How would you treat a patient with metastatic small cell of the prostate who is progressing on cisplatin/etoposide and has previous NGS without actionable mutations?

Small cell carcinoma of the prostate is a rare disorder. Primary pure small cell carcinoma is unusual, and characterized by a small blue cell tumor with neuroendocrine markers such as chromogranin A, and often lacks any PSA expression. These tumors do not usually meaningfully respond to anti androge...

I have given nivolumab > nivolumab + ipilimumab, extrapolating from CheckMate-032. Greater ORR with the combination, but similar OS and obviously less toxicity with single-agent nivolumab.