{"ok":true,"data":{"subject":{"kind":"trial","nctId":"NCT04384692","title":"Peritransplant Ruxolitinib for Patients With Primary and Secondary Myelofibrosis","sponsor":"Fred Hutchinson Cancer Center","phases":["PHASE2"],"status":"ACTIVE_NOT_RECRUITING","indication":null,"disease":"primary myelofibrosis"},"rows":[{"n":1,"question":"Is the biology right?","flags":[{"id":"somatic_driver","label":"Somatic driver evidence","value":"yes","detail":"JAK2 in primary myelofibrosis","rule":"Open Targets has somatic-mutation evidence for the target in this cancer","source":{"label":"Open Targets: JAK2 in primary myelofibrosis","url":"https://platform.opentargets.org/evidence/ENSG00000096968/MONDO_0009692","date":"2026-11-11T18:08:30.527Z"},"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":"JAK2: 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: JAK2 in primary myelofibrosis","url":"https://platform.opentargets.org/evidence/ENSG00000096968/MONDO_0009692","date":"2026-11-11T18:08:30.527Z"},"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":"JAK1, JAK2, JAK3 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 NCT04384692","url":"https://clinicaltrials.gov/study/NCT04384692","date":"2026-11-11T18:08:30.527Z"},"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":"Background therapy","text":"Cyclophosphamide, Fludarabine, Methotrexate: standard agents, not counted in these flags."},{"label":"IMPDH1 (via Mycophenolate Mofetil)","text":"Evidence types in primary myelofibrosis: clinical. Datasources: clinical_precedence.","source":{"label":"Open Targets: IMPDH1 in primary myelofibrosis","url":"https://platform.opentargets.org/evidence/ENSG00000106348/MONDO_0009692","date":"2026-11-11T18:08:30.527Z"}},{"label":"IMPDH2 (via Mycophenolate Mofetil)","text":"Evidence types in primary myelofibrosis: clinical. Datasources: clinical_precedence.","source":{"label":"Open Targets: IMPDH2 in primary myelofibrosis","url":"https://platform.opentargets.org/evidence/ENSG00000178035/MONDO_0009692","date":"2026-11-11T18:08:30.527Z"}},{"label":"JAK1 (via Ruxolitinib)","text":"Evidence types in primary myelofibrosis: literature, animal_model, clinical; literature and animal_model listed separately from human genetics. Datasources: clinical_precedence, impc, europepmc.","source":{"label":"Open Targets: JAK1 in primary myelofibrosis","url":"https://platform.opentargets.org/evidence/ENSG00000162434/MONDO_0009692","date":"2026-11-11T18:08:30.527Z"}},{"label":"JAK2 (via Ruxolitinib)","text":"Evidence types in primary myelofibrosis: clinical, literature, genetic_association, somatic_mutation, animal_model; literature and animal_model listed separately from human genetics. Datasources: clinical_precedence, eva, eva_somatic, cancer_gene_census, gene_burden, europepmc, impc.","source":{"label":"Open Targets: JAK2 in primary myelofibrosis","url":"https://platform.opentargets.org/evidence/ENSG00000096968/MONDO_0009692","date":"2026-11-11T18:08:30.527Z"}},{"label":"JAK3 (via Ruxolitinib)","text":"Evidence types in primary myelofibrosis: literature, animal_model, clinical; literature and animal_model listed separately from human genetics. Datasources: clinical_precedence, impc, europepmc.","source":{"label":"Open Targets: JAK3 in primary myelofibrosis","url":"https://platform.opentargets.org/evidence/ENSG00000105639/MONDO_0009692","date":"2026-11-11T18:08:30.527Z"}}],"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 NCT04384692","url":"https://clinicaltrials.gov/study/NCT04384692","date":"2026-11-11T18:08:30.527Z"},"context":[]},{"id":"small_denominator","label":"Small denominator","value":"no","detail":"53 enrolled; each patient moves a rate by 100 ÷ 53 = 1.9 points","rule":"Enrolment under 30; the arithmetic is shown, not a benchmark","source":{"label":"ClinicalTrials.gov NCT04384692","url":"https://clinicaltrials.gov/study/NCT04384692","date":"2026-11-11T18:08:30.527Z"},"context":[]},{"id":"primary_os","label":"Primary endpoint is overall survival","value":"no","detail":"Incidence of grade II-IV graft versus host disease (GVHD) in myelofibrosis patients","rule":"A registered primary outcome measure names overall survival","source":{"label":"ClinicalTrials.gov NCT04384692","url":"https://clinicaltrials.gov/study/NCT04384692","date":"2026-11-11T18:08:30.527Z"},"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 2026-04-03, 7 months ago; within 12 months","rule":"Primary completion (actual) more than 12 months ago and no results posted to the registry","source":{"label":"ClinicalTrials.gov NCT04384692","url":"https://clinicaltrials.gov/study/NCT04384692","date":"2026-11-11T18:08:30.527Z"},"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":"241 terminated, withdrawn or suspended trials of drugs against IMPDH1; 15 of the 200 most recent give no reason. Reasons are quoted as the registry gives them on the target page.","source":{"label":"IMPDH1: what already stopped","url":"/target/ENSG00000106348#stopped","date":"2026-11-11T18:08:30.587Z"}}],"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 NCT04384692","url":"https://clinicaltrials.gov/study/NCT04384692?tab=locations","date":"2026-11-11T18:08:30.527Z"},"context":[]},{"id":"eu_pip","label":"EU paediatric investigation plan","value":"yes","detail":"EMEA-002618-PIP02-20-M01 (ruxolitinib (phosphate), Treatment of vitiligo): PM: decision on the application for modification of an agreed PIP, 12 Apr 2024; EMEA-002618-PIP04-23 (ruxolitinib (phosphate), Treatment of prurigo nodularis): W: decision granting a waiver in all age groups for all conditions or indications, 31 Jan 2024; EMEA-000901-PIP04-17-M02 (ruxolitinib (phosphate), Treatment of chronic Graft versus Host Disease (cGvHD)): PM: decision on the application for modification of an agreed PIP, 3 Dec 2021; compliance positive 13 Oct 2023; EMEA-000901-PIP03-16-M02 (ruxolitinib (phosphate), Treatment of acute graft-versus-host disease (aGvHD)): PM: decision on the application for modification of an agreed PIP, 9 Apr 2021; compliance positive 13 Oct 2023; +1 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/3/14/1244 withdrawn 19 Feb 2014: Treatment of polycythaemia vera; EU/3/00/011 expired 30 Dec 2000: Conditioning treatment prior to haematopoietic-progenitor-cell transplantation","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":"Ruxolitinib Zentiva: opinion; Opzelura: authorised since 19 Apr 2023; CellCept: authorised since 14 Feb 1996; Mycophenolate mofetil Teva: authorised since 21 Feb 2008; +6 more","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":"Busulfan [Busulfex], 13 Jan 2003: For use in combination with cyclophosphamide as a conditioning regimen prior to allogeneic hematopoietic progenitor cell transplantation for chronic myelogenous leukemia","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":"2026-11-11T18:08:30.612Z"},"context":[]},{"id":"studies_under_18","label":"Registered studies open to children","value":"yes","detail":"1054 interventional studies of Busulfan, Melphalan, Mycophenolate Mofetil, Ruxolitinib include patients under 18; 212 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=%22Busulfan%22+OR+%22Melphalan%22+OR+%22Mycophenolate+Mofetil%22+OR+%22Ruxolitinib%22&aggFilters=ages%3Achild%2CstudyType%3Aint","date":"2026-11-11T18:08:30.618Z"},"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":"Fred Hutchinson Cancer Center (academic or other)","source":{"label":"ClinicalTrials.gov NCT04384692","url":"https://clinicaltrials.gov/study/NCT04384692","date":"2026-11-11T18:08:30.527Z"}},{"label":"principal investigator","text":"Rachel B. Salit, Fred Hutch/University of Washington Cancer Consortium","source":{"label":"Person page","url":"/person/Rachel%20B.%20Salit","date":"2026-11-11T18:08:30.527Z"}}],"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 NCT04384692","url":"https://clinicaltrials.gov/study/NCT04384692","date":"2026-11-11T18:08:30.527Z"},{"label":"Open Targets Platform","url":"https://platform.opentargets.org","date":"2026-11-11T18:08:30.527Z"},{"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":"2026-11-11T18:08:30.520Z"}