Guannan Wang (00:03) Hello everybody. ⁓ Welcome to another episode of the VetOmics podcast, genomics diagnostics and precision medicine in veterinary oncology. This is Dr. Guannan Wang. I'm a genomic scientist and the founder of VetOmics. We are committed to providing high quality clinical actionable genomic testing for pets with cancer. As we all know, while precision medicine has reshaped human oncology, veterinary medicine still faces significant gaps, limited genomic data, insufficient clinical evidence on drug use, and the barriers to access better targeted and immunotherapy. At VetOmics our mission is to help close these gaps by generating robust data. advancing education and partnering with key stakeholders. Together we aim to bring practical and effective precision oncology to the pets we love. I'm so excited to be joined today by Dr. Brandon Boostrom a board certified veterinary oncologist whose career reflects not only exceptional clinical training, but also a deep personal commitment. to helping pets and their families navigate cancer with hope, clarity, and compassion. Dr. Boostrom trained at several prestigious institutions throughout his career, including UC Davis, UPenn, and Colorado State University. He is currently practiced in North Virginia. His work has contributed. both to clinical practice and to the scientific community through publications in respected veterinary journals. Beyond his clinical expertise, Dr. Boostrom brings a thoughtful, family-centered approach to cancer care, one shaped not only by science, but also by his own experiences supporting a beloved pet through cancer. He is deeply passionate about helping families choose treatments, paths that offer the most joy, comfort, and meaningful time together. Dr. Boostrom, thank you so much for being here with us today. Would you like to share a few words before we dive into the topics that I'm excited to discuss with you? Brendan Boostrom (02:46) I'm I'd love to. I'm very, very excited to be here with you today, Dr. Wang, Guannan I consider you to be like a real thought leader for us and what you're doing is pioneering for genomics for pets. So thank you so much for your commitment to that. And having worked with you for now almost a decade, kind of seeing your growth into VetOmics has been really thrilling where you really get to take the lead, take the reins and do it with incredible integrity for the data and the science. and doing things the right way has been so exciting to like partner with you and to see our patients benefit from your treatment. So thank you so much for that. But I'm really excited to talk to you and learn more from you and have a good conversation about where genomics can take us in the future. Guannan Wang (03:34) Absolutely. Thank you for the nice words. think that's really keep me going day in and day out and I've been having fun. Not only the hard work, but to see the benefit and to see the support from the whole community really, really is rewarding. so so fortunate and so grateful to be part of the community now. And so I want to ask you your overall perspective using genomic testing. I know you are like early adopters so you've been using genomic testing and now primarily VetOmics ⁓ comprehensive genomic testing. So what is your overall ⁓ experience and perspective? Brendan Boostrom (04:29) Great question. Yeah, I think the first aspect of genomic testing that really got me excited is this concept of targeted therapy and precision medicine ⁓ in that we can choose treatments for pets based on a deep understanding and analysis of their own tumor, its makeup, ⁓ its genomics quite literally in terms of what are the driving mutations. Now since working with... excellent expertise like yourself and getting to collaborate on a lot of cases. I've since learned that like there's actually a lot more applications than maybe just that. So when we start to think about pets who are unfortunately predisposed to developing cancer, whether it's a breed predisposition and there's so many unfortunately, but if we think of Bernese Mountain Dogs and histiocytic sarcoma, so many of our wonderful giant breed dogs who are prone to osteosarcoma. Leinbergers and Great Danes and so many others. If we think of pugs and mast cell tumors, golden retrievers and lymphoma and hemangiosarcoma, there's both already some interesting results and exciting results to suggest that we can really narrow down and isolate some of the genetic drivers for them specifically and from there expand into talking about prevention and think prevention has a Guannan Wang (06:00) Mm-hmm. Brendan Boostrom (06:01) wide scope and umbrella but prevention for an individual patient ⁓ through targeted therapies for example or prevention through outbreeding programs where we learn about the causative genes and can help to educate both pet owners and breeders and ourselves about what we could maybe do differently to have healthier pets both today and in the next generations. So I think the applications are enormous and growing constantly. So I'm really excited to have it as another tool at, say, in our arsenal. Guannan Wang (06:40) That's a great ⁓ perspective, so far, most of our oncologists, our clinicians use genomic testing primarily for treatment decision to help in guiding more treatment options. And then the added benefit of Canine CGP is also one that we can provide diagnostic clarity in. approximately 30 % of cases. You are also advocating for the prevention side of the application. I think that's one we're barely ⁓ scratching the surface on just to share we've sequenced more than 10 dogs from this one huge family. ⁓ And this is a Siberia Husky. And we are able to identify germline predisposition gene which is really, really... ⁓ incredible to show how the germline variant can actually impact their cancer development at the early stage and unfortunately there is this proband that already developed and deceased from cancer. And we've identified similar alleles from other litter mates as well. Now we are kind of using that information to... learn whether these litter mates will also develop. I agree with you. we are definitely generating more data on that front. And the out breeding program, those opportunities are huge. What if we can, screen these ⁓ dogs, they used to breed, breeding dogs, exactly, screen them and identify whether they have these more detrimental pathogenic germline variants. Maybe that's something that can be a criteria in addition to the other trait selection Brendan Boostrom (08:32) Like a sire? Yeah. Guannan Wang (08:57) I think ⁓ there is a huge potential and need Brendan Boostrom (09:03) Yeah, absolutely agree. And I think there's already a great deal of interest. ⁓ I speak to a lot of families and families who One way I'd put it are just enamored with the breed ⁓ who will come to me with, let's say again, like a Leenberger who unfortunately has developed osteosarcoma and very close with like the Leenberger community in our area in Northern Virginia. And they're fantastic. They have Leenberger Health Foundation. They do so much more than just say, love these dogs. They want to deeply understand their disease predisposition and how they can help and how they can prevent. ⁓ Guannan Wang (09:16) Uh-huh. Yeah. Yeah. Yeah. prevent exactly. Yeah. Brendan Boostrom (09:43) interesting because even though sadly so many of them will go through the tragedy of losing a leonberger to osteosarcoma they're so in love with the breed that they're like I'd never get another dog so what they'd really want to have is a leonberger that's osteosarcoma resistant. leonberger that is a lower lifetime risk. I don't want anything else because sure like there are many breeds that are far less likely to develop osteosarcoma. You get a small dog but they don't want a small dog and I understand why. Guannan Wang (09:55) Yeah. Is this the hamburger? Yes. Yes, Exactly, exactly, yeah. Brendan Boostrom (10:13) Those dogs have big hearts. There's so much to love. I mean, here's our dog, our golden doodle, Bella. He's just fantastic sleeping over me. And as you said, like I've been there before where I lost our beloved dog Aiden to cancer, to liver cancer. Now about 10 years ago, I still miss him. But I think it's compelling to me to think of having a dog with a lower risk of cancer. Maybe we're extending their lifespan. Guannan Wang (10:17) Yeah. Yeah. ⁓ you and Brendan Boostrom (10:43) and thinking of longevity, we're also thinking about health span and that concept of more good time, more good years. I mean, cancer is a real champion. So we'd rather have, exactly, I'd rather have more of those senior years with them, you know, where they're such a part of the family and you're already so deeply in love with them. But time that's disease-free is always going to be a little easier for everybody. So as much as... Guannan Wang (10:52) Not just the more time. Yeah. Absolutely. Brendan Boostrom (11:12) 95 % of my patients are patients who have cancer and we're treating it. Try to make that as good as possible. What every family says when I ask them at the start of a consultation, what are your goals today and what are your goals immune pet's care? What almost every family says is I want them to feel as good as possible. I don't want them to have any pain. I don't want them to suffer. I want them to have quality of life. Guannan Wang (11:26) Thank Yeah. Brendan Boostrom (11:38) And I fully agree with that. think that is beautiful. But it would be even better to me if we could prevent them from having cancer in the first place. Guannan Wang (11:50) As we accumulate more data, I would think that's possible, especially with the dog, inbreeding, this is even more augmented than in humans. So there are a lot of hereditary. ⁓ bad alleles unfortunately break into alongside the good traits if we have enough data, have enough knowledge to be able to screen those, I'm hopeful that we are able to kind of cut this from the source. Yeah, and all the Siberian huskies that we've analyzed from that one big family, it all come from either the mom or dad side. and not every Siberian husky have those, Brendan Boostrom (12:34) That's a great point. Guannan Wang (12:47) if there's supporting data that we can kind of screen from the get-go, I think that's helpful to prevent that. Brendan Boostrom (12:57) Yeah, if we unpack that just a little bit, because one thing that I really ⁓ prioritize is trying to explain the amazing science to everyday people. everyday people that I meet come from incredibly ranging walks of life. That's one thing that's been just an incredibly pleasant surprise for me as a veterinary oncologist. I became an oncologist to help pets in a time of great need for them, to try to bring more comfort to a hard situation, to comfort their families as Guannan Wang (13:17) you Brendan Boostrom (13:27) on the journey and make it more, as you said at the start, like we're full of hope and clarity and ⁓ really good days. my favorite thing is when families send me an email or a video of their pet, you know, just romping around the backyard or wrestling or just goofing around swimming in their pool. And yet ⁓ when we do that, we have to explain this kind of science in a really practical way. So when you say germline mutations, if I'm not mistaken, Guannan Wang (13:44) Yeah. Mm-hmm. Brendan Boostrom (13:57) know if you'd correct me if I'm wrong, we're talking about ⁓ genetic variation that they carry in their normal tissues. Guannan Wang (14:05) Exactly. Brendan Boostrom (14:05) So in case we're testing their skin biopsies or we're testing their saliva, their blood sample, excellent. There's lots of great, like actually now more minimally invasive ways that we can collect those samples. And so we're talking about something that it is heritable. So if we talk about outbreeding, there's an opportunity there to select from the breeding pool. ⁓ And it's also something that predisposes versus when we talk about the most common use of your test, Guannan Wang (14:10) their blood. Exactly. that clip. Mm-hmm. Brendan Boostrom (14:35) which is a patient already diagnosed with cancer. that case, we're testing their tumor, right? We're testing their lymph node sample if it's lymphoma, or we're testing their spleen if it's hemangiosarcoma as examples. Their lung tumor, so many different options, which is incredible, like the diversity that your test offers. And then we're talking about tumor mutations. So something that could have happened. Guannan Wang (14:37) diagnosed with cancer. Yeah. Brendan Boostrom (15:01) uniquely within that tumor during its evolution and its development and its growth. So I think one big factor in why clients may or may not choose to pursue genomic analysis, like VetOmics the canine genomics profile, is just how comfortable they are with the science, how comfortable they are with the application, and just the frankness of, do you expect this to help my pet? Is this going to empower us in our Guannan Wang (15:08) Yeah. Mm-hmm. Brendan Boostrom (15:31) to where like we have more options, more options that I feel are better suited for my pet. Guannan Wang (15:33) Yeah. So that's actually one question that I want to ask you, but from a lot of our frequent users, as I mentioned, treatment, guiding treatment is the biggest factor, we've had many successful stories where the dog failed multiple lines of previous treatments. when they finally were treated with the genomic guided treatment, there is a Brendan Boostrom (15:59) Yeah. Guannan Wang (16:12) Some doctors call that Hail Mary, it's a miracle. there's no way that you would expect this kind of response in otherwise non-genomic guided treatment settings. So we don't see that all the time in 100 % of our cases. Otherwise, I would feel so comfortable to justify, right? So I think right now, so we have all these anecdotal, we have these successful cases, but we still lack the overall trend where we see a clear you separation, hopefully big separation of the Kaplan-Meier curve to show that the genomic guided treatment indeed outperforms the ⁓ non-genomic guided treatment. So we are collecting data, we are getting there and there are publications early data, early promises, but Does it help for every case? Not necessarily. Does genomics provide more options instead of spinning the chemo wheels or radiation, absolutely. It does add into that. And the list of target therapies and fortunately immunotherapies are growing So although I feel like we're still too slow, so we're working with pharmaceutical... ⁓ companies to hopefully to bring in more and better options. because most of the therapies that we have right now are like early generation, not so specific inhibitors. So we're hoping to kind of bring in more and better targeted small molecule inhibitors. I think it's safe to say that a lot of our doctors see the benefit. ⁓ but not 100 % yet. So what's your experience? Has genomic guided therapy meaningfully impacted your patient outcomes? And do you have some memorable cases where genomic guided therapy actually changed the course of disease development and outcomes? Brendan Boostrom (18:35) Yes, certainly. And I think that's one reason that I stay so engaged with it and consider it an option for so many families and so many pets is when you see those success stories. And like as you said there at the beginning, there are those patients where you're looking for a Hail Mary. But in my opinion, that's almost like waiting a little bit too long to sort of exhaust all other options and then start to do Vetomics testing. for one thing, why not start Guannan Wang (18:56) Yeah. Brendan Boostrom (19:05) start off like on your best foot, at least knowing what the lay of the land is, right? Am I going to have options for targeted therapy? And by that, usually we're talking about like oral chemotherapy drugs that the pet owner can administer on their own at home with our guidance, with our support, with regular recheck visits, like say about once a month, usually they see us for a recheck work and to make sure that it's well tolerated, of course, is extremely important. ⁓ But like that option, Guannan Wang (19:28) Okay. Brendan Boostrom (19:35) ⁓ is very appealing for us and for a lot of families because there are those pets that just would not be happy coming into the clinic to receive IV chemotherapy. Guannan Wang (19:48) Okay, okay, okay. Brendan Boostrom (19:49) Usually when they do that, they're at the clinic for several hours, some are very anxious. ⁓ For some, it's a question of the number of visits that they could manage, the frequency of treatments. ⁓ For others, it's the cost of care. And that's when we start to talk about contextualized decision making, that there really is not one gold standard of care. Guannan Wang (19:53) Yeah. Yeah. Yeah. Yeah. Yeah. Mm-hmm. Brendan Boostrom (20:15) any situation because even if we have significant research that states that a given treatment is likely to lead to a good outcome, every pet and every cancer is unique. It's developed independently and so it doesn't always read the book, we say, right? And that treatment may not be accessible for that family for a variety of reasons like costs and access to care and others. So I think we really Guannan Wang (20:24) Mm-hmm. Exactly. Yeah. Brendan Boostrom (20:45) do value having another option. ⁓ Guannan Wang (20:49) Is that? Brendan Boostrom (20:49) think about oral therapy. personally, some of the most exciting, compelling cases that we've treated are ⁓ really the proactive ones, where we have a patient, Petey, who's thankfully still doing very well, who's a lovely pit bull. We've been treating pit bulls in our family for a long time, and most often for the common cancers like mast cell tumors. But Petey, unfortunately, developed a lung cancer. Guannan Wang (21:15) this time I called him Petey Brendan Boostrom (21:18) I think his family would really get a good laugh out of that. Yeah, was just unique. Wonderful. ⁓ Guannan Wang (21:26) Okay, that's better. Petey is better. I remember Petey. Yes, excellent case. Brendan Boostrom (21:37) Yeah, so you remember then, so he was treated for a lung cancer that was surgically removed. And unfortunately, about a year later, while we were doing like routine monitoring with chest x-rays, ⁓ he was feeling fantastic, no cough or breathing changes, but we saw about a two centimeter lung nodule had developed at his surgery site. So we followed up with a CT scan to make sure that it was solitary, that it hadn't developed any more widespread than Guannan Wang (21:42) Yes. Thank huh. huh. Mm-hmm. Brendan Boostrom (22:07) just that and thankfully it was contained. So he had a second surgery, but this time knowing that a recurrent cancer is high risk just by nature is inherently ⁓ high risk. And also that his tumor this time returned as a grade two instead of grade one, know, his risk had increased significantly for having like further spread or for having another recurrence. So I recommended running a genomics profile. And in that we had a really interesting Guannan Wang (22:08) Yeah. Yeah. ⁓ huh. Yeah. Yeah. Mm-hmm. Brendan Boostrom (22:37) array of options. Like he could have gone straight to oral targeted therapy and like I've never submitted a genomics profile to you at VetOmics that hasn't had a treatment option, which is really great. Like because you run whole exome analysis and are looking at, you know, say 22,000 genes, like you're really casting a wide net and then do an excellent job of narrowing that down, kind of distilling that down to those really actionable genetic mutations. Guannan Wang (22:50) I will. Mm-hmm. Brendan Boostrom (23:05) believe are real drivers for that cancer and what we believe we have treatments that could actually address those. So we narrow it down but in his case we had those options but then we also had the option of immunotherapy because his lung tumor came back with a very high tumor mutational burden, TMB. So meaning across this whole profile of all ⁓ his genes he had a very high rate of gene mutations. Guannan Wang (23:08) you you Yeah. Yes. Yeah. Brendan Boostrom (23:35) in his tumor. So some tumors we would say are more quiet, right? They're just, there are mutations, or we wouldn't have cancer, but there's relatively few of them, and some are very hot. And hot, indicating a lot of mutations, means that it's also a tumor that is very ⁓ visible to the immune system. That our immune system. Guannan Wang (23:37) Yes, exactly. Mm-hmm. Yeah, more mutations may translate to more neoantigens, and get presented on the tumor surface. So that makes it a better target than just with a few mutations, a few neoantigens. Brendan Boostrom (24:13) Yeah, perfect. Guannan Wang (24:14) Yeah, so TMB, as you mentioned, is one of the strongest ⁓ biomarker that predicts the immune checkpoint inhibitors in human patients. And we see more evidence as in Petey's case. Yeah. Brendan Boostrom (24:25) Mm-hmm. Yes, exactly. Yeah, that's a great way to put it. these antigens on the surface are like signals to the immune system. There's something irregular. There's something not right happening here. And unfortunately, we know that cancer is very good at evading the immune system. So even in that context, we have many other examples for humans or for pets, if we think of melanomas as a good example, that are other hot cancer types that have a high tumor mutational Guannan Wang (24:37) Yeah. ⁓ Yes, exactly. Brendan Boostrom (25:00) in general, the immune system alone struggles to overcome those cancers, struggles to defeat them, to put them into remission to prevent spread. But now with the advent of drugs like Gilvetmab, which is like our canine equivalent of Keytruda, pembrolizumab Guannan Wang (25:07) with them. Okay. control that. exactly. Brendan Boostrom (25:21) Yeah, right. So it's so wonderful to have options like that and a lot of credit to the scientists, the researchers, the clinicians who have made that possible. To have new drugs, even in the last 10 years since my own dog had cancer is really... ⁓ Guannan Wang (25:28) you you Brendan Boostrom (25:41) It gives me hope. You know, I think that we're making progress. That we're really making at least incremental progress and new options, deeper understanding to where, you know, I'd hope in another 10 years we're curing more cancers. We are extending life and quality of life even better. That we don't have to sit still, that we're getting better. And even though every individual tumor is a challenge and is evolving, over the course of time cancer is not going to get any better at what it's doing, but we are. And I think that means that in the end we can really win. ⁓ So, Petey was treated with Gilvetmab and that's an IV immunotherapy treatment that he received every two weeks. In his case, he had five infusions of Gilvetmab, although you can give 10 ⁓ in a routine course, you can get more even as exceptions. So he had five therapies of that to really help to mount a powerful immune response against his residual cancer. Guannan Wang (26:11) you you Brendan Boostrom (26:40) And now it's been actually over 15 months since he completed that therapy and he's still in complete remission. Yeah, we're very happy for Petey And I believe he's going to stay in remission. He's doing really, really well. So that kind of experience is very compelling. When you look at the bigger landscape of immunotherapy, both for humans and for pets, while it's very exciting, the biggest limitation, I think, is fairly consistent across species. Guannan Wang (26:47) Yeah. ⁓ me. Yeah. ⁓ Yeah. Brendan Boostrom (27:11) is case selection. Really knowing who's going to benefit because Guannan Wang (27:13) Exactly. Brendan Boostrom (27:17) These treatments may benefit 30 or 40 % of patients on average in various studies. So it's hard to justify reaching for a treatment that is fairly expensive, that is fairly involved, like having IV infusions given. If you truly have like a one in three expectation that it's going to help. Thankfully, it's been very well tolerated in my experience. We've used Gilbet-Mab for over a dozen patients for various applications and they tolerate it quite well, thankfully. Guannan Wang (27:23) Yeah, yeah. Yeah. Yeah. Brendan Boostrom (27:47) ⁓ But a 30 % response rate is not quite good enough. So to have genomic guidance, tumor mutational burden, to have kind of an index that says, this is a patient with a higher likelihood to benefit is really, really powerful for us. Guannan Wang (27:48) Mm-hmm. No, yeah. Yeah, so glad to hear. Petey already finished the gilvetmab treatment, right? the idea hopefully is that, know, his cancer is completely wiped out by the immunotherapy. ⁓ Brendan Boostrom (28:15) Exactly. Guannan Wang (28:17) Should there is a, hopefully not, progression, we also have other options for him, but we hope that he will never need that. completely cancer free. But. Brendan Boostrom (28:24) them. That's a really good point that you raised Dr. Wang, though, because that idea of having other options is really helpful as well. When you asked, when do you run this kind of a test and do you reach for it, even if you set out with a plan like Petey's gilvetamb if his cancer is to come back, it feels very good to have alternatives. Guannan Wang (28:52) other options. Brendan Boostrom (28:53) And thinking back again to like when I first came out into practice like 10 years ago or so, you know, it was often the case that if a lung cancer came back, we'd feel almost obligated to provide comfort care at that stage. You know, we did have a few injectable, like cytotoxic chemotherapy options, but the response rates are relatively poor. And there are some side effects we have to think about as well, like bone marrow suppression and GI upset, sometimes leptin. Guannan Wang (29:19) Yeah. Yeah. Yeah. Brendan Boostrom (29:23) ⁓ So just to have the alternatives and you know even on a genomic profile you might give me three or four options to choose from. And it's very helpful how like with your experience and your expertise and leaning on a lot of other oncologists who have used these treatments, you are able to almost rank them to say like based on your knowledge, prioritize them. I'd suggest you start with olaparib but you do have an option like lapatinib you do have your palbociclib So to have these alternatives is really powerful because even with the best genomic guidance, Guannan Wang (29:45) Yes, prioritize. Yes. Brendan Boostrom (30:02) cancer is challenging and we'll have some patients where their cancer still progresses in the face of that treatment and we're really grateful to have something else to transition to, for example. So I think that's been really useful in terms of having early genomic results. Even with your speed, which is pretty impressive that like within two weeks typically you have a complete whole exome analysis and report back to us with all that guidance is really, really impressive. that two weeks is important. So we might be starting something off the shelf for a patient in the meantime while we're awaiting that kind of analysis and guidance. Guannan Wang (30:46) Such good experience and sharing. I have a few thoughts while I was listening to you. At the beginning when we first launched the VetOmics back in September or October 2024, ⁓ Even a lot of the doctors who knew me before, who worked with me before, yourself included, oftentimes send us these basically last resolved cases. where patients pretty much failed everything else, everything that's published. and then came to us as a last resort of a Hail Mary situation but lately especially in last fall winter So we actually see a significant increase of newly diagnosed cases, which is encouraging to see as more veterinarians become aware of these tests and options. So they actually integrate these early on in their cancer management journey, which is encouraging, right? Not only to have options as a backup maybe sometimes even as a frontline treatment if you know that the conventional options the response rate is poor so I think that's encouraging ⁓ change. So that's one comment. Second of all, so you mentioned melanoma in terms of the low response rate as we see in dogs for immune checkpoint inhibitors. you probably know this, but there is a big distinction between canine melanoma versus a human melanoma. most of the human melanoma are cutaneous and high percentage of them have a higher tumor mutation burden that makes human melanoma the most successful cancer type in terms of response to immune checkpoint. Brendan Boostrom (32:55) Yeah. Guannan Wang (32:58) But in dogs, as you know very well, most of the melanoma we see are not cutaneous. They are mucosal They are not sun- induced. And they don't have that intrinsic high percentage of high tumor mutation burden. Brendan Boostrom (33:11) Mm-hmm. Guannan Wang (33:20) which may explain the lower to moderate response rate to immune checkpoint inhibitors. that's something that we strongly advocate is to bring awareness that just because human melanoma is a perfect disease type for immune checkpoint inhibitors, does not automatically put canine melanoma a... ⁓ Brendan Boostrom (33:40) Yeah. Guannan Wang (33:48) perfect disease for immune checkpoint inhibitors. We do, however, see other cancer types, for example, cutaneous hemangiopharcoma. that a lot of them have a higher tumor mutation burden. We're actually doing some studies and we want to see whether these cancer type might be a better overall cancer type that will respond to immune checkpoint inhibitors. So that's why I think the science has to get there for us to really make that distinction overall what cancer type might respond. Brendan Boostrom (33:57) Yeah. Guannan Wang (34:26) But yeah. Brendan Boostrom (34:27) Absolutely. And the solar induced component of dermal or cutaneous hemangiosarcoma like in those thin coated kind of fair skinned pit bulls often, right? Who just love to lay on their back and soak in the sun, unfortunately. Yeah. Guannan Wang (34:38) Exactly. Yeah, in the sun, right? In New Mexico, on the mountains. Yeah. Yeah. Brendan Boostrom (34:45) Yeah, ⁓ Guannan Wang (34:53) Exactly, skin cancer. Yeah. Bye. huh, huh, huh. ⁓ Yeah. Brendan Boostrom (35:15) potential candidates for immunotherapy based on their sort of origins and their tumor mutational burden. So maybe not the strongest need for that kind of Whereas if you could select from those oral melanomas in dogs, you have a higher tumor mutational burden with your kind of analysis. Maybe then you're identifying that 30 to 40 % of patients who could significantly benefit from treatment. Yeah. Guannan Wang (35:21) Mm-hmm. I see, I see, I see, okay. Yes, that developed. Exactly. So that's the thing overall we found across many cancer types. So we found high tumor mutation burden cases. So I think the promise here, kytruda is not ⁓ approved for a single cancer type melanoma. It's basically all solid tumors. Right. So I think there's the pan cancer, all solid tumor, or even lymphoma. Brendan Boostrom (35:59) Right. Yeah. Guannan Wang (36:06) that to identify those patients that potentially respond better to immune checkpoint inhibitor within all cancer types, not just the one or two cancer types, I think holds a huge potential. And we do see higher tumor mutation burden in all types of cancer. Even some rare cancer types, we see like these high tumor mutation burdens, in some cases, if there's no other better options, we prioritize immune checkpoint inhibitors as the front line. So I think that's, the real potential there to identify all, maybe 20, 30 % of all cancers that have a better chance. better biology to respond to immune checkpoint inhibitors. Yeah. Brendan Boostrom (36:56) Absolutely, yeah. And that kind of alludes to a change in the landscape of tumor identification and treatment options where, like historically, up until probably 10 or 15 years ago, we would treat lung tumors based on the lung tumor data and guidance and the kind of treatment options that had been evaluated and colon cancers based on their colon cancer research. And then it turns out that you can have lung tumors that Guannan Wang (37:13) and then. Brendan Boostrom (37:26) behave and respond to therapy much more like a colon cancer and vice versa. That the tissue of origin, the anatomy of a tumor is maybe not as important as we long thought. That its actual genomes and its mutations and its sensitivities are probably the most important thing. And it makes it a little bit difficult to come up with like really good large ⁓ clinical trials because they are each so unique. Guannan Wang (37:39) Mm-hmm. Brendan Boostrom (37:56) And when we start to use precision medicines and targeted therapy, you can have remarkable benefits for like a lot of the patients that we've seen. You can see great responses, but you can't expect it to work for every tumor because they would really need to have the matching mutations and the context and everything else that is so important, right? The right timing, the right mutation, the right patient, the right family. Guannan Wang (38:22) Yeah, the right drag. Brendan Boostrom (38:24) everything has to kind of align. Guannan Wang (38:26) Align Brendan Boostrom (38:28) Yeah, so I think it would be interesting, for example, if you were able to go back and collaborate with a group like Merck who developed Gilbatmab and look retrospectively at their tumor biopsy samples, who were those 30 to 40 percent that responded so well to their Gilbatmab? Could you find tumor mutational burdens across the board and see if there is really a strong correlation there? Because to my knowledge, we still don't have a normal range. Guannan Wang (38:45) Thanks Yeah. Brendan Boostrom (38:58) We don't have a reference range for low, medium, or high for tumor rotational burden in pets. We can do comparative analysis and you can say this is the highest one I've ever seen and that kind of a thing, but to have an index and a reference range would be really helpful. Guannan Wang (39:09) Yeah. Yeah, yeah, yeah, we would love to collaborate and, be able to analyze those cases, where we can kind of have exactly like you said, reference level, what are considered. ⁓ high and what are considered low and do they correspond to the actual response so those are the kind of golden data set we'd love to yeah to get our hands on that on those cases and analyze and publish, right? So the TMB high, TMB low on the human side is not just based on genomics. It's actually based on large prospective clinical trials that the patients are treated with immune checkpoint inhibitors and those respond better and that group will be considered. TMB high, of course we're kind of doing it retrospectively, ideally, prospectively, but you know, like even retrospectively, I think we'll learn a ton Brendan Boostrom (40:24) yeah, there's so much to learn still. Guannan Wang (40:24) Yeah, yeah. that actually, know, the like one large piece of the equation, what I call is to collect follow-up data on these, patients, client-owned patients whose tumor was analyzed. and also are treated based on genomic guided treatment or even not that can be our control group. But I want to pick your brain. because as I mentioned earlier, we've seen a lot of successful cases, But overall, this is still kind of anecdotal. So we still lack that overall trend where we show that. Brendan Boostrom (40:59) Yeah. Guannan Wang (41:07) very, clear overall improvement of survival. So one of the biggest hurdle, so this is not new in my current post. So we've experienced this in my previous. post and when I was at UPenn, so the first thing that we want to do is to not only do the genomics right, that's only one side of the equation, but also we need to show whether genomic guided treatment actually outperforms everything else or at least equal. So, then there comes the piece of follow-up data, collect follow-up data. Brendan Boostrom (41:30) Yeah. Guannan Wang (41:49) tried so far surveys, email, quick follow up. trying to get that information. The intrinsic nature of the real world data is messier than a prospective well-designed clinical study Because these real world cases, ⁓ They are one not only treated with the genomic guided. recommendations they are also maybe treated with others so that increase the background. But also it's kind of challenge to actually get that follow-up data. so I'm gonna pick your brain how do we do that how do we kind of improve this process so that we can get more patient follow-up data to see the association with the genomics as a practicing oncologist. I know you guys are all super busy, so I'm very grateful you share some data, but overall, this has been a challenge for us. Yeah. Brendan Boostrom (42:46) Yeah. True. Yeah, I think ⁓ that's an excellent question. ⁓ And then through that, really bringing more people into the fold, there are already people, like colleagues of mine, who are dipping a toe in the world of genomics and interested, ⁓ but really maybe waiting for there to be more compelling published data, right? And so one thing to have personal experience that's been compelling, another to see it presented at conferences and the like, which I you're already Guannan Wang (43:07) Yeah. Thank Yeah, exactly. Brendan Boostrom (43:30) doing already on those ⁓ committees and discussion boards and everything. So my suggestion would be a couple of things. One is, in ⁓ parallel perhaps, to collect the medical records from these pets. And you may need to ask for permission from their clients, for example. So maybe in the submission form there could be an option for client consent to share their medical record. ⁓ And there are good ways to leave the Guannan Wang (43:50) Yes. Brendan Boostrom (44:00) personal information out of it and just make it about the medical data and respect their privacy. With those medical records now Yeah, there are so many incredible AI tools available to us that like is just growing exponentially, but ⁓ there's more than I could count that can do like a rapid analysis of these medical records to identify really key points like, you know, time of last chest X-rays and are they clear? Are they in remission? Do they change therapies? Do they have changes in their blood work even, know, trends in blood work that like I may not notice on first glance. Guannan Wang (44:22) you Brendan Boostrom (44:39) because it's still normal and it's not getting flat, but the liver values have gone up within the reference range twofold, for example. So I would suggest that you really consider using some of these artificial intelligence tools to do PDF summaries of whole medical records and you could even, I'm sure, create scripts to a degree that say like these are the key questions that I'd like to ask and you know see what it could tell you and inform you because you're doing an amazing job, Dr. Wang. Guannan Wang (44:41) uh huh uh huh uh huh uh huh AI tools. ⁓ Mm-hmm. Brendan Boostrom (45:09) ⁓ But you're only one person, you're one amazing person. And so as you're doing the genomic analysis and writing the reports and growing even as a business, I think you'll need more help and more tools like that to make it really feasible. So that would be one suggestion. ⁓ The other I think about is really trying to seek some funding for a prospective clinical trial because doing that ⁓ in parallel is gonna bring different data and ⁓ Guannan Wang (45:20) Absolutely, yeah, absolutely, yeah. Brendan Boostrom (45:39) It's also going to look at different questions, perhaps. So if that's a prospective clinical trial, for example, on splenic hemagostarcoma, it's probably a really good opportunity there. ⁓ Where I think there are a lot of organizations, and there are a lot of even like pet owners who would be ⁓ passionate about supporting something like that. Guannan Wang (45:42) Thank you. Mm-hmm. Yeah, yeah, yeah, yeah, yeah. Brendan Boostrom (46:05) And that way might have a little more consistency in the timing, the drug therapies, because the data is cleaner, right, and easier to evaluate, and makes a more compelling argument. Guannan Wang (46:10) Absolutely. The data is cleaner. Mm-hmm. Brendan Boostrom (46:20) That is a challenge in a way of precision medicine is that like if we have five different clinicians treating 10 patients each, each of those patients could end up with a different therapeutic protocol and they almost should, right? But by necessity, if we're treating them all the same, then we're no longer doing targeted therapy. having that kind of ⁓ prospective approach could at least say like these were the guidelines we followed in terms of treatment. If a patient was Guannan Wang (46:33) Yeah, exactly. Yeah. Brendan Boostrom (46:51) to receive a treatment like olaparib, This is at least the dosing protocol and the timing and the schedule of their therapy that we ⁓ follow so that within their targeted therapy there is some consistency. Guannan Wang (46:53) Mm-hmm. Mm-hmm. Yeah, yeah, yeah, yeah. Those are great, great thoughts. So mining medical records, I hear you say that leveraging more AI agent to really like process a large amount of data to. to kind of find those information that are relevant in this context, right? And the AI might be able to pick up things that our human eyes won't pick up immediately. Brendan Boostrom (47:28) Yeah. Guannan Wang (47:36) And I would love to hear your recommendation of some of the AI tools that works really well for you because so far we have not found some, especially in the veterinary medical record because the medical, veterinary medical records like is more diverse than the... Brendan Boostrom (47:43) Yeah. Yeah. Guannan Wang (47:57) Definitely. leveraging AI that's front and center in a lot of ways. But we want to leverage AI, but also in a very reliable way because AI can be dangerous. If you really know the data, you will know that AI sometimes ⁓ doesn't make sense. So that's why some like really quality control work that we have to be able to do. Brendan Boostrom (48:19) True. Yeah. Yeah. Guannan Wang (48:26) Yeah, recently, at Northwest Oncology Conference, Dr. Charles Tripp, ⁓ Dr. Lisa Parsley, so we were actually discussing for our Feline CGP test whole exome sequence for cats Brendan Boostrom (48:38) . So exciting. I I brought the mouse. Thank you. Thank you for prioritizing cats. They often get missed in these conversations. Yeah. ⁓ Guannan Wang (48:44) You're one of those who really pushed us towards this direction and we think it's very much needed. Genomic side, we are confident, comfortable right now. But in terms of drug dosing, cats are a lot trickier than dogs. And there's a... Brendan Boostrom (48:59) Right. Guannan Wang (49:03) much limited data in terms of drug dosing in cats. So we are actually thinking maybe we should start some prospective dose escalation. Brendan Boostrom (49:08) Thank Guannan Wang (49:13) study for cats for certain drugs because otherwise we don't have a place to start. I think in prospective study Brendan Boostrom (49:18) Excellent. Guannan Wang (49:25) it doesn't always happen, but I think we should not forget that there's the perfect, the right way in order to make this a proof of concept. Yeah, I appreciate you reminding us that because we're so like ⁓ deep in the weeds of the... the daily routine and the cases where we see a great potential and we want to leverage the real world cases. But do not forget, there's also the other better avenue of doing it prospectively. many of our doctors are more than willing to share information. I Brendan Boostrom (49:52) video. you Guannan Wang (50:07) feel so grateful of the support and the trust from the whole community. But there's ways that we can make it. Brendan Boostrom (50:11) Thank you. Guannan Wang (50:16) very very doable and easy in order for you guys in your busy schedule to share that information with us. Brendan Boostrom (50:23) Yeah, you asked about some AI tools. mean, the one that I use most often is Covet. And Covet has a really excellent like medical records and PDF summary tool, because it's intended to allow us to create basically a history before we've met a pet for an initial consultation. So we can collect all of their primary care records, we can collect your diagnostic results, you know, their Guannan Wang (50:27) Thank Okay. Perfect. I know. Brendan Boostrom (50:53) Radiology report of their x-rays or their CT scan their ultrasound report and like we'll have those in hand And I'm still a little old school I'd like to have them printed out to discuss with the family at least the core like not the whole hundred pages But you know the 5c report the ultrasound report I like to have it in hand But we've got a really nice concise summary of like the the high level points and you're right AI is still flawed and AI can invent things ⁓ Guannan Wang (50:57) Okay. Okay. Okay. Okay. Okay. Brendan Boostrom (51:23) and so you can't always take it, know, face value, you know, double-track, right. But sometimes I think like we're a little hyper-critical of technology mistakes because like we're all capable of mistakes, every, you know, my problem. Yeah. Yeah. Yeah. Guannan Wang (51:25) Yeah, exactly. Yeah. We are, but when it comes to patient care, we need to be super, super careful. Brendan Boostrom (51:47) ⁓ 100%. Yeah. But like, medical errors is a huge cause for morbidity and even sadly, mortality. Like we know that on a really deep level on the human medical side, but also I think on the veterinary side, and it's becoming more okay to talk about medical errors and how we double check one another. And that's, you know, I think probably always been a huge part of oncology practice because we're so aware that the drugs we're giving can be highly toxic. So Guannan Wang (52:00) exactly. Mm-hmm. Yeah. Brendan Boostrom (52:17) when we double check our dose calculations and our route of administration. like personally in our practice, I really like the pre-flight checklist, you know, method where if I'm doing a major procedure, you know, like electro chemotherapy procedure with our vet, I cure machine, you know, I'm saying this is Sally. She's a 12 year old Yorkie. We're treating a mast cell tumor scar on her, you know, right carpets above her wrist. And every now and then in that conversation, someone's like, I think it's her left carpets, right? Guannan Wang (52:26) Mm-hmm. and Brendan Boostrom (52:47) We'd much rather have that conversation out loud and be double-checked. But we're all capable of mistakes. It's good that we double-check technology and AI as well. really is. But maybe it's one more tool that can make things safer and more efficient. so I'm really impressed with that. So I think CoVet would be an interesting way to explore analyzing your medical records. There's also some really good tools. Guannan Wang (52:51) Yeah. Absolutely. Yeah. ⁓ You actually use it immune daily practice. Brendan Boostrom (53:13) Yeah, every day, yeah. And we use it to help us generate some really good detailed care instructions for clients as well. So I think of it kind of like a co-pilot. You know, it helps me to make better medical records. And at first, I believed that it was going to be just more efficient. Like everyone, you know, really puts it forward as time saving. And it is time saving, but it's better. Like my medical records and what I can share with the family is better than what it was six months ago before I Guannan Wang (53:20) Enjoy. Mmm. Mmm. ⁓ Yeah. Brendan Boostrom (53:43) use covet because it can do in five minutes what would take me two hours. So it's just incredibly efficient. Guannan Wang (53:48) Yes. yeah. Okay. Good. That's encouraging to hear because we feel like we are kind of stuck in the process of how do we better collect more follow-up data, which is so critical I mean, we are a genomic company, but we don't consider sending out the report is end of our service. We do want to follow up and see how the patient is doing. that data will feed back into our recommendation, into the prioritization. And even from the anecdotal data that ⁓ Brendan Boostrom (54:20) Yeah. Guannan Wang (54:33) is shared with us. We've already learned so much and actually feed into our pipeline. I'm excited to see what AI can help enhance this process and we'll be able to share more data. Brendan Boostrom (54:53) Yeah, we're all excited to do it. Guannan Wang (54:54) Yeah, that's the most thing. just feel like without good data, I feel like not able to make any conclusion, right? Whether this actually helps or this does not help. know, like providing more options. Are these good options? Are these okay options? So very critical of our... ⁓ Brendan Boostrom (55:07) Mm-hmm. Yeah. Hahaha Guannan Wang (55:22) test in general. Brendan Boostrom (55:25) You have so much on your mind. You're brilliant, but I don't know how you get any sleep. And a great mom, too. Guannan Wang (55:31) I have very, very, very rewarding moments. ⁓ Brendan Boostrom (55:37) good. Yeah, you wear a lot of hats. You do a very good job of that. Yeah, we're very lucky to have you, you know, doing this for us. you know, I think it's one thing to have a whole bunch of veterinarians or even veterinarian oncologists, you know, putting our minds together trying to figure things out. But like you bring a unique perspective, like really that emphasis on science and data and genomics, you know, in ways that like I honestly try to, but I'll never understand like at your level and at your depth. that collaboration is so helpful. And I think that like it always takes a village, right? Like as a parent, takes a village to a kid and it takes a village to care for a pet with cancer too. Like no one should have to do it alone. Guannan Wang (56:10) Yeah. Yeah. Absolutely. And no one can do it alone. Yeah, it's so critical. Yeah, exactly. Yeah. Brendan Boostrom (56:22) Yeah, we can't do it well alone. Yeah, there's too much and there's so many options now that is both powerful to have so many options and the sort of diversity of care treatments. But then on that spectrum of care, there are families where what feels best to them and maybe even what is truly best suited for their own pet is a relatively simple comfort care plan where it's, you know, what can I do at home? What can I do without all the Guannan Wang (56:47) Mm-hmm. Brendan Boostrom (56:52) extra hospital visits, what can I do that's not going to have a significant risk of side effects, even if we can say that most pets are going to tolerate a cancer treatment course quite well and maybe 20 to 25 percent of them will have side effects, but still some of them. So some families would rather not even go there, you could say. And then you have pets where they want kind of an intermediate approach and they want to do something that feels balanced, you could say, but I don't want to Guannan Wang (56:54) Yeah. ⁓ There are exceptions. Yeah. Yeah. You sack. Brendan Boostrom (57:22) throw everything at this, but I would like to try. I would like to feel like I tried and did something for them. And you know, that might be, I really enjoy using electro chemotherapy and doing this tumor specific electroporation treatment where, hi sweetie, hi. Like if it was Piglet, I'd want to do something balanced, right? Because I feel like that's a treatment with electro chemotherapy that is both well tolerated and a good experience and requires maybe two treatments. Guannan Wang (57:25) Yeah. Thank you. you Yeah, yeah. Thank Brendan Boostrom (57:52) And so it's just a balance of helping without an expectation of harm. It's more affordable. And that's where I think we fall a lot of times with targeted therapy, is you can do this treatment at home. You can do a genomic profile and have that guidance. And we can prescribe these medications through a compounding pharmacy, and they'll be delivered to your home through compounding pharmacies, both in terms of practical use and also regulations. Guannan Wang (57:52) Mm-hmm. Yes. Mm-hmm. Mm-hmm. Yeah. Brendan Boostrom (58:22) We can compound these drugs because that way the dose is very precise. That way the dose is what a cat needs and not a human dose, you off the shelf. We can do that because of the formulation being something that's easier for them to accept. ⁓ But the huge bonus that I think we all appreciate is that usually these compounded drugs are much more affordable that are Guannan Wang (58:30) Exactly. Yeah. Yeah. yet. Brendan Boostrom (58:46) you know, $20,000 drug becomes $200. And that's still significant amount of money, but that's much more within reach for a lot of families. $200 a month perhaps is something that people can make adjustments, know, or adjust their budget or sometimes making sacrifices, but try to pull that off. So I really like that, you know, targeted therapy can really fall in a realm of care that is approachable for a lot of families. I think we can even expand Guannan Wang (58:54) Yeah. Exactly. Brendan Boostrom (59:15) that to perhaps being in the hands of more primary care vets. Because there are a finite number of veterinary oncologists in the world. It takes a strange breed to be a veterinary oncologist, And so we can't ever treat all the pets with cancer, you know, as much as we'd like to. We might each see something like three or four initial consults a day and do our best and stretch, but there's just not enough of us out there. But if we're able to use this Guannan Wang (59:25) Thank All the Brendan Boostrom (59:45) kind of approach ⁓ to put that care back in the hands of more primary care vets. I know dozens of just really brilliant primary care vets in my region alone that would be really interested to do that, that already manage treatments like chlorambucil. They're already doing this kind of chemotherapy prescription and management for small cell lymphoma in cats, let's say. And so think they're quite capable, but they would really need us to first do the legwork and the Guannan Wang (59:47) Mm-hmm. Mm. Okay. ⁓ Exactly. Brendan Boostrom (1:00:15) and have clear protocols because they're not giving it to you. Yeah. ⁓ Guannan Wang (1:00:18) I have clear protocol, a lot of hand holding, right? High level, even, you know, like more hand holding. so that we, you know, we don't, don't, yeah, cause, yeah, yeah, yeah, yeah. In the right framework, yeah, I would see that huge, huge, yeah, upside. Yeah. ⁓ Brendan Boostrom (1:00:26) Yeah. that collaboration. Yeah, because you don't need the right framework. Yeah, because you don't need to have a chemotherapy hood. You don't need to have you know, personal protective equipment, you know, within your clinic. You don't need to have intense chemotherapy safety training, you know, for your team. You do need to have clear safety and handling guidelines for the families, you know, that are, you know, really consists of pretty simple things, but, you know, keep this medication bottle well out of reach so no one accidentally has an overdose like a, I haven't had it happen, but I always fear a hungry lab. Guannan Wang (1:01:02) and then Brendan Boostrom (1:01:12) a whole bottle of chemotherapy, right? I just fear that. So put it well out of reach. Wear gloves when you're handling these medications. Wash your hands afterwards. Don't crush them and mix them with milk to get to your kind. have to give them a whole. So that kind of education is important. But because you don't need those really intensive protections and restrictions within your clinic like we do to safely administer and to protect our team from chemotherapy. Guannan Wang (1:01:15) You Yeah. Yeah. Yeah. Yeah. Yeah. Brendan Boostrom (1:01:42) then it maybe could be back in their hands more often. Guannan Wang (1:01:46) Yeah, I hear you. That's a huge untapped potential there. At the end of the day, we want to have more pets with cancer being taken care of, right? So this takes the specialist as well as the primary care veterinarians but again being very ⁓ Cautious on the Protocol safety and the data side we are developing a standard of protocols for the drug dosing schedule and I think we need to overall Have a really good protocols so that Brendan Boostrom (1:02:28) Thank you. Guannan Wang (1:02:35) there will be variations, but at least to have a standard place to start, I think is critical. And that's also a crowdsourcing effort, we have these protocols from the new drug. application from the beagle data When they get the FDA approval. But then, we see some concerning side effect from the real world patients and we actually, curate that all that information together so that when this gets to a new ⁓ Brendan Boostrom (1:02:55) Yeah. Yeah. Guannan Wang (1:03:09) new vets either oncologists or primary vets they can bear these mind, these side effects or this dosing range. So that's something we're actively collaborating with the whole oncologist, community to learn that. That's something that we want to kind of set up ⁓ the good framework. Brendan Boostrom (1:03:29) Thanks for watching! Mm-hmm. Guannan Wang (1:03:36) am I good to assume that you are pretty excited about this field and the potential? Brendan Boostrom (1:03:45) Yeah, yes, very very excited. Yeah, it's it. It's just so wonderful to have another tool and to have the information that really helps us think that we are even better than yesterday, doing right by these pets and their families, that we have a new range of options that were not quite as limited as we maybe have been historically. It's so exciting. And so much of what we've discussed today, there's more to come, We've given ourselves a lot more. Guannan Wang (1:04:07) ⁓ huh. Yeah, definitely. Brendan Boostrom (1:04:21) marching orders today. Guannan Wang (1:04:22) Yes, exactly. definitely. Are there any areas that you'd like to see happening within near future or long term? And also I want to ask you if you do have a couple like practice tips for colleagues that are new to this field. Brendan Boostrom (1:04:33) Mmm. Mmm. Yeah, great question. Maybe we've talked about a lot of those next steps to great deal. I I'd love to see more of that ⁓ cancer predisposition analysis. Guannan Wang (1:04:56) huh. huh. huh. ⁓ huh. Brendan Boostrom (1:04:57) understanding why and then what potentially can be addressed there. know, how do we reduce the incidence of cancer in all of our pets but especially in those at-risk breeds, you know, and the giant breed dogs, the golden retrievers, pugs like this. I've loved so many dogs ⁓ but you those ones come to mind again and again, right? So I think that's a real emphasis for me and a real opportunity but then so much of what you just Guannan Wang (1:05:03) huh. ⁓ huh. Thank Okay. Brendan Boostrom (1:05:27) with just getting the clinical trials underway, collecting the data in a more efficient way, and just having more to share. There's still quite a few oncologists, I think, that are brilliant, absolutely brilliant, and have their doubts, and want to see the data before they're gonna jump in, which is very reasonable. Guannan Wang (1:05:36) Mm-hmm. Right. Yeah, absolutely. Yeah. Brendan Boostrom (1:05:55) Yeah, so I think there's still a lot of work to do to get people to come off the sidelines and to really join. And the more that we have, then the more successful we'll be because they bring great ideas and different experience and new collaborations and connections and just more patience into the fold. So I think that would be wonderful. In terms of practice tips, I'd say one thing that comes to mind is just in how I try Guannan Wang (1:06:02) huh. Yeah. Mm-hmm. Mm-hmm. Brendan Boostrom (1:06:25) to frame these options. ⁓ Guannan Wang (1:06:27) Mm-hmm. Brendan Boostrom (1:06:28) I even when I try to be careful, ⁓ it's notable to me like how many families still feel overwhelmed by all the information that if we spend 45 minutes or an hour sitting down together having a consultation and I know my team wishes I didn't spend quite as much time in the room but anyone who's ever worked with me knows that that's probably not gonna change. ⁓ But that's a lot of information to relay. And so I try to frame it Guannan Wang (1:06:37) Mm-hmm. you Mm. Yeah. Brendan Boostrom (1:06:58) know, one, in terms of, you know, what decisions do we need to try to make together today? What decisions can we make over the course of this journey? So here's what we need to decide on first. Guannan Wang (1:07:05) Mm-hmm. ⁓ Okay. ⁓ Brendan Boostrom (1:07:13) Secondly, I try to share information like in multiple modalities. We discuss it, but also giving written information and sending like a co-vet developed care instruction, right? That can be so detailed and thorough so that they just have that time to process everything. And I find that a lot of pet families, come back to me with questions after the fact, and I think it's great. It really shows they've been like diving into it. Now I have families come to me and say like, hey, I plugged this into chat. Guannan Wang (1:07:21) of it. Mm-hmm. Mm-hmm. Brendan Boostrom (1:07:43) GPT and here's some new ideas that they have, you know, so we're gonna see more and more of that Guannan Wang (1:07:47) They are also pushing. Brendan Boostrom (1:07:51) Yeah, but which is really great because I think like a lot of this information, you know ought to be publicly available. ⁓ Getting away from the ⁓ paywalls of journal articles that you know for a long time some of the best data and research that was out there and published was maybe only accessible if you had a membership or if you were a physician and that kind of thing. So we're really getting more and more information out to more people and I think that's really powerful again with a grain of salt and they usually Guannan Wang (1:07:57) Yeah. you Brendan Boostrom (1:08:21) are a little sheepish when they share that with me. I'm like, that's great, we're working together here. I love that you're bringing ideas to the table too. ⁓ So I think that's important, that it's a collaboration and that you share information in a way that is kind of gradual. ⁓ Otherwise the concept of genomics can be a little bit overwhelming. Guannan Wang (1:08:42) Yeah, absolutely. It's a ⁓ pretty steep learning curve. But fortunately, I do want to say that, it's not the first time that we are doing this. We have the entire human precision medicine. Brendan Boostrom (1:08:48) Yeah. Mmm. Guannan Wang (1:08:58) serve as our proof of concept. Granted the messaging is not always consistent or uniform but the overall trend seems to suggest that this is working and actually some owners they learned about this from their own experience or their family experience. sometimes not always Brendan Boostrom (1:09:12) you Guannan Wang (1:09:21) being promoted or being pushed from the owner's side. We have not an insignificant number of cases that get to us from the owner. Very, Motivated devoted owners that they want to leave no stone unturned and they hear from us either from LinkedIn from Facebook group. we don't even have a Facebook group I Mean just they found us out from a Facebook group. So which is Surprising but encouraging this has to come from all sides, right? So Brendan Boostrom (1:09:48) Yeah, sure. ⁓ Guannan Wang (1:10:01) us being able to provide more robust data with the help of you guys and then you learn from the data and also your real world experience and also the advocate from the owner's side. So it all comes together. But overall, feel like we make some strides and we continue to do. Continue to work hard. Yeah. All right. Yeah. Thank you. So, yeah. Brendan Boostrom (1:10:28) be dust. Good work. Guannan Wang (1:10:37) With that, I'd to thank you so much for your time. This is your one day away from the clinic and you devoted almost two hours to this program and share your experience, which is so valuable and will definitely ⁓ get those thoughts not only in our head, but also in action, Stay tuned. ⁓ Brendan Boostrom (1:11:03) Yes, I'm really excited. I'm happy to help as well, but thank you. It's very good to speak to you again. I'll talk to you soon. Thanks for bringing cats into the fold last year. I'm excited to see maybe ferrets come next and all of our little loved ones. Yes, I'm so excited. Guannan Wang (1:11:09) Okay, likewise. We've done two ferrets now. I know, we've done two ferrets. And some oncologists want to send in swans. I was like, no, no, no, not yet, not ready. We don't have that kind of data. But so far, know, dog, cats, and very limited data on ferrets. So we'll see what this new year brings to us to add to us. But we're excited. Brendan Boostrom (1:11:28) I'm sorry. ⁓ again. Yeah, I know there's interest. was just asked last year by a lovely ferret servant ⁓ if we could meet him in office. Yeah, we always love to serve. Yeah, so I know there's interest. mean, people really love them like family. So thanks for helping our family members, Dr. Wang. Guannan Wang (1:11:46) Yeah. Right? Fair enough, exactly. Yeah. Likewise, same. We all work as a team. OK. All right. Thank you. Bye. Brendan Boostrom (1:12:04) Yeah, because that's Bye. Bye bye.