Veracyte, Inc. (VCYT) Earnings Call Transcript & Summary

Good morning, everyone. This is Matt Sykes, Senior Life Sciences Tools and Diagnostics analyst at Goldman Sachs. And I have the pleasure of welcoming the Veracyte management team to our conference. With us today, we have Bonnie Anderson, the Executive Chairperson; and Marc Stapley, the Chief Executive Officer from Veracyte. Thank you both for joining us. We're really happy to have you here.

Thank you, Matt. Pleasure to be here.

Great. Maybe there's been a lot of things going on with Veracyte lately. A lot of exciting news. You guys have been very busy. I thought maybe what we'd start out, Marc, if you can kind of take us through sort of a bit of the history and the journey that Veracyte has been going through, leading us up to where we are today.

Yes, I'm happy to. And actually, Bonnie is sharing a slide that, hopefully, you're able to see that I think really does help given an image of what I'm about to describe. The journey that Veracyte has been on really commenced very early on in the beginning with the creation of diagnostic tests that answer very specific questions, clinical questions and help physicians make key decisions. And that started in Veracyte's early beginnings. But the current -- the strategy that we have that has been playing out over a number of years that I'll describe really kicked into this gear in 2017 when Bonnie and the Board made the decision that to truly be a global diagnostics business, you needed to have your own platform in order to do that. And so the decision was made to acquire a platform that would enable global expansion, as you can see here. And that decision was -- came to fruition really 2 years later with the acquisition of the global diagnostic rights for the excellent nCounter platform from NanoString. So that's what really started the next phase of this growth. Now in order for that platform to enable global expansion, a couple of things needed to happen. One is menu expansion. For a platform to be adopted widely for the installed base to grow, you need to have a menu of tests, not just 1 or 2 tests. Now we acquired a couple of tests, as you can see here, Prosigna and LymphMark with the platform. So that's the first menu that was available. And then as you know, very recently, we acquired Decipher Biosciences, which also added to our portfolio of menu, and I'll talk shortly about how those tests might pull to that platform, but that added menu. And then more recently, just in the last week, we truly cemented, I'd say, the final step in this strategic growth here or building the platform for strategic growth by acquiring HalioDx. So what HalioDx gives us is, first and foremost, the opportunity to move the manufacturing of the kits and the IVDs we're going to need for global expansion over to our own platform, over to the nCounter and for the manufacturing to be done at our location with HalioDx in Marseille in France. So that gives us end-to-end control of the manufacturing supply chain, the manufacturing process, and of course, our ability to control our own COGS and pricing structure on that. So that was the final step that really gave us the platform that we can use for expanding, particularly in Europe and other key strategic geographies, and then we'll continue to build menu. As far as the menu on that platform is concerned, we're starting this year with Envisia and porting that over to the nCounter. Next year, our nasal swab, and we'll talk about our nasal swab data, I'm sure. But our nasal swab will be developed on the platform and then launched the following year. And then as I mentioned just now, the Decipher Biosciences' urologic assets will also be candidates for moving on to the nCounter platform. So at that point, that would give us a very extensive menu, which will help us drive installed base throughout Europe, and as mentioned, beyond that. The final -- kind of the final part of really helping to achieve this strategy, which as I just mentioned, I kind of started in 2017. And it will be completed 2 years from now when we complete manufacturing transition. So it's a 6-year end-to-end. But the final piece that really helps us achieve this is the management change that we recently announced. Bonnie brought me on with the Board, brought me on to Veracyte to help to drive this global expansion with my experience, both internationally large, high-growth multinational companies, not to mention, manufacturing tools, instruments, reagents and diagnostics. So I'm coming on Board to lead the company through this transition. And really importantly, Bonnie is going to stay on as an active Executive Chairwoman working on a number of elements of the business with me, partnering with me on strategic planning, on business development, but really importantly, on the HalioDx completing that acquisition and then the integration of that. So together, we're going to complete this strategic -- the strategy, this vision that we're laying out here in the next 18 to 24 months, and so that 6-year journey end-to-end will be completed.

Great. Well, thanks for that overview, Marc. I think it's really helpful to kind of tell a story and look at what you've built so far, which is really impressive. Maybe we'll start with some of the latest news that you've had and the data at ASCO that you referenced. Maybe just take a -- sort of a 30,000-foot view for those who haven't had a chance to dig into the data and just describe what was presented there, and then we can kind of go into some more specifics.

Yes. I mentioned the nasal swab, but there was also some other important data. So I'm going to ask Bonnie to talk about the high-level ASCO presentations and data that we launched.

Yes. Thanks, Marc. Yes, so we had a really great coming out party of data with our lung cancer portfolio that includes our nasal swab, and it will launch later this year along with Percepta Atlas. And what we're trying to do is serve the physician and the patients at every point in their journey in lung cancer. It can be quite confusing to doctors what test to use at which point, and we want to be able to answer all of those questions and be an excellent service provider for the doctor. Of course, the most exciting product, the one that gets a lot of the attention is our nasal swab, which actually began its journey a number of years ago as well. The one thing we know about these diagnostics is to do them well and to validate a well-designed prospective clinical studies, it takes time. In '15, we acquired actually the assets that were part of the portfolio of these field of injury tests that collect epithelial cells, and based on the damage of those cells from smoking and other exposures, are able to use that data to predict the risk of lung cancer, and potentially, other diseases. There's about a $15 million (sic) [ 15 million ] patients that are eligible now for screening in lung cancer through low-dose screening that is part of the preventative task force approach. This is really important because low-dose screening is a very sensitive way of non-invasively identifying, we estimate, over 1 million patients every year that have a suspicious nodule that needs worked up for lung cancer. The challenge for the doctors is what to do next. And today, there's really no tool to accurately classify the patient's risk so the right next step can be taken. And we've solved that, we believe, with the nasal swab test where our data show, we are going to be able to identify over 40% of those patients with nodules that are truly benign and classify them as very low risk of cancer. It's with a very high sensitivity, over 96%, and in the population that we'll be testing that computes to less than 3% risk of malignancy, which is even lower than the guidelines call for low-risk stratification and the movement of these patients to CT surveillance. We classify patients as moderate risk, which really puts them into about a 20% to 25% risk bucket. These patients by guidelines would go on for biopsy. And then high-risk patients, what we want to be able to do is identify early stage. These are often smaller nodules that through clinical assessment often get classified as low risk, where they're moved to surveillance, and if the patient gets lost to follow up, these are the patients that come back and get diagnosed at Stage 3 or Stage 4. As we all know, those patients only have about a 5% likelihood of 5-year survival. So the whole idea here is to get the earlier-stage patients that we can identify, estimated almost 60% of the true malignant patients in our validation study were classified as high risk with greater than 90% specificity, a positive predictive value near 70%, which fits right into the guidelines for moving this patient into workup, further evaluation, diagnosis and treatment to accelerate saving lives.

Great. Bonnie, I think if investors were to kind of walk away with 1 key point from this data, I mean, I think about the PPV and some of the other data in there. What would you kind of want them to take away from this data set?

I think there's 2 answers that are really important for patients. When they have any test that's a screening test to see if they have cancer, they're hoping not to get the positive result. But if they have cancer, that's an important result to give. You want to classify that risk high enough so that it is worthy of those patients going on to have the workup. I think if any of us sitting here today were told, you are at risk for lung cancer and your risk is about 70%, you're going to not have a problem getting that biopsy, and you're going to still hope that it comes out negative at the end. But the other end is also very important. We want to be able to give patients a negative result or a low-risk classification that they can walk away and go to surveillance and not worry about a cancer being missed. And these are both really important, but rolling out cancer is what many of us go through a screen. I know me as a woman, we go for mammograms every year, and we're just expecting that result to be negative, and we have a sigh of relief because we know that negative result means we likely don't have cancer.

Got it. That's really helpful to kind of help us define that. And maybe thinking a little longer term, there's obviously been a lot of interest in asymptomatic cancer screening opportunities. Maybe can you speak to the long-term pre-cancer screening nasal swab opportunity and how you see that fitting in the care continuum in the patient journey going forward?

Marc, allow me to take that. I'll just finish the story here. The future pre-cancer detection on this slide, this is obviously a massive market opportunity and a really exciting initiative that we have been on this journey in conjunction with Johnson & Johnson, our partners. What we know about the field of injury is that we now have validated this approach, if you will, in Percepta, in bronchial airway brushings. In fact, we had 2 validations, a first-generation and a second-generation test, both highly valid data to be able to use the field of injury to inform likelihood and risk of cancer. We now have a very exciting validated test in nasal swab that we'll launch earlier this year where I just described. And we're not done yet. We announced our NOBLE study, it's NOBLE as N-O-B-L-E in conjunction with J&J, where we're going to enroll over 9,000 patients into a clinical study and be able to look at those patients that don't have cancer upfront, but develop cancer, and see if we can pull a signature out of the nasal swab that would predict the likelihood that patient will develop cancer. J&J has talked about the World Without Disease and plan to develop interceptive therapies, which I think is one of the most exciting new class of drugs, find those patients that have cancer, but they have dysplasia or early cancer signs and put them on a treatment that literally can halt progression to disease. So that will be the second really exciting advancement. But we're truly excited with where the nasal swab is today, big market opportunity. Once we get the nasal swab on the nCounter platform and can take it to global markets, there is no doubt it will change the way physicians are able to provide patient care.

Got it. And I think one question we get a lot, just regarding how this could potentially complement or compete with liquid biopsy screen test for lung cancer. I mean how much more accuracy is possible from the field of injury science in the airway that maybe can't be achieved by blood alone?

Well, I think you just have to compare the data, right? We now have multiple sets of data. And I think the nasal data are very compelling. As I said, you want to be able to roll in and get the right people worked up and diagnosed. And pathology biopsy for staging is going to continue to be the standard of care. And we obviously have shown we can be highly sensitive. So rolling out is also possible. I'm not sure we could see that same level of sensitivity in blood.

Got it.

I think, Matt, that's going to be -- sorry, Matt, that's going to be one of the challenges is when somebody -- as Bonnie mentioned earlier, the rolling out is really important. When somebody is being told, you have a low risk of Stage 1, Stage 2 cancer, you need that to be very high sensitivity and very confident. Whereas, I think with a lot of the liquid biopsy tests today, that's going to be the challenge early on.

Got it. Got it. And maybe you talked a little bit about it, Bonnie, at the beginning about the communication with the doctors and how important that is. Maybe talk about some of the work that you've done in order to help maybe in terms of education, but just increasing those communications to make sure that they -- they're communicating with their patient the right way.

Well, I would say back in '15 when we acquired Allegro, and we brought with it 33 KOL investigators that were part of the development of the AEGIS cohort, which contributed to the nasal swab. Since then, we've expanded that cohort of KOLs, and they actually have been the ones to help us determine where is the best spot in the clinical pathway of care to put the nasal swab, where is the place where you have the biggest challenge. And it's been universal for them to help us position this test to be the first test that can be done post nodule so that they can guide the next steps with the patient in conjunction with guidelines and use our patient results and our data to help patients get comfortable that they are being told, you're safe to go to CT surveillance. Often without data, patients that have a low-risk nodule are still so nervous about it. They want the doctor to take them in and work them up. The opposite is true. There are patients that are high risk for cancer that don't want to undergo the procedure to be worked up. And both of these can be solved when you change the paradigm with data that the doctor can use to have those conversations. And we've heard this over and over.

Maybe just talk a little bit about what you think some of the key advantages are of your platform that you've built. I mean, Marc, you went through the journey on that slide, and it's really impressive what you guys have built. And as we look out a few years, arguably, it could be a more competitive market. Just talk about the competitive advantages of the platform that you built really give Veracyte in sort of over the next few years?

Yes. I think there's a couple of things. Firstly, just having the platform itself, our own platform with the control of the entire manufacturing that in and of itself is a significant advantage outside of the U.S. We know that the CLIA lab model works very well here. We know that it doesn't translate very well to non-U.S. markets, sending samples to the U.S. is -- and having the reimbursement dealt with and everything else that you have to deal with then, not to mention, turnaround times and so on. So having our own platform that we can distribute into our customers in Europe and beyond is a very key differentiator, which is why that strategic decision was made and has been executed over a number of years. So that I would say is number one. Number two is the deep scientific expertise that Veracyte has always had and continues to have and acquires companies who have. And if you look back at, again, the way I opened the conversation today was Veracyte answers very specific questions. So it's not a question of building menu for tests that don't yet have a question that needs to be answered. It's a case of building very specific tests that answer questions and help physicians make decisions for patients with improved outcomes. The third, I would say, is the large amount of data that is generated by Veracyte. It's a very strong approach of looking at the entire transcriptome. And amassing significant amounts of data across individual patients that certainly improve products going forward, create opportunities going forward, and I think, give a really distinct competitive advantage to the company. And these are some of the reasons why I joined Veracyte. I looked to the opportunity, the global opportunity that we have as a company, the way we've approached it. And to me, it's extremely well positioned. Bonnie, I don't know if you have anything you want to add?

No. No. That says it all.

I mean you mentioned data there at the end, and that's one of the things that has struck me kind of first. And Bonnie, you and I've talked about the biorepository and the value of that data. Could you just talk a little bit more about what you've built there, the competitive advantages you think it gives you? And how you can grow that data set?

You can go ahead, Bonnie.

Okay. Yes. I mean from the beginning, we have always done all of our discovery work and then brought products to market in the U.S. CLIA lab measuring the whole transcriptome on every patient that we have run in our lab, every patient that has been part of the development of a test. And what that gives you the great opportunity to do is build biorepositories when you enroll patients post launching clinical utility studies and gain their consent to continue to follow them. If you're measuring a cancer like in lung cancer that we're going to do with Percepta Atlas and what is today the impact of the Decipher grid in prostate cancer where they have 90,000 at all stages and types of prostate cancer in a database, every patient with whole transcriptome, 46,000 transcripts of data. That allows companies to mine that data and to use the test to enroll patients in drug trials where Decipher is now being used in 7 clinical trials as the test for enrollment, classifying the patient as high risk or low risk for metastatic disease. That then allows these companies to get access to 46,000 transcripts of data, which can give underlying signatures that help guide future tests, such as patients' ability to respond to a drug or not respond, et cetera. So it's of enormous value in setting up future pipeline, but also building, monetizing partnerships as well along the way.

Great. And you mentioned Decipher. Maybe let's shift gears to Decipher. The acquisition was made in March. Maybe tell us a little bit more about the opportunities that you see in neurologic cancers and kidney cancer tests that might be in the pipeline? And just talk a little bit about the potential and what Decipher brings to Veracyte?

Yes. Maybe I'll do a quick high level and ask Bonnie who drove that acquisition to talk a little bit more about the opportunity there. But clearly, we have opportunities today in prostate, and Decipher has come out with a really good test in prostate cancer. And then just recently, we announced this last week that we had a coverage decision for bladder as well. And then there's obviously going to be kidney opportunities going forward. But Bonnie, do you want to talk a little bit more about Decipher?

Yes. I think it is simplistically elegant. This test was developed with an endpoint of likelihood of metastatic cancer. I think we all understand that localized prostate cancer is diagnosed, but a small percent of those patients are likely to metastasize. Those are the ones you want to identify because you don't want to give the aggressive treatment that can be life-changing to people that have indolent prostate cancer. And so this slide does a great job of showing if we are part of the initial workup at a biopsy stage when the patient has just been diagnosed with localized prostate cancer, our test has been demonstrated to inform low risk of metastatic disease versus high risk. Low-risk patients can be moved to active surveillance. So again, who to workup, who not to workup. Sounds similar, similar to our nasal swab actually. If a patient on the other end is post prostatectomy, our test has been validated to predict those that have high-risk metastatic disease, so they don't just stop with the surgery. They actually intervene with a more intense, more aggressive treatment because it is warranted. And we have data that has been publicly shown showing that when a patient at high risk is given the right therapeutic intervention, it extends their life and actually improves patient outcome. When that same treatment is given to a patient with low risk, it -- actually, the treatments themselves have higher risk of heart attack and other situations. Giving those drugs to a low-risk patient, in fact, declines the outcome for the patient. So some great data on the prostate. And as Marc said, we were excited to get Medicare coverage on bladder, which we said would come when we did the announcement. And now this test will begin commercial ramp. Same call point, which is fabulous, and we'll follow that with kidney, which is in the pipeline.

Got it. Got it. That's really helpful. And maybe just keeping sort of big picture, but a question we get quite a bit, and we're asking a lot of companies just in terms of COVID headwinds. Can you just touch on the cover you're seeing in terms of patients returning to visit their physicians? Any pent-up demand or backlog you're seeing there in patients who were delaying visiting physicians during COVID?

Yes. As we talked about on our Q1 call, obviously, we saw a fair bit of impact in our pulmonology business, as you can imagine, especially as those physicians are dealing with COVID themselves and the COVID cases. So it's clearly an impact there. There's going to be a backlog of cases at some point. And I think it's fair to assume that, that comes back to kind of pre-COVID levels or it should do at least, and then the growth opportunity that we saw pre-COVID continues. As far as the other parts of our portfolio are concerned, I think it's fair to say that the thyroid part of the business has really started to recover. And the prostate side of the business, interestingly, not as significantly impacted, and I think, why you can't extrapolate the good results that we had for just a few days that we had Decipher in the first quarter. Clearly, Decipher has come out strongly this year and is looking to grow nicely. So I'd say, less impact on the prostate. And then again, I think that's largely due to the call points and what those physicians are having to do to deal with patients on an ongoing basis, less impacted by COVID.

Got it. Maybe I can sneak in an audience question here. You mentioned thyroid. Just Afirma, obviously, we're going back a little ways, but can you maybe just talk about the current penetration rate and what you're seeing there? You just mentioned that you saw some recovery there. Just maybe talk about Afirma a little bit?

Yes. Bonnie, do you want to talk about Afirma?

Sure. Yes. Afirma, our sort of flagship product, we're about 35% penetrated into the market, definitely have created a new standard of care, created the market actually for thyroid. This is a good example of how -- when we started the company and asked physicians what answer they needed to change care, they told us they needed to know who had cancer. And we determined that if we answered that question, we probably wouldn't change care for anyone. We needed to find out who was benign so that those patients with a benign nodule could avoid cancer, and we could have that economic benefit. So today, Afirma has created that new standard of care. We classify about 70% of the cases that we test to benign with greater than 91% sensitivity. I think it's 94%, 95% NPV. And today, on those patients that are not benign and likely cancer, we can inform on the variants that help guide surgical, the extent of surgery as well as potential treatment decisions. So this is execution. We continue to build up the sales team. We've had some great patient education programs, a lot of medical education that now can happen across the nation instead of city by city. So the marketing for these tests has become more efficient based on COVID. Everyone learned they could do that, right? And we think there's still a lot of room for growth for Afirma.

Perfect. And another thing that impressed me in Veracyte is just how global you are, given the size you are and the ambitions you have. And nCounter was a big part of that. Maybe just touch on what you think that has brought to Veracyte, obviously, in addition to sort of the global presence? And just what are you seeing in terms of diagnostic volumes in nCounter internationally today?

Yes. So I mean, obviously, that's one thing that really impressed me about Veracyte as well, and that's entirely enabled by our platform approach and strategy here. The installed base is reasonable. Obviously, there was an existing installed base. And as I mentioned before, we have menu, but what really drives that is the addition of menu on the platform. So not only porting our own products, as I described earlier, as well as continuing to advance new products -- our own new products on the platform as well as partnership opportunities. And so as we spend the next 18 to 24 months, transitioning the manufacturing, I think that's the right time to really push the menu and push the installed base. And I think that's one thing that you got to be really deliberate and thoughtful about is you don't want to advance the installed base faster than you can support it, and you also don't want to leave opportunities behind. So balancing that is a key part of our ongoing strategy.

Great. I think maybe Marc, turning it to you directly. Obviously, management transition, you bring a wealth of experience from Illumina. I would just love to kind of hear some of the most valuable things you learned in your prior experience. What you can -- what that will bring to Veracyte and just your sort of initial thoughts? As you started, I know it hasn't been a long time, but I'm asking you to kind of give your thoughts on that and kind of loop it in with your background.

Yes. Well, thank you, and we're in week number two now for me and Bonnie starting our new jobs, both of us started on the same day with our new roles. And it's playing out pretty much as I expected. On the first day, we launched our acquisition of HalioDx. And obviously, I was very much aware of the strategic vision and the plans that we had in place to achieve that. Now my experience in global high-growth companies, I think, really is what I can bring to bear to Veracyte here. I have been in large multinational organizations for 20 years or more. More recently, the last 10 years in genomics, in various different ways, both with Illumina and Helix and before that in pharma. With my experience in genomics, it's covered both driving installed base and utilization of that installed base with instruments and reagents, the manufacturing supply chain challenges behind all of that globally. So that's been my Illumina experience for 7 of the last 10 years or so. And then recently with Helix. We grew Helix in the last year, less than a year to become one of the largest COVID testing labs in the country. And so a very rapid diagnostic business grown from a very small nonexistent basin certainly in infectious disease. So that's -- those are a couple of things, I think, in terms of what I've learned is to be able to grow a business in those ways, you need a lot of focus. You need a lot of clarity. You need the organization aligned around what needs to happen. And so I'll be bringing that to Veracyte, which Bonnie and the team have already done a great job with that. So I'm looking to help achieve this vision. You see on the slide here, address this global market by continuing the great work that's already been done.

Great. I mean, I think, when I looked just recently of all the things that you guys are doing, what you've built, and then the management succession. I would love just to hear a little bit more about how you two are working together? And Bonnie, how the transition is working? And how closely you're working together, just given all the things that are going on at Veracyte today?

Bonnie, if you want...

Yes. Marc has described so perfectly. I mean there's a lot going on because that was the plan. That's what we had to execute on in order to achieve the outcomes that were expected from many years ago. And as we all know, you don't always choose the timing of all these things. But I think we're fortunate to have picked this moment in time for the executive transition because it's about company first, right? We have to have leaders in the company that can step in, be excited about what we're doing, and then we have to have enough going on to attract someone like Marc. I'm actually really proud of that. And I think for me, being able to support Marc in his role taking over the helm for the next couple of years is exciting for me because I can help play out what I set in motion, but do that knowing when I do finally step maybe into just a Board role or whatever that the person that's at the helm is ready to just take it all over and drive success. You don't often see this kind of transition, which kind of surprises me in a way because I cannot imagine a better point in time and a better person to come in that I can work with to see this through. So I'm super excited, as you can tell about my role, very excited about where the company. There is nobody poised to compete in this space the way we are. And Marc is the person to lead us through it.

And for me, Matt, the opportunity to work with Bonnie in an active role over the next couple of years is a really important and key part of my decision process coming here. Also, I'd like to point out with our recent acquisitions and our ability to attract and retain really talented people, we have 4 existing or former CEOs on our leadership team, which I think is also unusual. And so together, this team can accomplish all of the things that we very thoughtfully and deliberately put in place.

Yes. I mean that's one thing I wanted to ask about is just people talk about acquisitions. A large part, they focus on the assets and kind of forget about the talent. And -- but also integrating that talent and making sure that everyone's got the necessary autonomy is also crucial, too. So just given the number of acquisitions you've made, the talented people that you've got on, how are you balancing their priorities, the autonomy that you're giving them? And how are you thinking about that going forward to make sure that, that journey that you described continues?

Yes. I think it's a really important point. Our strategy on this has been -- we've acquired these companies for their assets, including their people, and we want to retain and maintain those assets. And so part of that is you let those businesses operate without slowing them down, getting in their way, shuffling them in any way. At the same time, there are things that they will benefit from for being part of a larger organization that has over many years, flexed a lot of muscles, muscles in reimbursement, global expansion, has its own platform, for example. And so you're very thoughtful and targeted and surgical about where you integrate. And so every step is guided to help the company be even better than it would have been on a stand-alone basis. And so that's our approach. That's why we put so much energy into integration. It's one of the reasons we've got somebody with Bonnie's experience leading the acquisition integration of Halio.

Great. And maybe -- I feel like we've been talking about capital allocation throughout the session in sort of a roundabout way, just given the activity that you guys have done. But just talk about where we are with the balance sheet? How you feel about sort of moving forward organic versus inorganic? Clearly, you've done some inorganic stuff. So maybe talk about where we are on the balance sheet? And how you think about capital allocation sort of over the next year or so?

Yes. And we're fortunate, and it was by design and nothing else, but we have a very strong balance sheet that enabled us to do a couple of the really important strategic moves that we laid out at the beginning here, and we've been very supported by our investors in doing that and that has been fantastic. As I mentioned earlier, acquiring HalioDx really is the final step in that global expansion for the -- with the platform journey, and owning that manufacturing is important. And we know we're going to be focused on that integration over the next 18 to 24 months. Having said that, I would never say never if there was an opportunity with a positive ROI and that drives long-term growth, we would need to consider it, of course. But we need to be very thoughtful and balanced in our approach. And that's what I've been doing for the last 10 years is really thinking about capital allocation. And how you drive long-term ROI and top line growth with near-term profitability and cash flows, and that's been my experience. And I know that's how Bonnie has managed the company, too. So I'm coming into a company that's already very effective at doing that.

Got it. Maybe in the last minute we have, Bonnie, turning it to you for a minute. Just what are you most proud of that you've accomplished? I know you're going to be very active, so I don't doubt that continuing in the company. But I kind of would like to get your perspective, reflecting back on that journey that Marc started with. What are you most proud of? And where do you think this company can go in the future?

Look, I just -- I'm amazed at the focus and vision that we've had on patients from the very day we founded the company. It's always been about understanding the clinical pathway of care for patients and intervening with better tests that make the outcomes better and make care more efficient. We thought we hit the ball out of the park when we brought thyroid to market and the Afirma test became almost an overnight adopted test moving patients out of surgeries they didn't need at a rate of 90% within 6 months of us launching that test, which was amazing. We built a reimbursement powerhouse, have a really great process and recipe on how to develop the right level of evidence. So these tests cannot only be adopted but also paid for. And now we're sitting in -- when we closed the Halio acquisition, we will not only have our platform to take these global, we will have a presence in 8 of the top 10 cancers by incidents in the U.S., and it's only been 13 years. So I am incredibly proud of the team and just want to thank everybody for being so passionate about the vision of really improving patient outcomes at every point in their journey all over the world, and we are very set up to execute on that.

Great. Well, I think that's a perfect place to end. Bonnie, Marc, really appreciate your time. Thanks for joining.

Thank you, Matt.

Thank you.

All right. Take care.

Take care. Bye-bye.