Veterinary college’s clinical trials advance cancer care in pets, people
Virginia Tech faculty have long been engaged in frontline, boundary-breaking research to advance cancer treatments that help people — and animals.
From cutting-edge technologies to more-effective drugs, the innovation and inspiration, energy and commitment, of Tech’s cancer researchers were highlighted during the celebratory announcement of the university’s most ambitious fundraising campaign to date, Boundless Impact: The Campaign for Virginia Tech.
As a presenter at this historic event, John Rossmeisl, the Dr. and Mrs. Dorsey Taylor Mahin Professor of Neurology and Neurosurgery in the Department of Small Animal Clinical Sciences at the Virginia-Maryland College of Veterinary Medicine, described significant progress in wide-ranging efforts to combat glioblastoma, the most common malignant brain tumor, determinedly resistant to even the most aggressive treatments.
“Thanks to collaborations between veterinary medicine, biomedical engineering, and cancer biology at Virginia Tech,” Rossmeisl said, “we’re on the cusp of the next truly big breakthrough.” Playing a critical role in these advancements have been clinical trials involving companion animals.
At the conclusion of his presentation, Rossmeisl was joined by Laura Kamienski and her dog, Emily, who was diagnosed with a glioma brain tumor in early 2018. As of June, no growth of the tumor has been detected in Emily’s last four MRIs, a testament to the deep impact and efficacy of collaborative research across the university.
Learn more about Rossmeisl’s research and Emily’s journey in this 2018 story from VMCVM’s Tracks Magazine.
Companions lead the fight against cancer
When Emily, a 10-year-old Portugese water dog, started having seizures in early 2018, her owner, Laura Kamienski of Portersville, Pennsylvania, was shocked and scared. A specialist in Pittsburgh performed an MRI of Emily’s brain, and the results showed a brain tumor. Kamienski was devastated. “I sat in the middle of the exam room at the hospital and sobbed,” she said.
Kamienski was referred to VMCVM’s Veterinary Teaching Hospital to enroll Emily in a clinical study led by John Rossmeisl that aims to determine the safety of a new chemotherapeutic drug — molecularly targeted cytotoxins — and drug delivery method in the treatment of brain tumors in dogs. Funded by the National Institutes of Health (NIH), the work is a collaboration between the college and the Thomas K. Hearn Brain Tumor Research Center at the Wake Forest School of Medicine.
After performing an MRI, Rossmeisl confirmed that Emily had an aggressive glioma brain tumor, notoriously difficult to treat in both animals and people — and always fatal. The same type of cancer claimed the lives of senators John McCain and Ted Kennedy. Without treatment, Emily was given two-and-a half months to live.
A life-extending decision
Radiation therapy was the only option in Pittsburgh, and specialists there estimated that the treatment would add only a few weeks to Emily’s survival. Wanting the best possible option for her beloved companion, Kamienski decided to enroll Emily in Rossmeisl’s trial as the 15th participant.
“I had to sign her up. She’s a member of my family. She’s my everything,” Kamienski said. “She has gotten me through some serious hardship over the years. It was my turn to do the same for her.” Kamienski paid for the cost of the initial MRI to confirm Emily’s diagnosis, while the study covered the treatment and follow-up examinations.
Response to the experimental treatment has varied among study participants. “There are multiple sub-types of gliomas,” Rossmeisl explained. “The tumors are different, so their genetics are different. We’ve had some tremendous success stories with dogs living for a year with their tumor shrinking, while others have had no response.” In addition, the study design called for the drug dosage to increase progressively; as a result, the dosage has doubled six times since the study began in 2014.
Emily received the treatment in April. The drugs, which are designed to affect only cancerous cells and to leave healthy cells unharmed, were injected directly into the tumor by way of convection enhanced delivery, a procedure performed by inserting specialized brain-specific catheters directly into the tumor and slowly infusing the drugs over several hours. During the MRI-guided procedure, Rossmeisl’s team watched the drug cover the tumor, confirming that the treatment goals had been achieved.
Back at home, Kamienski noted that Emily’s seizures stopped and that the dog was “back to being herself.” A follow-up MRI in June revealed that the drug was killing parts of the tumor, which had shrunk by more than 50 percent. According to Kamienski, Emily resumed her favorite activities, romping in the woods and swimming in lakes and creeks with Leo, a 2-year-old Portugese water dog.
December 2018 marked eight months since Emily’s treatment in the study. “We are just enjoying each day that we have,” Kamienski said. “If it weren’t for this trial, she’d be gone by now. I knew at the start that it’s not a cure. But it gave me hope and has given her more time.”
Advancing treatment from canine to human patients
Thus far, the study’s results have been promising, leading to a five-year, $9.2 million grant from NIH’s National Cancer Institute to advance the same treatment methods into human trials within the next several years.
Principal investigator for the grant, Waldemar Debinski, director of the Brain Tumor Center of Excellence at Wake Forest Baptist Medical Center, leads the multidisciplinary team, whose work began 16 years ago when Virginia Tech and Wake Forest University researchers set out to uncover a treatment for glioblastoma.
Along with Rossmeisl, Virginia Tech researchers working on the grant are Rafael Davalos, a professor of biomedical engineering and mechanics who co-wrote the grant; John Robertson, a research professor of biomedical engineering and mechanics; and Scott Verbridge, an assistant professor of biomedical engineering and science. Other team members are Chris Rylander, formerly of Virginia Tech and now an associate professor at the University of Texas at Austin, and Akiva Mintz, formerly of Wake Forest and now a professor of radiology at Columbia University Medical Center.
The research team will examine four different approaches to treating glioblastoma in humans, who face a survival rate of about 14 months when the disease is in its most aggressive form, according to the American Brain Tumor Association.
Because the canine model is as close as researchers can get to studies with humans, Rossmeisl explained, clinical research involving canine companions with naturally occurring cancer can be a pathway to accelerate drug development for human cancers. Significantly, the Food and Drug Administration has indicated its willingness to use the dog data from the trials as a safety indicator for developing human trials.
“The dogs are benefiting from this treatment, and eventually these drugs are intended to benefit humans,” Rossmeisl said. “The data from our study in dogs will inform both animal and human trials, so it’s mutually beneficial.”
A synergistic, additive approach
To advance the diagnosis and treatment of cancer in pets and people, VMCVM continues to expand enrollment in comparative oncology studies — akin to the study that helped Emily — which involve spontaneous, naturally occurring cancers in companion animals.
Because dogs often develop the same or similar cancers as humans and at roughly the same rate, some trials at the college provide pets access to leading-edge technologies and novel therapies that have already been tested in human patients. For example, a current study is treating solid tumors in canine patients with high-intensity focused ultrasound (HIFU), which has been shown to activate the immune system in humans, leading to more effective destruction of cancer cells.
To accommodate the oncology program’s expansion, VMCVM’s new Comparative Oncology Research Center — under construction on the Virginia Tech Carilion (VTC) Health Sciences Campus in Roanoke, Virginia, and scheduled to begin seeing patients in spring 2020 — will be a center of excellence for comprehensive animal cancer care and research, including comparative oncology trials.
The center’s location in the new biomedical research building of the Fralin Biomedical Research Institute at VTC will allow researchers across disciplines to investigate animal and human health together, embodying a One Health approach that will advance cancer care across species.
Bridging laboratory discoveries and patient care
In addition to its nationally recognized oncology research, VMCVM’s clinical research program includes specialties in cardiology, neurology, internal medicine, radiology, and regenerative medicine. Enacting a translational “bench-to-bedside” approach, researchers aim to take laboratory findings directly to clients in a clinical setting to achieve meaningful health outcomes.
Working closely with veterinary patients and their owners, referring practitioners, and funding partners, including federal agencies, private foundations, individual donors, and biotech and pharmaceutical companies, VMCVM’s Veterinary Clinical Research Office (VCRO) facilitates clinical trials and translational research studies that advance a common goal of improving animal and human health. Current studies are investigating mitral valve disease and glioblastoma in dogs, hyperthyroidism and inflammatory bowel disease in cats, and equine protozoal myeloencephalitis in horses.
“Through our work in translational medicine and research, we further the college’s mission of providing compassionate clinical care and creating new medical knowledge,” said Gregory B. Daniel, the college’s interim dean. “Our ability to develop and deploy new approaches to diagnosing and treating disease is due to the shared commitment of our faculty experts and their collaborators, the clients who bring their animals to our hospitals for treatment, our sponsors and donors, and our referring practitioners, including specialists in our Collaborative Research Network.”
Established in 2014, the Collaborative Research Network enables specialty practices in Virginia and Maryland to build unique partnerships with researchers and to participate in the college’s research. For example, when a practice in the network identifies a mass on an MRI that looks like a glioma, VCRO is contacted to connect the patient’s owners with relevant clinical trials happening at the college.
“Because the number of cases seen in the greater Washington, D.C., Richmond, and Baltimore areas far exceeds the number seen in Blacksburg, this specialist referral network has increased our ability to complete clinical trials quickly,” said Mindy Quigley, clinical trials coordinator at the college. “And by increasing the number of cases within our studies, the results and findings have greater scientific merit.”
“We want the very best for our patients,” said Quigley. “I love connecting an owner with an innovative care option for a beloved pet and knowing that our efforts made a difference in a patient’s health outcome.”