H药 汉斯状®食管鳞状细胞癌获批上市 消化道肿瘤免疫治疗新选择

发布时间:2023-09-25 内部来历于: 浏览量:

项目來源:复宏汉霖


202五年8月22日,上海市-复宏汉霖(2696.HK)发出,我司独立自主研发部门的创新发展抗PD-1单抗H药——汉斯状®(专用名:斯鲁利单抗针剂液)聯合含氟尿嘧啶类和铂类调理药物应用于PD-L1抗体阳性的无法做手术部分区域肺肉瘤朋友朋友肝转回/又复发或转回性食管鳞状血生殖细胞系癌(ESCC)的闽东南调理新自我调节环境症的美国上市登陆个人申请(NDA)刷出地区产品监察的管理局官方网站审批,为食管鳞癌的人保证了调理新抉择。之前,H药已应用调理微遥感卫星间距不相对稳定(MSI-H)物理瘤、鳞状非小血生殖细胞系肺肉瘤朋友朋友(sqNSCLC)和常见期小血生殖细胞系肺肉瘤朋友朋友(ES-SCLC)等三项自我调节环境症。复宏汉霖继续深化体制改革H药在肺肉瘤朋友朋友、吸收道肉瘤等这个领域的一定的差别化、多关键点空间布局,从而着力推进的人刷出极高受惠。




复宏汉霖副副总经理长兼执行力副副总经理张文杰

H药应用第4项融入症采用中药治疗食管鳞癌,图标着一款高产品质量抗PD-1单抗难堪治的消化不良不良道恶性肉瘤行业前沿技术带来了新盼望。自2023年7月应用纳斯达克上市一来,H药在临床试验实行中大范围谋福利消化不良不良道恶性肉瘤、非小细胞肺癌等行业前沿技术求美者,立足本职起不错的口碑网,并型成该品牌相互作用。以后,公司将立即展现H药资源优势和潜质,加速H药的市场扩展步调,为世界各国更加求美者带去可负担重的科技创新药剂。


复宏汉霖下达命令下达董事、腹黑总裁下达命令官、腹黑总裁兼腹黑总裁会计官朱俊



以监床标准为向导,复宏汉霖发展壮大癌肿抗体脱贫制疗教育领域,自动对焦癌肿突出病种,进1步推动H药多瘤种平面布置,多方面发展其在世界上依据同时组织开展的各项抗体协同手术治疗方案冲击试验。旨在H药应用食管鳞癌,进1步安全验证了H药的制疗潜力股,更加充分显现复宏汉霖的研究开发去创新能力。期许H药末来其他多方面监床但是的生产,进1步做出贡献更宽泛的肝癌病患。


 H药食管鳞癌Ⅲ期临床研究主要研究者、中华医学界物理员工淋巴肿瘤卫生院黄镜老师



食管鳞癌为食管癌中最为常见的病理类型,临床需求较大且总体预后相对较差。斯鲁利单抗围绕不能手术切除的局部晚期或转移性食管鳞癌开展了一项Ⅲ期临床研究(ASTRUM-007)并取得优异结果,该研究基于大样本量的本土人群数据,充分确证了斯鲁利单抗联合化疗一线治疗局部晚期/转移性、PD-L1阳性(PD-L1 CPS≥1)食管鳞癌患者,能够带来PFS、OS的显著获益,期待其在临床实践中惠及更多患者。

聚焦临床迫切需求,凝心打造优质选择

食管癌是全球第六大癌症死亡原因,也是我国的高发恶性肿瘤。统计显示,中国食管癌发病率和死亡率分别位列恶性肿瘤的第六和第四位,其中食管鳞癌为最常见的病理类型,约占中国所有食管癌病例的85.79%[1]。由于早期症状不明显,在我国约70%的患者确诊时已为局部晚期或转移性食管鳞癌,失去了手术治疗机会[2]。近年来,多项研究表明抗PD-1单抗联合化疗可为食管癌患者带来生存获益,免疫检查点抑制剂联合化疗已成为我国食管癌的一线治疗标准[3]


此次获批主要基于一项随机、双盲、多中心的Ⅲ期临床研究(ASTRUM-007),旨在研究斯鲁利单抗对比安慰剂联合化疗(顺铂+5-FU)在既往未接受治疗、PD-L1阳性(PD-L1 CPS≥1)的晚期食管鳞癌患者中的疗效和安全性。根据全世界知名品牌学术界论文期刊Nature Medicine发表的ASTRUM-007临床研究结果显示,斯鲁利单抗联合化疗带来了总生存期(OS)和无进展生存期(PFS)的全面生存获益,并具备良好的安全性。值得注意的是,PD-L1高表达人群接受斯鲁利单抗联合化疗较意向性治疗(ITT)人群具有更大生存获益,在针对PD-L1 CPS≥10人群的分析中,斯鲁利单抗联合化疗组的中位OS长达18.6个月,较对照组绝对延长4.7个月,死亡风险降低41%。目前,ASTRUM-007调查技术成果已依次面世于2022 ESMO Asia大会、2023 ASCO大会等国家科研会仪,得到国外学界界层面认定。

多瘤种布局大癌种覆盖,致力惠及全球患者

紧扣H药,机构整合肺癌患者与消化吸收道肉瘤两种癌种,积极态度加快推进H药与机构任何新产品的协同作战已经与创新发展中医疗法的联和,于世界各国同样抓好10多项恶性肿瘤免疫抗体联席治疗方式临床护理冲击试验,累记到组逾3600名受试者,國際化的药学分析资料还有机会为环球申办展示强有力的支撑着。对应消化不良道肺部肿瘤,H药已获准MSI-H实体线瘤适用于症,可称MSI-H高发期的结结肠癌和直肠癌等人群带去开展想要。直接,该药在食道癌新辅助软件制作/辅助软件制作等方面已进行Ⅲ期临床实践探析,还有机会使食道癌人群在前线便从肉瘤免疫检测治疗方案中收益。肺肿瘤方向,H药已新批sqNSCLC和ES-SCLC两种适于症,并变为全球最大第一个新批标杆城市控制小内部系肺肿瘤(SCLC)的抗PD-1单抗,我司亦工作方案于2023-5年下一段时间就H药标杆城市控制非鳞状非小内部系肺肿瘤(nsNSCLC)在全球提交推出学生申请。与此并且,H药根治SCLC接连得到了英国食品饮料制剂监查工作菅理局官方网站(FDA)和法国共同体理事会会(EC)给予的弃儿药执证认定书,该药不错根治ES-SCLC的法国共同体推出经营许可资料申请办理(MAA)己经202两年12月得到法国制剂工作菅理局官方网站(EMA)授理,现已于202四年上一年后得到获得许可。复宏汉霖亦在英国开启好几回项H药对照一二线标准单位疗法阿替利珠单抗在ES-SCLC的头对头桥接实验设计,预计于2025年在英国出具挂牌上市可证请求(BLA)。除此以外,复宏汉霖还稳中求进统筹推进H药仅限期小生殖细胞肺肿瘤(LS-SCLC)的国际多重心Ⅲ期临床探究探究。


商用扩展层面,复宏汉霖真对H药去了预测分析性的布置图,并保持维度空间、多业务完善该物品的可及性,直到近年,H药已造福逾3.六万名国我们,并在国镜内搞定29个地域的中标挂网,也,已进行南京市、苏州市、杭州市、珠海市、山东省、山东回族村民自治县等36省/市里订制型商用食用医疗机构安全列表。真对国内外整个领域,复宏汉霖与KGbio于2018年促成合作的,颁授其H药首支单药治疗及两种联和治疗在东西南亚地区划分10个部委独门联合开发和商用化的财产权;202两年11月,司加大力度骤就H药在东南亚北非位置12部委的独门商用化的财产权颁授KGbio。于此,司还颁授银河集团官网 医疗H药在新西兰整个领域的独门商用化的财产权,分工协作扩展H药的国内外整个领域布置图,专业专注履盖全世界更非常广泛的我们群体行为。
未来是什么,复宏汉霖将将延续的提升研产量全产链综和潜力,发展壮大优质中药医治与转成理论研究的中药医治风险管理体系,多方面体现H药医学交换价值,将延续定制良性肿瘤天然免疫中药医治新标杆企业,为全球性客户带去爱护与我希望。

关于H药 汉斯状®

H药 汉斯状®为重组人源化抗PD-1单抗注射液(通用名:斯鲁利单抗注射液),是全球首个获批一线治疗小细胞肺癌的抗PD-1单抗,目前已有4项适应症获批上市,1项适应症上市申请在欧盟获受理,10余项临床试验同步在全球开展。


2022年3月,H药正式获批上市,目前可用于治疗微卫星高度不稳定(MSI-H)实体瘤、鳞状非小细胞肺癌(sqNSCLC)、广泛期小细胞肺癌(ES-SCLC)及食管鳞状细胞癌(ESCC)。H药联合化疗一线治疗广泛期小细胞肺癌(ES-SCLC)的上市申请也获得欧盟EMA受理。聚焦肺癌和消化道肿瘤,复宏汉霖积极推进H药与公司其他产品的协同以及与创新疗法的联合,相继获得中国、美国、欧盟等国家及地区的临床试验许可,在全球同步开展10余项肿瘤免疫联合疗法临床试验。截至目前,H药已于中国、美国、土耳其、波兰、格鲁吉亚等国家和地区累计入组超3600人,其中2项国际多中心临床试验入组白人的比例超过30%,是拥有国际临床数据较多的抗PD-1单抗之一。H药的3项关键性临床研究结果分别发表于知名期刊《美国医学会杂志》(JAMA)、《自然-医学》(Nature Medicine)和British Journal of Cancer。此外,H药还荣获《CSCO 小细胞肺癌诊疗指南》、《CSCO 非小细胞肺癌诊疗指南》、《CSCO 食管癌诊疗指南》、《CSCO 结直肠癌诊疗指南》、《CSCO 免疫检查点抑制剂临床应用指南》和《中国食管癌放射治疗指南》等多部权威指南推荐,为肿瘤临床诊疗提供重要参考。海外方面,H药治疗SCLC也已获得美国FDA和欧盟EC的孤儿药资格认定,并在美国启动了一项H药对比一线标准治疗阿替利珠单抗用于ES-SCLC的头对头桥接试验。

关于复宏汉霖

复宏汉霖(2696.HK)是家世界上化的多元化海洋生物工程制品制药厂企业有限集团公司,全力于为全世界客户打造可的负担的高服务高质量海洋生物工程制品药,企业新食品遍及肺部肿瘤、自己本身免疫检测传染性重大疾病、皮肤科传染性重大疾病等行业领域,已在中意大利出现5款企业新食品,在世界上意大利出现1款企业新食品,19项转变症获准,二个意大利出现申报分离获意大利FDA和欧盟委员会委员会EMA立案。自206年集团公司设立起来,复宏汉霖已俊工一身化海洋生物工程制品制药厂企业服务手机平台,更高效率的及多元化的随时升级核心区意识引向科研开发、生產及业务营运全房产链。有限集团公司已构建不停的完善更高效率的的全世界多元化机构,按世界上非处方药生產服务高质量工作规范起来(GMP)条件使用生產和服务高质量监管,不停的压实一身化总合生產服务手机平台,在当中,东莞徐汇园区已荣获中和欧盟委员会委员会GMP注册,松江园区(一)也已荣获中GMP注册。


复宏汉霖前瞻性布局了一个多元化、高质量的产品管线,涵盖20多种创新单克隆抗体,并全面推进基于自有抗PD-1单抗H药 汉斯状®的肿瘤免疫联合疗法。继国内首个生物类似药汉利康®(利妥昔单抗)、中国首个自主研发的中欧双批单抗药物汉曲优®(曲妥珠单抗,欧洲商品名:Zercepac®,澳大利亚商品名:Tuzucip®和Trastucip®)、汉达远®(阿达木单抗)和汉贝泰®(贝伐珠单抗)相继获批上市,创新产品汉斯状®(斯鲁利单抗)已获批用于治疗微卫星高度不稳定(MSI-H)实体瘤、鳞状非小细胞肺癌、广泛期小细胞肺癌和食管鳞状细胞癌,并成为全球首个获批一线治疗小细胞肺癌的抗PD-1单抗。公司亦同步就16个产品在全球范围内开展30多项临床试验,对外授权全面覆盖欧美主流生物药市场和众多新兴市场。


Henlius' Novel Anti-PD-1 mAb HANSIZHUANG (Serplulimab) Approved for the Treatment of ESCC

Shanghai, China, Sep 22nd, 2023 – Shanghai Henlius Biotech, Inc. (2696. HK) announced that the new drug application (NDA) for new indication of HANSIZHUANG (serplulimab injection), an innovative anti-PD-1 monoclonal antibody independently developed by the company, in combination with drugs containing fluorouracil and platinum for the first-line treatment of patients with PD-L1 positive unresectable locally advanced/recurrent or metastatic esophageal squamous cell carcinoma (ESCC), has been approved by the National Medical Products Administration (the "NMPA"), providing a new treatment option for patients with ESCC. Up to date, HANSIZHUANG has been approved for the treatment of microsatellite instability-high (MSI-H) solid tumors, squamous non-small cell lung cancer (sqNSCLC), and extensive stage small cell lung cancer (ES-SCLC). To further benefit patients, Henlius continues to differentiate and optimize product portfolios and the roadmap of HANSIZHUANG in lung cancer, gastrointestinal cancer, and other cancers.


Wenjie Zhang, Chairman, and Executive Director of Henlius, remarked, "ESCC is the fourth approved indication of HANSIZHUANG and its approval signifies that this high-quality anti-PD-1 mAb offers a new ray of hope for the treatment of difficult-to-treat gastrointestinal cancer. Since it launched in March 2022, HANSIZHUANG has benefited a wide range of patients with lung cancer, gastrointestinal cancer, and other tumors, further solidifying its positive reputation with a strong brand effect. Moving forward, we will continue leveraging the strengths of HANSIZHUANG and fully tapping its potential to accelerate market expansion to provide affordable, innovative treatments to more patients worldwide."


Jason Zhu, Executive Director, Chief Executive Officer, President and Chief Financial Officer of Henlius, said, "Henlius is driven by unmet clinical needs and has devoted itself to precision immunotherapy for tumors. We are focusing on major cancer types, steadily expanding the clinical layout of HANSIZHUANG in multiple cancer types, and actively initiating immune combination therapy trials worldwide. The approval of ESCC further validates the potential of HANSIZHUANG and demonstrates the innovation capabilities of Henlius. We look forward to more positive study results of HANSIZHUANG to make further contributions to cancer treatment for more cancer patients."


Prof. Jing Huang, the leading principal investigator of ASTRUM-007, from Cancer Hospital Chinese Academy of Medical Sciences, said, "ESCC is the most common pathological type of esophageal cancer with high clinical demand and relatively poor overall prognosis. The phase 3 clinical study (ASTRUM-007) on serplulimab plus chemotherapy for unresectable locally advanced/metastatic esophageal cancer achieved promising results, which was conducted on a large sample of the local population and fully demonstrated that serplulimab in combination with chemotherapy as a first-line treatment for locally advanced/metastatic and PD-L1 positive (PD-L1 CPS≥1) esophageal cancer patients can significantly improve progression-free survival (PFS) and overall survival (OS). We are hoping that serplulimab will benefit more patients in clinical practice."

Providing a new solution for urgent clinical needs

Esophageal cancer is the sixth leading cause of cancer-related deaths worldwide as well as a prevalent malignant tumor in China. According to the data, the incidence and mortality of esophageal cancer rank sixth and fourth, respectively, among all malignant tumors in China, of which ESCC is the most common pathological type that accounts for about 85.79% of all esophageal cancer cases[1]. As the symptoms of early esophageal cancer are often subtle, about 70% of patients are diagnosed at mid-to-late stage, missing out on surgical treatment[2]. In recent years, many studies have shown that anti-PD-1 mAb combined with chemotherapy can bring survival benefits to patients with esophageal cancer. Up to date, immune checkpoint inhibitor combined with chemotherapy has become the standard first-line treatment for advanced esophageal cancer in China[3].


The approval was primarily based on ASTRUM-007, a randomized, double-blind, multicenter, phase 3 study aiming to compare the efficacy and safety of serplulimab versus placebo in combination with chemotherapy (5-FU + cisplatin) in patients with previously untreated, PD-L1–positive (PD-L1 CPS≥1), advanced ESCC. According to the study results published in the international leading journal Nature Medicine, serplulimab in combination with chemotherapy significantly improved progression-free survival (PFS) and overall survival (OS), its safety was also manageable. Notably, the PD-L1 high-expression group receiving serplulimab combined with chemotherapy gained a greater survival benefit comparing to the intention-to-treat (ITT) group, in the analysis of the group with PD-L1 CPS≥10, the combination of serplulimab and chemotherapy group had a median OS of 18.6 months, with an absolute extension of 4.7 months compared to the control group and a 41% reduction in the risk of death. The results of ASTRUM-007 have been released at many world-class conferences, such as the 2022 ESMO Asia Congress and the 2023 ASCO Annual Meeting, receiving high recognition from the international academic community.

Widening indication coverage for patients worldwide

Henlius focuses on lung and gastrointestinal cancer and promotes the synergy of HANSIZHUANG with innovative therapies, in which more than 10 clinical trials on immuno-oncology combination therapies have been initiated worldwide. As of now, the company has enrolled more than 3,600 subjects, and the global clinical research data will provide strong support for its NDAs in overseas markets. In terms of gastrointestinal cancer, HANSIZHUANG has been approved for the treatment of MSI-H solid tumours, which brings hope to patients with MSI-H colorectal cancer and MSI-H gastric cancer. Furthermore, HANSIZHUANG has led the way with a phase 3 clinical study on neoadjuvant/adjuvant therapies for gastric cancer, striving to benefit gastric cancer patients from the early line of immunotherapy. In the field of lung cancer, HANSIZHUANG has been approved for sqNSCLC and ES-SCLC, making it the world's first anti-PD-1 mAb for the first-line treatment of SCLC. The company also plans to submit a marketing application for HANSIZHUANG as a first-line treatment for non-squamous non-small cell lung cancer (nsNSCLC) in China in the second half of 2023. In addition, HANSIZHUANG was also granted orphan drug designations by the U.S. Food and Drug Administration (FDA) and European Commission (EC) for the treatment of SCLC, and its Marketing Authorization Application (MAA) for the first-line treatment of ES-SCLC was validated by the European Medicines Agency (EMA) in March 2023, with the expectation of approval in the first half of 2024. Henlius also lanuched a head-to-head bridging trial of HANSIZHUANG versus first-line standard-of-care atezolizumab for ES-SCLC in the U.S. and the company plans to submit a Biologics License Application (BLA) for HANSIZHUANG in the U.S. in 2024. Furthermore, Henlius is steadily advancing a global multi-center clinical research of HANSIZHUANG for the limited stage small cell lung cancer (LS-SCLC).


Henlius proactively promotes the commercialization of HANSIZHUANG to enhance its accessibility through multiple dimensions and channels. Up to date, HANSIZHUANG has benefited over 37,000 Chinese patients and has completed the tendering process on the procurement platform in 29 provinces in Chinese mainland and was included into the customized commercial medical insurance directory in 26 Provinces and cities such as Shanghai, Chengdu, Ningbo, Xiamen, Fujian, Ningxia Hui Autonomous Region, etc. For the overseas market, Henlius forged a partnership with Kalbe Genexine Biologics (KGbio) to grant it an exclusive license to develop and commercialize HANSIZHUANG in relation to its first monotherapy and two combination therapies in 10 Southeast Asian countries. In August 2023, the company further granted KGbio exclusive development and commercialization authorizations of HANSIZHUANG in 12 Middle East and North Africa (MENA) countries. In addition, Henlius entered into an exclusive license agreement with Fosun Pharma for the commercialization of HANSIZHUANG in the U.S., aiming to expand the overseas market layout of HANSIZHUANG and reach out to a wider range of global patients.


In the future, Henlius will continue to enhance its capabilities in innovation, manufacturing, and commercialization, dedicating its efforts to the development of a system for precision treatment and translational medicine research and maximizing the clinical value of HANSIZHUANG to set the pace in tumor immunotherapy to deliver warmth and hope to patients all over the globe.

【符合论文】

[1] Chen R, Zheng R, Zhang S, et al. Patterns and trends in esophageal cancer incidence and mortality in China: an analysis based on cancer registry data[J]. Journal of the National Cancer Center, 2023.

[2] 王天云, 张瑜, 徐泳, 卢铀, & 彭枫. (2018). 骨转移食管鳞癌爱美者四线化疗药功效及极限生存数据分析. 湖南省医疗癌症研究会老龄人肺部肿瘤医疗专委会再次次学术研究交流企业大会暨湖南省医疗癌症研究会医疗癌症药剂非常专业编委会会1次学术研究交流企业大会. 湖南省医疗癌症研究会.

[3] 食管癌诊治手册(2030年版). 国内的国家清洁卫生健康保健理事会会.

About HANSIZHUANG

HANSIZHUANG (recombinant humanized anti-PD-1 monoclonal antibody injection, generic name: serplulimab injection) is the first anti-PD-1 mAb for the first-line treatment of SCLC. Up to date, 4 indications are approved for marketing in China, 1 marketing application is under review in the EU, and more than 10 clinical trials are ongoing across the world.


HANSIZHUANG was launched in March 2022 and has been approved by the NMPA for the treatment of MSI-H solid tumours, squamous non-small cell lung cancer (sqNSCLC), extensive-stage small cell lung cancer (ES-SCLC), and esophageal squamous cell carcinoma (ESCC). Its marketing applications of the first-line treatment for ES-SCLC are under review by the EMA. Focusing on lung and gastrointestinal cancer, the synergy of HANSIZHUANG with in-house products of the company and innovative therapies are being actively promoted. It has successively obtained clinical trial approvals in China, the U.S., the EU and other countries and regions to initiate more than 10 clinical trials on immuno-oncology combination therapies in a wide variety of indications. As of now, the company has enrolled more than 3,600 subjects in China, the U.S., Turkey, Poland, Georgia and other countries and regions, and the proportion of White is over 30% in two MRCTs, making HANSIZHUANG an anti-PD-1 mAb with one of the largest global clinical data pools. The results of 3 pivotal trials of HANSIZHUANG were published in the Journal of the American Medical Association (JAMA)Nature Medicine and the British Journal of Cancer, respectively. Furthermore, HASIZHUANG was recommended by the CSCO Guidelines for Small Cell Lung Cancer, the CSCO Guidelines for Non-Small Cell Lung Cancer, the CSCO Guidelines for Esophageal Cancer, the CSCO Guidelines for Colorectal Cancer, the CSCO Clinical Practice Guidelines on Immune Checkpoint Inhibitor, the China Guidelines for Radiotherapy of Esophageal Cancer, and other definitive guides, providing valuable references for clinical diagnosis and treatment of tumours. On the other hand, serplulimab was granted orphan drug designations by the U.S. FDA and the EC for the treatment of SCLC, and its bridging head-to-head trial in the United States to compare HANSIZHUANG to standard of care atezolizumab (anti-PD-L1 mAb) for the first-line treatment of ES-SCLC is well under way.


About Henlius

Henlius (2696.HK) is a global biopharmaceutical company with the vision to offer high-quality, affordable, and innovative biologic medicines for patients worldwide with a focus on oncology, autoimmune diseases, and ophthalmic diseases. Up to date, 5 products have been launched in China, 1 has been approved for marketing in overseas markets, 19 indications are approved worldwide, and 2 marketing applications have been accepted for review in the U.S., and the EU, respectively. Since its inception in 2010, Henlius has built an integrated biopharmaceutical platform with core capabilities of high-efficiency and innovation embedded throughout the whole product life cycle including R&D, manufacturing and commercialization. It has established global innovation centers and Shanghai-based manufacturing facilities in line with global Good Manufacturing Practice (GMP), including Xuhui Plant certificated by China and the EU GMP and Songjiang First Plant certificated by China GMP.


Henlius has pro-actively built a diversified and high-quality product pipeline covering over 20 innovative monoclonal antibodies (mAbs) and has continued to explore immuno-oncology combination therapies with proprietary HANSIZHUANG (anti-PD-1 mAb) as backbone. Apart from the launched products HANLIKANG (rituximab), the first China-developed biosimilar, HANQUYOU (trastuzumab for injection, trade name in Europe: Zercepac®; trade names in Australia: Tuzucip® and Trastucip®), the first China-developed mAb biosimilar approved both in China and Europe, HANDAYUAN (adalimumab) and HANBEITAI (bevacizumab), the innovative product HANSIZHUANG has been approved by the NMPA for the treatment of MSI-H solid tumors, squamous non-small cell lung cancer (sqNSCLC) and extensive-stage small cell lung cancer (ES-SCLC), and esophageal squamous cell carcinoma (ESCC), making it the world's first anti-PD-1 mAb for the first-line treatment of SCLC. What's more, Henlius has conducted over 30 clinical studies for 16 products, expanding its presence in major markets as well as emerging markets.




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