This is certainly an interesting approval given that IIIA patients weren’t included in the trial. While we have yet to encroach this in practice, I think that this will be decided on a case-by-case basis. For example, I think that if you see a younger, healthier patient, oncologists are going to want to be more aggressive in the adjuvant setting. As with everything, it will end up being about weighing risks and benefits. I am happy that more patients than just those eligible for the trial can potentially benefit from this, but it certainly creates some gray areas!

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