6a57d64841594d5075e86a70-mp3

Jul 15, 2026 22:38 · 20:00 · English · Whisper Turbo · 5 스피커
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0:02
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
I just jump right in.
0:03
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
The reason I'm bringing it up is like,
0:05
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
you know,
0:05
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
even in these meetings,
0:07
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
which are like all informed people and in the guidelines and things,
0:10
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
like it does, it impacts the community because like,
0:13
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
you know,
0:14
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
it's hard for me as Joe Blow,
0:16
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
community doc,
0:17
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
even though you guys are doing it,
0:19
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
you're my offer, you can get away with it.
0:20
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
I'm like, you know,
0:21
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
I wonder when are they going to update these things to make it seem more legit.
0:26
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
I don't know if that makes sense,
0:27
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
but since that's the case,
0:29
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
I'm going to jump right in.
0:31
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
Just pointing it out.
0:32
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
For sure,
0:34
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
yeah.
0:34
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
And this is labeled stuff,
0:36
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
so we're going to get into discussion of some of the data.
0:40
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
No,
0:41
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
it's good,
0:42
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
it's good.
0:43
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
Yeah,
0:44
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
please do.
0:44
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
All right,
0:46
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
next slide.
0:47
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
Yeah, okay,
0:47
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
so here's the discussion slides for the first time.
0:51
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
What has been your experience with initiating step -up dosing in the community
0:55
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
versus referring to that?
1:00
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
I screwed up.
1:01
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
Yeah,
1:02
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
no.
1:03
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
I mean,
1:04
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
you know, so it's interesting with this group,
1:07
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
actually.
1:07
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
You know,
1:08
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
honestly, I feel like I...
1:11
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
have been very heavy in a managed care world,
1:14
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
and I realize you three are pharmacists,
1:17
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
and you know,
1:19
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
you have some managed care problems,
1:22
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
but relatively limited,
1:23
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
and FCS does not have as heavy a managed care population
1:27
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
as we do,
1:29
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
and like,
1:30
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
I don't know, I'm curious to hear more from you about FCS and what they're doing in managed care,
1:34
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
but historically they are not a heavy,
1:37
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
you know, managed care friendly entity.
1:41
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
as opposed to you know locally you know it's really us
1:46
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
and like you know there's a few other entities that are starting
1:50
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
to get their toes in it but I fell into this world and now I feel I
1:55
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
weirdly became like a weird expert in it which is surprising even to me but
1:59
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
it's a big issue because you know in places where
2:03
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
you're talking about like
2:05
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
costs of care and efficiency and people who have financial
2:09
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
limitations, you know,
2:11
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
these are major concerns,
2:13
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
obviously.
2:14
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
And so,
2:16
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
you know, referring to an academic center is a burden on the patients,
2:20
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
it's a burden on the system,
2:22
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
and it's not easy.
2:24
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
And so if we're going to be bringing these treatments up,
2:27
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
we feel strongly they need to be done in an efficient
2:31
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
but safe way.
2:32
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
For sure.
2:35
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
limitations there.
2:36
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
So, for example,
2:37
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
certain TGH pharmacists have
2:41
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
cheaped out and not stocked Tosi at their hospital.
2:44
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
And,
2:46
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
no,
2:47
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
but like, you know,
2:48
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
that's an issue for us.
2:49
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
So even though TGH is five minutes from my office,
2:52
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
you know,
2:53
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
I can't reliably trust them to be there to back me up,
2:58
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
which is unfortunate.
2:59
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
And Moffitt is not...
3:03
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
very friendly to a lot of the plans and has its own issues.
3:07
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
And so,
3:08
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
you know, sometimes it feels like we're out on an island like
3:12
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
fending it for ourselves.
3:13
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
You know,
3:16
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
I'm starting the meeting by attacking the pharmacist and then attacking the
3:20
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
hospital system.
3:20
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
But like, you know,
3:22
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
I, you know.
3:23
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
You tell me what it is.
3:25
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
But these are the frustrations in my life.
3:28
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
And,
3:28
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
you know,
3:29
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
it's a real thing.
3:33
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
Which to this question,
3:34
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
it limits you from being able to initiate.
3:36
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
It's a major hurdle because,
3:40
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
you know,
3:41
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
you can do it.
3:43
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
It's not that you can't do it.
3:45
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
But if you're trying to do it in a way that is efficient
3:49
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
and patient -friendly and just makes sense,
3:54
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
it's almost impossible.
3:56
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
Respectives,
3:58
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
downs.
3:59
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
Yeah, I'm going to hear from this.
4:00
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
Yes, that's what I want to hear.
4:02
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
So our relationship with managed care is
4:06
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
pod -dependent.
4:06
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
So in certain areas where managed care is much more abundant,
4:10
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
we would have relationships for it.
4:12
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
But I think the biggest thing to think about is that conceptually,
4:15
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
we approach it at an FCS level with
4:19
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
managed care organizations.
4:20
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
So we try to find a middle ground in terms of what the philosophies are.
4:24
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
Thinking about managed care and HMOs,
4:26
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
they're really thinking about cost.
4:28
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
structures not necessarily sacrificing quality of care
4:32
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
but they're definitely valuing the present as opposed to the future and so
4:37
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
there's always an open discussion about what it is that we're willing to do to be able to provide good
4:41
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
quality of care for our patients and then at the end of the day what we need
4:45
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
for overall long -run efficacy.
4:47
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
And I think there are a lot of managed care organizations that are starting to warm up to
4:51
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
that idea.
4:51
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
But understanding that a lot of payers are operating
4:56
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
five to ten years behind on their sciences.
5:00
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
the processes,
5:01
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
especially as an oncology.
5:02
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
You know,
5:04
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
HMOs and managed care really found its breadth within primary
5:08
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
care, the breadth of general medical medicine diseases.
5:12
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
Lo and behold,
5:13
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
as you get older,
5:14
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
cancer is part of it,
5:16
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
and I don't think that philosophy has ever really transferred very well.
5:19
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
care, but I think that's where value -based care really
5:23
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
does come in.
5:24
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
I usually say that's quality divided by cost,
5:27
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
and I think there is a middle ground and an opportunity for an industry to
5:31
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
really think about how to restructure the next set of clinical trials
5:36
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
and FDA labels and approvals to be able to meet those needs.
5:40
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
Because industry care is not going to go away in terms of that,
5:43
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
so I usually say that it's a multi -stakeholder special that we've
5:47
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
had.
5:49
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
We bring in our hospital partners to really partner that discussion.
5:52
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
So are you?
5:54
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
You are doing step -up dosing in the community setting?
5:58
S… Speaker 2 (6a57d64841594d5075e86a70-mp3)
You are,
5:59
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
yeah, okay.
5:59
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
Yeah, we've been probably over,
6:01
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
across all of our sites,
6:03
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
we've probably had about 800 or 900 step
6:07
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
-up dosing.
6:07
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
Wow.
6:08
S… Speaker 2 (6a57d64841594d5075e86a70-mp3)
Combination right now.
6:12
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
I think right now we try to adhere to the label as much as possible.
6:15
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
That's really actually right here.
6:23
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
Correct.
6:24
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
But you know,
6:24
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
I think the rate limiting step is really,
6:27
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
to your point earlier,
6:29
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
is finding a really good,
6:30
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
motivated hospital partner to get a lot of help from an AD agent.
6:33
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
Because all of us know that as
6:38
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
soon as you light the fire,
6:39
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
you need to make sure you have a good system to keep the patient safe.
6:44
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
Even if you're able to keep the majority of patients outpatient,
6:48
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
10 % of them are going to get admitted at some point in time anyway.
6:52
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
So if you do enough of these,
6:53
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
it lights the bulb for both payers as well as hospital
6:58
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
partners too.
6:58
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
Because while we think about it really from an outpatient perspective,
7:02
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
looking out for our hospital partners is important because a lot of our hospital
7:06
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
partners may not necessarily do oncology.
7:11
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
And so to your point earlier about Chelsea being stocked,
7:14
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
sometimes it's a decision internally amongst hospitals to
7:18
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
decide, well,
7:20
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
it's hard for us to really justify,
7:21
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
depending on how many patients we're treating,
7:24
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
to be able to harbor that cost.
7:25
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
And how does managed care treat inpatient
7:30
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
hospitalization,
7:30
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
even if it's considered elective,
7:33
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
which is not really it's elective.
7:34
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
Even though it's packaged and served,
7:36
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
it's an elective admission.
7:39
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
Get them in office.
7:40
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
We all know at the table,
7:42
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
these patients are not really hot.
7:44
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
So those are the fundamental breaks and barriers
7:48
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
that I think really put down and limit the
7:52
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
adoption of bispecific therapy or cell therapy in general.
7:55
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
I think the biggest thing is understanding that it all comes down to money.
7:59
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
It has nothing really to do with patient care.
8:04
S… Speaker 2 (6a57d64841594d5075e86a70-mp3)
I do think the finances of
8:08
S… Speaker 2 (6a57d64841594d5075e86a70-mp3)
it are playing a bigger role than people like to talk about because
8:12
S… Speaker 2 (6a57d64841594d5075e86a70-mp3)
there's so many people impacted from the pharmaceutical side,
8:16
S… Speaker 2 (6a57d64841594d5075e86a70-mp3)
from the managed care side,
8:17
S… Speaker 2 (6a57d64841594d5075e86a70-mp3)
from the hospital system side.
8:19
S… Speaker 2 (6a57d64841594d5075e86a70-mp3)
And there's this dance happening right now that is very complicated.
8:23
S… Speaker 2 (6a57d64841594d5075e86a70-mp3)
And I feel like I'm in the middle of the ballroom just looking around.
8:27
S… Speaker 2 (6a57d64841594d5075e86a70-mp3)
And I think that...
8:32
S… Speaker 2 (6a57d64841594d5075e86a70-mp3)
you know, some of the managed care plans just hope it goes away and fizzles out,
8:36
S… Speaker 2 (6a57d64841594d5075e86a70-mp3)
which is clearly not going to happen.
8:37
S… Speaker 2 (6a57d64841594d5075e86a70-mp3)
And the hospital systems are like trying to
8:42
S… Speaker 2 (6a57d64841594d5075e86a70-mp3)
stall until they can figure out how to make it make financial sense.
8:45
S… Speaker 2 (6a57d64841594d5075e86a70-mp3)
And then obviously the pharmaceutical industry is trying to rush things along
8:49
S… Speaker 2 (6a57d64841594d5075e86a70-mp3)
as fast as they can.
8:50
S… Speaker 2 (6a57d64841594d5075e86a70-mp3)
So,
8:51
S… Speaker 2 (6a57d64841594d5075e86a70-mp3)
you know, it's like a tug of war of trying to speed things up and slow things down.
8:55
S… Speaker 2 (6a57d64841594d5075e86a70-mp3)
But at the end of the day,
8:56
S… Speaker 2 (6a57d64841594d5075e86a70-mp3)
it's a train and it's going to keep on moving.
8:58
S… Speaker 2 (6a57d64841594d5075e86a70-mp3)
So this is coming.
9:00
S… Speaker 2 (6a57d64841594d5075e86a70-mp3)
And, you know,
9:01
S… Speaker 2 (6a57d64841594d5075e86a70-mp3)
from my perspective,
9:02
S… Speaker 2 (6a57d64841594d5075e86a70-mp3)
as somebody who lives and breathes managed care,
9:06
S… Speaker 2 (6a57d64841594d5075e86a70-mp3)
you know,
9:07
S… Speaker 2 (6a57d64841594d5075e86a70-mp3)
and wants to be able to provide high -level,
9:10
S… Speaker 2 (6a57d64841594d5075e86a70-mp3)
efficient care,
9:11
S… Speaker 2 (6a57d64841594d5075e86a70-mp3)
you know,
9:12
S… Speaker 2 (6a57d64841594d5075e86a70-mp3)
I feel like it's better that we come up with a plan that works
9:16
S… Speaker 2 (6a57d64841594d5075e86a70-mp3)
for the patients, works for the hospital system,
9:19
S… Speaker 2 (6a57d64841594d5075e86a70-mp3)
so everybody can get on the same page,
9:21
S… Speaker 2 (6a57d64841594d5075e86a70-mp3)
so that we can do this efficiently in the community.
9:25
S… Speaker 2 (6a57d64841594d5075e86a70-mp3)
You know, we're very thoughtful in my practice,
9:27
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
to be honest.
9:28
S… Speaker 2 (6a57d64841594d5075e86a70-mp3)
We're unusually considerate to all these factors.
9:31
S… Speaker 2 (6a57d64841594d5075e86a70-mp3)
But we're a small mom and pop organization compared to
9:35
S… Speaker 2 (6a57d64841594d5075e86a70-mp3)
the big players.
9:36
S… Speaker 2 (6a57d64841594d5075e86a70-mp3)
And we were,
9:39
S… Speaker 2 (6a57d64841594d5075e86a70-mp3)
you know, we have roots in managed care.
9:42
S… Speaker 2 (6a57d64841594d5075e86a70-mp3)
But that's very unusual.
9:43
S… Speaker 2 (6a57d64841594d5075e86a70-mp3)
There's very few practices like us.
9:45
S… Speaker 2 (6a57d64841594d5075e86a70-mp3)
Most practices and most oncologists have very little experience in this
9:49
S… Speaker 2 (6a57d64841594d5075e86a70-mp3)
arena. And they are much less thoughtful in these things.
9:53
S… Speaker 2 (6a57d64841594d5075e86a70-mp3)
And I think if people don't come up with a better systemic
9:57
S… Speaker 2 (6a57d64841594d5075e86a70-mp3)
plan,
9:58
S… Speaker 2 (6a57d64841594d5075e86a70-mp3)
you know,
10:00
S… Speaker 3 (6a57d64841594d5075e86a70-mp3)
going to pay for that in the long run so to me it seems like a no -brainer
10:04
S… Speaker 3 (6a57d64841594d5075e86a70-mp3)
to come up with a things like adjusting the labels
10:08
S… Speaker 3 (6a57d64841594d5075e86a70-mp3)
like people like Moffitt should point out that like oh
10:12
S… Speaker 3 (6a57d64841594d5075e86a70-mp3)
we do this all outpatient even though the label says it's all inpatient
10:16
S… Speaker 3 (6a57d64841594d5075e86a70-mp3)
you know, they're getting that based off the studies you guys did,
10:19
S… Speaker 3 (6a57d64841594d5075e86a70-mp3)
whatever, 10 or 15 years ago,
10:21
S… Speaker 3 (6a57d64841594d5075e86a70-mp3)
even though now you're doing it on outpatient,
10:24
S… Speaker 3 (6a57d64841594d5075e86a70-mp3)
but then the community doctors,
10:26
S… Speaker 3 (6a57d64841594d5075e86a70-mp3)
myself included,
10:27
S… Speaker 3 (6a57d64841594d5075e86a70-mp3)
are nervous because if the package insert says that
10:31
S… Speaker 3 (6a57d64841594d5075e86a70-mp3)
even though you guys are not doing it,
10:32
S… Speaker 3 (6a57d64841594d5075e86a70-mp3)
it's hard,
10:33
S… Speaker 3 (6a57d64841594d5075e86a70-mp3)
you can get away with that,
10:34
S… Speaker 3 (6a57d64841594d5075e86a70-mp3)
you know, but it's nervous for a community doctor to go do that.
10:38
S… Speaker 4 (6a57d64841594d5075e86a70-mp3)
Is it just,
10:38
S… Speaker 4 (6a57d64841594d5075e86a70-mp3)
well that's just an example,
10:39
S… Speaker 3 (6a57d64841594d5075e86a70-mp3)
but, and then like the TGH is not stalking TOSI.
10:44
S… Speaker 4 (6a57d64841594d5075e86a70-mp3)
So we'll say,
10:44
S… Speaker 4 (6a57d64841594d5075e86a70-mp3)
TOSI will be able to be a baby,
10:48
S… Speaker 4 (6a57d64841594d5075e86a70-mp3)
I don't think they'll be able to spray them.
10:49
S… Speaker 3 (6a57d64841594d5075e86a70-mp3)
Right, well guess what, where TGH has an oncology practice,
10:52
S… Speaker 3 (6a57d64841594d5075e86a70-mp3)
they have TOSI very conveniently,
10:54
S… Speaker 3 (6a57d64841594d5075e86a70-mp3)
where it's their financial interest to do that,
10:56
S… Speaker 3 (6a57d64841594d5075e86a70-mp3)
and their community hospital.
10:58
S… Speaker 4 (6a57d64841594d5075e86a70-mp3)
They should ship TOSI at all,
10:59
S… Speaker 4 (6a57d64841594d5075e86a70-mp3)
that doesn't take too long.
11:01
S… Speaker 3 (6a57d64841594d5075e86a70-mp3)
If it was a patient care issue,
11:02
S… Speaker 4 (6a57d64841594d5075e86a70-mp3)
they would.
11:03
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
Yeah.
11:04
S… Speaker 2 (6a57d64841594d5075e86a70-mp3)
So there's two things to say to that.
11:07
S… Speaker 2 (6a57d64841594d5075e86a70-mp3)
So one, I completely agree with you regarding the labeling.
11:10
S… Speaker 2 (6a57d64841594d5075e86a70-mp3)
I think the labeling makes a big difference.
11:11
S… Speaker 4 (6a57d64841594d5075e86a70-mp3)
Must,
11:12
S… Speaker 4 (6a57d64841594d5075e86a70-mp3)
should,
11:15
S… Speaker 5 (6a57d64841594d5075e86a70-mp3)
hospitalize,
11:16
S… Speaker 5 (6a57d64841594d5075e86a70-mp3)
must, you know,
11:16
S… Speaker 4 (6a57d64841594d5075e86a70-mp3)
there's like...
11:17
S… Speaker 3 (6a57d64841594d5075e86a70-mp3)
It makes a
11:22
S… Speaker 2 (6a57d64841594d5075e86a70-mp3)
big difference.
11:22
S… Speaker 2 (6a57d64841594d5075e86a70-mp3)
You know,
11:23
S… Speaker 2 (6a57d64841594d5075e86a70-mp3)
REMS program makes a big difference.
11:25
S… Speaker 2 (6a57d64841594d5075e86a70-mp3)
Myeloma bispecifics are the only bispecifics right now with the REMS program,
11:28
S… Speaker 2 (6a57d64841594d5075e86a70-mp3)
which adds another issue.
11:30
S… Speaker 4 (6a57d64841594d5075e86a70-mp3)
It's kind of interesting,
11:31
S… Speaker 4 (6a57d64841594d5075e86a70-mp3)
isn't it?
11:31
S… Speaker 4 (6a57d64841594d5075e86a70-mp3)
It is.
11:32
S… Speaker 4 (6a57d64841594d5075e86a70-mp3)
The REMS is a lower.
11:33
S… Speaker 4 (6a57d64841594d5075e86a70-mp3)
To me, the REMS is a lower.
11:36
S… Speaker 4 (6a57d64841594d5075e86a70-mp3)
It's operational,
11:37
S… Speaker 2 (6a57d64841594d5075e86a70-mp3)
but the FDA labeling definitely makes a big difference.
11:39
S… Speaker 2 (6a57d64841594d5075e86a70-mp3)
And I think now,
11:42
S… Speaker 2 (6a57d64841594d5075e86a70-mp3)
another thing to talk about is just by specifics in general,
11:46
S… Speaker 2 (6a57d64841594d5075e86a70-mp3)
it's not just within heme space,
11:48
S… Speaker 2 (6a57d64841594d5075e86a70-mp3)
right? It's like solids,
11:50
S… Speaker 5 (6a57d64841594d5075e86a70-mp3)
it's exploding.
11:51
S… Speaker 2 (6a57d64841594d5075e86a70-mp3)
In a matter of a few years,
11:52
S… Speaker 2 (6a57d64841594d5075e86a70-mp3)
it's going to be all,
11:53
S… Speaker 2 (6a57d64841594d5075e86a70-mp3)
like we're already doing clinical trials in a lot of solid tumors.
11:58
S… Speaker 2 (6a57d64841594d5075e86a70-mp3)
So it's coming.
11:59
S… Speaker 2 (6a57d64841594d5075e86a70-mp3)
So, you know,
12:00
S… Speaker 2 (6a57d64841594d5075e86a70-mp3)
we really need to start,
12:01
S… Speaker 2 (6a57d64841594d5075e86a70-mp3)
you know, thinking for hospitals to start thinking about Thosalizumab really from
12:05
S… Speaker 2 (6a57d64841594d5075e86a70-mp3)
a larger perspective because it's not just few agents,
12:08
S… Speaker 2 (6a57d64841594d5075e86a70-mp3)
like more patients are going to be having different,
12:11
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
you know.
12:11
S… Speaker 2 (6a57d64841594d5075e86a70-mp3)
therapies.
12:12
S… Speaker 3 (6a57d64841594d5075e86a70-mp3)
Everybody's stalling this problem,
12:14
S… Speaker 2 (6a57d64841594d5075e86a70-mp3)
but we all know it's coming.
12:16
S… Speaker 4 (6a57d64841594d5075e86a70-mp3)
We all know it's coming.
12:17
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
But I
12:25
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
think
12:30
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
this slide illustrates one of the biggest root causes
12:34
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
of what we're talking about right here.
12:35
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
The instance of CRS.
12:37
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
That's why we're having the considerations with the labeling.
12:41
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
We're having nervousness about treating in the community centers because of the rates of
12:45
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
CRS, which range anywhere from 46 to 79 %
12:49
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
in the main clinical trials that were put forward with this.
12:52
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
which didn't use TOSI,
12:53
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
but again,
12:54
S… Speaker 4 (6a57d64841594d5075e86a70-mp3)
that's significant.
12:55
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
ICANN's rates of 3 to 11%,
12:58
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
so significant toxicities based on the registrational trials that
13:02
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
are out there, and that's what's driving a lot of this.
13:04
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
So when you look at,
13:05
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
next slide, please.
13:06
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
When you look at some of the evolving
13:10
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
data that's coming out,
13:11
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
especially in the second -line therapy,
13:13
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
TEC3,
13:13
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
which looks at teclistimab and daritumumab in second -line therapy,
13:19
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
a large open -label trial demonstrating the benefits after first relapse.
13:23
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
Progression -free survival with a secondaire of 83 % versus
13:27
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
29 % in the control arm.
13:29
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
Overall survival,
13:30
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
again, 83 % versus 65%.
13:32
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
So some good data of pushing this up earlier into therapy,
13:36
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
right, and really demonstrating the huge benefit of
13:40
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
these drugs.
13:41
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
And I promise we'll get back to the discussion around CRS
13:45
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
and side effects in the outpatient.
13:48
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
This will kind of set the table.
13:49
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
So next slide.
13:50
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
Looks at TEC9,
13:53
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
which was an abstract at ASCO this past year.
13:55
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
Illustrates the improvements in progression -free survival and overall survival.
14:00
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
What took us to have is mild therapy and second -line therapy.
14:03
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
And,
14:04
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
you know, 69 .8 % progression -free survival versus
14:09
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
26.
14:09
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
Overall survival benefits as well.
14:12
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
So significant here.
14:13
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
I mean, look at the rates of CRS in this trial,
14:16
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
though. Again,
14:16
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
similar to what we saw in our trial.
14:18
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
earlier rates in that 66 percent TAL,
14:24
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
next slide please.
14:25
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
TAL3 is Tauquetimab with neritumumab and Zecamon therapy again
14:30
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
just furthering these results were presented earlier this year representing
14:34
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
that whether it's given in combination or given alone demonstrates really
14:39
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
impressive two -year progression for survival.
14:43
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
So more and more data suggesting that these drugs need to be moved off
14:47
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
of fifth -line therapy and up earlier in therapy for these relapsed patients.
14:51
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
When you look at the CRS grades that were in
14:55
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
both the Taquatimab alone or in combination,
14:59
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
again,
14:59
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
right
15:00
S… Speaker 2 (6a57d64841594d5075e86a70-mp3)
down the middle of what we've seen overall next
15:04
S… Speaker 2 (6a57d64841594d5075e86a70-mp3)
slide and this just this slide just shows that graphically so why
15:10
S… Speaker 2 (6a57d64841594d5075e86a70-mp3)
why is it important because instead of 5 000 patients
15:14
S… Speaker 2 (6a57d64841594d5075e86a70-mp3)
that we're talking about it's 27 000 patients
15:18
S… Speaker 2 (6a57d64841594d5075e86a70-mp3)
So five times the number of patients are eligible.
15:21
S… Speaker 2 (6a57d64841594d5075e86a70-mp3)
You're going to see more patients that potentially could benefit from this therapy that
15:25
S… Speaker 2 (6a57d64841594d5075e86a70-mp3)
is, again,
15:26
S… Speaker 2 (6a57d64841594d5075e86a70-mp3)
changing outcomes in this space.
15:28
S… Speaker 2 (6a57d64841594d5075e86a70-mp3)
So it's really important that we try to figure out,
15:32
S… Speaker 2 (6a57d64841594d5075e86a70-mp3)
okay, now that we've seen that giving it earlier is better,
15:34
S… Speaker 2 (6a57d64841594d5075e86a70-mp3)
how do we do that?
15:35
S… Speaker 2 (6a57d64841594d5075e86a70-mp3)
How do we do that in a community setting?
15:37
S… Speaker 2 (6a57d64841594d5075e86a70-mp3)
We had a discussion earlier as we got started.
15:40
S… Speaker 2 (6a57d64841594d5075e86a70-mp3)
It's great if we do all this care in academic medical centers and patients
15:44
S… Speaker 2 (6a57d64841594d5075e86a70-mp3)
outside of those territories don't get therapy and
15:48
S… Speaker 2 (6a57d64841594d5075e86a70-mp3)
succumb to these outcomes.
15:50
S… Speaker 2 (6a57d64841594d5075e86a70-mp3)
We have to do better in this space.
15:51
S… Speaker 2 (6a57d64841594d5075e86a70-mp3)
We have to figure out how do we push this out.
15:54
S… Speaker 2 (6a57d64841594d5075e86a70-mp3)
And that's the whole thing for some discussion.
15:57
S… Speaker 2 (6a57d64841594d5075e86a70-mp3)
So, another question for the group here,
16:00
S… Speaker 2 (6a57d64841594d5075e86a70-mp3)
and based on the initial data with bispecifics and second line,
16:03
S… Speaker 2 (6a57d64841594d5075e86a70-mp3)
where in the relapsed multiple myeloma treatment
16:08
S… Speaker 2 (6a57d64841594d5075e86a70-mp3)
landscape are you thinking about Ticlistamab and Telquivab
16:12
S… Speaker 2 (6a57d64841594d5075e86a70-mp3)
-based treatments?
16:13
S… Speaker 2 (6a57d64841594d5075e86a70-mp3)
I'll open it up for discussion.
16:15
S… Speaker 2 (6a57d64841594d5075e86a70-mp3)
Well,
16:17
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
I mean, I think the major decision point is that are they CAR -T eligible or not?
16:21
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
I think it's an important distinction in all of this,
16:24
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
because I think...
16:33
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
because we know that it's curative.
16:35
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
Obviously,
16:37
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
the data looks extremely good from Majestic 3 and
16:41
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
how remission rates and whatnot.
16:42
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
We may come to a point in time where we will find that we
16:47
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
stopped therapy on some of these patients,
16:49
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
so they do fine.
16:51
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
But I think that's kind of where the data still stands,
16:54
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
that you triage these patients appropriately between the two.
16:57
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
But hands down with logistics issues,
17:00
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
vulnerabilities, access to care,
17:03
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
things like that,
17:03
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
that it certainly makes sense that you really consider these patients for my specific therapy.
17:08
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
I'll add also that I think the number
17:12
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
of patients additionally per year is probably lower
17:16
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
than what we really think.
17:18
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
just partly because the quad therapy is actually good.
17:21
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
And so I think what we find is that there's going to be fewer and
17:25
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
fewer of these patients that we're trying to see that transplant is less needed even
17:29
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
in the frontline setting now.
17:30
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
And so how many of these patients will actually exist probably
17:35
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
remains to be said.
17:36
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
But knowing from the data that we have now and early consideration
17:40
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
of these products are really,
17:42
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
really important.
17:42
S… Speaker 2 (6a57d64841594d5075e86a70-mp3)
This is exploding.
17:46
S… Speaker 2 (6a57d64841594d5075e86a70-mp3)
So that pocket of
17:50
S… Speaker 2 (6a57d64841594d5075e86a70-mp3)
patients then is going to be...
17:54
S… Speaker 2 (6a57d64841594d5075e86a70-mp3)
Have you used the bispecifics in the second
17:58
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
line? I have,
17:59
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
yeah.
17:59
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
Okay.
18:00
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
And to point about managed care and things like that,
18:03
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
you know, the patients that we're treating at the community are not in the registry studies.
18:07
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
The last patient that I treated with teclisimab in Dero was
18:11
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
91 years old.
18:12
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
She outlived all of her friends,
18:15
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
family,
18:15
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
and neighbors,
18:17
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
and so forth.
18:18
S… Speaker 2 (6a57d64841594d5075e86a70-mp3)
Wow.
18:18
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
She's still very sprightly and knows her care,
18:21
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
all of her medications really well,
18:23
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
but she just
18:26
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
So those are the patients that we treat in the community that will
18:30
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
never make those registration slides.
18:33
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
They all have CKD,
18:34
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
they all have coronary artery disease.
18:36
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
Their EF might be less than 30%,
18:39
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
but they're chugging along just fine.
18:40
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
So understanding,
18:43
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
I think these are things that J &J and others know from me very well at
18:47
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
this point, is that community -based trials are very,
18:50
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
very important.
18:51
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
Because that's really the proof of concept.
18:54
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
to understand how can you really implement this community and provide confidence.
18:59
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
And understanding,
19:00
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
are you allowing a patient to get treated on trial that has
19:05
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
phase one support?
19:06
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
Do they actually,
19:07
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
are their office built into a hospital?
19:10
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
Do they have a motivated hospital?
19:13
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
Do they even have neurologists that are available?
19:16
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
That's why I think there's a lot of value in having a community -based
19:20
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
trial as a perfect concept.
19:22
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
And that's really what payers are really looking at.
19:24
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
They look to the model of what you have established within an
19:28
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
industry in these major randomized clinical trials and saying,
19:31
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
that's the standard.
19:32
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
So there's this artificial barrier to say,
19:35
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
okay,
19:36
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
for this bispecific patient,
19:38
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
if you want to actually undergo and treat these patients long -term,
19:41
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
do you have this?
19:42
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
Do you have this?
19:43
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
And some of this we self -impose at FCS because we don't want to necessarily
19:47
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
treat patients with bispecific therapy unless they meet a minimum
19:51
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
standard that we can offer services.
19:54
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
And at the end of the day,
19:56
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
with bispecific therapy,
19:57
S… Speaker 1 (6a57d64841594d5075e86a70-mp3)
it's not just about treating the patient and making sure you

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