CClinicalTrials.gg
RecruitingNCT05040360Updated Dec 15, 2025

Testing the Use of Chemotherapy After Surgery for High-Risk Pancreatic Neuroendocrine Tumors

A Phase 2 interventional study of Capecitabine and Temozolomide in Metastatic Malignant Neoplasm in the Liver, Pancreatic Neuroendocrine Tumor and Stage I Pancreatic Neuroendocrine Tumor AJCC v8, sponsored by SWOG Cancer Research Network. Recruiting at 448 sites in 3 countries. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2025-12-15.

Sponsored by SWOG Cancer Research Network · Phase 2, Interventional, and Treatment

Phase
Phase 2
Study type
Interventional
Enrollment
141
Allocation
Randomized
Ages
18 Years and older
Sex
All
01

Study summary

This phase II trial studies the effect of capecitabine and temozolomide after surgery in treating patients with high-risk well-differentiated pancreatic neuroendocrine tumors. Chemotherapy drugs, such as capecitabine and temozolomide, work in different ways to stop the growth of tumor cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Giving capecitabine and temozolomide after surgery could prevent or delay the return of cancer in patients with high-risk well-differentiated pancreatic neuroendocrine tumors.

Read the detailed description

PRIMARY OBJECTIVE:

I. To evaluate recurrence-free survival (RFS) in participants with resected pancreatic neuroendocrine tumors (pNETs) randomized to treatment with capecitabine + temozolomide (CAPTEM) compared to observation only.

SECONDARY OBJECTIVES:

I. To evaluate overall survival (OS) in participants randomized to treatment with CAPTEM compared to observation only.

II. To evaluate the safety and tolerability of CAPTEM compared to observation only.

BANKING OBJECTIVE:

I. To bank specimens for future correlative studies.

OUTLINE: Patients are randomized to 1 of 2 arms.

ARM I: Patients receive capecitabine orally (PO) twice daily (BID) on days 1-14 and temozolomide PO once daily (QD) on days 10-14. Treatment repeats every 28 days for up to 4 cycles in the absence of disease progression or unacceptable toxicity.

ARM II: Patients undergo surveillance with no active treatment.

After completion of study treatment, patients are followed up every 6 months for 3 years and then annually until 5 years from randomization.

02

Conditions studied

  • Metastatic Malignant Neoplasm in the Liver
  • Pancreatic Neuroendocrine Tumor
  • Stage I Pancreatic Neuroendocrine Tumor AJCC v8
  • Stage II Pancreatic Neuroendocrine Tumor AJCC v8
  • Stage III Pancreatic Neuroendocrine Tumor AJCC v8

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03

Who can participate

Ages eligible
18 Years and older
Sexes eligible
All
Accepts healthy volunteers
No

Inclusion criteria

  • Participants must have a histologic diagnosis of well-differentiated pancreatic neuroendocrine tumor (pNET) that was resected between 14 and 120 days prior to registration. Participants must have a scan within 90 days prior to registration without evidence of metastatic disease. Acceptable scans are multiphase computed tomography (CT) abdomen, magnetic resonance imaging (MRI) with intravenous (IV) contrast of the abdomen, or positron emission tomography (PET)-CT DOTATATE imaging if the DOTATATE PET-CT included IV iodine contrast for the CT portion of the exam
  • Resection must have been an R0 or R1 per treating investigator's assessment and/or pathology report
  • Ki-67 testing, which is considered part of standard of care in the pathology report, must have been performed between 14 and 90 days prior to registration and the result must be >= 3% and =\< 55%. Treating investigators are encouraged to contact the S2104 Study Chairs and/or the study pathology chair with questions. If more than one Ki-67 is reported (e.g., primary tumor versus lymph node or metastatic site), the highest one should be considered for the study eligibility criteria
  • Participants with localized resected pNETS must have a Zaidi score of >= 3 derived by the following factors and points:

    • 1 point; symptomatic tumor defined as one of the following:

      • Gastrointestinal bleed
      • Jaundice
      • Gastrointestinal obstruction
      • Pain from primary tumor prior to surgical resection
      • Pancreatitis
    • 2 points; primary pancreas tumor size > 2 cm
    • 1 point; Ki-67 3% to 20%
    • 1 point; lymph node positivity = 1
    • 6 points; Ki-67 21% to 55%
  • Participants may have received resection/ablation of liver oligo-metastatic disease (up to 5 liver metastases) at the time of well-differentiated pNET resection
  • Participants must have recovered from effects of surgery as determined by the treating investigator
  • Participants must be >= 18 years old
  • Participants must have Zubrod performance status of 0-2
  • Participants must have a complete medical history and physical exam within 28 days prior to registration
  • Leukocytes >= 3 x 10\^3/uL (within 28 days prior to registration)
  • Absolute neutrophil count >= 1.5 x 10\^3/uL (within 28 days prior to registration)
  • Platelets >= 100 x 10\^3/uL (within 28 days prior to registration)
  • Total bilirubin =\< institutional upper limit of normal (ULN) unless history of Gilbert's disease. Participants with history of Gilbert's disease must have total bilirubin =\< 5 x institutional ULN (within 28 days prior to registration)
  • Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) =\< 3 x institutional ULN (within 28 days prior to registration)
  • Serum creatinine =\< 1.5 x institutional ULN (within 28 days prior to registration)
  • Calculated creatinine clearance >= 50 ml/min (within 28 days prior to registration)
  • Participants must be able to swallow pills
  • Participants must be able to tolerate CT or magnetic resonance (MR) imaging including contrast agents as required for their treatment and the protocol
  • No other active malignancy or history of prior malignancy is allowed, except for the following: adequately treated basal cell or squamous cell skin cancer, in situ cervical cancer, adequately treated stage I or II cancer from which the participant is currently in complete remission, or any other cancer from which the participant has been disease free for two years
  • Participants must be informed of the investigational nature of this study and must sign and give informed consent in accordance with institutional and federal guidelines

Exclusion criteria

Exclusion Criteria:

  • Participants must not have unresected or unablated metastatic disease
  • Participants must not have clinically apparent central nervous system metastases or carcinomatous meningitis
  • Participants must not have received prior neoadjuvant therapy for treatment of pancreatic neuroendocrine tumor. Use of somatostatin analogs prior to surgery is permitted
  • Participants must not have received somatostatin analogs after surgery
  • Participants must not be planning to receive warfarin while on protocol treatment. Other anticoagulants are allowed
  • Participants must not have history of allergic reactions attributed to compounds of similar chemical or biologic composition to temozolomide or capecitabine
  • Participants must not have known absorption issues that would limit the ability to absorb study agents
  • Participants must not have had an arterial thromboembolic event, unstable angina, or myocardial infarction within 12 months prior to registration
  • Participants must not have active or uncontrolled infection
  • Participants must not have serious medical or psychiatric illness that could affect study participation in the judgement of the treating investigator
  • Participants must not be pregnant due to the possibility of harm to the fetus. Individuals who are of reproductive potential must have agreed to use an effective contraceptive method with details provided as a part of the consent process. A person who has had menses at any time in the preceding 12 consecutive months or who has semen likely to contain sperm is considered to be of "reproductive potential." In addition to routine contraceptive methods, "effective contraception" also includes refraining from sexual activity that might result in pregnancy and surgery intended to prevent pregnancy (or with a side-effect of pregnancy prevention) including hysterectomy, bilateral oophorectomy, bilateral tubal ligation/occlusion, and vasectomy with testing showing no sperm in the semen
04

Study design

Phase
Phase 2
Primary purpose
Treatment
Allocation
Randomized
Intervention model
Parallel assignment
Masking
None (open label)
Enrollment
141 participants (estimated)

Study arms

  • Experimental
    Arm I (capecitabine, temozolomide)

    Patients receive capecitabine PO BID on days 1-14 and temozolomide PO once QD on days 10-14. Treatment repeats every 28 days for up to 4 cycles in the absence of disease progression or unacceptable toxicity.

    Drug: Capecitabine · Drug: Temozolomide

  • No intervention
    Arm II (surveillance)

    Patients undergo surveillance with no active treatment.

Interventions

  • DrugCapecitabine

    Given PO

    Also known as: Ro 09-1978/000, Xeloda

  • DrugTemozolomide

    Given PO

    Also known as: CCRG-81045, Imidazo[5,1-d]-1,2,3,5-tetrazine-8-carboxamide, 3, 4-dihydro-3-methyl-4-oxo-, M & B 39831, M and B 39831, Methazolastone, RP-46161, SCH 52365, Temcad, Temodal, Temodar, Temomedac, TMZ

05

What researchers measure

Primary outcomes

  1. Recurrence-free survival (RFS)

    Distribution of RFS in each arm will be estimated using the method of Kaplan-Meier and compared using the stratified log rank test.

    Time frame: From date of randomization to progression/recurrence or death from any cause, assessed up to 5 years

Secondary outcomes

  1. Overall survival (OS)

    Distribution of OS in each arm will be estimated using the method of Kaplan-Meier and compared using the stratified log rank test.

    Time frame: From date of registration to date of death due to any cause, assessed up to 5 years

  2. Incidence of adverse events

    Evaluated using National Cancer Institute Common Terminology Criteria for Adverse Events version 5.0.

    Time frame: Up to 30 days after completion of treatment

06

Study locations

381 of 448 sites recruiting
  • Anchorage Associates in Radiation Medicine
    Anchorage, Alaska 98508, United States
    Recruiting
  • Anchorage Radiation Therapy Center
    Anchorage, Alaska 99504, United States
    Suspended
  • Alaska Breast Care and Surgery LLC
    Anchorage, Alaska 99508, United States
    Recruiting
  • Alaska Oncology and Hematology LLC
    Anchorage, Alaska 99508, United States
    Recruiting
  • Alaska Women's Cancer Care
    Anchorage, Alaska 99508, United States
    Recruiting
  • Anchorage Oncology Centre
    Anchorage, Alaska 99508, United States
    Suspended
  • Katmai Oncology Group
    Anchorage, Alaska 99508, United States
    Recruiting
  • Providence Alaska Medical Center
    Anchorage, Alaska 99508, United States
    Recruiting
  • Fairbanks Memorial Hospital
    Fairbanks, Alaska 99701, United States
    Active, not recruiting
  • Banner MD Anderson Cancer Center
    Gilbert, Arizona 85234, United States
    • Site Public Contact · Contact · 602-747-9738
    • Zachary Yeung · Principal investigator
    Recruiting
  • Kingman Regional Medical Center
    Kingman, Arizona 86401, United States
    • Site Public Contact · Contact · research@sncrf.org · 702-384-0013
    • John A. Ellerton · Principal investigator
    Recruiting
  • Cancer Center at Saint Joseph's
    Phoenix, Arizona 85004, United States
    Recruiting
  • Mayo Clinic Hospital in Arizona
    Phoenix, Arizona 85054, United States
    • Site Public Contact · Contact · 855-776-0015
    • Timothy J. Hobday · Principal investigator
    Recruiting
  • Banner University Medical Center - Tucson
    Tucson, Arizona 85719, United States
    Recruiting
  • University of Arizona Cancer Center-North Campus
    Tucson, Arizona 85719, United States
    Recruiting
  • Mercy Hospital Fort Smith
    Fort Smith, Arkansas 72903, United States
    • Site Public Contact · Contact · 800-378-9373
    • Jay W. Carlson · Principal investigator
    Recruiting
  • CARTI Cancer Center
    Little Rock, Arkansas 72205, United States
    • Site Public Contact · Contact · Research@CARTI.com · 501-906-4199
    • Jay W. Carlson · Principal investigator
    Recruiting
  • Mission Hope Medical Oncology - Arroyo Grande
    Arroyo Grande, California 93420, United States
    Recruiting
  • PCR Oncology
    Arroyo Grande, California 93420, United States
    • Site Public Contact · Contact · research@sncrf.org · 702-384-0013
    • John A. Ellerton · Principal investigator
    Recruiting
  • Tower Cancer Research Foundation
    Beverly Hills, California 90211, United States
    Recruiting
  • Keck Medicine of USC Buena Park
    Buena Park, California 90621, United States
    • Site Public Contact · Contact · 714-522-0908
    • Syma Iqbal · Principal investigator
    Recruiting
  • Providence Saint Joseph Medical Center/Disney Family Cancer Center
    Burbank, California 91505, United States
    Recruiting
  • Mercy Cancer Center - Carmichael
    Carmichael, California 95608, United States
    Recruiting
  • Mercy San Juan Medical Center
    Carmichael, California 95608, United States
    Recruiting
  • Epic Care-Dublin
    Dublin, California 94568, United States
    Active, not recruiting
  • Mercy Cancer Center - Elk Grove
    Elk Grove, California 95758, United States
    Recruiting
  • Bay Area Breast Surgeons Inc
    Emeryville, California 94608, United States
    Active, not recruiting
  • Epic Care Partners in Cancer Care
    Emeryville, California 94608, United States
    Active, not recruiting
  • Keck Medicine of USC Huntington Beach
    Huntington Beach, California 92648, United States
    Recruiting
  • UCI Health - Chao Family Comprehensive Cancer Center and Ambulatory Care
    Irvine, California 92612, United States
    • Site Public Contact · Contact · ucstudy@uci.edu · 877-827-8839
    • Jennifer B. Valerin · Principal investigator
    Recruiting
  • Keck Medicine of USC Koreatown
    Los Angeles, California 90020, United States
    • Site Public Contact · Contact · 213-388-0908
    • Syma Iqbal · Principal investigator
    Recruiting
  • Los Angeles General Medical Center
    Los Angeles, California 90033, United States
    Recruiting
  • USC / Norris Comprehensive Cancer Center
    Los Angeles, California 90033, United States
    • Site Public Contact · Contact · 323-865-0451
    • Syma Iqbal · Principal investigator
    Recruiting
  • Cedars Sinai Medical Center
    Los Angeles, California 90048, United States
    • Site Public Contact · Contact · 310-423-8965
    • Andrew E. Hendifar · Principal investigator
    Recruiting
  • Contra Costa Regional Medical Center
    Martinez, California 94553-3156, United States
    Active, not recruiting
  • Mercy Cancer Center
    Merced, California 95340, United States
    Recruiting
  • Providence Queen of The Valley
    Napa, California 94558, United States
    • Site Public Contact · Contact · 707-521-3830
    • Charles W. Drescher · Principal investigator
    Recruiting
  • USC Norris Oncology/Hematology-Newport Beach
    Newport Beach, California 92663, United States
    • Site Public Contact · Contact · 323-865-0451
    • Syma Iqbal · Principal investigator
    Recruiting
  • Bay Area Tumor Institute
    Oakland, California 94609, United States
    Active, not recruiting
  • UC Irvine Health/Chao Family Comprehensive Cancer Center
    Orange, California 92868, United States
    • Site Public Contact · Contact · ucstudy@uci.edu · 877-827-8839
    • Jennifer B. Valerin · Principal investigator
    Recruiting
  • Keck Medical Center of USC Pasadena
    Pasadena, California 91105, United States
    • Site Public Contact · Contact · 323-865-0451
    • Syma Iqbal · Principal investigator
    Recruiting
  • Mercy Cancer Center - Rocklin
    Rocklin, California 95765, United States
    Recruiting
  • Mercy Cancer Center - Sacramento
    Sacramento, California 95816, United States
    Recruiting
  • Pacific Central Coast Health Center-San Luis Obispo
    San Luis Obispo, California 93401, United States
    Recruiting
  • Mission Hope Medical Oncology - Santa Maria
    Santa Maria, California 93444, United States
    Recruiting
  • Providence Medical Foundation - Santa Rosa
    Santa Rosa, California 95403, United States
    • Site Public Contact · Contact · 707-521-3830
    • Charles W. Drescher · Principal investigator
    Recruiting
  • Providence Santa Rosa Memorial Hospital
    Santa Rosa, California 95405, United States
    • Site Public Contact · Contact · 707-521-3830
    • Charles W. Drescher · Principal investigator
    Recruiting
  • Saint Joseph's Medical Center
    Stockton, California 95204, United States
    • Site Public Contact · Contact · 209-461-5257
    • Shahzad Siddique · Principal investigator
    Recruiting
  • Torrance Memorial Physician Network - Cancer Care
    Torrance, California 90505, United States
    Recruiting
  • Epic Care Cyberknife Center
    Walnut Creek, California 94597, United States
    Active, not recruiting
  • BASS Medical Group - Lennon
    Walnut Creek, California 94598, United States
    Active, not recruiting
  • Woodland Memorial Hospital
    Woodland, California 95695, United States
    Recruiting
  • Rocky Mountain Cancer Centers-Aurora
    Aurora, Colorado 80012, United States
    Active, not recruiting
  • Boulder Community Foothills Hospital
    Boulder, Colorado 80303, United States
    Active, not recruiting
  • Rocky Mountain Cancer Centers-Boulder
    Boulder, Colorado 80304, United States
    Active, not recruiting
  • Rocky Mountain Cancer Centers - Centennial
    Centennial, Colorado 80112, United States
    Active, not recruiting
  • Penrose-Saint Francis Healthcare
    Colorado Springs, Colorado 80907, United States
    Recruiting
  • Rocky Mountain Cancer Centers-Penrose
    Colorado Springs, Colorado 80907, United States
    Recruiting
  • Saint Francis Cancer Center
    Colorado Springs, Colorado 80923, United States
    Recruiting
  • Cancer Center of Colorado at Sloan's Lake
    Denver, Colorado 80204, United States
    • Site Public Contact · Contact · 303-777-2663
    • Patrick W. Cobb · Principal investigator
    Recruiting
  • National Jewish Health-Main Campus
    Denver, Colorado 80206, United States
    Recruiting
  • The Women's Imaging Center
    Denver, Colorado 80209, United States
    Active, not recruiting
  • AdventHealth Porter
    Denver, Colorado 80210, United States
    Suspended
  • Colorado Blood Cancer Institute
    Denver, Colorado 80218, United States
    Active, not recruiting
  • Presbyterian - Saint Lukes Medical Center - Health One
    Denver, Colorado 80218, United States
    Active, not recruiting
  • Rocky Mountain Cancer Centers-Midtown
    Denver, Colorado 80218, United States
    Active, not recruiting
  • Saint Joseph Hospital - Cancer Centers of Colorado
    Denver, Colorado 80218, United States
    • Site Public Contact · Contact · 303-318-3413
    • Patrick W. Cobb · Principal investigator
    Recruiting
  • Rocky Mountain Cancer Centers-Rose
    Denver, Colorado 80220, United States
    Active, not recruiting
  • CommonSpirit Cancer Center Mercy
    Durango, Colorado 81301, United States
    Recruiting
  • Mercy Medical Center
    Durango, Colorado 81301, United States
    Recruiting
  • Mountain Blue Cancer Care Center - Swedish
    Englewood, Colorado 80113, United States
    Active, not recruiting
  • Rocky Mountain Cancer Centers - Swedish
    Englewood, Colorado 80113, United States
    Active, not recruiting
  • The Melanoma and Skin Cancer Institute
    Englewood, Colorado 80113, United States
    Active, not recruiting
  • National Jewish Health-Western Hematology Oncology
    Golden, Colorado 80401, United States
    Recruiting
  • Saint Mary's Hospital and Regional Medical Center
    Grand Junction, Colorado 81501, United States
    Recruiting
  • Good Samaritan Hospital - Cancer Centers of Colorado
    Lafayette, Colorado 80026, United States
    Recruiting
  • Rocky Mountain Cancer Centers-Lakewood
    Lakewood, Colorado 80228, United States
    Active, not recruiting
  • Saint Anthony Hospital
    Lakewood, Colorado 80228, United States
    Recruiting
  • Rocky Mountain Cancer Centers-Littleton
    Littleton, Colorado 80120, United States
    Active, not recruiting
  • AdventHealth Littleton
    Littleton, Colorado 80122, United States
    Suspended
  • Rocky Mountain Cancer Centers-Sky Ridge
    Lone Tree, Colorado 80124, United States
    Active, not recruiting
  • Longmont United Hospital
    Longmont, Colorado 80501, United States
    Recruiting
  • Rocky Mountain Cancer Centers-Longmont
    Longmont, Colorado 80501, United States
    Active, not recruiting
  • AdventHealth Parker
    Parker, Colorado 80138, United States
    Suspended
  • Saint Mary Corwin Medical Center
    Pueblo, Colorado 81004, United States
    Recruiting
  • National Jewish Health-Northern Hematology Oncology
    Thornton, Colorado 80260, United States
    Recruiting
  • Rocky Mountain Cancer Centers-Thornton
    Thornton, Colorado 80260, United States
    Active, not recruiting
  • Saint Anthony North Hospital
    Westminster, Colorado 80023, United States
    Recruiting
  • Intermountain Health Lutheran Hospital
    Wheat Ridge, Colorado 80401, United States
    Recruiting
  • Smilow Cancer Hospital-Derby Care Center
    Derby, Connecticut 06418, United States
    • Site Public Contact · Contact · canceranswers@yale.edu · 203-785-5702
    • Pamela L. Kunz · Principal investigator
    Recruiting
  • Smilow Cancer Hospital Care Center-Fairfield
    Fairfield, Connecticut 06824, United States
    • Site Public Contact · Contact · canceranswers@yale.edu · 203-785-5702
    • Pamela L. Kunz · Principal investigator
    Recruiting
  • Smilow Cancer Hospital Care Center at Glastonbury
    Glastonbury, Connecticut 06033, United States
    • Site Public Contact · Contact · canceranswers@yale.edu · 203-785-5702
    • Pamela L. Kunz · Principal investigator
    Recruiting
  • Smilow Cancer Hospital Care Center at Greenwich
    Greenwich, Connecticut 06830, United States
    • Site Public Contact · Contact · canceranswers@yale.edu · 203-785-5702
    • Pamela L. Kunz · Principal investigator
    Recruiting
  • Smilow Cancer Hospital Care Center - Guilford
    Guilford, Connecticut 06437, United States
    • Site Public Contact · Contact · canceranswers@yale.edu · 203-785-5702
    • Pamela L. Kunz · Principal investigator
    Recruiting
  • Smilow Cancer Hospital Care Center at Saint Francis
    Hartford, Connecticut 06105, United States
    • Site Public Contact · Contact · canceranswers@yale.edu · 203-785-5702
    • Pamela L. Kunz · Principal investigator
    Recruiting
  • Yale University
    New Haven, Connecticut 06520, United States
    • Site Public Contact · Contact · canceranswers@yale.edu · 203-785-5702
    • Pamela L. Kunz · Principal investigator
    Recruiting
  • Yale-New Haven Hospital North Haven Medical Center
    North Haven, Connecticut 06473, United States
    • Site Public Contact · Contact · canceranswers@yale.edu · 203-785-5702
    • Pamela L. Kunz · Principal investigator
    Recruiting
  • Smilow Cancer Hospital-Orange Care Center
    Orange, Connecticut 06477, United States
    • Site Public Contact · Contact · canceranswers@yale.edu · 203-785-5702
    • Pamela L. Kunz · Principal investigator
    Recruiting
  • Smilow Cancer Hospital-Torrington Care Center
    Torrington, Connecticut 06790, United States
    • Site Public Contact · Contact · canceranswers@yale.edu · 203-785-5702
    • Pamela L. Kunz · Principal investigator
    Recruiting
  • Smilow Cancer Hospital Care Center-Trumbull
    Trumbull, Connecticut 06611, United States
    • Site Public Contact · Contact · canceranswers@yale.edu · 203-785-5702
    • Pamela L. Kunz · Principal investigator
    Recruiting

Showing the first 100 of 448 sites across 3 countries.

07

Registry details

Key details

Study ID
NCT05040360
Lead sponsor
SWOG Cancer Research Network
Collaborators
National Cancer Institute (NCI)
Responsible party
Sponsor
First posted
Sep 10, 2021
Start date
May 5, 2022
Primary completion
Mar 31, 2027 (estimated)
Completion
Mar 31, 2027 (estimated)
Last update
Dec 15, 2025

Study contacts

Heloisa P Soares
principal investigator · SWOG Cancer Research Network

Oversight

Data monitoring committee
Yes
FDA-regulated drug
Yes
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

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