Merck & Co., Inc. (MRK) Earnings Call Transcript & Summary

Okay. We're at the top of the hour now. Hi, everyone. My name is Trung Huynh. I'm the U.S. pharma analyst here at UBS. It's my pleasure today to present at Merck, and we have Jannie Oosthuizen, hopefully, I've not destroyed that pronunciation, President of Human Health in the U.S. at Merck. Thanks for your time. So for everyone -- if anyone wants to ask a question, just stick your hand up and I'll try and get to you. Also, if you have the app downloaded, you can send me your questions through the app, and I can attempt to ask those questions. But yes, let's begin. So before we start, Jannie, how about can you give us a bit of background about yourself, an introduction to yourself? And perhaps give us a recap of your highlights from 3Q results.

Perfect. Well, thank you, Trung. Thanks for having us. So Jannie Oosthuizen. I've been Merck for the last 9 years. Prior to Merck, I spent about 21 years with Eli Lilly across mostly the international markets. I worked previously in headquarters for Lilly in the U.S. The rest of my time, I spent pretty much traveling the world with my family working in places like Russia, South Korea, Asia Pacific in total for 12 years. Before returning to the U.S., I led the MSD business in Japan, the Merck business in Japan for 5 years. I came back in '21 to lead the global oncology business with Merck, and then moved into the Head of U.S. Human Health at the beginning of 2022. So it's just about 2 years that I've been leading the Merck U.S. Human Health business. So that's me. In terms of Merck, I think we've had a really strong year. We just came off our quarter 3 with growth of about 8% if you exclude LAGEVRIO and the exchange rate, total $16 billion across Human Health and Animal Health in the third quarter. If you pull that apart a little bit, about $14.3 billion, well, $14.3 billion was the Human Health component of the $16 billion and we grew the business 10% in quarter 3. The key drivers were oncology, as you can expect, with KEYTRUDA continuing to do extremely well. We grew KEYTRUDA 17% in the quarter to $6.3 billion. The rest of the growth was coming from GARDASIL at 16%, $2.6 billion in total sales. And that's pretty much the highlights for quarter 3, I think.

Excellent. Well, I guess, let's start off with the growth drivers, obviously, KEYTRUDA. In 2022, we saw super normal growth for KEYTRUDA, driven in part by new indications that you added on in 2021, things like triple-negative breast and so on and so forth. In 2023, sales growth has come down, obviously, because of the law of large numbers. But also in '22, you didn't have as many approvals and indications in 2021 to grow your 2022 base. This year, we have seen some really interesting announcements. We've seen 671 get approved quite recently. We've seen some data recently at ESMO with the EV-201 study. We're going to see additional approvals in Europe. So as we head into 2024, do you think these things can see a little boost for 2024 on sales? Or should we continue to think law of large numbers, this is a big target, should just keep trending now?

Just one that I omitted, the other growth driver for this year is VAXNEUVANCE, which we feel really good about. So that was the additional component for our growth coming from the pediatric business where we took about 1/3 of the pediatric market. You're right. So we're kind of lapping a lot of those launches from 2 years ago now, driven by triple-negative breast, adjuvant, RCC adjuvant melanoma that has been just phenomenal growth drivers. And we still saw some of that through this year. As we move forward, these early-stage indications will continue to be a significant growth driver for the KEYTRUDA business. We are -- when we look at it, we are growing our business across almost every tumor. So there's a big metastatic base that continues to deliver well. But increasingly, the growth is driven by the early stage. And we see in '23, early stage is about 20% of our revenue, and it's going to go up to 25% by 2025. In the U.S., probably closer to 30%. So as we continue with the early stage expansion and lung will definitely be a part of it. We have already launched KEYNOTE-091 where we took leadership. And we're in the process now of launching 671 that will continue to expand our presence in that front setting in lung and hopefully be a catalyst for treatment rate and diagnosis to continue to go up in lung as well. And if we can do that, I think it will continue to be a strong contributor to our growth moving forward. And then in the metastatic settings, the combination KEYTRUDA plus PADCEV is really going to be a game changer for first-line metastatic urothelial cancer where there's really been no new treatment delivered in the last 10 years. And we still see 5-year survival at less than 10%. So this is going to be a significant change for patients in that first-line setting. And the data we saw in ESMO is basically more than doubling the patient opportunity in that first-line setting. So it's going to be a big contributor to our growth moving forward. KEYTRUDA is a big base business. If you look at it, we have grown year-to-date 21% sitting at $18.3 billion. So it's a big base to move. We feel really good about that growth. Will we accelerate that growth? I think that's a big ask. So -- but we will definitely continue to see significant growth coming through on KEYTRUDA, yes.

Excellent. So one of that, the 671, recently got approved. I know very, very early days. How have physicians taken that data? And also payers, how are those discussions going?

Yes. So on the U.S. side from a payer perspective, there's no real additional discussion either. The indication has proved it will be reimbursed as per the label. But it is early days, as you say. We literally just started to launch about a week, 2 weeks ago. But you have to believe, with us delivering both PFS and OS dual primary endpoints in this early stage setting has to be very significant for prescribers in terms of confidence to use the product in the new adjuvant setting. But also, I think, for systems to put forward a more concerted effort to make sure that patients are screened. And when screened and nodule is detected that is real follow-up and to get patients now on a treatment that has proven to be extending life. So it's early days, and we -- but we're very excited about what the data is handing out in terms of the entry into early stage lung.

And how important is that OS data? Because when we speak to KOLs, they talk about how Opdivo is well used in the neoadjuvant study that they had the 816 study, but that doesn't have OS data. So do you think getting that OS data is the additional bump needed for physicians to use KEYTRUDA in the neoadjuvant management setting?

Yes. I believe it will make a difference. We've seen the field getting more used to other endpoints, but I think there's still an expectation for OS. And when they see OS, I think it's still a very significant endpoint that is meaningful in terms of increasing the confidence to use the product in that setting. So I think KEYTRUDA should get really good traction based on the OS data. Obviously, Opdivo was used early on when no other product had OS in that setting. So I think now that we have OS, we'll need to see. I'm not sure if the others will come with OS, it will not be a primary endpoint, it will be secondary endpoints anyway. So I think this is really meaningful for KEYTRUDA in that setting.

And you noted 25% of your 2025 sales potentially from adjuvant or 50% of the growth is going to come from adjuvant. How much of that is lung? Lung is clearly the biggest adjuvant area along with breast.

Yes. So we don't really put out what the different tumors are driving. But what I would say is that lung will increasingly become meaningful, especially if we can increase the screening, diagnosis and treatment rates in that setting, It's going to be -- I think lung -- we always said it's going to be a bit of a slower build just because there's such a low screening happening at the moment. So a lot of room for improvement and growing that patient population. And then even -- we look at it, there's basically 3 types of patients that we are focusing on to advance this field. The one is those patients that are diagnosed and they either planned to be resected or they have already resected, right? So we can take care of both those patient types with either 671 or 091. And hopefully, increasingly, we'll be able to get the multidisciplinary team to consider the neoadjuvant adjuvant, the perioperative approach. The second one is patients that they have to take a nodule through a CT scan or an X-ray, but for some reason there is no follow-up. And I think there should be a real urgency now for the systems to make sure that these patients are not lost given that there's a highly effective treatment that could be administered alongside surgery. And then thirdly is these patients that are at high risk and not screened at all. So how do we expand screening? So I think if we can hit on all 3 of those, we're really going to see a good expansion in the frontline lung setting. That will become a meaningful contribution. But I think this is positioning us for lung to be a good growth driver for our KEYTRUDA business moving forward.

Excellent. We had a surprise last week with KEYTRUDA. We got approval in first-line pembro track. That was the KEYNOTE-966. That was a few months ahead of schedule there. I guess no one's asking me a question on this, but what are your thoughts about this as a potential opportunity? And then we did look at the data and you hit OS, but you also missed I think, ORR and PFS. So have you spoken to doctors about that? And how is that being translated?

I mean it's also early days. I think this is hopefully very meaningful for patients. It is a small tumor, so it's not a significant driver in the business, but critically important if it does address an unmet need. But it's early days. I don't have any firsthand or anecdotal feedback from prescribers.

One of the important life cycle management studies with KEYTRUDA is getting in a subcutaneous dose. Can you give us an update perhaps on timing of that? Or when should we see that Phase III data in lung? And you also previously had a non-hyaluronic acid dose. What happened with that one there?

Yes. So on your second question, so the formulation we're taking forward is the coformulation of pembrolizumab and hyaluronidase to active ingredients from a coformulation perspective. But we also believe would be treated separate from an IRA perspective to KEYTRUDA in the vial. So that's the one thing. The second one is in terms of the subcu study. So we will have a readout in late 2024, second half of 2024. So that's when we will see that. So looking forward to that. And then we believe that subcu will be particularly the application will particularly be relevant in the early stage setting where treatment is going on for a bit longer in combination with orals, where you don't need an infusion or for some of the indications like KEYTRUDA still used as monotherapy. So those will be, I think, the most significant areas where the subcu will be used eventually.

Okay. And do you have any updated thoughts on IRA and how it relates to the subcutaneous formulation given the fact that CMS really wants to see innovation here? What's your sort of base case thoughts on if that's going to be included or not?

Yes. So there has been some clarification in terms of how they look at the rule around fixed-dose combinations. And the way that we interpret it now is that if it's 2 active ingredients in a fixed-dose combination that it will be viewed as a separate product. So our expectation in terms of current interpretation is that subcu will not be negotiated with KEYTRUDA ultimately.

Okay. Excellent. Okay. If we can move past KEYTRUDA and the second big growth driver, GARDASIL, continues to surprise investors. The sheer growth there is incredible. For 2024, where are you with supply given the fact that there is increasingly a lot of demand for this product there?

Yes, that's right. GARDASIL has done exceptionally well, and there's still a huge opportunity. If you just look at global vaccination rates and the evidence we have that GARDASIL is a meaningful vaccine in terms of preventing HPV-related cancers. We are still not completely unconstrained from a supply perspective, but we have made significant progress. So -- and that's really what's been helpful in driving the growth in China, in particular, where there's huge underlying demand, and we've been increasingly able to supply for that demand. But as we head into 2024, we will still be constrained. We should be unconstrained by 2025. So that's the time line that we want to be in a position where we can really supply in an unconstrained way across the world.

Okay. And you noted, I think earlier this year, right at the start, you want to double GARDASIL sales in the future. And geographically, where is that going to come from? I think from our sort of analysis, we think that China is probably 70% of the ex U.S. market, I guess. Is that right? And then where else, what's the geographies that you can grow?

Yes. So we spoke that we will get to $11 billion plus of sales for -- and we will continue to see growth in China. I mean China has done exceptionally well, but there's still opportunity in China. And then when we look beyond that, I think there's really broadly 3 areas. In low- and middle-income countries, once we can pursue that volume -- and that's really where the unconstrained supply will come in, we know it's going to be at lower price points. So we also need to look at manufacturing costs that can accommodate a lower price point. So that's the one thing that needs to be true to really expand into that low-, middle-income country opportunity. Within the established markets, we need to increasingly move beyond the cohorts, basically the adolescent cohorts that were vaccinated within publicly funded programs. And really, what we're looking at is the mid adult segment, right? So it's basically that 27- to 45-year-old population where I think there's -- we believe there's a strong scientific rationale. More than 50% of infection -- HPV infections happen after the age of 27. So there's a really strong rationale to vaccinate that population. But a lot of education is also needed to bring about that understanding and to really get the activation going. So that's a bit more resource intensive to get that done, but certain opportunity that will continue to add to this growth. And then the third one is really gender-neutral vaccination, where we know that the evidence for preventing other HPV-related cancers like head and neck, oropharyngeal means that there's a real need to also vaccinate males. And similarly, there we need to look at education and bring about understanding for the meaningful protection that can be done. There's still a number of markets that have not approved the indication for gender neutral, including China. The study is ongoing, and we are hopeful to get the indication in China, but it's really expanding that indication across the market as well so that we can really go after that gender-neutral vaccination, yes.

And perhaps an unfair question because you're President of Human Health in the U.S., but China, Merck is one of the bigger players in China. We've seen a significant slowdown in the Chinese economy there. Have you seen any kind of impact to that? And then also crackdown on regulations?

Yes. I mean on the anti-corruption drive, we think that's a good thing for business. I think that -- and my counterpart, Joe Romanelli, who actually manage China now is leading international do believe that, that will help to create an even playing field, which we think is good for business but it's also good for patients, right? Their decisions are made in the interest of what is best for patients and not for any other reason. So in terms of the economic slowdown, I mean, that's been ongoing for a while. We haven't seen it in our business for the most part because our business is pretty much in the private segment. So it's less affected by public funding, government spend. So -- and I think it's also indicative of the value that KEYTRUDA as well as GARDASIL, in particular, bring to the Chinese population as well as JANUVIA in terms of diabetes. But our business is mostly in the private segment, so less affected, I guess, by government constraints at this point.

And is there any manufacturing risk? Do you have much exposure to China there?

From a supply chain point of view?

Correct.

Yes. I mean we constantly look at expanding our supply chain to multiple sources and not be overly dependent on China. Obviously, China is a big supplier to the world, but that is something that we're actively addressing to make sure that supply chains can be -- can continue to run from other sources around the world.

Okay. Excellent. So I'll switch up to ADCs, an area where you've recently invested in. It's certainly in areas that appears to be getting costlier by the day. Bristol did another deal in the area a couple of days ago, I think. What appeals to Merck about the ADC opportunity?

Yes. So I think we've advanced the field of oncology significantly over the last 10, 12 years with immuno-oncology. Despite all the advancements, we know there's still significant unmet need, right? Many patients are benefiting from what is possible today, but still a lot of patients are not responding or not really getting the help needed to treat the cancer. So we believe that ADC is a meaningful expansion to continue to drive benefit for patients and improve the outcomes. It's a targeted way to deliver chemotherapy, and we're really excited to be part of this push into the next chapter of how oncology is going to continue to evolve.

And with the partnerships that you have and the experiencing -- experience that you're gaining, I guess, can you develop your own platform here? Where is Merck in that sort of period?

Yes, I don't want to speak on behalf of Dean, but I think there are capabilities starting to feature that will -- and obviously, when you look at ADCs, there's at least 3 components, right, in terms of the antibody, the linker technology and in the payload. So I think increasingly, it's evident that the tissue targeting is going to be a clear choice of what mAb we use, but there's going to be a lot of technology and innovation around the linkers and the payload. So that's definitely an area that we will be interested in to continue to evolve.

Okay. Excellent. And we do have a TROP2-ADC. We've seen a lot of competitor data surrounding TROP2 very recently. How that evolved your thinking about TROP2 in breast?

Yes. So we bring that into -- if you think about non-small cell lung cancer, there's 2 pieces. There's the one which is in EGFR mutations post TKI, where I think there's an application. But if you think about moving into non-small cell in the first-line setting, the way we think about it is, today, there is a pretty high hurdle in terms of KEYTRUDA plus chemo in the all-comer population and KEYTRUDA's monotherapy in the PD-L1 high expressers, for instance. So when you bring a TROP2 into that setting, how are you going to create a differentiated effect, right? So we do believe that it's probably going to require a biomarker approach for entering into these tumors and lines where there's very high standard of care already and going after a smaller segment. And probably it could be that multiple ADCs will be needed to replace chemotherapy and even a KEYTRUDA plus chemo type of combination over time. So it might not just be one push with one ADC into that space, but it might be multiple to really target that segment that will produce a differentiated effect.

Okay. Excellent. And I want to move on to the pipeline in the last 20 minutes. But if anyone has a question, then please raise your hand or send me a question on the iPad. On the pipeline, I get many questions on the next catalyst for that. People, compared to peers, they think you perhaps might have a more modest catalyst path. I somewhat agree but somewhat disagree. Perhaps can you outline the main catalyst that we should expect coming from that over the next sort of year?

Yes. Yes. So I think one of the exciting launches that we will have early in '24 is sotatercept as we move into PAH. So certainly, we've seen the data. We know the PAH community is ready to use the product. So sotatercept will definitely be a great start to 2024. We will see data on V116 soon at the World Vaccine Congress West Coast in November. And then hopefully, a filing that will take place before the end of the year for V116, which is our push into adult pneumococcal vaccination. And we feel very excited about what we're going to continue to do with population-specific vaccines moving forward, V116 being the next one after VAXNEUVANCE. So those are two really exciting ones. I talked about the data that we're going to see for subcu earlier. We also have islatravir, lenacapavir reading out early in 2024. So there's a lot happening. And I think we have increasingly better visibility across these areas in terms of what it means for the next decade for Merck.

Okay. Excellent. So the big one, sotatercept launch. On the call at 3Q, you mentioned there were physicians warehousing patients for that. So perhaps can you expand on that? And yes, what's the initial feedback you've had from physicians?

Yes. And I think just, first of all, we kind of maybe not calling it warehousing so much as we know that a lot of physicians, especially the experts and COEs that have very specific patients in mind that they believe is ready to be put on sotatercept as the next step. These are patients that maybe had disease progression already. There really isn't anything else versus what they are on today. They're already on triple therapy. So there's -- in physicians' lines already a list of patients that they have in mind that should go on sotatercept or maybe patients on dual therapy that couldn't tolerate the prostacyclin. So likewise, those are patients that physicians have in mind. So that's more -- so it's maybe not a technically not a warehousing, but definitely some predefined patients that physicians would like to get on sotatercept as soon as possible.

Yes. And the data are excellent. The STELLAR data, we'll have more studies read out, hopefully, this year -- or sorry, next year.

Next year, yes.

HYPERION and CADENCE, given -- do you think you could potentially have interim readouts next year?

Yes, I think there's -- I mean there's always a view to do interim if possible. So we'll have to see. I don't know if there's a specific plan set for that, but we often have interim reads. So CADENCE will read out next year. HYPERION will be October 2025, and then -- oh no, actually HYPERION is 2028, ZENITH will be 2025. Yes, that's right.

And how do you think about the opportunities in these settings like the [ P8 ] setting hasn't got...

Exactly. I mean if you think about CADENCE that left heart pulmonary hypertension patients, it's a population that has nothing today, right? So this will really be an additional population to be added and hopefully can benefit significantly from what sotatercept can do. HYPERION will inform us how early should treatment be started. So how long should you wait, and that could potentially be even a cost saving to the system. So I think it's very exciting to think about that. And then ZENITH, enrollment is going really well. These are in-state patients, but can you get them off the transplant list, right? So I think this is a product that's going to continue to bring more and more value to the system over time as these datasets read out.

Okay. One of the more interesting pipeline drugs that we think is the oral PCSK9, the Phase II data are, again, very good. But how are you going to stop it going the way of the injectable PCSK9s? You've mentioned pricing are not whenever anyone discusses it. So just some of your thoughts there.

Yes. So I think, first of all, we obviously will be able to take 616 and oral into a very different setting where patients can access it versus where you have to go for an injectable PCSK9 today. From an access and reimbursement perspective, no doubt, there's a lot of work we need to do from a guideline and policy point of view to make sure that access is as broad as possible, and that's work that we're embarking on. But our ambition is really to democratize the availability of a proven pathway. And so how do we bring that to every patient that is struggling to basically get to go in terms of managing the LDL cholesterol. Today, 70% of patients at risk of cardiovascular disease is not at goal, right? So we know there is a significant need. Only 5% of patients are accessing injectable PCSK9. So you can look at that, it's why are you still using it or you can say, well, there's a significant opportunity to change that. And I think we are determined to do that.

And how important is CVOT studies here? Like is that when we'll actually start to see an inflection [ in there ]?

Yes. I think there's going to be certainly a big opportunity upfront that we will take. And then CVOT will come in as part of life cycle management. And in the U.S., I think the big opportunity will be to unlock the primary prevention segment of the market, which is huge, right? So I think it's going to be 2 phases. But we do believe despite not having CVOT that we need to establish an urgency to bring down LDL cholesterol in a population that need it today; and then over time, work with the CVOT to hopefully broaden access to an even larger population.

Yes, it's interesting there. You mentioned the primary population, primary prevention population. The opportunity there is huge. But you're starting your secondary prevention trials now and then you'll have the CVOT. Again, relating back to IRA, because when IRA kicks in, it starts from the point that you have your first approval. So is that changing the way your clinical study program is approached?

Again, I think I don't know if -- I don't think it's right to let patients wait because the IRA is looming, right? So I think we have an urgency to get this out to patients, not just in the U.S. but globally as soon as possible. And by the way, we believe that an oral PCSK9 has a huge opportunity, not just in the developed markets, but really in the entire world. So that's a big part of it. This really is going to be a big volume push. And as I said, it would have been handy to have CVOT earlier, but we're not going to wait for that before we launch. And we just have to make this work in the context of the IRA. So I think we're determined to make sure that we harvest the opportunity upfront and continue to do it over the life cycle.

Excellent. I think one of your next catalysts on the horizon is PRA023 that you acquired from Prometheus there. What's your expectations there as we get that maintenance data? And what do you need to be used in the first-line -- as a first-line therapy in IBD?

So the way we look at our reentry into immunology, so to speak, is that we want to bring to immunology what we did in oncology, which is a biomarker approach. So we believe that the efficacy data we see in the all-comers today is encouraging. We've seen that in the induction. So it gives a lot of hope for how the maintenance is going to work out. So if you can have that great effect in an all-comer population similar to current treatments and then think of a biomarker population, we can have even a greater effect size, it's going to be a very strong entry into that first-line setting. And we know there's a lot of cycling through therapies for these patients. So having a strong entry into the first-line setting on a biomarker population but having efficacy data to cover in that second-line use, I think it's going to continue to expand the opportunity beyond the first line as well. So we are very, very excited about what PRA023 or 7042 (sic) [ 7240 ] is going to be for us.

Yes, yes. And are you establishing any infrastructure there at the moment? Because immunology is not the biggest area within that today.

Yes. You're right, in the U.S., we haven't been in immunology for a while. We still have infrastructure outside of the U.S. where it's still being promoted in collaboration with J&J. But we have some time to build this, and this is what we will do, right? So we will definitely build this back. I think there's still a lot of institutional memory in terms of immunology. We will leverage that. And I think we've shown -- I mean, similar to where we were 10 years ago, we had almost nothing in oncology and we were able to pivot and build a phenomenal oncology business. We're doing the same in rare disease now with PAH, where we're creating a clear focus on that area to make sure that we bring the best experience to patients in PAH. And similarly, we will pivot for immunology when the time is right to do that.

You have a bunch of fixed-dose combinations with IO. Perhaps can you give us an update on the time lines of when these things are expected to start reading out for you guys?

Yes. So we have the combination with TIGIT, KEYTRUDA plus TIGIT, pembrolizumab plus LAG-3 and CTLA-4. So we should see the pembrolizumab LAG-3 data reading out in 2024. So we'll see that come through in CRC specifically. Then in '25, we will see the TIGIT combination and '26 is CTLA-4.

Okay. Excellent. And you also have the KRAS. You've shown some promising Phase I data. I think you've made comments that you want to accelerate this quickly through the clinical trial process. Any comments on the Phase I data or your excitement over...

Yes, not so much on the data itself. I mean it is still early stage. I think what we -- obviously, when you look at targeted therapies, KRAS is a significant portion of populations. Lung, it's about 15%. So it's a pretty significant size that is addressed with KRAS specifically. I think the most exciting component about this or aspect for this compound is the combined ability with KEYTRUDA potentially moving forward or maybe even other products, right? So I think it's -- as we look at deepening responses with combinations, the KRAS we have seems to be combinable, which is what is, I think, very exciting about it.

Yes. It's interesting you mentioned that because you -- Mirati who has a KRAS has a combination study with KEYTRUDA in the frontline setting. So I guess with Bristol now acquiring, does that change in any way?

For them or for us?

For you.

For us, no, I think we will continue, right, our work and see where we take it. I don't think that necessarily changes that. I think it kind of goes back to the early days of immuno-oncology where we're all running at breakneck speed to figure out where do we go next. I think we'll do the same -- continue to do the same with the combinations.

Yes. We're heading into the last 5 minutes. Does anyone have a question? Okay. And then three things you think that investors are overlooking today at Merck.

Yes. I think the first one is, I think we've made significant progress over the last 2 years in really setting our company up for great success in the next decade. And I think we have good visibility now across cardio, metabolic, oncology and vaccines, immunology of what this means from a revenue perspective moving forward. So really -- and it's not to say that more is not needed, we definitely will continue to do more. But I think that's the first one is just the amount of work we've done to position Merck well for the next decade. The second one is V116, which we spoke about it. I think this is really going to be -- we're going to continue to bring, as I said, to the right populations the right vaccine for the right type of coverage to protect them from disease. And if you just look at with one serotype more than PCV20, we're going to keep about 30% more protection from an IPD perspective. And if you compare that even to the 24-valent that is coming with Vaxcyte and Affinivax, we're still going to beat that by 25%, right? So that will give them about 60% coverage of disease versus 85% with V116. So I think just shifting this paradigm to more is not better, it's really about the right serotype composition for the population and the disease that you're trying to cover. And I think that will continue to benefit how VAXNEUVANCE is perceived as well. The other one is sotatercept. Really, I think it's the one to watch. We know that the data is strong. Patients are waiting, and there's more to come beyond the first indication. And then the other one is WELIREG. WELIREG has been in the market, has been doing well in VHL-related tumors. And with LITESPARK-005, we are now expanding into advanced renal cell in later lines. So that will be early in 2024 as well if we get that approval. So yes, those are probably maybe I mentioned 4 instead of 3, but those are the 4 areas I would highlight.

Okay. Excellent. Well, if there's no more questions, I thank you for your time. Thanks very much. There's a lot of exciting things going on at Merck at the moment, so it's keeping your hands busy.

Thank you, Trung.

And we've got the next session in the next 20 minutes.

All right. Perfect. Thank you.

Thank you.