What's changed in eight years?

First of all, we've had some new drug approvals.

What hasn't changed is we really still don't have any targetable biomarkers other than HER2 low, HER2 ultra low.

But what has changed is we've had immunotherapy for a subset of triple negative patients that are PD-L1 positive.

We have CARP inhibitors.

and we have the antibody drug conjugates.

So when I was first diagnosed in 2011 with stage one triple negative, it was chemotherapy, chemotherapy, or chemotherapy.

If I'm a patient, newly diagnosed, metastatic, and if I am thinking about decision-making broadly, regardless of drug choice, etc., My overly simplified version of the story is I am choosing between quality of life and quantity of life, or at least some sort of balance.

And I think that's what we're hearing from the FDA and from the ODAC.

Janice, do you have anything you wanted to ask? We've already talked about this previously, but I just think there are some questions.

We don't have overall survival data.

Do patients live longer when we switch due to molecular progression? What does that mean for treatments down the road? Because we have a finite number of treatments.

in the metastatic setting for all subtypes.

And does that mean if we're switching earlier based upon molecular progression, does that then mean that we are burning through treatments faster and possibly not getting an overall survival benefit in the length of that person's life? What does that look like? And what does that mean? I'm disappointed because I am all pro CT DNA and biomarkers and all of that as a way to get closer to precision medicine for patients.

So in that respect, I felt disappointment too.

And then hopefully we'll continue to see interventional trials, both in metastatic breast cancer and early stage breast cancer.