{"ok":true,"data":{"subject":{"kind":"trial","nctId":"NCT03366103","title":"Navitoclax and Vistusertib in Treating Patients With Relapsed Small Cell Lung Cancer and Other Solid Tumors","sponsor":"National Cancer Institute (NCI)","phases":["PHASE1","PHASE2"],"status":"TERMINATED","indication":null,"disease":"clear cell adenocarcinoma"},"rows":[{"n":1,"question":"Is the biology right?","flags":[{"id":"somatic_driver","label":"Somatic driver evidence","value":"yes","detail":"MTOR in clear cell adenocarcinoma","rule":"Open Targets has somatic-mutation evidence for the target in this cancer","source":{"label":"Open Targets: MTOR in clear cell adenocarcinoma","url":"https://platform.opentargets.org/evidence/ENSG00000198793/MONDO_0005004","date":"2026-11-11T17:17:54.927Z"},"context":[{"figure":"2.3× relative success for targets with somatic (IntOGen) support in oncology","dataset":"Minikel et al., Nature 2024","years":"drug programs to 2023","caveat":"A ratio between groups, not a probability for this program; mostly phase 2 to 3."}]},{"id":"human_genetic","label":"Human genetic evidence","value":"yes","detail":"MTOR: somatic","rule":"Any germline or somatic human genetic evidence for the target in this cancer, counted apart from animal-model and literature evidence","source":{"label":"Open Targets: MTOR in clear cell adenocarcinoma","url":"https://platform.opentargets.org/evidence/ENSG00000198793/MONDO_0005004","date":"2026-11-11T17:17:54.927Z"},"context":[{"figure":"2.6× relative probability of success, phase 1 to launch, with human genetic support","dataset":"Minikel et al., Nature 2024","years":"drug programs to 2023","caveat":"All therapy areas, mostly germline evidence; not a probability for this program."}]},{"id":"pediatric_target","label":"Pediatric target","value":"yes","detail":"MTOR on the FDA list","rule":"Target is on FDA's Pediatric Molecular Target List (relevant targets); membership alone neither requires nor waives a study","source":{"label":"FDA Pediatric Molecular Target List (Listed as February 2026 on the FDA Pediatric Oncology page; the file served is 9.7.22_the_relevant_molecular_target_list.xlsx, whose Summary of Changes sheet is headed 'SEPTEMBER 2022 UPDATE' (footnote date 2022-09-01))","url":"https://www.fda.gov/media/191157/download?attachment","date":"2026-11-11T07:05:03Z"},"context":[]},{"id":"haematologic","label":"Haematologic cancer","value":"no","detail":"Solid tumour","rule":"From the indication, or the registry conditions when no indication matches","source":{"label":"ClinicalTrials.gov NCT03366103","url":"https://clinicaltrials.gov/study/NCT03366103","date":"2026-11-11T17:17:54.927Z"},"context":[{"figure":"Likelihood of approval from phase 1: 7.5% haematologic vs 4.6% solid","dataset":"BIO / Informa / QLS 2021","years":"2011–2020","caveat":"Population-level, not a prediction."}]}],"facts":[{"label":"BCL2 (via Navitoclax)","text":"Evidence types in clear cell adenocarcinoma: literature; literature listed separately from human genetics. Datasources: europepmc.","source":{"label":"Open Targets: BCL2 in clear cell adenocarcinoma","url":"https://platform.opentargets.org/evidence/ENSG00000171791/MONDO_0005004","date":"2026-11-11T17:17:54.927Z"}},{"label":"BCL2L1 (via Navitoclax)","text":"Evidence types in clear cell adenocarcinoma: literature; literature listed separately from human genetics. Datasources: europepmc.","source":{"label":"Open Targets: BCL2L1 in clear cell adenocarcinoma","url":"https://platform.opentargets.org/evidence/ENSG00000171552/MONDO_0005004","date":"2026-11-11T17:17:54.927Z"}},{"label":"BCL2L2 (via Navitoclax)","text":"Open Targets has no association between BCL2L2 and clear cell adenocarcinoma.","source":{"label":"Open Targets: BCL2L2 in clear cell adenocarcinoma","url":"https://platform.opentargets.org/evidence/ENSG00000129473/MONDO_0005004","date":"2026-11-11T17:17:54.927Z"}},{"label":"MTOR (via Vistusertib)","text":"Evidence types in clear cell adenocarcinoma: literature, somatic_mutation; literature listed separately from human genetics. Datasources: cancer_gene_census, europepmc.","source":{"label":"Open Targets: MTOR in clear cell adenocarcinoma","url":"https://platform.opentargets.org/evidence/ENSG00000198793/MONDO_0005004","date":"2026-11-11T17:17:54.927Z"}}],"pending":[{"what":"Normal-tissue expression in vital organs","source":"Human Protein Atlas (ticket 36)"},{"what":"Pan-essential in cell lines","source":"DepMap (ticket 36)"},{"what":"Approved drug on this target","source":"Drugs@FDA (ticket 30)"}]},{"n":2,"question":"Can the result be trusted?","flags":[{"id":"randomised","label":"Randomised","value":"no","detail":"Single group","rule":"Registry allocation field","source":{"label":"ClinicalTrials.gov NCT03366103","url":"https://clinicaltrials.gov/study/NCT03366103","date":"2026-11-11T17:17:54.927Z"},"context":[]},{"id":"small_denominator","label":"Small denominator","value":"yes","detail":"15 enrolled; each patient moves a rate by 100 ÷ 15 = 6.7 points","rule":"Enrolment under 30; the arithmetic is shown, not a benchmark","source":{"label":"ClinicalTrials.gov NCT03366103","url":"https://clinicaltrials.gov/study/NCT03366103","date":"2026-11-11T17:17:54.927Z"},"context":[]},{"id":"primary_os","label":"Primary endpoint is overall survival","value":"no","detail":"Number of Participants With Dose Limiting Toxicities (Phase I); Overall Response Rate (ORR) (Phase II)","rule":"A registered primary outcome measure names overall survival","source":{"label":"ClinicalTrials.gov NCT03366103","url":"https://clinicaltrials.gov/study/NCT03366103","date":"2026-11-11T17:17:54.927Z"},"context":[{"figure":"Non-OS primary endpoint: odds ratio 2.79 for a positive phase 3","dataset":"Otsuka 2021, 400 phase 3 oncology trials","years":"to 2020","caveat":"Shown with the next figure: a surrogate is easier to hit, and often a weak guide to survival."},{"figure":"52% of surrogate-to-OS correlations are low","dataset":"Prasad 2015","years":"published to 2014","caveat":"Shown with the figure above."}]},{"id":"results_overdue","label":"Results overdue","value":"no","detail":"Results posted 2023-05-03","rule":"Primary completion (actual) more than 12 months ago and no results posted to the registry","source":{"label":"ClinicalTrials.gov NCT03366103","url":"https://clinicaltrials.gov/study/NCT03366103?tab=results","date":"2026-11-11T17:17:54.927Z"},"context":[]}],"facts":[],"pending":[{"what":"Treated and evaluable counts, assessor, confirmed response, follow-up and data cutoff","source":"Readout extraction (ticket 32)"},{"what":"Primary endpoint changed between registry versions","source":"Registry versions in the store (ticket 32)"}]},{"n":3,"question":"What must it beat?","flags":[],"facts":[],"pending":[{"what":"Control-arm result and approved therapies for the same segment, with label links","source":"Drugs@FDA, FDA labels and readouts (tickets 30, 32)"}]},{"n":4,"question":"Too crowded, or too late?","flags":[],"facts":[{"label":"Stopped on this target","text":"147 terminated, withdrawn or suspended trials of drugs against BCL2; 9 give no reason. Reasons are quoted as the registry gives them on the target page.","source":{"label":"BCL2: what already stopped","url":"/target/ENSG00000171791#stopped","date":"2026-11-11T17:17:54.951Z"}}],"pending":[{"what":"Programs on the target by phase and months behind the leader","source":"Programs and Drugs@FDA (ticket 33)"}]},{"n":5,"question":"Can it be approved, and stay approved?","flags":[{"id":"single_country","label":"Single-country","value":"yes","detail":"All 14 sites in United States","rule":"All listed sites are in one country; the share of US sites is shown","source":{"label":"ClinicalTrials.gov NCT03366103","url":"https://clinicaltrials.gov/study/NCT03366103?tab=locations","date":"2026-11-11T17:17:54.927Z"},"context":[]},{"id":"eu_pip","label":"EU paediatric investigation plan","value":"yes","detail":"EMEA-000478-PIP02-18 (navitoclax, Treatment of myelofibrosis): W: decision granting a waiver in all age groups for all conditions or indications, 14 Aug 2018","rule":"An EMA PIP decision (agreement, modification or waiver) lists the drug as its active substance, exact name","source":{"label":"EMA EMEA-000478-PIP02-18","url":"https://www.ema.europa.eu/en/medicines/human/paediatric-investigation-plans/emea-000478-pip02-18","date":"2026-11-11T09:12:26Z"},"context":[]},{"id":"eu_orphan","label":"EU orphan designation","value":"yes","detail":"EU/3/19/2233 withdrawn 16 Dec 2019: Treatment of myelofibrosis","rule":"An EU orphan designation lists the drug as its active substance (exact name) or belongs to a medicine that does; withdrawn and expired designations are listed with their status","source":{"label":"EMA EU/3/19/2233","url":"https://www.ema.europa.eu/en/medicines/human/orphan-designations/eu-3-19-2233","date":"2026-11-11T09:12:26Z"},"context":[]},{"id":"eu_authorised","label":"Authorised in the EU","value":"no","detail":"EMA lists no centrally authorised medicine of Navitoclax, Vistusertib","rule":"An EMA medicine record lists the drug as its active substance or INN, exact name; national-only authorisations are not in this file","source":{"label":"EMA data download (dated snapshot)","url":"https://www.ema.europa.eu/en/documents/report/medicines-output-medicines_json-report_en.json","date":"2026-11-11T09:12:26Z"},"context":[]},{"id":"fda_orphan","label":"FDA orphan designation","value":"not published","detail":"FDA's orphan designation database turns away automated requests, so this app does not read it; search it by hand at the link","rule":"Would be: an FDA orphan designation names the drug","source":{"label":"FDA orphan designations search","url":"https://www.accessdata.fda.gov/scripts/opdlisting/oopd/","date":""},"context":[]},{"id":"fda_ped_approval","label":"FDA pediatric oncology approval","value":"no","detail":"FDA's table lists no pediatric approval of Navitoclax, Vistusertib","rule":"FDA's Pediatric Oncology Drug Approvals table names the drug","source":{"label":"FDA Pediatric Oncology Drug Approvals (content current as of 2026-03-03)","url":"https://www.fda.gov/about-fda/oncology-center-excellence/pediatric-oncology-drug-approvals","date":"2026-11-11T17:17:54.970Z"},"context":[]},{"id":"studies_under_18","label":"Registered studies open to children","value":"yes","detail":"5 interventional studies of Navitoclax, Vistusertib include patients under 18; 3 are recruiting, not yet recruiting or active","rule":"The registry's age group includes Child (birth to 17 years), which also counts studies that set no minimum age","source":{"label":"ClinicalTrials.gov search","url":"https://clinicaltrials.gov/search?intr=%22Navitoclax%22+OR+%22Vistusertib%22&aggFilters=ages%3Achild%2CstudyType%3Aint","date":"2026-11-11T17:17:54.982Z"},"context":[]}],"facts":[{"label":"Caveat","text":"Site counts are not patients per country, and trials registered only outside ClinicalTrials.gov are not covered. Where the sites are is a fact about the record, not a judgement of its quality."},{"label":"Rare pediatric disease voucher","text":"FDA, content current as of 29 Apr 2026: “As of February 3, 2026, enactment of the Consolidated Appropriations Act, 2026, the rare pediatric disease PRV program will sunset after September 30, 2029. FDA may not award any PRVs under this program after September 30, 2029.” Voucher sale prices are not shown here; they appear only as company-reported news.","source":{"label":"FDA: Rare Pediatric Disease Designation and Priority Review Voucher Programs","url":"https://www.fda.gov/industry/medical-products-rare-diseases-and-conditions/rare-pediatric-disease-designation-and-priority-review-voucher-programs","date":"2026-11-11"}}],"pending":[{"what":"Precedent approvals for target, modality and endpoint; accelerated-approval status","source":"Drugs@FDA and FDA accelerated-approval tables (ticket 30)"}]},{"n":6,"question":"Can the sponsor finish?","flags":[],"facts":[{"label":"Sponsor","text":"National Cancer Institute (NCI) (academic or other)","source":{"label":"ClinicalTrials.gov NCT03366103","url":"https://clinicaltrials.gov/study/NCT03366103","date":"2026-11-11T17:17:54.927Z"}},{"label":"principal investigator","text":"Christine L Hann, JHU Sidney Kimmel Comprehensive Cancer Center LAO","source":{"label":"Person page","url":"/person/Christine%20L%20Hann","date":"2026-11-11T17:17:54.927Z"}}],"pending":[{"what":"Filed cash, quarterly spend and the runway arithmetic","source":"SEC XBRL company facts (ticket 37)"},{"what":"Sponsor's completed vs stopped oncology trials and results-reporting record","source":"Registry, by company (ticket 37)"}]}],"limits":"Public records cannot show: sales forecasts; a probability of success for this asset; full deal terms and net prices; FDA designations and action dates before approval (shown only as company-reported); clinical holds unless the company disclosed them; manufacturing; patents on unapproved drugs; whether preclinical findings have been replicated.","sources":[{"label":"ClinicalTrials.gov NCT03366103","url":"https://clinicaltrials.gov/study/NCT03366103","date":"2026-11-11T17:17:54.927Z"},{"label":"Open Targets Platform","url":"https://platform.opentargets.org","date":"2026-11-11T17:17:54.927Z"},{"label":"FDA Pediatric Molecular Target List (Listed as February 2026 on the FDA Pediatric Oncology page; the file served is 9.7.22_the_relevant_molecular_target_list.xlsx, whose Summary of Changes sheet is headed 'SEPTEMBER 2022 UPDATE' (footnote date 2022-09-01))","url":"https://www.fda.gov/media/191157/download?attachment","date":"2026-11-11T07:05:03Z"}]},"source":"ClinicalTrials.gov + Open Targets","fetchedAt":"2026-11-11T17:17:54.923Z"}