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NCT03482791

Proton Beam Therapy in the Treatment of Esophageal Cancer

Active, enrolled NA Results posted Last updated 2 April 2026
What this trial tests

NA trial testing Proton beam therapy in Esophagus Cancer in 22 participants. Participants enrolled and being followed up; not accepting new ones.

Timeline
19 April 2018
Primary endpoint
13 September 2022
9 August 2026

Quick facts

Lead sponsorWashington University School of Medicine
PhaseNA
StatusActive, enrolled
Study typeINTERVENTIONAL
Allocationnon randomized
Designparallel
Maskingnone
Primary purposetreatment
Enrollment22
Start date19 April 2018
Primary completion13 September 2022
Estimated completion9 August 2026
Sites1 location across United States

Drugs / interventions tested

Conditions studied

Sponsor

Washington University School of Medicine

Who can join

18 and older, any sex, with Esophagus Cancer or Esophageal Cancer. Patients with the condition only — healthy volunteers not accepted.

Results — posted to ClinicalTrials.gov

Per-arm endpoint measurements with 95% confidence intervals where reported. Source: trial results section.

Change in Patient-reported Outcomes of PBT for Esophageal Cancer as Measured by the MD Anderson Symptom Inventory (MDASI)-Plus Primary · Baseline, post completion of chemoradiation, 2 months, 4 months, and 6 months

The MDASI-Plus is a reliable, validated tool for assessing cancer-related symptoms regardless of therapy or specific cancer diagnosis. Patients are asked to fill out a twenty-seven question inventory. 21 questions ask the patient about the severity of their symptoms with answers ranging from 0=not present to 10=as bad as you can imagine. 6 questions ask the patient about how their symptoms interfered with their life with answers ranging from 0=did not interfere to 10=interfered completely. The higher the score the more severe symptom experience the patient experienced.

Baseline
GroupValue95% CI
Arm 1: Resectable (Proton Beam Therapy)1.994± 1.641
Arm 2: Unresectable (Proton Beam Therapy)1.127± 0.634
Post completion of chemoradiation
GroupValue95% CI
Arm 1: Resectable (Proton Beam Therapy)4.135± 1.795
Arm 2: Unresectable (Proton Beam Therapy)3.024± 2.454
2 months
GroupValue95% CI
Arm 1: Resectable (Proton Beam Therapy)1.012± 1
Arm 2: Unresectable (Proton Beam Therapy)1.31± 1.112
4 months
GroupValue95% CI
Arm 1: Resectable (Proton Beam Therapy)2.429± 2.107
Arm 2: Unresectable (Proton Beam Therapy)1.714± 2.603
6 months
GroupValue95% CI
Arm 1: Resectable (Proton Beam Therapy)1± 0.632
Arm 2: Unresectable (Proton Beam Therapy)0.738± 1.044
Change in Patient-reported Outcomes of PBT for Esophageal Cancer as Measured by the EuroQol (EQ-5D) Questionnaire Primary · Baseline, post completion of chemoradiation, 2 months, 4 months, and 6 months

The EQ-5D is a standardized 2-part, patient-administered instrument used for direct and indirect assessment of health state utilities. The first part asks respondents to "check the ONE box \[next to the appropriate statement\] that best describes your health TODAY" for each of 5 health dimensions, including mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. The second part of the EQ-5D is a visual analogue scale (VAS) valuing current health state. Both the 5-item index score and the VAS score are transformed into a utility score between 0 "Worst health state" and 1

Baseline
GroupValue95% CI
Arm 1: Resectable (Proton Beam Therapy)0.664± 0.405
Arm 2: Unresectable (Proton Beam Therapy)0.486± 0.496
Post completion of chemoradiation
GroupValue95% CI
Arm 1: Resectable (Proton Beam Therapy)0.56± 0.358
Arm 2: Unresectable (Proton Beam Therapy)0.607± 0.39
2 months
GroupValue95% CI
Arm 1: Resectable (Proton Beam Therapy)0.803± 0.295
Arm 2: Unresectable (Proton Beam Therapy)0.818± 0.124
4 months
GroupValue95% CI
Arm 1: Resectable (Proton Beam Therapy)0.802± 0.287
Arm 2: Unresectable (Proton Beam Therapy)0.645± 0.488
6 months
GroupValue95% CI
Arm 1: Resectable (Proton Beam Therapy)0.816± 0.202
Arm 2: Unresectable (Proton Beam Therapy)0.942± 0.083
Change in Patient-reported Outcomes of PBT for Esophageal Cancer as Measured by the Medical Outcomes Study (MOS) Social Support Survey Primary · Baseline, post completion of chemoradiation, 2 months, 4 months, and 6 months

The 19-item MOS Social Support Survey was designed for use with patients with chronic diseases and measures how often different kinds of support are available, if needed. Response choices range from "none of the time" (1) to "all of the time" (5). A mean social support score for all 19 items is computed to a 0-100 scale with higher scores indicating a greater availability of social support.

Baseline
GroupValue95% CI
Arm 1: Resectable (Proton Beam Therapy)89± 14.2
Arm 2: Unresectable (Proton Beam Therapy)71.1± 25.8
Post completion of chemoradiation
GroupValue95% CI
Arm 1: Resectable (Proton Beam Therapy)88.2± 15.8
Arm 2: Unresectable (Proton Beam Therapy)83.4± 24.4
2 months
GroupValue95% CI
Arm 1: Resectable (Proton Beam Therapy)90.2± 15.9
Arm 2: Unresectable (Proton Beam Therapy)98.4± 3.3
4 months
GroupValue95% CI
Arm 1: Resectable (Proton Beam Therapy)88.5± 25.3
Arm 2: Unresectable (Proton Beam Therapy)84.2± 27.3
6 months
GroupValue95% CI
Arm 1: Resectable (Proton Beam Therapy)88.2± 16.8
Arm 2: Unresectable (Proton Beam Therapy)98.7± 1.9
Change in Patient-reported Outcomes of PBT for Esophageal Cancer as Measured by the 4-Item Center for Epidemiological Studies Depression Scale (CES-D) Primary · Baseline, post completion of chemoradiation, 2 months, 4 months, and 6 months

The CES-D questionnaire is a 20-item measure which evaluates depressive symptoms. This trial will make use of the validated 4-item screening version in order to reduce participant burden. Possible range of scores is 0-60, with the higher scores indicating the presence of more symptomatology.

Baseline
GroupValue95% CI
Arm 1: Resectable (Proton Beam Therapy)19.763± 13.438
Arm 2: Unresectable (Proton Beam Therapy)16.355± 11.098
Post completion of chemoradiation
GroupValue95% CI
Arm 1: Resectable (Proton Beam Therapy)16.67± 7.287
Arm 2: Unresectable (Proton Beam Therapy)15.914± 11.118
2 months
GroupValue95% CI
Arm 1: Resectable (Proton Beam Therapy)12.47± 4.758
Arm 2: Unresectable (Proton Beam Therapy)14.15± 8.316
4 months
GroupValue95% CI
Arm 1: Resectable (Proton Beam Therapy)12.47± 5.845
Arm 2: Unresectable (Proton Beam Therapy)14.15± 10.184
6 months
GroupValue95% CI
Arm 1: Resectable (Proton Beam Therapy)11.21± 5.368
Arm 2: Unresectable (Proton Beam Therapy)11.21± 4.158
Change in Patient-reported Outcomes of PBT for Esophageal Cancer as Measured by the MD Anderson Symptom Inventory (MDASI)-Plus Primary · Baseline, post completion of chemoradiation, 2 months, 4 months, 6 months, 9 months, and 12 months

The MDASI-Plus is a reliable, validated tool for assessing cancer-related symptoms regardless of therapy or specific cancer diagnosis. Patients are asked to fill out a twenty-seven question inventory. 21 questions ask the patient about the severity of their symptoms with answers ranging from 0=not present to 10=as bad as you can imagine. 6 questions ask the patient about how their symptoms interfered with their life with answers ranging from 0=did not interfere to 10=interfered completely. The higher the score the more severe symptom experience the patient experienced.

Baseline
GroupValue95% CI
Arm 1: Resectable (Proton Beam Therapy)1.994± 1.641
Arm 2: Unresectable (Proton Beam Therapy)1.127± 0.634
Post completion of chemoradiation
GroupValue95% CI
Arm 1: Resectable (Proton Beam Therapy)4.135± 1.795
Arm 2: Unresectable (Proton Beam Therapy)3.024± 2.454
2 months
GroupValue95% CI
Arm 1: Resectable (Proton Beam Therapy)1.012± 1
Arm 2: Unresectable (Proton Beam Therapy)1.31± 1.112
4 months
GroupValue95% CI
Arm 1: Resectable (Proton Beam Therapy)2.429± 2.107
Arm 2: Unresectable (Proton Beam Therapy)1.714± 2.603
6 months
GroupValue95% CI
Arm 1: Resectable (Proton Beam Therapy)1± 0.632
Arm 2: Unresectable (Proton Beam Therapy)0.738± 1.044
9 months
GroupValue95% CI
Arm 1: Resectable (Proton Beam Therapy)0.878± 0.858
Arm 2: Unresectable (Proton Beam Therapy)2.476
12 months
GroupValue95% CI
Arm 1: Resectable (Proton Beam Therapy)1.224± 1.319
Arm 2: Unresectable (Proton Beam Therapy)0.524± 0.202
Change in Patient-reported Outcomes of PBT for Esophageal Cancer as Measured by the EuroQol (EQ-5D) Questionnaire Primary · Baseline, post completion of chemoradiation, 2 months, 4 months, 6 months, 9 months, and 12 months

The EQ-5D is a standardized 2-part, patient-administered instrument used for direct and indirect assessment of health state utilities. The first part asks respondents to "check the ONE box \[next to the appropriate statement\] that best describes your health TODAY" for each of 5 health dimensions, including mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. The second part of the EQ-5D is a visual analogue scale (VAS) valuing current health state. Both the 5-item index score and the VAS score are transformed into a utility score between 0 "Worst health state" and 1

Baseline
GroupValue95% CI
Arm 1: Resectable (Proton Beam Therapy)0.664± 0.405
Arm 2: Unresectable (Proton Beam Therapy)0.486± 0.496
Post completion of chemoradiation
GroupValue95% CI
Arm 1: Resectable (Proton Beam Therapy)0.56± 0.358
Arm 2: Unresectable (Proton Beam Therapy)0.607± 0.39
2 months
GroupValue95% CI
Arm 1: Resectable (Proton Beam Therapy)0.803± 0.295
Arm 2: Unresectable (Proton Beam Therapy)0.818± 0.124
4 months
GroupValue95% CI
Arm 1: Resectable (Proton Beam Therapy)0.802± 0.287
Arm 2: Unresectable (Proton Beam Therapy)0.645± 0.488
6 months
GroupValue95% CI
Arm 1: Resectable (Proton Beam Therapy)0.816± 0.202
Arm 2: Unresectable (Proton Beam Therapy)0.942± 0.083
9 months
GroupValue95% CI
Arm 1: Resectable (Proton Beam Therapy)0.863± 0.161
Arm 2: Unresectable (Proton Beam Therapy)0.734± 0.377
12 months
GroupValue95% CI
Arm 1: Resectable (Proton Beam Therapy)0.84± 0.181
Arm 2: Unresectable (Proton Beam Therapy)1± 0
Change in Patient-reported Outcomes of PBT for Esophageal Cancer as Measured by the Medical Outcomes Study (MOS) Social Support Survey Primary · Baseline, post completion of chemoradiation, 2 months, 4 months, 6 months, 9 months, and 12 months

The 19-item MOS Social Support Survey was designed for use with patients with chronic diseases and measures how often different kinds of support are available, if needed. Response choices range from "none of the time" (1) to "all of the time" (5). A mean social support score for all 19 items is computed to a 0-100 scale with higher scores indicating a greater availability of social support.

Baseline
GroupValue95% CI
Arm 1: Resectable (Proton Beam Therapy)89.0± 14.2
Arm 2: Unresectable (Proton Beam Therapy)71.1± 25.8
Post completion of chemoradiation
GroupValue95% CI
Arm 1: Resectable (Proton Beam Therapy)88.2± 15.8
Arm 2: Unresectable (Proton Beam Therapy)83.4± 24.4
2 months
GroupValue95% CI
Arm 1: Resectable (Proton Beam Therapy)90.2± 15.9
Arm 2: Unresectable (Proton Beam Therapy)98.4± 3.3
4 months
GroupValue95% CI
Arm 1: Resectable (Proton Beam Therapy)88.5± 25.3
Arm 2: Unresectable (Proton Beam Therapy)84.2± 27.3
6 months
GroupValue95% CI
Arm 1: Resectable (Proton Beam Therapy)88.2± 16.8
Arm 2: Unresectable (Proton Beam Therapy)98.7± 1.9
9 months
GroupValue95% CI
Arm 1: Resectable (Proton Beam Therapy)87.5± 18.8
Arm 2: Unresectable (Proton Beam Therapy)99.3± 0.9
12 months
GroupValue95% CI
Arm 1: Resectable (Proton Beam Therapy)91.8± 11.3
Arm 2: Unresectable (Proton Beam Therapy)100± 0
Change in Patient-reported Outcomes of PBT for Esophageal Cancer as Measured by the 4-Item Center for Epidemiological Studies Depression Scale (CES-D) Primary · Baseline, post completion of chemoradiation, 2 months, 4 months, 6 months, 9 months, and 12 months

The CES-D questionnaire is a 20-item measure which evaluates depressive symptoms. This trial will make use of the validated 4-item screening version in order to reduce participant burden. Possible range of scores is 0-60, with the higher scores indicating the presence of more symptomatology.

Baseline
GroupValue95% CI
Arm 1: Resectable (Proton Beam Therapy)19.763± 13.438
Arm 2: Unresectable (Proton Beam Therapy)16.355± 11.098
Post completion of chemoradiation
GroupValue95% CI
Arm 1: Resectable (Proton Beam Therapy)16.67± 7.287
Arm 2: Unresectable (Proton Beam Therapy)15.914± 11.118
2 months
GroupValue95% CI
Arm 1: Resectable (Proton Beam Therapy)12.47± 4.758
Arm 2: Unresectable (Proton Beam Therapy)14.15± 8.316
4 months
GroupValue95% CI
Arm 1: Resectable (Proton Beam Therapy)12.47± 5.845
Arm 2: Unresectable (Proton Beam Therapy)14.15± 10.184
6 months
GroupValue95% CI
Arm 1: Resectable (Proton Beam Therapy)11.21± 5.368
Arm 2: Unresectable (Proton Beam Therapy)11.21± 4.158
9 months
GroupValue95% CI
Arm 1: Resectable (Proton Beam Therapy)12.89± 5.052
Arm 2: Unresectable (Proton Beam Therapy)8.27± 0
12 months
GroupValue95% CI
Arm 1: Resectable (Proton Beam Therapy)12.843± 5.323
Arm 2: Unresectable (Proton Beam Therapy)8.27± 0
Physician-reported Toxicity of PBT for Esophageal Cancer Primary · Through 6 months following chemoradiation (estimated to be 9 months)

Number of participants with grade 3 or higher specific cardiac, metabolism/nutrition, gastrointestinal, respiratory/thoracic/mediastinal, and skin/subcutaneous toxicity using NCI Common Terminology Criteria for Adverse Events (CTCAE) version 4.03 related to PBT

GroupValue95% CI
Arm 1: Resectable (Proton Beam Therapy)2
Arm 2: Unresectable (Proton Beam Therapy)0
Change in Patient-reported Outcomes of PBT for Esophageal Cancer as Measured by the SF-12 Questionnaire - Mental Component Score Primary · Baseline, post completion of chemoradiation, 2 months, 4 months, and 6 months

The SF-12 will be measured at each of 7 interviews, and mental and physical component scores will be calculated in addition to calculating the measure's eight individual subscales (physical functioning, social functioning, role limitations due to physical problems, body pain, general health, role limitations due to emotional problems general health, vitality, and mental health). Higher scores indicate better quality of life. MCS scores from the SF-12 are recoded, weighted, and summed, and standardized by the SF-12 scoring procedure. SF-12 is a licensed product and this procedure is implemente

Baseline
GroupValue95% CI
Arm 1: Resectable (Proton Beam Therapy)45.0± 15.1
Arm 2: Unresectable (Proton Beam Therapy)44.5± 16.4
Post completion of chemoradiation
GroupValue95% CI
Arm 1: Resectable (Proton Beam Therapy)45.7± 9.6
Arm 2: Unresectable (Proton Beam Therapy)45.7± 13.0
2 months
GroupValue95% CI
Arm 1: Resectable (Proton Beam Therapy)50.9± 11.0
Arm 2: Unresectable (Proton Beam Therapy)45.3± 15.9
4 months
GroupValue95% CI
Arm 1: Resectable (Proton Beam Therapy)50.4± 10.2
Arm 2: Unresectable (Proton Beam Therapy)44.6± 12.3
6 months
GroupValue95% CI
Arm 1: Resectable (Proton Beam Therapy)50.8± 8.2
Arm 2: Unresectable (Proton Beam Therapy)54.7± 1.4
Change in Patient-reported Outcomes of PBT for Esophageal Cancer as Measured by the SF-12 Questionnaire - Physical Component Score Primary · Baseline, post completion of chemoradiation, 2 months, 4 months, and 6 months

The SF-12 will be measured at each of 7 interviews, and mental and physical component scores will be calculated in addition to calculating the measure's eight individual subscales (physical functioning, social functioning, role limitations due to physical problems, body pain, general health, role limitations due to emotional problems general health, vitality, and mental health). Higher scores indicate better quality of life. PCS scores from the SF-12 are recoded, weighted, and summed, and standardized by the SF-12 scoring procedure. SF-12 is a licensed product and this procedure is implemente

Baseline
GroupValue95% CI
Arm 1: Resectable (Proton Beam Therapy)45.8± 12.6
Arm 2: Unresectable (Proton Beam Therapy)41.9± 18.1
Post completion of chemoradiation
GroupValue95% CI
Arm 1: Resectable (Proton Beam Therapy)33.5± 10.5
Arm 2: Unresectable (Proton Beam Therapy)37.6± 11.4
2 months
GroupValue95% CI
Arm 1: Resectable (Proton Beam Therapy)40.4± 12.0
Arm 2: Unresectable (Proton Beam Therapy)39.4± 12.6
4 months
GroupValue95% CI
Arm 1: Resectable (Proton Beam Therapy)42.6± 13.3
Arm 2: Unresectable (Proton Beam Therapy)42.9± 14.2
6 months
GroupValue95% CI
Arm 1: Resectable (Proton Beam Therapy)42.3± 12.0
Arm 2: Unresectable (Proton Beam Therapy)51.9± 6.1
Change in Patient-reported Outcomes of PBT for Esophageal Cancer as Measured by the SF-12 Questionnaire - Physical Component Score Primary · Baseline, post completion of chemoradiation, 2 months, 4 months, 6 months, 9 months, and 12 months

The SF-12 will be measured at each of 7 interviews, and mental and physical component scores will be calculated in addition to calculating the measure's eight individual subscales (physical functioning, social functioning, role limitations due to physical problems, body pain, general health, role limitations due to emotional problems general health, vitality, and mental health). Higher scores indicate better quality of life. PCS scores from the SF-12 are recoded, weighted, and summed, and standardized by the SF-12 scoring procedure. SF-12 is a licensed product and this procedure is implemente

Baseline
GroupValue95% CI
Arm 1: Resectable (Proton Beam Therapy)45.8± 12.6
Arm 2: Unresectable (Proton Beam Therapy)41.9± 18.1
Post completion of chemoradiation
GroupValue95% CI
Arm 1: Resectable (Proton Beam Therapy)33.5± 10.5
Arm 2: Unresectable (Proton Beam Therapy)37.6± 11.4
2 months
GroupValue95% CI
Arm 1: Resectable (Proton Beam Therapy)40.4± 12.0
Arm 2: Unresectable (Proton Beam Therapy)39.4± 12.6
4 months
GroupValue95% CI
Arm 1: Resectable (Proton Beam Therapy)42.6± 13.3
Arm 2: Unresectable (Proton Beam Therapy)42.9± 14.2
6 months
GroupValue95% CI
Arm 1: Resectable (Proton Beam Therapy)42.3± 12.0
Arm 2: Unresectable (Proton Beam Therapy)51.9± 6.1
9 months
GroupValue95% CI
Arm 1: Resectable (Proton Beam Therapy)43.9± 9.8
Arm 2: Unresectable (Proton Beam Therapy)40.4± 17.6
12 months
GroupValue95% CI
Arm 1: Resectable (Proton Beam Therapy)42.1± 11.1
Arm 2: Unresectable (Proton Beam Therapy)39.8± 7.2

Adverse events — posted to ClinicalTrials.gov

Time frame: Adverse events are collected from start of treatment through 1 year. All-cause mortality is collected from start of treatment through 5 years.. Reporting threshold: 0%. Adverse-event reports describe events observed during the trial — not all are caused by the drug.

Arm 1: Resectable (Proton Beam Therapy)
Serious: 12/15 (80%)
Deaths: 8/15
Arm 2: Unresectable (Proton Beam Therapy)
Serious: 4/6 (67%)
Deaths: 4/6

Serious adverse events (31 terms)

ReactionSystemArm 1: Resectable (Proton …Arm 2: Unresectable (Proto…
Disease progressionNeoplasms benign, malignant and unspecified (incl cysts and polyps)
DysphagiaGastrointestinal disorders
SepsisInfections and infestations
DehydrationMetabolism and nutrition disorders
Generalized muscle weaknessMusculoskeletal and connective tissue disorders
Febrile neutropeniaBlood and lymphatic system disorders
Atrioventricular block first degreeCardiac disorders
Chest pain-cardiacCardiac disorders
Heart failureCardiac disorders
Pericardial effusionCardiac disorders
Pericardial tamponadeCardiac disorders
Abdominal distensionGastrointestinal disorders
Abdominal painGastrointestinal disorders
AscitesGastrointestinal disorders
EnterocolitisGastrointestinal disorders
EsophagitisGastrointestinal disorders
Gastric ulcerGastrointestinal disorders
Hemorrhoidal hemorrhageGastrointestinal disorders
Abdominal infectionInfections and infestations
COVID-19 infectionInfections and infestations
AnorexiaMetabolism and nutrition disorders
Back painMusculoskeletal and connective tissue disorders
ACE induced coughRespiratory, thoracic and mediastinal disorders
HypoxiaRespiratory, thoracic and mediastinal disorders
Pleural effusionRespiratory, thoracic and mediastinal disorders
Other adverse events (7 terms — click to expand)

ReactionSystemArm 1: Resectable (Proton …Arm 2: Unresectable (Proto…
DiarrheaGastrointestinal disorders
Gastric stenosisGastrointestinal disorders
Hepatitis viralInfections and infestations
SepsisInfections and infestations
Flank painMusculoskeletal and connective tissue disorders
AspirationRespiratory, thoracic and mediastinal disorders
DyspneaRespiratory, thoracic and mediastinal disorders

Most-reported serious reactions: Disease progression, Dysphagia, Sepsis, Dehydration, Generalized muscle weakness, Febrile neutropenia, Atrioventricular block first degree, Chest pain-cardiac.

Data from ClinicalTrials.gov NCT03482791 adverse events section.

Sponsor's own description

The investigators plan to include both operable and inoperable patients with esophagus cancer in this prospective trial. Since both proton and photon treatments are biologically equivalent, the investigators do not expect a difference in tumor control compared to intensity modulated radiation therapy (IMRT). The investigators have a prospective experience of physician-reported toxicity and patient outcome using IMRT for patients with inoperable esophagus cancer that will serve as a comparison group. For the resectable patients receiving trimodality therapy (chemoradiation followed by surgery), the investigators will carefully track toxicity and patient outcomes prospectively. The central hypothesis is that the biologic efficacy for tumor control should be similar between protons and photons, and therefore survival measures should be similar between the two groups, but that the main difference lies in the total severe toxicities experienced by the patients undergoing therapy.

Publications & conference data

1 peer-reviewed publication reference this trial (live from Europe PMC):

  1. The modern approach to esophagectomy-review of the shift towards minimally invasive surgery.
    Dolan DP, Swanson SJ. · · 2021 · cited 3× · PMID 34164535 · DOI 10.21037/atm.2020.03.143

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