 My name is Leslie Montgomery and I'm the Chief of the Division of Breast Surgery at Hackensack University Medical Center. So everything that we know with respect to the advances of breast cancer treatment over the last 50 years has come about because of patients who are willing to participate in clinical trials. The importance of clinical trials is to seek novel approaches to improve outcomes in patients and the major obstacle in patient response in a particular trial of interest is that only a certain percentage of patients respond to treatment and the question is why is there such a heterogeneity in patient response and outcome. We have two types of clinical trials that we belong to here in Hackensack University Medical Center. One is cooperative group trials where these are national trials where we are one of many different institutions that accrue patients to a specific trial and that we all pool this knowledge and this these patients information and so that answers can be made on a much larger scale that any one individual institution could achieve. This is a very interesting trial involving the investigation for the first time of the microbiome in breast cancer patients. So the microbiome is the bacteria that exist in all of our GI tracts, our small intestines and our large intestines and we are learning a great deal about this microbiome that these bacteria have impact on our bodies. The ultimate idea would being that it is possible that you could alter the microbiome to potentially have less chemotherapy side effects or a better outcome but this is the first time we've ever seen one done in the world of breast cancer and it's a very exciting trial for us. Part of our study is to understand if there's any by any mutualistic relationship between the gut microbiome and the immune cells in the tumor microenvironment and to see if they both if if there's a trend if the composition of the bacteria in your gut that predicts a good response is it correlated with the T cells in your tumor microenvironment that will actually eradicate the tumor cell itself. We participate in numerous chemotherapy, radiation and surgical clinical trials that are cooperative group trials in hopes about a national level answering these important questions. The other types of trials that we participate in are investigator initiated trials where these are individuals here at Hackensack University Medical Center that will do our own clinical trials using our own patient population and very often partner in sort of translational research with basic scientists associated with our medical school or Jurisd Research Center where we can gather patient information and then these basic scientists can look at at very specific biologic questions and together we work to again make these very significant advances. Obviously the the the goal of of clinical trials at Hackensack University Medical Center as well as the John Toyer Cancer Center is to improve response, prevent residual disease and obviously try to cure all of our cancer patients. So any time a patient with triple negative breast cancer is identified it's important for them to be a part of any trial. It's important that we understand as much as we can about this particularly aggressive kind of breast cancer as quickly as possible to help these women.