 So it just means that you, that's correct, consider surgery truly being treatment naive. Oh, I'm sorry. Maybe the mic's off. I was just saying that Dr. Tan was saying that if you've had surgery, can you really be considered treatment naive? And I said it just depends upon what treatment you're referring to. One reason is that. Yeah, so typically for clinical trials, what we're looking at is treatment naive being no therapy whatsoever, other than surgery, the initial, that's usually okay. And then one line of therapy would allow for, like maybe if you had adjuvant sous-tent or in a clinical trial, because that hasn't really been out that long, or if you had some other therapy to begin with that you would be eligible for that. So those are just trials usually looking for people who have had zero or one therapy prior. Great question. And yes, palliative care embraces the entire family unit. And by that it would be, for example, when I spoke about the patient with a brain tumor that was 27 years old, and they would be working with his brother, his sister, his mom, and his dad, as well as him to have conversations. I think that's a tricky question because it really depends on where you're being treated. If you're being treated at a center that has palliative care, for example, at UNC or Duke, and they have them in, you know, actually where palliative care is available as a specialty, then of course you can speak with your provider, but in some of the rural hospitals, it's a little more difficult to find specialists that are trained in palliative care. We do have a separate palliative care team, and I need to say that they work with your medical oncologist. They do not work independent. You know, you would still be working with the palliative care team, and you'd be working with your medical oncologist. And it's just, like I said, it's not taking the place of the symptom management that you're getting from your medical oncologist. It's just a different layer of support. And primarily looking at those conversations and trying to bring your family on board and trying to have conversations that are difficult. And we call them serious illness conversations. Yes. So how do you pick one? Well, how do you pick one? Yeah, so that's a great question. I think that the answer is we don't know the answer, right? And that's why we do the clinical trials. And so I think that you need to sit down, obviously, with your doctor and have a discussion. It's like when I asked Dr. George the question about how does he manage the issue of now having adjuvant sous-tent as an option? How do you discuss that with patients when you have adjuvant clinical trials that include a placebo? And I think you need a doctor who's willing and able and has the knowledge base to be able to have that sort of conversation with you. In addition, it's important that if you can, you do some of that legwork yourself just in terms of being able to come to the table with questions that might have been generated by discussing it in situations like this or online forums or reviewingclinicaltrials.gov because it can be confusing. Treatment naive, one or two prior therapies. I mean, all of these things are issues that patients will often bring into the room which do require a thorough discussion. But we are excited about certain therapies more than other therapies perhaps and we are certainly excited about a lot of the advances in the immune therapies in this disease. And so I think that may that may be the short answer to your question. Is there an advantage in having to go into an app versus something that's recently proven by the FDA or whatever? So standard of care versus clinical trial. So the answer is that we don't know if there's an advantage. There is a hypothesis that there may be in many circumstances based on the fact that the clinical trial is being performed. And what I generally say to patients that come to our center is you're here, you're coming to a large academic medical center. We don't have a cure if it is a situation in which we don't have one and we are always looking for better treatments. And that's why we do clinical trials to be able to try to get the answer to that question which is to develop better treatments to improve outcome for patients. Is it going to help you? We don't know the answer, but the reason why we're doing this study is because we're hopeful that it may. One more, one more, one more. Somebody said you have a placebo. So it depends, so the answer is that it is allowed. There are certain circumstances where unfortunately there is no better treatment than placebo. And so under circumstances such as that, clinical trials can be designed with a placebo in place. The placebo generally includes best supportive care. So in other words, what Gene was speaking about in terms of palliative care, so making sure that we manage symptoms and take care of the patient. But there may not be a cancer directed therapy that's effective in that particular disease state such that a placebo in cooperation with standard of care, supportive management of someone, palliative care, whatever it may be is absolutely appropriate. The other thing we talk about with clinical trials is it does give you an opportunity to get a medication that isn't available at present and the things that are commercially available will likely be commercially available later. So if you're up for it, we would consider giving you that clinical trial drug because it's not a drug that you have access to at this time and the other ones could still be there. I think it is tough. I think sometimes they have clinical trials running on things that we find interesting that we do not yet have running. Obviously there's a lot of cost associated with that decision and we don't know if it's gonna be better or worse than what we're doing here. I think that's kind of a personal decision ultimately, but what do you think, Dr. Holmes? Yeah, I think that, I often will say to my patients, and this is what I say, is I say if I knew that there was a treatment in the farthest corner of the globe that was able to cure your cancer, I would send you there. And that's genuine, I mean, I've had family members with cancer, right? I mean, we all have had experiences both personally, those of us that are in the field professionally and acknowledge the fact that we're all looking to find better treatments for this disease. I will tell you that within this area, we collaborate. It's a very collegial environment. We reach out to Dr. George, Dr. Armstrong, Dr. Zang and everyone. We go back and forth, we share clinical trials because if we don't have something available for a patient, we will often check to see if there's a trial available for a patient or a wake or Levine. I mean, so I think that we really, certainly in this area, and I think nationally more or less across the board, try to do that. In terms of trials going on in other countries, most of the large trials of these very exciting agents are international-type trials. They're going on all over, and they're going on in the United States, and so we do have access to those drugs. It's another absolutely excellent question. You know, the answer about adding another immuno-oncology drug to one drug that you perceive that works similarly is an answer we don't have at the moment. I think that if you said, could there be a rationale in a patient that, for example, has previously received immunotherapy to give them a new immunotherapy combination, if in fact they were in an appropriate situation to be able to tolerate and receive that therapy, the answer is possibly. We really think that most of the current PD1, PDL1 inhibitors function pretty similarly, but combinations make it much more complicated, and it very well may be that there is rationale to consider doing that in appropriate patients. I think most of us would say that if a patient was doing well on a VEGF therapy and tolerating it, even with the advances and the recent data that's been presented, we would be reluctant to stop. Doing well is patients achieve a benefit with respect to survival associated with the use of VEGF targeted agents. So I think, could it be that someone at some point will develop progression on a VEGF targeted agent at this very moment when we have this new combination and then we move to that combination? That's a very reasonable scenario. That may not be the approval, right, because the approval is gonna be in the first line setting, but it very well may be that in discussion with your physicians that that's something that they would consider depending upon where things are at that point in time in terms of some of the data that will be presented in the near future. Lance, or? I guess to the combo, like when you're thinking about, would you use the combination? The other thing I would wanna know is how well did the person do on the Novolumab to begin with? If you did have a response to the Novolumab, that would be something that maybe would push us more toward considering the combination. If you did not have a response, I don't know that I would be really super excited about the combination, but that's just me personally from, you know, backtracking. Yeah, but if, yeah, when, oh yeah. Yeah, I think definitely if somebody's stable, we agree, I wouldn't mess with anybody who is stable, because stable's good. Right, and that's another part of it, like are the side effects affecting your life in a way that isn't manageable?