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. And welcome to the Veterinary Cancer Pioneers Podcast.

Welcome to the Veterinary Cancer Pioneers podcast. I'm your host, Dr. Rachel Venable, and I am so excited today that we have Dr. Philip Bergman with us. And when I think of a pioneer, Dr. Bergman, your face, your background really comes to mind. And thank you so much for being on our show today.

Dr. Bergman:  Thank you so much for having me. I don't know that I deserve this pioneer status, but I appreciate the interest. 

Dr. Venable: You're welcome. But I think looking at your background, your bio, I would say, say that you can fit in that pioneer background. You are the director of clinical studies for VCA. So anybody in veterinary medicine knows VCA is a huge group. So being a director, that's quite an accomplishment. You're also adjunct faculty at Memorial Sloan Kettering Cancer Center. And you were the principal veterinary investigator for the Canine Melanoma Vaccine Oncept®, which was fully licensed in 2009. So we'll talk about that in a minute. talk more about that because that's quite an exciting endeavor. And the other thing on your background that I find really interesting is you completed a PhD fellowship in human cancer biology from the MD Anderson Cancer Center in Houston, Texas. You know, unless you live under a rock and you've never heard of cancer, everybody knows that's a huge cancer center for people. You know, I know a lot of people, you try to get, you know, you there for treatment or even doing like they do some telehealth visits and saying so. But anyway, what was it like being a veterinarian there at that program? 

Dr. Bergman: You know, I'll be honest, it was a scary first six months. I remember specifically saying to my wife then that I think I've made a mistake. She said something that has stuck with me for a long time. She goes, you're out of your normal routine. You've now gone up another level when it comes to sort of the training side of things. And of course, you're going to feel like a fish out of water. And what really happened was is that, you know, I went from a residency and you know what that's all about, hardcore clinical training, some didactic training, but you know, you're really being trained to be a clinician, not a scientist. And what I learned very quickly when I made that move to Houston to do that, even though I was brought on, I think in a different way than a typical grad student, because the site that I ended up choosing at MD Anderson, the department chair was a DVM Ph.D. by the name of Josh Fidler. And Josh Fidler is kind of known in the scientific world as kind of the seed and soil hypothesis guy when it comes to metastatic biology. But what he did is he cultivated me, and this is compared to like Duke and Stanford and a couple of other places that I think academically are probably stronger than MD Anderson, but they put together a package that made more sense to me because I wasn't going to be treated like a typical graduate student.

I was coming in then as a DVM that had already done a master's, had done a residency, gotten boarded at that point. And so Josh or Dr. Fidler said, "Hey, we're gonna get you an American Cancer Society fellowship, so it'll be better for you financially. That fellowship will bring money to the lab that you'll be at in my department." And they really rolled out the red carpet very differently than the Dukes and the Stanford's of the world. That’s what told me, let's go to MD Anderson, even though it's not as academically potentially as strong. But that first six months was like just amazing to me because clinicians and researchers talk differently. And those two hands, as I've learned, don't talk well to each other. Now, we all know clinicians speak and we don't necessarily know everything from a scientific and molecular speak and we don't necessarily know everything from a scientific and molecular speak. And that first six months were tough ones. Once I got the lingo down and started to kind of understand how a clinician navigates that, then I said, "Okay, I'm back into my normal frame of reference," and yeah, it was hard being that far into your career and going back and taking, you know, graduate biochemistry and graduate this and graduate that. It was a long and hard five and a half, six years that I spent there, but I'm so glad that I did because, you know, it opened up a lot of doors that I don't think would have opened up without it, especially when I then went to AMC and, you know, with Sloan Kettering and, you know, for a lot of folks that aren't familiar, those two groups always go back and forth as the top two human cancer centers, being MD Anderson in Houston and Sloan Kettering in New York. They're always one, two, and it depends on the year they flip back and forth. 

Dr. Venable: Yeah, that's really exciting that you've been able to be involved with both those really renowned programs. And I can only imagine, like you said, feeling like a fish out of water and having to relearn new things. And what do you think helped you just in general to keep pushing through? I mean, you've certainly pushed through a lot, right? Getting through vet school and specialty and then that PhD. What do you think might help other people? Like younger vets or maybe people wanting to be vets. Like, where did you kind of find that strength or what would you recommend? You know, is it like having a great friend or partner? Like, you know, like you said, your wife helped you. 

Dr. Bergman: Each of us have had in our journeys, mentors that pushed you. And, you know, I think back to Withrow and Rod Straw and those types of folks which I'm forever indebted to. I think about, you know, Roger Fingland in my internship at Kansas State, he pushed me to keep going and take the next step. Greg Ogilvie was instrumental in me becoming an oncologist because he was there at the right time during vet school that I said, "Hmm, maybe this is something that I wanna do," even though I was very interested in I thought I was gonna be either a dairy practitioner or I thought I was gonna be a orthopedic surgeon and quickly figured out neither of those were for me. And it's funny how those little tiny things that happen in life, in addition to a strong mentor, really gets you to refocus and think about potentially different things. Another one at school was Eric Eger, who was a surgeon there and said, you know, we can tell you care and you work hard and we want you to take those extra next steps. And, you know, those people can be incredibly beneficial and fruitful in your life. And everyone you talk to that does all these things, as you know, have those incredibly special mentors that made you take that next step in addition to, you know, what's happening in your family and personal background. 

Dr. Venable: Yeah, no, that's true, mentorship can be a lot. And sometimes I think, like you said, even just little moments, like they may not even realize how much of an influence they had on you, right? When you were younger, like as a vet student or something sometimes I think we may not even realize little things that we can say how much that can really mean to someone in the moment.

Dr. Bergman: Completely agree.

Dr. Venable: And I am a bit curious though you said you were thinking about being a dairy farmer, a surgeon but then you ended up getting a Ph.D. at MD Anderson how exactly. I don't know. Can you walk us through that journey a little bit?

Dr. Bergman: Yeah, you know so growing up you know there's a place in Wisconsin named Plain, Wisconsin. P-L-A-I-N. It's a town of about 400 people and about half are Bergmans and they're almost all dairy farmers. So I remember summers going out there and I knew forever I wanted to be a veterinarian, but you know, it was what was around me. And as the saying goes, you know what you know. And so I thought when I got to vet school that I was going to become a... a dairy veterinarian and then realized that was not for me. I very quickly came to that realization, And you know then started thinking about surgery and things like that. And that's when you know Withrow and Straw and Ogilvie and all those folks you know during vet school. I had that happen and then I had a grandfather that had metastatic prostate cancer. All those things happen within a very short period of time and that's when I said, "Well, maybe we should think about pivoting to cancer." So that really didn't get concreted until internship at Kansas State. And then I was lucky enough to come back to Colorado State to do the residency there in the early '90s. It was in the residency that I got, I call it bit by the research bug. Started doing a number of studies, you know, when I was a resident, which I truly enjoyed. You know. I quickly learned that if if I was going to learn what was state of the art on the human side, I needed to go and bed myself in that type of training program. And up until that time point, there were extremely few, you know, very oncologists that had done PhDs at all, if not at human cancer centers. So I thought, you know, gosh, am I ready to commit four, five, six, seven years as a typical robust PhD and decided, yeah, I think it would be worth doing that. And that's what, what ended up getting me to Houston compared to Duke or Stanford or something like that.

And again, so incredibly appreciative. Another mentor that had a profound impact on me was Greg McEwen, you know, one of our grandfathers of veterinary oncology. When I was doing my PhD. He did his sabbatical from UW at MD Anderson, mainly based on Josh Fidler's name. And there were a number of other investigators at that department that Greg had immense respect for, one being Jeannie Kleinerman, who's a human medical oncologist for kids with osteosarcoma. And, you know, Greg obviously having a tight connection to the whole osteosarcoma space. And, you know, I knew of him peripherally, you know, you always thought, oh my God, there's the God, there's the book, you know, and blah, blah, blah. And next thing I know, he shows up and he's one lab down from the lab that I was in. And so we got to know each other quite well. And it was always amazing to me that, you know, here is Greg, you know, that's many, many decades into life, many decades into a professional career. And just like me, he was, you know, busting it. He was, you know, there from 7am to 11pm. And, you know, he knew that in his sabbatical, he needed to learn what was state of the art and human medicine to take that back to his program at University of Wisconsin. But he was actually the one that pushed me when I was finishing the PhD to go to AMC. And AMC was not on my radar screen whatsoever. If anything, I thought, oh my God, New York City, that scares me. I don't know if I would even, to be honest, would be considering that. But it was Greg that said, no, Phil, you have to go to AMC because Sloan Kettering is in your backyard, and you will do things that you'll never even dream about. And he was so spot on. And so that's sort of how the genesis of the whole melanoma vaccine happened too, 'cause without Greg McEwen pushing me to go to AMC and therefore be in Sloan Kettering's backyard, those connections would have never been made. And so again, it's amazing how mentors sort of, really guide you through those various things that were faced with in personal and professional life. 

Dr. Venable:  Yeah, that is quite a puzzle. Right? And that is really exciting how he was able to help you because I was just thinking you know you said you were a small-town dairy farmer going to New York. Right? I mean that's almost like a movie so I can imagine how when he was first saying that to you you're probably like “I don't know.” You know, but that is really interesting that he already you know knew those connections and I wanted to kind of dive a little bit more about the melanoma vaccine you know you mentioned the osteosarcoma, you know, dogs are a pretty good model, you know, of that cancer, especially because in people, it's a pediatric, it's pretty rare. So trying to get data is a bit more challenging than what we're able to do with dogs. Now, what about melanoma? So I kind of wanted to know, how did that happen? Because, well, dogs get melanoma, it's usually more in the mouth. And so just thinking of it, especially when you guys were doing it, you know, people weren't really using dogs as much as a translational model, apart from like here about hound studies, but I'm talking about dogs that spontaneously get cancer. So how did that whole bridge? I know you said McEwen seemed to already kind of know things were brewing over there, but how did that all come about?

Dr. Bergman: Well, you know, with Greg, since he started the Donaldson Atwood Cancer Clinic many, many years previous, you know, he had all the pieces of the puzzle there. And, you know, it shows you the reverence that he had for AMC, where he's pushing people to go back to his alma mater. And so I went there, right away was introduced to a number of folks at Sloan Kettering, mainly in the Cytotoxic side, like O’Conner and a couple of other folks that were on the Lymphoma team. And then one night got invited to go to the Princeton Club of all places and AMC and at the time Jedd Wolchok, who's the MD, PhD that I did the melanoma vaccine work, he's a high flyer on the human side because he's basically an MD, PhD that is, you know, basically devoted his life to treating people with melanoma. He's responsible for three of the checkpoint inhibitors that are FDA commercially available. A true rock star in every way you could think about it. His colleagues would tease him incessantly when he started working with me that he was now becoming a doggy doctor and he would keep a smile on his face that whole time, even though they were riven him. And so anyway, we go to the Princeton club and I meet Jedd and, you know, super nice guy, but he asked me and I remember to this day where I was and when he asked, he said, "Do dogs get melanoma?" And I said, "Yeah, well, why do you ask?" And he goes, "Well, you know, I've got this vaccine that uses a different species DNA to trick the immune system into formulating a response. We've had really good prolongations in survival and safety in mice. But I know I'm 10 to 15 years minimum away from getting this into people. We're putting all foundations in place to put this into people. And I'm wondering if dogs could be a bridge where we are able to help both dogs as well as then those data turn around and help people. So again, incredible foresight, crazy smart guy. And literally, three months later, we were taking his vaccine. We slightly changed it in that, you know, this idea of a Xenogeneic vaccine. Xeno being, you know, different and genetic being sort of the species side of this. And so we quickly realized that if we were going to use that vaccine to make it Xenogeneic or a different species to give to people, that was a scenario where they wanted to use mouse-origin DNA. And then the beauty of us in veterinary medicine using human DNA for our vaccine was that would be xenogeneic in every veterinary species. So early on we had a nice mechanism to subset those out so there wouldn't be bleed between the two approaches. 

And so again, three months later we started putting the vaccine in. We quickly learned it was safe. We started seeing dogs that were sent home essentially to die. I hate to say that, but that, you know, in our world, world, we know when we've got poor prognosis patients and we try to be as above board with those clients as you know. But, you know, stage three and stage four melanoma, as you know, has a horrible outcome, typically less than three to six months, if not even shorter. And so, you know, we would vaccinate those dogs and they would go through protocol and, you know, the owner would then call back three months or six months later and says, hey, fluffy still kicking. Do you want to see them?" And it's like, "Yeah, yeah, yeah, yeah. Please bring them back in." And you start to see enough dogs that have disappearance of their pulmonary lesions, dogs that are having prolongation of survival when they got both local control and vaccine. We then started publishing that work. We then realized we needed an industrial partner to take it to the next level. So Jedd and I literally flew around the country talking to different animal health companies and every single one of them, except for one, just literally laughed us out of the room and said, "This is the craziest idea I've ever heard. This is like Star Trek." I would hear the term BS. There's no way this can work. It's too crazy. And this whole thing about DNA, and are we going to be turning veterinary patients into humans? And it's like, we obviously don't understand the vaccine technology when you say those kind of things. But it was Mariel at the time that said, and there was a gentleman by the name of Bob Norgren that I'll always be indebted to, not a veterinary scientist. And he talked his team into saying, Hey, you know, let's give this a better review. And so they funded a couple of additional studies. And we then realized that, you know, one, it looked extremely safe. So I think we have really good data around the that. We had significant prolongations in survival. You know, we had instead of, as you remember, prior to vaccine with surgery, you know, we would typically get somewhere between three months and 18 months, depending on the stage of that patient. Digit melanoma, same thing. You know, half of them were dead at a year and 98% were dead at two years without the vaccine. And we started seeing you know, one both gross antitumor responses and prolongations in survival.

And that's when, you know, I think Mariel at the time, who now, you know, got bought by Boehringer, they saw utility in this. So we set up a USDA registration trial. I'll also remember during that time point that when we did that study, we were about I want to say, two and a half years into allowing the data to mature, you know, have those patients tell us, “Are we doing well or are we doing poorly?” And we had not reached what we call immediate survival time, meaning that, you know, we still had, I think it was like 70% of the dogs were alive at that two-and-a-half year mark. And I remember, you know, those industrial colleagues saying, well, Dr. Bergman, we, you know, we don't have a median survival time yet, so I don't think that's good and we should wait." And I said, "Oh my God, are you crazy? It's a good thing that we don't have a median survival time because we've not crossed over that 50% threshold and we may be here another two years from now and maybe still never crossed that 50% threshold." So I said,

 "Yeah, you've got to send that back to the government” And so that's what we did as a team and that's when it, you know, converted from conditional licensure to full licensure in 2009. We were really proud of that moment because it was the first therapeutic vaccine for cancer that was approved by the US government. HPV vaccine on the human side was the first preventative vaccine for cancer. So yeah, it was a really proud moment and I know for Jedd, he had shared with me that even though obviously he's an MD PhD it was something that he was very proud of as well, and all of the stuff that we did together rolled up to a lot of their applications on the human side as well. So I quickly learned that you know veterinary and human cancer centers can get along. They can collaborate and they can work well together. We are better working together to address really difficult-to-answer fundamental biologic questions that we need in the clinic. 

Dr. Venable: So much to take away from that journey. I mean, even what you were just saying now and how he saw like, yeah, this is working in the mouse, but I know it's such a leap to the person, right? And that's where I agree. I feel like the dog is such a great middle-of-the-road option because when they get like melanoma, they get it spontaneously. So it's such a better model than just the mouse, you know? And when we're able to use things like. the melanoma vaccine on our dogs, then we get new therapies for our dogs and then helping the science towards people. So to me, I agree, it seems like such a win-win and, it sounds like you went through so many challenges and really to overcome to get such a monumental thing. It's the first cancer vaccine, which is really exciting. What would you say was the biggest challenge? I mean, it sounds like getting an industrial partner was pretty hard. I mean, it is. that what you would say was the biggest or what would you say from that whole journey was the biggest challenge? 

Dr. Bergman: Yeah, it was up there because again, most of them thought this was way too crazy and an idea to work. One of the other aspects, and this I think is a great segue from what you just said related to the model aspect is that invariably when I would present that work to a bunch of MDs, literally every time that that would happen, they would either ask me live or they would pull me to the side if they were embarrassed to ask in public. They would ask me, and I know that you'll giggle over this because you'll inherently get it. But they'll say, "Well, I just don't understand this stuff about dogs and melanoma because you take somebody's dog and take them into the back." That was the other thing that they would say,

 which I always, I saw. about, but they would ask them, "We go give the dog melanoma in the back of the clinic." And I was like, "No, no, no, no. This is the fundamental thing that they don't understand because in their world, it's either a person or it's a model. And that model is obviously often with mice. And as you know, most of the time, those are not spontaneous formed cancers they're induced, or they're given to mice that have poor immune systems so they can't reject those those tumor cells. So very artificial you know we all for folks that have experience in centers that do mouse work. I wish I could be a mouse oncologist because you you care a heck of a lot more patients than you do through other means because it's it's a very artificial very atypical you know it doesn't represent the biology that that you and I are used to seeing in our patients. And so it was very eye-opening to me when those physicians would say that because it was obvious that they didn't understand, no, this is a spontaneous disease model that is no different. You know, they have intact immune systems, as far as we can tell, those immune systems age over time, no differently than in people.

The disease metastasizes to the same exact bizarre places, like a dozen people like meninges, adrenal glands, stuff that you can't predict based on flow of blood and gets back to the whole seed and soil hypothesis,  that there's something unique about that soil for that specific seed or metastatic cancer cell. So it's a really cool thought as to how that all kind of came together and when you're you then got that MD to realize oh my god this is a dog that lives in our world eats and sleeps and drinks and does all the things that that we do. But it spontaneously develops so it has all those pressures they then start to go that's when the light bulb goes off and they go, “Oh, now, I get it. this is not induced this is really representing what we do in the clinic side.” And unfortunately, as you know our our patients don't live as long as people. And so that timeline is compressed as well. So we have a unique ability, as you know, in veterinary oncology, we can address some questions that may not necessarily be so easily addressed on the human side. You know, I think back to when we first started it, we were constantly beating that drum of, you know, spontaneous animal disease. And, you know, we would all talk about one medicine, one health, and sometimes that would get co-opted by the zoonotic side or this or that, but we, you know, thanks to McEwen's and with Withrow’s, and Vail’s and folks like that, you know, the, we're now in a very different space when you move forward to what a couple of generations now, where our models, which, you know, I snicker as well at that because they're not really models. These are the patients that you and I are seeing all the time that in fact they represent. represent the very best way to interrogate, you know, new diagnostics or new therapeutics. And it was gratifying when Jedd Wolchok came to that realization as well. And he would say that publicly that you guys should really be thinking about these veterinary correlates and surrogates to try and better figure out what's working versus not.

And I think the osteosarcoma field, you know, recognize that the first melanoma recognizes that second. So now it's becoming, you know, relatively commonplace and it makes the jobs of like the people at the comparative oncology wing at the National Cancer Institute. You know, Amy and those folks, they have it a lot easier now than the folks did 30 years ago because I think it's finally become much more commonplace for people to agree with that.

Dr. Venable: Yeah, I completely agree. I think it is interesting. you know, like he said, like people actually thought we were growing tumors on pet dogs, you know, versus 'cause they just never occurred to them.

 I clearly had never had a pet with cancer before. And, you know, when I tell people about how good of a model, like how much could we share and learn together? You know, our dogs get cancer, it's unfortunate, but when it happens, you know, what can we do where we could actually learn from each other? You know, like I was saying, medications. And I think a lot of people get excited about that and a lot of people get excited about that. you know, like, oh, maybe I will be part of this clinical trial because not only could this maybe help my dog, but it could help other dogs down the road and maybe even people, you know, with some of the things, depending on what you're investigating. So, it is exciting and I certainly appreciate all the hard work that you guys did early on of trying to get that into people's heads and understand like,

 hey, this is this can be one health and really trying to explain to people how we can help each other. So I certainly, as an oncologist now, really appreciate that work that you guys have been doing over the last few decades.


Dr. Bergman: Yeah, thank you very much, yeah. 

 Dr. Venable: Yeah, and kind of talking about new technology and things, is there anything out that you find exciting on the horizon with veterinary oncology or maybe something inhuman that you think might come over our way? What are you excited about right now? 

Dr. Bergman: Yeah, there's a couple of things brewing. One of which, as you know at VCS, just got announced a couple of weeks ago with Gilvetmab, the new checkpoint inhibitor. I've been working with Merck since 2015 on that molecule and made a couple of trips to Ames, Iowa on its behalf. Now we have that commercially available and there are nine of those products on the human side that are FDA-approved. We have one in veterinary medicine which is conditionally licensed. I see how those checkpoint inhibitors have revolutionized the treatment of human cancer. For your viewers, especially those that may not necessarily know what these products are. You know, you see the commercials on TV all the time. I always say that's living longer with your cancer commercials. As you know, cancer cells have gotten so crazy smart, they know where to touch our T cells to tell them to turn off. And so now they've designed some drugs to stop that. So it basically takes the breaks off of your own immune system. Depending on the histology or cancer type, you know, we see some like liquid tumors like lymphomas and leukemias that don't seem to respond to those. But then you see the melanomas where it's 40-50%. And what's remarkable about it is that that's all they get. You know, it's not like they're getting some vaccine or something else with it. They're again, you know, getting a product that allows your own immune system to take off and not be inhibited by those cancer cells, pinging them left and right to turn off. 

The vast majority of the people, in fact, New England Journal of Medicine just last week came out with a really cool paper that showed that people who stopped taking the maintenance phase of that drug that were already in remission, so they declined to continue. continue to get the drug. They wanted to know how did those patients do, and 98 % stayed in remission. So there's now accumulating data that shows that if you get a complete remission with one of your checkpoint inhibitors, you very likely are cured forever. Most of the data shows that. So we now have one of those products in veterinary medicine, and going back to Jedd Wolchok, you know, the gentleman I talked earlier about that we developed the melanoma vaccine with. I remember his words sort of would have been 2011, 2012. He uses the this thought that we got the pendulum. And for years and years, we've been on this side of the pendulum, meaning a very antigen based approach where we train the immune system to go after whatever, maybe a peptide vaccine, maybe an RNA vaccine or in the melanoma vaccines perspective, it was a DNA based vaccine. But it was again, we were training the immune system to go after an antigen. You now move forward to today, the pendulum has completely swung to the other side where it's an antigen-independent approach through checkpoint inhibitors. So it's agnostic of the cancer type, which is kind of cool when you think about it, that you could have a product that would be like that. But the problem is that the funny saying they have it's long term Kettering is, is, yeah, it's magic. 20% to 30% of the time it works,

 and when it works, it works. Well, the problem is, is they're crazy expensive molecules. They're $150,000 to $200,000, and when it only works 20% to 30% of the time, you need better predictive factors and insurance companies get cranky because most of the time it doesn't work.

We now are on the precipice of having our first one and all the initial data, which our shop was one of the sites that did the pilot study for mast cell and for melanoma. And we very much recapitulated that 20 to 30% when it works, it works. I'm super happy that we finally have one in our toolkit. I kind of feel like we're at a similar time point to when Rituxan® first came out on the human side, which was 97, things exploded on the human side with all of those therapeutics. You know, there's now over 200 that are approved for different types of cancer in people. We now have our first checkpoint inhibitors. So, I have no doubt that in addition to, you know, unlabeled use that oncologists are going to use it at a lot of different things. And we're going to learn a lot of things as we go. Plus, I'm proud to say that Merck is, you know, that they have a grant program where you put in interesting ideas and they'll then fund that by giving you a free drug to try to answer those important fundamental questions that we have with it. So I think it's one of the most exciting times to be in oncology because I think we're now starting to get some therapeutics that really do make a lot of sense rationally, have a good scientific basis behind them, are really well categorized, and worked up to know that they've bind to their target of interest because we've had some ups and downs with that in veterinary medicine over time with like some of the Aratana products.

We're on the precipice I think of truly impacting in major, major ways how we treat our patients. And to go back to the pendulum discussion, so again, we were antigen here we then went checkpoint and what Jedd said back in 2011, 2012 he goes, “I predict Phil, that we will have a day coming sometime in the next 10, 15 years, where the pendulum goes back to the middle, where we do both, we do antigen, and we do checkpoint.” You know, that hopefully gets us out of that 20 to 30% when it magically works. It works. So we start thinking about combination approaches. And that's always been the holy grail that we always talk about. You know, we go to the meetings and combination, combination, combination. But, you know, we bearly have one, as you know, never mind combinations so we're now at that point where we can be rationally thinking about it and we know from the human side that a lot of those checkpoint inhibitors allow radiation to work better and potentially create immune responses or we call abscopal responses. So yeah, it's crazy exciting to have an agent like that and you know it also generates more more interest in veterinary oncology, because that I think is a hard thing for a lot of folks to understand, is that a blockbuster on the human side is a multi-billion dollar drug per year. In veterinary medicine, that's a couple million. You want those 50 to 100 million dollar drugs like you see in the antlementic space and vaccine space, but we don't have those yet in veterinary oncology, so it's really up to us to prove that that market, in fact, does exist. And it's hard for companies because they look at the return on investment and say, oh, blockbuster is a multi-billion dollar drug in veterinary medicine. It's 50 to 100 million. Does my ROI add up? But we both know as practicing clinical oncologists that we still see plenty of cancer out there that doesn't have a really good standard of care. And we can do better. 

So I have no doubt that in knowing, you know, if I kind of wear my clinician scientist hat, which is what I do when I'm not in the clinic, there is some incredibly cool stuff that's coming to veterinary medicine by specific antibodies, things that grab two things at once that are known to work a lot better and better immune engagers. I constantly worry about who's going to be able to afford them because, you know, are agents that are not of trivial expense. They have come way down for the cost of goods, but in the end, they're just based on that ROI side of things. If these companies don't make money, they're not going to give us products, so there has to be a balance there. Seeing the things that are coming, I know that, and that's why I framed this around that Rituximab idea where that's what blew up human oncology and started the whole thing. And I think we're similar to that now. And more and more of these agents will be in our hands over time. 

Dr. Venable: Yeah, I agree. We're kind of on that precipice, right? People are getting excited. We're getting interest, new products. I think some of it's going to be training the veterinarian how to use it, too, though, because I think sometimes vets, when you hear 20, 30 % response, they're like, oh, I'm not going to mess with it. But it's like, no, but for the ones it works, it works really well. Like we shouldn't necessarily just blow it off. 'Cause otherwise, you know, for like these melanomas, if you can't do much of anything else, like you said, they're kind of sent home to pass away. So why not try, even if it's lower, it's better than what you were going to do otherwise, right? And I think with a lot of these different things, it's going to be educating the community and the pricing. That's something that, you know, you hear a lot about people talking about the price of veterinary medicine. Personally, I think it's probably going to have to be insurance at some level, trying to help with some of these prices. I know I always tell friends or family, like when they get puppies, I say get insurance. And I'm saying no, because of course, they're always thinking about cancer when I say it. And I'm like, I know you just got a puppy, but even if this puppy eats something and you have to have emergency surgery, do you have the cash sitting around to pay for that? Because it can be several thousands of dollars anywhere in the country, not just on the coast. 

Dr. Bergman: Yeah, I'm wholly aligned with that. I constantly say it bothers me that our industry has not trained our clients to recognize that when you get a puppy, yeah, there's some costs related to spay-neuter and vaccines and all those things. And then you go to middle age and there's usually less. Then you get to older age and there's some catastrophe. Whether that's hit by a car or develop diabetes or develop cancer or whatever that spontaneous disease is. I tell all my friends that are not veterinary related that, you know, if an $8,000 bill is something you can handle as a family easily, you don't need insurance. But if that $8,000 bill is going to wreck your family's insurance, then somewhat like an annuity that you pay into, you should really think about getting insurance. 

And you and I know of case after case after case, where it's a financial-based euthanasia, which I hate. It's one of the worst feelings in the world that a client can't do even any level of standard of care. And then that translates into the euthanasia of that patient. And one of the best words that we hear in specialty is, "I have insurance." because we know that that's a client that then is gonna be able to afford standard of care therapeutics, whether that's hit by a car or a bloat or cancer. You know, there's even studies that I'm sure you've seen that suggest that there's a greater chance that you'll diagnose a certain type of cancer when they have insurance because owners come in and they get that lump or bump checked out. And, you know, it's exactly why, why at VCA that we've partnered with one of those insurance companies because we really believe in their mission. But yeah, we've done a really poor job of telling the public that there's gonna be a major event that happens in that animal's life, whether it's like you said in middle life or end of life. And if you're not financially prepared for that, get insurance because it will pay off. 

Dr. Venable: I totally agree. And to see how things play out to people too. You know, up for us that trickles down because so many of the products is it's coming from the places or industry, like you sa at the same expectations, you know, is it worth going into vet med? So I hope they continue t to see us as a good market so we can keep having good options for our dogs and cats and various pets that people have.

And as we're wrapping up this talk, and I think it's really been exciting to hear all the different things that you've been involved with and the one health and kind of where we're heading in veterinary medicine. I'm just wondering if there's anyone else that you recommend that we should interview on this podcast. 

Dr. Bergman: The name that automatically comes to mind just 'cause you know, I think of him as one of our preeminent clinician-scientists in veterinary oncology is Doug Thamm. He's one that I would think of. Another is Heather Wilson-Robles. And part of why I think about her is, you know, she was foundational to the Nu. Q blood test. She has navigated a lot of things when it comes to kind of the obstacles piece that you've talked about previously. And I think she could probably have some journey aspects that she could share with you from both personal travails in addition to what she's been through with Nu. Q and,

 you know, some of the things where her professional journey has taken her currently. I think that would be a pretty interesting discussion as well. 

Dr. Venable: Yeah, those all sound great. Thank you so much. We'll certainly have to reach out to those guys. And yeah, I think those could all be great conversations. I think thank you so much for being on today. I really learned a lot. I hope other people, you know, if they didn't know really understanding,

 like, to me, it's that one hell. That's how much we can help each other. I just feel passionate about that, 'cause that's where I really see we can all progress both animals and people. So thank you so much for all the work you do in that arena, and we'll continue to see, yeah, the Gilvetmab. I was hoping you were gonna say that, 'cause that's what I thought. thought you were going to say. And I'm really excited to see, one, what they get out of all those grants. I think that was brilliant that they're doing that. And then also with the vaccine, you know, the melanoma vaccine, like how can we charge up the immune system with all this? So stay tuned. It's exciting. Hopefully we'll get all these results, you know, over time. 

Dr. Bergman: Well, baby steps. I so want to thank you for the opportunity to be with you and all the folks. that watch you. So I greatly, greatly appreciate it. 

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 share our podcast with your friends and colleagues. And it would be even more wonderful if you want to give us 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.