Episode 70: Advanced cancer diagnoses lead to more targeted treatments

With the vast diagnostic techniques surrounding oncology, veterinary medicine has begun to shift towards developing more personalized patient care, according to Barbara Powers, DVM, veterinary pathologist at Antech Diagnostics headquartered in Fountain Valley, California. Echoing this notion, Barbara Kitchell, DVM, DACVIM, veterinary specialist in oncology at VCA Veterinary Care Animal Hospital and Referral Center in Albuquerque, New Mexico, stated, “We are transitioning now in veterinary medicine, following a personalized medicine approach in humans where it’s not just what the title of the cancer is, but really what made the cancer happen in this individual patient.”

In an episode of The Vet Blast Podcast, both Powers and Kitchell joined Adam Christman, DVM, MBA, to chat about the importance of a healthy communication pathway between veterinary oncologists and pathologists and the latest diagnostic techniques and targeted treatment options within the oncology space.

Oncology and pathology: The crossover

According to Kitchell, the shift has also brought about the idea of discovering if there are any signatures that veterinarians can exploit in making therapy more effective and less toxic for the patients. “It’s just a new threshold for us to cross as clinicians. Having both better immunochemistry and molecular profiling, and all these new things that allow us to understand what the tumor is—is what guides our therapeutic choices to do the best we [can] for individual patient care,” she said.

Adding to that, Powers elucidated the importance of the oncologist and pathologist relationship. “Well, the communication between the oncologist and pathologist is really important because [the pathologist] is looking at a piece of tissue on the slide, and the [oncologist] is looking at the whole animal,” she said.

Leveraging the oncologist and pathologist relationship

One example that Kichell provided where it’s crucial that an oncologist collaborates with a pathologist is in the field of lymphoma care. She explained that this field has morphed into 2 broad categories: B cell and T cell lymphoma. She stated that within those 2 categories, the pathologist can say more about what species of T cell it might be because that “does make a difference in selecting how aggressive the therapy should be, and sometimes even what drugs we should use.”

Another advantage identified by Powers is the pathology field becoming digitalized. She explained that she can now look at slides via the computer, no longer relying solely on a microscope. The plus side of this is that any pathologist can get a second opinion or perspective on tumors they might not be sure about by simply sending the image slide or case to another colleague.

The role of genetic profiling

Personalized veterinary medicine has enabled the use of utilizing a pet’s genetic profile to help determine a diagnosis. “We’re looking at genetic alterations [and] gene mutations—that is something that is just starting to be very important now and can help us with the diagnosis even,” remarked Powers. She continued to explain that a certain set of mutations might be more suggestive of some tumors vs another, so when pathologists are stumped with the second opinions and immunochemistry, genetic profiling can be used to help offer clarity to the diagnosis process.

Expanding on this, Kitchell shared that although genomic studies in felines are lagging behind their canine counterpart, this method can help oncologists understand what exactly “went off the rails” in a cell that led to it becoming cancerous and what therapy approaches are most beneficial. “The new molecular medicines in human medicine are vastly exploding. There is probably about 280 individual, small molecular inhibitors, and we’re just getting started in veterinary oncology to apply those tools to our patents, but we're already seeing the benefits,” she imparted.

Take home points

Both Powers and Kitchell concluded by sharing similar sentiments on the uptick in clients seeking genetic profiling to garner more information about a specific diagnosis. In addition to this, genomic sequencing not only allows clients to become more involved in the diagnostic process but also helps in elevating therapy plans by fostering a more tailored treatment approach. “That’s rewarding in a field like oncology where we have lost so many patients; to have new avenues and new hope of better outcomes is exciting,” Kitchell remarked.

Powers agreed, imparting that one of the greatest advantages is that the biopsy sample that pathologists have—where they’ve made the diagnosis—can also be used for genetic profiling. "The clinician does not have to go back and do another biopsy or take another sample because [pathologists] already have the [genetic profile]. We then send it off to labs that will do the genetic profiling,” she concluded.

View the full podcast below.