Thomas J. Lynch, Jr., M.D. - Bristol-Myers Squibb Co.
Analyst
Andrew, thank you for your questions. And the first question is really a hypothetical. And it really is impossible for me to be able to opine on a potential hypothetical of missing PFS or hitting PFS or missing OS or hitting OS. And I really think we have to wait until we get more data from the MYSTIC study to really understand that. As we've said earlier, we have PFS and OS as co-primary endpoints in 227 and we have not disclosed our final statistical plan in that setting. Your second question regards the new formulation of the non-fucosylated CTLA-4. I think one of the reasons we've looked at these two new CTLA-4 targets, first, we believe in the target. We think the target's important. The target's been shown to have a survival advantage, and as I illustrated in my answer to Jami's question. So we think the target's important. And if we think the target's important. And if we think the target's important, the question then becomes, how do we optimize the therapeutic index? How do we make CTLA-4 a better molecule, an even better molecule than it is? And there's two main approaches. With the CytomX approach, the thought is, the Probody technology will allow a differential exposure of tumors to CTLA-4, allowing us to enhance the immune response within the tumor itself and possibly not see the same degree of side effect profile that you could see with immune side effects in other areas. So that's the thought behind the new formula, behind the CytomX approach. With the new formulation, there's a possibility that there could increased potency of the drug that could actually allow us to have more effectiveness in that setting. And, again, very early. We just started, as we announced at the last earnings call, we just started trials with the non- fucosylated CTLA-4. And so we're going have to see how that evolves. And your third question, Andrew, is around the concept of patient selection. And I think you've hit a very important point is that, as we look at these cancer types, and as I mentioned this about lung cancer earlier, we are seeing increased fragmentation in the patient populations. And we're seeing the biomarker selection is becoming increasingly important as we look at patient populations. Lung cancer, for example, is not just one disease. It's many diseases defined by EGFR and ALK and ROS and possibly Tumor Mutational Burden and PD-L1 positivity. So I think as we go forward, attention to patient selection and attention to thinking are we treating the right patients is something that we take very seriously in our tumor design and our trial design. It's one of the reasons, as Charlie mentioned earlier, we're continuing to up-invest in R&D and up-invest in translational medicine because we think it's important for us to prospectively be selecting the correct patients.