In our fourth webinar of this series, we welcomed Dr. Barbara Kitchell, renowned veterinary oncologist, who will discuss repurposed and translational (human and animal) drugs amidst the COVID-19 pandemic.
Recently, drugs like hydroxychloroquine, traditionally for Malaria, are being repurposed to treat COVID-19. Such repurposing is not common but also not unprecedented. Dr. Kitchell shared past cases of such repurposing in the veterinary world and pointed out its opportunities and challenges.
In our second segment, Dr. Kitchell was joined by panelists Lilissa Williams, CVT and Deb Bascombe, LVT, two highly experienced veterinary technicians who shared COVID-19's impact on their roles and on the families and animals they serve.
Gerry Post, DVM, MEM, DACVIM (Oncology)
Let's first define "repurposed drugs."
These are drugs originally used for one medical condition and then used for another condition.
They are different from "translational drugs" which are drugs used in one species that we then used in another species for the same or similar medical conditions. FidoCure® targeted therapies are examples of translational drugs (from humans to canines).
Barbara Kitchell, DVM, PhD, DACVIM (SAIM & Oncology)
Question: What does “repurposed drugs” mean, especially in relation to COVID-19?
- Repurposed drugs mean an opportunity to evaluate existing drugs for other indications and adding them to the cancer care armamentarium.
- DNA testing, like FidoCure, helps vets better understand specific pathways for malignancy. This opens the door to treating animals with bioinformatics-based drug assignments.
- COVID-19 highlights repurposing, especially due to the big push for non-viral licensed drugs (like hydroxychloroquine).
- This is an opportunity to conserve PPE by using oral therapies.
- Repurposed therapies are also cost-effective, which is especially important during this time.
- It is a great opportunity to introduce and pair targeted therapies (repurposed drugs) along with standard-of-care therapy.
Question: With the new information we have today, how has our approach to drugs changed over time?
- Anecdotally, it often wasn’t until later re-evaluations that veterinary researchers realized human drugs could actually be used effectively for dogs. FDA licensing filings were not available for them to use at the time. As a result, researchers were only familiar with human drug doses.
- Today, we can look at preclinical pharmacological toxicology data from dogs in FDA and EMA IND filings and have a real understanding of safety and doses to keep our patients safer.
Question: Do you agree that targeted therapies are an important tool for veterinarians looking to expand their “toolboxes,” especially now?
- Today, yes! Understanding what is deranged in cancerous cells allows veterinarians to personalize and directly target the cancer, instead of using traditional cytotoxins to just treat rapidly dividing cells. Targeted therapies allow much more nuance.
- The current economic crisis we’re facing opens the door to cheaper options, like targeted therapies! We don’t want to bankrupt a client in the pursuit of helping their pet live longer.
- USP 800 compliance is uncertain.
Question: This economic crisis will likely dampen the amount of veterinary research funding available. How do you see veterinary oncology research funding faring in this new reality?
- In the 2008 crisis, the Obama Administration helped veterinary oncologists with grants to allow researchers to still make some discoveries. It’s hopeful but unclear if the Trump Administration will do the same. However, veterinary research remains largely dependent on donors.
- Repurposing drugs is inexpensive and allows research opportunities for young doctors. Thinking creatively about this is important!
Question: How do you think COVID-19 will affect veterinary residency training, both in terms of applications and the training they’ll receive?
- The staggering student loan debt crisis already exists. One thing that could happen is a call for reducing or eliminating student debt, which might allow young people to pursue advanced training without the debt load.
- However, even this year, there has been a decrease in the number of students pursing advanced training. Maybe they wanted to, but the reality is that they could not due to financial reasons.
- The challenge is how to get students to come into the field, maintain them, and keep them actively contributing to make the world a better place. It’s a huge economic burden. As a consequence, it’s an open-ended question right now, but I’m always an optimist. We will continue forward as a profession and help our best and brightest be the best they can be.
Lilissa Williams, CVT & Deb Bascombe, LVT
Question: How has COVID-19 affected your job?
- Previously, patient care was the main focus. Now, techs must focus on their own safety and the safety of their entire team while still maintaining quality patient care.
- Accommodating the lack of staff is difficult, especially in cities with stay-at-home orders.
- Most clients are understanding. However, some don’t understand why they cannot enter the building to speak with techs and must remain curbside. This exacerbates existing safety difficulties.
- Often, clients will rely on techs who have a very close relationship with them. It’s not always doctors. The elimination of physical closeness has made things tough for clients and techs.
- The most important thing is transparency for both staff and clients.
Question: Are clients and staff concerned about getting COVID-19 from pets, or vice versa? What can you do to reassure these people?
- There’s minimal contact with pets due to the PPE (masks, gloves, etc), which hopefully reassures our clients.
- According to the CDC, there is minimal evidence of human-to-animal transmission.
- Furthermore, IDEXX and Antech have done thousands of tests for COVID-19 in cats and dogs. They have not found any cases of transmissions from pets.
Question: In terms of client interactions, are you implementing any new technologies to help bridge the distance?
- There’s a desire to have video conferencing with clients but the technology is often difficult to set up and takes a lot of time.
- Our techs have been sending videos of pets to clients’ phones in the parking lot. But they are using personal devices for this.
Question: Has this pandemic affected your thoughts about belonging to the veterinary profession, whether negatively or positively?
- It is stressful to perform client care normally while trying to promote personal safety and safety among the team. In addition to limited/eliminated client and patient interactions, it feels very demoralizing.
- It feels like it’s more about COVID-19 protection, and less about client care sometimes.
- On a positive note, the pandemic has helped to build better relationships with some clients. Due to the absence of physical interaction, there are lots of personal conversations over the phone.
- Self-care is very important!
Question: Is there a process that you would keep from COVID-19 after the pandemic has subsided?
- Better record-keeping: Clients are giving techs more information because they’re on the phone so much. They aren’t getting distracted in-person.
- Promoting strong support networks between all members of the staff, leading to increased teamwork and better morale!
Question: How can organizations, such as the CDC and AVMA, improve communication with veterinary professionals?
- More information on what positive animal tests mean (i.e. positive test on zoo tiger that made the news recently) - clarity and transparency is very important!
- We need information that’s comprehensible by clients and veterinary professionals in equal measure.
- Establishing a collaborative team between veterinary and human medical professionals would produce a good source of information.
- Social media misinformation is a huge problem. Professional organizations should work really hard to combat it.
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