Karyopharm Therapeutics Inc.

Q4 2021 Earnings Conference Call

1/11/2022

spk_0: good morning my name is like new the and i'll be a conference operate of today at this time i would like to welcome everyone to the carry farm three therapeutic fourth quarter and for your twenty twenty financial results conference call they'll be a question and answer session to follow please be advised that this call is being recorded at the company's request i would know like to turn the call or were to mister he and carp care your farm senior vice president in western public relations please go ahead
spk_1: there's so much of the you for joining us grave coffins ball to the south korea forms or quarter and four year twenty twenty been a result we didn't have the is is he a cart and i'm joined today by dr michael augment or to the doctor mister might make them chief financial officer john demaree to commercial officer doctor david shaw to medical off as or amateur stephen michener cheap in his officer on the other they might want to write an overview key recent corporate development and an update on a little progress and then migration will provide an oreo on the fourth quarter and for your twenty twenty financial results you conclude with a q and a portion of the call earlier this morning we issued a press release be joined caravans results with the fourth quarter employ your point one this release along with a slide presentation that no reference are available on our website that care reform but can't support begin to for comments are reminded that nurse from arsenal make today cause du pont looking statements for purposes of a safe harbor provisions under the private securities litigation or for not making as bad as outlined on slide three these it was davis better future expectations clinical development and regular format as a timeline the potential successor quality product candidates including our expectations related to the commercial lazy expo financial product projections and our plans prospects actual results may materially differ the not indicated by the been looking statements as a result of various important factors including us discussed in the respect or section of the most recent call report on flunked and que which is on fire with the ftc and and other finally that we may make with yes it's you have future and he voted tuesday has misrepresent our views as of today own when they like to update you spoke as big as at some point we specifically display many applications yourself never he's changed your of are you should not rely on his like a statement as representing our views as if any date subsequent to the day with that amount from the over michael common chief executive officer
spk_2: thank you in good morning everyone twenty twenty was a pivotal year a farm and i'm extremely proud of the significant progress our team has made towards that commercial clinical development and operational objectives with the ultimate goal of having positive impact the lives of patients battling cancer most notably or year is marked by to us ft a rules were expelled leo first in june for the treatment of patients with relapse to refracted if i beat alabama or deal be feel and then in late december once weekly expel the out received additional approval in combination with worked as an ebb and deck math his own for the treatment of adult patients with multiple myeloma have received at least one prior therapy we expect to carry the momentum of these important achievements in the twenty twenty one and i'm already started the air with several weeks and accomplishments as outline and side for expel the net product from the fourth quarter in full year of twenty twenty were twenty point two million and seventy six point two million respectively more than one hundred seventy and seven hundred new additions and accounts prescribe expel the over the first time in queue for and in twenty twenty overall respectively these achievements are particularly encouraging keeping in mind expel the oh it's only first approved for use by the ft a july twenty nineteen and of course for most of twenty twenty we've all been in power acted in some shape or form of the ongoing covered nineteenth academic expansion and launch of expel the l into the second and third line treatment settings significantly increases the address or patient population rates mobo represents a meaning growth opportunity for carry a farm in both a near and long term separately in december tradition of three expel the a treatment regimens from multiple myeloma to the national comprehensive sir networks clinical practice guidelines in oncology represented another key achievement that we believe will help further expand expand the as utilization for our pipeline progress we recently announced that the european medicines agencies committee for medicinal products for human use or see hmp adopted a positive opinion recommending a conditional google or next bob of the brand name for sonics or in europe in combination with eczema as on the treatment a mile alma an adult patients with heavily pre treated disease and indication nearly identical to the food indication that expo the we safe in the twenty nineteen accelerated approval issued by the ft a in the united states i will talk a bit more about are expecting step for europe and just a few minutes additionally we are excited to secure our first regulatory approval outside the united states in israel for both myeloma the a b c l which when was last week thirty now to either program updates from our ongoing human illogical in salads and were clinical studies our phase three see under study evaluating expel the of individual cancer past it landed room futility and upsizing analysis and we look forward to the top line results expected in the second half of this year in addition the first station in the face two three exploit the lbc i'll dash out three oh study of a way to expel the own patients would be a b c l has now been treated treated and this study will serve as a confirmatory study for expel the has accelerated approval in the a b c l granted last year finally on the financial promptly end of the quarter with a strong cast position of approximately two hundred seventy six point seven million dollars that along with expected future revenues we anticipate will be sufficient to find are planned operations into late twenties on a to let me now turn aside five provide additional details on expel the of sales performance to twenty twenty in the first three quarters of twenty twenty we generated steady increase sales for expel the out due to both unique attributes of expel the as was hard work of are dedicated commercial team net sales for the both a full year of twenty twenty well as for the fourth quarter specifically were largely driven by prescription the man from both academic community based on colleges for patients with tend to refractory multiple myeloma the five percent decrease in products as in the fourth quarter as compared to the third quarter with result of the impact from both a recent so urging us covered nineteen cases as well as some increased competition for pays more specifically as we turned aside six we believe the surgeon called the nineteen cases impacted both patient visits to their health care provider as well as in person access for carrier farms commercial team to it's initial customers additionally increase competition from recently launched drugs and penta refractory my loma and in refractory the lbc off that it's also contributed to some additional sales pressure in the quarter however we are seeing a meaningful rebounding demand and new pace starts in speaks bandit approval for the reinforcing our confidence in the future growth the tank or for expel the via as mentioned previously the addition of multiple expel the a combination regiments to the ncc and guidelines and expanded ft a approval of expel the oh provided strong talent for sales growth in december following declines in october and november we're still in a very early stages the launch of of go into the second and third line settings that we expect to see significant increase in annual sales largely driven by both earlier use and longer duration of treatment in patients with my allama moving out of slide seven the graph here shows the prescription rico rate for expel the over twenty twenty for both the first and second refills the those patients eligible for refills these numbers have remain encouraging throughout twenty twenty and are significantly higher compared to our missile launch period and twenty nineteen these rico rates coupled with an average still three treatment cycles per patient as at the end of twenty twenty further reinforce the positive feedback we have received from positions and patience regarding your experience and uses of expel via importantly the patient discontinuation rated good side effects remain relatively low at thirty percent which we believe is a testament to more and more position getting comfort in helping our prices prevent and manage the side effects of expel the out with proper prophylactics portland supported therapies as well as those modification in addition to the expanded labels breaks the on the u s we believe the future international expansion of expel the oh in europe will be another key strategic area broke carry a farm which are now highlight on slide eight the see a campy positive opinion for next phobia which was issued at the end of january could lead to our first regulatory approval in europe and recognizes the positive clinical benefit response pile of world expo via we look forward to the european commission's final decision or and expel the old submission which is expected in april twenty twenty one we intend to submit a sec and regulatory filing based on the data from the face three boston study with the goal of further expanding the global reach of next bobby a digital patients in need of new treatment options and encouragingly even before a possible european regulatory approval the european hematology association and european society for medical oncology recently updated their treatment guidelines for my allama in november of twenty twenty and added sell an actor velcade ducks i'm a regimen to their second line recommendations and sell an exit wood ducks him at the zone to the third line plus treatment guidelines in parallel to the regular react which were also continuing to have a potential collaborated with partners in europe and japan we're committed to making expel the all about available in europe if approved in april with the greatest opportunity come potentially before the end of twenty twenty one when we would help to receive an expanded approval in europe based on the data from our face three boston study i'd be remiss if i do not mention updates on a number of additional exciting pipe i'm up to these that we are pursuing for expel the out which can be seen on slides nine and ten we have a robust clinical development plan for expel the own both even illogical malignancies and solid tumors this includes are face three see and study in patients with meet ya cancer or expect to have a top line data out before the end of this year i'll note that there are two additional new important clinical trials we plan to initiate twenty twenty one which we will believe will help further define the odd clinical utility of expel the of as a potential partner of choice with other active anti cancer agents first we expect to initiate a new randomized phase three study if a lady it's the in combination with analyst and eczema the zone in patients with previously treated my lama if results of this trial a positive this regimen or represent a potent oral drug option to patients with the factory disease next we plan to initiate a new phase to study evaluating expel ah in combination with kicked outta in patients with new if i noticed or recurrent metastatic melanoma or particularly excited about this study based on some encouraging data from the md anderson investigator sponsored trial evaluating his comment your regimen which was presented at the annual asthma conference in twenty twenty with that are now turn to call over to my mason to review the quarterly financials might
spk_3: and you michael
spk_4: presley early
spk_5: das i will just focus on the highlights which began on like for that product relevant cause or or of twenty one was twenty one two million per cent on seven on a fourth quarter of two thousand that product revenue for year and i'm a thirty five one was amazed by demand and at thirty five banner of year and toilet the as many girls that discount or exposure twenty five saladin are estimated range of and twenty percent
spk_1: license another avenue for the fourth or twice when he was fourteen point nine million compared to zero point four million but fourth quarter of two thousand and thirteen an increase is driven by nine point nine million dollars a month from as a gym or malcolm payments as a regulatory filings and asia
spk_4: as all the five million are upon payment from course therapeutics on his execution of a commercial distribution agreement for plaza license and other avenue and twice funny or not or nine million to ten point four million by that
spk_1: she spends the fourth quarter twenty twenty or thirty seven point two million compared to thirty one point six nine for the or or of twenty one aren't you as a year and a twenty twenty five hundred and fifty nine or nine hundred twenty four three million a year and two thousand bucks the increase in orange expensive and twenty twenty two parts or nineteenth was primarily for of costs us in are related to our have a nice and trial activity which will not record and twenty twenty one and continued activity and are other ongoing uncle child regulatory actors selling general and administrative expenses or or twice on he was thirty three million compared to twenty eight point four million votes or or of to does
spk_5: increase nest sj battle against the prior year as you primarily to activities to support us marshal nation of social on flights thirteen you can see the cast cass of once for strict cast investments as it's i'm an early on it's on it tottenham some is spite of a million dependent child i'm twenty nine at some other person's ability
spk_1: finally a son our current operating plans care if i'm expects non gaap on dns next passes which excludes stock based compensation expense of a full year twenty twenty one to be in the range of slurry a three hundred know a company expect that it has been cast as problems and us and the revenue expects to charity mix of your products build and other like is remnants of be sufficient on it's plan operations instantly times like them we're not providing pentagon's for twenty one today and will just begun the initial launch an expose your and expand an indication but we do expect me around twenty twenty one relative to twenty funny but the ramp i'm still increasing the second half of the year and expects to the benefit of a the interest of treat them from alter my long face his prescribing spokeo earlier in her treatment course and or in combination with i'll get i'll now turn to call back our michael person including remarks my own
spk_2: thank you mike before moving to the queue and i let me highlight some of the key commercial clinical and regulatory milestones that we expect for twenty twenty one and slide fourteen first we are actively in the process of launching expel the elite the second and third line settings in my lama in the us and we expect a significant increase in annual sale on twenty twenty one as compared to twenty twenty next we anticipated decision on the conditional problem expel the l europe based on the storm data in april and plan to submit the austin data the type to variation shortly thereafter which could result in expanded approval in europe later this year finally in the second half of this year we expect that line different phase three see and of study in endometrial cancer as well as multiple clinical trial initiation and the presentation of additional combination data with expel the oh and other cancer therapies and various medical meetings before you open the called of questions i do recognize our phone carrier farm team for a truly remarkable twenty twenty we've already started the new year off strongly and i'm confident that we are well positioned to execute on a commercial clinical element and operational goals and growth opportunities outline today we appreciate your ongoing support and look forward to keep you updated on our feet progress on i'll turn the call over the operator for operator
spk_0: we will not back the question and answer session to ask a question you may press start than one on your touchstone phone is he using the speaker phone please pick up your hands said before pressing the keys to withdraw your question please press start than to please limit yourself to one question and one follow up with you have further questions he marry into the question que had this time the will pass momentarily to assemble a roster the first question comes from mani re craft with jeffrey please go ahead
spk_1: hide the morning everyone in aggregator could breath on the progress things for the my question i'm so for stay as we we likely won't be a major arrived in the number rebels and at least the next quarter info with the numbers are presented in nagar at inept at the numbers are presented in aggregate so would you consider breaking out that know emperor or other sales numbers by line of treatment and twenty twenty one i guess you plan on providing more granularity going forward
spk_2: let me turn into in to start
spk_6: yeah they face boy
spk_1: i say for now that the reality is in terms of the the clarity of of data we get our we don't see from our from mars or distributors and specially pharmacies we don't get a level of data that tells us what line of their the of your prescription was given it so we we'd right now we don't have that clarity we do get some of that information for market research what we'll do later on the year but that will be available later in the are so i think what's the kind of let's let's let the launch play out and and as we get more information i think will be more specific in terms of where the glove is come from
spk_7: got him again and then i'm one follow up just kind of potential be the opportunities in europe just wondering if we could say anything additional i'm adding that back and take place on be prior to the be boston acceptance and approval air
spk_2: they that over to stephen merchant are keep isn't officer stephen that's hi the morning why the great question and i'm certainly since they've gotten a positive opinion in europe is been a lot of great moment still are currently under another discussions on the for both europe and japan it and will look into making decisions and hopefully adnan in the next few months will be to bring that effectively to our european patients at the get a thing i would add to it on a positive note with had a lot of interest beyond just the both one lama indication an infant never look into exposed and and and how bout beyond just the the first part of argument ah supports yeah
spk_7: great okay thank you for doing questions
spk_0: the next question comes from brine abrahams with rbc capital markets please go ahead
spk_8: a good morning on thanks for taking my questions and retinal the progress of so i'm curious what some of the key metrics that you guys are going to be looking for in order to assess earlier line uptake am against beyond our new patients starts as this primarily duration is or anything that you might be able to tell from don't levels just given the spread on that already and i understand and not looking for a are not expecting a major inflection until closer the back here for the year but on how quickly my you expect some the potentially yeah potential leading indicating signals are to manifest themselves are you starting to see any our initial trends here ah since december now the whereas cause the mid february
spk_2: yeah let me let me start ah with in and then move it i'm going to john archie tomorrow flops or in
spk_6: david great question
spk_1: mean clearly one of the one of the the most obvious indicators will be new patient starts and for some of the data that we receive the and we didn't mention on the comic call that that we have seen an uptick in or books are certainly growth and new kitchen starts to that certainly encouraging and will continue to follow that we've also seen document that percent of explore your prescription at the eighty milligram twice a week dollars and an increase in the doses ah that would indicate that that expo he has been used in combination of doses moment of a to know them twice a week so we think that's also another positive indicator that more positions are likely to choosing to music spob yell and the combination regimen and now we don't have visible the as do you know what percent of that is with velcade represented that is with another animal on the ancient but certainly were encouraged that the percentage of of prescriptions written for the eighty milligram dose of is coming down quite significantly so those are the kinds of the that we're looking at my think you mentioned as we get into probably the second half of the year will really be looking at duration of treatment and and that is it a metric that we can follow with me half of our our business that goes through the specimen pharmacies and can see what the numbers of prescription that each individual patient is getting but again that's a number that we wouldn't expect to materially increase until we get to the back up your arm
spk_5: as the duration of we can benefit from the duration tree and of john of there's i think and you that to not get them in in addition the duration of therapy in the fk ewe maxilla get down what combinations are getting we also are doing monthly a to you read out to look at intend to prescribed by line of their appeal by combinations about of the a leading indicator of update we also had pulse research going on on a regular basis to measure physician opinions and prescribing attacked as well as the number as add board to track perception of perception changes over time all those eventually leading indicators to that watched success or have taken the boss space
spk_8: may and what are you seeing on some of those sir i guess just initially and as that even would the label expansion and ncc and nine collusion
spk_9: john doe
spk_5: yeah while course were still less than two months and to watch were very encouraged by what we're seeing their the feedback were receiving from physicians in the one on one meeting in the market research in the ad boards has been quite odd that are already seeing an increase on prescription demand relatively what we saw at mentioned product of or november we were able to launch of medieval yet at approval across all functions in the company which was imperative and were saying the impact of that in in the context of the rapid promotional efforts are already seeing the chefs the and that in the terms of dosage and more patients now starting xv date and starting on xd so early signs in the market read
spk_1: search on from the ad boards are positive again it's early the theory barely leading indicators are headed the right direction
spk_8: that's really helpful the maybe just a quick follow up on they could am with respect to the competitive landscape and curious what your market research and on the ground physician discussions or are telling you are from the key consideration this for and for docs in their choice of a new ah my lama treatment to add onto to add on and and later and in later stage refractory patients know how i can
spk_2: he thinks yeah let me let me start here and then i will try to over so many others on the call i think that meant the main point it is that while there are a number of different therapies people can take in the second and third line settings of the actually the regimen is is really unique and in many ways first of all it is the therapy that appears to have the fewest number of overall though his and the least amount of clinic time that a patient's required span i'm and that's a super important point in any time especially when you consider that three quarters of the patients are over seventy years old ah and really don't don't have a ease of transportation and so on and and most it in fact no patient with the wants to spend a lot of time ago a hospital and that's even more important during of it the second point is the data we get i'm from this study are are potentially very relevant to the real world visa think the fact that we used once weekly velcade in the expound on alarmists of the only study that's resulted in a velcade based approval that used actually what people like doctors are treating with so it's a it's a very unique regimen in the last point to make his on and i think john's researchers really homeless are carefully for us is that we represent the fourth and and it mechanism for use in the early early levels and disease ah obviously the the pretty dumb inhibitors image and cd thirty eight monoclonal antibodies are very important in these areas but when a patient goes through them and sometimes now in front locked patients are getting all three of these regiments costs steroids on it he begs the question of what to do in the second and third lines and we represent the fourth independent mechanism that's now approved in combination for the use their and and not only approved for velcade but how as nccn guidance the on that for palm and death and dara with data of course which i promise object new one i only thing and and john
spk_10: neither goes acolyte michael on the other day the key consideration is really novel that was that the other piazza images of getting and including see dirty eight in the first line arm into a new mechanisms are key consideration of and they continue to the in the day because bloodied sufficient to live for many years and so having something that's wild
spk_2: tolerated
spk_8: without was your long term side effects is keith lose out on the arctic mud sequencing and what they're looking at dirty lines of their be so those are the two key considerations of not a good uniquely positioned this combination well
spk_0: thanks so much it's really helpful color preheat
spk_11: the next question comes from peter larson with barclays please go ahead i think said taking my questions am i guess the first ones to the brand what the current duration of friedman is if you can get of he was any kind of sensor and man and
spk_2: where that could potentially increase to overturn
spk_1: sure alien it very well and and while we said and answer loosen on the costs about three the three months right now where fruit to twenty twenty ah and that's been consistent are probably the last couple of quarters and also consistent with the data that we saw coming out of the original storm study that showed about a three month average duration of treat remember you know they're gonna be patient been around for a month and we patients that are on were in over here but the average is about three what we did see in the bottom studied it was that the average was about ten months of therapy so i think that gives you a sort of the range from the clinical studies ah and our hope is that in obviously and were able to grow the average duration of the of therapy from a point of three today to something i'm closer to ten
spk_11: but obviously the time will tell how effective we are at that moving has been bases weekend are only lots of treatment so that's where the number stand today and and i think that gives us some sense of how high they could possibly go
spk_1: and it is there any kind of sense that they are are taken up do you thing that more that kind of back half hours ahead of him it's yeah wait it's way too early to know that ah yes the ten months i was on that was from the boston study just got here
spk_11: yeah there's again there's there's it's it's way too soon to know if there's been any changes to the average treatment
spk_12: a think and then there anyway can quantifying the covert impact on the weather's the never scripts and the number of do you dogs and i'm kind of what will gives you the confidence that in a this is a can of a temporary event vs if you're kind of hidden penetration
spk_5: and john the wanna talk about that yeah we do you take the coven impact is is adding false that impacts we know in person that it's by or salesforce near slade on air teams to a key stakeholders continues to be impacted in most parts of the country research estimates that we've seen or that fifteen to twenty percent of hp hc peak anything and person they continue to believe that it's at challenging to educate positions in this environment in are putting in place multiple tactics a digital a link to this no training on virtual engagements to try and pants that we also know the impact of of it includes were just a something that that we saw some that there for days or
spk_11: she's putting them at the spike as mentioned in the fourth quarter of a duel and that we saw covered in the context of the fourth quarter
spk_2: but it it sounds like this is devon him can have it a temporary issue as opposed to be kind of cap on multiple myeloma earl yeah absolutely were seeing a lot more doctors get interested in desert and remember this is a fundamentally different asset now second and third line setting with patients now getting a a new option a very convenient option a very real life set of data to keep in which to base a clinical decision to administer xv day
spk_11: he and then as we said additional support the other so shall we absolutely believe this is the this is the fundamental the as for beginning of a fundamentally new asset and ramp or for expel the eyeing my allama
spk_0: great thanks for the midwest
spk_13: the next question comes from jonathan time with as we be leaving please go ahead good morning and thanks for telling my questions i first question why wouldn't we see and and flash and fails until the second half of boston i finder's can't the first half numbers might not fully reflect a longer duration of treatment option that reflect the significantly increased number patient
spk_2: available and airline setting
spk_1: yeah turned out to and to start yeah i'm reserving we do expect that much or subsides i was unclear we we actually do expect roads are beginning in his first quarter of this year so well as absolute expect to see growth because it to your point know we should have digital patients are we do have additional patients that we're now eligible to treat ah and that's a much larger patient cool so we absolutely expect to see our growth relative to the to the fourth quarter of last year i think the point that were making is that that growth should accelerates it throughout the year and sir
spk_13: huntley as we get into the second half of year because not only do have the benefit of more patience but you have the benefit of the longer duration of treatment for patients that are getting treated today so that was the that's the dynamic that we expect to it understood just one far to that
spk_2: cut in boston and the earlier line out cannibalize the storm opportunity and are you playing any evidence of that thank you
spk_14: yeah what are the most nearly all drugs or use multiple times in a given patient during their journey on on the therapy
spk_2: and so didn't the real use some expel the i will not be really the storm administration but it'll be in our your lines we expect will be mostly expel the of l box with some expel the palm decks if someone wants to add to use and nccn guided all oral therapy and later on it could be expo via direct x or expel the of petrol it's decks
spk_0: in the in a later line so we we do expect that we will see multiple uses of expel the we don't have a date on it yet how anecdotally we've heard of a couple patients who are getting a second course of expel the have to be journey but right now it's too small numbers
spk_15: got it thank you the next question comes from eric joseph that jp more than please go ahead
spk_2: the morning that his hand on the eric thanks for sticking our question is just a couple from us or first what is the status a commercial preparations for it's know the only you are dealing with a punter factory population or stealing or in anticipation of accessing the third and second line patient populations of the doctors admission and i have another one of the that yeah stephen you want to take that chirp the you know as initiative for we we are very excited that get positive opinion on the storm indications are have the number of discussions right now i'm both internally and with actual partners on the best way to leverage that opportunity with the pending boston some indication that said come up with an end of the here so it's it's something that were just really largely through and to had a desperate that asset to that market a properly without a different pricing implication that sequencing that we can we can work through of a political question
spk_15: i just sadly we absolutely have the dog arm will make the drug available once it's got a european commission approval assuming that that goes well i'm exactly the real the real market opportunity here is clearly in the boston type population ah and and so the the big big push that were going to have is gonna be for a boston hopes to boston approval by the end of the air but we will have the drug available for patients and on time
spk_16: okay great thank you that's helpful and an author in that vein do you expect that for the sonics prescribing patterns or the forbids on eon the u s
spk_17: just preliminary thoughts on that
spk_2: jake new on it's that in terms of prescribing patterns arm
spk_5: that i'd die can just jump in and get real quick a i get you know one of the problems in europe is that one of that one a challenge is is that there's old a lot less reimbursement for off label use and south positions tend to be restricted to what's on label at least in certain in most of the countries
spk_15: i'm there are some countries that are more liberal ah and provided that the line of therapy is appropriate physicians would be using the drug as they see fit but think them the main difference will be just on me and restricted access our reimbursement i'm john you wanna pick up on that
spk_0: i would say wow prescribing patterns may differ somewhat crossed the us and europe early research that we dine does get a positive reaction for the x yep cdr or boston profile so you expected to have a good penetration and european market as well as a lot of that occasion
spk_18: okay great variable interested in the question
spk_19: the next question comes from might also a bad please go ahead
spk_18: i don't think the taking the questions and regulation at all the progress as well maybe i could just as to follow up on some of the prior questions related fulvio trends
spk_20: you get to mention
spk_6: an increase in demand starting in december and also in january to just curious the month over month trend weekday and acceleration there another call it
spk_1: i think home yeah they won't leave it at the got we don't want to get to into the weeds in terms of weekly or monthly prescription friends or believe that to our our quarterly summation when we have discussed cause i think devices to say we're pleased with
spk_18: the early indicators and and the growth that we're seeing since approval the and and again i think when we get to work or forty one numbers of it'll be much clearer in terms of our donald are often up for the full first one the
spk_16: got it that's there and then maybe just the a follow up on and c c and guidelines
spk_5: obviously you've got reputation in combination with velcade which is on label what you've also got a recommendation off label with list and dies the legs i know it's early budget since those guideline updates of you noticed the not some sort of in off label use on those combinations night
spk_7: john on take that dumb as
spk_21: airbags or dad epa so our sales game and marketing team of course only promote expand the out on a to prove the a label which is that dex the combination we do know that made possessions and airs rely on the seen guidelines out like treatment decisions and as you mentioned of just am recently added three
spk_5: different expel the out regiments a that what has made regiment or xd accommodation would get to the matter xd the an omelette a my or x p d important athletes they actually and then was a crab what category one recommendation represents the highest level signed by yeah
spk_22: just yet
spk_0: was we track and secondary market research as the imagine and were doing going forward we will look at a break out and see how much use it as an xp the vs x p d vs x katie etc joy to have those data to date as again it will gather for market research as we get wrapped year
spk_23: it thank you very much
spk_24: the next question comes from at live with at sea wainwright please go ahead morning everyone
spk_2: maybe if i can ask question i'm the pipeline if he can wish your priorities and solid tumors you mention the endometrial and metastatic melanoma studies i just want to get an update for on long on colorectal cancer and aids is bm yeah well those are all the leave ball sort of equal priorities were were enrolling patients into our own studies in all the ones that you mentioned long colorado and gbm on he had single age an activity and gbm am which we've talked about ten percent and
spk_24: we've we've seen activity as well in colorado and loop seen an investigative sponsored child i've mentioned added been ongoing now with some activity long so we you know this drug seems to be a are a variant are not on therapy or addition to some of the acted drugs that are used across multiple different indications and that's that's because as in a fundamental mechanism of we attack upon an anachronism cancer which is it activation of tumor suppressor proteins and we reactivate those tumor suppressor protein and then of course don't forget we have our see and okay three study meeting up our by the end of this year where we're using ah expel the l vs pussy
spk_1: well in the maintenance setting at the front line therapy so broad the active drug and ah our being very careful about how we use our precious resources but we we see it ah across a number of different therapies will pick pick the best winners and move them forward as a expeditious as possible
spk_24: great thanks michael and maybe just talking about resources and question from my korean did he use the a tm ad in the fourth quarter were thus far in
spk_5: twenty twenty one and
spk_1: are you including any proceed from the a pm
spk_5: in the young cash runway guidance
spk_7: mike
spk_24: they are dead so wow so was
spk_5: come on going on redneck as we've but let's be done with not you that or during the fourth quarter i'm and we just don't include that in our our guide and it's more on current deny proven to indications plus current on collaboration there we are that happened place of step by step which we guys who would be
spk_24: some of the drink to a million three hundred million that fight at fine
spk_0: okay thanks mike in and also gets stabbed a it's far as that guidance goes on the runway and does that include any
spk_2: milestone payment a potential milestone came in from a european partnership
spk_0: so when i go any new ones like that guy is a new collaboration about a something that's a part of even focus or python and what entire and of complaints makes aware brain a commercialized and europe but a no i did not include any significant parents are new alliances
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