Novartis AG (NOVN) Earnings Call Transcript & Summary

May 20, 2020

SIX Swiss Exchange CH Health Care Pharmaceuticals conference_presentation 42 min

Earnings Call Speaker Segments

Laura Sutcliffe

analyst
#1

Good morning, everyone. Welcome to the last day of the UBS Global Healthcare Conference. Thank you for being with us. My name is Laura Sutcliffe. I cover Novartis here at UBS, and I'm delighted to be joined by Susanne Schaffert, who's the CEO of Novartis Oncology. We've got about 40 minutes. I will ask Susanne to kick off with some opening remarks, which I don't think will take very long, and then we'll jump into Q&A. I have some prepared, but if you'd like to ask a question yourself, you can do that via the webcast. If that's not working for you, you can always drop me an e-mail, [email protected]. And we'll try to get through as many of them as we can. So with that, I will hand you to Susanne for a few opening comments.

Susanne Schaffert

executive
#2

Thank you so much, Laura, and thanks, everybody, for joining. So let me give a few introductory remarks, and then we get right into the Q&A. So we delivered a very strong quarter at Novartis Oncology. We delivered $3.6 million in sales (sic) [ $3.6 billion ], which was a 12% growth versus previous year. And this strong growth was really driven by very strong uptake of our launches, for example, Piqray and Adakveo. But we were also very pleased with the performance of Kisqali, our CDK4/6 inhibitor, growing 82% and making it, with that, the fastest-growing CDK4/6 in the class. We have several other growth drivers that continue to deliver double-digit growth, namely Promacta/Revolade or Revolade or Tafinlar + Mekinist or Jakavi. So we feel the underlying momentum is very, very strong, and that is despite COVID-19. In the Q1 numbers, we saw some forward-buying or forward-purchasing in. But as I said, the overall momentum is very, very strong. When you look at the different elements of our portfolio, you should also be aware that there is a few products that are going or that are -- went -- that went off-pattern. And so we saw erosion by generics for Afinitor, for Exjade in the U.S. and Sandostatin LAR in Europe. But seeing the strong results, I think, clearly tells you that the growth product more than compensated for these erosions. Maybe to just zoom in on 2 of our recent launches, Piqray, I think, very strong performance. And there, the big focus for us is on testing PIK3CA. As you might know, Piqray is the first-in-class PIK3CA inhibitor. And it's really for a population of 40% of breast cancer patients, but testing is required, and that is our big focus. So when we look at testing rate, they are definitely up, and then that has been driven the strong rationale for Piqray. And we continue focusing on that. We have also launched a broad development program called EPIC because we see PIK3A being very relevant also in other cancer types, like HER2-positive cancer, triple-negative breast cancer, ovarian cancer and PROS. So all these protocols has been aligned with the FDA, and we have started or are ready to start. And maybe the last product to focus on, Adakveo. This was our most recent launch. We launched actually in November. And that's a product for the treatment of vaso-occlusive crisis, or VOCs, in sickle cell disease. And some people might think sickle cell disease is a small disease. But actually, there is more than 50,000 patients in the U.S. who have sickle cell disease with one or more of these VOCs per year. And it was very important for us to get access because these are patients that are often in Medicaid, and therefore, it was very important to get guidelines updated and get into the programs. And then I'm quite pleased to say that 12 of the 23 states that are relevant for sickle cell disease have already published their guidelines. We have C code received in April, and we expect a J code in July, which should further improve reimbursement. We have accounts starting ordering, and there's around 320 accounts that we activated. And even now, we see that additional accounts get in, so we're quite pleased. Also the awareness for the brand amongst hematologists is 96% in Q1. So very pleased about that. So I hope you see it's -- we have a very strong momentum in Novartis Oncology, and the focus is really on executing on those launches and driving these growth drivers. But there is also several catalysts that we expect for, still 2020, that we're excited about. So we expect the readout of lutetium PSMA, which is our radioligand therapy in prostate cancer. We expect readout for asciminib, which is our STAMP inhibitor in CML. And we have starts for several Phase III trials. So we are looking forward to end of the year. And then one, I think, product we are quite excited with is our triplet for our PD-L1 inhibitor with Mekinist + Tafinlar in melanoma. So a lot to come. And then we just got approval for Tabrecta, which is capmatinib or INC280, which is the first-in-class MET inhibitor for exon-14 skipping mutation. And we are quite pleased to really go ahead in the U.S. with the launch of Tabrecta, even in these days. So you see good momentum and still a lot to come this year. So we are definitely busy in implementing all of that. And with that, Laura, really looking forward to your questions.

Laura Sutcliffe

analyst
#3

Super. So how about we stay a little bit more general to start with and talk about what are the biggest ways that -- your sort of ways of working at Novartis Oncology have changed given the current environment? And maybe you could also just sort of touch on things like Lutathera. Are things much more difficult under lockdown conditions?

Susanne Schaffert

executive
#4

So I mean, of course, I think the biggest challenge in that lockdown is that we have quite a number of field-based associates, these representatives with MSLs, account manager, that of course are usually working in the field. And we had to quickly completely change how we work. I think the good thing was that, as you saw, Novartis is quite committed to go big on digital, in data since a while. And I have trained all my field-based associates already last year on what we call a multichannel engagement. So people were already trained about how to engage with physicians via different channels like e-mail, like webcast, like other tools. So we could quickly retrain them basically within 2 weeks and then make them efficient, of course, to continue with digital interactions. The rest of the team is working from at home like probably any other company. And we really focused on 2 aspects facing this crisis. One was our associates. So very clear that we have to keep them safe, and that's why a lot of measures were taken really to protect our people. And then the second goal was really to support patients. I mean, we are dealing with cancer. Cancer has a 100% mortality. And even if COVID is scary and frightening, it's relatively low-mortality. So that, for us, was the goal. And I mean, you were asking specifically, Laura, about challenges. I mean, you know we have 2 therapies that are produced on demand for individual patients. And that is our radioligand therapy, Lutathera; and that's our cell therapy or CAR-T therapy, Kymriah, for leukemia and DLBCL. And these products are shipped across the Atlantic and that really for individual patients. And that was quite a challenge because usually, these products are shipped on normal airlines, and they all stopped from 1 day to the other, flying. So I think my team really did a remarkable job and got that on carrier flights, which is not so easy, given the low volume. Basically, we are talking about one pack. And I think that was really the focus of my team, and I'm quite proud that we did not miss one shipment. And quite amazing story we saw there, how we got these drugs delivered. So overall, I think in that situation, what we really have done differently is -- I mean, we have had to train our reps. We have to get them efficient even in digital engagement. And there, I just can share an example from China that in February, when COVID started there, we reached around 7,000 patients digitally. And in March, the team already could expand their reach to 500,000 physicians. So you see that we really could ramp up quickly. And in a way, that was good because these learnings, we could use also for really the other countries, Europe and U.S., mainly. I think one thing we learned, I think it was not the way how we engage and what tools we used that I think we were trained on, but how you deliver content, how we're packaging, that is where we took a lot of learning from China to be effective. So quite some different way of working. But I felt we were fairly well prepared as we have embarked on our digital journey before.

Laura Sutcliffe

analyst
#5

Super. Okay. Maybe let's put COVID aside for a second and talk a little bit more about the nuts and bolts of the business. Again, quite a high-level question, but sometimes, oncology is characterized as quite a crowded field. Do you think that's fair? Or do you think that's treating it in too simplistic way, and maybe people are too heavily focused on crowding and things like PD-1s and PD-L1s? What's your view of crowding as a concept here?

Susanne Schaffert

executive
#6

I have to say it is very crowded, and I would say it's a very fair statement. When you see the investment in R&D focused on oncology in the different companies, it's quite massive. And it's probably the highest spend, in R&D, in any category, is in oncology. I mean, when you look at this from a patient's view, I think it's amazing. I was in and out of oncology, but during my career, I mean, I have to say the advancement we have now or we can bring to the market are really amazing. And I mean, it's clear. All the numbers suggest that the outcome of cancer has definitely improved, and that's the good news. I mean -- but what it means for a player in oncology, I think, is really several things, that I think any new product has to be really, well differentiated. I mean, I think that's always true in our business. But I think in oncology, it's even meant more. I think you have to look where is the medical need. And I think new therapies have to address that. You have to be first, or maximum, second to market, so speed is everything. And I think if you really want to lead, you need to do bold moves. For example, like when we went into immuno-oncology, we went completely new routes by focusing on protumor inflammation with canakinumab, which is bold in the sense that it of course has some risks. But if science suggests to you that, that is a meaningful therapy, then I feel you have to take some risk and go in very bold. I mean, what I -- since I'm in the role, what I was really focused on is that internally within Novartis, we -- I said we need to get very well organized, how we do drug development and research and how we bring products to market. And I'm a big fan of what I would call end-to-end management. So that means that we already, from talk of assets or even pre-talk of an asset, we talk as a unit. So that means that development is involved and also commercial is involved early, early on. So with that, I think you speed up things. You design Phase II trials that can immediately go into pivotal trials, you really set up your development program to answer as many questions as possible, but also ensures speed. So I believe we came also together closer internally. And with that, manage interfaces better and hopefully can develop products that are winning in this competitive field, but also are very differentiated to help patients.

Laura Sutcliffe

analyst
#7

Great. So I think there's a number of interesting questions we can explore off the back of that. So my first one would be, you have kind of 2 businesses within your business, if you like. You have AAA and you have the CAR-T franchise. And they're based on quite bold and distinctive science, and maybe they're very well housed into a leading company like Novartis that can support execution. But is this some sort of approach that you are making consciously? Should we expect more of these businesses within the business? Or is this just sort of something that evolved organically?

Susanne Schaffert

executive
#8

Yes. I mean, when I look at my portfolio, probably, when you look at Novartis Oncology versus other companies, we have one of the broadest portfolio. And some people might say it is complex. I actually take a different view and say I think it's giving us a competitive advantage. And what we look at, what are the current treatment approaches for cancer, and are we present? And that's when you look at the oncology portfolio. Actually, we have 4 platforms. First, the targeted therapy. I think there, we are a leader in the field and we have a lot of new assets coming to the pipeline. We are in immuno-oncology. But as we were late on checkpoint inhibitors, we take a very different novel approach there. And then we added 2 areas where we believe it's cutting-edge science and is also getting as part of modern cancer treatment, and that is the cell therapy part, it's the radioligand part, where we're probably the only company that is in next field. What I am excited about that, is that it allows us to combine within these 4 platforms. And you see this more and more. I think when you talk about what is the future of cancer, it's really combinations. And I feel we are very well equipped to then be able to combine in-house, which again gives us beat, gives us independence and also would help us to get products reimbursed. Because then, we can basically decide on our own portfolio, how, what pricing we would offer and how we would get in. I mean, as you asked, I think the -- we are quite excited about the platform, cell and gene and radioligand. And I think it was really evolving because that's what we believe are modern cancer treatment. So it's not a strategy that we say, let's add these platforms, by no means. But on the other side, if something is arising, we feel we are quite well equipped for hosting something like that. But it always has to be meaningful and we have to see this as a major part of cancer treatment, then we would go there.

Laura Sutcliffe

analyst
#9

Great. So that leads nicely into a question that one of our audience participants has sent in for me. If anyone else would like to ask a question, you absolutely can via the webcast or by asking me on e-mail. And this person would like to know, Novartis has done sort of limited oncology M&A since Vas arrived. Do you feel like that you've done enough to sort of combat the patent expiries that you're facing? Or would you expect to be a bit more acquisitive if the opportunity arises in oncology?

Susanne Schaffert

executive
#10

Yes, very good question. I mean, I think we did M&A, especially on the radioligand. So that is a piece where we really thought we are very well differentiated, we are the only company. And after the acquisition of AAA, we added on the acquisition of Endocyte. And that was -- I think that was, I think, very important for the business. I mean, when I look at M&A. We stay very open. And for me, it's very important that we really -- we have a portfolio that is well balanced between external assets, internal assets and also collaborations with universities and so on. And that's where we stay open. I mean, what I have to say is, we, of course, closely watch the market and the opportunities. And we, as an enterprise, and we take these decisions together really as an executive committee across all indications, we thought the prices for some of latest assets paid were quite premium. And then for us, the question is, do we need to be in there? Are we willing to pay such a premium? Or would we really elect more carefully? And that's currently the approach. So I think there's a lot of support also by Vas. I think we pushed a lot also on the internal pipeline to really focus there and accelerate some of the assets. We remain very open, but we would not pay probably every price just to be in, as we already have scale. So I think maybe that gives you quite a good picture about our strategy.

Laura Sutcliffe

analyst
#11

Super. So the audience have started asking some questions. I have a few on the screen in front of me.

Susanne Schaffert

executive
#12

Good.

Laura Sutcliffe

analyst
#13

Let's take another audience question because they're more interesting than mine. This is also along the lines of some of these kind of novel platform technologies that you have. This person would like to know about the supply chain risk of developing some of these things. So -- and they're thinking particularly about the cell and gene therapy space. Does this kind of constrain innovation for you in any way? How do those risks impact what you do and what you think about doing in the future?

Susanne Schaffert

executive
#14

Yes. Very good question. And I have to say that's also why we run these platforms, like cell and gene and radioligand, a little bit separate. So these are kind of semi-independent units within oncology because they have specifics on the supply chain. And if you enter there, being the first or one of the first to commercialize, obviously, it is pioneering work. I mean, you bring a highly sophisticated onetime [ therapy ], so of course, you need to prepare the market to get them ready for that. And I think with Kymriah, you see what we believe is you need a global footprint for production. And I think it has proven to be the right thing actually during COVID-19. As you know, we have manufacturing sites in the U.S. and in Europe and even in Asia, and I think that's something that helped us tremendously. And that was kind of a proof also that, as I said, we did not miss one shipment of Kymriah during COVID. That really just helps us to differentiate. I mean, it is an upfront learning and it's an upfront cost. But we feel on the other side, it also is quite a high hurdle to get in. And if you do this well and if you really, I think, master this well, I think it is a competitive advantage. And I mean, when you look at like the Kymriah platform or the CAR-T platform, if you have a good footprint, you can easily block on additional technologies. And that's, I think, what is our plan and our strategy, that you have sufficient scale to then of course expand volume, but also add additional new platforms. So we feel it's something that has some risk, but on the other side, if you manage it very well, it gives you a quite good competitive advantage with very high hurdles to enter for maybe others.

Laura Sutcliffe

analyst
#15

And maybe just a quick follow-up on that for me then. How is the supply situation with Kymriah? Because I know in the past, you've been sort of supply constrained, you've been selling all that you can. But how is the expansion of supply going there?

Susanne Schaffert

executive
#16

Yes. I mean it's going quite well. And you saw our Q1 numbers were quite strong. So Kymriah really doing very well. And that obviously, once we really continue profiling Kymriah versus other therapies in the field, but then also by expanding access. So we got another capacity expansion in -- approved in Morris Plains, which will bring us now to 7 slots a day. So it's quite a nice increase. And we also expect to get the commercial approval to produce in Stein and in France, Italy, in the first half of 2020. So with that, it's another important milestone in increasing capacity. And the -- but I have to say we're still not yet at demand. So that would mean we still could sell more than we can deliver or supply. But our goal and our plan is -- and I think we should hold, despite COVID, that by end of the year, we then would be in the position where we can supply all the demand. So I think that's our goal, and we work against that. I mean, what I have to say, during COVID, as I said, one of our principles was to keep our people safe and ensure continued supply, because as you know, patients are having apheresis. We take blood of the patients, and then it's going to our site and stays there basically for several weeks. So we have to make sure that every blood sample we take, we need to -- we can deliver at the end in 3, 4 weeks. So what we did is on purpose. We reduced slots, especially in the U.S., down to, again, only 5 or 6 a day because we didn't want to have 100% staff in the labs. So that was a voluntary measure, but it helped us to keep all our people safe, and we had very, very minimum number of infections. So with that, we really could ensure continued supply also for this complicated therapy.

Laura Sutcliffe

analyst
#17

Great. I have another really good audience question here. This person says Novartis has done a remarkable job of re-inflecting some of the brands they got from GSK. Do you have any -- is there any interest in some of your other end market assets, maybe, that are going into -- sort of in existing tumors where you think the Novartis commercial team can add value? So is there other, other things that are sort of hiding in plain sight here that we should be thinking about?

Susanne Schaffert

executive
#18

And I guess the question is about, is there hiding any assets externally? Or is the question more about internal assets question?

Laura Sutcliffe

analyst
#19

No, it's an internal question. I think it's around -- if you have any other end market assets where you think your team can really add value and sort of offer an inflection that we've not seen yet and are maybe not modeling?

Susanne Schaffert

executive
#20

Yes, yes, yes. I think definitely one, probably, I would want to mention is Kisqali. I think we had a very slow start in the U.S. when we launched first. And I think that's something where I think we took a lot of learnings and definitely could turn this, when you look how we launched ex-U.S., There, we are very well-established,#2 in the class. But that's maybe you're aware that we had for Kisqali, 2 pivotal trials reading out overall survival data last year. And I feel that's the opportunity for Kisqali. That is really the product that has consistently proven to prolong life, that's what patients and physicians want. So that's one product where I really put an acceleration plan behind. I think this product really has big opportunities, and it's a matter of execution and putting resources behind. So we put -- we started DTC in the U.S. We added additional field force line. And you saw the numbers, we had 82% growth in first quarter. Unfortunately, there, COVID is going a little bit against us. Obviously, as reps are not as efficient. I mean they're still in contact with doctors, but it's different than to do a direct detail. So unfortunately, maybe the curve is a little bit slowing down, but plans are in place, and I feel Kisqali is so well differentiated now that I want to take some bets there. So that's one of the internal assets. I mean as I say, melanoma, Mekinist + Tafinlar are still super important, high double-digit growth. And there, we will have the readout of our triplet with our PD-L1. And people, I think, have questioned in the past, why do you need PD-L1? And actually, in my view, that's exactly to support some other big franchises, like melanoma franchise, with restricted access and reimbursement discussions. I feel it suits us well to have it all in one shop and then really see to get fast access. So there's a few of these areas where we really drive growth and stay very focused. And obviously, there is some in the pipeline where I believe they are quite exciting, like canakinumab, which is an internal asset that we repurposed into cancer, in non-small cell lung cancer, which is a completely new approach of how we tackle immuno-oncology by focusing on protumor inflammation. And that's an area where I got encouraged as, of course, more and more science is published. But when I saw how the trials recruited, they were 5 months ahead of our time line, shows me there is still a very high medical need. So canakinumab can be quite big for us. It's currently in the market with the name Ilaris, so maybe therefore, some people know it. But I think the potential in oncology could be much bigger. And I think the other one where I have a big focus on is lutetium PSMA, is our radioligand product in prostate cancer, where I'm quite excited about, there is some data presented at ASCO from IIT that has the same protocol or trial protocol than our VISION trial. And there, you see this treatment is really, really meaningful. And that's also something where we would, of course, enter into third, fourth line, but we have plans there to expand it into earlier lines. So I -- you hear me, I'm quite excited about a few of these assets where we really feel this can be a major growth driver for the unit and also make a big impact on patients.

Laura Sutcliffe

analyst
#21

Okay. Maybe let's just touch on canakinumab specifically then. Like you say, repurposed asset, but the trials have recruited well. What is the potential to use it beyond non-small cell lung cancer, then? So where else could this go in oncology?

Susanne Schaffert

executive
#22

Yes. So I think we really use the non-small cell lung cancer indication to prove the concept, the concept of protumor inflammation. And maybe you know the CANOPY program that we are running is in different combinations. It is in combination with chemotherapy, it's in combination with a checkpoint inhibitor. So I think these trials will give us a very good idea of how this mechanism works. We have a follow-up compound that we are testing in other indications. It's gevokizumab. That is also anti Il-1 beta. And for that product, we have started trials drives in other tumor tiles, for example, colorectal or other types. So you see, I think, for us, non-small cell lung cancer has very high medical need, and that's where [ were ] created. That's why we had a very strong rationale to go there. But if the concept is proven, then definitely, we would go quite boldly also in other indications and in different combinations.

Laura Sutcliffe

analyst
#23

Okay. Super. Maybe that -- we've got about 10 minutes left, so maybe let's look at the slightly earlier pipeline. Again, if you have questions, now is a good time. Please feel free to e-mail me, also via the webcast. Let's talk a little bit about the molecular glue modality that you've highlighted a few times. Could you just explain for us sort of what that is and how it might be useful for Novartis?

Susanne Schaffert

executive
#24

Yes. I think it's really about how you get -- how you target some of the major pathways in cancer and how you can make basically the undruggable druggable. And for that, we use basically this molecular clues. And I mean, you saw we have a SHP2 inhibitor that just started in clinics, we have an IND filed there. And I think that's one of these examples where you really tackle a major [Audio Gap] and see how you get chemistry in a very innovative way, done, so that you have these targets with a druggable asset. I mean, this kind of pathways are quite interesting. I think the whole KRAS pathway is one of the major pathways. And for us, we have really a dedicated team that works on the whole MAP Kinase Pathway, which is Ras, MEK, ERK, SHP2 and so on. I mean, when you look at, for example, KRAS, I think, is a major target. And there is some promising single-agent data. But probably realistically, these assets need to be combined. And for example, SHP2 is one of this quite promising combination. So maybe you're aware, we have started a clinical trial in collaboration with Mirati and their KRAS. And we just started entering clinics and doing these combinations. And I think that's something that is quite promising for the future. So I think this technology is really to go into pathways with that we know are very important for cancer. But currently, it was like undruggable space, and that's where we try to enter.

Laura Sutcliffe

analyst
#25

Okay. And maybe I'll follow-up on that then. You mentioned you're going to try your SHP2 with the Mirati molecule. Do you think that when you're sort of talking about trying to look at something on a whole pathway basis, strategically, do you need to own all of the agents that are required to target the things you want? Or do you think it's okay just to own one of those agents? I'm thinking about what you've done with Taf/Mek, for example, like you own both of those. So strategically, what's the kind of -- what's the preferred approach?

Susanne Schaffert

executive
#26

Yes. I think it depends really how strong, probably, the combination partner is. Ideally, I think you would own probably the majority of the combination partners. And when you look, especially in these pathways. You will also potentially see combinations with CDK4/6, with PIK3CA, with MEK. So I think we feel we are in a quite good position to really cover the whole space. We also have our own research on KRAS. So I think that's an area where, ideally, as you say, and Mekinist + Tafinlar is a good example. And that's why we add our own PDR001 there, is an example where of course you get much more independent. And I'm always having all this reimbursement and access discussions in my view. And therefore, I think the more of some of these combination partners you own, the better. And of course, that's not always possible, but that's, in a way, how we look into how we develop our portfolio.

Laura Sutcliffe

analyst
#27

Okay. And you've mentioned just now that word undruggable. That comes up quite a lot in the context of KRAS in particular. What are the kind of hardest problems you are trying to solve in oncology? Like what are the sort of undruggable things, if that's sort of one way of approaching the question, that you're trying to go after? And like what is Novartis doing that sort of differentiates an approach to solving these really tough scientific problems?

Susanne Schaffert

executive
#28

Yes. I think actually, probably, the biggest problem I would even name before even the drug, if they are druggable, is resistance. I mean, when you look at cancer treatment and the outcomes, especially in solid tumors, I think great progress has been made with both immuno and targeted therapies. But you still see resistance, cancer cells developing resistance, mutations and so on. So in a way, what you really want to strive for is overcoming this mechanism by combinations, by applying new treatment approaches. And I think the very ultimate goal that you have is to have deep and durable outcomes. It's really about durability. That's, for example, why we are excited about our CAR-T program where it's all about duration. It's durability of the treatment, very high response rates. But that, you achieve also with other combinations and then the durability. So that's the areas where we focus on because, unfortunately, cancer, we always call it is the smartest disease that is existing and finds all this way to escape. So therefore, to really overcome resistance and achieve a durable long-term outcome is the goal. But of course, then, as you say, drugging the undruggable would give us, of course, new areas to enter on. And we need to look what are the key oncogenic drivers and how do we tackle them? And like the KRAS and also the whole MAP kinase pathway, is it's an area where of course we would focus on to find new assets. So it's really -- I think it starts in the more basics with the whole issue of resistance. But then, of course, you also strive for really a cures -- curative treatment and really look into new pathways to add new munition base to your current treatment option.

Laura Sutcliffe

analyst
#29

Okay. Great. And I think we've got just 1 or 2 minutes left, and I'd really like to get in a question from the audience, if I can, as the last question. It's on radioligand, it's on Lu-PSMA. I think you mentioned it before. And if you -- if there's good data in Phase III, I think there's some very big numbers out there in terms of opportunity. But how do you view the uptake of this? Is it going to be like other oncology drugs where you can get to quite high penetration? Or is it going to be a little bit more difficult like it has been with Lutathera? So the need for authorized centers, the supply logistics, patients in the community, et cetera? Sort of what's your view on the uptake for that product?

Susanne Schaffert

executive
#30

Yes. And I think that's a very good question. So that, for sure, I -- what we hope of course and aspire for is very meaningful data. It's a group of very, very high medical need. And when we enter, it's in third and fourth line, which is still a very big population, but it's not of course like the whole prostate area. So that's why I think that will give us time to really prepare centers. And as you say, unfortunately, they have to be certified or authorized, we have to help them to build. But I think the good news is that in this field, the treatment decision will be made by oncologists and urologists, but the application will be done by a nuclear medicine physician, and that actually are the same then for Lutathera. So that, I think, is making us excited that we can really leverage the current footprint and repair centers. Of course, neuroendocrine tumors is a more rare disease, and that would mean that definitely, we need to make sure that patient flow is guaranteed from oncologists and urologists and that we work also on capacity in the nuclear medicine field. But I can only say medical experts are quite excited because that's an area where nuclear medicine usually was not in. I mean, they had iodine treatments in some very, very limited areas. But usually, they were the ones responsible for diagnostics. So also for this whole part of medicine, it's a huge opportunity to get into treatment. And therefore, I think it's a very strong collaboration. And we feel, with the experience from Lutathera, but then also going in early, we should be able to ramp this up very quickly. And I think, as you say, the big numbers really come then from the expansion into earlier lines. And here, for example, a program now that we start in pre-taxane, which really then gets us into earlier treatment. And that's where really the significant opportunities lie.

Laura Sutcliffe

analyst
#31

Great. I think we've just about hit time. So Susanne, thank you so much for being with us today. And thank you to everyone who joined us on the webcast and on the phone. I hope this was useful for you. And have a great day, everyone.

Susanne Schaffert

executive
#32

Thank you, Laura. Thanks, everybody. Have a good day. Thank you.

Laura Sutcliffe

analyst
#33

Thank you. Bye, everyone.

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