A New Hope for Pancreatic Cancer Patients? Dr. Allyson Ocean Explains

追加: 2026-06-06

[00:00:00]I just want to introduce everyone to my friend Dr. Allison Ocean. She is a medical oncologist. She's also an attending physician in gastrointestinal oncology at Wild Cornell Medicine and New York Presbyterian Hospital. She's uh currently leading a lot of clinical trials investigating radiolabeled antibodies, antibbody drug conjugates, ankalytic viruses and targeted therapies. Her specialty basically is pancreatic cancer. She treated uh Steve Price, Dave Price's wonderful older brother. I often call Allison for advice when someone has been diagnosed with pancreatic colon cancer, other cancers, and she's an incredible doctor >> and an incred and an incredible person.

[00:00:49]>> Thank you.

[00:00:50]>> Such a caring oncologist. I'm getting kind of tearary because it's well, it's so special to have someone like you when people are going through such a difficult time. Um, but I really was excited to talk to you because first of all, can you explain what Asco is to everybody who's watching?

[00:01:08]>> Yes. And I want to say thank you to you, Katie, because your advocacy and your um platform has led to improved survival in people getting their colonoscopy, getting their mammogram, getting everything. And so I want to thank you for what you've done for everybody.

[00:01:29]>> Um uh so ASCO is stands for the American Society of Clinical Oncology. It is the largest meeting worldwide meeting every year that happens in June in Chicago attended by about 45,000 oncologists all specialties and they have one session called a plenary session which are abstracts research projects clinical trials that are presented that are usually practice changing data from clinical trials. Sometimes it's most of the time they're positive, meaning that the results are favorable and good, but even negative trials sometimes can be important because if we were practicing one way and we found out that that way is incorrect, we need to let everyone know about it also.

[00:02:23]>> Absolutely. And and one thing that's making a lot of news is something you and I talked about a few weeks ago and that involves uh pancreatic cancer and an experimental drug called well you tell me because I can't even pronounce it.

[00:02:39]>> Yeah. So the name of the drug is Doxan Rasip and the reason why this is getting so much press and why this is such a breakthrough is because pancreatic cancer as you know from your sister and from your friends and other patients that it is a devastating disease with very few treatment options and the long-term survival is you know in the teens like less 13%. And um there have been really no breakthroughs other than standard of care chemotherapy for many many years.

[00:03:20]The tumor grows in the pancreas because it is being um sparked to grow by a mutation that's called kass k. And this mutation is a growth protein. And for decades and decades, scientists have been unable to shut this protein off.

[00:03:42]And that's because the protein has a smooth surface to it, and they couldn't actually get drugs to stick to the outside of the protein to inhibit it.

[00:03:53]Revolution Medicines, the the maker of of Deroxan Rasib and scientists affiliated with them developed the drug which is an oral medication that it acts like a molecular glue and can stick to the protein and inhibit it. And so therefore the the tumor cells cannot grow and they die. And thi that's the mech mechanism of action of how it works. So that's incredibly exciting and there were clinical trials but my understanding Allison and maybe this was a different a different development in pancreatic cancer is this is only efficacious in a subset of pancreatic cancer patients. Am I wrong about this?

[00:04:43]Is this for everyone who has pancreatic cancer or those with the specific genetic mutation?

[00:04:50]Uh you're you're partly correct, partly incorrect. So partly correct is the fact that it the tumor needs to carry a kass mutation. So 90 over 90% of pancreatic cancers have that mutation. So essentially it is available for everybody because most pancreatic cancers carry a Krass mutation. There are different letters associated with the mutations. There's Kass G12D which is the most common. There's G12V, G12R, G12 C, 13 C 61. This there's many letters alphabet soup mutations for that exist. And this is a pan RAS inhibitor, meaning it targets all of those mutations.

[00:05:40]>> Wow.

[00:05:41]>> Yeah, that's that's the crazy thing. And there's also data showing that even if the tumor does not carry a krass mutation, meaning that it's normal or wild type, there was still activity in blocking that growth cascade using deroxan rasub even for tumors that did not carry the krass mutation. But the majority of tumors do have it. So, what does this mean, Allison, for people who have pancreatic cancer and maybe even pancreatic cancer that has metastasized, which of course was >> what happens often with with pancreatic cancer to the liver, to the lung, etc. >> Is this still is this effective for people who have metastatic pancreatic cancer?

[00:06:32]>> Yes. So the trial that was reported at ASCO was for patients with metastatic disease disease that has spread outside of the pancreas stage 4 and it was for the second time patients were treated.

[00:06:46]So they received chemotherapy in the first line setting meaning the first time they were treated when they were first diagnosed and then that treatment stopped working and then they were eligible to go on the clinical trial and the clinical trial randomized the patient. The computer decided which arm the patient got, whether they got Dox on Rasib, the pill to take every day or whether they were randomized to get chemotherapy.

[00:07:11]And so it was a direct comparison in the second line of Doxon Rasib versus chemotherapy. And the amazing results that led to a standing ovation when Dr. Walpin from Dana Farber presented it at ASCO just last week was that Droxon rasib improved overall survival significantly and had a doubling of overall survival compared to chemotherapy.

[00:07:40]In the second line setting the the median overall survival was 13.2 months whereas chemo was 6 months. And that is huge because remember these patients have already received chemo and now this is a targeted therapy that beat out chemo.

[00:08:00]>> So can this now be used as a firstline therapy when people are diagnosed with pancreatic cancer? And you know listen it's obviously so exciting but it's also only 13 months. I don't mean to be a Debbie Downer here Allison. No, you could. Absolutely. We have to we have to keep it real for sure. That's median survival. Okay. So, half of them are above that.

[00:08:29]Half of them are below that. But you're right. We have to It is. But we have not had anything with those numbers. We We were looking at numbers of two to three month improvement in survival. Not a doubling, >> right, >> in that situation. So that's why it's so significant. And the other reason why it's so significant is because this is just the beginning. Now we have found a way to crack the code, if you will, of RAS. Now we the K Rass that that hard shell.

[00:09:00]>> Exactly. Now they know how to inhibit it. So now that they can inhibit it, we can find out ways to improve upon that by adding other drugs to this that so that we can get even better results. So to answer your question about the first line treatment, those trials are under are ongoing right now. We cannot use this in the first line setting because we don't have the data that says that it's better than chemo in the first line setting. Um they're also studying it in the adgiant setting after someone has surgery for pancreatic cancer. They get their prevention chemotherapy for six months and then they can enter a trial taking deroxid versus placebo to see if it prevents recurrences from happening.

[00:09:49]>> Wow.

[00:09:50]>> After they've been treated.

[00:09:51]>> Okay. So, of course, I have many questions. Allison, what are the side effects? Is this the same drugs on Senator Ben Sass where Oh, thank you.

[00:10:02]>> Thank you, Julia. Where uh Yes. Uh he had all those soores all over his face.

[00:10:10]>> Yes. Yes.

[00:10:11]>> Is there anything that can be done to mitigate some of those side effects?

[00:10:16]>> Absolutely. So the main side effect is a rash. Um it is it happens to most people. Uh they grade the rash as grade one, grade two or grade three. Grade two means that you have to take some medicines for it. Grade one is doesn't bother you at all. grade three is pretty bad and um the the rash that you were seeing with with the senator was probably grade three. Um it also has to do with how much of the body is affected by the rash. The bottom line here is that the rash will happen, but if you get ahead of it with treatments, antibiotics, certain creams, then it's very it's pretty manageable um and um acceptable. Some patients don't get a rash, but the majority do.

[00:11:06]>> He described rashes so severe his skin was bleeding, intense nausea. Right.

[00:11:11]>> And his face felt, in his words, nuclear. That's right.

[00:11:14]>> Having said that, he still called it a miracle drug.

[00:11:18]>> Um, so uh uh so there are side effects.

[00:11:22]Um, and >> I mean I I think that unfortunately the public saw him at the beginning of his journey when he had the the rash and it there wasn't enough time to um treat it.

[00:11:36]So that if they interviewed him now, he probably has no rash. So, you know, um I I think that it is manageable for the most part. You just have to be very proactive with it. What about uh being able to apply this therapeutic approach to other cancers to other K Rass cancers because I know that's another thing people are super excited about.

[00:12:00]>> Exactly. So RAS is the biggest ankco gene in in cancer because there are ras mutations in pancreas, colurectyl, lung, um melanoma. uh so many cancers have ras mutations. So this is just one step into treating all of these other cancers because we can now target this pathway and we will see many clinical trials in the different cancers of of using kass directed drugs including derxon rasib and there are other drugs being developed. I >> was going to ask you are there other drugs that do the same thing? There are other drugs that target the pathway at different areas within the KAS pathway.

[00:12:47]So they're think of it as like a cascade. The top is Kass saying grow grow. So they're inhibiting at the top, but then the cancer cells get smart and they can resist it and they mutate and they change. So as they're mutating and changing, they're they may pick up a new mutation along the way. So we are able to find out what that new mutation is and sometimes that new mutation is targetable with a second drug. So we this pathway the fact that we are able to target it now is so beneficial for all of these other cancers because we can get into it and we can try to outsmart the cancer before the cancer outsmarts the person.

[00:13:37]>> Right. And it sounds like Kass is almost like the fertilizer that's helping the cancer grow.

[00:13:42]>> It is. It's a It's a mutation that's telling, you know, like a big >> sending messages saying grow grow. Yeah.

[00:13:49]>> Go forth and multiply.

[00:13:51]>> Exactly. Exactly. And it needs to be turned off. And until now, we weren't able to turn it off.

[00:13:57]>> Well, when do you think that this drug will be available as a first-line treatment? You're saying they're still doing clinical trials and you don't have the data yet, but it sounds so promising. Um, when do you think that the data will be there and it will be why why is it available?

[00:14:16]>> Um, this these trials acrew very fast because uh everyone wants has heard about it. It's it's the you know it's what everyone's talking about. Um there are um sources like you know with Let's Win where we have a clinical trial finder and people can get try to find spots on clinical trials that have that are offering this the first time someone's treated. Um I think that in the next year they will acrue to the study and then they'll get the data out pretty fast. It's going to acrue very fast but getting into how you can get it now. So, it is not FDA approved yet.

[00:14:59]Hopefully soon it will be. It is available on an expanded access program.

[00:15:05]What does that mean? Everyone asks me this about 10 times a day. You know, why can't you get it? Why can't you get it?

[00:15:10]And the reason why we can't get it is because it is a very um a process that requires a lot of signoffs. signoffs of our IRB, our research bureau, the FDA has to make sure that we're giving it to the patients that it's indicated for.

[00:15:30]Patients with second line uh treatment of pancreat metastatic pancreatic cancer >> have already gone through chemo.

[00:15:38]>> Exactly. So, we have to follow the rules and we have to apply to to the our research uh team and to the FDA to be able to become a site that can prescribe the medication. And right now at Cornell, we're we've submitted the paperwork to be able to prescribe it, but we're still waiting to get the the okay.

[00:16:01]>> But you say you think in possibly about a year if >> first line data.

[00:16:07]>> That's what I mean. baseline data. Now it's at now it could I guess it just depends what hospital you're at and what medical center and if they have been approved to administer it.

[00:16:20]>> Exactly. Exactly. So there Sloanketing um I heard that they're um able to um start giving it out soon to patients that fit the criteria. Um there are still clinical trials with it. Now regarding first-line therapy, you know, if a patient is not tolerant of chemotherapy in the first line and they need it they need to go on to another therapy, then then they're considered second line therapy. So essentially it there it may be used earlier by a prescribing physician if they feel that the treatment is indicated for that patient, you know.

[00:17:00]>> Yeah. You have to I mean >> talk to your doctor.

[00:17:04]>> Exactly. Talk to your doctor. I mean it it I I'm not going to say that no patient in the first line setting is ever going to get Deroxan Rasa. That that's not true. There will be patients that will get probably get it prescribed in the in the front line off of a clinical trial once it's once it's approved. But um it really is um a decision and a a process that you have to go through with your oncologist. Will this be covered by insurance?

[00:17:31]>> Yes, it will be. Um because it will become a new standard of care to treat second line pancreatic cancer.

[00:17:40]>> Well, it's unbelievably exciting. And do you know much about the scientists? I'd like to interview the scientists who discovered this drug because we have to celebrate these brilliant minds that are coming up with new approaches and extending life and uh you know hopefully even going further so these diseases can either be cured or at the very least treated as a chronic condition.

[00:18:09]Absolutely. Um yes there um revolution medicine and scientist uh Dr. Kavon Shokat at um out of UCSF was instrumental in discovering this drug.

[00:18:22]He I would want to speak to him. I would love to speak to him and and and find out like how did you discover this like you know how they discovered penicellin.

[00:18:32]Um, you know, it's it's it's it's so exciting and it means so much because we have had no good news in this disease for years and years and years. And the good news is that some approvals got approval got approved for a two week improve approve a two week improvement in overall survival. Two weeks.

[00:18:56]>> Yeah.

[00:18:56]>> So this is Yeah. We we really needed a breakthrough and this is a breakthrough because it's just the beginning. The drugs are going to get better and better. There are already other pathway inhibitors that we have on clinical trial here at Cornell um that are targeting the Kass gene uh G12D. They're targeting a gene down from the pathway that's called the mech gene mek gene. We have um a drug called abby metanib which is which they also presented data at asco um this year which was very intriguing. This is a mech a dual mech inhibitor that they gave patients in the first line of therapy and there and the median overall survival for this pill in the first line was 17.2 months.

[00:19:45]>> Wow.

[00:19:45]>> So you know and that's in a phase two study. So that's going on now to phase three. So we in the next year to two years, we're going to have so much more data and I think more options for patients. That's so exciting. And of course, I want them to keep going and and do even more for patients because 13 months is obviously an exciting uh change, but it's not good enough.

[00:20:13]>> It's not. It's not. And that's why that's why we're still working at it.

[00:20:17]And it's you're right. It's not good enough. But but now we can think in terms of some milestones like someone can can see get to that graduation or get to that prom or their daughter's prom or get to, you know, whatever it is that that they're living for. And and we also have to keep in mind that we want not only do we want to lengthen life, we want to improve quality of life, too.

[00:20:43]And that was another thing that they showed in the in the trial that that pain improved >> on the study that the time for pain getting worse lengthened and that that that's an important end point also that they they felt better and their pain went away.

[00:21:00]>> And the other thing I want you to work on Allison in your spare time when you're not saving lives and treating patients is a better diagnostic tool for pancreatic cancer. Part of the problem is pancreatic cancer is diagnosed when you're symptomatic. By the time you're symptomatic, the cancer is often advanced.

[00:21:18]>> So I know I'm part of a a program called preede. I get screened every month because of my sister and so is my my sister and my brother because of my sister Emily.

[00:21:31]>> And then I have a great uncle and an uncle later in life who are diagnosed.

[00:21:35]And somebody actually Karen Oshana who's one of my most loyal followers asked if pancreatic cancer is genetic. There is a genetic component but it can also be sporadic. In other words, you could be the beginning of your family history.

[00:21:49]Can you explain that for us and what people can do if they have any family history of this?

[00:21:56]>> Right. So about 10 to 15% of pancreatic cancer is considered genetic in that it's linked to a gene that we know about and those genes you have heard of the brocha gene the BRCA gene uh broa atm palb2 um lynch syndrome those genes are um the genes that are most um linked to hereditary pancreatic cancer. Outside of that, there's hereditary pancreatic cancer that's not affiliate or attached to a gene, meaning that you you have it in your family like you do. You get tested, you don't carry any genes. The person affected didn't carry any genes, but nonetheless, it happened in in in close relatives.

[00:22:45]>> But Dr. Ocean, can I interrupt and ask you?

[00:22:48]>> I mean, the fact of the matter is there could be a gene mutation that's just not discovered yet.

[00:22:54]>> Absolutely. That's what I was just going to say. You took the words right out of my mouth. Um, so, uh, that that's what it is. There is a gene. We just don't know it. And so, we do recommend that those people seek out a screening program if they can. And a lot of them have strict criteria unfortunately because, you know, you have to have this many relatives affected and they have to be this close to you. And but I tell my patients who don't have any family known family history or known gene that they should talk to their doctor their internist or their gastroenterenterologist about their family history and find out if they can be screened uh meaning an MRI that they can have done to at at certain time intervals and if something is seen on MRI then they can get an endoscopic ultrasound and and look further.

[00:23:50]Um, >> what about pelvic ultrasounds? Do you think that they're effective? And and >> ultrasounds are not great because the bowel gas obscures the area near the pancreas. So, they're not good ways to screen um for pancreatic cancer. Um, the Proceed Consortium is wonderful for those are for high-risk people. Um, there are many centers that are have joined Proceed. I'm working on getting Cornell to join Proceed. Um, and yeah, so I think that the people should know about that. Another thing that people need to know about is that late onset diabetes, the onset of diabetes later in life is a risk factor for pancreatic cancer.

[00:24:35]>> Are you saying type 2 diabetes?

[00:24:37]>> Type two diabetes, not type one, not insulin dependent. type 2 diabetes that that gets diagnosed later in life in their 50s to 60s.

[00:24:50]One out of 125 of those patients go on to develop pancreatic cancer. It's 1% of those. But think about that. That's a lot of people. So now efforts in early detection are looking into screening these patients that get diabetes and doing extra testing on them to see because it it could be that the cancer is causing the diabetes. So long-standing diabetes is a risk factor for pancreatic cancer. But when someone gets cancer, that affects the function of the pancreas and insulin is made in the pancreas and that's why pe people can get diabetes. Oh, that's so interesting. What do you think about some of these liquid biopsies or blood tests that show early stage um cancers?

[00:25:41]You know, everyone I talk to, Allison, they basically say >> they're not ready for prime time. And I'm curious how you feel about these blood tests.

[00:25:53]>> Um, it's hard for me to to detect every day. I mean, to uh uh separate um everyday tests from the tests I do all the time cuz I check them those tests like 25 times a day on on so many patients. So I I think, oh yes, everyone needs them. Um the you mean like the Grail test or the um the Avantec test?

[00:26:18]There's a new one that just came out too.

[00:26:20]>> They're promoting shield >> shield now. Yeah.

[00:26:23]>> But a lot of people are saying it's not as good as say a stool test, a stool based test for the we were talking about for colon >> and or a colonoscopy. Um, so I think a lot of people, the ACS just recommended the shield tests as kind of a last resort if you couldn't do any other tests, >> right?

[00:26:44]>> But, um, you know, I'm hoping that those will be >> I think they will be I think they they're going to be improved. The detection is going to be improved and and um we're getting more data. There's a lot of big population studies that h that h we're waiting on data about screening blood tests. So I think we're going to have a lot more options and the price of these tests will come down.

[00:27:09]>> I don't like to talk up too much because I don't want people to put off regular screening in the hopes that they can just get a blood test in the future. You know what I mean?

[00:27:19]>> Right. No, no, no, no. For I mean right now there's no official screening test for pancreatics. So, you know, if you have any symptoms of back pain, weight loss, yellowing of your eyes, like jaundice, um >> my sister was jaundist, uh and >> you know, they just didn't think that it would ever be pancreatic cancer.

[00:27:41]>> It's it's so scary. Um if you have any symptoms at all, um like that that I just mentioned, talk to your doctor and say, you know, I need to get a work up done. Um so for for pancreas there's no official screening test. Obviously for for colon cancer there is the colonoscopy and we're seeing younger and younger people getting diagnosed with colurectal cancer. So age 45 is the screening age for colonoscopy. But if you have any symptoms at all and you're even younger than 45 because we see this all the time. Please, please don't ignore them and go to your doctor and tell them that you have some blood in the stool or you have weight loss or pain with going to the bathroom or whatever it is. Go talk to your make these symptoms known. Don't be embarrassed. It really could save your life.

[00:28:32]>> Definitely. And I've been very very obsessed. Oops. Where did I Sorry.

[00:28:37]>> That's okay. I've just been very focused and obsessed with early onset cancers because, you know, and I I know you guys who watch me regularly. Where are you, Allison?

[00:28:47]>> I I'm here. Um I'm trying to um >> Oh, that's okay. 14 cancers and all are on the rise among young people and uh they really are trying to figure out why. I was just saying 14 cancers are on the rise among people under the age of 50. And uh one of those is colon cancer.

[00:29:05]and and and they're really trying lung cancer, non-smoking lung cancer is really increasing dramatically which is >> so upsetting. Um >> so upsetting >> but anyway before we go and my final question and thank you Allison so much for doing this and I know you're such a busy person but was there anything else you heard at ASCO that was exciting news?

[00:29:31]So um I was very laser focused on the pancreas data. Um uh the um so uh I there there were breakthroughs in prostate cancer in um a a very um rare but difficult to treat saroma called lipos saroma. They have a new drug that is a breast cancer drug that it's actually being that was shown showing promise and increased survival in this differentiated lipos saroma. there was um uh obviously the pancreas data and um and I'm sure there's so much more but that's okay put you on the spot and you're not a medical reporter so why would you know but um because obviously you're paying attention to your specialty >> but um thank you so much for coming in and the other quick thing I wanted to just tell everyone watching is that people need to get genetic testing I I Absolutely. I I really want more people to get genetic testing because it just arms you with more information that helps you determine sort of your screening schedule. What are some of the things you can be doing proactively, other lifestyle changes you can be making? Um, you know, I just uh I I feel like more people should do that and I think a lot of people are hesitant to to get genetic screening, but it can be potentially life-saving. Not only just the rocket gene, but these panels have gotten so much better. In fact, I need to get genetic testing again because new gene mutations are being discovered all the time and and and now it's it's not that expensive. It's just like the swab in your cheek, right? I mean, it's >> absolutely and and there are a lot of um advocacy organizations that have um genetic testing drives that will cover it. So, um, if in addition to getting the genic test testing done, what someone should do is if your doctor doesn't ask you about your family history, tell them about your family cancer history because that can trigger the doctor then to refer you for genetic testing. You should, every good doctor should take a really sound family history about what cancers and who got them, aunts, uncles, cousins, grandparents, because that's how we determine who's eligible for genetic testing. So, if we don't know that someone has a strong family history, we're not going to think that they need to be tested. So we we have to ask people their family cancer history so that we know if we should refer them for testing >> because Susan is saying it's so hard to get genetic testing covered and affordable. But if in fact Go ahead.

[00:32:26]>> Yeah. But it Yes. But if they have a certain amount of relatives that have cancers that it gets covered.

[00:32:36]>> And what about if you have no family history of cancer? Is that what Susan's referring to? That makes it really hard.

[00:32:43]>> That's that's hard and that's where um you know where it doesn't get covered and you have to pay out of pocket for it and um it it yeah it's expensive. Um but there again there are advocacy organizations that can help patients find genetic testing um and and get it covered or at least get get it um partially covered for them.

[00:33:08]>> Yeah. Well, I hope the costs will go down. Um, it says genetic testing costs range from $50 for simple ancestry or trait kits to over $2,000 for more complex diagnostic procedures. So, um, you know, I think in if when and if possible and if you can afford it and you can talk to your doctor and that doctor can recommend it, um, and ago it co it gets covered by insurance, right?

[00:33:36]It's something more and more people should take advantage of.

[00:33:40]>> Definitely. Uh right. Thank you for telling that to everybody because it's so so important and we sometimes when people are touched by cancer they feel so much loss of control and they can't they don't they feel like they have no they nothing is is that they can control. But this is something you can do before cancer happens and you can take be proactive and and look into your family history and seek out genetic testing.

[00:34:11]>> Well, Allison Ocean, Dr. Allison Ocean, thank you so much. You are so terrific and really did a great job of explaining all this stuff in very understandable terms. Someone is just writing. Hi Allison, Lisa Frame and Katie. Hi Lisa.

[00:34:28]Uh a and let's win is where you will find the clinical trial finder. Sorry.

[00:34:35]Um let's win is a terrific organization that raises research dollars for pancreatic cancer and I'm a big fan of theirs and of course of yours Allison.

[00:34:47]Again, thank you so much. I hope this was helpful to people because um >> you know I can't even pronounce the drug much less understand the science half the time. So I I >> Droxan Rasib Droxon Rasib is the name of of it. And Katie, I just want to tell you quickly that when I was um just finishing my fellowship here in 2004, I printed out your JAMAMA article about how you did your colonoscopy on national television and it translated to improve survival because it led people to get a colonoscopy. And this was and I this is before I even knew you and I printed it out because I wanted to take it to you and have you sign it because I was so amazed at I'm serious. It's the truth.

[00:35:37]Um yeah. So I I thank you.

[00:35:41]>> I hope you still have that JAMAMA article because I will gladly sign it for you.

[00:35:45]>> Good. Excellent.

[00:35:47]>> Anyway, >> thanks. Thank you for all you do, for so many patients, and I really appreciate.

[00:35:53]We all are grateful for your time and helping us understand this this really important and exciting breakthrough.

[00:36:00]>> Thank you, Katie.

[00:36:02]>> Love you.

[00:36:02]>> Take care. Bye. Love you, too. Bye. Hi Alison.