Treg Modulation With CD28 and IL-6 Receptor Antagonists

1. Is the biology right?

• Somatic driver evidence: not published · This trial's cancer could not be matched to an Open Targets disease.

  Rule: Open Targets has somatic-mutation evidence for the target in this cancer. Source: Open Targets Platform, 2026-11-11
• Human genetic evidence: not published · This trial's cancer could not be matched to an Open Targets disease.

  Rule: Any germline or somatic human genetic evidence for the target in this cancer. Source: Open Targets Platform, 2026-11-11
• Pediatric target: no · Not 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: 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)), 2026-11-11
• Haematologic cancer: no · Solid tumour

  Rule: From the indication, or the registry conditions when no indication matches. Source: ClinicalTrials.gov NCT04066114, 2026-11-11

  Published context: Likelihood of approval from phase 1: 7.5% haematologic vs 4.6% solid (BIO / Informa / QLS 2021, 2011–2020). Population-level, not a prediction.

• Not loaded on this app yet: Normal-tissue expression in vital organs. Source: Human Protein Atlas (ticket 36).
• Not loaded on this app yet: Pan-essential in cell lines. Source: DepMap (ticket 36).
• Not loaded on this app yet: Approved drug on this target. Source: Drugs@FDA (ticket 30).

2. Can the result be trusted?

• Randomised: no · Single group

  Rule: Registry allocation field. Source: ClinicalTrials.gov NCT04066114, 2026-11-11
• Small denominator: yes · 24 enrolled; each patient moves a rate by 100 ÷ 24 = 4.2 points

  Rule: Enrolment under 30; the arithmetic is shown, not a benchmark. Source: ClinicalTrials.gov NCT04066114, 2026-11-11
• Primary endpoint is overall survival: no · The Proportion of Participants Who Remain Free of Biopsy-proven Acute T-cell Mediated or Antibody-mediated Rejection …

  Rule: A registered primary outcome measure names overall survival. Source: ClinicalTrials.gov NCT04066114, 2026-11-11

  Published context: Non-OS primary endpoint: odds ratio 2.79 for a positive phase 3 (Otsuka 2021, 400 phase 3 oncology trials, to 2020). Shown with the next figure: a surrogate is easier to hit, and often a weak guide to survival.

  Published context: 52% of surrogate-to-OS correlations are low (Prasad 2015, published to 2014). Shown with the figure above.
• Results overdue: no · Results posted 2024-10-09

  Rule: Primary completion (actual) more than 12 months ago and no results posted to the registry. Source: ClinicalTrials.gov NCT04066114, 2026-11-11

• Not loaded on this app yet: Treated and evaluable counts, assessor, confirmed response, follow-up and data cutoff. Source: Readout extraction (ticket 32).
• Not loaded on this app yet: Primary endpoint changed between registry versions. Source: Registry versions in the store (ticket 32).

3. What must it beat?

• Not loaded on this app yet: Control-arm result and approved therapies for the same segment, with label links. Source: Drugs@FDA, FDA labels and readouts (tickets 30, 32).

4. Too crowded, or too late?

• Stopped on this target: 4 terminated, withdrawn or suspended trials of drugs against CD28. Reasons are quoted as the registry gives them on the target page. · CD28: what already stopped

• Not loaded on this app yet: Programs on the target by phase and months behind the leader. Source: Programs and Drugs@FDA (ticket 33).

5. Can it be approved, and stay approved?

• Single-country: yes · All 7 sites in United States

  Rule: All listed sites are in one country; the share of US sites is shown. Source: ClinicalTrials.gov NCT04066114, 2026-11-11
• EU paediatric investigation plan: yes · EMEA-000309-PIP07-21-M01 (tocilizumab, Treatment of Coronavirus disease 2019 (COVID-19)): W: decision granting a waiver in all age groups for all conditions or indications, 29 Jan 2024; EMEA-000309-PIP09-21 (tocilizumab, Treatment of systemic sclerosis): P: decision agreeing on a investigation plan, with or without partial waiver(s) and or deferral(s), 10 Aug 2022; EMEA-000309-PIP06-21 (tocilizumab, Treatment of systemic sclerosis): RW: decision refers to a refusal on a request for waiver in all age groups for the listed condition(s), 29 Oct 2021; EMEA-000309-PIP04-17-M03 (tocilizumab, Treatment of cytokine release syndrome associated with chimeric antigen receptor (CAR) T cell therapy or T-cell-engaging bispecific antibody therapy): PM: decision on the application for modification of an agreed PIP, 13 Aug 2021; +8 more

  Rule: An EMA PIP decision (agreement, modification or waiver) lists the drug as its active substance, exact name. Source: EMA data download (dated snapshot), 2026-11-11
• EU orphan designation: yes · EU/3/10/764 expired 4 Aug 2010: Treatment of tuberous sclerosis; EU/3/07/488 withdrawn 14 Nov 2007: Treatment of gastro-entero-pancreatic neuroendocrine tumours; EU/3/11/894 withdrawn 30 Aug 2011: Treatment of gastric cancer; EU/3/07/449 withdrawn 5 Jun 2007: Treatment of renal-cell 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: EMA data download (dated snapshot), 2026-11-11
• Authorised in the EU: yes · Tosmova (previously Tocilizumab STADA and Tofidence): authorised since 20 Jun 2024; Afinitor: authorised since 2 Aug 2009; Avtozma: authorised since 14 Feb 2025; Tuyory: authorised since 27 Apr 2026; +3 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: EMA data download (dated snapshot), 2026-11-11
• FDA orphan designation: not published · 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: FDA orphan designations search
• FDA pediatric oncology approval: yes · Everolimus [Afinitor] &, 29 Oct 2010: Adult and pediatric patients aged 1 year and older with tuberous sclerosis complex (TSC) for the treatment of subependymal giant cell astrocytoma (SEGA) that requires therapeutic intervention but cannot be curatively resected

  Rule: FDA's Pediatric Oncology Drug Approvals table names the drug. Source: FDA Pediatric Oncology Drug Approvals (content current as of 2026-03-03), 2026-11-11
• Registered studies open to children: yes · 462 interventional studies of lulizumab pegol, antithymocyte globulin, tocilizumab, everolimus include patients under 18; 93 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: ClinicalTrials.gov search, 2026-11-11

• Caveat: 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.
• Rare pediatric disease voucher: 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. · FDA: Rare Pediatric Disease Designation and Priority Review Voucher Programs

• Not loaded on this app yet: Precedent approvals for target, modality and endpoint; accelerated-approval status. Source: Drugs@FDA and FDA accelerated-approval tables (ticket 30).

6. Can the sponsor finish?

• Sponsor: National Institute of Allergy and Infectious Diseases (NIAID) (academic or other) · ClinicalTrials.gov NCT04066114
• principal investigator: Flavio Vincenti, M.D., University of California San Francisco School of Medicine: Transplantation · Person page
• study chair: Sindhu Chandran, M.D., University of California San Francisco School of Medicine: Transplantation · Person page

• Not loaded on this app yet: Filed cash, quarterly spend and the runway arithmetic. Source: SEC XBRL company facts (ticket 37).
• Not loaded on this app yet: Sponsor's completed vs stopped oncology trials and results-reporting record. Source: Registry, by company (ticket 37).

What public data cannot tell you

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.