Dr. Guannan Wang (00:01)
Hello everybody. Welcome to yet another episode of the VetOmics podcast. Today we are thrilled to be joined by Dr. Daina Budreckis. So, but first let me introduce myself. I'm Dr. Guannan Wang, a genomic scientist and the founder of VetOmics. We are a company dedicated to delivering the best in class, clinical actionable genomic tests.

Daina Budreckis DVM, DACVIM (00:02)
everybody. Welcome to...

Dr. Guannan Wang (00:30)
for pets with cancer. As we all know, precision medicine has transformed human oncology, enabling treatment, prognostication, and diagnostics tailored to each patient's unique genomic profile. In veterinary medicine, we are making great progress, but challenges remain. For example, we still lack comprehensive genomic data in pets.

We still lack detailed drug usage information PK,PD and broad access to effective antigenomic guided therapies is also lacking. At VetOmics our mission is to help close that gap by generating better data, advancing education, and fostering conversation with key stakeholders about

the practicalities, challenges, and the promises of applying genomic diagnostics and the precision oncology solutions to our furry family members. So I'm so, so thrilled that Dr. Daina Budreckis agreed to be on the podcast. She is a friend, but she is also more importantly, a board certified veterinary oncologist.

whose career beautifully blends scientific curiosity, clinical excellence, and deep compassion for both patients and families. Dr. Budreckis is originally from the Boston area and holds degrees from Purdue and Northwestern. Before veterinary school, she actually conducted field research on orangutans in

Sumatra

Daina Budreckis DVM, DACVIM (02:30)
Sumatra, you got it.

Dr. Guannan Wang (02:31)
And

Sumatra, this is an early reflection of her lifelong curiosity about life in all its forms. She earned her DVM from Mississippi State University, completed an internship in small animal medicine and oncology, and went on to the medical oncology residence at UC Davis, where she became board certified.

Her clinical interests spans a wide range of cancers, including lymphoma, leukemia, mast cell tumors, bone tumors, bladder tumors, with a special focus on targeted therapies and pain management, always striving to make treatment both effective and compassionate. What impresses me the most is that Dr. Budreckis combine

deep scientific insight with a patient-centered approach. So many times she asked me questions about, what's the science behind this? What's the signaling pathways? So why do we use this drug? Why does this specific mutation inform this treatment choices? And I have to come up with signaling pathway diagrams. So she constantly asked questions that bridge

science and clinical care. And I think that's so important. So beyond her demanding work and family life here in the United States, Dr. Budreckis also dedicated time to building the veterinary oncology field in Lithuania, the country her family originally comes from. Dr. Budreckis, thank you so much for being here today.

Would you like to share a few words before we dive into some of the topics that I'm dying to ask you?

Daina Budreckis DVM, DACVIM (04:29)
Thank you.

Thank you.

I'm honored to be here. Guannan is a friend and ⁓ I have a lot of fun with her and ⁓ I'm so excited that you're doing this. Very, very excited, very honored to be here. ⁓ I'm in Santa Barbara, California and practicing out here, so yeah.

Dr. Guannan Wang (04:56)
Excellent. Welcome. Shall we dive in? Okay, excellent. All right. So the first set of questions, I asked these set of questions to most of my guests so that, you know, I want to understand and learn how you guys practice, how you guys make the decisions. So you might heard this before. But the first set of questions is about decision making in recommending genomic testing.

Daina Budreckis DVM, DACVIM (04:58)
Thanks, dear. Yes, let's dive in.

Dr. Guannan Wang (05:24)
How many new patients do you see weekly on average? And do you recommend genomic testing for all of them? Why or why not?

Daina Budreckis DVM, DACVIM (05:33)
Yeah, so I see ⁓ generally on average about eight new patients a week. ⁓ It can range from six to 12 new patients and ⁓ I always leave room. So it's about two patients a day new and I always leave room for emergencies. So, and as far as ⁓ doing kind of recommendations for tumor genomics, we'll sort of dive into it, but it is part of my

Dr. Guannan Wang (05:51)
Okay.

Mm-hmm.

Daina Budreckis DVM, DACVIM (06:02)
discussion when I talk about tumor biology and about cancer, I definitely explain a little bit of background of why cancer works, what cancer does, and ⁓ that's sort of a segway into recommendations for tumor genomic evaluation.

Dr. Guannan Wang (06:05)
Mm-hmm.

Okay, okay. So there I assume there are factors that influence or cancer types or Do you recommend this in an all comer basis that you are way ahead of the curve in the field?

Daina Budreckis DVM, DACVIM (06:33)
Yeah, so as oncologists, we're really educators. We're really there at a very scary time and we're at the forefront of my dog, my cat was just diagnosed with this terrible disease and cancer equals death. And they come in to see us and we're the ones who sort of break things down. We're the ones to say, ⁓

⁓ this is what the cancer means and here are our treatment options. And we're also there to explain to people what prognosis is. They're there to see us, to hear that information and how we deliver that information will say a lot about the kind of relationship we have with our patients and our clients in the future is delivering really difficult news. But really they come to us for

for knowledge and and so what I typically the way that I conduct most of my Appointments is what is this disease? What is what is it originating from? How is this disease going to progress and then what we know ⁓ if we do nothing, What does the survival time show. if we do standard of care, What does the median time show? What if we go in between what are we looking at?

And so we always have to talk about what do we know as far as the clinical data, the research papers, ⁓ what do we know in terms of survival time? And then oftentimes for some people, that's a lot of information to take in. I actually spend a full hour with my clients. And so we go through the rigmarole of different treatment options. But ultimately there's some cancers that are...

Dr. Guannan Wang (08:03)
Yes.

Daina Budreckis DVM, DACVIM (08:14)
more aggressive than others. And ⁓ there's some cancers where we haven't really improved survival time for decades. And so what other options do we have to try to improve that survival time? So ⁓ I always start by discussing the cancer itself and discussing what options we have before diving into what those options mean and side effects and how we go from there.

Dr. Guannan Wang (08:16)
Yes.

Mm-hmm.

Absolutely. So sounds like, let me summarize. It sounds like, so the timing, you know, is critical. So the first appointment might not be the best time to discuss all options. There is a lot of emotion management as well goes into that first. But I heard yet again, that the science centered approach, you go from the tumor biology and then the clinical data, what the data tells us, we don't

treat or if we treat with standard care therapy. And then if for some of the ones the needles hasn't been moved for years and then you will bring up, Okay so we we might have some new tricks up our sleeves for these guys. that's

Daina Budreckis DVM, DACVIM (09:24)
And a perfect example

of that that we as oncologists are all very familiar with is lymphoma. Lymphoma, how we practice, how we treat the drugs we use, the survival times that we discuss, you that's all in our back pocket. We can discuss those things in our sleep and it really hasn't changed. It hasn't changed.

Dr. Guannan Wang (09:44)
Yeah. Yeah.

Daina Budreckis DVM, DACVIM (09:46)
since I've been an oncologist, it hasn't changed since the people before me have been oncologists. And so one of the big things that I think all of us, and especially those of us who were recently at VCS and at recent discussions, is how do we improve that? And how do we improve that survival time? How do we improve that? And really it's going to be the utility of...

doing more than just chemotherapy to improve that survival time, whether it's ⁓ immunotherapy, whether it's targeted small molecule therapy, we really need to utilize more than what we've done. not to say that we've exhausted our resources with chemo, but we know that it's going to take a bigger leap in order to expand and extend that survival time. So generally for my cases like lymphoma, will those are those are the

my dog's gonna die either today, if I'm seeing them on an emergency basis, over the next several days to weeks with no treatment. With pred, we're looking at a couple weeks longer. And then we go through all of our treatment options, obviously, depending on certain prognostic parameters or prognostic factors. And then what else can we do? And this is where tumor genomics is really needed in our field, ⁓ as far as

of improving that survival time which is, which has been improved in human medicine, obviously with drugs like rituximab and monoclonal antibodies and unfortunately in veterinary medicine I always tell people we're smart enough to figure it out, we just don't have enough funding in order to figure it out. that's

Dr. Guannan Wang (11:17)
Absolutely. Yeah. Yeah. ⁓

Yeah. Yeah.

Daina Budreckis DVM, DACVIM (11:31)
to. We're smart

enough, but we don't have enough money to do it. So, but I think that the tumor genomic ⁓ information is really an area that is, ⁓ we always say is exploding and we're in it. We're at the forefront of it and you're at the forefront of it. You're helping those of us who aren't doing the genomics, you're the one who's helping us because that's your expertise. My expertise is animals and

Dr. Guannan Wang (11:34)
Yeah. ⁓

Yeah.

Yeah.

Daina Budreckis DVM, DACVIM (12:01)
and talking to them, yours is seeing what the DNA sequencing, figuring that out and assessing the driver mutations since there's lots of mutations but.

do all of them matter? And the answer is no, not all of them matter. The driver ones matter. So you're at the forefront of helping those of us who aren't in that, and especially those of us in private practice who love the science, miss the science during our residency in academia, but don't have the time to really dive into it. And you're really helping us. So I'm really grateful that you're here. And we're in a really exciting time in veterinary oncology.

Dr. Guannan Wang (12:11)
Absolutely.

Yeah.

Daina Budreckis DVM, DACVIM (12:41)
talking about it and it's just, we're slowly trying to jump into it, but it's happening. We're on the train.

Dr. Guannan Wang (12:47)
Yeah, it's

on the train Yeah, that's, ⁓ that's.

music to my ears. So like you mentioned on the human side, leukemia, lymphoma, it's a game changer once we figure out that the BCR-ABL Philadelphia chromosome is the driver of 50 % or 60 % of the CML. And then the use of the targeted drug actually increased the survival from 30%, 40 %

all the way to 80 percent. That's, you know, like you cannot get that, you know, like normally with another cytotoxic drugs. So it's exciting that, you know, we're hoping that by doing the right science, to start with the right science, the right knowledge, the right insight, we hope that we can help push, you know, the field forward, you know, not just, you know, okay, so genomic testing.

is a novel concept, let's all do it. have to have really grounded by science, grounded by the right insight. What are we looking at? Are we even looking at the right molecule, the right mutations? Are we target the right mutations? So that's something that we know from the get-go, like we, know, like this is really we need to.

Daina Budreckis DVM, DACVIM (13:55)
We do. Right. We do. Absolutely.

Dr. Guannan Wang (14:13)
we need to do this right, front and center, quality, actionability, how do we do it the right way. Yeah, I ⁓ love it. are there any particular cancer types that you feel like you recommend more than others?

Daina Budreckis DVM, DACVIM (14:15)
Great. Great.

Right.

So our cancers like the lymphomas, the leukemias, ⁓ where we're calming the patient down, we're discussing options and then starting treatment immediately and seeing how that patient

Dr. Guannan Wang (14:37)
Mm-hmm.

Daina Budreckis DVM, DACVIM (14:47)
performs, how they respond, and then kind of move from there and recheck visits, we can start talking about kind of the bigger picture sometimes if we're going to implement something like tumor genomics. ⁓ I personally don't discuss tumor genomics on that first consultation with lymphoma.

Dr. Guannan Wang (15:02)
Mm-hmm. Mm-hmm.

Daina Budreckis DVM, DACVIM (15:04)
⁓ Obviously in the future that might change, ⁓ but in cancers like hemangiosarcoma and ⁓ breast cancer, so mammary carcinomas, our ⁓ hepatic carcinomas, I have had a number of hepatic carcinomas where...

Dr. Guannan Wang (15:18)
Mm-hmm.

Daina Budreckis DVM, DACVIM (15:21)
surgery ⁓ wasn't an option, they were inoperable or ⁓ they already had ablation, they were sent to UC Davis and they had treatment up there and the disease is progressing. And I really don't have many options in those cases or nasal tumors ⁓ that where the client doesn't want to travel down to Los Angeles or up north in order to receive standard care radiation. ⁓ I need to come up with something because

Dr. Guannan Wang (15:34)
Mm-hmm.

Daina Budreckis DVM, DACVIM (15:51)
because we're sort of in this hard place. ⁓ But I do for my breast cancer patients and for my hemangiosarcoma, I, the first conversation, I'm already discussing tumor genomics. And then for the cases where we're not able to consider additional treatment or if they failed standard of care, of course I discuss tumor genomics as well.

Dr. Guannan Wang (16:00)
Mm-hmm.

Mm-hmm,

mm-hmm, mm-hmm, mm-hmm.

Daina Budreckis DVM, DACVIM (16:17)
But my standard for

the really big bad ones is I'm making those recommendations immediately for tumor genomics.

Dr. Guannan Wang (16:20)
Yeah. Yeah. Yeah.

Yeah, absolutely. Yeah, we see from our perspective, we see a lot of hemangiosarcoma. not a big surprise. So this is one that's so aggressive and the outcome is generally bad with all the combined standard of care chemotherapy. ⁓ we see a lot of those, not surprisingly, but also we kind of start to see more ⁓ rare cancer types as well. ⁓

Daina Budreckis DVM, DACVIM (16:31)
Right.

Dr. Guannan Wang (16:52)
we see and like in two different scenarios. So our frequent users such as yourself, you know, tend to send us ⁓

cases, know, even maybe like you said, you discussed this option from the get go. So you incorporate this ⁓ option, genomic guided therapy into your standard of care therapy. And we also see not an insignificant number of cases where ⁓

this is that they came to us as the last resolve.

It's gratifying that from the genomic perspective, we can always identify something. so here are the most likely drivers that drive this cancer, and that's so aggressive, or drive this metastasis. these are the drugs that can target these potential drivers.

Right. But there's also a timing issue that by that time, sometime it's way too late. No, like, yeah, the cancer is everywhere. So it takes a miracle. Unfortunately, even we think that this is a cutting edge is still not always miracle workers. We see some cases where, like the doctors consider this as a Hail Mary. OK, if we do something and this works, this is definitely Hail Mary because we pretty much

Daina Budreckis DVM, DACVIM (17:53)
Great, great.

way.

Dr. Guannan Wang (18:13)
exhausted everything. And it did work. Yeah, so those are all happy cases that we can actually help, but in a lot of other cases, by the time that the tumor genomics was done as the last resolve and we just didn't have time to treat or to test whether this is actually going to work or not. So that's the population that's very hard on me because, oh, what if

you know, we get this information a bit earlier and you know, would that change the course of ⁓ disease, ⁓ yeah, progression and survival.

Daina Budreckis DVM, DACVIM (18:51)
There's a, and it's interesting you bring

that up. And I actually have an example that ⁓ is hot off the press. I actually communicated with you about this over the last week, ⁓ but I have ⁓ a ⁓ 10 year old Australian shepherd who is owned by an elderly lady and ⁓ she has assistance at home to help with

Dr. Guannan Wang (19:02)
Yeah.

Daina Budreckis DVM, DACVIM (19:20)
⁓ with her memory care and the family lives outside of Santa Barbara. ⁓ And the dog.

basically came to the family veterinarian and ultimately to the surgeon with a 10 centimeter, 10 by 10 centimeter size mammary tumor. And not surprisingly, the tumor was very narrowly excised and had lymphovascular invasion, was considered a high grade tumor. And dog is an Australian Shepherd. So I went into the discussion of

The first day I see this patient, we're staging and ⁓ ideally we think, I want to use Dr. Ruberson, but I can't use it because it's a nausea, so I have to check for the MDR status.

⁓ We're checking the MDR status. My next best treatment is going to be Carboplatin, Cytoxin while I wait for the MDR results to return. The clients were very keen to do the tumor genomic evaluation, fortunately. And I had a whole conversation with the clients actually the day before I received my tumor genomic results back. I got the MDR results back from Washington State and the dog is heterozygous, MDR mutant We can't use doxorubicin

Dr. Guannan Wang (20:32)
Also confirmed.

Also confirmed by our test. Yeah.

Daina Budreckis DVM, DACVIM (20:36)
Also, yeah, I was just going to say that. And then the

next, I call the clients and I said, yep, we can't do doxorubricin. We're going to go to Carboplatin, come back this week and we're still waiting on the tumor genomics results to come back. I go through carbo. We talk about, we want to implement Cytoxin? What else do we want to do? And then I get your report and I read your report and yes, it supported the fact that this was an MDR mutant, which was fun to see.

And reading your report, I said, wait a minute, I was planning on giving carboplatin to this patient. And I was reading your report and I said, it doesn't look like I can give carboplatin to this patient. And then I contacted you and I said, in reading your report and you actually ⁓ reiterated and actually maybe you wanna, if you remember the case, you might wanna jump in to say that you found that this dog indeed would be resistant to carboplatin.

Dr. Guannan Wang (21:22)
Yeah.

Exactly.

we actually found a biomarker CCNI. If I don't remember wrong it's CCNI, ⁓ copy number gain.

Daina Budreckis DVM, DACVIM (21:35)
Yeah, that was

I think so.

Dr. Guannan Wang (21:47)
I don't have the report in front of me. I'm just drawing from memory. it's the evidence level, let's be completely, upfront that it's not like FDA approval or, you know, NCCN guideline recommended. It's not clinical trial recommended, but I believe it's a case study that shows that the presence of that mutation

Daina Budreckis DVM, DACVIM (21:49)
Right, of course. Yeah.

Dr. Guannan Wang (22:10)
is associated with resistance to platinum-based chemotherapy. that's, we, when we see that evidence, we'd like to put that in front, in the report, because not only are we finding drugs that the dog potentially can respond to, we also want to list all the drugs that the dog might not respond to so that you don't waste time and money to treat

treat

that. Yeah. So of course, so that's based on, human studies right now. So, but we'd like to continue to see that, for example, if we identify, the doctor has already treated with carboplatum, but it didn't work, that actually, you know, like kind of like reinforce that, okay, so this dog that has this mutation does not respond to carboplatin So that's example of resistance.

Yeah, biomarkers. So yeah, it's not all bad. We need that information. Same thing with the MDR, right? MDR1 test, yeah. And that was kind of like a really ⁓ lack of ⁓ understanding of what you guys need of the field, right? our test measures over 20,000 genes. Of course we measure ABCB1 or the MDR1 gene.

Daina Budreckis DVM, DACVIM (23:08)
In any... Right, need to crack those. Great.

Dr. Guannan Wang (23:33)
But until recently, we only report positive results. OK, so if you got an MDR1 mutant, whether it's heterozygous or homozygous, and then we actually got called out by another oncologist, you need to report. We need to know that you actually do this test.

Daina Budreckis DVM, DACVIM (23:42)
All

Dr. Guannan Wang (23:58)
So yes, of course. So this is kind of like a combined test, right? So not only do you get additional targeted therapy, immunotherapy options, but you also get MDR1. Yeah, yeah, that's it.

Daina Budreckis DVM, DACVIM (24:14)
Right. And actually this, this

I think is a, is a really great example because when I have this conversation with a client, I said, my recommendation will be ⁓ ideally to give Adria or to give some sort of platinum therapy because

That's what we think of with breast cancer, although the data doesn't show or support, at least as of yet, that we're really improving survival times, especially for these high-grade, large, intravascular invasion. We don't really know that we're improving survival times by giving Doxo. And when the client heard we can't give Doxo, she was very upset. And I'm like, I don't know that giving Doxo is going to improve. We don't know that it's going improve.

Dr. Guannan Wang (24:53)
Yes, exactly.

We don't know that. Yeah.

Daina Budreckis DVM, DACVIM (24:55)
There's other options

out there besides doxorubicin. and then after I discussed CARBO and then got your results, I'm like, wait a minute, I think we should jump. So this is an example where I am using the data, the targeted therapy and the results from the tumor genomics prior to chemotherapy. And actually I was supposed to get the patient in this week to start carbo platin and instead we're...

Dr. Guannan Wang (25:03)
you

Daina Budreckis DVM, DACVIM (25:20)
shifting gears just based on that data and the idea of resistance. And we know this will be a big bad tumor. ⁓ So it'll be interesting to see how this dog does and pans out. So, shifting gears and adapting because we don't have a lot of data in human medicine to suggest that traditional chemotherapy is helping extend survival time for dogs at least with these high grade.

Dr. Guannan Wang (25:23)
on that data.

how respond? Yeah, yeah, yeah, yeah.

Mm-hmm.

Mm-hmm.

Mm-hmm. Mm-hmm.

Daina Budreckis DVM, DACVIM (25:49)
things so. ⁓

Dr. Guannan Wang (25:49)
Yeah.

That's another that's another kind of mindset change for me at least at beginning I thought all cases that have genomic down should be like this you just replace out the standard of care therapy completely And you use the genomic guided therapy, you know, why not because this is what the tumor tells you but then you know So many of my doctors actually you included. Okay, it doesn't work that way by the time I get the genomic results

Daina Budreckis DVM, DACVIM (26:04)
Right. Right. Right.

Dr. Guannan Wang (26:20)
So the standard care therapy is already started. Sometimes the dog does respond, which is wonderful, right? Because the goal is not for us to do what test and to treat the...

Absolutely by a certain drug, it's how do we improve ⁓ survival overall, right? Overall. So like no matter what the venue is, no matter whether this is a chemotherapy, radiation, or target therapy, immunotherapy, it's good that we have all these new... ⁓

options available, but when the conventional therapy works, why not use it, right? And we actually see like a growing trend that combine the genomic guided target therapy with the...

standard care therapy like the first line chemotherapy this is again a unchartered territory, but a lot of our doctors actually worked out some protocols so that we have some real world data that, okay, by combining

Daina Budreckis DVM, DACVIM (27:14)
right.

Dr. Guannan Wang (27:22)
trametinib but with, for example, doxorubicin this is a safe in, 20 of my dogs. And we can also see, you know, efficacy compared to chemotherapy alone So that's another way of doing this, right, combined. And what you are describing, this case is actually because the standard of care therapy doesn't work.

by data, right? So we pretty much exhaust. You can't treat with doxorubicin because it's an MDR1 mutant. And you can't treat with carbo because our test says so. I'm glad that we do have some options for you.

Daina Budreckis DVM, DACVIM (27:57)
⁓ huh.

But in all honesty,

I would have, had I not had the option of assessing this, I would have said, okay, come in, we're starting your dog on carbo and then maybe in a month or thereabouts, this thing will grow and spread and I'll say, well, you know, it didn't work. carbo didn't work, it's that aggressive, it's that resistant, ⁓ which obviously, you know, realizing that that could still happen, but...

Dr. Guannan Wang (28:18)
It didn't respond. Yeah. Yeah. Yeah.

Yeah. Yeah.

Daina Budreckis DVM, DACVIM (28:29)
but at least having a little bit of understanding that, wow, okay, my frame of mind of my next best option, I need to kind of change that around. And as oncologists, as I began the conversation is we're educators. We come and we tell people what we know. We also say what we don't know. We give treatment options and we are ⁓ very linear data driven people. ⁓

Dr. Guannan Wang (28:39)
Mm-hmm. Mm-hmm.

Yes.

Daina Budreckis DVM, DACVIM (28:58)
one as veterinarians and then two as veterinary oncologist, as such a small subset of really nerdy people. ⁓ So we want the data, we want the research and we take an oath of do no harm. And so we are so ⁓ kind of bounded by those ideas of what does the research show? And on a regular basis, I'm constantly pubmeding, what's this? And all the time, on a daily basis, probably multiple times a day.

I'm looking and reading articles to see what's new, what's out there, ⁓ as most of us do. But I think that we're in this state of, ⁓ as I said, that the train is already moving. We're on it. We're learning more about these driver mutations, these tumor suppressor genes that we've known about, and now we have the ability to start learning. The reality is that we don't know

And this was something that we talked a little bit about at VCS when I saw you recently when we talking about hemangiosarcoma is we don't really, we're just beginning to understand all of the mutations, the driver mutations with hemangiosarcoma. But we know that it's a devastating disease, but there is some heterogeneity. There are some patients that excel and then obviously some that are

Dr. Guannan Wang (30:16)
Yeah. Yeah.

Daina Budreckis DVM, DACVIM (30:24)
are burning and circling the drain. The vast majority of them do, and we know that. But if we know who, ⁓ kind of what those baseline tumor genomic mutations are, and then if we do standard care, what the prognosis is based on your particular mutation, if we give six doses of doxorubicin, this is what we're looking at, versus your mutation, versus your mutation. If we have a baseline, and then we can start doing those, everybody wants those,

Dr. Guannan Wang (30:38)
you

Mm-hmm.

Daina Budreckis DVM, DACVIM (30:53)
prospective randomized clinical trials, which we all want ⁓ and seeking. Those of us in private practice want this too. ⁓ And the reality is ⁓ that we want, we're limited and there's not that many veterinary oncologists out there and there's not that many programs in the US that are out there and enough people and resources.

Dr. Guannan Wang (30:56)
I know. I know.

Pretty limited by funding and yeah.

Yeah.

Daina Budreckis DVM, DACVIM (31:21)
So we need to do good medicine kind of circling back around good medicine. We need to understand what we're looking at and then say, okay, if we gave a olaparib versus sorafenib versus just single agent doxo, and we knew what those survival times were. But to do that, we have to first understand what gene mutations there are, what driver gene mutations there are, and what

Dr. Guannan Wang (31:46)
Mm-hmm.

Daina Budreckis DVM, DACVIM (31:50)
and what the survival times of certain populations of dogs, again, those good ones, the ones that are circling the drain, to understand what mutations does one have compared to the other in terms of survival time is something we're lacking in the veterinary field. We just don't have it. And we're at a time that we need that information. And we all know this. And I think that's something we're all striving to

Dr. Guannan Wang (31:55)
Mm-hmm.

Mm-hmm.

Absolutely.

Yeah. Yeah.

Yeah. Yeah.

Daina Budreckis DVM, DACVIM (32:18)
to learn and then use this data to help those, help everyone obviously, but to help those really devastating cases too.

Dr. Guannan Wang (32:20)
Mm-hmm.

Yeah.

Yeah, yeah, absolutely. I cannot agree more. hemangiosarcoma is a perfect example that we kind of need everybody to be involved, because

when the dog gets hemangio sarcoma diagnosis, it's pretty much, it's very rare that it's not a death sentence. Yeah, it's a death sentence. And with advanced treatment by some of my doctors, right? And it still doesn't work with all the advanced treatment. at first, we think, ⁓ I ⁓ was fortunate to be one of the first to actually study hemangio tumor

Daina Budreckis DVM, DACVIM (32:50)
That sentence. Yeah. ⁓

Dr. Guannan Wang (33:13)
And even at that time, one, there's a dire need for us when we publish to have

translational impact. How does this disease compare to human angiosarcoma, So angiosarcoma is devastating, it's rare, there's no good way to study it, but dog can provide a good translational parallel patient population. But also there's a need, at least in my case and by looking at publications from other group as well.

there's a need for us to have, okay, so what are the ⁓ pathways mutations that we can relate the disease from the human? Which is, again, not wrong, but I think we are missing an important concept here that we need to look at hemangio sarcoma as its own disease. ⁓

so the genomics might be very different

from human angiosarcoma from

any other canine cancers. And we need to look at that in a comprehensive, unbiased way. when I published my second hemangioceratoma paper, so we pretty much boil down to five or six genes, TP53, PIK3CA, NRAS, PLC gamma 1, PTEN. So those are the main ⁓ players in hemangioceratoma.

Daina Budreckis DVM, DACVIM (34:19)
Right.

big ones.

Dr. Guannan Wang (34:39)
They are the main players, but they are not at all, all of them. And each tumor can be very different. Like a PIK3CA mutation, a TP53.

Daina Budreckis DVM, DACVIM (34:46)
Right.

rate.

Dr. Guannan Wang (34:51)
this case can be the main driver, but in another case, it's only present in a small percentage of the tumors. So if you treat based on that profile, it doesn't work. You have to kind of pick up what's the most likely, the most putative driver in that tumor. So we kind of really start to learn all that. so that's, I always say that for precision medicine to work. So like, of course we need to start

Daina Budreckis DVM, DACVIM (35:06)
or the main drivers.

for it.

Dr. Guannan Wang (35:21)
with the right insights, right genomic insights, right molecular insights, And the second part is, the access of the drugs, right? So like we can have the best genomics, which I finally am at peace with myself as a genomic scientist that

Daina Budreckis DVM, DACVIM (35:41)
Right.

Dr. Guannan Wang (35:42)
doing a pretty good job really looking at the genomics at each tumor or every tumor type, like very, very unbiasedly, very deep. And we're not missing much, ⁓

other things. So finally, I'm at peace with myself in terms of genomics. But then there's also the other part of the equation is access to drugs. So I want to pick your brain about, know, like we have the mutations. Are you always able to get

Daina Budreckis DVM, DACVIM (36:14)
Mm-hmm.

Dr. Guannan Wang (36:17)
drugs that we recommend. Are you always able to use the drugs that we recommend? How do you feel about in terms of safety, handling, you know, all that.

toxicity, how do you handle all that in terms of these relatively newer targeted small molecule inhibitors as well as emerging immunotherapies. I know you guys are the pros for chemo

Daina Budreckis DVM, DACVIM (36:36)
Right.

Great. Great.

so the reality is that of course these drugs are all considered off labels, so we don't really know long-term studies and we don't really know all of the safety parameters we need to be looking at measuring that sort of thing. ⁓ so a lot of the studies that we look at are based off of beagle dogs. So of course these are mostly healthy dogs that are dosed at various ⁓ amounts.

Dr. Guannan Wang (37:05)
Yeah.

Yeah.

Daina Budreckis DVM, DACVIM (37:13)
and ⁓ then we take that data. And then there are some studies that are out there that are looking at ⁓ different doses that were used, different diseases that were used. ⁓ But in short, what I tend to tell people is that if I don't feel comfortable with the drug, then I'm not going to prescribe it. And that's...

Dr. Guannan Wang (37:33)
Mm.

Daina Budreckis DVM, DACVIM (37:33)
for me, ⁓ that

Dr. Guannan Wang (37:34)
Mm-hmm.

Daina Budreckis DVM, DACVIM (37:35)
I'm not experimenting, we're currently not doing a clinical trial. So this is something where ⁓ I need to feel comfortable, I need to have read papers and seen the patient and recognized the limitations. So an example is that,

Dr. Guannan Wang (37:40)
Mm-hmm.

Yeah.

Daina Budreckis DVM, DACVIM (37:55)
I had a patient who was actually a lymphoma and ⁓ is on the verge of congestive heart failure. And the client elected not to do injectable chemo because she is convinced that the process will be so stressful for the dog that it's on the verge of heart failure that the dog will expire ⁓ during the process of chemotherapy. So she's convinced of that. ⁓ So I tried CCNU and of course that was short lived.

Dr. Guannan Wang (38:17)
Mmm. Mmm. Mmm.

Daina Budreckis DVM, DACVIM (38:24)
and we gave, CCNU lomustine we gave Elspar

⁓ And the woman said, I want something oral. I've tried Cytoxin. So we did the tumor genomic evaluation and ⁓ based on the top mutations, Ibrutinib is a good drug for this dog. Now in humans, ⁓ Ibrutinib causes severe ⁓ cardiac disease and is contracted for patients that do have severe cardiac disease. And so in looking at the data in dogs,

Dr. Guannan Wang (38:49)
Mm.

Daina Budreckis DVM, DACVIM (38:59)
The researchers and the Beagle studies aware of this understanding of cardiac changes in people, actually dosed and assessed ECG. And even at really, really, really high doses, they did not see any ECG abnormalities. So here I am with, okay, well, it hasn't been proven in the 20 dogs that they studied.

Dr. Guannan Wang (39:10)
Mm.

Mm-hmm.

Daina Budreckis DVM, DACVIM (39:23)
And of course these are beagles and their hearts are presumably relatively normal. ⁓

And there was one case where they injected Ibrutinib at a very, very, very high sort of toxic dose or assessing the heart. And ⁓ the dog actually surprisingly developed bradycardia rather than tachycardia, which is the issue in this case for this dog with borderline congestive heart failure. So it was a big conversation with the client of... ⁓

Dr. Guannan Wang (39:36)
Mm-hmm. Mm-hmm.

Mm.

Mm.

Daina Budreckis DVM, DACVIM (39:55)
What do we know in dogs in these small studies? They've studied them, they've done ECGs, they haven't seen any abnormalities even at really, really high doses and at severely toxic high doses, we had some bradycardia, which would actually be a good thing for your dog. ⁓ And so we had a discussion, she did still want the drug. ⁓ I did have her.

⁓ actually scheduled an appointment with a cardiologist within the same time. So within the same week of starting it, we had her see the cardiologist and the dog's heart, the dog is, and again, I'm not convinced that four days of ibrutinib ⁓ at my conservative dose would have caused anything. But we had a conversation of, we really don't know. And we know in people it causes this, but people are not dogs. And in the dog studies, didn't see anything. But it doesn't mean that in a dog with already underlying

Dr. Guannan Wang (40:23)
Mm-hmm.

Hmm yeah

Yeah.

Daina Budreckis DVM, DACVIM (40:48)
severe mitral valve disease and right-sided version of almost on the cusp of heart failure, it doesn't mean that that won't throw the dog over the edge. it's been kind of this ongoing conversation. So there's a couple other drugs we can consider for this dog, but that's kind of an example of if I don't feel good about a drug, I won't use it. So...

Dr. Guannan Wang (41:02)
Mm.

Mmm.

Mm-hmm. Mm-hmm.

Daina Budreckis DVM, DACVIM (41:13)
and to kind of answer back to your

original question, I haven't had too much difficulty

getting the medications. California is a little bit of a tricky state. Things like Peroxacam, getting it compounded have been difficult to have shipped to California because California has its own laws, own sort of sort of bans on things. So I have had at one point, I was prescribing olapa rib and then we couldn't get it. And then so there's these little scenarios that that pop up at least in terms of acquiring. For the most part, right

Dr. Guannan Wang (41:22)
Mm-hmm.

Mm-hmm. Yeah.

Mm.

Daina Budreckis DVM, DACVIM (41:50)
now at least, I'm able to get the vast majority of the drugs that I'd like to receive. ⁓ But as far as

Dr. Guannan Wang (41:58)
you are comfortable with.

⁓

Daina Budreckis DVM, DACVIM (42:00)
Yes, that I'm comfortable with ⁓ and managing again.

And it's a conversation of, ⁓ again, these are off label. A lot of the chemotherapy agents we use are considered off label. ⁓ And we don't have a lot of studies. And so in those instances, I'm seeing these patients a lot more frequently than what's normal. So initially I'm seeing them every two weeks and they're getting the full CBC chemistry UA physical exam in room with me monthly to check.

Dr. Guannan Wang (42:10)
Yes.

Daina Budreckis DVM, DACVIM (42:30)
in just to make sure there aren't any changes. ⁓ sometimes there have been a couple of instances where ⁓ have sort of surprised me with the use of some of this ⁓ small molecule ⁓ therapy and how it's affected dogs. ⁓ So you definitely have to monitor them like you would in a, almost like you would in a clinical trial, but it is in a clinical trial. And we have this conversation ⁓ from the get-go.

Dr. Guannan Wang (42:33)
Mm-hmm.

Mm-hmm. Mm-hmm.

Absolutely. Yeah.

Exactly.

Daina Budreckis DVM, DACVIM (42:59)
Bye.

Dr. Guannan Wang (43:02)
⁓ that's so much good information. one, I just want to acknowledge that, from our end, ⁓ we got the data, we get to recommended drug based on literature based on clinical trial from the human or based on anecdotal dogs or based on small dog studies.

But we don't get this kind of day-to-day involvement, like a dog who has lymphoma but also has heart disease. What do you do? Can you use ibrutinib? There's such a complex decision-making process. But that also kind of highlight the importance of what we call a real world clinical trial.

So this is exactly what you guys are doing, what we are hoping to push to accomplish. So even if, one, we don't yet have the kind of ⁓ funding sources as in people that, OK.

multi-million, ⁓ multi-arm, large-scale, prospective clinical trial for one drug. We don't have that resources yet. I don't know if we're ever going to have that. Two, there is

so much insight into the real world patient we can learn. from prospective clinical trials. Think about this. You probably will not recruit a dog that has comorbidities like a borderline heart failure. Even if we start a trial with an ibrutinib they don't get

Daina Budreckis DVM, DACVIM (44:46)
Right, right, right. Right, exactly. Right, right. They don't fit in the box.

Dr. Guannan Wang (44:57)
So this is the only scenario that you will get,

Daina Budreckis DVM, DACVIM (44:57)
Right, exactly. Exactly.

Dr. Guannan Wang (45:00)
you know, this real world experience, which I just treasure so much. And ⁓ they often say that, you know, from the prospective clinical trial, you get efficacy data.

but only when you go into real world patients, get the effectiveness. So whether this drug actually work in your everyday patients, that's the real measure of success. Not to say that prospective trial is not good, not important. We would love to have many of them for dogs, for cats, but we don't yet have them there. And I just want to emphasize, yeah, we all want it.

Daina Budreckis DVM, DACVIM (45:42)
Of course, we all want it. We all want it. And we all want to practice

good medicine. And that's what we're trying to do. And we're all, you know, even as I always say, even those of us that aren't in academia, we're at the forefront, we're spending a lot of time paying attention to these patients, paying attention to these clients, really exhausting ourselves doing this. And we want to do things right and pay attention to the patient.

Dr. Guannan Wang (45:48)
Good medicine, evidence-based, right? Database. Exactly.

Yeah, exactly.

Daina Budreckis DVM, DACVIM (46:10)
Another quick example is ⁓ olaparib I ⁓ commonly use olaparib I tell my clients that I'm very comfortable dosing olaparib And we know that in people and in dogs, it can cause anemia. And ⁓ I have a greyhound who is diagnosed with ⁓ T-cell lymphoma, underwent standard of care ⁓ treatment, so ⁓ underwent LOPP

Dr. Guannan Wang (46:11)
Yeah.

Mm-hmm.

Yeah.

Mm-hmm.

Daina Budreckis DVM, DACVIM (46:40)
And ⁓ basically we started olaparib and the dog's been on olaparib And ⁓ I kept checking blood work routinely and I'm seeing that the red blood cell count is going down, but it's still within normal and it's a greyhound. So greyhounds, as all of us veterinarians know, they have higher hemoglobin and their red blood cell counts are naturally higher.

⁓ And I didn't recognize initially that that red blood cell count, I saw that it was going down, but I was like, okay, it's still within normal limits. ⁓ everything else was fine, ⁓ liver values, kidney values, the platelets, everything was fine. then at one point I'm looking at the dog and the dog just looks more pale to me. We staged the dog, there's no evidence of disease. And then it dawns on me, ⁓ gosh, the...

Dr. Guannan Wang (47:03)
Mm-hmm.

Daina Budreckis DVM, DACVIM (47:30)
this dog is truly anemic, even though the standard of what we think of anemia, I was so focused on looking at where those levels were and then thinking, ⁓ this dog, it's a gray hound, its red blood cell count should be higher. I've been giving it olaparib and the red blood cell count's been going down, which is a side effect of olaparib but it's paying attention.

Dr. Guannan Wang (47:32)
Mmm. Mmm.

Yeah, yeah, that we have to manage.

Yeah.

Daina Budreckis DVM, DACVIM (47:56)
to these small details, which is really the responsibility of the oncologist and why I say my license is on the line and even if your dog is great, if I don't know what I'm doing, and again, let's be fair, we think we know what we're doing and oftentimes we don't, but if I truly don't feel comfortable with something, then I'm not going to prescribe it regardless of what the paperwork shows. And it's really,

Dr. Guannan Wang (47:58)
Yeah.

Yeah, yeah, yeah, yeah, yeah, yeah.

Daina Budreckis DVM, DACVIM (48:25)
it's really keeping an eye and we're learning these things. We're learning. I naturally thought, ⁓ anemia if the white blood cell count and everything else is fine, it wasn't on the top of my ⁓ kind of evaluation checklist.

Dr. Guannan Wang (48:29)
Absolutely, Yeah.

Yeah. ⁓

Absolutely.

yeah. Those are the things that you don't get from publications, trials. Yeah, but that's invaluable information. I always say that shamelessly, that we got the genomic part.

Daina Budreckis DVM, DACVIM (48:44)
Right.

Dr. Guannan Wang (48:54)
figured out. So finally we are happy. So can we do more? Can we do whole genome sequencing? Can we do more? Of course we can. But right now, so I think we have majority of the cases covered in terms of finding the putative drivers and pathogenic mutations and the targets that we can target. But in terms of ⁓ getting the drug dosing, the efficacy data, all that, this is going to be a crowd-sourcing

a team effort from all of you guys. We'll learn this from the real world patients. That's our hypothesis-driven clinical trial studies. we are actively follow up. So you've received our emails to, okay, how are these dogs doing? So we want to follow up and see whether genomic guided treatments can actually help.

Every cancer treatment.

have a side effect, right? like chemo, radiation, target therapies, immunotherapies, some of them are pretty severe. in people, that's the thing is that in order to cure a cancer patient, you pretty much have to kill him or her.

Daina Budreckis DVM, DACVIM (49:57)
You're right.

Dr. Guannan Wang (50:07)
because you dose it so maximum dose just to try to wipe out the entire tumor ⁓ population and for the patient to cover. I know that we don't practice like that in veterinary medicine, but there's a like ⁓ a fine line between finding the right dose of maximizing efficacy, but also minimizing side effect.

Yeah, yeah, I love it. Yeah, we have so much to learn. I can hear this all day. Yeah, yeah, and we hope to, you like we have our case highlights and like doctors actually they send me this patient. Like it's so striking. Okay, look at the tumor in August and this is the tumor in September.

Daina Budreckis DVM, DACVIM (50:38)
Right. Yeah, exactly.

We do.

⁓ me! Yeah,

that's fun! Uh-huh.

Dr. Guannan Wang (51:03)
It's so amazing. it's, it's

just, it blows my mind. Yeah. At first I couldn't find where the tumor was. But it's just so amazing that we know, hear these stories that, okay, so the, ⁓ genomic guided treatment works. It benefits.

Daina Budreckis DVM, DACVIM (51:15)
Right.

Dr. Guannan Wang (51:21)
If not for this drug, so I do not expect this dog to survive this long, not to mention doing so well at all. So we hear their story. That's why we are always hopeful that this will work. But we need to convert the anecdotal data, anecdotal cases, like individual case, N of one, into data trend.

Daina Budreckis DVM, DACVIM (51:41)
Yes, yes, we need to do that.

Dr. Guannan Wang (51:42)
And yeah, so that we can

all, you yeah. And another thing is that,

So if you have experience in certain drugs, I've bugged you multiple times about how to use a certain drug. I think it's really a crowdsourcing effort. anyone with experience, and everyone is willing to share them so that other people can learn from it. I think a lot of our new users benefit tremendously from this accumulated wisdom

from our more experienced users and we'd like to continue to be the conduit or to be the connector of that. Hopefully we can just push for more collaboration, more hand-holding, and more data generation overall.

This is so good. All right. So maybe one last question for my side is that, so what do you see the future of genomic guided oncology or omics guided oncology? I know we should not restrict ourselves to anything like genomic right now is the most reliable, reproducible, I know markers that we can base off of, but then I do not discount

Daina Budreckis DVM, DACVIM (52:58)
Great. All right.

Dr. Guannan Wang (53:09)
like the emergence of ⁓ mRNA, transcriptomics, proteomics, and other omics. to just basically we need to figure out the science to understand the cancer. Yeah. What do you see this?

Daina Budreckis DVM, DACVIM (53:23)
need to figure out. And I think that just sort of leads to

what you just described, which is that ⁓ obviously as oncologists we want

all of the big tumors, all of the cancers really to be evaluated for us to know what the driving markers are of the majority, knowing that there's variability from one patient to the other, but knowing what the majority is. And we're just now sort of realizing

what the drivers are of the main cancers, but the differences, so the small pockets or small pools of population that do really well or do poorly that have those same mutations but have slightly different kind of maybe suppressor genes ⁓ to be able to know where we are at a base and then to know.

Dr. Guannan Wang (54:02)
Mm-hmm.

Daina Budreckis DVM, DACVIM (54:15)
what the differences are, how a patient with one will behave versus the other. And essentially, we just, guess it just comes down to we need more information.

I wish that we could collaborate and ⁓ I guess this was something where we could find a clinical trial that we could get all dogs or contact surgeons have every spleen that's confirmed to be a hemangioceratoma sent to you where we ⁓ get a clinical trial going, get funding going where we fund you to assess the tumor genomic evaluation and then have the clients ⁓

Dr. Guannan Wang (54:47)
Mmm. Mmm.

Mm.

Daina Budreckis DVM, DACVIM (54:55)
either and the veterinarian involved in seeing how one patient will do compared to the next. We need that information because we don't know these small differences, this small pool of population. And then once we add the targeted therapy, we can then see how they'll progress or not. yeah, I...

Dr. Guannan Wang (55:02)
Mm-hmm. Mm-hmm.

Yes.

Daina Budreckis DVM, DACVIM (55:15)
We just need as much data as possible and I would love for us to be able to get funding.

Dr. Guannan Wang (55:18)
Absolutely, yeah

Daina Budreckis DVM, DACVIM (55:20)
I think it comes down to we're smart enough to figure it out. We just don't have the funds to figure it out. And I would love to see some sort of funding where we, ⁓ because the reality is there's people out there that don't want to do chemo, but their dogs could help other dogs.

Dr. Guannan Wang (55:25)
You just don't have the funds to figure it out. Yeah.

Yes.

Daina Budreckis DVM, DACVIM (55:38)
And I tell people this, say, sometimes if we even just getting this information will help the other dog that has this cancer. And I think that's really important and profound for most people to know that ⁓ their data, their dog's piece of tumor that information can potentially help other dogs. So even if people don't want to do targeted therapy, if we could take that tumor and assess it and then study that

Dr. Guannan Wang (55:49)
Mm-hmm.

Daina Budreckis DVM, DACVIM (56:07)
patient to see how they do with standard of care or not. ⁓ If we get that sort of baseline, I think that's going to be really important for us to understand how well one treatment will work compared to the next treatment will work based on that mutation.

Dr. Guannan Wang (56:08)
Mm-hmm. Mm-hmm. Mm.

Absolutely. Yeah.

Daina Budreckis DVM, DACVIM (56:24)
Yeah, so.

Dr. Guannan Wang (56:24)
Yeah, absolutely.

there are multiple variables in play, Like the tumor biology, tumor genomics itself, there's a molecular subtypes, right? And there's also different treatment. So different molecular subtypes may respond differently to standard of care therapy. And they may also respond differently to ⁓ target therapies. So one dog's tumor profile

Daina Budreckis DVM, DACVIM (56:44)
Great. Great.

Dr. Guannan Wang (56:52)
may make it a bad candidate for standard care therapy, but an excellent candidate for target therapy. So those are the information that we need to tease out. So we are hoping besides, of course, starting the clinical trial. that's our dream, right? And also, we want

to tease out that

variability even in our real world patient population, patient clinical trials. So because you have a dog that you profiled, have this mutation, but only did standard of care therapy. It didn't even have a chance to do target therapy. That means that, okay, this dog has really aggressive disease, does not respond very well to standard of care therapy. So that's data we can collect on.

Daina Budreckis DVM, DACVIM (57:33)
Okay. Great. ⁓

still data. Yeah, that's still data.

That's still information. when we don't have that in veterinary medicine, we need that information.

Dr. Guannan Wang (57:48)
Exactly, that's data. Yeah, that's the information. Yeah, that's valuable information. Yeah, exactly,

Yeah. Right now, we know all these pieces of information. So we really need to collect all that and systematically analyze, And of course, the real world.

Daina Budreckis DVM, DACVIM (58:05)
Right. Right.

Dr. Guannan Wang (58:11)
it's messier, right? Because it's ⁓ comorbidities, congestive heart failure. So that you don't see that from a very well-designed clinical trial. But even after all that variables, if we can still see signal that's true effectiveness, that's true benefit. So that's, I think it's even more.

valuable for us to learn and to see.

and this is so good. I've learned so much. I know I talk to you constantly and I still learn so much. And, I still haven't forget that your offer of inviting me to your clinic and shadow you for a day so that I get to know, get fully immersed in the veterinary oncologist. Yeah. Yeah. Yeah. Yeah.

Daina Budreckis DVM, DACVIM (58:46)
.

Yes, yes, yes, Yes, yes,

Yes, yes, yes, yes. yes. yes. yes. Yes,

Dr. Guannan Wang (59:07)
and I'll have you

shadow me to do reporting. exactly. Yeah, yeah, yeah. So before we end, do you have any questions for me?

Daina Budreckis DVM, DACVIM (59:10)
fine, yes.

I'm on that.

I

I do. And I know you and I are both cat people. We both have cats at home. ⁓ Tell me where we are at with cats and figuring that information out. I know where we're trying to figure out with dogs, but where are we in our kitty cat patients?

Dr. Guannan Wang (59:26)
Yes.

Yes.

At first we were trying to keep it under the wraps. So now it's not a secret anymore. We are soft launching Feline CGP. So yeah, this is also by ⁓ demand, a lot of demand. At first we said, OK, we need to figure out the dogs first. There's so much we need to figure out. We need the cat. We need the cat. We actually developed a Feline CGP.

Daina Budreckis DVM, DACVIM (1:00:00)
You're not mutually exclusive!

Dr. Guannan Wang (1:00:06)
So, we have already very proudly sequenced and reported 15, Feline cancer patients, which is pretty...

Daina Budreckis DVM, DACVIM (1:00:06)
Yay!

Dr. Guannan Wang (1:00:21)
amazing. from the the genomic perspective, we've consistently been able to identify putative driver mutations and the clinical actionable biomarkers across all 15 cases. genomic wise, I think we are very solid, we are also doing whole exome sequencing, so that we can understand each feline cancer,

Daina Budreckis DVM, DACVIM (1:00:23)
Very easy.

Dr. Guannan Wang (1:00:47)
unbiasedly and comprehensively. so genomic wise, I think the data is very solid. In terms of like genomic data annotation, the knowledge base, dog has a leg up because more people study dog than cats, right?

However, cats is closer to human in terms of a genome. yeah, that's why the performance and the knowledge-based matching is actually consistent between feline and canine. We were very happy about that. ⁓ so genomic-wise, I think it's very solid. ⁓ But that said, so ⁓ drug.

Daina Budreckis DVM, DACVIM (1:01:10)
⁓ interesting. Interesting.

Dr. Guannan Wang (1:01:35)
Dosing wise, I think we lack even more data in cats than in dogs because we criticize the lack of data in dogs all the time, but at least we have for every new drug that.

Daina Budreckis DVM, DACVIM (1:01:39)
Absolutely.

Mm-hmm.

Dr. Guannan Wang (1:01:52)
you know, is submitted to FDA that is approved to FDA. We always have the, always, always have the healthy beagle dog. Plus we have accumulated quite some primary canine patients data as well. But some of this information is just completely lacking in cats. So in two out of the 15 feline CGP,

Daina Budreckis DVM, DACVIM (1:01:52)
Mm-hmm.

Great.

Dr. Guannan Wang (1:02:19)
reports that we did so far, two of them. We found the putative driver mutations. We found a clinical actionable drivers, right? And recommended drugs. But we don't have dosing information for those. So it was almost like, okay, so it's the doctor's decision. Do you want to be the first one to try this new drug in cats?

Daina Budreckis DVM, DACVIM (1:02:41)
Right. Right.

Dr. Guannan Wang (1:02:46)
which is that we all know that cat's dosing is already tricky or do you want to not use the genomic guided treatment at all? I often say that Canine CGP is almost 100 % actionable. Feline we sometimes don't have the dosing information. That said,

Daina Budreckis DVM, DACVIM (1:02:46)
Great.

Yes.

Dr. Guannan Wang (1:03:11)
we have a group of doctors who are more experienced in using these novel drugs. So we hope that we can figure it out. I remember Dr. ⁓ MJ Hamilton said that it's a matter of science. you need to figure it out whether this drug can be used.

so of course we need to test it out, but there's a a scientific ground if it's toxic on paper, then likely it won't work. But we need to kind of figure out on paper from the NDA, from the dog data, from the human data and see whether this is a reasonable starting dose for us to test.

So I think we'll get there We are taking Feline CGP very, very slowly so that We want to do exactly like he said, do no harm. We actually invite our doctors to send patients that have pretty much failed everything and have no other options but still willing to go.

extra miles so that even if it doesn't work, we do no harm. So that's the mentality for right now. But once we have more data, so this is what I want, Feline CGP to be as ⁓ robust, as effective as Canine CGP We are just at a different stage for the two species.

Daina Budreckis DVM, DACVIM (1:04:46)
Me too.

Mm-hmm.

Dr. Guannan Wang (1:04:50)
This is actually the first time that I'm openly talk about felines. Because, you know, we have some data and we are more confident now.

Yeah, this is so great. We have so much to talk about, so much to figure out. Yeah, thank you so much for your time and to share your experience, to share how you do, like this is really honest feedback, right, how you practice, how you use these relatively new.

Daina Budreckis DVM, DACVIM (1:05:04)
so much to figure out.

Dr. Guannan Wang (1:05:20)
technologies into your practice and how you see challenges and hopefully promises as well in your daily practice. And ideally, we want to have ⁓ good science. Eventually, we want to translate that science and technology into patient outcome. I think that's what we are here for. Yeah.

Daina Budreckis DVM, DACVIM (1:05:45)
Right, right, yeah.

Right, exactly. That's what we're all studying before.

Dr. Guannan Wang (1:05:48)
Yeah, yeah, we cannot we cannot always

say that. the needles haven't been moved for 30 years. So it's what exactly exactly. Yeah, at one point, it's not okay to say that anymore. So we have to do something. Yeah. Yeah. All right. Yeah. Yeah. Yeah. Yeah. Yeah.

Daina Budreckis DVM, DACVIM (1:05:53)
Right, exactly. We have to do more than what we're doing, yes.

Right. Right. And we've been saying that for years. this is really that the omics is really what we're thriving, what we need to jump into. obviously, we all know

this. But ⁓ I'm so glad you are in our world in veterinary oncology and you're part of our team in figuring this out. Thank you.

Dr. Guannan Wang (1:06:26)
Yeah, absolutely.

definitely part of the team. Excellent. Yeah. Yeah. Yeah. Yeah. Yeah. Thank you so much for your time. yeah, until next time, we'll hopefully talk more about like benefit advantages you see in your patients.

Daina Budreckis DVM, DACVIM (1:06:28)
You are. You are. And we're happy for it. We're better for it.