{"ok":true,"data":{"subject":{"kind":"trial","nctId":"NCT04812548","title":"A Study of Sabatolimab in Combination With Azacitidine and Venetoclax in High or Very High Risk MDS Participants","sponsor":"Novartis Pharmaceuticals","phases":["PHASE2"],"status":"TERMINATED","indication":null,"disease":"myelodysplastic syndrome"},"rows":[{"n":1,"question":"Is the biology right?","flags":[{"id":"somatic_driver","label":"Somatic driver evidence","value":"no","detail":"None of HAVCR2, BCL2 has somatic-mutation evidence in myelodysplastic syndrome","rule":"Open Targets has somatic-mutation evidence for the target in this cancer","source":{"label":"Open Targets: HAVCR2 in myelodysplastic syndrome","url":"https://platform.opentargets.org/evidence/ENSG00000135077/MONDO_0018881","date":"2026-11-11T19:48:19.166Z"},"context":[]},{"id":"human_genetic","label":"Human genetic evidence","value":"no","detail":"No germline or somatic evidence for HAVCR2, BCL2 in myelodysplastic syndrome","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: HAVCR2 in myelodysplastic syndrome","url":"https://platform.opentargets.org/evidence/ENSG00000135077/MONDO_0018881","date":"2026-11-11T19:48:19.166Z"},"context":[]},{"id":"pediatric_target","label":"Pediatric target","value":"yes","detail":"HAVCR2 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":"yes","detail":"Haematologic","rule":"From the indication, or the registry conditions when no indication matches","source":{"label":"ClinicalTrials.gov NCT04812548","url":"https://clinicaltrials.gov/study/NCT04812548","date":"2026-11-11T19:48:19.166Z"},"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":"azacitidine: standard agents, not counted in these flags."},{"label":"HAVCR2 (via sabatolimab)","text":"Evidence types in myelodysplastic syndrome: literature, clinical; literature listed separately from human genetics. Datasources: clinical_precedence, europepmc.","source":{"label":"Open Targets: HAVCR2 in myelodysplastic syndrome","url":"https://platform.opentargets.org/evidence/ENSG00000135077/MONDO_0018881","date":"2026-11-11T19:48:19.166Z"}},{"label":"BCL2 (via venetoclax)","text":"Evidence types in myelodysplastic syndrome: literature, clinical; literature listed separately from human genetics. Datasources: clinical_precedence, europepmc.","source":{"label":"Open Targets: BCL2 in myelodysplastic syndrome","url":"https://platform.opentargets.org/evidence/ENSG00000171791/MONDO_0018881","date":"2026-11-11T19:48:19.166Z"}}],"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 NCT04812548","url":"https://clinicaltrials.gov/study/NCT04812548","date":"2026-11-11T19:48:19.166Z"},"context":[]},{"id":"small_denominator","label":"Small denominator","value":"yes","detail":"20 enrolled; each patient moves a rate by 100 ÷ 20 = 5.0 points","rule":"Enrolment under 30; the arithmetic is shown, not a benchmark","source":{"label":"ClinicalTrials.gov NCT04812548","url":"https://clinicaltrials.gov/study/NCT04812548","date":"2026-11-11T19:48:19.166Z"},"context":[]},{"id":"primary_os","label":"Primary endpoint is overall survival","value":"no","detail":"Rate of Dose Limiting Toxicities (DLTs) - All Grades (Safety run-in Patients Only); Percentage of Participants (Receiving 800mg Sabatolimab) Achieving Complete Remission (CR) Per Investigator Assessment","rule":"A registered primary outcome measure names overall survival","source":{"label":"ClinicalTrials.gov NCT04812548","url":"https://clinicaltrials.gov/study/NCT04812548","date":"2026-11-11T19:48:19.166Z"},"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":"Results posted 2024-06-11","rule":"Primary completion (actual) more than 12 months ago and no results posted to the registry","source":{"label":"ClinicalTrials.gov NCT04812548","url":"https://clinicaltrials.gov/study/NCT04812548?tab=results","date":"2026-11-11T19:48:19.166Z"},"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":"13 terminated, withdrawn or suspended trials of drugs against HAVCR2. Reasons are quoted as the registry gives them on the target page.","source":{"label":"HAVCR2: what already stopped","url":"/target/ENSG00000135077#stopped","date":"2026-11-11T19:48:19.185Z"}}],"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":"10 sites in 7 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 NCT04812548","url":"https://clinicaltrials.gov/study/NCT04812548?tab=locations","date":"2026-11-11T19:48:19.166Z"},"context":[]},{"id":"eu_pip","label":"EU paediatric investigation plan","value":"yes","detail":"EMA/PE/0000182075 (venetoclax, Treatment of malignant neoplasms of the haematopoietic and lymphoid tissue;Treatment of solid malignant tumours): PM: decision on the application for modification of an agreed PIP, 3 Jan 2025; EMEA-002931-PIP01-20 (sabatolimab, Treatment of myelodysplastic syndromes): W: decision granting a waiver in all age groups for all conditions or indications, 14 Apr 2021","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/3/21/2494 withdrawn 20 Aug 2021: Treatment of myelodysplastic syndromes; EU/3/17/1954 withdrawn 12 Dec 2017: Treatment of mantle cell lymphoma; EU/3/16/1766 withdrawn 14 Oct 2016: Treatment of diffuse large B-cell lymphoma; EU/3/16/1617 withdrawn 17 Feb 2016: Treatment of acute myeloid leukaemia; +2 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":"Venclyxto: authorised since 4 Dec 2016","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 EPAR Venclyxto","url":"https://www.ema.europa.eu/en/medicines/human/EPAR/venclyxto","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 sabatolimab, venetoclax","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":"2026-11-11T19:48:19.191Z"},"context":[]},{"id":"studies_under_18","label":"Registered studies open to children","value":"yes","detail":"112 interventional studies of sabatolimab, venetoclax include patients under 18; 85 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=%22sabatolimab%22+OR+%22venetoclax%22&aggFilters=ages%3Achild%2CstudyType%3Aint","date":"2026-11-11T19:48:19.195Z"},"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":"Novartis Pharmaceuticals (industry)","source":{"label":"ClinicalTrials.gov NCT04812548","url":"https://clinicaltrials.gov/study/NCT04812548","date":"2026-11-11T19:48:19.166Z"}},{"label":"study director","text":"Novartis Pharmaceuticals, Novartis Pharmaceuticals","source":{"label":"Person page","url":"/person/Novartis%20Pharmaceuticals","date":"2026-11-11T19:48:19.166Z"}}],"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 NCT04812548","url":"https://clinicaltrials.gov/study/NCT04812548","date":"2026-11-11T19:48:19.166Z"},{"label":"Open Targets Platform","url":"https://platform.opentargets.org","date":"2026-11-11T19:48:19.166Z"},{"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":"2026-11-11T19:48:19.157Z"}