Highlights

think traditionally we have practiced this paradigm that really hinges on how long patients have been in remission based on their last round of platinum-based therapy, but I think we are now moving more to molecular testing for current treatment, as opposed to this arbitrary time of platinum-free interval. So, for example if the tumor testing shows that the patient has a mutation, that will be amenable to immunooncology, let us say they have PD-L1 overexpression, they may become eligible for something like pembrolizumab as opposed to more platinum.

So, I think we are not there yet, but we are beginning to see a shift away from just the platinum-free interval as being the deciding feature that makes us choose the next line of therapy. So, I can tell you that our cancer practice, the whole cancer center in my hospital has moved to biosimilars, and I think it was a decision made at the hospital level just based on pricing. So, I see no pharmacology drugs in the ambulatory center, and specifically oncology drugs are driving a lot of the medical cost of care, so our cancer center made the decision that across all disease types, not just gyne, but any other cancer where the [bevacizumab] biosimilar agent is now available, that we would make the switch.