Hello, it's Anthony Chadwick from the webinarett welcoming you to another episode of the UK's top veterinary podcast channel, Vet Chat. So pleased to have one of my old friends, Doug Tom on the line. We're gonna be talking about oncology and all the new exciting bits that are coming.
I always start a conversation with Doug by asking him what's the weather like. I mean, it's really a bit of a pointless question in Colorado, isn't it, because the sun pretty much shines every day. Well, the sun does shine every day and that includes today, but we're actually experiencing somewhat of a heat wave today.
It's gonna top out about 41 degrees or so in the afternoon, so it can be a bit unpleasant. That's hot. It sure is.
That definitely is hot. Well, you know, usually the reason that we talk about it a lot in the UK is is because it's so changeable, so the morning it was quite dull. But it's now actually is quite sunny and and we're experiencing something of a heatwave, but it's kind of mid-twenties, which is a bit different.
That's your, that's your winter weather, isn't it? That's right, yep. I, I always start by reminding people that, of course in, in Colorado, dermatologists don't do as well in some ways because there really are no fleas in Colorado are there?
It's too high up and it's too arid for for fleas to really do well in. Do we, do we see the occasional flea or there really aren't the occasional, the occasional flea is present, but compared to other places I've practised, practised it's. No, nothing the same, so it's it's actually quite infrequent, and you're right that that does cut into some of the dermatologists business.
But from the other perspective, I know with it being so sunny, presumably you see a, a few more skin tumours than you would like. Yeah, we certainly do, especially in those short coated light skinned dogs and the and the white cats, that's one of the hazards of living at altitude in a place that's sunny 310 days a year. Yeah, because it is the altitude makes a big difference, doesn't it, on the the the strength of the sun that's that's hitting those cats and dogs.
Yeah, it sure does, you know, you, you don't, you wouldn't think that, you know, 1500 metres would make that big a difference, but it actually does. And sometimes I think, you know, when you've been up a mountain, it's cooler, there's wind, etc. And so you're not aware of how much that sun is burning your flesh until it's too late and you realise I really should have put some suntan cream on.
Absolutely, we get very used to covering up and to using a lot of sunblock here. What are the sort of common tumours that you're seeing, Skin wise in in dogs, you know, with so and so on. Yeah, so, so, I, I can dispense with you didn't ask about cats, but I think we all know that by far and away the most common sun associated, skin cancer in cats is squamous cell carcinoma.
We see those, you know, on the ear tips and around the eyes and on the nasal plan in places like that. In dogs, it is a little bit more of a mixed bag, so we do see. Squamous cell carcinoma and it's sort of a little precursor which is called squamous cell carcinoma in situ.
But we can also see some of the vascular tumours, so hemangiomas, hemangiosarcomas. We think that some benign dermal melanomas can also be associated with sun exposure in dogs. Most of them are not, but there's a subset that do seem to be as well just like they are in people.
So those, those are probably the, the, the most common ones that we see. Of course mast cell tumours are are also quite common, but not really sun-induced as such. Yeah, they don't seem to have a a a a UV component the way some of these others do.
But obviously we want to talk about new things that are happening, happening in oncology, and we were very fortunate to help Verbach and the Australian firm that had developed it to help to launch during the pandemic when nobody could meet up with Stelfonte. What's, what's your experience with Stelfonte? Have you been impressed?
Have you been using that much? Yeah, so, in the interest of full disclosure, I should say that, I'm on, Qbiotics' scientific advisory board, so I'm a paid consultant for them, but, my individual situation is kind of interesting because although again I am a consultant for them, my institution hasn't used the product. And again, the primary reason for that isn't because there's anything wrong with it or we think it doesn't work.
It's just because we have the best cancer surgeons in the world. And really, most, there are many, many tumours that other folks might say really can't be removed, whereas salonta might be an option, where our surgeons can remove them just fine and that's really our default. So, again, the the information that I have for the, you know, my experience has been secondhand, so through hearing what all my colleagues are saying at, at some of the meetings that I've been to as well as obviously what's available in the literature.
So just to back up a moment for folks who might be unfamiliar, so this is a a product that has approval both in the EU and in the US for the treatment of mast cell tumours in dogs specifically. And it's kind of an interesting drug, compared to a lot of the other drugs that we have in our arsenal because this is a drug that is actually injected directly into the tumour tissue, rather than something that's given intravenously or orally or those kinds of things. And this particular drug was isolated from the berry of of a rainforest tree in Queensland, Australia.
And it seems to work by activating a pathway called the protein kinase C pathway, which is, you know, a pathway that some kinds of cells actually use to survive, but I guess if you overactivate that pathway too much, if you get it too revved up, you can actually cause the cells to die. And It's a kind of, it's fairly interesting. So the data that's been published suggests that around 3/4 of properly selected canine mast cell tumours will disappear after a single injection of, of this drugs Delfonta.
And that's great, of course, but one of the things that owners and veterinarians need to be aware of is the fact that what you're left with after this tumour disappears is usually a quite substantial crater. So a very large ulcer that is, you know, kind of open and you know, unsightly and potentially sort of exudative for somewhere between usually 3 and 6 weeks. The thing that's actually quite unusual and quite remarkable about this ulcer is that it heals up remarkably well with no intervention.
So, you know, when we see these kinds of lesions that are induced by other things, so a wound breakdown from this, you know, surgery issue or burns or, you know, those degloving injuries, you know, are, are, . First impression or our first goal as a, as a surgeon would be to go in and do things. So let's debride it.
Let's put the dog on antibiotics. Let's put topicals on there, let's bandage it. Let's put an Elizabethan collar on there to try and stop them from doing additional self trauma.
And with this particular product, the ulcer that's formed. The recommendation of the company is to do absolutely none of those things. No antibiotics, no Elizabethan collar, no debridement.
Just, just let them go after it, let them sort of auto debride it by licking, and it heals up by itself in, like I said, an average of 3 to 6 weeks, sometimes it's longer, sometimes it's shorter. It's really quite remarkable and actually I know that the the folks at Qbiotics are actually Really doing some interesting work in the laboratory trying to get a better handle on why these wounds heal the way they do and you know, so what are the molecular mechanisms that are associated with that and are there ways that this product might be able to use, be used. To heal other kinds of wounds, for example, maybe irrespective of injecting them into a tumour, those kinds of things.
So it's really quite interesting. And the other thing I, I mentioned about 75% of these mast cell tumours will go away with one injection. If they go away completely, the majority of them, get about 80% of those will stay away for at least a year.
So, it's, it's really quite remarkable. So do we know what happens after a year? No, we don't.
I mean, so that's just, that was the end of the study. So is it possible that some of those could be sort of late recurrences? Absolutely, but you know, quite encouraging actually.
So there are some caveats that are worth mentioning, so that is, there's a size limitation for the kinds of tumours that that can be injected with this product and The size limitation is about 10 cubic centimetres, and there's a formula that they recommend using to to make that calculation. And the reason for that is that tumours that are in excess of that size, the amount of drug that you would need to give a patient with one of those larger tumours could be enough to actually make them systemically ill. So got to stick with the smaller tumours.
They can have spread, so these are for, for local tumours only. So dogs that have disease beyond that local site are generally sort of not considered good candidates for this therapy either. So it's licenced for, cutaneous tumours anywhere on the body and subcutaneous tumours, below the elbow or hock.
And the reason that it's not recommended to actually use this product for subcutaneous tumours that are, kind of on the trunk, for example, is that, it can be very, very hard to determine sort of where those tumours begin and end, with great accuracy to allow them to be injected. accurately and the other thing is that they've actually seen some unpleasant, sort of deep, abscesses and pendiculitis occur in some of those tumours that have been injected rather than that sort of open ulcer, which is kind of actually what you're shooting for. So for those reasons, we, they don't recommend using them for those kinds of tumours.
So at the end of the day, sort of how do I, how do I sort of assess this? I guess I would mention there's one additional caveat to to sort of doing this particular approach and that is, they do not recommend that you biopsy these tumours within 2 weeks of the time that they're injected. And the reason is if you do a little punch biopsy or something else that to sort of confirm the diagnosis or get a histologic grade.
And then you try and shoot this stuff into the tumour, what they've actually found is most of the product just shoots out of the biopsy tract, so it doesn't actually stay in the lesion. So that's why, again, if a biopsy is gonna be performed, they say wait at least 2 weeks to allow good wound healing before you do the injection. But what that means is that for the majority of these tumours we're actually not.
Getting information about histologic grade, mitotic index, those other things that can potentially pick out those bad acting mast cell tumours that might require more aggressive systemic therapy. So the tubiotics is actually very fond of advocating what's called cytologic grading. So, clinical pathologists, are able to use one of several different schemes.
One was developed here in the states, one was developed in Europe, to actually estimate the grade of a mass cell tumour based on its cytlogic characteristics and the company again strongly recommends that that request be made of any of these tumours that are not going to get a biopsy because you're going to inject them with steelfonta. So is that as good as as histology? Probably not, but seems to be reasonably accurate, so it is sort of the next best thing.
So, you know, at the end of the day, so how, where do I see this fitting in? . I think the, the tumours that are best amenable to this approach are also probably gonna be the tumours that are the easiest to remove with surgery.
And sort of that's where the, the problem lies is if you have a choice between doing this, this injection and doing a relatively straightforward surgery, I guess, again, our, our approach here would be to just recommend the surgery because you get the information about histopathology, you get the information about margins, you get all those things. But I do see this product definitely having a role for the treatment of what I, what I tend to refer to as the, the small tumours in tight spots. So, you know, the, the little, little mast cell tumour that's way down on the digit or on the paw, where even a marginal excision is actually very, very hard to do, and still allow you to achieve primary closure.
The little tumour on the tail, the little tumour on the muzzle. So, these ones where again, even a conservative surgery is actually gonna be somewhat of a challenge. Those are the tumours that I think at the end of the day, potentially are gonna be the most interesting to treat with Deelfonta and, and the ones where it's gonna be the most useful.
The other thing that's, that's really interesting is, This is a kind of treatment that might end up being useful for other kinds of cancer as well. And there's kind of limited information out there right now about how that might work and for what tumour types it might be most effective. One of the things that is out there is just a N equals 2K series of using this product for cutaneous neoplasia in horses.
And that's a really interesting one because for a long, for decades, large animal veterinarians have been shooting drugs into, into skin tumours and horses. So that's a concept that they're very, very familiar with. So I think that this approach has the potential to actually have a lot more early adaptation by the equine practitioners because like I said, they've been injecting sarcoids and squamous cell carcinomas with things.
With chemotherapy drugs and immunotherapy and other things for decades, so just grabbing a some a new drug to try and and inject, I think is something that that they may adapt to very, very quickly. And again, so the, this end of two case report was one sarcoid and one melanoma, I think if I remember right, and there did appear to be some efficacy with both of those. It does appear that horses may be a bit more sensitive to this product than than dogs are.
Meaning that they may feel a little off for a few more days. They might require some systemic anti-inflammatory therapy, things like that. But again, more information about sort of how it may work for those diseases as well, as well as potentially other tumour types in dogs, is sort of eagerly awaited.
We may find it, useful for some other tumours that haven't been investigated yet. Thanks. I think what really fascinated me with Selfonte was also this, this, you know, the, the discovery of the molecule was from a berry in a rainforest and from a sustainability point of view, if we cut all the rainforest down, we're gonna miss out on so many.
Interesting cures, aren't we? Oh, absolutely, you know, there, there's probably just hundreds and hundreds of really interesting chemicals that are in some of these plants and microorganisms and other things that are in the rainforest, in the coral reefs, in, you know, all kinds of places, and a lot of these may disappear before we even know about them, unfortunately. You're absolutely right.
Yeah, no, we're, we're very interested in webinar that we're gonna be holding a green forum at a nature reserve in September, so it's something that . We're really passionate about for all sorts of reasons. There's so much benefit isn't there, from a living in a, in a beautiful natural space rather than it being denuded by us taking too much from it.
Absolutely. I suppose, you know, as you rightly said, most of the time you want to just make sure that you can surgically remove. The tumours, but I remember some of the tyrosine kinase inhibitors, and they're not new anymore, of course, but again, they were used for those areas where it's difficult to do surgery.
How do they compare with Stelfonta? When will you use something like Mazivvet? Or or palladia.
So the advantages to the, to the, to the tyrosine kinase inhibitors is that again, they're, they're systemically delivered, they're both oral medications and as a result, you're not limited to solitary lesions that can of a certain size that can be reached via injection. So we certainly do feel like they have a very important role to play for the treatment of locally advanced, so large, you know, locally advanced tumours that would be too big for steelfonta. And patients who already have disseminated or multifocal disease where again you really wouldn't be able to use a local product like this.
So I think, again, both of them potentially have their roles, but again, for the small tumours and tight spots, I think a local treatment like Stelfonta makes a lot of sense. For those really big tumours or those tumours that have already spread, that's when we sort of look at alternate forms of systemic therapy like the tiresy chinase inhibitors or even some of the older cytotoxic agents that we've been using for a long time. Fantastic.
Moving on, perhaps to new forms of diagnosis. There are some blood tests that are out there that I've heard about, that can, supposedly detect tumours early. I remember for again, bringing it back to dermatology, we had the possibility of doing blood tests for food allergy.
And we kind of all recognised that it didn't really work and people could spend a lot of money on it and it didn't really further the case. Where are we at with the these these blood tests for tumours? Are they similarly a bit inaccurate or or are we doing really well with those?
Great question. So, again, don't know how things are in the UK or the EU at this point, but in the United States, there are actually two companies that have sort of hung out a shingle and have started, making available these blood-based cancer diagnostics. So one of these is a company called PETDX, and another is a company called Volition Veterinary Diagnostics, and the, and the two technologies are a bit different, so.
PEPDX looks for tumour DNA that's floating around in the blood, so theoretically shed from the tumour cells into the bloodstream and then can be detected through genetic sequencing. Volition actually looks for, what are called nucleosomes, which are, the little packages of, of DNA. So it's not just DNA itself, but it's DNA wrapped around histones that again are similarly leaked into the bloodstream.
by tumours, by certain tumours, and that's detected by a conventional eliza, so, a much more simple technique for, for its detection. So, with both of these tests, the main information that's available right now is to say, if I take a large number of dogs who have an a tumour that's already been diagnosed by conventional means. And run this test, hey, it looks like I can detect cancer in a reasonable number of them.
So, with the, with the PET X test, if you take all comers, it looks like around 60% of the time. If you have an already diagnosed cancer, this test will be positive. With the volition test, it's only been evaluated at least publicly or there's only public data for two kinds of cancer.
Hemangiosarcoma and lymphoma. And with both of those cancers, again, it looks like about 80% of the time or so the test is positive, in those cases that again have an already diagnosed tumour. So the question is how do we use that?
Well, we obviously don't need it. To diagnose an already diagnosed tumour. And one of the problems that we have is that, or, or one of the ways that we think that this could be useful would be as an early detection test.
So, is this something that we could use as a cancer screening tool? So, just like dogs come in once a year for their yearly physical examination. Again, when they're older, sometimes we'll offer to do sort of senior blood work kind of screening.
We'll get a CBC and a chemistry profile. So one of the things that one could imagine would be, could we tack on these kinds of, of blood, you know, cancer screening tests to these yearly diagnostics. Yeah, I mean, that's an interesting idea, but I do think it's important to note that we don't have any data yet to say whether either of these tests is useful when used in that fashion.
And at least with the PETDX test, which is this the sequencing based circulating tumour DNA test, they actually do have data that says that the earlier the tumour is, the worse the test works. So if you have small, non-metastatic tumours, so less than 5 centimetres with no evidence of spread, the test only works about 20% of the time. So if, considering the fact that those are the types of tumours that we would want to detect with an early detection test so that we can catch them when they're small, intervene, and potentially improve the outcome, it seems based on the data that we have so far that this, this test is not that good at picking out the exact kind of tumours that we would want to pick out with this test.
So it makes it very challenging to figure out exactly how to use this kind of, this kind of technology. There are some situations where I think one of these tests could be useful and, and the, the situation that comes to mind is, let's suppose we do a chest X-ray on a dog and we see, some kind of mass in the lungs, and it's not in the location that is amenable to sampling. So in other words, it's, you know, central enough that you really can't get, for example, an ultrasound guided fine needle aspirate to, to sample the lesion or whatever.
That's a situation where, you know, we've got a, a tumour in a bad spot where, wow, maybe we could do this kind of, this kind of blood-based test. And if the test is positive, especially with the PED X test, a positive is very reliable. So there's a very, very low false positive rate.
So if that test came back positive, up, this is probably neoplastic. I think we can make. Recommendations to the owner on that assumption, it's very hard to be able to interpret a negative result again because there's a fairly high false negative rate, but that is one situation in which I envisioned, you know, this test potentially being useful or those hard to sample internal lesions where, hey, is it cancer or not?
This might change how we move forward with treatment options kind of thing. But yeah, the jury is still out. I do know that both of these groups are doing some additional studies, actually trying to use this in older normal dogs as a screening tool and actually figure out how well it works.
And God bless them. So I'm very excited that they're actually taking the time and effort to do the appropriate studies to look at this as an honest to God treatment, or sorry, honest to God screening test. And that's, that's wonderful rather than just saying, well, here's what we know and, and use it if you want or not so they're, they're actually doing really good science to to back up their claims and I'm really looking forward to seeing sort of these subsequent studies that are using it in different ways that might actually be a lot more interesting.
And potentially a lot more applicable. Yeah, that's really interesting, Doug, and of course we're also moving on some of the fascinating new therapies we're seeing monoclonal antibodies being used a lot in human cancers. We've obviously got some of those drugs coming in, particularly drugs like Calencia and Librella, even Apaquel was obviously one of the first ones as well to come in.
How do you think, Those sort of drugs might be useful in in treating cancers and so on. That's, that's a really great question, and you're absolutely right. The sort of monoclonal antibodies have, have sort of revolutionised healthcare on the human side.
I think at least in the states, there's more than 100 monoclonal antibodies approved for different conditions in humans, not just cancer. Cancer, autoimmune disease, inflammatory disease, you know, a wide variety of different conditions. And it's really, really exciting to see that technology start to trickle into veterinary medicine as well.
And I think one of the questions that a lot of people might have is, well, is it really necessary to reinvent the wheel here and have sort of a dog or cat specific product. Can't we just take off the shelf one of these human monoclonal antibodies and use them in animals? And the answer to that largely is no, unfortunately, and I guess there's two big reasons for that.
In general, these monoclonal antibodies tend to be much more species specific than the small molecules are. So in other words, the likelihood. That the drug is gonna work the same way against the dog target as against the human target is much less, so there's a lot of validation that's required to actually determine if that antibody is actually gonna work in the same way but beyond that, if we think about it, if you get.
Human monoclonal antibody, a big human protein intravenously, usually to a dog or a cat. It's not gonna take very long for neutralising antibodies to develop against that protein, which is gonna pick that therapeutic off very rapidly and actually inactivate it, even if it was initially working. So you might get one, you might get one dose, you might get two doses, and then it's just simply gonna be inactivated.
So that, that really shows you why we need these canine and feline specific products. And, obviously, as you mentioned, the, the, first one that really, that really hit the market was our, our anti-itch, our dermatology product, which, again, I've only used this sort of or had experience with this because of my dermatology colleagues, but they certainly feel very strongly that there are a lot of pets who really benefit quite. Quite dramatically from it, so I think that's been quite a success.
I don't know if if US sort of retired from practise before that became available or not, Anthony. No, I was able to, to use it and of course, you know, felt that it was beneficial. The problem, I think when it first came out was they brought it out within a short time they, they ran out of stock, so of course dogs were doing very well and then they had to stop it, which wasn't the the best.
And then of course sight of pointers come along, which is an injectable. One as well, and then obviously we've got the, the new drugs coming through for osteoarthritis as well, which I haven't had the experience of. That, that's a really interesting one too.
So, so for example, Labrella, which is this, this new arthritis therapy for dogs, targets a, a, a pain-mediting growth factor, called nerve growth factor. And it certainly appears based on some work that's been done previously, that bone cancer, for example, also expresses nerve growth factor, and part of the reason that dogs with bone cancer may be so painful could be through signalling through the exact same pathway. That's responsible for some of the osteoarthritis pain, so a nerve growth factor.
So, intuitively, one might think that these sorts of drugs could also be useful for some kinds of cancer-related pain. So, I'm not familiar with any information that's out there yet to say that this has been looked at, or, oh my God, it's fantastic. But, obviously, it's something that I think is, would be really exciting to look at for these other kinds of pain.
Besides osteoarthritis. And again, bone cancer would be high up on my list because of what we know about it already, and the way it may use this particular pathway. So that could be very, very exciting.
The other thing to, to really keep everyone's eyes peeled for are some monoclonal antibody-based therapeutics for lymphoma. And the one that, that's probably the furthest along is one that may be useful for canine B cell lymphoma. So, for several decades, there has been a monoclonal antibody that's been used for the treatment of human B cell lymphoma called rituximab.
The brand name, at least here in the States is Rituxan. And this is really revolutionised the treatment of, of humans with B cell lymphoma. So for low grade B cell lymphomas in humans, it can actually be quite effective by itself.
For the more typical high grade B cell lymphomas, like, which is what we usually see in dogs, when it's added to the standard of care, it actually significantly improves the outcome compared to standard of care by itself. So, for quite a long period of time, we've been eagerly awaiting a similar monoclonal antibody, potentially for use in dogs. So the human one does not, does not work.
It does not recognise the same target on dog cells, unfortunately. But several years ago here in the US there was actually a small company that purported to have an antibody that recognised the same target, but unfortunately it didn't end up working. However, our friends at Elanco, actually do have an antibody that, that targets the same molecule on B cell lymphoma.
That does appear to be able to deplete normal B cells in dogs, in, in laboratory beagles, and does have some activity in mouse models of canine lymphoma. So we're actually quite encouraged that if and when this is is evaluated in dogs with, with B cell lymphoma, that it may be a very, very useful tool. So stay tuned there.
So the, again, the preliminary data that's been done in the laboratory looks really good, really. Solid, and we're actually quite hopeful that that could end up being a successful therapeutic in the near future. So stay tuned for that space, the B cell lymphoma monoclonal antibody space.
It's so exciting to see so much that we can now do for cancer. It used to be, you know, the big C. It was that terrible word, you know, for humans and dogs and cats, whereas.
Right. Our treatment successes are just going higher and higher and. It's great to see the research going into to bring these drugs out.
Absolutely, yeah, it's very exciting. And just a final one, any other sort of treatments that we should be looking at? How is it going with things like radiation treatments?
Is that changing? Are we getting better at really aiming the dose at the right place with with technology and machines and so on? Yes, we certainly are.
And this is something that's sort of been available in a limited fashion in the US for maybe 10 or 12 years, and we certainly do know there are some places in the EU that have adopted similar technology. So this is not something that's one of those things that, oh, you've got to fly across the Atlantic Ocean if you want to have your pet treated by them. So the, the, the, the names of the, of these new sort of radiation delivery types of therapies that you may encounter are what are called intensity modulated radiation therapy IMRT and what's also called stereotactic radiation therapy.
And these use similar technology but employ them in different ways. So both of them actually use very sophisticated image imaging, targeting, and treatment planning. To be able to deliver radiation much more specifically to tumour tissue and really be able to avoid giving high doses of radiation to the normal tissues in the area.
So, for example, if you're treating, for example, a nasal tumour, you're able to really do a great job of sparing damage to the skin and the oral mucosa and the eyes and the brain while still delivering very high doses of radiation to the tumour. And this has really allowed radiation oncologists to reduce the likelihood of unpleasant side effects, which is great for owners and pets, of course, and for certain kinds of cancer, they've been able to actually sort of shift the paradigm of how radiation is delivered, so that rather than giving a whole lot of very small treatments over a protracted period of time. Using this very sophisticated targeting, they're actually able to give a much smaller number of much higher dose treatments.
So instead of 15 or 19 daily treatments, for example, spread out over 4 weeks, now they're able to do 3 to 5 daily or every other day treatments and potentially have the same outcome with, again, only a week of treatment and a small number of anesthesias or heavy sedations. Versus what used to be, used to take much, much longer, and again, a lot longer in the hospital, a lot higher number of anesthesias. So that change, that ability to do that stereotactic radiation therapy has really, I can't say it's improved the outcomes, but it's really improved the convenience of being able to, to deliver radiation therapy to pets in a, in a reasonable and practical amount of time.
So it's very, very exciting. This was obviously one of the negatives always that. The treatments that we use not only kill the diseased cancerous cells, but they also kill the healthy cells, so the more that we can target just specifically against the the cancer cells, the better the treatment and also the more comfortable the patient feels they're not going to feel nauseous and have all the, the side effects that, you know, we've obviously know very well in, in, in oncology treatment.
Absolutely. And, and here with radiation, again, it's all done spatially, right? It's all done by, specifically keeping, keeping less radiation dose to those normal tissues and it actually works remarkably well to, again, decrease those local side effects and improve the quality of life in the patients that are undergoing that treatment.
Doug, it's great to hear all the things that are going on, that are already benefiting our, our pets, but also some of the really cool stuff that's just around the corner and I'm sure that you will be at the vanguard of this and that we'll. Have a webinar as soon as some of these newer treatments and drugs come out from you. So thanks again for sparing your time.
I know you're very busy. I really appreciate it and I'm, I'm closing it from the very sunny Liverpool er to equally sunny Colorado Springs. Fort Collins.
I was there, what a fantastic university as well and and great work that you do with all the oncology, as well as the dermatology, I can't forget the dermatologists either. Oh yeah, absolutely not. Thank you so much, Doug.
Alright, thanks Anthony, it was a pleasure. Bye bye. Cheers.
