Dr. Fenger: One thing I really valued is learning how to do a team science approach. And what that means is that you get people that have backgrounds, different areas of interest and between kind of that active conversation, I think that's really where a lot of ideas get generated. And oftentimes it helps when you have a multidisciplinary team, you really kind of leverage the strengths of each of those individuals. And so that truly is kind of what I find most fun about team science.
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.
Dr. Venable: Welcome to the Veterinary Cancer Pioneers podcast. I'm your host, Dr. Rachel Venable, and I am so excited today, we have Dr. Joelle Fenger, and we are going to learn more about what she does with Ethos and her career and comparative medicine and some clinical trials. And her background is really interesting. She's a medical oncologist, cancer biologist, and advanced training and comparative clinical trials.
She completed her veterinary degree at the University of California, Davis, and did a rotating internship and an oncology residency with a PhD. Quite impressed. I definitely did not do the PhD, in comparative and veterinary medicine at Ohio State. She was a faculty at Ohio State before joining Ethos and then Ethos Discovery in 2021. So her expertise is in comparative oncology and extending early preclinical findings into translational applications. So that's that's the stuff I really love. I love comparative oncology. And we'll look more at the studies and things she's doing. So Dr. Fenger, thank you so much for being on the podcast with us today.
Dr. Fenger: Well, thank you so much. I really appreciate the opportunity to speak with you and get engaged in the veterinary community, and just really pleased and grateful to have the opportunity.
Dr. Venable: Well, thank you. And you know something I always like to know just kind of getting to know someone a little bit better is what got you into oncology. And I feel like this is what people ask me all the time, when they find out you're an oncologist. So how about you? What got you into oncology?
Dr. Fenger: Yeah, well, I'm probably one of the rarer people in that, I didn't know that I wanted to be a veterinarian when I was a kid. It was actually something that I kind of fell into a little bit later. When I think back when I was a kid, I was going to be a journalist. And then when I was in high school, I actually played the flute and was going to be a flutist and, you know, life happens, and didn't get into music school.
And, ultimately ended up studying at the University of California, San Diego, which, aside from being, obviously beautiful location was a really great sounding board for me to just sort of be an undeclared college student. And there, you know, I really was just thrilled and curious about, really, the science that was going on on that campus. And, you know, I was really lucky to kind of go into more of a comparative animal physiology, sort of a training program. Spent some time at the Scripps Institute of Oceanography, and that really kind of like tickled my curiosity as far as just science. And then, you know, medicine it I really that that was the basis of like comparative medicine for me.
And what I will say is that really led to me kind of getting interested in the veterinary field and comparative medicine. And so that's sort of, you know, fast-forward how I ended up in veterinary school. With respect to, you know, specializing in oncology, it really came from a personal space for me. So when I was 23, my father was diagnosed with prostate cancer. And ultimately, you know, he also developed colorectal cancer. And so I will say that that was in my 20s, you know, you're pretty young, and honestly, being on the other side, being on the patient and family side really influenced sort of my understanding, like as being a patient and family member on the other side, I was curious to kind of understand, like the science and then the medicine and the biology that was going on, and then also just really came to recognize just the field of oncology and how much of a special field it is, you know, and that goes from everything from not just the fact that there's really new and innovative and really cool scientific stuff going on, but at the same time, there's so much more than that. And really like the survivorship piece and the family piece and truly like the journey going through. Anyone who's being treated with cancer is really what kind of like my experience. It was just something where I was kind of like, well, I get this. This is tough. I would love to be on the other side of it where I could actually be helping patients with cancer. And so, you know, sadly, my, you know, my father passed away in 2010, but, you know, he was really great at seeing that cancer journey. I think we all know it. And now that I'm a veterinary oncologist, I see it in my patients. There are good days. There are not-so-good days. You know, you have to think about survivorship and hope and kind of look out for new cures. You know it's it's tough. It's a long battle, and it can go up and down. And so you know, I think that personal experience ultimately combined with just my curiosity about science was really what drove me into that Like that field. I can't say that I'm here without the help and support of like, some really phenomenal mentors, many of which we know in the oncology field.
When I was a veterinary student at the University of California, Davis, I did a summer research project with Cheryl London and literally did like 80,000 Western blots, none of which worked. And so, you know, got to present my like, 12 slides of completely negative data. But it was a really great experience. And obviously, you know, she's a real pioneer in the field of oncology. I learned so much. And, you know, I to this day consider her, a friend first, colleague after that. But really, it was phenomenal working with her and obviously really kind of stimulated my curiosity. This was the days of, you know, the early Palladia field trials and seeing her enthusiasm about like, wow, this is like actually working and then understanding in the lab setting, like why this was working was really exciting. And so, you know, fast forward when I had done my internship and residency at Ohio State University, you know, Cheryl was also there as faculty.
That's where I had the opportunity to delve into the science part a little bit more. And I did my PhD with both Cheryl London and Dr. William Kisseberth, and really benefited from just the phenomenal mentorship that they started the spark. I'm really grateful for that. That's really, you know, how I delved into where I'm at now, you know, one thing I did do is I had the opportunity to stay on as a research-intensive faculty member at Ohio State University, and that was phenomenal.
You know, the Ohio State University is a really huge campus. They have a world-renowned, James Cancer Center. So one thing that I really had the opportunity to see there, and that I really loved in the academic setting, was learning more about team science. And so, you know, cancer is incredibly complicated. One brain is not going to fix the problem. And so one thing I really valued is learning how to do a team science approach. And what that means is that you kind of get people that have backgrounds. Sometimes they're quite different and surprisingly different areas of interest. But, you know, you can get a bioinformatician together with a genomic scientist, with a pediatric oncologist and then bring in a veterinarian who also treats, you know, tumors that are similar in the pediatric setting. And between kind of that active conversation, I think that's really where a lot of ideas get generated. And oftentimes it helps when you have a multidisciplinary team, you really kind of leverage the strengths of each of those individuals. And so that truly is kind of what I find most fun about team science. And honestly, when I had joined Ethos Veterinary Medicine, again, speaking to about mentors, you know, I was really lucky to work with Chand Khanna, who's wonderful and obviously another pioneer in our field. And really my discussions with him were that I want to, you know, it's time for me just kind of as a personal for me to kind of try something different. I still wanted to do research, but maybe not necessarily in like an academic environment. And so that's kind of what led to us discussing about opportunities with Ethos Veterinary Health and then Ethos Discovery.
So Ethos Discovery is a not for profit research, really an incubator of scientific research. And we work closely with the Ethos Veterinary Hospitals. And so the Ethos Veterinary Hospital network is now a network of over 145 specialty and emergency hospitals. Within that, there's a little over 70 oncologists. And these are, you know, oncologists that are spread all throughout the United States and Canada.
And so I honestly wasn't very clear about, you know, can I continue to do research? Can I still see patients and do that in kind of a new bubble? You know, I think working with Ethos Discovery and Ethos Veterinary Health has been really, you know, innovative and kind of rejuvenated me a bit from the standpoint that I am able to kind of wear a couple of different hats. And so, you know, I do see patients, as a medical oncologist. And then I have an opportunity to also help manage write up and kind of analyze all that, like real nerdy data on kind of the ethos discovery side, but again, within the context of a little different from academia, but also very parallel. In some ways, in that there's sort of multiple sites or multi-institutional, multiple investigators leading these trials across a wide variety of geographies, which is probably important.
Our goal is that we can kind of do this and hopefully, you know, be able to actually accomplish goals of of kind of high evidence based prospective clinical trials. But really, you know, it's just in a private practice setting. So that being said, we're very agnostic to who we work with. And so who do we work with? Ethos Discovery’s The boots on the ground is sort of clinician scientists like myself. Obviously, I spend some time in the clinic. I can be involved in clinical trials and seeing those patients. And then kind of on the flip side, be kind of on the scientific side where we can help with the design of trials, analyze that data. Talk about disseminating those findings within, like the scientific community. But, you know, that goes back to who our collaborators are. And so it's been really fun, in the sense that we've gotten a chance to collaborate with industry partners and academic partners. So, again, I hope to see this kind of a model be a little bit of a bridge between the ways that you can do team science. And so that part is, is again, that's what I loved when I was in academia is team science, you know, love that I'm able to find that kind of an opportunity. But just in a little bit of a different environment.
Dr. Venable: Yeah. I think that so many important points, you know, covered there and loved all the different stories and everything. And I, I am interested, you know, because Ethos like you said, it's a private practice. It's different. How would you compare it to academic science. Like are you still able because like the team, is it more narrowed with Ethos? Because I would assume in academia, especially like Ohio, like you said, you had access to all these various, you know, fields in different things. So how would you compare and contrast the two?
Dr. Fenger: Yeah, I think it's a really good question. And obviously the academic model is one that there's a huge opportunity to have all sorts of different multidisciplinary teams. You know, that's something that will always be phenomenal and hard to recreate in any other setting beyond a really large university setting, if you will, or college setting. You know, on the flip side, so when we talk about being clinician scientists in sort of a private practice infrastructure, one thing there are some important differences.
So what we don't have with Ethos Discovery is a true wet lab. So because of that, and I don't necessarily think it's a barrier, but our partners or whether that be industry partners, it could be actually academic partners. Those are the individuals that are actually able to have like the wet lab, you know, capabilities to do, you know, what someone say, you know, like the science part of it.
Obviously, what we have and we have tons of them is hospitals where you can actually conduct, you know, and you're seeing really high volumes of patients, you know, the clinic load is really quite heavy in private practice. That being said, the patients that we're serving, they also the patients as well as their families are interested in exploring things like clinical trials.
And that can be a little daunting. There's only so many veterinary schools. And like everything, there's access, geographic access to be able to actually be part of or have your, you know, your own pet participate in some of these really innovative trials has always been a barrier. Right. And so I would say that from this from the context of doing these trials within kind of the Ethos Veterinary Health network, the ultimate goal would be you could open a trial at each of those hospitals than it actually has.
That allows our pet owners to have accessibility to medical care and hopefully would be innovative, cutting edge trials that they can actually have access to. So, you know, again, I think one important difference is that the the scope and the scale of the geographic and catchment of sort of a private practice setting is really beneficial from the standpoint that that hopefully it could provide access to pet owners that otherwise wouldn't have that. Those are going to be, you know, the very big differences and recognizing those differences, it just sort of means it's a little bit nuanced in terms of where you're actually conducting your work in many cases. Again, the the wet lab being at, you know, an industry partner, academic partner, biopharma what we kind of our laboratory, if you will, is really going to be on the clinic floor. So that's my new laboratory is, you know, being in a, in a clinical hospital setting and being involved in the, the collection of clinical bio specimens, if you will.
Dr. Venable: Yeah. I think it's great because, like you said, there's, you know, roughly 70 oncologists. So, I mean, that's so much more than most, you know, academia. So I think it is cool. And also you guys can work with academia, you know. So hopefully we'll get those trials ahead. More dogs. You know I always think it's tough but I you know still practice a lot of medicine of cases where, you know, studies that maybe had 20 dogs. Right, 30 dogs. And so this big network I think that would be great, you know, and you guys have already ran studies. What's something that you guys are doing now that you're really interested in.
Dr. Fenger: Yeah, there's always the question of like, so how do you prioritize projects? How are you even picking these projects when you're in sort of an academic university? Oftentimes laboratory programs will sort of have a specific, you know, a theme or a niche that they're really into, whereas not kind of dictates sort of where their grants are going to be, where their projects are going to be, where the focus of their laboratory is really over like a ten, you know, 20 year time span.
So when we had created Ethos Discovery, and sort of knowing that it was within the context of sort of a private practice network, one of the things that we really wanted to do was identify scientific priorities that were really answering questions, concerns, grips, and gripes that clinicians that are like the boots on the floor that they were actually in need of.
So what we often will do in order to really sort of we will query our clinicians, and we ask them about what are the unmet needs that you have. You have a patient in the hospital today and like, what is the frustration or unmet need that you would like to have, evidence based medicine or evidence to support your practice of medicine for your patient today.
And so that has really, you know, that served as a sounding board for us to kind of see. So what is it that the clinicians, our stakeholders are asking for what would help benefit from them? And then what we do is that on the Ethos Discovery side, I mean, and again, you know, it's a bunch of clinician scientists. We have meetings we go through. What are the unmet needs that have been identified by our colleagues and then, you know, were the group that can kind of say, hey, well, let's try to see what industry partners are out there that might be able to help answer some of these questions that you have. And then how can we design a prospective clinical trial to help answer those questions so that ultimately the end goal would be that can we make some discoveries that would ultimately help you in your practice of medicine with that patient in front of you today?
So that kind of goes back to how our, you know, priorities have or at least our scientific portfolio, you know, has kind of emerged from one of the first programs that, you know, when we asked clinicians what an unmet need was, and this was you could ask a surgeon, an emergency clinician, an oncologist, we all hate hemangiosarcoma it's a crummy disease.
And all of us, we see it. And the owners ask us a lot of information, oftentimes kind of have these responses where you're like, that's a really great question. Unfortunately, like we don't really know that. And I can't really advise you one way or another. You know, particularly for emergency clinicians, you're presenting with a dog with a hemoabdomen and like a splenic mass talking to owners about, “Do you want to embark on what is going to be a lengthy, costly, you know, treatment protocol with a lot of unanswered, you know, a lot of unknowns before you even go to surgery?” And so that was really where we had launched. It's called the Ethos PUSH study. It's the Ethos Precision medicine umbrella Study for dogs with Hemangiosarcoma. We use lots of acronyms. But Ethos PUSH is the hemangiosarcoma study. And that's really asking some of these just basic questions that an ER clinician would like to know, which is G is how do I differentiate between whether or not this is a benign splenic mass that bleed that maybe you'll live with after surgery versus an a completely an entirely different kind of conversation, you know, is this going to be a very aggressive cancer that yes, we have treatments for.
However, your pet will succumb from this sort of taking a step back and saying, when we all trained in our residencies, we largely read retrospective studies and we know now, you know, I mean, our practice has changed. You know, histopathology has changed. So much has changed. And so I think there is some value in trying to see a little bit more of like, all right, nowadays, what is this disease looking like? You know, in that study, you know, one of the first things that we were just looking at was the what is like the incidence of benign versus splenic pathologies in dogs that are presenting with a hemo abdomen and a bleeding, you know, splenic mass. There's that thirds rule that, you know, two thirds of those are going to be cancer, two thirds of those are going to be sarcoma. And and we kind of say it, but we don't really know if there's evidence to support that. And so one of the important findings that just kind of came out of actually saying, all right, well, we're going to get these dogs to surgery and start doing pathology and actually determine like, what is the incidence of benign versus splenic pathologies. And, you know, again, if you look at the retrospective literature, they're usually pathology papers, but they can report anywhere up to 75 to like 96% of those tumors will be malignant. And so in our least in a specialty in emergency practice setting data so far, and we've now enrolled unscreened 407 dogs across like a multi-institutional nationwide prospective trial.
And the data keeps coming back that really the incidence of benign splenic pathology is probably about 40%. That means that 40% of those dogs that are presenting to you, you know, could actually have a really great prognosis and potentially a disease that they it's benign nodular hyperplasia and they may not die from that. And so I think it's a real game changer. And so, you know, that's just an example of sort of some of the prospective data that we can get out of that. The more scientifically nerdy questions that, you know, we're attempting to answer as well, in a prospective fashion would be related to answers about, you know, the genetics and epigenetics of this tumor type. So simply looking at a defined tumor histology and kind of understanding sort of molecular alterations that we may ultimately identify, and that might be related to prognosis and might be something where we could view it as a therapeutic vulnerability.
Again, you know, I think all this information is just good prospective information for us to know. And beyond that, because we, you know, have been collecting, you know, tumor tissue, blood samples from these dogs, I think there's a whole slew of questions that we could be asking related to what they're kind of looking at on the human side, obviously, which is, you know, things like circulating tumor cells, you know, is there noninvasive ways for us to detect, you know, either tumor mutations, tumor burden, if you don't have access to maybe a radiologist to be doing all of your ultrasounds, you know, is there a way to sort of monitor our patients that might be appropriate alternatives? You know, we have to answer that question, about whether, you know, what's the most appropriate. But I think there's a lot of avenues that we can look at. But again, these are patients that are with the help of the Push trial, these are our patients that in some cases wouldn't have access to what can be like a ultimately 12 to $15,000 bill in a private practice setting to kind of get through emergency splenectomy recovery.
Then they're starting on chemotherapy after that. You know, it's a huge effort. It's no feat that it's truly, you know, all the oncologists and, clinicians that are working at doing this, this is their day to day. But they truly are really helping pave progress for the future of our field. It's important to recognize, but it takes a really long time.
You know, it's baby steps. But I think that we should be really hopeful that there are some more hopeful messages that are emerging again, you know, there like 40% of the more benign, you know, splenic pathologies in our at least in the emergency and specialty medicine practice setting, most of these dogs undergoing splenectomy, post-operative recovery are getting discharged out of the hospital in like 48 hours.
And so we kind of, again, even just from a surgeon perspective, knowing and being able to counsel owners about what to expect post operatively what the recovery is like. All of this, it's more contemporaneous information now that the field has totally changed and expanded and specialized. And so I think this is really great data for us to to be able to share with owners, because they're the ones that really need to use this information to make the best decisions on behalf of their fur family.
Dr. Venable: When there's so much we don't know about, I mean, just hemangiosarcoma are really haven't moved the needle a whole lot right in the last few decades. So I'm certainly excited and encouraged what you guys are finding and what more, you know, questions you guys can answer. So I think that's fantastic. And I love how you approach it all from the real like what are the pain points in the clinic? I'm sure with research, sometimes it's easy to get so specialized that you kind of go down a rabbit hole that maybe doesn't, in the real world, help so much.
Dr. Fenger: Yeah. No, it's not uncommon for folks to sort of, you know, study a gene for a 20 years. And it's been fun to kind of get it back in the clinic and then kind of get back to and again, you know, based on what my experience was being on the other side and receiving information about a cancer diagnosis and, you know, recurrence and all that stuff, it's kind of nice. I would say that I go to the clinic, my laboratory, I see patients, and then I'm like, man, this is a crummy disease. I got to get working on that. So it stimulates you to really, like, want to keep going and learning more and advocating for your patients.
Dr. Venable: Right. It gives you that drive to really just keep going. And I think that's fantastic. And you know, as you mentioned, you guys like acronyms over there. But I've heard that you guys are starting a new trial called SOLID and working with ImpriMed on this. starting a new trial called SOLID. Can you tell me a little bit about what SOLID stands for if you know, if you've got it memorized? And what exactly are you guys doing in that trial?
Dr. Fenger: Yeah, and I am an employee of Ethos Veterinary Health. I work with Ethos Discovery. We actually don't receive any funding from ImpriMed for this. However, they are a collaborator on this upcoming SOLID clinical trial. That being said, so SOLID is actually an acronym for Stratified Outcomes for Lymphoma in Dogs. And so it's a real, you know, mouthful. But I don't have to tell anyone in the oncology community today that, you know, everyone believes that, you know, while we talk about lymphoma, we'll like, maybe say a T-cell, B-cell large cell, intermediate cells, small cell. We know that there are at least 25 different subtypes of lymphoma. And, you know, while we know that and that could be on a molecular basis, it could be on basically the phenotypic features of these lymphomas, if you will, from a flow cytometry standpoint and IHC standpoint.
But we oftentimes, you have not nuanced our treatment plans despite knowing that there are different flavors of lymphoma as well as, you know, we just don't know potentially if some types of those lymphomas may respond better to other therapies or not. And kind of the current state of treatment for dogs with lymphoma and cats with lymphoma, I mean, it's it's certainly come a long way, which is already exciting. But, you know, oftentimes when we sort of want to give or give owners information to help them make decisions regarding their pet care, some of the questions that they'll usually ask is, “What's the outcome? What should we treat with?” There's always that. I always say, “I forgot my magic crystal ball today, but the average survival times are going to be here. I hope that your pet is on the upper end, but just be prepared that it could go anyway.”
It's really tough. It's really tough to kind of break that news to people, but we've certainly had a lot of advancements in number one, the degree of histopathologists or pathologists that have a special interest in lymphoma. In addition, you know, some of the histologic markers that they can use to help kind of actually tell us a little bit more about what subtype of lymphoma that is. Even better yet, when we can take live cells from a patient, we can do flow cytometry on those samples. That information can help us, tell us kind of the phenotype of that cell and then help maybe predict the behavior and responsiveness of that tumor. And then obviously there's really like new and emerging technologies, which are the really exciting part, you know, and that goes anywhere from sort of more deep sequencing to understand kind of what is the genetic basis of lymphoma all the way to again, in relation to ImpriMed is actually taking cells from the patient and then incubating them in a tissue culture dish kind of a fake patient, if you will, and then applying the drugs that we're already that we're using to give the clinician a bit of an idea about, you know, how responsive we predict those cells or those lymphoma cells to be. And so again, these are like the newer tools that are out there. The question is, you know, again back to the clinician is “How do I use these tools? What patients is this best? Should I be using this in?” And then really like what do I do with that data. It's always the tough part. And so with the SOLID lymphoma trial again this is sort of looking at going to be various types of lymphoma. But we are specifically looking at the higher grade lymphomas, nodal lymphomas. And essentially, you know, we are starting from what we're doing now.
So what we're you know, what we currently treat most of our patients with are usually going to be multi-agent or CHOP chemotherapy protocols. And so again we're starting with this trial is prospectively looking at kind of our current state of lymphoma treatment in dogs with the idea that when you kind of use it and hopefully being able to look at all of these things, whether that's flow cytometry, histopathological information, looking at other assays like the ImpriMed in vitro assays and then looking at their use of AI-predicted cell sensitivities and then blood-based biomarkers, these are all things that we basically specimens that we would be collecting in a prospective fashion in dogs, you know, with high-grade lymphoma in both T and B cells in our current standard of care, which would be kind of CHOP, if you will. And so again, what I will say is that there's there is not necessarily a new therapeutic arm that we're offering in this trial. But the goal of this trial is, is really kind of a discovery trial is that can we actually start taking, specimens from these patients and then actually using a multitude of different assays, diagnostics to understand more about really like the utility. And then in a more prospective fashion, understanding where we use these diagnostics, how can they help us? And then, you know, I think because we know that science is really complicated and oftentimes we always say, well, it's very multifactorial. There's a bunch of different things that are going to contribute to this. That's kind of where I would get really excited, honestly, about some of these more AI-driven algorithms, because our brains, unless you're a biostatistician or a bioinformatics person, they know how to crunch a lot of really big data sets. But that's where I actually am really excited about, like learning about the role of AI.
You know what I mean? You can go into your, TikTok account right now and spend 15 minutes on it. And then based on how long you look at something, whether or not you paused it, it will track all of that data and then it will basically, you know, curate like Joelle-featured TikTok, which you don't never want to know about. But again, that's like kind of the interesting thing about AI is that can you actually use these training algorithms to start looking at just a multitude of factors. Because I think it's going to be really, really complicated. You know, you could look at the phenotype of a cell on flow cytometry. And then what if that doesn't match up with like the clinical expectation of how you thought that patient was going to do. But maybe there was a biomarker in the blood that could better inform you.
So these are sort of the hypotheses that you'd be testing in that setting. And again, you know, I think it is something where, you know, a lot of these patients are getting treated with CHOP to begin with. I think it's a great opportunity for oncologists that are in private practice to kind of get engaged in like a prospective clinical trial with the idea that we might not have a new therapeutic right now. But the goal of this would be to kind of discover new findings and then kind of iteratively build upon that, to start adding to the backbone or modifying things and ultimately figuring out if we can kind of improve not just diagnostics, but ultimately therapeutics and then outcomes, that would be the really, you know, celebratory goal for sure. You're very excited about it. I think that ImpriMed is going to be a collaborator with us. They've shown some really compelling data that has, you know, suggested that not only just the in vitro predictive responses of these cells, the question that we, you know, hopefully, would be trying to answer is, you know, how does that relate to the patient that you're seeing right now?
But I think one thing that's really, you know, cool and intriguing about it is, is really utilizing AI-driven algorithms in order to kind of start processing a lot of these data variables. And so again, my brain's too small to kind of do that, but I'm really excited about having a possible mechanism, you know, and AI is here. And so I think if there's a way that we can actually use it and integrate it into the management of our patients, I mean, I'm all for that. So I'm excited to see it's fun to change your practice of medicine. The other thing that is really nice about a trial like this is that, you know, again, back to being a practitioner in the hospital is that a lot of tools come out and you can sit in and a lot of CE and meetings. But honestly, if you don't have a chance to really use them in your day-to-day setting, it's very hard to change. And like start running new tests and learning how to build them and how and what samples to collect. And so honestly, you know, as a clinician, I really enjoy when I get to like run a new diagnostic just so that I can kind of see get a hands-on experience and kind of get myself used to changing the way I practice so specific phenotype of clinicians that want to do these trials. But if you're curious, it's a great way to hopefully gain new knowledge for our patients.
Dr. Venable: Well, I love it because you got to keep growing, right? Because I would say lymphoma. That is one of the spiels that I could probably do in my sleep, you know, because we haven't changed it a whole lot. But we all have had cases where it's like, well, everything on flow said, this should have gone great. And it didn't. You know. Yeah. Everything on flow should this should have gone terrible. But it actually did it, you know, and I think what you guys are doing hopefully like you said we'll get because we know there's more types of lymphoma. And if we could figure out more detail on this is what actually makes a difference or this, you know, really tease it out. And I agree with you too. I certainly don't want to crunch all those numbers. I think I it makes sense because then we can look at such bigger data sets than we could before, you know? That is really exciting. And I'm with you. I think you have to keep pushing for more pushing for better, because frankly, I feel like that's culturally what our society does. You know, if I think about when I was a kid, so much has changed. And so, you know, medicine, we want it to get better, right? We want to do more. So we also you can't get lazy and get stuck. You gotta keep pushing the needle.
Dr. Fenger: Absolutely. And again, it's the practice of medicine. So, you know, you can practice a whole different bunch of ways. And I hope to see I hope to evolve, you know, as a clinician and not be doing the same thing that, you know. That's usually what drives most people. But kind of back to the idea of, you know, what's the value of doing a prospective clinical trial, maybe not for like a novel therapeutic. I do think that within the context of lymphoma, you know, the one thing would be that if we can actually have a multitude of variables to look at, so there might be a bunch of variables as far as like the assay that's being performed. But then what's important and at least, you know, kind of what we would be doing with respect to running these trials through Ethos Veterinary Hospitals would be the idea that we can at least have a patient population that is fully credentialed and that can be, again, on like molecular basis, physical exam findings back to, you know, there's a subset of dogs that are basically going to progress during CHOP and become, you know, chemotherapy resistant lymphomas. And so even understanding, “Is there anything that we could do to actually identify those patients?” And we might we might not to you have to go into every day in whether it's the clinic or research based research laboratory, you know, you you have to be okay with negative data. It's not necessarily failure.
I think that sometimes it's just really good to know that, like, nope, this isn't worth looking at. And so, it can be quite daunting. You know, we all get a little bit discouraged by that. But I would say, you know, that that sometimes those negative findings are still important, especially because the ultimate goal would be, could you deliver some information that could help the oncologist that has a patient right in front of them that day? And so, like genomic studies take a really long time to do? This is really complicated stuff. This is not for, you know, faint of the heart. But I do think that there are some smaller questions that hopefully we could identify the answer a little bit quicker, as all of that other genomic information is really moving forward. So hopefully, you know, one trial can serve as a basis to answer a number of questions. It just sort of depends on what question you want to ask.
Dr. Venable: Right? Yeah. Research that I think that's the tough side right. When things aren't working or at least like they're not answering your hypotheses, but it's still such important information. I totally agree. And I've definitely done the Western blots that didn't work. I yes, I had that experience in vet school as well.
Dr. Fenger: You know, and I actually to your point, what is really, really challenging is that not every veterinary training program or oncology residency program has exposure to kind of the more basic sciences. You know, obviously we we all had to do a bit of research when we were kind of getting our paper, you know, requirements done. And and unfortunately, because it's such a high pressure, high volume pressure cooker when you're in a residency program, I'm not surprised that most people do come away with like a very bad feeling in their gut whenever they think of research. I would love it as you know, someone in Ethos Discovery and Ethos Vet Health. If I could actually work with a house officer and then convince them that, like it's not that bad, or even better yet, you know, if there's someone, an oncologist that I talked to that's like, oh gosh, I kept bringing up all these bad nightmares of my experience. I would love it if we could make it not so scary and not such a bad experience. I don't want I wanted to like, relive their trauma, but I really hope that we can relive it. And they can actually say like, you know what is a clinician, clinician, scientist? You can do work, you can do clinical research. You know, I have a PhD, and it certainly led to sort of my understanding of comparative medicine and got me here and helped me understand a bit more of the cancer biology part of it.
But I think that there is all of us, even just as a clinician, you're literally looking at data every day and then processing it in a really rapid fashion, probably in a 30 minute, you know, chemo recheck and then actually coming up with a diagnostic plan. And so we're actually crunching all that data in our heads so everyone can be a clinician scientist. It's just different levels of it. And and honestly it goes back to like how curious you are. So I hope to like change people's perception. If they had a really horrible, traumatic experience when they did their residency program. But what I will say is that I also can't generate their scientific curiosity. You know, all I can hope is just inspire people to be like, wow, seems like this gene is really interesting, you know, so but the curiosity is kind of there, like it's got to be inherent in you.
Dr. Venable: And I feel like the curiosity, you know, if you just think about what you said earlier on, you know, what are your pain points, what questions do you need answered? That's really starting research right there. So maybe people are more scientists than they think, I agree with you. I hope, you know, people as veterinarians, we had to do so much science. And you really are a scientist because like you said, you're going through so much data, whether you realize it in the moment, you really are thinking all these things through. So I love that. That's great. And I agree with you. I hope people can embrace some of the research and maybe not the bad experience. Hopefully they didn't have one, but if they did.
Dr. Fenger: Yes. There is some nice trials that hopefully pique someone's scientific curiosity and at the same time provide them access to care or a new drug or a new device for their patients that they wouldn't have otherwise. So, I, you know, I feel that it's a win win, but I understand it's daunting.
Dr. Venable: But it's the way we move the needle forward. So and I think it's so exciting to hear the different things that you guys are doing and how many different hospitals and geographically. Because I agree with you. I think sometimes geography plays a role. So I think that's really interesting. You guys are able to tap into different areas. And, you know, this has been such a great conversation. And as we're wrapping up here, I always like to ask, who else would you recommend as a guest on this show?
Dr. Fenger: Yeah, I love this question because honestly, there are so many wonderful and pioneering people in our field. You know, one thing that I am incredibly excited about is, like the younger generation of clinician scientists, like they're the future. It would pain me to sort of see the work that we've done, just sort of stall out, which I know it won't. But in that case, you know, I think that really love to give props to some of the emerging stars and current stars in our field and people to watch. Would it be, you know, I would say that from the standpoint of of cancer genetics, Dr. Heather Gardner and Katie McGuire at Tufts University are really, truly leading this field. That is no small feat doing, bioinformatics and understanding the genomic technology, which is truly changing on like a every six month basis. And so they really, I think, are the real emerging experts in the field and have worked really closely with Dr. Amy LeBlanc at the NCI. And so I, I can't wait to see what they're doing.
Additionally, to other friends and colleagues of mine that I've had an opportunity to work with through Ethos Discovery, our doctors, Jacob Cawley and Dr. Sridhar Veluvolu, and they are both doing postdoctoral fellowships in actually human cancer laboratories or human biology laboratories. And so again, they're in really well established laboratories. I think that they're getting like kind of a phenomenal post-doctoral experience. But at the same time, you know, those are the folks that are really going to be advocating for the inclusion of veterinary oncologists and, you know, comparative medicine specialists in kind of driving the field. And so they're doing a bit more molecular work, kind of in the field of osteosarcoma and hemangioma sarcoma. But I'm really excited to sort of see what they're doing.
And, you know, I love hearing the science from them because that's the stuff I love nerding out on. So all of those young pioneers, are going to truly change. They're going to change the face of a veterinary medicine. And I'm really excited to see kind of where they go with that.
Dr. Venable: Oh that's fantastic. Those people sound great. We'll definitely reach out to them and it is exciting. I agree to it. It's the future. What's up and coming. So I love it. We'll definitely reach out. And Dr Joelle Fenger, thank you so much for being on our show today. It was such a great conversation. Loved learning so much about what you guys are doing and just can't thank you enough for sharing with us today.
Dr. Fenger: Well thank you, I, I'm so grateful for the opportunity to speak with you and, and get all this messaging out to the, the listening community. So really appreciate what you're doing. And I really hope that it continues to grow.
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.