{"ok":true,"data":{"subject":{"kind":"trial","nctId":"NCT07468136","title":"Retifanlimab With or Without Difluoromethylornithine for the Treatment of Progressive High Grade Gliomas","sponsor":"Mayo Clinic","phases":["PHASE1","PHASE2"],"status":"RECRUITING","indication":{"slug":"gbm","name":"Glioblastoma"},"disease":"glioblastoma"},"rows":[{"n":1,"question":"Is the biology right?","flags":[{"id":"somatic_driver","label":"Somatic driver evidence","value":"no","detail":"None of ODC1, PDCD1 has somatic-mutation evidence in glioblastoma","rule":"Open Targets has somatic-mutation evidence for the target in this cancer","source":{"label":"Open Targets: ODC1 in glioblastoma","url":"https://platform.opentargets.org/evidence/ENSG00000115758/MONDO_0018177","date":"2026-11-11T17:18:46.953Z"},"context":[]},{"id":"human_genetic","label":"Human genetic evidence","value":"no","detail":"No germline or somatic evidence for ODC1, PDCD1 in glioblastoma","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: ODC1 in glioblastoma","url":"https://platform.opentargets.org/evidence/ENSG00000115758/MONDO_0018177","date":"2026-11-11T17:18:46.953Z"},"context":[]},{"id":"pediatric_target","label":"Pediatric target","value":"yes","detail":"ODC1, 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 NCT07468136","url":"https://clinicaltrials.gov/study/NCT07468136","date":"2026-11-11T17:18:46.953Z"},"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":"ODC1 (via Eflornithine)","text":"Evidence types in glioblastoma: literature, rna_expression, clinical; literature listed separately from human genetics. Datasources: europepmc, clinical_precedence, expression_atlas.","source":{"label":"Open Targets: ODC1 in glioblastoma","url":"https://platform.opentargets.org/evidence/ENSG00000115758/MONDO_0018177","date":"2026-11-11T17:18:46.953Z"}},{"label":"PDCD1 (via Retifanlimab)","text":"Evidence types in glioblastoma: literature, clinical; literature listed separately from human genetics. Datasources: clinical_precedence, europepmc.","source":{"label":"Open Targets: PDCD1 in glioblastoma","url":"https://platform.opentargets.org/evidence/ENSG00000188389/MONDO_0018177","date":"2026-11-11T17:18:46.953Z"}}],"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 NCT07468136","url":"https://clinicaltrials.gov/study/NCT07468136","date":"2026-11-11T17:18:46.953Z"},"context":[]},{"id":"small_denominator","label":"Small denominator","value":"no","detail":"33 planned; each patient moves a rate by 100 ÷ 33 = 3.0 points","rule":"Enrolment under 30; the arithmetic is shown, not a benchmark","source":{"label":"ClinicalTrials.gov NCT07468136","url":"https://clinicaltrials.gov/study/NCT07468136","date":"2026-11-11T17:18:46.953Z"},"context":[]},{"id":"primary_os","label":"Primary endpoint is overall survival","value":"no","detail":"Best tolerable dose level of Difluoromethylornithine (DFMO, or eflornithine) (phase I); Change in T cell/myeloid cell ratio (phase IIa)","rule":"A registered primary outcome measure names overall survival","source":{"label":"ClinicalTrials.gov NCT07468136","url":"https://clinicaltrials.gov/study/NCT07468136","date":"2026-11-11T17:18:46.953Z"},"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 2030-10-25; not yet due","rule":"Primary completion (actual) more than 12 months ago and no results posted to the registry","source":{"label":"ClinicalTrials.gov NCT07468136","url":"https://clinicaltrials.gov/study/NCT07468136","date":"2026-11-11T17:18:46.953Z"},"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":"7 terminated, withdrawn or suspended trials of drugs against ODC1; 2 give no reason. Reasons are quoted as the registry gives them on the target page.","source":{"label":"ODC1: what already stopped","url":"/target/ENSG00000115758#stopped","date":"2026-11-11T17:18:46.966Z"}}],"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 NCT07468136","url":"https://clinicaltrials.gov/study/NCT07468136?tab=locations","date":"2026-11-11T17:18:46.953Z"},"context":[]},{"id":"eu_pip","label":"EU paediatric investigation plan","value":"yes","detail":"EMEA-002798-PIP04-23 (retifanlimab, Treatment of lung cancer): W: decision granting a waiver in all age groups for all conditions or indications, 29 Dec 2023; EMEA-002798-PIP03-22 (retifanlimab, Treatment of Merkel cell carcinoma): W: decision granting a waiver in all age groups for all conditions or indications, 31 Jan 2023; EMEA-002798-PIP02-21 (retifanlimab, Treatment of endometrial carcinoma): W: decision granting a waiver in all age groups for all conditions or indications, 13 Apr 2022; EMEA-002798-PIP01-20 (retifanlimab, Treatment of squamous carcinoma of the anal canal): W: decision granting a waiver in all age groups for all conditions or indications, 9 Sept 2020; +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/3/11/902 withdrawn 27 Sept 2011: Treatment of neuroblastoma; EU/3/22/2743 positive 13 Jan 2023: Treatment of Merkel cell carcinoma; EU/3/21/2429 positive 20 May 2021: Treatment of neuroblastoma; EU/3/20/2343 positive 19 Oct 2020: Treatment of anal cancer; +4 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":"Zynyz: authorised since 19 Apr 2024, orphan medicine; Ifinwil: application withdrawn, orphan medicine; Vaniqa: authorised since 19 Mar 2001; Flynpovi: application withdrawn, 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":"yes","detail":"Eflornithine [Iwilfin], 13 Dec 2023: To reduce the risk of relapse in adult and pediatric patients with high-risk neuroblastoma (HRNB) who have demonstrated at least a partial response to prior multiagent, multimodality therapy including anti-GD2 immunotherapy","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":"2026-11-11T17:18:46.973Z"},"context":[]},{"id":"studies_under_18","label":"Registered studies open to children","value":"yes","detail":"23 interventional studies of Eflornithine, Retifanlimab include patients under 18; 11 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=%22Eflornithine%22+OR+%22Retifanlimab%22&aggFilters=ages%3Achild%2CstudyType%3Aint","date":"2026-11-11T17:18:46.980Z"},"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":"Mayo Clinic (academic or other)","source":{"label":"ClinicalTrials.gov NCT07468136","url":"https://clinicaltrials.gov/study/NCT07468136","date":"2026-11-11T17:18:46.953Z"}},{"label":"principal investigator","text":"Terence C. Burns, MD, PhD, Mayo Clinic","source":{"label":"Person page","url":"/person/Terence%20C.%20Burns%2C%20MD%2C%20PhD?ind=gbm","date":"2026-11-11T17:18:46.953Z"}}],"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 NCT07468136","url":"https://clinicaltrials.gov/study/NCT07468136","date":"2026-11-11T17:18:46.953Z"},{"label":"Open Targets Platform","url":"https://platform.opentargets.org","date":"2026-11-11T17:18:46.953Z"},{"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":"2026-11-11T17:18:46.951Z"}