We are good to go, so good afternoon, everyone. I hope you enjoyed lunch. My name is Cory Kasimov, one of the senior biotech analysts here at Evercore ISI, and it's my pleasure to host our next discussion with SpringWorks, one of our recent launches, and we're thrilled to have the company's CEO, Saqib Islam, here with us, and so with that, maybe to start, Saqib, if you can provide us with a really brief overview of the story and outline kind of the key value drivers as you see them as we start looking towards 2025. Sure. Thank you, Cory. Thanks all for having us here today. It just, I don't know for you guys, but it just dawned on me that this is a 45-minute meeting. So this is, Cory, this is more of a podcast than a typical interview here, but looking forward to the lengthy discussion. I would say, and I think you captured it well in your initiation report, we have a lot in front of us right now. You know, SpringWorks, we are in the enviable position to have one drug launched in an indication without an approval. This is our desmoid tumor medicine that we launched last year just about this time. We are well on the way to kind of beating and exceeding expectations multiple times over in that launch. Quite frankly, what we found, as you see in often in rare diseases where there's no approved treatment, is the patient population is a lot bigger even than what you expected. I'm sure we'll talk about that a little bit. I think first and foremost, we are about nine months publicly into that launch and feel very, very good about the dynamics of the launch, the depth of the patient pool, the benefit that we are providing those patients currently now, and I think the longevity that we expect to have with that launch. Next year, though, you know, to repeat the opportunity, we have our second medicine with a February 28th PDUFA date that is mirtametinib for neurofibromatosis-associated plexiform neurofibroma. That is an even larger disease in terms of the number of patients out there. We have data that we believe will certainly be first in class for adults and best in class for children with that disease. As I said, you know, we've got a February 28th PDUFA date and much to do towards that. 2025, as we think of those two molecules and now medicines, is going to be a busy year where we actually have three launches ahead of us: the U.S. launch of mirtametinib, the European launch of Ogsiveo for desmoid tumors, and the European launch of mirtametinib, all occurring, you know, in the next 12 months looking forward. So I think from where we are at the moment, certainly we've got a lot of enthusiasm for what we're doing in the solid tumor space and the multiple myeloma space with our TEAD program, with ovarian granulosa cell tumor. You can go down the list of the pipeline and much to do and execute on, but I think that all gets dwarfed with, you know, medicines launched. I think that first and foremost, that is going to be our area of focus, our area of emphasis, and happy to take, you know, further questions. We have only an hour left in this discussion, so we'll have lots of time for. It's a good thing we have all that time with all you have going on. Yeah, thank you. So as you said, it's been about a year since the approval of Ogsiveo. Can you speak to how the commercial dynamics have evolved, maybe where we stand today and how this is different relative to the expectations you would have had if we sat here and had this discussion a year ago? For sure. I think it's right to look at it about a year ago as we're doing all our work pre-launch. Here's where we were a year ago, and here's what we said about the size of the opportunity. We believed at the time, here is what is still the same, which is if you think of the epidemiology in the U.S., newly incident diagnosed patients, about 1,600-1,700 per year. That is confirmed with work we've done in Denmark and other closed systems where you see that epidemiology play out. That is a marker for what we expect in terms of new diagnoses outside the U.S. too, because there's no demographic predisposition for this disease. That is the same and continues to be the same right now. Here's what's changed. At that time, we thought there was about 5,500-7,000 people in the U.S. currently being treated at that time for a desmoid tumor. Well, we think the number is significantly more than that now. How do we know that? It's actually there is a new ICD-10 claims data, this code only originated from October of last year. So you didn't have that information before. So that when you get diagnosed, this is the ICD-10 unique claim for a desmoid tumor. We have in nine months over 10,000 unique ICD-10 claims based on now the availability of that claims data. And so how do we feel about that? Right? So that tends to be, and even that is an undercount of the overall opportunity for three reasons. One, that's less than a year's worth of claims data. Number two, it typically takes two to three years before the claims data is used universally by clinicians. And number three, we can say that we already are treating, you know, a meaningful minority of patients who came in under the old claims, you know, before the ICD-10, even since the ICD-10 data has been used. So we think that, you know, the denominator, if you're to kind of do this in kind of simple terms of the patients who are currently getting treatment for a desmoid tumor is significantly larger, potentially, you know, double what we thought it was. And so I think that is meaningful here. So if I think of where we are now versus a year ago, we see kind of the span of that opportunity is much more significant. What do we know now? In addition to what we suspected a year ago is we have the benefit of much more work with clinicians in terms of what we expect them to be using going forward. Within nine months, Ogsiveo has already become the systemic standard of care for patients. If you are diagnosed with a desmoid tumor and you wind up getting a systemic treatment and you are much more likely to get a systemic treatment now than you were before, there was nothing approved for the disease, you are greater than 50% likelihood already that you're going to be on Ogsiveo. So that likelihood of usage actually is significant. And we've got data from clinicians indicating the following. If they have used Ogsiveo, they are over 95% likely to use it again going forward. Over 90% of clinicians will now use Ogsiveo in frontline treatment. Beyond that, of this same group of physicians, 60% expect to use it more next year than they're using it now. So I think we are at the early innings, in the early innings, of something that is quite substantial as you think of this patient population that we did not know a year ago versus where we are now. Two more important pieces of data that I would highlight. One, we actually shared data at the CTOS conference, connective tissue conference a few weeks back that gave people the information that they needed for the benefit of long-term dosing. What do I mean by that? We had always pointed to, you know, in phase I, the median time on treatment was about four years. In phase II, the median time on treatment was about four years. In phase III, you know, we had median time on treatment of two years because that's when we stopped the study and, you know, then evaluated the data. Yet still, there was this concern of, okay, well, how long will people stay on drug? Will people stay on for a year? Will it be less? How will doctors modulate that? Well, we shared data from our open-label extension. So let's walk through what that means. So you had all of the patients from our phase III who were on for two years. So it's a very sick patient population who all benefited from Ogsiveo treatment. Some of those patients stayed on an open-label extension. That data is now public. So another year on drug. What we showed is that patients continued to improve from year two to year three. It takes the concept of drug holiday of stopping treatment because what we've always been able to show is what we showed in the New England Journal article is that people benefit dramatically early and consistently in terms of their pain, physical function, quality of life, a whole bunch of metrics from taking Ogsiveo and staying on Ogsiveo. What we now have is data to show that those patients will continue to benefit and have that benefit increase with use up to three years. So all of that is new. So, you know, you ask an open-ended question, I'm going to take the time and answer it. But I think that's what we know now that we didn't know then. So you put that together with a denominator that is significantly bigger, a numerator, as you think of the patients we cover. We highlighted for the first time we have 800 people unique prescriptions in the month of September. So probably more patients than that, right? These are the unique prescriptions within that month where we are steadily making traction into that group. We are steadily adding patients. And then you get the fact that those who have used Ogsiveo, patients, and then importantly, obviously the prescribers, they are very, very likely to use it again. And add to that, obviously, the longer-term data for usage. That's all new. So what it creates is some very interesting conversations as we think about what is now a view of a peak sales opportunity, which we've always said in the U.S. is over $1 billion. Now, you know, all I'll say is even greater confidence, right, in that number and more. Then a proportionate, all of these elements should be existing outside the U.S. as well. Right. Okay. That's very helpful. And we're going to explore some of those comments a little bit more. One question I have, there was a big part of the third quarter narrative was the transition over to the blister pack. Yeah. Can you talk about why this is such a significant development for the ongoing commercial rollout? Yeah, it's a really important development from our perspective. So let me explain a little bit of context. In our phase, our approved dosage is 150 mg twice a day. Our first form of the medicine for the first, you know, six months or so was 50 mg tablets, right? So if you or I were diagnosed with a desmoid tumor, God forbid, and we got fortunately treated for the desmoid tumor with Ogsiveo, what you will get is 180 pills, right? That's your month. Three in the morning, three at night, times 30 days. That is what you would get to take over the course of the month. Now, that is the experience of the patient. What we saw in the phase III, in our phase III study, is that up to 40% of patients over time down dosed from 150 mg, which is the label approved dose, down to 100 mg. So what does that result in in the real world is that you will have people not refilling at 30 days, right? If I am extending the use and instead of taking six pills a day, I'm taking four pills a day, I am now using it for 45 days rather than for 30 days. And so that is what we have seen the early innings of, certainly, you know, in the early part of the launch. What we did in the third quarter is we made the conscious decision, and obviously we've been working on and getting approved the new formulation with the FDA in the background for a while to introduce blister packs. So the new world is as follows. If you are now getting Ogsiveo, you will get a blister pack with an AM and PM pill. You take one in the morning, you take one at night. And so we believe that that will create greater adherence, greater compliance, certainly, you know, reduce the pill burden for patients for sure. In addition, we have a 100 mg formulation in addition to a 150 mg formulation. And they are priced at par. So that 100 mg patient is refilling now, you know, should be closer to 30 days than 45 days. And that makes a big difference. So let's do math among friends, right? If you think of 40% of the aggregate patient population now using the drug 50% longer when it's 50 mg tablets, that's the opportunity you recapture by introducing the blister pack. In addition to improving compliance, adherence, convenience for patients, you also think of the commercial opportunities to have that all managed with refill rates that are much more consistent. We introduced them in the third quarter. That caused a little bit of an air pocket for us because you have to get people to get a second prescription. First, they get their tablet prescription, then they transition over to a blister pack prescription. We had some people without access to medicine for two weeks or so, and that created a little bit of an air pocket in July. That was followed with our strongest month ever in August and followed again by our strongest month ever in September. What we expect to see going forward is we are 2/3 of the way through that transition as of the third quarter, as we talked about publicly. We have a third left. We expect it to be done by January. And then going forward, as patients, if they need to drop to 100 mg, we have a form for them that is equally convenient and that we are economically indifferent to and that actually should benefit them going forward. And that's what, you know, I think the significance of that, I think both from a patient standpoint for convenience and obviously from a stakeholder standpoint, I think, you know, is worth highlighting. Okay. The other point of discussion on your third quarter call was some of the seasonality you experienced over the summer, as you mentioned upfront, and given that, what are your thoughts? You're going to also experience some level of seasonality during the holiday. Listen, I think in non-lethal diseases, you do see some seasonality, and what that means is when somebody needs a renewal, some physicians want to see the patients again and people are traveling and it's just you have delays, right, so the question is a fourth quarter question. Yep, we've got holidays in the fourth quarter and we expect to see some seasonality. Obviously, we're working off of a larger base. One thing that I said on our earnings call is we are continuing to steadily add patients, right, so the 10,000 + ICD-10 codes, we, you know, we have 800, you know, unique patients on drug, which I, you know, I'd argue is obviously it's going to be a little bit more than that, but let's just say for amongst friends, we're 1/3 of the way to what would be a billion-dollar drug in the U.S. I think the fact that we're already there within nine months, you know, is, I think, puts us in a very good position. The key is, are you continuing to add patients? Are patients continuing to stay on drug over time? And are you having low discontinuations? And does that continue? That's what I expect to see in the fourth quarter. And obviously, with more patients on drug, the impact of a seasonality is diminished over time. Right. Right. Right. Okay. Yeah. And I guess that is sort of the segue into thinking about Ogsiveo in 2025 and the trajectory there. You know, some of the trends you saw this past quarter, you said August was your best month until September, which was the new best month. So what are your expectations as you head into 2025 in terms of these new patient adds and kind of the stacking of patients on top of each other? Yeah, I think, you know, we are in a very strong position. We are seeing very low discontinuations, you know, less than 10% as we saw in our study. We think that the value proposition to patients is quite clear. The enthusiasm of physicians and patients, you know, you've seen sell-side surveys. We've done our own surveys. We've got investors on the buy side who are doing surveys. And there is, you know, not much gap between everybody's assessment of what they're hearing back from the patient community and the physician community. So I expect to be adding patients. Now, let's, you know, the transparent discussion is as follows. What do we have going for us? A very large patient population, bigger than what we expected, a very enthusiastic patient population, a transition to blister packs, which will be done by, you know, by very early next year. And then, you know, we think from our perspective, you know, we are in a very good position where we're continuing to add these patients over time. What we have to continue to work towards is it is a disease that the typical prescribing pattern was either, you know, before Ogsiveo was watchful waiting or surgery. There are still patients that are being lost to surgery, even though there's a very high recurrence rate, there's very high recidivism from that surgery and the morbidities associated with it, but it still happens, right? There is muscle memory in the system. There is still a watchful waiting element that most physicians will go through. A patient comes in, they are on, they've been diagnosed with a desmoid tumor. The typical move used to be, let's wait. Let me see you again in, you know, in a couple of months. And that used to be the case because the opportunity for these patients is, you know, kind of a litany of poor outcomes: surgery, chemo, TKIs, opioids, hormone treatment, anything that is, you know, that is a hallmark of let me keep trying to give you things that finally work. And so now there is something that works and our opportunity is to shrink that time, increase the urgency to treat. And I think that that will result in, you know, adding patients steadily over time. One thing that I'd highlight for you, though, is that when I say, you know, let's start with that 10,000 + in the ICD-10 code and that I would acknowledge is probably the lower limit. I think there are more patients being treated than that. Let's remember that this is a group that is heavily influenced by sample bias. What I mean by that is as follows. If you are going to get checked for a desmoid tumor, you have some symptoms. It isn't being found in a normal checkup. Chances are if you're going through the trouble to go see your physician, to go get looked at, and then you get diagnosed with a desmoid tumor, you have some symptomatology. You've got pain, you've got loss of function, you've got some quality of life impediment, enough that's going to make you go out and get some imaging done and go get that checked out. Our data before Ogsiveo got approved is that from a diagnosis, a patient was over 90% of patients will get treated over the course of their lifetime. Now, that number becomes higher when you've already got, you know, a drug on label for the treatment of that disease. So the likelihood of treatment, even with what we're working against, is a little bit of watchful waiting, a little bit of surgery, is that we will eventually get these patients, and what I feel very comfortable saying is it's not a function of whether you're going to get treated with Ogsiveo for your desmoid tumor, it's just when, and so that's stacking, so it ties back to your question of what do we expect in 2025, I expect to be steadily adding patients, now, you don't see in rare disease massive boluses, massive swings, the key is going to be to continue to add those patients, and now we've got the data where I think the CTOS data is incredibly exciting, it makes the case for staying on medicine. Right. Okay. So what does your team in the field hear from physicians in terms of side effects that they're seeing with real-world use of Ogsiveo, managing those side effects, and then avoiding discontinuation? Yeah. I mean, listen, I think it's a critical piece of data. I'd say is the adverse event profile is consistent with what we saw in phase III. It's largely GI and rash tend to be the biggest impediments for patients to stay on medicine. What we found in the phase III, actually we've been using in the real-world setting is that early on, as the study was launched, we had more discontinuations in the first half than the second half. And the key was treating with antidiarrheals early. And physicians are getting better about doing that kind of early care and almost prophylactic care before you get on drug, before you have a run-in of medicine. And we're seeing that play out right now in the, you know, in the real-world kind of commercial setting versus the clinical setting from the study. I think that's what's contributing to kind of the less than 10% discontinuation rate. You also tend to have most of those discontinuations, you know, within six months. The typical patient journey, no patient is typical. None of us would want to be considered typical in any situation, but I can speak in the aggregate is that you've, you know, the challenges you face from an adverse event profile of the medicine are going to be early. Once you get through those, you tend to be able to stay on. How do I know that? We can once again point to the open label extension data where now going from year two to year three, you had all of these improvements on tumor size shrinkage, pain, physical function, a whole host of PRO scores, complete responses, partial responses without a change in the adverse event profile from year two to year three. So I think the key is to get in early and manage some of these largely GI side effects. And I think the team has done a good job of that. What's the role or potential role of ovarian dysfunction in terms of discontinuation? We have not seen that ovarian dysfunction be an impediment to treatment at all, and I, you know, I'd kind of, that's consistent with any sell-side research, any buy-side, so it's, you know, obviously we're biased, we are, you know, selling the Kool-Aid as well as drinking it, so, you know, you can confirm this externally, but I think there's a logic behind this, right? First and foremost, the primary reason that we can say this comfortably and the physicians say this comfortably is that you have 100% of people have any ovarian issues become resolved once they stop taking the drug, so it's not a permanent. It is reversible. On top of that, 75% of people had resolution while on drug, and so that is a massive comfort. But the second element of this is actually really important to highlight too is that on the ovarian dysfunction side, you think of the alternatives for these patients. They are in indications that we know have an impact on their either ovaries or fertility, whether it's chemo or TKIs. And those have not been studied the way we have studied ovarian dysfunction. And they do not have resolution rates like we do. So I think you put that together, I'm giving you the reason why it hasn't been an impediment to physicians. But, you know, we're very open, you know, to our own detriment right up front that this is a possibility. But all the data since then, we've seen this remarkable resolution data of ovarian issues that you don't have with the alternatives. Right. Okay. So you've alluded to duration of treatment on a few occasions. And it's a common question that we get. So I want to go back to this a little bit. You know, you have data that very clearly shows the benefits if you stay on treatment for a long duration of time. But the question we keep getting is like, is there a risk of patients falling off therapy around the one-year mark as physicians do reassessments of their patients? And what's your team doing to try to kind of aid in terms of patient persistence? I think a month ago it would have been, let me bring you, let me show you the clinical data from our phase I, phase II, phase III, dear doctor, and show you the benefits of continued treatment and how patients continue to, you know, we can see that they have the ability to stay on drug for a longer period of time. Now, there is a natural predisposition for a first approved treatment without history for people to say, well, let me evaluate after a year. And that is a very natural thing to say. But now we have actual data showing the continued benefit. Now, we've had that data in hand for less than a month, right? You know, that we're out there with our medical teams informing the community. But I think it was incredibly well received the CTOS. What you can tell, you know, physicians straight-faced is on the one hand, your patients are going to see meaningful pain reduction very quickly. That pain reduction will be dramatic and it will be long-lasting as long as you're on drug. That's what we used to be able to say. In addition, now what we can say very succinctly is patients will continue to benefit over time from this treatment without a change in the AE profile. Now, if the bulk of AEs you see are within the first six to eight months and now you're at the one-year mark and you see data showing of continued improvement and no change in AEs, and that's not even from year one to year two. That's year two to year three, and that is deepening tumor responses, CRs, PRs, patient reported outcome, pain reduction, all continuing to trend in one direction. That's how you make the case for longer-term dosing. So I'd say a lot of those concerns we are able to address now much more aggressively with empirical clinical data that we couldn't even a month ago. Right. Okay. And then in terms of the competitive landscape with desmoid tumors, how confident are you that you can build a moat around Ogsiveo given that there's another program currently in phase III? We're very confident. I know that program. We had a good look at it. It was bought for $20 million about a year ago. That same molecule was housed in a company that went bankrupt when we shared our phase III data. I feel I know the molecule quite well. What I would say is as follows. When you compare head to head in a, you know, apples to apples in a true comparator study as we've done, there is nothing that I've seen that will distinguish that program. Having said all that, that is assuming that program gets approved and has any kind of data, notwithstanding the challenges that are there, we have at least a three-year head start and have the following advantages. In a rare disease, you know, give me an example. It's actually that other program is the same mechanism of a similar mechanism coming from behind with undistinguished data that's three years late in a rare disease where we have already, you know, captured a meaningful portion of the physician mind share, patient mind share, patient group mind share. We feel very, very good about where we are. Okay. So I think the earliest we'd see them is probably, you know, the next program, late 2026, early 2027. I like our chances. Okay. Before we switch over to mirtametinib, I'd want to ask about potential indication expansions for Ogsiveo real quick. You're pursuing ovarian granulosa. You've been looking at combos with nirogacestat and BCMA for a long time. Kind of where's your sort of confidence on those two endeavors and kind of the unmet medical need and bar for success there? So a lot of questions in that. So let me start with ovarian granulosa cell tumor. Ovarian granulosa cell tumor affects 5% of all ovarian cancers. It's a FOXL2 mutation, which is Notch tends to be connected to that mutation. So we have, you know, we have a molecule that kind of, you know, operates within the Notch and Wnt pathway if I can get into the biology for a moment. So that's the logic behind looking at ovarian granulosa cell tumors. These are patients who are typically quite beaten down with platinum-based treatments. This is a salvage opportunity. But having said that, it's a couple thousand newly diagnosed patients per year. It is kind of akin to desmoid in size as we think of this patient population. They, you know, the average expected life for a person at that point is about eight years. You know, the aggregate pool is not as large for desmoid as it is for desmoid tumor. We've got data that we'll have in the phase II data in the first half of next year. Based on that data, I think, you know, we're quite confident that this will be a tool in the toolkit for what is, you know, a pretty, you know, beaten down group of, you know, patients when you think about ovarian cancer and this subtype of ovarian cancer. On BCMA, different story where, you know, we have a number of programs ongoing with partners looking to share data hopefully next year. We kind of leave that to Regeneron, Pfizer, and AbbVie and others to kind of share that data, you know, at their time. We have consistently shown the following, which is what we believe and we've seen it with all our partners, including GSK, which is that, you know, if you can prevent the cleavage of the BCMA receptor off the tumor cell surface, which is what a gamma secretase inhibitor does, you can improve that target's availability. You can dose down. You can improve the efficacy of the drug. I think the world has kind of gotten away from thinking that, you know, CAR T will be the only solution here clearly. I think there are a number of very interesting bispecific programs, which we are, you know, partnering with, you know, with a number of them. And I think they will need to distinguish among themselves. And we think the introduction of Ogsiveo will allow them to do that. So we'll have data with, I think, both partners next year, you know, so look out for that. So we're hopeful. All right. Terrific. So now let's transition over to mirtametinib. As you prepare for a likely launch in the first quarter of 2025, what are the learnings or the synergies that you can take from the Ogsiveo launch and sort of apply it to mirtametinib? So there are some, and there are some that are, and there are some that aren't. So let's take a step back and understand the opportunity here for NF1-PN. There are more patients. There are 40,000 people in the United States with neurofibromatosis associated plexiform neurofibromas. And so that is a big number in a rare disease. There is, you know, if you think of that grouping, 1/4 of those are people under the age of 18, so children, and 3/4 of those are adults, people over the age of 18. We are going to be looking for, we have a PDUFA date looking for approval in both children and adults by the end of February. So I think that's, you know, you have some kind of macro differences in both of these opportunities. At the more operational level, you know, there is one approved treatment for NF1-PN. That is Koselugo by AstraZeneca Alexion, and they have done a nice job for, they have an approval just in kids. So that's 1/4 of the total opportunity, and they're doing about $500 million of run rate revenue in that 1/4 of that opportunity. Now, we believe we have data. I think, you know, we just got back from the Society for Neuro-Oncology Conference where we shared our data, and it's clear that we've got, you know, we'll have the first approval, first -in -class for adults. So we'll have that market for a period of time, that 3/4 of that market until AZ is approved there. But even in the children, we believe we have a best -in -class drug. More efficacious, deeper responses, better formulation. The AE profile is significantly better. The discontinuation profile is significantly better. Our drug follows an intermittent dosing schedule, which gives patients a break, three weeks on, one week off, and so as a consequence, we think we'll have a best- in -class there, so what we can take from Ogsiveo as far as the desmoid tumor opportunity, we don't have to condition the, introduce the disease. It's a very well-known disease. It is a better organized group of prescribers and patients because they've been familiar with this disease because there are more patients who deal with this issue. We will be facing some competition, certainly with children, but I think what we can do is, you know, we've got a pretty good process from a regulatory standpoint to get a good label. We've got a good commercial team that is positioning ourselves for a very strong launch. More importantly, we have very meaningfully distinguishing data. As we get ready for the launch, you know, February 28th, PDUFA. So let's assume, you know, all goes well and we get it on that date or around that date. We have already hired our sales team in the U.S. for that launch. They're in training, getting ready for that launch. It's about 35 salespeople in the U.S., analogous to the size of our desmoid sales team. We've got a common backbone from a marketing standpoint, from an importantly a market access standpoint, which becomes really important as we think about pricing the drug, getting it on formularies, and getting reimbursed for the medicine. So I think that's the shared element to what we're doing. But I view them as two very distinct call points as well, neuro-oncologists versus sarcoma specialists. And so there are some learnings, but there are really different market opportunities in both size and in terms of the competitive profile. To your point that Koselugo is out there for peds and AstraZeneca has been building this market, but you'll be in front of them with adults. How does that kind of impact how SpringWorks sort of strategically thinks about these two segments, following in, entering a competitive market on the pediatric side, and then being first to market and trying to go as fast as you can, I presume, on the adult side? We have a lot of respect for, as I said, for the folks at AZ and Alexion. I think they've done a very good job of first entering this market opportunity and I think serving patients here. The fact remains, though, I do not view us, and my team knows this, as being any different the measures for success between the adults and the peds because we believe we've got a better medicine for peds. And they themselves at AZ have said they lose 50% of their patients within 12 months because they can't stay on drug. And this is where I think, you know, I come back to, you know, situations like this where, you know, I kind of like get to simple math, right? They are losing half their patients within 12 months by their own admission. They're doing $500 million run rate revenue in 1/4 of the revenue opportunity. What do we think our revenue opportunity becomes? You've got 3/4 of that market to yourselves. Shame on us if we aren't actually highlighting the opportunity for adults across the board when we've got it, at least, you know, let's just say we've got that market to ourselves for a year, but even after that, let's remember it's the same molecule, so any asset or liability that Koselugo has for children is likely similar to what they have in adults. Just as similarly, any advantages we have for children will be the same as what we'll have for adults. For children, I am not prepared to give up that opportunity and view it as any different because we believe we've got a drug that is better tolerated, better formulation to be taken, has deeper responses, and people should want to be on this independent of what else is out there. We believe they're about 10% penetrated even in children, notwithstanding a very good revenue number. That is a marker of the opportunity in front of us. The feedback we had at the SNO Conference recently was, you know, kind of unbridled and positive, you know, in distinguishing what we have. I think the opportunity is kind of as dramatic. So given all that, how do you think about the potential launch cadence in these two segments? The cadence will be in terms of, you know, the curve, is that how you think about this? You know, what I'd say is we will attack both with the same level of determination. I think clearly for adults, you know, we have an opportunity to get to kind of more of an evergreen field of people who have not recently taken a MEK. But for children as well, I think that there are multiple rationales for us to be getting to that 90% of the kids population that has not yet been penetrated and the 10% because of that 10% that has been penetrated, we know that they're going to lose 1/2 of those people, right? And a MEK inhibitor, what has clearly been shown is that this class of medicine, these MEK inhibitors help people with NF1-PN. We are coming with what we think is a better version, what we believe, and we'll have to prove that out. Right. So obviously the product, Koselugo, has meaningful sales. Of course. But to your point, it's only 10% penetrated. Do you think it's only 10% penetrated because of some of the safety liabilities of the product, or is there something else about this market that's keeping that number relatively low? I think it's probably, you know, it's always, you know, both, right? You know, I think there's going to be some liabilities of any given medicine that limits its penetration. You know, you still have people. We see data of people on trametinib, you know, kind of another MEK inhibitor, you know, for the treatment of NF1-PN. So there's clearly an opportunity there. I think there's still, you know, you've got to get to everybody. Not everybody will go to a systemic treatment first. You still see a little bit of surgery there as well, even though it's even tougher to do surgery in this indication where you see these tumors are wrapped around nerve sheaths. So it's, you know, tougher to remove. But I assume it's, you know, it's going to be a little bit of both. Okay. All right. So I want to ask a few bigger picture questions as we wrap it up here in the last five minutes or so. First of all, is kind of strategically going it alone outside of the U.S. and your comfort level there for both Ogsiveo and mirtametinib? Yeah. So I'd say on Ogsiveo, we are going to be launching in Europe ourselves. And you know, and you say Europe, but that means Germany and then France, you know, sequencing that. And I think that's a much easier call for us. You know, our phase III DeFi study, 1/2 the sites were in Europe. We know the key opinion leaders. We know the key institutions where people do get funneled into in the centers of excellence. And we already, for an example, we already have over 250 patients on compassionate use in Europe, right? So we are well- positioned to do that launch ourselves. I think for mirtametinib, it is clear, and that's one of the things that AstraZeneca has shown us, is that there is a meaningful opportunity outside the U.S. There is pricing that they have gotten, the patients they have found outside the U.S. has been admirable. I think there is a meaningful opportunity outside the U.S. We have to, over the next six to nine months or so, make a decision about, you know, how much we invest ourselves into doing a European launch at first for mirtametinib for NF1-PN. I think that, you know, I can see the logic behind controlling the molecule. You know, there are always people who are willing to help. You know, we'll have to make that decision. Okay. And then curious as to how you're thinking about the long-term outlook for SpringWorks beyond Ogsiveo and mirtametinib. Maybe asked another way, are you confident enough in your earlier pipeline programs, or do you anticipate being more aggressive on the business development front? I can say yes to both, though, right? I think we're quite confident on the early pipeline. You can do whatever you want. You know, I'm as confident as one can be in phase I programs, right? So, you know, our metrics of what is an attractive program is, do you think you have a molecule that gets to an addressable market that is large enough? Excuse me. Excuse me. Thank you. And so I think that what we've got in TEAD, what we've got kind of preclinically that's moving to IND over the course of this year, yeah, we're super excited, but it's phase I. And then you got to get, you know, we've done the full spectrum. So, you know, I'm not a phase I hyper or a phase II hyper. We have the benefit of late-stage programs. So I'm quite sanguine about probability assessments of, you know, of progression. So yes, we are excited about that. Yes, I think we will continue to look at business development as an opportunity for us. We're a company that kind of started with business development. We've done a lot of deals since we've been, you know, since we've been a company. But I would say the following, you know, we have $500 million as of the last quarter on hand, give or take, that will fund us through profitability in the first half of 2026. I am not going to be giving up that level of, you know, stewardship of our own destiny, you know, for BD, you know, without being incredibly careful about what it is we're bringing in. We believe we've got at least two north of $1 billion U.S. opportunities with Ogsiveo for desmoid tumors, for mirtametinib for NF1-PN. And I think that that is, you know, that can't be the mark for everything we look at bringing in, but you better be looking at things that are worth your time that will divert your attention and focus from the very important work of these launches. And so part of this is, you know, being thoughtful about our own cash management and making sure we work really hard to get ourselves to a position where, you know, we are independent of the capital markets as it relates to fundraising, that, you know, large-scale BD would probably change that. You'd have to fund that separately. Right. Okay. Well, you did a very good job of anticipating what that final question was going to be around strategically thinking about your balance sheet and that path to profitability. So I think it's reassuring to hear that you don't want to compromise that, especially with these two launches that are ongoing. There's enough for us. There is enough for us to, you know, for us not just to talk about, but to execute against, particularly over the next two years that, you know, that I don't think we're worrying. Now, I'm cognizant of the fact that ultimately, you know, it's always what's next, right? So we do, you know, you can't ignore what else is coming, but we will not do that, you know, at the risk of our financial independence. Okay. Terrific. Well, I'm glad we had the full 45 minutes to be able to talk about this. I was hoping we had another hour. We can talk about our workouts and all the rest of it too. Next time, I'll work on a longer slot next year. Thank you very much. Thank you for your time. Looking forward to following the progress. Thank you. Good to see you, Cory.
Loading workspace