{"ok":true,"data":{"subject":{"kind":"trial","nctId":"NCT04338269","title":"A Study of Atezolizumab in Combination With Cabozantinib Compared to Cabozantinib Alone in Participants With Advanced Renal Cell Carcinoma After Immune Checkpoint Inhibitor Treatment","sponsor":"Hoffmann-La Roche","phases":["PHASE3"],"status":"TERMINATED","indication":null,"disease":"papillary renal cell carcinoma"},"rows":[{"n":1,"question":"Is the biology right?","flags":[{"id":"somatic_driver","label":"Somatic driver evidence","value":"yes","detail":"CD274, KDR, MET in papillary renal cell carcinoma","rule":"Open Targets has somatic-mutation evidence for the target in this cancer","source":{"label":"Open Targets: CD274 in papillary renal cell carcinoma","url":"https://platform.opentargets.org/evidence/ENSG00000120217/MONDO_0017884","date":"2026-11-11T20:20:16.195Z"},"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":"CD274: somatic; KDR: somatic; MET: curated genetic literature, germline, 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: CD274 in papillary renal cell carcinoma","url":"https://platform.opentargets.org/evidence/ENSG00000120217/MONDO_0017884","date":"2026-11-11T20:20:16.195Z"},"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":"CD274, MET 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 NCT04338269","url":"https://clinicaltrials.gov/study/NCT04338269","date":"2026-11-11T20:20:16.195Z"},"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":"CD274 (via Atezolizumab)","text":"Evidence types in papillary renal cell carcinoma: literature, somatic_mutation, clinical; literature listed separately from human genetics. Datasources: clinical_precedence, cancer_gene_census, europepmc.","source":{"label":"Open Targets: CD274 in papillary renal cell carcinoma","url":"https://platform.opentargets.org/evidence/ENSG00000120217/MONDO_0017884","date":"2026-11-11T20:20:16.195Z"}},{"label":"KDR (via Cabozantinib)","text":"Evidence types in papillary renal cell carcinoma: literature, rna_expression, somatic_mutation, clinical; literature listed separately from human genetics. Datasources: clinical_precedence, cancer_gene_census, europepmc, expression_atlas.","source":{"label":"Open Targets: KDR in papillary renal cell carcinoma","url":"https://platform.opentargets.org/evidence/ENSG00000128052/MONDO_0017884","date":"2026-11-11T20:20:16.195Z"}},{"label":"MET (via Cabozantinib)","text":"Evidence types in papillary renal cell carcinoma: rna_expression, genetic_literature, clinical, literature, genetic_association, somatic_mutation; literature listed separately from human genetics. Datasources: uniprot_variants, eva, clingen, genomics_england, intogen, orphanet, uniprot_literature, gene2phenotype, cancer_gene_census, clinical_precedence, eva_somatic, europepmc, expression_atlas.","source":{"label":"Open Targets: MET in papillary renal cell carcinoma","url":"https://platform.opentargets.org/evidence/ENSG00000105976/MONDO_0017884","date":"2026-11-11T20:20:16.195Z"}}],"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 NCT04338269","url":"https://clinicaltrials.gov/study/NCT04338269","date":"2026-11-11T20:20:16.195Z"},"context":[]},{"id":"small_denominator","label":"Small denominator","value":"no","detail":"522 enrolled; each patient moves a rate by 100 ÷ 522 = 0.2 points","rule":"Enrolment under 30; the arithmetic is shown, not a benchmark","source":{"label":"ClinicalTrials.gov NCT04338269","url":"https://clinicaltrials.gov/study/NCT04338269","date":"2026-11-11T20:20:16.195Z"},"context":[]},{"id":"primary_os","label":"Primary endpoint is overall survival","value":"yes","detail":"Progression Free Survival (PFS) as Assessed by an Independent Review Facility (IRF) (IRF-PFS) According to RECIST v1.1; Overall Survival (OS)","rule":"A registered primary outcome measure names overall survival","source":{"label":"ClinicalTrials.gov NCT04338269","url":"https://clinicaltrials.gov/study/NCT04338269","date":"2026-11-11T20:20:16.195Z"},"context":[]},{"id":"results_overdue","label":"Results overdue","value":"no","detail":"Results posted 2024-02-28","rule":"Primary completion (actual) more than 12 months ago and no results posted to the registry","source":{"label":"ClinicalTrials.gov NCT04338269","url":"https://clinicaltrials.gov/study/NCT04338269?tab=results","date":"2026-11-11T20:20:16.195Z"},"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":"415 terminated, withdrawn or suspended trials of drugs against CD274; 1 of the 200 most recent give no reason. Reasons are quoted as the registry gives them on the target page.","source":{"label":"CD274: what already stopped","url":"/target/ENSG00000120217#stopped","date":"2026-11-11T20:20:16.219Z"}}],"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":"135 sites in 15 countries; 24 in the United States (18%)","rule":"All listed sites are in one country; the share of US sites is shown","source":{"label":"ClinicalTrials.gov NCT04338269","url":"https://clinicaltrials.gov/study/NCT04338269?tab=locations","date":"2026-11-11T20:20:16.195Z"},"context":[]},{"id":"eu_pip","label":"EU paediatric investigation plan","value":"yes","detail":"EMEA-001143-PIP01-11-M06 (cabozantinib, Treatment of solid malignant tumours): PM: decision on the application for modification of an agreed PIP, 7 Aug 2023; EMEA-003418-PIP01-23 (tiragolumab;atezolizumab, Treatment of lung carcinoma): W: decision granting a waiver in all age groups for all conditions or indications, 8 Aug 2023; EMEA-001638-PIP02-21 (atezolizumab, Treatment of all conditions included in the category of malignant neoplasms (except central nervous system tumours, hematopoietic and lymphoid tissue neoplasms and melanoma)): W: decision granting a waiver in all age groups for all conditions or indications, 8 Sept 2021; EMEA-001638-PIP01-14-M02 (atezolizumab, Treatment of all conditions included in the category of malignant neoplasms (except central nervous system tumours, haematopoietic and lymphoid tissue neoplasms)): PM: decision on the application for modification of an agreed PIP, 12 Jun 2019; compliance positive 20 Sept 2019","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/3/08/610 positive 6 Feb 2009: Treatment of medullary thyroid carcinoma","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/3/08/610","url":"https://www.ema.europa.eu/en/medicines/human/orphan-designations/eu-3-08-610","date":"2026-11-11T09:12:26Z"},"context":[]},{"id":"eu_authorised","label":"Authorised in the EU","value":"yes","detail":"Cabometyx: authorised since 9 Sept 2016; Cometriq: authorised since 21 Mar 2014, orphan medicine; Tecentriq: authorised since 20 Sept 2017","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":"yes","detail":"Atezolizumab and hyaluronidase-tqjs [Tecentriq Hybreza], 24 Nov 2025: Treatment of adult and pediatric patients 12 years of age or older with unresectable or metastatic alveolar soft part sarcoma (ASPS); Atezolizumab [Tecentriq], 9 Dec 2022: As a single agent, for the treatment of adult and pediatric patients 2 years of age and older with unresectable or metastatic alveolar soft part sarcoma (ASPS); Cabozantinib [Cabometyx], 26 Mar 2025: Treatment of adult and pediatric patients 12 years of age and older with previously treated, unresectable, locally advanced or metastatic, well-differentiated extra-pancreatic neuroendocrine tumors (epNET); +2 more","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":"2026-11-11T20:20:16.234Z"},"context":[]},{"id":"studies_under_18","label":"Registered studies open to children","value":"yes","detail":"50 interventional studies of Atezolizumab, Cabozantinib include patients under 18; 30 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=%22Atezolizumab%22+OR+%22Cabozantinib%22&aggFilters=ages%3Achild%2CstudyType%3Aint","date":"2026-11-11T20:20:16.243Z"},"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":"Hoffmann-La Roche (industry)","source":{"label":"ClinicalTrials.gov NCT04338269","url":"https://clinicaltrials.gov/study/NCT04338269","date":"2026-11-11T20:20:16.195Z"}},{"label":"study director","text":"Clinical Trials, Hoffmann-La Roche","source":{"label":"Person page","url":"/person/Clinical%20Trials","date":"2026-11-11T20:20:16.195Z"}}],"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 NCT04338269","url":"https://clinicaltrials.gov/study/NCT04338269","date":"2026-11-11T20:20:16.195Z"},{"label":"Open Targets Platform","url":"https://platform.opentargets.org","date":"2026-11-11T20:20:16.195Z"},{"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":"2026-11-11T20:20:16.192Z"}