Immunotherapy has transformed cancer treatment. It tinkeres with the immune system to attack malignant tumors that have evaded the body's natural defenses. This advancement offers an alternative to treating cancer with surgery or chemotherapy and radiation, which can attack healthy tissue and cause extreme side effects.
The treatment is not only scientifically complex but also expensive. The investment of time and money makes sense when it comes to saving humans. But what about when it comes to dogs?
Dr. Hans Klingemann has worked and researched cancer immunotherapy for decades, leading departments at Rush University Medical Center in Chicago and Tufts Medical Center in Boston. Now he is the chief scientific officer of cellular products at ImmunityBio, which develops immunotherapy drugs for people. But he also wrote two papers exploring whether new treatments could one day extend the lives of dogs.
The following interview has been condensed and edited for clarity.
What interests you about immunotherapy and dogs?
I love dogs. I have dogs: Sophie and Maximilian. They weigh about 18 kilos each, they are a mix between a bichon and a Cavalier spaniel.
Have they developed cancer?
Luckily they didn't get cancer… Still. But as dogs get older, many get cancer. Are there any benefits from immunotherapy? Could we make life, what remains, easier for the dog and the owner?
In most cases, dogs actually receive chemotherapy treatments. We don't know how much these treatments affect your remaining quality of life, and in most cases, it's not even very clear how effective they are.
Your first article on the topic have found significant obstacles in developing immunotherapy treatment for dogs. Can you describe them?
Pharmaceutical companies are very financially conscientious. They haven't really developed monoclonal antibodies or other more targeted immunological treatments for dogs. It doesn't make financial sense to them. For example, an antibody treatment for a dog could easily cost thousands of dollars and no insurance company would pay for it and, with the occasional exception, of course, no dog owner would. So there really is no market for big pharma companies.
At the time, was there any evidence that these drugs worked on dogs?
Veterinary research centers would treat 12 to 15 dogs with drug X, but there was no real comparison. How would they do it with another drug, like drug Y? These comparisons offer the most controlled studies, which have not been systematically conducted in dogs. Additionally, cancer risk depends on race. The risk depends on the breed and age of the dog. It's difficult to get, say, 20 dogs for one breed. So it's hard to get clean data.
And in humans, we can weigh the benefits versus the harms because a doctor can ask us how we feel. But you can't ask the dogs. They just stand in the corner and don't like what we're doing.
In your first article you also raised the point that human medications may not work for dogs because our genetics are different.
Dogs and humans have a genetic homology of between 80 and 85%. While that sounds good enough, it's not enough to simply give a dog immunotherapy that has been shown to work in humans.
Efforts are underway to get an evaluation for the dogs in terms of how well they take immunotherapy and cancer treatment in general. Some centers are trying to get a scale for how an animal feels and the response rate to treatment.
A recent study tested whether a human immune protein can be administered by inhalation to dogs that have extensive metastatic disease from melanoma or lung bone cancer. It has shown promising results; they define the tolerated dose in dogs, showing encouraging survival times in treated dogs and good tolerability. It will pave the way for future studies using immunoactive human cytokines in dogs.
But there hasn't yet been much push to develop new immunotherapies for dogs. There has been little progress, a stagnation. It's a little harsh, but basically it's right. I hope that in a few years we will have more targeted immune treatments for our dogs, but they need to be accessible.
Has this awareness forced you to rethink the possible death of your dogs?
What I'm wondering for now is how we can make the remaining life after a cancer diagnosis more tolerable for the dog (and owner) with palliative treatment options that prolong life but also maintain the quality of remaining life. That's all I would ask and I know many dog owners feel the same way.
How are your dogs?
Sophie is 3 years old. Maximilian is 13 years old; he took a walk on the beach today. He is not sick with anything. He gets tired simply because he is older and sleeps a lot. But I understand it completely.