{"ok":true,"data":{"subject":{"kind":"trial","nctId":"NCT04176419","title":"Perioperative Analgesia on Postoperative Opioid Usage and Pain Control in H&N Cancer Surgery","sponsor":"Case Comprehensive Cancer Center","phases":["PHASE3"],"status":"TERMINATED","indication":null,"disease":"post operative nausea and vomiting"},"rows":[{"n":1,"question":"Is the biology right?","flags":[{"id":"somatic_driver","label":"Somatic driver evidence","value":"no","detail":"None of GRIN1, GRIN2A, GRIN2B, SCN1A, SCN5A, SCN4A, PTGS2, PTGS1, FAAH, CACNA1H, CACNA2D1, CACNA1C has somatic-mutation evidence in post operative nausea and vomiting","rule":"Open Targets has somatic-mutation evidence for the target in this cancer","source":{"label":"Open Targets: GRIN1 in post operative nausea and vomiting","url":"https://platform.opentargets.org/evidence/ENSG00000176884/EFO_0004888","date":"2026-11-12T07:07:37.178Z"},"context":[]},{"id":"human_genetic","label":"Human genetic evidence","value":"no","detail":"No germline or somatic evidence for GRIN1, GRIN2A, GRIN2B, SCN1A, SCN5A, SCN4A, PTGS2, PTGS1, FAAH, CACNA1H, CACNA2D1, CACNA1C in post operative nausea and vomiting","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: GRIN1 in post operative nausea and vomiting","url":"https://platform.opentargets.org/evidence/ENSG00000176884/EFO_0004888","date":"2026-11-12T07:07:37.178Z"},"context":[]},{"id":"pediatric_target","label":"Pediatric target","value":"no","detail":"Not 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 NCT04176419","url":"https://clinicaltrials.gov/study/NCT04176419","date":"2026-11-12T07:07:37.178Z"},"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":"GRIN1 (via Ketamine)","text":"Evidence types in post operative nausea and vomiting: clinical. Datasources: clinical_precedence.","source":{"label":"Open Targets: GRIN1 in post operative nausea and vomiting","url":"https://platform.opentargets.org/evidence/ENSG00000176884/EFO_0004888","date":"2026-11-12T07:07:37.178Z"}},{"label":"GRIN2A (via Ketamine)","text":"Evidence types in post operative nausea and vomiting: clinical. Datasources: clinical_precedence.","source":{"label":"Open Targets: GRIN2A in post operative nausea and vomiting","url":"https://platform.opentargets.org/evidence/ENSG00000183454/EFO_0004888","date":"2026-11-12T07:07:37.178Z"}},{"label":"GRIN2B (via Ketamine)","text":"Evidence types in post operative nausea and vomiting: clinical. Datasources: clinical_precedence.","source":{"label":"Open Targets: GRIN2B in post operative nausea and vomiting","url":"https://platform.opentargets.org/evidence/ENSG00000273079/EFO_0004888","date":"2026-11-12T07:07:37.178Z"}},{"label":"SCN1A (via Lidocaine)","text":"Evidence types in post operative nausea and vomiting: clinical. Datasources: clinical_precedence.","source":{"label":"Open Targets: SCN1A in post operative nausea and vomiting","url":"https://platform.opentargets.org/evidence/ENSG00000144285/EFO_0004888","date":"2026-11-12T07:07:37.178Z"}},{"label":"SCN5A (via Lidocaine)","text":"Evidence types in post operative nausea and vomiting: clinical. Datasources: clinical_precedence.","source":{"label":"Open Targets: SCN5A in post operative nausea and vomiting","url":"https://platform.opentargets.org/evidence/ENSG00000183873/EFO_0004888","date":"2026-11-12T07:07:37.178Z"}},{"label":"SCN4A (via Lidocaine)","text":"Evidence types in post operative nausea and vomiting: clinical. Datasources: clinical_precedence.","source":{"label":"Open Targets: SCN4A in post operative nausea and vomiting","url":"https://platform.opentargets.org/evidence/ENSG00000007314/EFO_0004888","date":"2026-11-12T07:07:37.178Z"}},{"label":"PTGS2 (via Acetaminophen)","text":"Evidence types in post operative nausea and vomiting: clinical. Datasources: clinical_precedence.","source":{"label":"Open Targets: PTGS2 in post operative nausea and vomiting","url":"https://platform.opentargets.org/evidence/ENSG00000073756/EFO_0004888","date":"2026-11-12T07:07:37.178Z"}},{"label":"PTGS1 (via Acetaminophen)","text":"Evidence types in post operative nausea and vomiting: clinical. Datasources: clinical_precedence.","source":{"label":"Open Targets: PTGS1 in post operative nausea and vomiting","url":"https://platform.opentargets.org/evidence/ENSG00000095303/EFO_0004888","date":"2026-11-12T07:07:37.178Z"}},{"label":"FAAH (via Acetaminophen)","text":"Evidence types in post operative nausea and vomiting: clinical. Datasources: clinical_precedence.","source":{"label":"Open Targets: FAAH in post operative nausea and vomiting","url":"https://platform.opentargets.org/evidence/ENSG00000117480/EFO_0004888","date":"2026-11-12T07:07:37.178Z"}},{"label":"CACNA1H (via Gabapentin)","text":"Evidence types in post operative nausea and vomiting: clinical. Datasources: clinical_precedence.","source":{"label":"Open Targets: CACNA1H in post operative nausea and vomiting","url":"https://platform.opentargets.org/evidence/ENSG00000196557/EFO_0004888","date":"2026-11-12T07:07:37.178Z"}},{"label":"CACNA2D1 (via Gabapentin)","text":"Evidence types in post operative nausea and vomiting: clinical. Datasources: clinical_precedence.","source":{"label":"Open Targets: CACNA2D1 in post operative nausea and vomiting","url":"https://platform.opentargets.org/evidence/ENSG00000153956/EFO_0004888","date":"2026-11-12T07:07:37.178Z"}},{"label":"CACNA1C (via Gabapentin)","text":"Evidence types in post operative nausea and vomiting: clinical. Datasources: clinical_precedence.","source":{"label":"Open Targets: CACNA1C in post operative nausea and vomiting","url":"https://platform.opentargets.org/evidence/ENSG00000151067/EFO_0004888","date":"2026-11-12T07:07:37.178Z"}}],"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":"yes","detail":"Randomised allocation","rule":"Registry allocation field","source":{"label":"ClinicalTrials.gov NCT04176419","url":"https://clinicaltrials.gov/study/NCT04176419","date":"2026-11-12T07:07:37.178Z"},"context":[]},{"id":"small_denominator","label":"Small denominator","value":"no","detail":"30 enrolled; each patient moves a rate by 100 ÷ 30 = 3.3 points","rule":"Enrolment under 30; the arithmetic is shown, not a benchmark","source":{"label":"ClinicalTrials.gov NCT04176419","url":"https://clinicaltrials.gov/study/NCT04176419","date":"2026-11-12T07:07:37.178Z"},"context":[]},{"id":"primary_os","label":"Primary endpoint is overall survival","value":"no","detail":"Total opioid consumption measured in daily morphine equivalent; Pain levels on Visual Analog Scale (VAS)","rule":"A registered primary outcome measure names overall survival","source":{"label":"ClinicalTrials.gov NCT04176419","url":"https://clinicaltrials.gov/study/NCT04176419","date":"2026-11-12T07:07:37.178Z"},"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":"yes","detail":"Primary completion 2021-06-23, 64 months ago; no results posted","rule":"Primary completion (actual) more than 12 months ago and no results posted to the registry","source":{"label":"ClinicalTrials.gov NCT04176419","url":"https://clinicaltrials.gov/study/NCT04176419","date":"2026-11-12T07:07:37.178Z"},"context":[{"figure":"40.9% of applicable trials report results within a year","dataset":"Results-reporting studies summarised in spec §11","years":"all therapy areas","caveat":"All areas, not oncology only."}]}],"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":"281 terminated, withdrawn or suspended trials of drugs against GRIN1; 9 of the 200 most recent give no reason. Reasons are quoted as the registry gives them on the target page.","source":{"label":"GRIN1: what already stopped","url":"/target/ENSG00000176884#stopped","date":"2026-11-12T07:07:37.234Z"}}],"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":"The only site is in United States","rule":"All listed sites are in one country; the share of US sites is shown","source":{"label":"ClinicalTrials.gov NCT04176419","url":"https://clinicaltrials.gov/study/NCT04176419?tab=locations","date":"2026-11-12T07:07:37.178Z"},"context":[]},{"id":"eu_pip","label":"EU paediatric investigation plan","value":"yes","detail":"EMA/PE/0000245997 (ketamine;sufentanil, Treatment of acute pain): PM: decision on the application for modification of an agreed PIP, 13 Jun 2025; EMEA-003255-PIP01-22 (lidocaine hydrochloride, Local anaesthesia): W: decision granting a waiver in all age groups for all conditions or indications, 28 Oct 2022; EMEA-001310-PIP01-12-M03 (gabapentin, Treatment of chronic pain): PM: decision on the application for modification of an agreed PIP, 19 Jul 2018; EMEA-002994-PIP01-21 (gabapentin, Treatment of postherpetic neuralgia): W: decision granting a waiver in all age groups for all conditions or indications, 12 Aug 2021; +4 more","rule":"An EMA PIP decision (agreement, modification or waiver) lists the drug as its active substance, exact name","source":{"label":"EMA data download (dated snapshot)","url":"https://www.ema.europa.eu/en/documents/report/medicines-output-paediatric_investigation_plans-output-json-report_en.json","date":"2026-11-11T09:12:26Z"},"context":[]},{"id":"eu_orphan","label":"EU orphan designation","value":"no","detail":"No EU orphan designation names Ketamine, Lidocaine, Acetaminophen, Gabapentin","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 data download (dated snapshot)","url":"https://www.ema.europa.eu/en/documents/report/medicines-output-orphan_designations-json-report_en.json","date":"2026-11-11T09:12:26Z"},"context":[]},{"id":"eu_authorised","label":"Authorised in the EU","value":"yes","detail":"KemSu: opinion under re-examination; Fortacin: authorised since 15 Nov 2013; Senstend: withdrawn since 14 Nov 2019","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 Ketamine, Lidocaine, Acetaminophen, Gabapentin","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":"2026-11-12T07:07:37.250Z"},"context":[]},{"id":"studies_under_18","label":"Registered studies open to children","value":"yes","detail":"1188 interventional studies of Ketamine, Lidocaine, Acetaminophen, Gabapentin include patients under 18; 168 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=%22Ketamine%22+OR+%22Lidocaine%22+OR+%22Acetaminophen%22+OR+%22Gabapentin%22&aggFilters=ages%3Achild%2CstudyType%3Aint","date":"2026-11-12T07:07:37.256Z"},"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":"Case Comprehensive Cancer Center (academic or other)","source":{"label":"ClinicalTrials.gov NCT04176419","url":"https://clinicaltrials.gov/study/NCT04176419","date":"2026-11-12T07:07:37.178Z"}},{"label":"principal investigator","text":"Jamie Ku, MD, Cleveland Clinic Taussig Cancer institute, Case Comprehensive Cancer Center","source":{"label":"Person page","url":"/person/Jamie%20Ku%2C%20MD","date":"2026-11-12T07:07:37.178Z"}}],"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 NCT04176419","url":"https://clinicaltrials.gov/study/NCT04176419","date":"2026-11-12T07:07:37.178Z"},{"label":"Open Targets Platform","url":"https://platform.opentargets.org","date":"2026-11-12T07:07:37.178Z"},{"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":"2026-11-12T07:07:37.175Z"}