In our third webinar we were fortunate to have Professor Cheryl London, DVM, PhD, ACVIM (Oncology).
Dr. London is a global leader in veterinary targeted therapies and truly a luminary in the fields of veterinary and comparative oncology. She played a pivotal role in the development of Palladia and in bringing Apoquel to market. Dr. London is a member of FidoCure's Scientific Advisory Board.
Dr. London discussed potential risks to veterinary staff, the value of targeted therapy in times of constrained PPE resources, and the effects of COVID-19 on research activity.
Cheryl London, DVM, PhD, DACVIM
Question:Can you comment on circulating misinformation about risks of COVID-19 to pets and therefore veterinarians?
- It is very unlikely that there are active viruses in the majority of treated patients, at least in the population at large.
- In the community, there’s no uptick in veterinarians becoming infected at a greater rate due to their exposure to pets.
- In papers about animal transmission, the animals used were directly infected with heavy viral loads directly into their nasal cavity - not like real world infections.
- The American Veterinary Medical Association’s position is that the risk to veterinarians remains very low.
Question: How has COVID-19 affected your practice and clinical trials, as well as your research?
- Most laboratories nationwide are closed and research is on hold, unless it relates directly to COVID-19.
- Researchers are attempting to keep patients already enrolled in clinical trials on track and receiving treatment, but there are restrictions on enrolling new patients.
- At Tufts, patients only may enroll in clinical trials if they are emergency room patients - no outside patients may be solicited.
Question: Can you comment on the value of targeted therapies in our contemporary circumstances (COVID-19)?
- In human oncology, there’s been an explosion of small-molecule inhibitors being used in cancer therapy. There is no question that they are effective in many circumstances. In veterinary medicine, there is only one drug (Palladia) commonly used, and so these target therapies represent a major new opportunity to rethink biases against taking advantage of targeted therapies that are already on the table in human medicine
- Because there are major restrictions on PPE and hospital visits, targeted therapies allow veterinarians to still treat their patients, so there is a rethinking of treatment options.
- Regarding prescribing the medication - while there won’t be extensive pharmacokinetic and pharmacodynamic experiments, there’s a good sense of how to begin dosing due to existing human data and canine experiments during pre-clinical trials. Most toxicities are relatively easily managed compared to traditional therapies.
Question: Can you comment on the safety of targeted therapies?
- There’s usually a large body of safety data on targeted therapies for humans, and by and large, much of the testing is done in dogs!
- The safety/toxicity data provides an excellent starting point for dosage and use guidelines.
Question: How helpful was the original pharmacokinetic data in managing Palladia, as it related to the actual dosing used in clinics?
- Researchers used a combination of limited data from research dogs and modelling done in mice, and arrived at a far different dosage recommendation than the original data would have suggested. At the end of the day, it’s important to see how actual patients react and make adjustments.
Question: What are the promising areas of research in the future of veterinary medicine, and specifically oncology?
- The explosion of genomic information has allowed things like “blood biopsies” which have drastically improved the genomic assessment of cancer.
- Being able to identify genomic drivers of any kind of disease has changed and will continue to change how patients are treated.
Question: Do you think COVID-19 will accelerate or stifle veterinary research?
- There’s been a total 180 research studies done by all medical professionals to focus all their efforts on just one virus. Pandemics will continue happening as we grow closer together, and this unified work may allow a better response in the future.
- No one knows what will happen with funding in the long-term, but it’s likely there will be federal assistance.
Question: What’s the value of real-world evidence, and can you explain a little bit about it?
- Real-world evidence is critically important for not only identifying aberrations, but today, when time is limited, it’s also reasonable to use real-world evidence to make decisions.
The real world evidence is not anecdotal, but should take the collective experiences of those people collecting data to assess the value of a therapy.
- In the past (i.e. with Palladia), real-world evidence has been helpful to complete the picture.
Question: What happens to pets in clinical trials that are cancelled?
- At least at Tufts, the administration has given permission for studies to continue, given that the patients involved would suffer serious harm if the study were terminated.
Question: Who mans the hotlines to determine what pets need to come in?
- Emergency room doctors generally take these calls. Doctors are triaging as much as possible.
Question: Since it’s difficult to collect PK/PD data for all of Fidocure’s targeted therapies, what would you recommend as an alternative to balance tolerability and efficacy?
- Going back through the available FDA IND (Investigational New Drug) data, there is a lot of PK exposure data buried, but it’s challenging to access.
- PD data is far more challenging - it may now be possible to look at circulating tumor DNA or exosome data, but these are expensive and time-consuming options.
- Looking at creating fillable case report forms that veterinarians can use to track outcomes and adverse events - crowdsourcing. Community feedback has worked before (Palladia).
Pamela Schwartz, DVM, DACVS, CCRP
Intro: discussion of current situation and new procedures
- Many new procedures/policies, and they’re changing day by day. Following all CDC/WHO guidelines, and the World Small Animal Veterinary Association more specifically.
- Curbside check-in, and only two clients in the lobby at a time.
- All who can work remotely are doing so, and limits the number of staff working in the building.
- Telemedicine and phone consults are being used.
- Hotlines for clients and referring veterinarians to call.
- Majority of the case-load is urgent/pain relief, and continuing treatment of cases that already began it on an as-needed basis.
Question: How do you effectively communicate the new changes to decrease the stress level of your staff and clients?
- Nonstop communication to determine what worked/what didn’t and what changes are necessary tomorrow/in the future. The communication doesn’t only have utilitarian value, but helps reassure all parties involved.
Question: Is your hospital, being located in NYC, donating PPE and ventilators?
- The recommendation from the CDC has changed, and so the hospital is distributing masks, but recommending to reuse them, as well as looking into making cloth masks. Obtaining cloth gowns, as well as sourcing from companies that haven’t historically been used.
- Some of their ventilators are actually human ventilators, and they’ve been donated to human hospitals in the area. However, the pet hospital continues to operate and see patients.
Questions to both Drs. London & Schwartz
Question: How do you deal with the difficult decision to tell clients that their pet currently can’t come in?
- Now that people are understanding the gravity of the situation, there is a lot of compassion from clients. Clients are just as stressed and concerned as vets, but it tends to manifest as kindness.
- Clients tend to be extraordinarily grateful when they are able to come in, and of course veterinarians make the greatest effort possible to still treat patients.
- Clients tend to understand, but it remains enormously tough to break the news to them.
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