{"ok":true,"data":{"subject":{"kind":"trial","nctId":"NCT04271956","title":"Efficacy and Safety of Zanubrutinib Plus Tislelizumab Treatment With or Without Sonrotoclax for Patients With Richter Transformation","sponsor":"German CLL Study Group","phases":["PHASE2"],"status":"RECRUITING","indication":null,"disease":"Richter transformation"},"rows":[{"n":1,"question":"Is the biology right?","flags":[{"id":"somatic_driver","label":"Somatic driver evidence","value":"yes","detail":"BTK in Richter transformation","rule":"Open Targets has somatic-mutation evidence for the target in this cancer","source":{"label":"Open Targets: BTK in Richter transformation","url":"https://platform.opentargets.org/evidence/ENSG00000010671/MONDO_0002083","date":"2026-11-11T21:27:59.027Z"},"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":"BTK: 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: BTK in Richter transformation","url":"https://platform.opentargets.org/evidence/ENSG00000010671/MONDO_0002083","date":"2026-11-11T21:27:59.027Z"},"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":"PDCD1 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 NCT04271956","url":"https://clinicaltrials.gov/study/NCT04271956","date":"2026-11-11T21:27:59.027Z"},"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":"PDCD1 (via Tislelizumab)","text":"Evidence types in Richter transformation: literature, clinical; literature listed separately from human genetics. Datasources: clinical_precedence, europepmc.","source":{"label":"Open Targets: PDCD1 in Richter transformation","url":"https://platform.opentargets.org/evidence/ENSG00000188389/MONDO_0002083","date":"2026-11-11T21:27:59.027Z"}},{"label":"BTK (via Zanubrutinib)","text":"Evidence types in Richter transformation: literature, somatic_mutation, clinical; literature listed separately from human genetics. Datasources: cancer_gene_census, clinical_precedence, europepmc.","source":{"label":"Open Targets: BTK in Richter transformation","url":"https://platform.opentargets.org/evidence/ENSG00000010671/MONDO_0002083","date":"2026-11-11T21:27:59.027Z"}}],"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":"Non-randomised","rule":"Registry allocation field","source":{"label":"ClinicalTrials.gov NCT04271956","url":"https://clinicaltrials.gov/study/NCT04271956","date":"2026-11-11T21:27:59.027Z"},"context":[]},{"id":"small_denominator","label":"Small denominator","value":"no","detail":"83 planned; each patient moves a rate by 100 ÷ 83 = 1.2 points","rule":"Enrolment under 30; the arithmetic is shown, not a benchmark","source":{"label":"ClinicalTrials.gov NCT04271956","url":"https://clinicaltrials.gov/study/NCT04271956","date":"2026-11-11T21:27:59.027Z"},"context":[]},{"id":"primary_os","label":"Primary endpoint is overall survival","value":"no","detail":"Overall response rate (ORR) after induction therapy according to the refined Lugano Classification (Cheson et al, 2016)","rule":"A registered primary outcome measure names overall survival","source":{"label":"ClinicalTrials.gov NCT04271956","url":"https://clinicaltrials.gov/study/NCT04271956","date":"2026-11-11T21:27:59.027Z"},"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":"Primary completion expected 2027-08; not yet due","rule":"Primary completion (actual) more than 12 months ago and no results posted to the registry","source":{"label":"ClinicalTrials.gov NCT04271956","url":"https://clinicaltrials.gov/study/NCT04271956","date":"2026-11-11T21:27:59.027Z"},"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":"688 terminated, withdrawn or suspended trials of drugs against PDCD1; 1 of the 200 most recent give no reason. Reasons are quoted as the registry gives them on the target page.","source":{"label":"PDCD1: what already stopped","url":"/target/ENSG00000188389#stopped","date":"2026-11-11T21:27:59.045Z"}}],"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":"no","detail":"11 sites in 3 countries; 0 in the United States (0%)","rule":"All listed sites are in one country; the share of US sites is shown","source":{"label":"ClinicalTrials.gov NCT04271956","url":"https://clinicaltrials.gov/study/NCT04271956?tab=locations","date":"2026-11-11T21:27:59.027Z"},"context":[]},{"id":"eu_pip","label":"EU paediatric investigation plan","value":"yes","detail":"EMA/PE/0000235505 (tislelizumab, Treatment of all conditions included in the category of malignant neoplasms (except central nervous system, haematopoietic and lymphoid tissue)): W: decision granting a waiver in all age groups for all conditions or indications, 12 Jun 2025; EMEA-003489-PIP01-23 (sonrotoclax, Treatment of malignant neoplasms of haematopoietic and lymphoid tissue): P: decision agreeing on a investigation plan, with or without partial waiver(s) and or deferral(s), 16 Apr 2025; EMEA-003489-PIP02-23 (sonrotoclax, Treatment of neuroblastoma): P: decision agreeing on a investigation plan, with or without partial waiver(s) and or deferral(s), 16 Apr 2025; EMEA-002354-PIP03-24 (zanubrutinib, Treatment of lymphoplasmacytic lymphoma;Treatment of mature B-cell neoplasms (excluding lymphoplasmacytic lymphoma)): W: decision granting a waiver in all age groups for all conditions or indications, 10 Jul 2024; +2 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":"yes","detail":"EU/3/21/2446 withdrawn 21 Jun 2021: Treatment of nasopharyngeal cancer; EU/3/20/2269 withdrawn 6 Mar 2024: Treatment of hepatocellular carcinoma; EU/3/21/2438 withdrawn 20 May 2021: Treatment of marginal zone lymphoma; EU/3/19/2167 withdrawn 29 May 2019: Treatment of lymphoplasmacytic lymphoma; +1 more","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":"Brukinsa: authorised since 22 Nov 2021; Tevimbra: authorised since 15 Sept 2023; Tizveni: withdrawn since 19 Apr 2024","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 Tislelizumab, Zanubrutinib, Sonrotoclax","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":"2026-11-11T21:27:59.061Z"},"context":[]},{"id":"studies_under_18","label":"Registered studies open to children","value":"yes","detail":"16 interventional studies of Tislelizumab, Zanubrutinib, Sonrotoclax include patients under 18; 9 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=%22Tislelizumab%22+OR+%22Zanubrutinib%22+OR+%22Sonrotoclax%22&aggFilters=ages%3Achild%2CstudyType%3Aint","date":"2026-11-11T21:27:59.065Z"},"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":"German CLL Study Group (academic or other)","source":{"label":"ClinicalTrials.gov NCT04271956","url":"https://clinicaltrials.gov/study/NCT04271956","date":"2026-11-11T21:27:59.027Z"}},{"label":"principal investigator","text":"Barbara Eichhorst, Prof., Department I of Internal Medicine, University Hospital Cologne","source":{"label":"Person page","url":"/person/Barbara%20Eichhorst%2C%20Prof.","date":"2026-11-11T21:27:59.027Z"}}],"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 NCT04271956","url":"https://clinicaltrials.gov/study/NCT04271956","date":"2026-11-11T21:27:59.027Z"},{"label":"Open Targets Platform","url":"https://platform.opentargets.org","date":"2026-11-11T21:27:59.027Z"},{"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":"2026-11-11T21:27:59.025Z"}