Fireside Chat with Dr. Len Lichtenfeld - Former Deputy Chief Medical Officer of American Cancer Society

Exclusive fireside chat with a distinguished trio of cancer experts: Dr. Len Lichtenfeld former Deputy Chief Medical Officer for the American Cancer Society (and FidoCure Scientific Advisory Board Member) with Dr. Gerry Post, Chief Medical Officer, FidoCure and Christina Lopes, CEO, FidoCure.

Hear first-hand about their 8-year journey together in the fight against cancer on both ends of the leash.

INTRODUCTION

My name is Christina Lopes. I'm co-founder and CEO of One Health, and we've brought to the market
FidoCure, the first precision medicine for dogs with cancer. And I am so honored to today have here two
prestigious thought leaders, Dr. Len Lichtenfeld, who is a medical oncologist for humans, a primary care
physician, but has very notably served 20 years at the American Cancer Society as Deputy Chief Medical
Officer, Interim Chief Medical Officer, and very importantly, someone who's spearheading the policy
level, lots of innovation and really at the front line to advance cancer care. And some of his work actually expands to the other side of the leash where we help in terms of advancing care for our four-legged family members. It's an honor to have Dr. Len Lichtenfeld with us.

And we also have with us our Chief Medical Officer, Dr. Gerry Post, and I'll let him introduce himself in
just a moment. But Dr. Post also is a thought leader and coming from the veterinary oncology side,
caring for patients, but also moving the needle on how we should have architecture to advance care for
dogs and also on the human side. And the purpose today is really to share with everyone this
conversation we've been having actually for years on the intersections of care for cancer, both for
canines and for humans, and what we can learn by caring for dogs, by delivering care, by even
transforming the cancer journey of dogs, what we learn there, how that can also go back and help
accelerate cancer R& D for humans.

And this is a fascinating intersection. It's why we founded the company, it's why we have these
illustrious folks with us, and we've just been publishing a lot in the Nature family of journals. So it's a
really wonderful moment to talk more openly and kick off a fireside chat webcast to share with the
community. And so without further ado, I'll turn it over to Dr. Post. Tell us a little bit your
background and then we're going to go back to our illustrious guest, Dr. Lichtenfeld, and kick off what I
hope is a fun conversation.

Dr. Gerry Post:
Thank you so much, Christina. It's a pleasure to be here. So my name is Dr. Gerry Post. I am a board
certified veterinary oncologist. I've been that for over 30 years in practice. I did my internship and
residency at the Animal Medical Center in New York. And during my residency I spent one day a week at
Memorial Sloan Kettering and really saw firsthand the value and power of comparative oncology,
watching human patients go through chemotherapy, and then watching my own patients at the Animal
Medical Center go through chemotherapy, radiation therapy, and the like, and really seeing the
similarities.

After I left my residency, I started a practice in Connecticut, which eventually became the largest
standalone, privately owned, strictly veterinary oncology facility in the country. During that time, I was
involved in over 40 clinical trials, so we were a clinical trial center in Connecticut as well. I worked with
folks on both sides of the leash, both veterinary oncologists as well as human oncologists at Yale and
other institutions. And again, really saw the power of comparative oncology to help my own patients.

And when I moved out to California, actually before that, I met both Len and you, Christina at an
Institute of Medicine meeting, now the National Academy of Medicine in 2015 where we had the, really
for the first time, a meeting at the national stage talking about comparative oncology where human
oncologists, veterinary oncologists, cancer researchers, biotech companies as well as big pharma, were
all gathered under one roof to really discuss, and I really think elevate, this incredibly important topic.
And so it's been my unbelievable pleasure and honor to be part of FidoCure for the past four years.

And again, speaking from that 30,000, 30 year viewpoint, it's been wonderful to see the progress that has
happened over these past four years in terms of expanding the toolbox for veterinarians and veterinary
oncologists and for pets in terms of cancer care, diagnostics, and therapeutics.

Christina Lopes:
Thank you, Gerry. And you said the word comparative a few times. I want to turn it back over to Len. How did you get into this? Maybe in that you can explain a little bit what is comparative oncology from where you sit? But I want to hear your story first and foremost.

Dr. Len Lichtenfeld:
So thanks, Christina. It's a pleasure to be here with you and Gerry to have this conversation. It's a topic
that has become very near and dear to my heart on multiple levels and perhaps I'll have the chance to
share some of those experiences over the course of this conversation. But I was, as you mentioned
earlier, Deputy Chief Medical Officer for the American Cancer Society. One of my colleagues said, "We
need to have you participate in this Institute of Medicine meeting on dogs and cancer." At which point I
just resisted. I said, "I don't know anything about dogs and cancer." It turned out neither did many other
people, but the bottom line was they asked me to attend and provide a summary of the sessions at the
end. I resisted, but then I finally said, "Okay." They were persuasive. And to make a long story short, not
many days after I accepted that, we had two golden retrievers and one of our golden retrievers who
came down with cancer.

And we lived at the time in a small town in South Georgia. There was no access to veterinary oncology,
and the same people who were participating in that session became my colleagues and my friends and
helped us through that journey. And lo and behold, the week before we had this gathering, this seminar,
the week before Willie passed, and it was a pretty emotional moment for me when I got up in front of
this group. But the bottom line is that there were people out there doing some academic research, The National Cancer Institute had gotten involved with some grants and the Office of Veterinary Medicine. And the point of that meeting was about comparative oncology. That is our dogs, our companion animals, they live with us.

My doggie is sitting right here on my desk. I have a Cavalier King Charles named Riley. He's an adorable
pet. He's my doggie, he's with me all the time. But doggies like Riley and many of us who care about our
pets, they live with us and sometimes they eat like us. Whether that's good for them or not, I don't
know, but they're subject to some of the same exposures that we have. They developed cancers. And at
that time, as Gerry mentioned, in 2015, very little was known about those cancers. But it appeared to
me as someone coming from the human oncology side that if we could demonstrate the similarities, we
had the opportunity. And I shared, this was obviously the point of the meeting, I shared with the experts
who were also there, an opportunity to advance treatment not only for our pets, for our dogs, but also
for humans as well.

Well, that was not quite 10 years ago, but subsequent to that, I remain engaged with folks like One
Health and FidoCure, I've also been very involved with Flint Animal Cancer Center in Colorado State
University in Fort Collins. And I followed that story through, and it's what I call one of those evergreen
moments. One of those moments in life where you don't expect something to happen, and lo and
behold it's become a cornerstone, not just in my life, but myself, my wife, and many people that
surround me in many ways to try to advance this field, to help advance this field. I mean, there are
obviously wonderful people like yourselves, your company, and other researchers. And to see it grow
over time, to see what we've learned from where we started, it's been a very spectacular experience to
help others make a difference in advancing cancer research, our understanding of cancer, and frankly
the treatment of cancer, both for people and for our companion dogs who play, as I mentioned before,
such a great part, great role in our lives.

Christina Lopes:
So Len, in that, when you and I first met back in San Diego at the inaugural FORTUNE Brainstorm Health
meeting, there was a round table about what can we do and what can we do now? And I surfaced, well actually, did you know dogs get cancer and we don't have HIPAA and things are very accelerated. You can really learn and we can help the dogs in doing that. And I thought that was a little bit cheeky of myself stepping into this very illustrious meeting and saying that, and you, we didn't know each other, you had my back. You right away jumped in. And can you recount here what the story you shared? Because then from you joining in and creating almost some momentum in the meeting, I then met Amy Abernethy who became very close to the company and also has been a great guide, and even others that were just right there in that, it was actually kind of a circle. So over to you, what did you join me in that was so exciting and really bonded us?

Dr. Len Lichtenfeld:
You've got an incredible memory and I appreciate that. The only thing I remember is outside after the
meeting was over having the conversation, but I think we've had several conversations at that time. So
good for you. Number one, one of the questions about that meeting that we had back in 2015 at the
Institute of Medicine, one of the questions was how do we move veterinary oncology down a path? And
I made the comment publicly and I'll share it here as well, today when we look at human oncology,
human cancer care, we have incredibly sophisticated cancer centers, incredibly sophisticated treatment
options, a wealth of opportunities for treating patients. Not enough, but incredible progress. So we tend
to look at where we are today and forget that when human oncology started many years ago, I was there when it started and we had a couple of drugs and it's a whole other story perhaps for another time.

Christina Lopes:
And was the thinking then, if I may join you, that for humans, that cancer had this aura of death
sentence a bit?

Dr. Len Lichtenfeld:
Well, it did. And that was the beginning of quote, "the war on cancer" from President Nixon. And I
assure you that that quote "war" went on for decades before we started to see a sudden change in the
progress in treating cancer where our research finally came together.

And it wasn't that long ago we started to see the fruits of all that research. So what we see today was a lot different than what we saw 10 years ago and certainly 20, 30, 40 years ago. So in the veterinary community, it was pretty much the same thing. How do we make this happen? And of course the issue was, you need to do the basic blocking and tackling research. You have to create awareness. I mean, dogs and cancer were not...
Cancer was a death sentence for dogs and people... There were very few treatment systems around.
Gerry mentioned the Animal Center in New York City, but there weren't a lot of places engaged.
And today that's still an issue, but it's certainly a lot different today than it was then. And organizations
like FidoCure, for example, are helping doggies and pet owners around the country provide them
options that they did not have before. I think that's critically important. So it's a process, but along the
way, the key question was, what's the business case? What makes it happen? Yes, we can treat dogs, we
can figure it out.

But there were a couple things that I had said back then. First thing I said, I actually said
at the  conference, if we're going to make this happen, we need to find out whether or not cancer in
dogs and cancer in people are the same cancers. What are the characteristics of the cancer?

And remember back in 2015, we had some genomic studies in cancer in humans, but we didn't have a lot.Well, that's one of the incredible stories. And really from my perspective, it's really amazing to see what
organizations like FidoCure have done to advance the knowledge of the similarities of cancer between
our companion dogs and people. And there's a lot more similarities, that's a study that recently was
published in one of the Nature magazines. That's incredible. That's one piece.

The second piece is, what can we learn from the doggies that we can take into people? And there are examples of that. So for example, I mentioned Flint Animal Cancer Center. Advances in the treatment of disease like
osteosarcoma came because the veterinary oncologists who see a lot of osteosarcoma came together
and figured out a different way of treating the disease that made a real difference. Limb preservation,
for example, made a real difference in the lives of so many young people, children who get
osteosarcoma and continue today. There are trials that go on based on what we've learned from the
pets and what we have found out from treating pets.

One story in particular though really sticks with me and was recently published in a book, so it's now
public. When I heard it, I couldn't really share too much, but one of the leading drugs in cancer, a drug
called IMBRUVICA, has been one of the most successful drugs in cancer treatments, still used quite a bit
today. Someone shared the story with me, and as I mentioned, now it's public and been published,
shared the story that when they purchased the company, they weren't sure if the drug would work or
not, there was no information. And they did a study in dogs and the comment was, it worked. And lo
and behold, they took that, so they had dogs with a similar type of cancer, did a trial that worked in the
doggies and went on to become a major drug in human oncology today as we speak. So the reality is that we can learn, most of our models in oncology come from mice that have been genetically altered or other animals that may have been genetically altered and are treated in cages, and that's something we need to have. But we also have an opportunity to learn from the dogs who walk beside us.

Christina Lopes:

So let see if I understand this. So you're saying that the owner of IMBRUVICA at the time, it probably had
a different name, essentially wasn't sure if this drug was going to work. And lo and behold, they tested
the drug in a clinical trial in pet dogs, so a human drug in development being tested in pet dogs, unsure
if they could generate a signal, if this drug works, with the aim of it working for humans and really
potentially shifting a cancer in humans, I believe lymphoma, right? So you are saying that then this drug
being tested in dogs gave a signal for it to move forward. Is that the story?

Dr. Len Lichtenfeld:
That's the story.

Christina Lopes:
Wow.

Dr. Len Lichtenfeld:

And the rest is history, so to speak. So it made a huge impact in human cancer care and the dogs were
one part of obviously a lot of other research that went on, but it was an important part of that research.
So yeah, that's the study that sort of stands out for me. But that's what we're talking about here. We're
not talking about using dogs as research animals in a cage in a lab somewhere. We're talking about the
dogs we care about, our pets. And there are a lot of people who are incredibly devoted to them. Dogs
are such an important part of our lives. I mean, this doggie sitting on my desk right now is with me
almost 24/7 and we both benefit from that. We care about our pets and they're very much a part of our
lives. There's a huge opportunity for us to improve their lives and also to learn at the same time.

Christina Lopes:
And so just to back up to what I was saying in that meeting in San Diego, you actually discussed this
journey of IMBRUVICA and how it actually was helping dogs and how you had had a dog, I believe with
lymphoma. And then also how you knew, given your role in leadership, thought leadership frankly in the
United States, but globally in cancer care, you also knew humans that were personally being helped by
the launch of this drug, which has been a huge success both for patients, also for the industry. So it's just
a magnificent story and that helped inspire us. And Gerry, maybe you can talk about from where you sit,
how this lands to you, but also from these kind of stories we just published in a few journals. What are
some takeaways that you'd like to share here that have taken these initial narratives and excitement in
Washington DC and National Academy of Medicine, leaning in, where have we taken this as we meet
here today in 2023?

Dr. Gerry Post:
Yeah, so I guess the first thing when we talk about IMBRUVICA is it's not only academic to me important,
but it's incredibly personal. So my father who recently passed was on IMBRUVICA for six years and really
it kept his cancer under control for all that time. And so my mom was also on a targeted therapy that
kept her cancer in remission for four years. So it's way more than academically important to me, it's
personal. And just as I've received personal benefit from targeted therapy for my parents, I want that
same benefit to accrue to my veterinary patients, the dogs that I take care of, that we take care of, that
we love.

As you guys know, I have two French bulldogs who are with me 24/7. And so I fully appreciate the power
of comparative oncology to help our pets as well as people. In terms of the paper that Len mentioned, it
puts a smile on my face to see it in print because it really does show that not only are cancers similar
when you look at them underneath a microscope or when you see their biologic behavior, but now we
know that those cancers are similar down to their genetic mutations. And in some, it's the exact same
amino acid in that gene that's mutated in both dogs and humans for the same cancer.

So the similarities are incredibly profound. And I remember like it was yesterday, Len standing up at that
meeting in 2015 and really leading the charge for what we needed to do in order to bring comparative
oncology to the fore. And one of them was to understand the genomics of cancer in dogs, because we
were right in the middle of the genomic revolution in 2015 for people and he saw the writing on the wall
and was I think quite correct. And so I'm so grateful for his leadership and also it really validates the
genomic aspect of veterinary oncology and the importance of including that in the toolbox that's
available to veterinarians, veterinarian oncologists, as well as pet parents.

Christina Lopes:

Thanks, Gerry. I'd love to shift this conversation now to the topic of data. And I say this because again,
interweaving here so much of what brings us together, when we started, and I think back to this
meeting at National Academy of Medicine, one of the big gaps is, okay, high level, we think there's
similarities between dogs and humans. If so, then we can perhaps transform and accelerate care for
dogs in a way that then starts to converge with where care for humans is at. We need to understand
some information, however, how are we going to handle this paucity of data? And so that's just helping
map the canine cancer journey, which Gerry's saying we've been really leading the field and integrating
clinical genomics, the era of genomic medicine into the everyday veterinary clinic. So that we're really
proud of, we've been publishing on it.

But another aspect that we've been very thoughtful and we've been thoughtful about this day one, it's a
really important point to underscore, and Len, you maybe you don't even know, we're very instrumental
in this. Because when we met in San Diego, you talked to me about from the human lens, one of the big
missing pieces to really get oncology R&D to a whole next level is data. You said, "There's not even
data on the zip code of patients correlating to the date of death." So basically measuring that survival,
like just two data points that for me, who actually I am not a medical oncologist, I'm not a veterinary
oncologist, but I come from helping build out markets, especially Brazil where I'm from and in countries
that have a lot of unmet needs. That was shocking to me that such a well established and capitalized
space like human oncology would have such paucity of data also.

And one of the aha moments was when we were talking so much about needing to close gaps and
help dogs, but actually there are advantages that we could leverage, now as we meet here in the year of
2023 with AI and all of these tools which can be used in a benevolent way and not, but we are talking
how can we use these tools to accelerate and maybe leapfrog even, the care for dogs? Thinking the data
first and thinking these very minute data points, the phenotypical information of a dog, where they live,
what breed they are, what age they are, all of that, the type of cancer of course, but then genomically
sequencing that dog and then helping to deliver targeted therapies.

With our pharmacy partner, we really helped to bring a whole  toolbox of targeted therapies
to pet dogs and then measuring survival. So being able to do all that, Len, you were inspiring to me and
you talked about the Tower of Babel and I don't know if you remember this, but it was very important so
that we could structure the data day one and then our paper with AI at Stanford is an outcome of that.
But do you want to talk about that a little bit and just bring us in, because it was not insignificant?

Dr. Len Lichtenfeld:
I have to say it's another hour discussion. So you keep bringing up these great topics and I have to be
respectful of everyone's time and try to compress a very, very important issue. And yes, I actually do
remember the conversation. I remember how excited you were and when you said, "We can work with
our veterinary colleagues in our community to get information and we have that information about the
dogs." People will be surprised to hear that even today we still have trouble gathering accurate
information and data about people, humans with cancer. It is far from perfect and a lot of the data that
we need is unfortunately not accessible because it's not what we call structured format. So that was a
problem then and it's still a problem today. In fact, I just had a conversation in an interview about AI you
mentioned. Because everybody's excited about AI and think it's going to solve everything.

We still have a lot to learn. If we're going to have these learning systems and understand that potential,
we need to have data, we need to have information. So again, it was important then and it's important
today, and you made the point about how the veterinary community, in treating their dogs, has much
better information. Back then, literally back then I was part of another discussion talking about
academic research in oncology in underserved communities. And someone sat there and they said,
"Well..." It was a research professor and very highly regarded person, but this is a number of years ago,
who said, "Well, I'm going to have the genome, the gene sequencing of people, and I have all the
information I need about where they come from and everything else." And I actually spoke up in that
session and said, "Well, wait a minute. You're also going to want to have a lot of other information
about the person, we call it sociodemographic information. So 10 years from now, when you really begin
to understand that data, you can bring all those factors to play."

I don't think that that comment was very well received at that moment, but here we are 10 years, 15
years later, that's exactly what people are saying. We need to have as much information, because it's
not just the genomics that influence what happens with cancer, both in people and dogs and other
animals, it's also the influences of our environment. It's what we're exposed to. It's the food we're
exposed to. It's the environments we're exposed to. It's the stresses we're exposed to. So the more
information we have, the more we learn, and it's universal. It's universal, not just for, as I said, for
people, but for our understanding, our environment of what we learn. That's what this is all about.
Because companion animals, as I said, they live with us.

They have exposures, they have a much shorter lifespan and they get exposed and the impact of those
things happens much more quickly. And so understanding that is another area where we can get clues
about what impacts cancer and what we can do. We're learning so much every day. We just are. We're
in an incredible place in development, cancer research development, but we have so much more to
learn and every piece of that puzzle that we can bring together can make a huge difference. And so yes,
we had that conversation. You had the foresight and you also had the ability to say, we're going to do
that. And here we are and my journey's not completed.

One more comment I want to make for the audience. Listening to this conversation, the audience may not
appreciate how much capacity is available to treat doggies with cancer. There's some cancer centers out there. I made the mistake at that Institute of Medicine conference of saying, "Well, who has radiation oncology for dogs?" Lo and behold, the radiation oncologist stood up and I said, "We're there." So I learned my lesson very early on. We have those capacities. Unfortunately, most of that is centered in large cities or large veterinary schools. We need to figure out a way to broaden that opportunity to learn from dogs, to treat our dogs. We need to expand that and FidoCure and One Health are clearly at the forefront of making that happen. The word we use is democratizing the opportunity, spreading out to more people and more places, more opportunities. So I think that's important that we all understand that's part of this conversation.

Christina Lopes:
Thank you. That's beautiful. And just to tag on that, not only partly by having folks like you and others that are leaders in basically thinking ahead and planning, where are the gaps that we need to urgently close so they really help? So essentially in this paper we published earlier this year alongside Stanford AI Health, what we're demonstrating is that well-structured data really makes a difference. And having all those data points, we're up to almost 1.2 billion data points. This is the biggest, the deepest canine cancer dataset in the world and one of the biggest in the world period, if you think of a mammal with cancer. So we're very proud of that and to have done it so quickly, obviously with the partnership of all the veterinary community and the parents. But what's amazing about this paper where we're demonstrating with the first, if I may say, to really demonstrate that precision medicine tools are improving patient outcomes.

Dr. Len Lichtenfeld:
Christine, If I can make one point, because I know-we're coming to near the end of the session, there's another group that I want to acknowledge, and that's the investors who had the faith in what you were doing to support you through this journey and continue to support you. Yes, investors make investments for obviously specific reasons, but this has also been a journey and their willingness to participate in this journey has had and will continue to have impact far beyond whatever other types of returns that they may get. It's made a big difference. And we're here today having this conversation because some really spectacular research has been done really bringing information together, the billions of data points you're talking about that didn't happen
in the vacuum. And I just want to express that their engagement, NCI, National Cancer Institute's
engagement, willingness to step up has helped bring us to this point and will help us continue discovery
going forward.

Christina Lopes:
Absolutely, a16z Andreessen Horowitz, a bio fund, really very early believer of in leading the way in this
nexus of computational and biology coming together. So shout out Polaris in Boston has been amazing.
Other funds [inaudible 00:33:42], the list goes on. Really amazing collaborative partnership that have
been invaluable. And yeah, amazing to have this kind of full capital turn its attention and focus here. Not
obvious, not easy, and immense gratitude. So thank you for that shout out. And also the governmental
organizations that are helping to fund. And also, Gerry, you didn't mention actually Animal Cancer
Foundation, did you? That you founded, sorry, you did. Do you want to say that? And then maybe in
conclusion as we reach our half hour, bring this conversation together that I hope is just the beginning
because there's so much we could say and I can't stop smiling just in terms of sheer gratitude for all of
this. Over to you, Gerry, to close out the session.

Dr. Gerry Post:
Thanks so much. And Len, I appreciate your thanking the investors. I'd also like to thank a group of
people and animals, and those are the pet parents and the pets. Because every pet that goes through
FidoCure helps cancer research, full stop. And that's just wonderful. The pet parents who work with
their veterinarians and the veterinary oncologists who enroll their dog in FidoCure, big shout out and a
big thank you to you, because we couldn't do this without you. In terms of Animal Cancer Foundation,
yes, I founded the organization back in 1999 for the express purpose of funding, very early stage
comparative oncology research. Because again, given my experience at the Animal Medical Center
during my residency, seeing work at Memorial Sloan Kettering as well as the Animal Medical Center,
really saw the power of comparative oncology. And my dream was every dog who went to see an
oncologist was really part of a clinical trial, is actually now happening through FidoCure in terms of the
data that they're generating.

Because I agree with you, Christina, the data is incredibly important. And I remember when I joined the
company, you said, ground up, that data is in our DNA as I think you put it. And so I guess I would close
also with a huge smile on my face because I really do believe that we are helping dogs, pet parents, and
cancer research. So a win, win, win scenario is just so difficult to achieve nowadays, and I'm so proud of
working with all of the fantastic people at FidoCure, the amazing advisors that you've put together. It's
just a joy every single day.


Christina Lopes:
Thank you all with that gratitude and hope this was beneficial. And thank you all for your time and how
much fun.