Episode 519: What is the Appropriate Approach to Adjuvant Therapy for UTUC?

(upbeat music) - Welcome to another Your Amigos podcast. Tom and I are pleased to be joining by our friend and colleague, Shilpa Gupta from Cleveland Clinic. And Tom, we're actually gonna talk about one of your tweets today, which is unusual to be talking about your tweets. - I didn't know you read about it. - You sent it to me. Actually, you sent me a screenshot. That's the reason I read it. - So I sent you my tweets all night. I'm up all night sending you my tweets. I took three or hobby of mine, bombarding your phone with rubbish. - I blocked your number. So it says, "I wonder how you would treat a patient after a nephro-U for high grade T3 N0M0 upper-tracked urothelial cancer. The tumor is PDL1 positive and CTDNA negative. And the patient is not eligible for cis-platin. So resected upper-tracked high-risk urothelial cancer, PDL1 positive, CTDNA negative, and cis-platin ineligible. There were four choices that got almost equal votes. Surveillance, Gem Carbo, single-agent Evolomab or EV Pembro. And they were all pretty much at 25%. Actually, Evolomab got a couple more percentage, but probably statistically equivalent. And this was over 400 votes at the last look. So there were a lot of comments. I hope you had some comments on here, so we thought, I thought this was a really good clinical scenario. It's something that I certainly face in clinic. And I think Tom, I've even called you about patients like this. So show up, I'm going to turn it over to you. I guess I know where to start. Tell us, what do you think of the choices and what would you do? - Hi, Tom and Brian. Thanks for having me. And this tweet was really good. And I think the tweet tells us that it's a data problem and not really disagreement. Every option is resting on weak subsets or extrapolation from bladder pretty much because there's been no dedicated trial in this setting. So I thought it was a very interesting case that high risk disease, T3, CTDNN negative. And I was surprised to see that a quarter of people would still do surveillance in this setting when we know T3 is high risk. And Jim Carbo to my, you know, understanding that's the only study that has shown DFS benefit in a dedicated upper tract setting and that's what I offered to pay. - That's what you went for. - Yes, that's what I went for. That's what I went for. Nevoloma, we know that in the checkmate 274, although, you know, about 20% patients had upper tract, the hazard ratio was 1.23. And we've also seen that Tom from your trial and we get over know as well as ambassador trials. So I'm not really offering a Nevo to my patients. An EV Pembro, yes, hypothetically, it should work, right? It works everywhere. We know from maybe three or two in the medesthetic setting, but we don't have data in this particular setting. So that's why I went with Jim Carbo. - So I'll show a couple of questions. So what would you estimate the risk of occurrence for this patient? - I would think the risk of recurrence for a PT-3 would be close to 50%. What do you think, Tom? - That was the number I had in my head. I just want you to say, I mean, I think surveillance is still reasonable. That's probably not what I would have chosen, but I guess, you know, with a 50/50 proposition, I guess I'm just saying, I don't think it's unreasonable right to surveil such patients. Given the limited data. - I think in the current era, I would say because we have even Pembro for salvage therapy, it's certainly reasonable, but I think Tom can tell us, because in the pout, people who did recur in the surveillance arm, I think only about 60% made it to salvage chemo at the time. - Yeah, so I guess that's right. I mean, look, these patients are at high risk, and T-3 cancers in this population is pretty serious. And, you know, if you look at DFS, for example, in the pout trial, about 70% of patients overall relapsing, so it's a high risk population. And when you look at the four options, I think that, you know, it's difficult. And I guess the place to start is probably historically with pout. And in pout, it was a randomized study. It had 270 patients. It was GEMSIS or GEM Carbo versus surveillance. It had DFS as the primary endpoint, which it hit with 0.55, has a ratio. The OS in the final analysis was trending the right way, but the study was too small that was stopped early because it was positive. And it's created a real grainer here. And let me tell you why it's created a grainer. Because adjuvant chemotherapy, Platinum-based chemotherapy, GEMSIS adjuvant therapy in bladder cancer, has never been positive. And so, when we look at this population overall, and we start trying to find, you know, the likelihood is that this is similar to bladder cancer. It's not exactly the same, but it's likely to be similar. So, if you've never had a positive trial for chemotherapy before, now you might say this is positive in that changes things. I totally kind of agree with that. But then the second problem then comes down to carbon platinum. And even in the new adjuvant setting, carbon platinum's never worked. And in the powtrial, this carbon platinum subset was less impressive. And, you know, the hazard ratio for DFS was drifted a little bit. And the final analysis, the OS hazard ratio was 0.86. Now, you're going to say, Tom, it's a subset. And Jock and Bellman had this big argument with me in the guidelines around this. And the end he was right. And he said, yeah, Tom, I know it's a subset. But because carbon platinum's never worked before anywhere else, it's a really important subset. Because if carbon platinum had always worked before, and this was another subset, and it's analysis is 0.6, you'd say, oh, just give it the benefit of the Dow. It's just noise. But with carbon platinum, because it's always failed previously, carbon platinum becomes much more controversial. And of course, this was a cisplatin, ineligible patient. So is there overwhelming evidence for carbon platinum in perioperative urethelial cancer? Absolutely not. And does the powt trial completely change that? Jock and would say not. And that's why in the guidelines, there's no guidelines, we only recommended cisplatin. Now, some people disagree with that. And that's fair enough. And the reason they made this-- I'm not giving Jim Carbo in the circumstance. I'm not giving Jim Carbo. I'm going to tell you in a second why I'm not giving Jim Carbo. But I'm not super keen on Jim Carbo. But that doesn't mean there aren't really people much more talented than me who are giving it, because they interpret things slightly differently. By the way, in the powt trial, 44% grade three or four adverse events. So platinum chemotherapy, we know as associated with toxicity. And that takes us across to this new volume app question. And there have been two studies that have looked at this subset famously for single asian immune checkpoint inhibition. There's the volume app data 274, and there's 010, which is the autism app data. And then the volume app data, both of those has ratios for OS and for DFS in the upper track cohort are above one. Now, the numbers are small. They're much, they're even smaller than the powt carboplatin subset. And actually, they're all looking at slightly differently, because they put the ureters different from the kidney. But the bottom line is, in neither of these studies, does it seem to be working. And I think that's fair enough. And so therefore, I was surprised that the volume app got a tick. It got the most-- it's the same number of votes. That surprised me. But actually, we put in it with PDO on positive on purpose. And the reason I put that in was because actually, the PDO on positive data for upper track uretheal cancers never been looked before. And in 274, the PDO on positive in the ITT population, DFS was 0.59, and OS was 0.51. So I'm sure those people who are voting for that are coming back and saying, look, I know it's upper track disease, but it's PDO on positive. And therefore, I'm going for it. And you know what? I'm pretty supportive of that. But then I've got this real problem. And you know my problem. I don't believe in the PDO on biomarker. And so then I start-- I don't believe in the biomarker in uretheal cancer. And into other studies, the same biomarker, it's the TC biomarker that's being used in full nevolumab, the biomarker's failed more times than it's exceeded. You know, it failed in the front line meta-state study. It failed a number of times. And so it shouldn't be used in the biomarker. No, we shouldn't. So again, I'm not supportive of that. So it brings me back to pout again. But can I keep going, Brian, because I've got-- I could have had one more thing that I've got. Yeah, I'm going to keep going. So then that takes me to surveillance. And surveillance actually is quite attractive. Because surveillance in the CTDNA negative population, we have looked at in a number of different studies. The majority of upper-track uretheal cancers are positive. In invigor 010, we excluded it from invigor 011. And the reason we excluded it from invigor 011 is we knew the upper-track has a ratio of retesilism happens above one. So we'd be insane to include it. So that's why invigor 011 is only a bladder cancer. trial. So you cannot extrapolate that into this setting. So like so many times, almost all the other settings, it's very difficult to get clean data from this population. Nevertheless, in Invigor O10, the retrospective analysis, there was a proportion of upper track patients. It was about 10% of patients. And for what it's worth, there have been other subsequent publications. In fact, John Hopkins, they've recently released some data in this space on, as I know it's 2022 patients. But the majority, maybe in Invigor O10, only 40% of patients were positive. It's a much higher proportion of upper track disease are positive. And so therefore, that negative population, we know from this trial, but also from previous studies that it looks like CTDNA is accurate here. And if your PDL1 negative, your chances of relapse are probably only about 30% in this setting. Yes, your CTDNA negative. If your CTDNA negative, your chance of relapse is probably only 20% to 30%. If you track that CTDNA, it's going to be even lower. And of course, then if you were to relapse, you can then give clean EV Pembro. And clean EV Pembro, clean EV Pembro, in my opinion, is better than all of the other options, which I've discussed with all of which have flawed. So clean EV Pembro, we know in the subset analysis for upper track disease, the OS has a ratio of 0.53. That's the cleanest. That's the best data we have. So in CTD, negative patients with bad biomarkers, with carbohydrates that seems unlikely, with an volume out of other bits and pieces not working, we're bedrock just waiting close surveillance and giving really effective therapies when the cancer comes back. And I realised that's a bit controversial, but that was my vote. Let's take these in sequence. So first, I alluded to this a little bit. Surveillance in CTDNA negative, you would agree, is reasonable. Yes. Given the, you know, as time says, there's no perfect piece of data, but there's bits of data and surveilling those people with CTDNA, imaging obviously, is reasonable. And then how about the PDO1 positive piece in giving Evolumab? Did that, I mean, I think you said you voted for Gem Carbo, but do you think that should influence some sort of dismissed the biomarker? But obviously, there's some data from 274 that it influenced. So yeah, I'm not a fan of PDL1, Brian, I'm not checking for any patient. And the indication in the US, if at all, we've to use Evolumab, doesn't need PDL1 and it's not a useful biomarker. So to me, the only thing that would sway me towards active surveillance in this case, which is also reasonable, is the CTDNA negative piece that Tom mentioned. But again, we've not really seen the CTDNA data from checkmate 274 in upper tract patients and in a vigorous bit, but the subset was really very small. And what about the argument for you both? I'll just start with you. So, so let's say the patient's high risk for recurrence, the other CTDNA negative, but let's say I'm still nervous and I want to treat. So let's take surveillance off the table. If I'm going to give a patient like this treatment, why wouldn't I choose Evolumab, right? If it's if there's never going to be direct comparison, it's, you know, a rare population in all the caveats. But if I'm the patient, I'm giving me the most active drugs you have, right? Which clearly would be Evolumab in the circumstance. Yeah, Brian, I think that's a reasonable thing. But I think what Tom said, you know, to keep it clean, you know, we discussed the pros and cons with the patient, a setting we know it might work. And again, I mean, I'm trying to think of ways why Evolumab won't work here. But due to the lack of data and we know that if a patient were to recur, then Evolumab is definitely going to work. There are a lot of upper tract patients in EV3 or 2. So I think that's a discussion we need to have with the patient. And that's why we really need dedicated clinical trials in this patient. But would you give Evolumab in this circumstance? I would discuss it with the patient, but we don't share a decision making on this podcast, and we don't have that. You get to decide. Patient says, Doc, you're the expert. I'll do whatever you want. I'm in your hands. I want to get treatment. I'm really nervous about this. Give me something. I will say, well, CTDNA is negative. I would rather watch you with CTDNA testing. But they say, I want, you're going to give them treatment. I'm forcing you into a circumstance here. They want treatment. You're going to give it, you know, let's say you have to give something. I know that's not how the real world works, but you have to give something. So my anxiety around, because my anxiety around now, honestly, is that, you know, if this patient is CTDNA negative, their chances of the cancer coming back is much lower than it was in the trials. And all the trials were pretty underwhelming. So none of the trials show the data was particularly good in this population. It was okay. And the powder's got the best data in my opinion. But none of them are overwhelming in this particular population. You know, the powder has a ratio of OS 0.86. So if you then say, okay, we're going to take this and we're going to actually, your risk is much lower than that. That's pretty unconvincing. And if you give them platinum chemotherapy at this point and haven't forbid their cancer comes back, then Evie Pembro asked a platinum chemotherapy, you know, it's probably more complicated. So although I accept within the trial we did in the frontline metastatic study that the hazard ratios were irrespective of whether I had prior chemotherapy, you know, my preference is probably not to do that. And then Brian, giving Evie Pembro at this point, well, that just feels, if something was to go wrong, although their PDL1 positive, you know, there is all there is no data. And, you know, and, and I think in my, what if there's a positive thing at this point? Oh, if they're seeing positive, then everything becomes really complicated. Because I mean, then yeah, so it's not that complicated. I don't think this is, you know, it then becomes really complicated. Because then you said, well, what do you think? What is CTDNA positive? Are you brought into it or not? I think most people are including the FDF, including the FDF, including the FDA, so that most people watch this patient, right? You're nervous to watch this patient. So I'm treating, yeah, so this is frontline metastatic disease. They're going to, it's in the, the Kapline Myocerv for the placebo arm of in figure 010 for 111 for 274. But every look at CTDNA, it almost always comes back. There's a 95s and bladder cancer is pretty lethal. And so this, you would treat just, if they had negative scans at this point, if there's CTDNA positive, you're giving them the EV Pembro. Is that what I hear? If they're positive, I'm definitely doing that. I'll give them EV Pembro. If I didn't know their CTD, and if I didn't know they were CTDNA negative, and they have a 70% chance of the cancer coming back, and I would be much keener to give EV Pembro, like the only place. If you didn't have the data, if I didn't have the, if I didn't have, if I knew they're CTDNA negative, giving a regime when their risk of re-ups is, yeah, but positives are the unknown. If the positives are the unknown, if you're going to give a regime at this point, with some little really robust data, no clear survival advantage, and you've got this, you know, the EV Pembro data, which looks really good, if you're going to do something, you might as well do it. But doing it in CTDNA negative feels over to that. Yeah, fun. Put the negatives aside, Shilpa, you have the CTDNA positive patient in front of you, scans negative, same patient, but now positive. Or is that going to force you to treat right away, or would you watch such a patient, and if you treated or when you treated, what would you give them? Yeah, I think that really tips the equation, Brian and Tom, you know, CTDNA positive is a harbinger of them recurring, you know, that. So I would really move up the scans, do another CTDNA, and talk about EV Pembro for sure, because then we know it's just a matter of time before the recurrent, then I would not waste time with platinum. Okay, so it seems like that CTDNA result is really the big issue for both of you, the algorithm, you know, in the algorithm, that's a bit of number one, obviously aside from the diagnosis, negative, you're comfortable watching, those patients may do well, we don't have great data, but positive that's basically metastatic disease, and you're going to give the best regimen, you're not going to give Carbo in that circumstance, Carbo Jam. Right, and I think also from the immigrant one, we saw that in terms of the risk, the CTDNA trumped the pathologic staging, so I'll be more comfortable with that, definitely. But it looks like 75% of people who answer the question weren't, Brian. It looks like the community sort of is really uncertain around this, and what that point to me is a couple of things, either I wasn't really clear in the question, you could say. Usually there's some misspellings, so congratulations, there's none in this one, but yeah, I think you were clear. I think you were in the question. Or number two is we genuinely are in a position where all of the anxiety which I've expressed on the call so far is actually what everyone else is feeling, is there's nothing that you're particularly comfortable with and the outcomes? Yeah, but there isn't, but you see an upper track patient, you really want to give him a volume up? No, I don't personally, but yeah, But it did come first and I think that was because of the PDO on positivity I think that's a reflection of people being brought into the biomarker which personally I feel is a mistake But that's my favorite comment and I won't tell you who it's from it's right directed you It says jumping from Nevolumab's DFS to Gem Carbos OS is taking bad practice i.e. Cross-Trial comparison and making it worse with selective endpoints Were there any positive comments? If my mum wrote was on there or had been something positive Well let's take a lot of the comments were just that there's echo correcting typos I get the correcting typos comments quite a lot. I get those a lot of those comments I'm sure but you commented about it. I was gonna ask about ongoing trials in this space Can we just before we get there? Can we just before we get there? Can we talk about the cross-trial comparison? Because I don't want to belittle that question. It's an important one Yeah, yeah, I agree. So look I think this is quite complicated because I totally agree when someone sort of stands up in front of a big audience and puts on Seven different studies which are slightly different from each other and then makes drawing you know dramatic conclusions from those studies saying well, this is best because this analysis even some of the meta analysis that I see You know when you kind of have slightly different populations and slightly different controller arms and you shut I totally agree cross-trial comparison is something we need to look at with caution But when we're talking to patients, we just need to talk to them about the data that we have And that's the data that you know the data we have is the data we've discussed today We you know we can't get to a position where we can't discuss any data because it's we don't have a 17 arm randomized trial And and that's what guidelines committees do and it's what we do the best You know guidelines committees are not that useful when there's level 1a evidence You know frontline metastatic kidney cancer Guidelines committees are not particularly useful because the level 1a choose your medicine use it well Menomized toxicity. They're all totally acceptable But in scenarios like this where there are problems And we don't have robust data. We have to use the data in front of us And that's essentially this is essentially it and then we need to make a decision I don't think you can say to patients or we can't do anything because there isn't a big randomized trial within your arms in it So I think there are times when cross-trial comparisons is hazardous We all know what they are but there are times when we need to look at the data in front of us and try and answer the question I think the the issue is about the word comparisons right you're not comparing one hazard ratio with another necessarily but it's context what is the context of the clinical options in front of you right and what you're supporting each And by definition you have to do some sort of quote-unquote comparison because you're choosing one right you're Yeah, but we're not back into a patient But I'm not suggesting for one second the value of cross-trials. Yeah, no, I'm not suggesting for one second that because the carbon-placing arm of Of of of Pout can be compared to the PDO on positive arm of 274 I mean that's ridiculous, but but we're gonna have to do that because that's where we are Yeah, I just enjoy any negative comments about you on Twitter. That's why I pointed it out Maybe go to maybe go to maybe look at another tree because there's some negative ones there too That's what I do all night Should we talk about where we go from here, right? Obviously the field is moving to Evie Pembro. We're probably not moving towards Jim Carveau the PDL one has been unreliable But but still sort of lingering in some people's mind. So Is there a way to solve this or are we always going to be stuck with this imperfect data? Yeah, and I was going to say that I had a positive comment about doing a trial in this place So I think so there is no dedicated trial to my knowledge and Tom can correct me if I'm wrong There is an adjuvant trial that AstraZeneca is launched the tropian trial where high-risk disease after cystectomy or nephryuretrectomy They switched the ADC target if patients got new adjuvant EV Pembro but that also has a cap for upper tract patients. So So Brian, no there's no dedicated Pout-like trial and that's what we should be doing at this point I mean, I'm going to give a quick shout out to the the Pout group So Alison, Rob Jones, Rob Jones, Simon Krab, others 260 patients, investigation initiated, you know a huge undertaking Many people think it couldn't couldn't be done You know, and that was a time when we were struggling to recruit into Adjuvant, you know, Chora Sturmberg's brilliant EORTC study which was the whole of that cancer Multiple sites didn't recruit that you know, I could honestly more patients, but so I think that that group Demonstrated really clearly that there are these patients and of course in China It's extremely common to have upper tract disease and the issue is China Because of the relationships between urologies and how thing urology and insurgery they find it hard to do perioactive studies You'll know we we have a numb, you know, EV303 and EV304 and vulgar and only there aren't that many Perioactive trials coming out China. I think they struggle to recruit into them Although they're using DV Tory Palimab a lot and I bet they're using a lot of DV Tory Palimab Neoadjuvantly in this setting And I think that's the last thing in the last two seconds I did want to discuss because It would have been very reasonable for us somewhere else to be critical Brian as price you didn't actually Anonymously write some critical tweet saying I don't actually use adjuvant therapy I use neoadjuvant platinum based chemotherapy and had had he had neoadjuvant therapy Then it's possible by then you wouldn't have removed his kidney his kidney function could have been better And then we could have just solved the problem with gymsis which we made everyone more comfortable And I know in the US that's popular. It's in the US guidelines And so, you know, the the challenge of course is often you don't get tissue or have tissue and that can cause long delays But where are we or where are you folks in the US? Certainly in Europe, we're not using very much neoadjuvant therapy in upper tract disease But where are you folks with that and what how do you feel about neoadjuvant EV Pembro in upper tract disease as well? Because clearly 303 and 304 would support that direction Right. So, but what do you think? Yeah, I think again, Tom, we need a trial to explore that. I know many people are already extrapolating the EV Pembro to neoadjuvant And in the US, I think the practice patterns are very different, you know, at some situations everybody gets neoadjuvant platinum Again, for the same reason that you can probably give sis platinum before and not after But we are not doing that for everybody Most of these patients get up front nephew yo and we see them after their surgery. So, I think Definitely a very operative trial, but with the neoadjuvant and adjuvant component done separately or a pure adjuvant ADCIO trial is what would really help move the field Yeah, I agree. I mean, I think we're Seeing most of these patients after surgery, so the neoadjuvant isn't a choice because that's already happened But I certainly don't think it's unreasonable, right? You got really active drugs, a really active regimen that hasn't failed in any circumstance It's hard to believe, you know, extrapolating a bit from 303 and 304 that there wouldn't be benefit You know, and sometimes I'll get patients where they have some nodes and they're 1.2 centimeters You know, there's some specter of more than just localized disease, right? And we'll give those patients systemic therapy with EVP But I mean, obviously that's a relatively rare patient, but I don't I don't think it's too big of a leap to get there from the data that we have You know to use EVP in that setting Neither do I need to live so I was going to ask just to finish It may and show, but you may just mention this let's assume that you can't accrue any trial you want Let's put aside the rarity of the disease and the practicalities In upper track disease broadly speaking. What's the one trial you would do can be neoadjuvant adjuvant both whatever you think But just yeah, I think I'll decide I would do a pure adjuvant trial Because you know a lot of these patients we are seeing after surgery And like Tom like Tom just said you know in China, they're also doing nephro use pairing trials right neoadjuvant ADC IOs and then patients can spare their kidneys, but I don't think we are there yet in the U.S I would do a pure adjuvant trial Compared it to the standard of care, which is IO versus chemo whatever the investigators choices allow neoadjuvant treatment whatever it may be And then the experimental R&B and ADC and IO combination and I think EVP might be that combination sacked EMT PEMRO might be that combination You know we've seen data from sacked EMT which is the TROP2 ADC and PEMRO in metastatic setting And it showed really good early responses 60% patients were up a track So I think we do have some really novel ADCs which we can use in an adjuvant setting and I'm hoping to work on such a trial Great, thank you so much Tom last word. What do you think trial in this space? What would you like to see? So I think it's tricky because I think these patients are getting left behind And I think you know are we it's going to take a long time to recruit a randomized trial And we probably need to you know if you could show Really high CTDNA clearance rates With with an ADCIO combination, which I think you would, that might be the reassurance that we need that this is an option on the table, which you could do relatively quickly. I think there is a need for large randomized trials, but it will take seven or eight years to complete them and get the OS output in the end. I think the need is greater and I think the risk for patients is currently high, so I would like to see an approach where, and I think CTA clearance is a strong surrogate with outcome, and I think, as I said before, a lot of these patients are positive, so I think that the answer, in my opinion, would be to really look at this group, and this is going to be a bit unorthodox, it's not normally what I say, but to look at this group in a slightly different way, to say that let's not do an 800 patient randomized trial on way eight years. Let's do a bladder sparing neoadjuvant study with ADCIO combinations and see where we go with 100 patients. Let's do an adjuvant study in the seasonal positive patients to see if we can clear and see if they can have brilliant outcomes and track the negative patients to make sure that they're okay. Let's do that as well. I would be looking at this in a subop, you know, saying we're going to accept that it's suboptimal, we'll accept that some of these trials might not be traditionally registrational, but people will extrapolate into this and get, and because otherwise, we will be here in eight years' time still discussing the ongoing enrolling study of ED Pembro's versus Platinum, chemotherapy. Yeah, so maybe smaller trials with less thresholds. Yeah, although it feels uncomfortable, doesn't it? Yeah, not so much for registration, but to inform in the short term, we'll be waiting. Yeah, in the short term, we'll be waiting. Hey, Shilpa, thanks for joining us. Shilpa Fabulous. Shilpa Fabulous. I need help on most of his tweets, so we appreciate it. We're grateful, Shilpa. Thank you. We'll see you at our meeting. November 13th, 14th National, it's my shameless plug at the end of the podcast. Oh, there's going to be a live session, Shilpa. A live session of Perry Opera. Yeah. Yeah, and Shilpa, you're leading one of the teams, is that right? Yes, I am. I am leading team India, Tom. Thank you for having that team, and I'm really excited. I'm really excited. I've got to tell you, we've got more brilliant t-shirts. You're going to love the t-shirts. Yeah. And yes, joining the t-shirt committee was the highlight of my career this year, so thank you for having me on that. That's the only consistent figure I get. It's the t-shirt committee is the highlight of anyone's career. It used to be winning the URMEGO World Cup, but it's now been part of the t-shirt committee. I'm not actually on the committee, Shilpa. I've been kicked off the t-shirt committee, but we'll talk about that later. That's true. That's true. Thank you, have a good day.