Dr. Elizabeth Iorns is a scientist whose research focuses on identifying mechanisms of breast cancer progression. She is a cofounder and CEO of Science Exchange, and she helped launch the Reproducibility Initiative. She was involved in the development of Olaparib, a targeted therapy directed at the BRCA1 and BRCA2 mutation, best known for its relation to breast cancer (and recently added to the FidoCure® platform).
When Dr. Iorn’s dog got cancer, she sought out veterinary oncologists and was surprised by what she experienced. She joined us for a very special discussion and shared a candid view on veterinary oncology through her expert lens.
You have a fascinating scientific background as a cancer biologist with academic research interests and then you started a company called Science Exchange. Can you tell us about each of these experiences and how and why you got involved? How are these two roles related, if at all?
I’ll start by telling you a little bit about my journey of being a cancer biologist. I did my Ph.D. in Cancer Biology at the Institute of Cancer Research in Alan Ashworth’s lab, who was one of the first discoverers of the function of the BRCA2 gene.
I was very fortunate that the lab worked on the discovery of PARP inhibitors that specifically killed BRCA deficient cells. That subsequently led to the development of Olaparib, now in the clinic for human oncology. And also, very exciting to hear it is now available for dogs through FidoCure®. It’s hugely exciting to be part of the journey to make this drug available to dogs, and potentially how much more it can help in the canine oncology world than the human world.
I became Assistant Professor at the University of Miami’s Miller School of Medicine and worked on a number of new target discoveries in the field of breast cancer biology. As I was doing that research, I saw technology becoming more specialized and specific. Finding the right partner to manage projects and exchanging payment for work became a real challenge. Administration was taking up about 30% of my time. This is where I came up with the idea for Science Exchange.
We would use software to create a marketplace to outsource research and development. By doing so, contracting and administrative setup work goes through organizations that offer services. This enables companies and researchers to initiate their work immediately and manage their work effectively.
We’ve been involved in biotech industries, novel oncology drug discovery products that have been brought to market. Seeing this innovation has been a really proud point!
Not only are you a cancer biologist, but you are also a pet parent, whose pet Frenchie, Lily, is undergoing cancer therapy. How is that journey going? What have you learned about veterinary oncology that surprised you? What did you experience that did not surprise you?
It’s been an incredible eye-opening experience for me. I think it’s been helpful as a cancer biologist who has worked to work in the biotechnology pharmaceutical industry. I already know the research and development (R&D) of these companies and was able to reach out to talk about the latest in their cancer research and pipeline of drugs. I’m always aware this isn’t available to most people.
When I think about my experience and the journey I’ve had, I feel like there is a significant opportunity to improve what is available for canine oncology patients. I’m grateful to FidoCure® for what you’re doing to enable that.
As a pet parent, my journey started when my dog had multiple seizures one day. During COVID, it’s worse because you rush your dog to the ER and cannot go in. For them to say it could be a variety of things and it could all be very expensive, at that point, it pushed towards euthanasia. I did not want to go that route and went for specialists.
Getting into the specialist was a challenge. Veterinary oncologists are very busy in the Bay Area. It’s a sad reflection about the number of oncology cases in the canine world. It’s also exciting to know people want specialist care for their pet.
The diagnosis with canine glioma and the prognosis was extremely poor. Our local veterinary specialist recommended a path of palpation with 30-60 days survival, or take a path with no data. How could I sequence my options to give her the best life with the time I have left with her?
I had to navigate this with key opinion leaders at different clinics running clinical trials. They were so kind and responsive to me reaching out randomly. All of these sites responded to me immediately and gave advice on what they would do. It was a great thing to see from the community. Unfortunately, the information was difficult to digest. I was getting information from the human oncology field of outcomes-based data and mortality rates based on intervention.
In the end, I chose to not do clinical trials to have some control on the path I was taking for my dogs. I was able to access an experimental compound that holds a lot of promise in human oncology and combined it with another radiation therapy.
Now, I’m in a waiting pattern to see when her tumor relapses. I’ll continue to investigate other options during this time. This whole journey helped a lot by being able to talk to Dr. Post, Christina, and Ben to understand the latest available for dogs.
My takeaway is there is a lot of room for what we can do for pet parents. Many would do anything, but they do not have the ability to read through hundreds of papers to come up with a plan. It would be helpful to give them outcomes options outlined.
Given your unique perspective – as a cancer biologist, business entrepreneur, and pet parent whose pet is undergoing cancer therapy – what are your thoughts on how we can improve the field of veterinary oncology?
I think there is a myth in the community that surrounds the market size for canine oncology. FidoCure® is demonstrating there is a commercial space.
There is significant demand for oncology products for canines. If you look at the radiation therapy, it’s $10-15k per treatment and this industry is expected to grow to $4 billion in the next few years. There's such a high demand that you can’t even get your pet in. It's a good marker for the demand in canine oncology.
The market seems small because there are few options available.
The lack of FDA approved drugs and lack of knowledge whether the drug is safe and effective is a challenge for veterinary oncologists. With the teams we’ve worked with, I come to them with a lot of different options. It’s a question of working through the data. Often, there isn’t any data. There’s data about talks and distribution, but nothing about efficacy. It becomes a question of risk and benefit.
There is enormous potential to take information already captured about how dogs are being treated extra-label and use that to inform other veterinary oncologists. I know this is part of what FidoCure® is doing.
How can you connect canine oncology clinics so the data can inform an outcomes database that can be leveraged by everyone? How can we start to take all of the drugs that should work in dogs and make them available to be tested in that cohort? And quickly look at the real world evidence?
There is huge potential in the human oncology space, as well. It’s the opposite issue. There’s so many FDA approved drugs available. The canine oncology data can be used to inform the human oncology space.
How, in your opinion, can we harness the power of comparative oncology, for the betterment of both pets and people?
It’s really surprising people do not look at this as the go-to model. It’s a well understood translational model. There is a big opportunity if we can connect veterinary oncology sites.
They have to also benefit the dog. What I’ve seen happen is the excitement for trials that are single-site. But it’s only to inform their human development. Even if they see a good effect in canines, it doesn’t mean they make it available for other dogs. I have ethical issues with this. If you’re asking a patient to undertake risks to go through a trial, then you owe it to the population to make this information available, whether it is positive or negative.
Some information is not made available or is actively withheld. It needs to be a goal to benefit the dog and the human.
There needs to be a focus on commercialization of the product for both the canine and the human.
With regards to Science Exchange, is there room for veterinary oncologists to participate in the larger biomedical research? And if so, how do you see that going forward?
It’s something I’ve been thinking a lot about in this journey. At Science Exchange, we contract and qualify various sites that provide R&D services, such as clinical trial sites and contract research organizations (CRO) to Next Generation Sequencing (NGS) and antibody development. It’s a huge range of things being offered.
I started thinking if there is an opportunity to target the veterinary oncology sites that would be interested in participating in clinical trials to get set up as sites on Science Exchange, then go after pharmaceutical companies we’ve already worked with to explain the amazing opportunity to use this translational predictive model. I really do 100% agree it needs to be done not as a subject, but as a patient. You want as many people to participate with their pets, as possible.
For me, I made this decision deliberately because I wanted my dog to be a patient, not a subject. Even though it was extremely costly, I chose that path because I felt that
I would also add that through Y Combinator, we get to see a lot of exciting products. When I met Christina, it was very much on the cutting edge. There’s an explosion of companies developing things for dogs. I feel like it’s the tipping point. People are realizing it’s a huge opportunity. It’s growing dramatically in oncology and other areas for pets and their health. It’s an exciting time for people thinking about starting a company in this space.
When dealing with biotechnology and pharma companies, how do we in the veterinary community convince them that there is real economic benefit to get involved?
There is a distribution arm that is practical for biotech. What happens today in the human oncology space is that most innovation is coming from small biotech companies. They are being bought by large companies once they’re already in the clinical setting.
You’re never going to have a small biotech company say, “Oh yeah, I’m going to develop this for canines, as well.” They have to stay ultra focused. I think what we can do is make it possible to say if someone is tested in a certain setting, it will be informative and effective for humans. Secondly, as part of the trial, make possible there to be a distribution channel for that drug that you’re not really responsible for.
Even in the big pharma space, Elanco or Merck, you’re not really seeing those companies translating companion animal oncology products, either. They’re making them for humans but they’re not pushing them across. They’re focused on areas not on the companion animal market. If you create a clinical trial network and get biotech and pharma to understand the value for the animal-human translation, you ask for the ability to translate the products, the animal benefit is successful.
For the average parent at the ER being pushed towards euthanasia often means the end of the road. They don't have the resources or knowledge of this speaker and they trust the ER doctor. Is the problem actually in educating those first line doctors so they can educate their patients? Why are they so inclined to push towards giving up? On the other hand, is it better not to give hope because parents cling on when they shouldn't?
Dr. Post: I do think veterinarians, in terms of veterinary education, are caught between a number of competing factors in our role as healthcare givers to the pets. We are there to benefit the health of the pet. But because the decision maker is not the pet, we have to be cognizant, compassionate, and understanding of the concerns and financial aspect the owner has.
I do think it’s likely a problem that originates at the veterinary education level. I don’t think veterinary education teaches enough about the intersection of finance and medicine.
From my experience in training interns and residents, I explained my philosophy to give the owners all of their options. If people were given more options, they would have done more. I think it is a problem that can be solved by teaching students to communicate to pet owners options in a non-judgemental way.
Dr. Iorns: I think it’s important to communicate with the pet owners all of the options. With brain tumors, it would be, “Here are the theories of the treatments you can undertake to give you the best chance to gain quality of life and here is the cost.”
I don’t think people know enough. The information i got to start with was very much, “You can do surgery. It’s not clear if surgery will have a better outcome than palliation. There’s a 10-15% mortality rate.”
It’s difficult information to hear, not even taking into account the cost of surgery. It is important to get to the outcomes, options for the patient, cost, and the time it buys. if people have that information, they will be able to make better decisions.
How is this relevant to cats?
Much of it is relevant to cats. This is on our radar.
At this point in time, we started with dogs because there is much more known about the dog genome and the drug metabolism in dogs. FDA and EMA use dogs as a model for when they submit drug approvals. That information is available, whereas the drug metabolism in cats is quite different. We all know that they’re not small dogs!
We absolutely agree that cats need to come next.
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