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Paclitaxel Albumin-Stabilized Nanoparticle Formulation, Gemcitabine, and Bevacizumab in Treating Patients With Metastatic Breast Cancer

2017년 3월 6일 업데이트: Alliance for Clinical Trials in Oncology

Phase II Trial of Albumin-Bound Paclitaxel in Combination With Gemcitabine and Bevacizumab in Patients With Metastatic Breast Cancer

RATIONALE: Drugs used in chemotherapy, such as gemcitabine and paclitaxel albumin-stabilized nanoparticle formulation, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Monoclonal antibodies, such as bevacizumab, can block tumor growth in different ways. Some block the ability of tumor cells to grow and spread. Others find tumor cells and help kill them or carry tumor-killing substances to them. Giving combination chemotherapy together with bevacizumab may kill more tumor cells.

PURPOSE: This phase II trial is studying how well giving paclitaxel albumin-stabilized nanoparticle formulation and gemcitabine together with bevacizumab works in treating patients with metastatic breast cancer.

연구 개요

상세 설명

OBJECTIVES:

Primary

  • To determine the 6-month progression-free survival rate of patients with metastatic breast cancer treated with paclitaxel albumin-stabilized nanoparticle formulation, gemcitabine hydrochloride, and bevacizumab.

Secondary

  • To determine the overall survival of patients treated with this regimen.
  • To determine the progression-free survival of patients treated with this regimen.
  • To determine the confirmed response rate in patients treated with this regimen.
  • To determine the duration of response in patients treated with this regimen.
  • To determine the time to treatment failure in patients treated with this regimen.
  • To determine the quality of life of patients treated with this regimen.

OUTLINE: Patients receive paclitaxel albumin-stabilized nanoparticle formulation IV over 30 minutes and gemcitabine hydrochloride IV over 30 minutes on days 1 and 8, and bevacizumab IV over 30-90 minutes on day 1. Courses repeat every 21 days in the absence of disease progression or unacceptable toxicity.

Quality of life is assessed at baseline and after every other course, and then after completion of treatment.

After completion of study treatment, patients are followed periodically for 5 years.

연구 유형

중재적

등록 (실제)

50

단계

  • 2 단계

연락처 및 위치

이 섹션에서는 연구를 수행하는 사람들의 연락처 정보와 이 연구가 수행되는 장소에 대한 정보를 제공합니다.

연구 장소

    • Arizona
      • Scottsdale, Arizona, 미국, 85259-5499
        • Mayo Clinic Scottsdale
    • Connecticut
      • Hartford, Connecticut, 미국, 06105
        • Saint Francis/Mount Sinai Regional Cancer Center at Saint Francis Hospital and Medical Center
    • Florida
      • Jacksonville, Florida, 미국, 32224
        • Mayo Clinic - Jacksonville
    • Indiana
      • Beech Grove, Indiana, 미국, 46107
        • St. Francis Hospital and Health Centers - Beech Grove Campus
      • Richmond, Indiana, 미국, 47374
        • Reid Hospital & Health Care Services
    • Iowa
      • Cedar Rapids, Iowa, 미국, 52403
        • Cedar Rapids Oncology Associates
      • Cedar Rapids, Iowa, 미국, 52403
        • Mercy Regional Cancer Center at Mercy Medical Center
      • Clive, Iowa, 미국, 50325
        • Medical Oncology and Hematology Associates - West Des Moines
      • Des Moines, Iowa, 미국, 50309
        • CCOP - Iowa Oncology Research Association
      • Des Moines, Iowa, 미국, 50309
        • John Stoddard Cancer Center at Iowa Methodist Medical Center
      • Des Moines, Iowa, 미국, 50309
        • Medical Oncology and Hematology Associates at John Stoddard Cancer Center
      • Des Moines, Iowa, 미국, 50314
        • Medical Oncology and Hematology Associates at Mercy Cancer Center
      • Des Moines, Iowa, 미국, 50314
        • Mercy Cancer Center at Mercy Medical Center - Des Moines
      • Des Moines, Iowa, 미국, 50316
        • John Stoddard Cancer Center at Iowa Lutheran Hospital
      • Mason City, Iowa, 미국, 50401
        • Mercy Cancer Center at Mercy Medical Center - North Iowa
      • Ottumwa, Iowa, 미국, 52501
        • McCreery Cancer Center at Ottumwa Regional
      • Sioux City, Iowa, 미국, 51101
        • Siouxland Hematology-Oncology Associates, LLP
      • Sioux City, Iowa, 미국, 51104
        • St. Luke's Regional Medical Center
      • Sioux City, Iowa, 미국, 51104
        • Mercy Medical Center - Sioux City
    • Michigan
      • Ann Arbor, Michigan, 미국, 48106-0995
        • Saint Joseph Mercy Cancer Center
      • Ann Arbor, Michigan, 미국, 48106
        • CCOP - Michigan Cancer Research Consortium
      • Battle Creek, Michigan, 미국, 49017
        • Battle Creek Health System Cancer Care Center
      • Big Rapids, Michigan, 미국, 49307
        • Mecosta County Medical Center
      • Dearborn, Michigan, 미국, 48123-2500
        • Oakwood Cancer Center at Oakwood Hospital and Medical Center
      • Flint, Michigan, 미국, 48503
        • Hurley Medical Center
      • Flint, Michigan, 미국, 48503
        • Genesys Hurley Cancer Institute
      • Grand Rapids, Michigan, 미국, 49503
        • Butterworth Hospital at Spectrum Health
      • Grand Rapids, Michigan, 미국, 49503
        • CCOP - Grand Rapids
      • Grand Rapids, Michigan, 미국, 49503
        • Lacks Cancer Center at Saint Mary's Health Care
      • Grosse Pointe Woods, Michigan, 미국, 48236
        • Van Elslander Cancer Center at St. John Hospital and Medical Center
      • Jackson, Michigan, 미국, 49201
        • Foote Memorial Hospital
      • Lansing, Michigan, 미국, 48912-1811
        • Sparrow Regional Cancer Center
      • Livonia, Michigan, 미국, 48154
        • St. Mary Mercy Hospital
      • Muskegon, Michigan, 미국, 49443
        • Mercy General Health Partners
      • Pontiac, Michigan, 미국, 48341-2985
        • St. Joseph Mercy Oakland
      • Port Huron, Michigan, 미국, 48060
        • Mercy Regional Cancer Center at Mercy Hospital
      • Saginaw, Michigan, 미국, 48601
        • Seton Cancer Institute at Saint Mary's - Saginaw
      • Traverse City, Michigan, 미국, 49684
        • Munson Medical Center
      • Warren, Michigan, 미국, 48093
        • St. John Macomb Hospital
      • Wyoming, Michigan, 미국, 49519
        • Metro Health Hospital
    • Minnesota
      • Alexandria, Minnesota, 미국, 56308
      • Burnsville, Minnesota, 미국, 55337
        • Fairview Ridges Hospital
      • Coon Rapids, Minnesota, 미국, 55433
        • Mercy and Unity Cancer Center at Mercy Hospital
      • Duluth, Minnesota, 미국, 55805
        • CCOP - Duluth
      • Duluth, Minnesota, 미국, 55805-1983
        • Duluth Clinic Cancer Center - Duluth
      • Duluth, Minnesota, 미국, 55805
        • Miller - Dwan Medical Center
      • Edina, Minnesota, 미국, 55435
        • Fairview Southdale Hospital
      • Fridley, Minnesota, 미국, 55432
        • Mercy and Unity Cancer Center at Unity Hospital
      • Hutchinson, Minnesota, 미국, 55350
        • Hutchinson Area Health Care
      • Maplewood, Minnesota, 미국, 55109
        • Minnesota Oncology Hematology, PA - Maplewood
      • Maplewood, Minnesota, 미국, 55109
        • HealthEast Cancer Care at St. John's Hospital
      • Minneapolis, Minnesota, 미국, 55407
        • Virginia Piper Cancer Institute at Abbott - Northwestern Hospital
      • Minneapolis, Minnesota, 미국, 55415
        • Hennepin County Medical Center - Minneapolis
      • Robbinsdale, Minnesota, 미국, 55422-2900
        • Hubert H. Humphrey Cancer Center at North Memorial Outpatient Center
      • Rochester, Minnesota, 미국, 55905
        • Mayo Clinic Cancer Center
      • Saint Cloud, Minnesota, 미국, 56303
        • CentraCare Clinic - River Campus
      • Saint Cloud, Minnesota, 미국, 56303
        • Coborn Cancer Center
      • Saint Louis Park, Minnesota, 미국, 55416
        • CCOP - Metro-Minnesota
      • Saint Louis Park, Minnesota, 미국, 55416
        • Park Nicollet Cancer Center
      • Saint Paul, Minnesota, 미국, 55102
        • United Hospital
      • Shakopee, Minnesota, 미국, 55379
        • St. Francis Cancer Center at St. Francis Medical Center
      • St. Paul, Minnesota, 미국, 55101
        • Regions Hospital Cancer Care Center
      • Waconia, Minnesota, 미국, 55387
        • Ridgeview Medical Center
      • Willmar, Minnesota, 미국, 56201
        • Willmar Cancer Center at Rice Memorial Hospital
      • Woodbury, Minnesota, 미국, 55125
        • Minnesota Oncology Hematology, PA - Woodbury
    • Montana
      • Great Falls, Montana, 미국, 59405-5309
        • Big Sky Oncology
      • Great Falls, Montana, 미국, 59405
        • Sletten Cancer Institute at Benefis Healthcare
    • Nebraska
      • Lincoln, Nebraska, 미국, 68510
        • Cancer Resource Center - Lincoln
      • Omaha, Nebraska, 미국, 68106
        • CCOP - Missouri Valley Cancer Consortium
      • Omaha, Nebraska, 미국, 68122
        • Immanuel Medical Center
      • Omaha, Nebraska, 미국, 68124
        • Alegant Health Cancer Center at Bergan Mercy Medical Center
      • Omaha, Nebraska, 미국, 68131-2197
        • Creighton University Medical Center
    • North Dakota
      • Bismarck, North Dakota, 미국, 58501
        • Bismarck Cancer Center
      • Bismarck, North Dakota, 미국, 58501
        • Medcenter One Hospital Cancer Care Center
      • Bismarck, North Dakota, 미국, 58501
        • Mid Dakota Clinic, PC
      • Bismarck, North Dakota, 미국, 58502
        • St. Alexius Medical Center Cancer Center
    • Ohio
      • Dayton, Ohio, 미국, 45405
        • Grandview Hospital
      • Dayton, Ohio, 미국, 45406
        • Good Samaritan Hospital
      • Dayton, Ohio, 미국, 45409
        • David L. Rike Cancer Center at Miami Valley Hospital
      • Dayton, Ohio, 미국, 45415
        • Samaritan North Cancer Care Center
      • Dayton, Ohio, 미국, 45420
        • CCOP - Dayton
      • Findlay, Ohio, 미국, 45840
        • Blanchard Valley Medical Associates
      • Franklin, Ohio, 미국, 45005-1066
        • Middletown Regional Hospital
      • Greenville, Ohio, 미국, 45331
        • Wayne Hospital
      • Kettering, Ohio, 미국, 45429
        • Charles F. Kettering Memorial Hospital
      • Troy, Ohio, 미국, 45373-1300
        • UVMC Cancer Care Center at Upper Valley Medical Center
      • Wilmington, Ohio, 미국, 45177
        • Clinton Memorial Hospital
      • Xenia, Ohio, 미국, 45385
        • Ruth G. McMillan Cancer Center at Greene Memorial Hospital
    • Oklahoma
      • Tulsa, Oklahoma, 미국, 74136
        • Natalie Warren Bryant Cancer Center at St. Francis Hospital
    • Pennsylvania
      • Allentown, Pennsylvania, 미국, 18105
        • Morgan Cancer Center at Lehigh Valley Hospital - Cedar Crest
    • South Dakota
      • Sioux Falls, South Dakota, 미국, 57105
        • Medical X-Ray Center, PC
      • Sioux Falls, South Dakota, 미국, 57117-5039
        • Sanford Cancer Center at Sanford USD Medical Center

참여기준

연구원은 적격성 기준이라는 특정 설명에 맞는 사람을 찾습니다. 이러한 기준의 몇 가지 예는 개인의 일반적인 건강 상태 또는 이전 치료입니다.

자격 기준

공부할 수 있는 나이

18년 이상 (성인, 고령자)

건강한 자원 봉사자를 받아들입니다

아니

연구 대상 성별

모두

설명

DISEASE CHARACTERISTICS:

  • Histologically or cytologically confirmed infiltrating breast cancer

    • Clinical evidence of metastatic disease
  • Measurable disease, defined as at least one measurable lesion per RECIST criteria

    • No non-measurable disease only, defined as all other lesions, including small lesions (longest diameter < 2 cm) and truly non-measurable lesions, including any of the following:

      • Bone lesions
      • Leptomeningeal disease
      • Ascites
      • Pleural/pericardial effusion
      • Inflammatory breast disease
      • Lymphangitis cutis/pulmonis
      • Abdominal masses that are not confirmed and followed by imaging techniques
      • Cystic lesions
  • Patients with HER-2/neu positive tumors, must have received prior treatment with trastuzumab (Herceptin®) or have a contraindication for trastuzumab
  • No evidence of active brain metastasis, including leptomeningeal involvement, on MRI or CT scan

    • CNS metastasis controlled by prior surgery and/or radiotherapy allowed

      • Must be asymptomatic for ≥ 2 months with no evidence of progression prior to study entry
  • Hormone receptor status not specified

PATIENT CHARACTERISTICS:

  • Menopausal status not specified
  • Life expectancy ≥ 12 weeks
  • ECOG performance status 0-1
  • ANC ≥ 1,500/mm³
  • Platelet count ≥ 100,000/mm³
  • Hemoglobin ≥ 9.0 g/dL
  • AST and ALT ≤ 2.5 times upper limit of normal (ULN)
  • Alkaline phosphatase ≤ 2.5 times ULN
  • Total bilirubin ≤ 1.5 times ULN
  • Creatinine ≤ 1.5 mg/dL
  • Urine protein:creatinine ratio < 1 or urinalysis < 1+ protein

    • Patients discovered to have ≥ 1+ proteinuria at baseline must demonstrate 24-hour urine protein < 1 g
  • Not pregnant or nursing
  • Negative pregnancy test
  • Fertile patients must use effective contraception during and for 30 days after completion of study therapy
  • Able to complete questionnaires alone or with assistance
  • No peripheral neuropathy > grade 1
  • No history of allergy or hypersensitivity to albumin-bound paclitaxel, paclitaxel, gemcitabine hydrochloride, bevacizumab, albumin, drug product excipients, or chemically similar agents
  • No stage III or IV invasive, non-breast malignancy within the past 5 years
  • No other active malignancy, except nonmelanoma skin cancer or carcinoma in situ of the cervix

    • Patient must not be receiving other specific treatment for a prior malignancy
  • No uncontrolled hypertension (i.e., blood pressure [BP] > 160/90 mm Hg on ≥ 2 occasions at least 5 minutes apart)

    • Patients who have recently started or adjusted antihypertensive medications are eligible providing that BP is < 140/90 mm Hg on any new regimen for ≥ 3 different observations in ≥ 14 days
  • No bleeding diathesis or uncontrolled coagulopathy
  • No hemoptysis within the past 6 months
  • No prior arterial or venous thrombosis within the past 12 months
  • No history of cerebrovascular accident
  • No history of hypertensive crisis or hypertensive encephalopathy
  • No abdominal fistula or gastrointestinal perforation within the past 6 months
  • No serious non-healing wound, ulcer, or fracture
  • No clinically significant cardiac disease, defined as any of the following:

    • Congestive heart failure
    • Symptomatic coronary artery disease
    • Unstable angina
    • Cardiac arrhythmias not well controlled with medication
    • Myocardial infarction within the past 12 months
  • No comorbid systemic illnesses or other severe concurrent disease which, in the judgment of the investigator, would make the patient inappropriate for study entry or interfere significantly with the proper assessment of safety and toxicity of the prescribed regimens

PRIOR CONCURRENT THERAPY:

  • See Disease Characteristics
  • No prior chemotherapy for metastatic disease

    • May have received one prior adjuvant chemotherapy regimen
  • Prior neoadjuvant chemotherapy allowed

    • More than 6 months since prior adjuvant or neoadjuvant taxane (i.e., docetaxel or paclitaxel) therapy
  • Prior hormonal therapy in either adjuvant or metastatic setting allowed
  • More than 4 weeks since prior radiotherapy (except if to a non-target lesion only, or single dose radiation for palliation)

    • Prior radiotherapy to a target lesion is allowed provided there has been clear progression of the lesion since radiotherapy was completed
  • More than 4 weeks since prior cytotoxic chemotherapeutic agent or investigational drug
  • More than 2 weeks since prior and no concurrent acetylsalicylic acid, anticoagulants, or thrombolytic agents (except for once-daily 81 mg acetylsalicylic acid)
  • More than 6 weeks since prior major surgery, chemotherapy, or immunologic therapy
  • More than 1 week since prior minor surgery (e.g., core biopsy)

    • Placement of a vascular access device within 7 days is allowed
  • More than 3 months since prior neurosurgery
  • No concurrent treatment in a different clinical study in which investigational procedures are performed or investigational therapies are administered

    • Trials related to symptom management (Cancer Control) which do not employ hormonal treatments or treatments that may block the path of the targeted agents used in this study may be allowed

공부 계획

이 섹션에서는 연구 설계 방법과 연구가 측정하는 내용을 포함하여 연구 계획에 대한 세부 정보를 제공합니다.

연구는 어떻게 설계됩니까?

디자인 세부사항

  • 주 목적: 치료
  • 할당: 해당 없음
  • 중재 모델: 단일 그룹 할당
  • 마스킹: 없음(오픈 라벨)

무기와 개입

참가자 그룹 / 팔
개입 / 치료
실험적: paclitaxel + gemcitabine + bevacizumab

Patients receive paclitaxel albumin-stabilized nanoparticle formulation IV over 30 minutes and gemcitabine hydrochloride IV over 30 minutes on days 1 and 8, and bevacizumab IV over 30-90 minutes on day 1. Courses repeat every 21 days in the absence of disease progression or unacceptable toxicity.

Quality of life is assessed at baseline and after every other course, and then after completion of treatment.

After completion of study treatment, patients are followed periodically for 5 years.

연구는 무엇을 측정합니까?

주요 결과 측정

결과 측정
측정값 설명
기간
6-month Progression-free Survival (PFS) Rate
기간: at 6 months
The primary endpoint of this trial is the 6-month progression-free survival rate. A patient is considered to be a 6-month progression-free survivor if the patient is 6 months from registration without a documentation of disease progression (note, the patient need not be on study treatment at 6 months to be considered a success). The proportion of successes will be estimated by the number of successes divided by the total number of evaluable patients. Confidence intervals for the true success proportion will be calculated using the properties of the binomial distribution. Progression is defined using the RECIST Criteria, as at least a 20% increase in the sum of longest diameter (LD) of target lesions taking as reference the smallest sum LD recorded since the treatment started or the appearance of one or more new lesions, appearance of one or more new lesions, or unequivocal progression of existing non-target lesions.
at 6 months

2차 결과 측정

결과 측정
측정값 설명
기간
Overall Survival Time
기간: Up to 5 years
Overall Survival time is defined as the time from registration to death due to any cause. The distribution of survival time will be estimated using the method of Kaplan-Meier (1958).
Up to 5 years
PFS Time
기간: Up to 5 years
Progression-free survival time is defined as the time from registration to the earliest date of documentation of disease progression. If a patient dies without a documentation of disease progression the patient will be considered to have had disease progression at the time of their death. The distribution of time to progression will be estimated using the method of Kaplan-Meier (1958). Progression is defined using the RECIST Criteria, as at least a 20% increase in the sum of longest diameter (LD) of target lesions taking as reference the smallest sum LD recorded since the treatment started or the appearance of one or more new lesions, appearance of one or more new lesions, or unequivocal progression of existing non-target lesions.
Up to 5 years
Confirmed Response (Complete or Partial Response) Rate
기간: Up to 5 years
A confirmed response is defined to be either a complete response (CR) or partial response (PR) noted as the objective status on 2 consecutive evaluations at least 8 weeks apart. The confirmed response rate (percentage) will be estimated by the number of confirmed responses in evaluable patients divided by the total number of evaluable patients multiplied by 100. The appropriate confidence interval will be calculated based on the binomial distribution.
Up to 5 years
Duration of Response
기간: Up to 5 years
Duration of response is defined for all evaluable patients who have achieved a confirmed response as the date at which the patient's earliest best objective status is first noted to be either a CR or PR to the earliest date progression is documented. If a patient dies subsequent to the confirmed response without a documentation of disease progression, the patient will be considered to have had disease progression at the time of their death. In the case of a patient failing to return for evaluations before a documentation of disease progression, the patient will be censored for progression on the date of last evaluation. The distribution of duration of response will be estimated using the method of Kaplan-Meier (1958).
Up to 5 years
Time to Treatment Failure
기간: Up to 5 years
Time to treatment failure is defined to be the time from the date of registration to the date at which the patient is removed from treatment due to progression, adverse events, or refusal. If the patient is considered to be a major treatment violation or is taken off study as a non-protocol failure, the patient will be censored on the date they were removed from treatment. The distribution of time to treatment failure will be estimated using the method of Kaplan-Meier (1958). Progression is defined using the RECIST Criteria, as at least a 20% increase in the sum of longest diameter (LD) of target lesions taking as reference the smallest sum LD recorded since the treatment started or the appearance of one or more new lesions, appearance of one or more new lesions, or unequivocal progression of existing non-target lesions.
Up to 5 years
Quality of Life, as Measure by the Mean Change in FACT-B TOI Score at Cycle 8
기간: From baseline to end of Cycle 8; Up to 24 weeks

Quality of life (QOL) as measured by the mean change (from baseline) in FACT-B (TOI) Trial Outcome Index at Cycle 8 (24 weeks). FACT-B was scored according to the published scoring (*) criteria with higher scores representing better QOL. The FACT-B TOI was the sum of the following FACT-B subscale/scale scores: physical (score range 0-28), functional (score range 0-28), and Breast Cancer Subscale (score range 0-40); range of the FACT-B TOI is 0-96 (the change scores have a possible range of -96 to 96). The mean change and 95% confidence interval are reported below. A one-sample t-test is used to compare the change from baseline to a value of 0.

(*)= Brady MJ, Cella DF, Mo F, Bonomi AE, Tulsky DS, Lloyd SR, Deasy S, Cobleigh M, Shiomoto G. Reliability and validity of the Functional Assessment of Cancer Therapy-Breast (FACT-B) quality of life instrument. J Clin Oncol 1997;15:974-986.

From baseline to end of Cycle 8; Up to 24 weeks

공동 작업자 및 조사자

여기에서 이 연구와 관련된 사람과 조직을 찾을 수 있습니다.

수사관

  • 연구 의자: Donald W. Northfelt, MD, FACP, Mayo Clinic

간행물 및 유용한 링크

연구에 대한 정보 입력을 담당하는 사람이 자발적으로 이러한 간행물을 제공합니다. 이것은 연구와 관련된 모든 것에 관한 것일 수 있습니다.

일반 간행물

  • Northfelt DW, Dueck AC, Flynn TP, et al.: Phase II trial combining nab-paclitaxel (NP), gemcitabine (G), and bevacizumab (B) in patients (pts) with metastatic breast cancer (MBC): NCCTG N0735. [Abstract] J Clin Oncol 29 (Suppl 15): A-1126, 2011.

연구 기록 날짜

이 날짜는 ClinicalTrials.gov에 대한 연구 기록 및 요약 결과 제출의 진행 상황을 추적합니다. 연구 기록 및 보고된 결과는 공개 웹사이트에 게시되기 전에 특정 품질 관리 기준을 충족하는지 확인하기 위해 국립 의학 도서관(NLM)에서 검토합니다.

연구 주요 날짜

연구 시작

2008년 11월 1일

기본 완료 (실제)

2010년 8월 1일

연구 완료 (실제)

2013년 8월 1일

연구 등록 날짜

최초 제출

2008년 4월 18일

QC 기준을 충족하는 최초 제출

2008년 4월 18일

처음 게시됨 (추정)

2008년 4월 21일

연구 기록 업데이트

마지막 업데이트 게시됨 (실제)

2017년 4월 17일

QC 기준을 충족하는 마지막 업데이트 제출

2017년 3월 6일

마지막으로 확인됨

2017년 3월 1일

추가 정보

이 정보는 변경 없이 clinicaltrials.gov 웹사이트에서 직접 가져온 것입니다. 귀하의 연구 세부 정보를 변경, 제거 또는 업데이트하도록 요청하는 경우 register@clinicaltrials.gov. 문의하십시오. 변경 사항이 clinicaltrials.gov에 구현되는 즉시 저희 웹사이트에도 자동으로 업데이트됩니다. .

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