Whiskey and the MIMIC Study for Minimally Invasive Metastasectomy in Canines

What is the MIMIC study for Minimally Invasive Metastasectomy in Canines? What does Whiskey the Tripawd have to do with it? In this episode of Tripawd Talk Radio #118, you’ll find out.

In Loving Memory of Whiskey the Tripawd

In this episode of Tripawd Talk Radio, Whiskey’s mom Eleni Merkh shares all the details about Whiskey’s osteosarcoma metastasis surgery victory over lung mets. Her adorable pup thrived for over 18 months after lung mets were discovered and she underwent the procedure. It was only recently when Whiskey got her angel wings on May 3, 2023.

We dedicate this episode to her life and legacy.

And you’ll also get to know the MIMIC study’s director, Dr. Chris Thomson. He’s a Diplomate of the American College of Veterinary Surgeons, specializing in surgical oncology, minimally invasive surgery, and interventional radiology. And he’s also an active participant in clinical research with Ethos Discovery. His projects focusing on minimally invasive treatments for osteosarcoma and other cancers. And that’s why we’re excited to to talk with him today.

Tripawd Talk Radio Episode #118

Whiskey and the MIMIC study for Minimally Invasive Metastasectomy in Canines

Dr Thomson is working on the MIMIC clinical study for Minimally Invasive Metastasectomy in Canines. That’s a mouthful. But it means making advances in resection of lung metastases in dogs, with quicker recovery, some surprising results. AND more data toward finding curative treatments for metastatic cancers.

And that’s where Whiskey comes in. Eleni Merkh is also here to tell us how their participation in Dr. Thomson’s study went. Join us!

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Don’t want to listen to the podcast? Read the full transcript below. Or watch on video here!

Tripawd Talk Episode #118 Video: The MIMIC Study for Minimally Invasive Metastasectomy in Canines

Dr. Chris Thomson is an active participant in clinical research with Ethos Discovery. His projects focusing on minimally invasive treatments for osteosarcoma, thrombocytopenia, urogenital cancer, and several others.

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Tripawd Talk Radio Transcript:

Whiskey and the MIMIC Study for
Minimally Invasive Metastasectomy in Canines

TRIPAWDS: Dr. Thomson you are pioneering this procedure. What motivated you to get into this specific area of cancer treatment for dogs and hopefully cats someday? Let’s talk about your background a little bit.

DR. THOMSON: I am a surgical oncologist by training. Meaning that similar to the human side of things. I went to vet school. After vet school, I went through internship and residences specifically for surgery. And then after surgery residency, I went on to a surgical oncology fellowship at Colorado State.

The big difference for me is that I’ve always had a massive passion for surgical oncology. The reason behind that is surgery truly has some of the most dramatic ways to have an impact on a patient that is living with cancer. Meaning that of all of the treatments you think of for a cancer patient, surgery is often going to be the most effective way to treat patients with cancer.

We give the greatest ability for hope through something like surgery. But the downside is surgery is painful. Surgery is complicated. Surgery is associated with a lot of effects on patients, both in the short term and potentially for the rest of their life. And so, one of the frustrating things about surgical oncology is there are many times that we can do surgery but it always comes at a cost.

One of the things that I’ve always spent as much of my time and passion towards is doing whatever we can to minimize the pain, the morbidity, and the effects that surgery plays on a patient with cancer. I’ve really focused my research in clinical practice towards minimally invasive ways of treating cancer patients.

A lot of that comes through minimally invasive surgery. Meaning doing endoscopic-based techniques. So thoracoscopy, laparoscopy, and even like endoscopic things within the nose and airways as well as interventional oncology. So, using interventional radiology or live or moving x-rays to be able to do treatments.

This study or this technique is really a perfect melding of a lot of those passions. It gives us a chance to give patients diagnosed with osteosarcoma the greatest chance of a long-term survival. While taking away the pain and morbidity that was historically seen with some of these pretty invasive lung-based surgeries or thoracic surgeries.

TRIPAWDS: You mentioned MIMIC so I presume that means something like minimally invasive what now?

DR. THOMSON: Yes! It’s an acronym. It stands for Minimally Invasive Metastasectomy in Canines. We actually have one of our team members that is savant for acronyms and he came up with that for us. It is a way to do a minimally invasive surgery to remove pulmonary metastases or lung nodules from cancer elsewhere, specifically in dogs.

TRIPAWDS: And this would be instead of a lobectomy or something like that where they have to go in and remove part of the lung, right?

DR. THOMSON: It actually includes a lobectomy. The main difference is the approach to surgery. The problem is again, these patients are developing nodules or metastases, little tumors on the lungs that are coming from cancer elsewhere in the body. And in order to treat that, again, one of the most effective ways of treating pulmonary metastases is to surgically remove it, particularly for tumors like sarcomas.

Historically, if we wanted to do that surgery, we would have to do either an intercostal thoracotomy where you make this huge incision and split the ribs apart to get access to where the lungs are located. Or especially for patients if they have multiple nodules or nodules on both sides of the chest, we would have to do a median sternotomy. Where you actually crack the breastbone in order to get in. And get access to both of the sides of the lung – where the lungs are located. This is different than that.

Instead of doing that huge open surgery, we just insert a very small camera.

It’s about the – a little bit smaller than the width of your pinky finger that just slides in between the ribs. And then gives me access from the inside out to visualize all of those nodules. Then again, using long but very narrow, small instruments through little baby incisions in the chest wall. We actually go in and do that same surgery.

The lung nodules are still getting resected. It’s often either a partial lung lobectomy. Meaning a little wedge resection. Where we remove a small amount of lung on the outside of those nodules. But even in some cases, we have to remove a subtotal portion of the lung or even an entire lung.

For reference, for Whiskey, the patient that we are going to be talking about today, she actually had five nodules in four different lungs. And one of the lungs was at near subtotal lobectomy, meaning one of her lung lobes is almost entirely removed in surgery, but it’s also able to be accomplished through these little baby incisions to minimize the pain associated with it.

TRIPAWDS: It’s my understanding that when you do a lobectomy that you are also reducing the dog’s lung capacity. Is that the case with this surgery too?

DR. THOMSON: Yeah, to an extent. And so, the amount of lung that has to be removed is very dependent on the nodule size and location. For all of these patients, in order to be included, we do a CT scan or CAT scan prior to the surgery. The CT scan gives me a 3D map of all of the lung fields down to less than a millimeter precision. So I know exactly where these nodules are located within the lungs. As well as the relationship to the major blood vessels and airways of the lungs.

The procedure itself is dependent on the location of those nodules.

Some nodules are just located at the very tip of the lung lobe. And so for those patients, they are losing less than 5-10% of their lung volume with that. There are patients that have them located more towards the base of the lung. And for those patients, we do have to remove more lung volume.

The really interesting or beneficial thing about dogs is that they very resilient, number one. And number two is that we can remove upwards of 60-65% of their lung volume and they don’t have any effect on their pulmonary function.

So again, there are a lot of patients that we are taking a significant initial portion of their lung volume. But within again, days to weeks, their lungs just expand to fill that space that was lost with the surgery.

TRIPAWDS: Eleni, we would love to hear about Whiskey’s story. Let’s talk about it from beginning. You got the diagnosis for osteosarcoma when and how old was she, all that stuff.

ELENI: Whiskey turned 1 in the beginning of October 2021. And she – it was Halloween, she started limping. So we went to the vet the next day thinking maybe she torn an ACL. Of course, I Googled and diagnosed her myself with that.

And so, I took her to the vet and they are like, “Well, she is a puppy. She is running around. Maybe let’s give her some medicine, some pain medicine. Put her on bed rest for two weeks. See if it gets better.” I’m like, “OK. Sounds reasonable.”

That’s what we said. And when the two weeks – when that was up, she wasn’t any better. It almost felt to me as if she was worse. And I could see at that point, the two weeks later, that there was a lump on her leg because her muscles had atrophied.

We took her back. And they did – well, there was some discussion between the vets at the clinic. If it was something wrong with her hip or her knee. Or if she had hip dysplasia or they just couldn’t tell. So like, “We’re just going to go ahead and x-ray it and just see.” OK. Sounds great.

They take the x-ray. The vet comes back in and just the look on her face, like we could tell something was wrong.

And she said, “I’m pretty sure that she has bone cancer which is not what I was expecting to see or tell you because she is only 1. And I personally have never seen this in a dog that young.”

I had never had experience with a dog that had cancer before Whiskey. I was like a little naïve to the whole scope of what was going to come. And of course, we went back home and we start Googling some more.

We find out that our options are we can biopsy it and wait for the results to come back in. Or we can amputate it and then send it off for the biopsy. But that if it was bone cancer. And with her being a puppy essentially, we needed to move quickly because it was moving quickly.

We talked as a family and decided that we would amputate her leg and then send it off. Because if it was an infection they had told us, she would be on antibiotics for up to a year. And then it may not even work. She may still need to have it amputated. So we just decided from the top we would just amputate it, take the pain away, and go from there. We made an appointment with another vet that I was recommended for the surgery.

She was hesitant to do the amputation when we talked to her over the phone.

She said, “She is only a year old. It’s probably not cancer. Maybe it’s an infection.” Or there was another thing it could have been. She wanted to see us on person and for us to maybe go a different route.

I said OK. So we go and we met up with her and do the consultation. She takes an x-ray. And she says, “No, we are going to do the amputation because of how different the x-rays were from a week apart.” The bone was eaten up even more.

They did the amputation in December. She started chemo December 20, 2021. She finished chemo in March I believe or the end of February, March 2022. And then we went back for our post chemo follow-up. They did x-rays and that’s when they found one lung met. And so at that point, our oncologist said – he said, “Well, you can try another chemo or not. There’s no guarantee that another round of chemo is going to work.” And it happened so quickly after she finished the chemo. He gave us 1 to 3 months with her.

And so at that point, it was just – we were back to square one. Trying to figure out what our next move was.

TRIPAWDS: And at this point, you’re already talking more than a year ago, just about.

ELENI: Yes.

TRIPAWDS: And why is that?

ELENI: Because of Dr. Thomson.

TRIPAWDS: You are obviously a very research-oriented, take action, don’t hesitate kind of person. How did you first hear about the MIMIC procedure?

ELENI: Google. I just was Googling clinical trials and she was disqualified for most of them because she had the lung mets. There was one at Tufts University. I think it was some sort of for – it almost seemed like an inhaler of some sort. But they disqualified her from that one. Because we lived in Texas. She was going to need to be in the area for 6 months or something. It was an extended amount of time that they didn’t feel reasonable for us to come there.

So really, the MIMIC trial was – if Dr. Thomson approved us for it, that was our only option at that moment to go. Or we could try chemo again.

My fear was if whatever we tried next didn’t work for her, I didn’t want her to feel miserable during that time. If we only have 1 to 3 months left with her in the end. I want her to feel the best that she can feel during that time.

TRIPAWDS: Unfortunately, our community, we’re such a small, little corner of the pet parent universe, but we have seen dogs as young as, I want to say 15 months, I don’t think we’ve ever seen a year old dog with osteosarcoma in our community, but it happens.

ELENI: There was one in the bone group. He was only 8 months old.

TRIPAWDS: Is that unusual, Dr. Thomson? Are you seeing this in your practice?

DR. THOMSON: It’s not common but it’s known.Meaning that osteosarcoma is one of the cancers that we know has, we call it a bi-modal distribution. Most cancers, we assumed cancer as a – almost an age-related disease. Meaning it’s a disease that is associated with a lot of DNA mutations over time.

But osteosarcoma is one of the cancers that we know, it has one peak or the biggest peak where we see dogs diagnosed with it at an older age. So again, anywhere from 6 to 10 years of age, but there’s also this peak of dogs that will get it or this population of dogs that will get it between 0 to 2 years of age.

Unfortunately, it’s both in dogs and people where we see a juvenile version of the disease.

TRIPAWDS: Wow! Yeah. I mean our Jerry fit the profile of a dog who gets it. He was 8 years old, a larger dog. Whiskey is not a larger dog, right?

ELENI: No.

TRIPAWDS: She is 30-pound-ish? Around there?

ELENI: About 38.

TRIPAWDS: So you reached out to Dr. Thomson about this trial and then what happened next?

ELENI: Well, I told Courtney about it, my girlfriend, Whiskey’s other mom, and she is the reasonable one. She is like, “Let’s really think about this.” Because I was like in the car ready to go. I haven’t even talked to Dr. Thomson. I’m like, “I’ll just knock on the door and see if he will answer, right?” So we really talked about it. And I called – well, I filled out the form online. Dr. Thomson responded via email. And then we set up a phone call and I called him all the time.

TRIPAWDS: Dr. Thomson, that’s how basically how people reach out to you is through the website? Do you actually need the dog’s information to decide whether or not you’re even going to meet with them?

DR. THOMSON: I mean it’s always useful. We get contacted for this from a variety of different ways. A lot of it is just word of mouth of other veterinarians in San Diego. But there is a fair of number of clients that will come to us from our website just from Googling.

There’s a fair number of clients that will come to us because of Whiskey and Eleni. And other kind of word of mouth on some of these groups. And a lot of those patients, they contact us through the website. It’s just a form to fill out kind of your information for me to reach out.

Usually, the first thing that I always ask is for the medical records and medical information. Just so I can review that and have an educated conversation about what’s going on. And whether or not things are feasible.

TRIPAWDS: And what are the prerequisites or requirements? Who can or cannot participate?

DR. THOMSON: The exciting thing about the trial right now is that it is not necessarily only for dogs with osteosarcoma. Meaning that our trial is kind of two phases.

The first phase is for 18 dogs that are any cancer, except for hemangiosarcoma that has gone to the lungs. And, that there is nodules within the lungs but not so many that again, the dogs would not have an adequate lung function afterwards. They can’t have evidence of cancer outside of the lungs. Meaning that if it’s in the lungs, in the liver, and the skin then those patients don’t qualify.

The big thing is there has to be enough lung reserve following surgery. So that those patients will still have a good quality of life. The number of nodules is not specific but then the volume of lung to be resected is specific. And then a nodule that’s not bigger than 5 centimeters in size. Just because I can’t do the minimally invasive version of the surgery if it’s bigger than 5 centimeters.

TRIPAWDS: What’s the next step after that? Do you tell people just to come to the clinic? Do they have to do pre-workup at their own oncology clinic? How does that work?

DR. THOMSON: Most clients that are coming to me do have a fairly extensive workup before the discussion. Just because in order to get the diagnosis of the pulmonary metastases, they’re usually working with either an oncologist or their family veterinarian to get those x-rays done. And so, that’s usually the main thing that we will evaluate at the time of the initial consultation.

The first thing as part of the trial is a CT scan of the thorax.

We do a CT scan of the entire lung field to get a 3D map of what’s going on. Where the nodules are, the size of the nodules. And we get with again, a very advanced CT scanner. We get down to less than a millimeter precision. To know where these nodules are in relationship to the rest of the lungs. And the other important structures of the thorax. That is most commonly done at our practice in San Diego.

There are clients that have come to me. They want to know or ensure that they would qualify for surgery before coming to San Diego. And so for reference, one of our recent patients was from Seattle. They actually got the CT scan done in Seattle to allow me to look at that and say with more confidence, “Yes, this is a patient that would qualify for surgery.” Or, “No, these are nodules that are either in a position that are not amenable to surgery. Or there are too many that surgery would not be feasible.” So if they are traveling from a distance, often, we will do a CT scan prior to coming to San Diego.

TRIPAWDS: What percentage of people who reached out to you actually get to qualify for this procedure?

DR. THOMSON: It’s pretty variable. I would say right now, it’s probably close to 50-50. And the reason I say that is, unfortunately, a lot of dogs that are looking for these options are doing so late in the stage of disease. Meaning that it’s kind of a last ditch effort for some of these clients after they’ve tried nonsurgical options. After they’ve tried vaccines or other chemotherapies, and things are continuing to progress.

It’s a bit frustrating. I wish I was talking to them earlier before a lot of that happens. But just based off of the delay, unfortunately, some of these patients are coming to me with too extensive of disease. But again, a good 50% of them are allowed to be enrolled in the study if they have a set of disease that’s amenable to surgery.

TRIPAWDS: And you mentioned 18 dogs in the study. Here we are March 2023. How long would the study possibly go on? Are you still accepting dogs?

DR. THOMSON: Yeah. So we are going to do a total of 36 total dogs in the trial. And we are going to keep going until we get that full 36. The second set of dogs is going to be osteosarcoma only. Right now I’m having patients with melanoma or head and neck tumors that are coming to me that we’re also doing this on. But that second group will be osteosarcoma only. And again, the trial will be open until the full 36 are enrolled. Or if there’s a reason to stop prematurely.

TRIPAWDS: And again, we will include all the links, but what is the website for your initial intake?

DR. THOMSON: So if they are going to the Ethos Discovery website, so the trial is through Ethos Discovery. This is the nonprofit research organization that I work with that is doing some of the funding. A lot of the work to bring this to light. If they just go to the Ethos Discovery website, it lists all of our clinical trials. The MIMIC is one of them.

TRIPAWDS: Eleni, were you excited about this? Were you nervous about this? How hopeful were you when you went?

ELENI: It is. I would be lying if I said that I wasn’t super hopeful. I just – I’m just always hopeful that it’s going to do something productive or positive for her. Which can lead to it being extra hard when we hear hard news. Or it doesn’t work out or whatever it may be. But I’m always – I always start off super hopeful and I’m like, “OK. This is it, this is what we need. And this is how we’re going to get to the next stage in Whiskey’s life.” Which I said, which is why it’s great that I have Courtney. She balances me out with being reasonable. Saying, “OK, but A, B, and C, this is what we need to think about. We can’t always just lead with your heart immediately.”

TRIPAWDS: Right. And there are financial considerations too. I’m going to be nosy here. Do you have pet insurance?

ELENI: So Whiskey does not have pet insurance.

I will never have another that does not have pet insurance. Our other two dogs, they now have pet insurance because of her. But like I said, I have never experienced a dog with cancer. The last dog I had, she – we were never at the vet. She was just such a hearty dog. And she was always fine until the day she passed away. She just went to sleep like it was you know.

I’d heard about pet insurance. Maybe I had rolled the idea around in my head when she got older. That would be something that we would look into. But as a puppy, it seemed like we could spend our money elsewhere. It turns out, that’s not always the case. So yes, I’m a big advocate for pet insurance now.

TRIPAWDS: Dr. Thomson, is this funded study or are there costs involved for the pet parent?

DR. THOMSON: Both. So it’s a partially-funded study. Through the trial, we have an ability to pay for the CT scans. If they are done at my facility or in another Ethos facility. The enrolment CT scan again, if that’s done with us then we can cover that. If it’s outside of our hospital, we can’t.

The surgery itself has a stipend, we have a $5,000 stipend for the procedure itself. Unfortunately, this is an expensive procedure even beyond that. And so, owners are expected to pay a couple of thousand dollars in addition to that $5,000 stipend.

And then after the surgery, the trial can cover for CT scans for the monitoring after surgery. The goal is to do a CT scan two months after surgery and six months after surgery. And again, those are covered through the trial.

TRIPAWDS: Can we talk about minimally invasive? Is this like a day procedure, in and out of the office, or how minimal is this? What’s the recovery like?

DR. THOMSON: Our ultimate goal from the beginning of us talking about whether we could do this as an outpatient procedure. Meaning coming in the morning, doing surgery, going home at the end of the day. I think there is a chance that it might be feasible for some patients eventually. Right now, they generally are seen in the hospital one night, overnight. That’s really just for monitoring. Meaning that from a pain and comfort status, these patients within hours are honestly acting like nothing even happened to them. Whiskey is a good testament to that.

From a pain status, that’s not really the reason that I’m keeping hold of them. It’s usually just to monitor them. It is still a major lung intervention. Meaning that we are removing tissues of lung and we are in the chest cavity. It’s probably a bit overcautious. But I would rather keep an eye on them that first night in particular.

So far, all but one patient has gone home fewer than 18 hours after surgery. It again is dramatically different compared to the historic surgeries. Where again, If we are cracking the breastbone, those patients are usually in the hospital for multiple nights. Just because of the pain and morbidity related to that.

TRIPAWDS: You don’t have a very large incision and ribs being spread and that sort of thing.

DR. THOMSON: Right.

TRIPAWDS: Eleni, what was Whiskey’s recovery like? Tell us about that.

ELENI: She felt no pain and was trying to jump on and off the bed and run around. Which ended us in our local vet to re-staple her incisions from just jumping up on the bed when I couldn’t get to her fast enough. She came home the next night I believe it was after her surgery and she was like, “OK. Let’s go! Let’s go live life.” I mean it was incredible really.

TRIPAWDS: We all know metastases do metastasize. If they reoccur, is this a procedure that can be repeated and would that be outside the scope of the study?

DR. THOMSON: Yeah, good question. So specifically to osteosarcoma, it’s a crazy, frustrating disease. We are doing everything we can to get a better understanding. Both of why patients develop lung metastases, what we can do to prevent them, and what we can do to treat them. It is for better or worse a disease that also happens in people. And so, we have a fair amount of information about osteosarcoma in humans that can somewhat translate to dogs and dogs can translate to humans.

We know that once we go forward with the initial surgery and chemotherapy for these dogs that inevitably, about 90% of them will develop metastases within the lungs. And this trial is again, to treat those patients. Meaning those patients that develop the spread or nodules within the lungs.

After we do that in dogs, we frankly don’t have a lot of information. Meaning that we don’t really have a lot of data to say what to expect for those patients after we removed the nodules within the lungs.

In people, we know that they will develop often again, additional nodules. The interesting thing is that many times, it is still within the lungs. Many times, it’s also outside of the lungs. And after their second relapse, meaning when they develop additional nodules outside of the lungs, they do have a higher incidents of going to pretty random places in the body. Meaning even in the skin, in the muscle, and some other various locations. If it is found in various other locations, the treatment again is really focused or dependent on where and the severity of that.

Again, in people, one of the very interesting things and the reason that we are really pushing for this trial is that they will continue to do pulmonary metastasectomy. So surgery, to remove those pulmonary nodules even on their second, third, fourth relapse within the lungs any time it’s possible. Just because of the massive survival benefit that is observed if you completely surgically excised those nodules.

And one of the interesting things is that even if a patient develops a second relapse within the lungs, if you’re able to go and completely resect them again, there’s about a 30-40% chance of a 5-year cure for those patients after a second pulmonary metastasectomy. It is something that again, when surgery is possible, surgery is often recommended. We can get a good survival benefit from that.

TRIPAWDS: Eleni, it sounds like you’re doing an awesome job managing this. And showing people that yes, it is possible to live with cancer. To not feel like it is just a complete loss.

Whatever happens with Whiskey, we hope that she gets to live the longest, healthiest life possible. And we cannot thank you enough for participating in this study. It’s a game-changer for so many people like us. Thank you so much.

ELENI: I appreciate that. I mean it really is. And there are times on this journey where it just feels completely hopeless. I mean you guys know that. It’s like you get this timeframe. Here, you have 1 to 3 months left with your dog. Go have fun. And the entire time, you’re grieving not having longer. You just get sucked in to this hopeless void of not knowing where to turn.

At least knowing that this trial is out there, this procedure is out there, it gives some light to that journey, some hope in the end. So regardless of how Whiskey’s journey ultimately ends up, I am forever thankful to Dr. Thomson and this whole journey that we’ve been on.

TRIPAWDS: And in your case, it’s not only Whiskey. It’s for the greater good, getting more data into the study, getting more things so we can understand the causes and work towards an actual cure.

There has been some discussion over the years with other oncologists in the past on the show and in clinics. About removal of a primary tumor possibly facilitating growth elsewhere. And I wonder if you see a large nodule, what are your thoughts or insight on that? Does it tend to cause it to spread more elsewhere?

DR. THOMSON: Yeah. That’s a huge rabbit hole that we could talk about for 12 hours.

There is data. There is absolutely data that we know. We have for osteosarcoma and other cancers that fits with what we call a concomitant tumor resistance theory. The basis of that is when you have a tumor present, that tumor does have some degree of suppressive affects on the development of metastases or additional nodules.

We know that when you remove that primary tumor, we see evidence of increased circulation of some of those cancer cells.

The most important thing is taking care of that primary tumor. So our recommendation is never not to go forward with treatment of the primary tumor. But we do have to recognize that when we do things like surgery, it changes how the cancer behaves.

And so, the big thing that we are really all looking into is how can we identify that. So, one of the things of our clinical trial is that all of these patients are getting a liquid biopsy. Meaning we are working with Dana-Farber Cancer Institute to kind of validate or perfect a cell-free DNA-based testing. To actually quantify those circulating cancer cells before, during, and after surgery.

The other things that we are looking at include the lung micro environment. Meaning that patients after you remove their primary tumor, there are going to be more circulating cancer cells. Chemo is really good at killing off 99% of them. But that 1% that survives, generally, 90% of them go to the lungs.

And so, what is it in the lung that is making it such a good soil for these cancer cells to set up shop? Is there something that we can do to block that?

And then similarly, what are the genetic changes that are going on that we can then use to treat these patients?

And so, you’re absolutely right in that it’s frustrating. We know once you take care of a primary tumor, it changes the actual behavior of these cancer cells. And, how they respond in the body. It’s still is. Removing those nodules is still the best and most effective treatment. But now, it’s important for us to get a better understanding of what we can do about that. And how we should change our behavior based off of the cells’ behavior.

TRIPAWDS: Thank you so much, Dr. Thomson, for all of your work and putting this treatment out there, making it available, and continuing to give people hope. We cannot thank you enough for all of your hard work with this.

Eleni, thank you for sharing Whiskey’s story with us. We will continue to share her progress and the news of this study as well. So thanks again for joining us.

DR. THOMSON: I have to thank Eleni again. It’s champions like her that are willing to look for hope when often they are not presented with it. Again, this is something that it can be very frustrating deafening to hear these prognoses and the lack of options.

There are so many clients that don’t have that same drive to say, “I’m going to do my own research and figure out is there something more than I should consider.” So definitely, thank you to her just for doing, putting in that work, and not taking no for an answer right away.

Then also just for kind of talking about the experience. Because again, I’ve had several people contact me about the trial just because of Whiskey and her story and their ability to kind of champion this work. And so, I definitely appreciate that.

TRIPAWDS: Thanks you two. We appreciate your time today and keep in touch.

DR. THOMSON: Yeah, of course.

ELENI: Thank you.

DR. THOMSON: Thank you both.

[End of transcript]