Andrew Baum: Thank you, it’s Andrew Baum with Citi. Staying with in HER2. And PAM tumor trial. So you have HER2 low as part of that trial, and there’s been very clear signals and many malignancies that HER2 is active. And obviously, you have the manufacturing, it’s been derisked. So my question is, are you leaving money on the table by not seeking to expedite development for individual HER2 low indications because it looks like you’re not going to get approval per pan-tumor in HER2 low? So you’re going to need to set trials — there are competitors with HER2 assets, we’ve initiated trials in those HER2-low settings. So have you just left white space for a competitor to come in when you’ve got an asset that you could be monetizing in that setting? And then the second question is in relation to Truqap. I’m curious what you think of the enabolosib data? And how that’s going to impact the use of Truqap, given you’re hitting the same PI3K-AKT pathway?
Susan Galbraith : Yes. So for the white space question, when you got a brand like in HER2, which has really exceptional activity across. I think the philosophy is to make sure that we develop it to the maximum of its potential. So again, not everything that we’re planning to do is currently visible, but you’d expect to see other trials. So I do think that we can build on what we’ve actually seen with pan-tumor, and I think it creates a lot of opportunity there. So we intend to leave this little white space as possible.
Pascal Soriot: And in terms of the…
Susan Galbraith : You want to address the market size for this.
David Fredrickson: Yes, sure. I mean look, I think that what I would comment on most, Andrew, is that we’re seeing very positive receptivity to Truqap. We’ve seen strong uptake in terms of number of new patients that are being started on therapy. We’re actually hearing an awful lot of desire among the community to have seen a broader label based upon the data sets that were presented and what we’ve seen and obviously, within the context of the competitive landscape, the Truqap data will ultimately be looked at within that context, but I think it really is showing favorably within that context. And we anticipate that we’ll continue to have a strong launch for the medicine through the year and look forward to the additional life cycle readouts that we’re going to have on the heels of, obviously, the 291.
Susan Galbraith : So again, there are other opportunities, I would just say with capivasertib for combination, but also remember that treats a broader group of patients than just look at an alpha mutant group. You’ve got Pan you’ve got the AKT activation as well. There’s multiple ways in which it is different. But I think the first-line space is also something that is of interest.
David Fredrickson : Andrew, I mean, I think that the pace on this and maybe I skipped over because I thought it was kind of without saying, but Truqap is post CDK4/6 and the Invotas is not. So we are looking at different populations and different spots.
Susan Galbraith: It is a different population. So they’re taking into that first-line setting, fast progresses. So it’s not even if you take the same population that went into 291 and look at them in the first line, they don’t completely lack with the invoice patient population that’s clear.
Peter Welford: It’s Peter Welford with Jefferies. Two questions sticking to the norm. So first question is on the investor event on the 21st of May. I think it was called after it’s an R&D event. I guess curious, can you outline, is this going to be a de very much focused on the midterm pipeline? Or will you also be giving that 10-year vision? And if on that, is this going to be a 10-year vision setting another 10-year revenue aim? And I guess, what sort of granularity should we anticipate when we look forward to how you’re going to set the aim for the next period? And then the second 1 is on Airsupra. So you mentioned obviously that the 2023 was very much a year of building access, building awareness, building this. I guess curious now in 2024, the comment made, I think, was over time, we expect U.S. PCPs to change 50 years of habit.
I mean that sounds there’s still a lot of slog to go. So you just talk about how debate and discussions gone? Was that successful? Is the barrier now the doctors? Or should 2024 be a year where we got anything in the model? Or is this another year where we should be really thinking about the action set to come?
Pascal Soriot: So 2 great questions, Peter. Let me just cover the first 1 and Ruud, you could cover Airsupra. So the R&D Day, really what we want to do, as I explained earlier, is explain what our strategy is and why we think we can grow strongly over the next 10 years. So we are, of course, going to look at our midterm pipeline, but also we want to look at the investments we’re making in new technologies, new platforms, that will actually deliver growth from ’28, ’29 and beyond. So we actually give you a good understanding of not only the near term but also the midterm and the long term. As it relates to whether we’re going to set up a long-term revenue ambition we may, but we haven’t decided this. But I can tell you that we are very, very confident that we can actually grow very strongly over the next few years and work through some of the issues that have been mentioned by some, for instance, Medicare Part reform, we can work through that.
In the end, the impact of this is there, but it’s relatively limited. I hesitate to use the word margin, but it’s quite limited in the context of our global sales. So we can walk through this. We can work through the patent expiries that we have that are limited and continue to deliver very strong growth. And of course, it’s not going to be the same gross number every year. But if you look at it over the next 5 years and then 10 years, we suddenly can grow, and that’s what we actually want to hopefully convince you as we share our strategy and we’ll see whether we come up with a number or not.
Ruud Dobber : Yes. Let me first rearticulate, let’s say, the excitement we have regarding Airsupra. First of all, this is a very substantial market. In the United States alone, there are roughly 15 million to 18 million scripts only for cobiterol in the asthma 18s indication. Having said that, we started our journey in order to gain access last year. So the good news is, we have now formulary listings in 3 of the largest commercial PBMs. Based on the registration, we were just too late in order to get Part D. So we are bidding for Part D in the course of 2024. So hopefully, that will create more access moving forward. Many patients anyway are in commercial are younger patients. What we have seen in the first few weeks, it’s still very early days, is a very nice number of trialists already thousands of GPs, but also specialists are prescribing Airsupra.
Having said that, Axis is still, let’s say, an issue we are working through. So we need to buy down the scripts, the course per script quite substantially. So my clear star is we are off of a very strong start in the United States. But equally, of course, it will take time to get enough access in order to switch off the now conversion and hence, then the sales will follow. And it’s more or less the pattern we have seen with breast. You’ve seen in the announcement, Braceras growing over 70%. It’s on its way to become a blockbuster hopefully very soon. And I think we are expecting the same pattern also for Airsupra moving forward.
Pascal Soriot : I think really the important point, as Ruud said, is really to expect that this is not an oncology new indication that really addresses a big unmet need with a very fast sales ramp up. It’s more progressive. But the beauty of this kind of inhaled products is that when you are established, you have a very durable asset. I mean look at Symbicort, it’s been around for a long, long time. And it’s still out there and it’s still a very good product with good sales, very good profitability. So we have to have the resilience to get it to the right level, and then it will stay at a good level for a long time to come because there’s not a huge amount of competition, and there is a clear unmet need there.
Mark Purcell : Is Mark Purcell from Morgan Stanley. Two questions. The first 1 for Aradhana. I guess what some people have been concerned by this morning is the certain anticipated transactions part of your CR guidance, which you expect to increase substantially in 2024. I guess they’re triangulate that with a Part 1 selected moving forward. And the last time you move forward with a PARP inhibitor, you had a 1.6 billion up from milestone from a partner. So can you confirm that R&D as a potential revenue is still in the low 20s, I presume it is. But more importantly, could you give us some qualitative guidance on SG&A, which obviously stepped up a lot in Q4 and just where that will land for full year 2024. And then the second question is on your CKM [ph] syndrome pipeline.
I guess this is all about going after symptomatic diseases like obesity and reserved election heart failure to capture asthmatic diseases like CKD. So could you help us understand the opportunity here and the level of investment you’re going to put behind this combination of assets, this franchise — and then specifically on the Ecogen drug. We’re getting a lot of questions around manufacturing. If you can help us understand how many CMC steps this product has given that with Orphagen is estimated to be over 30% and therefore, incredibly difficult to scale. Thank you.
