as well, and they don't work as long. So we are doing a disservice to the patients by doing a blanket approach, and we're not moving towards more personalized medicine, particularly for lymphoma.  So I do offer phenotyping. So I actually have shifted my practice to using, essentially, ImpriMed for nearly all of our lymphoma phenotyping in dogs now.  And really, just because it's very price competitive, but also the turnaround time is very quick. And it's within 72 hours. I actually get both flow cytometry and clonality by PARR back. That allows me to make decisions quite quickly.  

The other part of it, then I tell clients, hey, if we're doing phenotyping if you want more information, there is a newer emerging diagnostic test. There still only has been done in about, you know, 4,000 patients. So it's still a relatively small sample size when you compare it to, say, a human diagnostic test. But I've used it for a few years now. I mean, I'm comfortable interpreting results, and I tell clients, very intuitively, it's kind is of very similar to something that they're familiar with, say, like a bacterial culture and sensitivity where they keep certain cells alive,  cancer cells versus bacteria. And they basically subjected to a variety of different drugs. In our case, not antibiotics, but chemotherapeutics to see potentially what would work and what the best course of action would be. And I feel like a lot of clients, when I describe it that way, they have a very intuitive, easy-to-understand way of saying, hey, I understand that that makes sense to me.  And I know that's still very, you know, it's still emerging. And a lot of clients, I feel like when I do the phenotyping, I recommend that. And I offer the upgrade also to drug sensitivity. It's actually a surprising amount of clients who will take me up on that to upgrade that little bit extra to see if we can get more information. And that's a newly diagnosed patient. They also like the fact that they're contributing to research that could potentially help other pets in the future. And also, now, because they have been working, the improvement has been working with human oncologists and human hospitals. They like that feeling that this could potentially be helping with other round cell or immune system malignancies, like their publications recently with multiple myeloma in humans and potentially things like diffuse large B-cell lymphoma and non-Hodgkin's lymphoma in humans as well. So that's kind of, you know, the long roundabout way of me using it as a free service,  but now offering it as part of my practice day to day.  

Dr. Venable: Wow, you said so many great things in that. I kind of want to pick apart some of it because there were a lot of good takeaways there. You mentioned lymphoma, the blanket way of just treating everything with CHOP, is that really the best thing? Because I feel like there's still a lot of debate about that, right? Because there's some paper showing T-cell you should treat with MOPP or maybe LOPP, and then others showing, no, they didn't live as long versus just chop and all this kind of back and forth. And then it, to me, where I also find it can get a bit frustrating is when you really look at those studies, there are not very many dogs, right?  And I know you said 4,000 is a small dataset, which is probably compared to people, but in our vet studies, I mean, if we get 20 dogs, that's usually a lot, right? And so I agree with you. It is something where I feel like, especially anyone that's treated lymphoma, you know they don't all behave the same, right? I've had some that fall along just like they're supposed to and others not at all, either in a good or bad way, you know? And I like how you said that we're doing a disservice. I think you're right by just, you know, but that is sort of the way I lean to where it's like,  well, we can do CHOP and then see what happens. But you do feel like there's got to be something better, right? What if we could tease this out?  And so, how have you felt those drug predictions? I know you said that we're still learning, and the clients understand that, but how are you feeling? Because I know they don't have the data, at least I don't, believe they have data yet, quite going towards that. But how have you felt changing up the protocols or that kind of thing?

Dr. Choy: So that's the ultimate holy grail in terms of, you know, in the future, we would like to have a human or a dog patients where you'd be nearly diagnosed with, say, a multi-centric high-grade lymphoma, kind of analogous to non-Hodgkin's lymphoma in people. They would take a sample of your lymph node, you know, they would figure out what subtype it is and also then have a ranking of these are the top few drugs that we're using, and then you could make a customized chemotherapy protocol moving forward to say we're going to use the top three or top four drugs. And, of course, still a lot of prospective research is will need to be done to get to that point. And I feel like we're still a ways off from that. 

But I use the ImpriMed platform in my practice in two ways. The naive newly diagnosed patients. And currently, unless there are very significant changes, it's really to help me choose what's the best first-line therapy for me based on the current standard of care or the current published literature. So I'm not going to really try to reinvent the wheel too, too much, unless there's very significant data and without consultation with the client. So mainly for me, I'm deciding between do I use a standard CHOP protocol, say for a B-cell lymphoma.  Do I use maybe a Tanovea or Tanovea-Doxoribicin-based protocol for some patients? Or if I do know that, say, a patient has a pre-existing liver condition, I don't want to use liver-toxic drugs like Lomustine, for example. Can I pick something that's in a similar drug category based on the drug assay or sensitivity where I can make a single drug substitution knowing that at least there is something on paper? Now clinically, we're getting to whether or not we're seeing that match out well. I can at least have a little bit of confidence to say I can do some drug substitutions that way. So that's a naive patient. 

For naive or newly diagnosed T-cell patients, I feel like we have two or three published studies right now supporting maybe more MOPP or LOPP-based therapies for naive T-cell lymphoma patients. I am actually seeing that reflected in some of our newly diagnosed T-cell lymphoma patients submitting to the platform. They support the use of more alkylators heavy like Lomustine-based protocols. They show a lower response to Doxorubicin, and there are papers to show that right now for single dosing. And they also support the use of Mechlorethamine or Mustargen-based protocol. So I am seeing that comfortably also reflected in the protocol itself.

The other way I use it right now is also in relapse patients, and those are the ones that are the really tough ones. Once you get into a relapse situation, I think we've all been through that scenario. We're all kind of playing out the same unfortunate song in that it's not a matter of if it's when it doesn't work, then we go to a plan C, then we go to a plan D, and we're kind of delaying the inevitable. And I think I played that same broken record so many times I was really desperate to find something else. Is there something else I can offer my clients? Not just drugs and not just picking drugs randomly at this point and doing empirical therapy and seeing what happens, is there a way that we can actually better target or at least have the best guess or best estimate in terms of what a more likely responding drug would be to not only focus on finances and resources appropriately but also for clients avoiding drugs that may have a lower likelihood of response. So you don't waste finances and resources and put the patient through unnecessary side effects as well. So those are kind of the two main ways I use it. 

How do I feel in terms of the overall observed response? With each generation I've used, I feel like the dependability, at least subjectively, and they are very receptive to continue to improve their dataset, their models, and publish. This is one of the few companies I've worked with where they're still publishing and peer review journals at least once or two a year, which is very, very good in terms of at least having all the data out there being very transparent. And that's why I've continued to work with them because of that strive forward. And I feel like the first model they had was very broad categories. They didn't really give a lot of percentages. They were very, I wouldn't say generic, but broad in the description. They used the words like mediocre response, medium estimated response, or likely to be effective. So it was not a, it was something, but it wasn't as clinically useful as ranking the drugs as well. And I would get things where they would say, hey, CHOP should work, and I used it, and the drugs didn't, it relapsed pretty quickly, and I would retest them, and they would say, CHOP should still be working right now. And I would call them up or email to say, hey, what I'm seeing clinically is not working well with the report. And they were very, very open to getting more data, you know, offering to repeat more samples for the patients for free for the sake of learning more about it to improve their model. And over the last five years, they've gone through multiple different iterations and models. And I've seen the dependability of it a lot better now. In fact, I've had some case reports of some patients where I've used it, you know, in both the naive setting when they're newly diagnosed to four relapses in, and you can actually see a very clear cut match in terms of the resistance pattern of drugs showing up, where the response rate starts to drop over time to what you've observed. And then when I try, you know, one of the drugs in the top 3 rankings that they use, we generally, you know, I've seen a very good response in patients. So I've had some very durable repeated responses or re-inductions or emissions using this repeatedly.

Dr. Venable: Oh, that's really interesting. Again, so many good points in there. And I think you're very right in saying, you know, how, especially for those relapse patients, which we know it's going to eventually happen, you know, how can we better target for the best treatment? Because we know, you know, the more drugs you use, the more resistant cancer gets, it's less responsive, but also just money too, you know, because we don't have the same level of insurance as they do in people with our dogs. And so, how can we really target? Because so often in colleges, we talk about spinning the chemo wheel, right? And there's got to be something better than that. And I know we all, hopefully, everyone is looking at papers and looking at responses, but still, when you stare at an individual dog, sometimes you're like, well, will it be this drug, or will it be that drug? So that is exciting that you've seen some actual clinical response, you know, like kind of what you're seeing from the data collection, what you're getting. And that especially the ones that you've tested more than once, like from the original, and then once they're resistant to things, and you retest them, and that is actually showing that they are resistant. So that's exciting to see that the data is, is following along. So, that is really interesting. And, you know, with all, and I guess, you know, even before I do want to make a point, you said about publishing studies, I think that's huge too. I talked to a lot of family vets, and they'll ask me about various different products. And there are a lot of companies out there that don't publish anything. And those are the ones that always make me a bit nervous, you know, there's a, and I feel like especially oncology, there's a lot of companies, they're like, Oh, I just heard of this, or, you know, pet owners will say, I just googled this. And then you go to the website, and there's nothing published. What, what do you like to tell clients, you know, about some of those companies, because I'm sure you get people that bring stuff to you that you can't find any data. 

Dr. Choy: Yep. And in this day and age, I would say a big part of my practice and my consults, and I feel like my initial consultations for newly diagnosed clients, I feel like even over the last 10 years, it’s gotten longer and longer and longer. And, I feel like it used to be most of my conversation was on the tumor, the diagnosis, you know,  what it is, why did my pet develop this, how is it likely to behave based on that, what kind of diagnostics would I recommend for your patient to help guide treatment and ultimately we'll think to discuss prognosis. But I feel, I think it's empowering clients, but it's also a little bit to our dismay is that the power of more information also comes with a lot of power, a lot of misinformation as well. So I spent a lot of time actually going through a lot of things that clients have found on the internet themselves and explaining how to really critically analyze companies and data that you have and not all data, all because it's published on the internet, it's not all created equal as well. 

So I have used a lot of diagnostic companies, even with clients, you know, where they know that, you know, there's little to no published data, I will be very open with them. I said I am willing to learn and try and try new things as long as it's not going to impact, say, the resources towards doing treatment. If it's going to eat into that too much, I'd rather put that towards treatments to make your pet feel better at that point and treat their condition. But if say, finances are not an issue, it's not going to be a detriment to the patient either due to delaying treatment or something that's very invasive to them, I would say more power to more information. But I do educate the clients in saying that their platform may be initially, it's always based on some research, but it may be based on preclinical research, it may be done on, you know, mouse models or, you know, non-dog models as well. And what it really amounts to in veterinary medicine is that you may be an out-of-pocket clinical trial, you are basically paying for their research at this point. And my little soapbox is that if they are doing that, they really should be doing a service to the science community in trying to at least release data, you know, present data on a timely basis, whether or not it's good or bad so that we can continue to move forward to help clients as well. And I think you and I have as well, we've seen a lot of, you know, these companies and startups, it's a very exciting time for us. But we've also seen an equal number of these companies fail to either deliver or they may have had therapeutics, we've had actually new drugs and new immunotherapeutics have come and gone from the market as well. So I think it's really given us a more cautious approach to a lot of these samples and treatment options as well. So it's more of a still wait-and-see. And that's why we have a very frank conversation with the clients, and they have to really go into it with eyes open that is not going to be a magic bullet. It's something that will be another tool in our tool belt, another bit of information to help us care for your patient. 

Dr. Venable: Well, I think that's great. I think it's good that you said that you're open-minded and willing to try. I'm such a data head. I really like all the data. But I can be open-minded. But I lean towards being a big data head. So I think that's great and very true. A lot of important nuggets, what you just said. And just in general, what do you think are the most significant challenges that we're starting to face now in veterinary oncology? 

Dr. Choy: So I think it's very similar to human oncology. I think we're really going to be collecting data in a timely fashion, knowing what to do with the whole bunch of data that we're getting, and finding a relevant and significant pattern that's true. And also the cost. As these new fancy techniques, diagnostics, and new drug options are available, it's kind of scary when you think of, say, a  metastatic melanoma patient in humans. Some of these treatments per year for an average-sized human male could be coming up to almost a million dollars a year if you don't have insurance. And even then, it's still a big financial burden to the average American or an average person living in the world on month-to-month wages as well. So I feel like leveraging new technologies to not only look at economies of scale but also, if we had limited resources, where's the best way to apply them will be a big challenge. 

Dr. Venable: Yeah, that's true. I had a client who once wanted me to price out Trametnib. It was for a targeted therapy. And I looked at, was it regular human pharmacies where I was looking at, and it was going to be over $25,000 a month. So it's like what you said. I mean, it's just, if you're paying out of pocket, and I actually worked with someone, and it was one of those unfortunate, really sad stories where he had cancer, and he couldn't afford his medication. So he started not taking as much, taking breaks because he couldn't afford it. And he did end up succumbing to his cancer. And sometimes you just wonder, like, could it have gone better if he could have afforded it? Right? And so it's, I think sometimes people forget because they think about dogs, but it's in people. This is actually a really big topic as well. A lot of oncologists are publishing papers and things just about their clients can't afford it. So I think you're right. I think as all these new technologies emerge, we have to kind of balance the expectations on pricing. Where does all that lie? How can we use the resources? So yes, I think in people, too, right? There's got to be a better way with some of this. I don't, unfortunately, have the answer, but I think it's true. 

Dr. Choy: And I think that's from both ends too. So not only as these new technologies and new treatments are, they're all custom-made, but they're targeted biologics and immunotherapies. A lot of these take a lot of research and effort to build, but as we get better at it, I feel like the economies of scale and technology will help reduce a lot of this. A case in point again is DNA sequencing, it was all done by hand manually. I think to my recollection, the Human Genome Project, I think it took over five to six years and multiple teams of postdoc Ph.D. researchers to manually piece everything together as the world's biggest jigsaw puzzle. And now, we talk about whole genome sequencing, and we can get it done in an hour using a whole genome array and computer-aided design. So in the future, my hope would be something like Star Trek, where they can have computers that can make these drugs on a molecular basis faster scale that will bring down the treatment side. But then, right now, if we can even identify what drugs are more likely to work, we can use the limited resource that we have in a much more efficient way to not say do three treatments of chemotherapy and the cost and time involved with it, find out that it doesn't work. And now we have to go switch to something else. We could have put our best foot forward. So that's also another way to help provide treatments to our patients.

Dr. Venable: Yeah, that's very true. That's a great idea. And in your experience, what's been the most rewarding aspect of working in veterinary oncology? I know we've talked about some of the challenges. So what's a positive?

Dr. Choy: So, you know, the whole reason it's a full circle. I came about doing veterinary medicine because I liked, you know, science, medical aspects, and it ended up being kind of like treating my own brothers and sisters, you know, the pets are my family. And that's really what it comes down to. It's not only the doctor-patient relation and the bond that you form with them, I feel like oncology is one of the few fields where you see your patients over and over, and sometimes you actually see them for the rest of their lives. And you form really good relationships with not just the pets but also with the clients. I feel like you're helping them through a very difficult time, good or bad as well. And now, with a lot of translational oncology, not only do we have the opportunity to potentially change a lot of diagnostics and treatments that may help the pet owner one day, if they were unlucky enough unfortunate enough to have cancer, I feel like that even strengthens the bond that we have together with both the pet parent and the pet itself. And that's really the most rewarding part that I have. 

Dr. Venable: That does sound very rewarding, right? Making those bonds and then also how we can help everybody. Like you said, that full circle of helping the animals and helping people. So I think this has been a wonderful conversation, Dr. Choy. It's really been my pleasure to get to learn more about you and hear your opinions. It's been very insightful. And I really just want to thank you again for being part of this podcast. 

Dr. Choy: Thank you so much for inviting me. It was an honor to be here. Thanks, Rachel. 

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. The Veterinary Cancer Pioneers Podcast is presented to you by ImpriMed.