Dr. Amanda Nizam

But neuroendocrine is a completely different beast.

I think we all use chemotherapy in that.

But squamous, she's presented previously on data with EV alone and EV Pembro and squamous.

And we've had

some comparable responses to what we would see with the urothelial.

And then also the Memorial Sloan Kettering team also presented this similar data on EV pembro and variant histologies.

So overall, it does seem to be active.

There is a trial out of Emory that is looking at this EV pembro in patients specifically with variant histologies.

So we'll see what comes of that.

But certainly in the interim, in the absence of randomized data,

These large real-world registries will help us see how patients with these variant histologies do.

So I'm not using ctDNA in the metastatic setting to make treatment decisions.

It does help to kind of see what the treatment is doing and how the disease is responding.

But in terms of neuropathy, when I talk to my patients up front, I tell them, you will eventually get neuropathy from this drug.

It's a cumulative effect.

Usually, you know, median onset is about three months, but usually between three and six months is when we see the most.

We do not want patients to get to grade two neuropathy because that really impairs quality of life.

Patients can't button their shirts.

Sometimes they can have some gait instability.

We don't want patients to get there.