{"ok":true,"data":{"subject":{"kind":"trial","nctId":"NCT04592237","title":"Cabazitaxel, Carboplatin, and Cetrelimab Followed by Niraparib With or Without Cetrelimab for the Treatment of Aggressive Variant Metastatic Prostate Cancer","sponsor":"M.D. Anderson Cancer Center","phases":["PHASE2"],"status":"ACTIVE_NOT_RECRUITING","indication":null,"disease":"urinary bladder small cell neuroendocrine carcinoma"},"rows":[{"n":1,"question":"Is the biology right?","flags":[{"id":"somatic_driver","label":"Somatic driver evidence","value":"no","detail":"None of TUBB4B, TUBB1, TUBA3C, PDCD1, PARP2, PARP1 has somatic-mutation evidence in urinary bladder small cell neuroendocrine carcinoma","rule":"Open Targets has somatic-mutation evidence for the target in this cancer","source":{"label":"Open Targets: TUBB4B in urinary bladder small cell neuroendocrine carcinoma","url":"https://platform.opentargets.org/evidence/ENSG00000188229/MONDO_0004114","date":"2026-11-11T18:54:58.228Z"},"context":[]},{"id":"human_genetic","label":"Human genetic evidence","value":"no","detail":"No germline or somatic evidence for TUBB4B, TUBB1, TUBA3C, PDCD1, PARP2, PARP1 in urinary bladder small cell neuroendocrine carcinoma","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: TUBB4B in urinary bladder small cell neuroendocrine carcinoma","url":"https://platform.opentargets.org/evidence/ENSG00000188229/MONDO_0004114","date":"2026-11-11T18:54:58.228Z"},"context":[]},{"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 NCT04592237","url":"https://clinicaltrials.gov/study/NCT04592237","date":"2026-11-11T18:54:58.228Z"},"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":"TUBB4B (via Cabazitaxel)","text":"Evidence types in urinary bladder small cell neuroendocrine carcinoma: clinical. Datasources: clinical_precedence.","source":{"label":"Open Targets: TUBB4B in urinary bladder small cell neuroendocrine carcinoma","url":"https://platform.opentargets.org/evidence/ENSG00000188229/MONDO_0004114","date":"2026-11-11T18:54:58.228Z"}},{"label":"TUBB1 (via Cabazitaxel)","text":"Evidence types in urinary bladder small cell neuroendocrine carcinoma: clinical. Datasources: clinical_precedence.","source":{"label":"Open Targets: TUBB1 in urinary bladder small cell neuroendocrine carcinoma","url":"https://platform.opentargets.org/evidence/ENSG00000101162/MONDO_0004114","date":"2026-11-11T18:54:58.228Z"}},{"label":"TUBA3C (via Cabazitaxel)","text":"Evidence types in urinary bladder small cell neuroendocrine carcinoma: clinical. Datasources: clinical_precedence.","source":{"label":"Open Targets: TUBA3C in urinary bladder small cell neuroendocrine carcinoma","url":"https://platform.opentargets.org/evidence/ENSG00000198033/MONDO_0004114","date":"2026-11-11T18:54:58.228Z"}},{"label":"PDCD1 (via Cetrelimab)","text":"Evidence types in urinary bladder small cell neuroendocrine carcinoma: literature, clinical; literature listed separately from human genetics. Datasources: clinical_precedence, europepmc.","source":{"label":"Open Targets: PDCD1 in urinary bladder small cell neuroendocrine carcinoma","url":"https://platform.opentargets.org/evidence/ENSG00000188389/MONDO_0004114","date":"2026-11-11T18:54:58.228Z"}},{"label":"PARP2 (via Niraparib)","text":"Open Targets has no association between PARP2 and urinary bladder small cell neuroendocrine carcinoma.","source":{"label":"Open Targets: PARP2 in urinary bladder small cell neuroendocrine carcinoma","url":"https://platform.opentargets.org/evidence/ENSG00000129484/MONDO_0004114","date":"2026-11-11T18:54:58.228Z"}},{"label":"PARP1 (via Niraparib)","text":"Open Targets has no association between PARP1 and urinary bladder small cell neuroendocrine carcinoma.","source":{"label":"Open Targets: PARP1 in urinary bladder small cell neuroendocrine carcinoma","url":"https://platform.opentargets.org/evidence/ENSG00000143799/MONDO_0004114","date":"2026-11-11T18:54:58.228Z"}}],"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 NCT04592237","url":"https://clinicaltrials.gov/study/NCT04592237","date":"2026-11-11T18:54:58.228Z"},"context":[]},{"id":"small_denominator","label":"Small denominator","value":"no","detail":"120 planned; each patient moves a rate by 100 ÷ 120 = 0.8 points","rule":"Enrolment under 30; the arithmetic is shown, not a benchmark","source":{"label":"ClinicalTrials.gov NCT04592237","url":"https://clinicaltrials.gov/study/NCT04592237","date":"2026-11-11T18:54:58.228Z"},"context":[]},{"id":"primary_os","label":"Primary endpoint is overall survival","value":"no","detail":"Progression-free survival","rule":"A registered primary outcome measure names overall survival","source":{"label":"ClinicalTrials.gov NCT04592237","url":"https://clinicaltrials.gov/study/NCT04592237","date":"2026-11-11T18:54:58.228Z"},"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 2027-12-31; not yet due","rule":"Primary completion (actual) more than 12 months ago and no results posted to the registry","source":{"label":"ClinicalTrials.gov NCT04592237","url":"https://clinicaltrials.gov/study/NCT04592237","date":"2026-11-11T18:54:58.228Z"},"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":"362 terminated, withdrawn or suspended trials of drugs against TUBB4B; 18 of the 200 most recent give no reason. Reasons are quoted as the registry gives them on the target page.","source":{"label":"TUBB4B: what already stopped","url":"/target/ENSG00000188229#stopped","date":"2026-11-11T18:54:58.258Z"}}],"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 NCT04592237","url":"https://clinicaltrials.gov/study/NCT04592237?tab=locations","date":"2026-11-11T18:54:58.228Z"},"context":[]},{"id":"eu_pip","label":"EU paediatric investigation plan","value":"yes","detail":"EMA/PE/0000230610 (cetrelimab, Treatment of malignant bladder neoplasms): W: decision granting a waiver in all age groups for all conditions or indications, 16 Apr 2025; EMEA-002268-PIP02-18-M02 (niraparib (tosilate monohydrate), Treatment of all conditions included in the category of malignant neoplasms (except haematopoietic and lymphoid tissue neoplasms)): PM: decision on the application for modification of an agreed PIP, 19 Jul 2024; EMEA-003006-PIP01-21 (cetrelimab, Treatment of urothelial carcinoma): W: decision granting a waiver in all age groups for all conditions or indications, 11 Aug 2021; EMEA-002789-PIP01-20 (niraparib (tosilate monohydrate);abiraterone acetate, Treatment of prostate malignant neoplasms): W: decision granting a waiver in all age groups for all conditions or indications, 15 Jul 2021; +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/3/26/3258 positive 28 Jul 2026: Treatment of ovarian cancer; EU/3/10/760 positive 4 Aug 2010: Treatment of ovarian cancer","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":"Jevtana: authorised since 17 Mar 2011; Cabazitaxel Accord: authorised since 28 Aug 2020; Akeega: authorised since 19 Apr 2023; Zejula: authorised since 16 Nov 2017, orphan medicine; +1 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":"no","detail":"FDA's table lists no pediatric approval of Cabazitaxel, Cetrelimab, Niraparib","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":"2026-11-11T18:54:58.288Z"},"context":[]},{"id":"studies_under_18","label":"Registered studies open to children","value":"yes","detail":"10 interventional studies of Cabazitaxel, Cetrelimab, Niraparib include patients under 18; 2 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=%22Cabazitaxel%22+OR+%22Cetrelimab%22+OR+%22Niraparib%22&aggFilters=ages%3Achild%2CstudyType%3Aint","date":"2026-11-11T18:54:58.297Z"},"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":"M.D. Anderson Cancer Center (academic or other)","source":{"label":"ClinicalTrials.gov NCT04592237","url":"https://clinicaltrials.gov/study/NCT04592237","date":"2026-11-11T18:54:58.228Z"}},{"label":"principal investigator","text":"Ana Aparicio, M.D. Anderson Cancer Center","source":{"label":"Person page","url":"/person/Ana%20Aparicio","date":"2026-11-11T18:54:58.228Z"}}],"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 NCT04592237","url":"https://clinicaltrials.gov/study/NCT04592237","date":"2026-11-11T18:54:58.228Z"},{"label":"Open Targets Platform","url":"https://platform.opentargets.org","date":"2026-11-11T18:54:58.228Z"},{"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":"2026-11-11T18:54:58.226Z"}