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Clinical Trial Details — Status: Recruiting

Administrative data

NCT number NCT05554380
Other study ID # NCI-2022-07304
Secondary ID NCI-2022-07304EA
Status Recruiting
Phase Phase 2
First received
Last updated
Start date September 22, 2023
Est. completion date August 31, 2025

Study information

Verified date January 2024
Source National Cancer Institute (NCI)
Contact n/a
Is FDA regulated No
Health authority
Study type Interventional

Clinical Trial Summary

This phase II ComboMATCH treatment trial tests the usual treatment of chemotherapy (paclitaxel) plus ipatasertib in patients with solid tumor cancers that that cannot be removed by surgery (unresectable), has spread to nearby tissue or lymph nodes (locally advanced) or from where it first started (primary site) to other places in the body (metastatic), and has an AKT genetic change. Chemotherapy drugs, such as paclitaxel, work in different ways to stop the growth of tumor cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Targeted therapy, such as Ipatasertib, may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. The addition of ipatasertib to paclitaxel in solid tumors with an AKT genetic change could increase the percentage of tumors that shrink as well as lengthen the time that the tumors remain stable (without progression). Researchers hope to learn if paclitaxel plus ipatasertib will shrink this type of cancer or stop its growth.


Description:

PRIMARY OBJECTIVE: I. To assess the overall response rate (ORR) (confirmed and unconfirmed, complete, and partial) with the combination of paclitaxel plus ipatasertib in participants with advanced AKT-altered non-breast solid tumors who have previously progressed on taxane-based therapy SECONDARY OBJECTIVES: I. To assess the progression-free survival (PFS) in the study population. II. To assess the duration of response (DoR) in participants who respond to treatment. III. To assess the overall survival (OS) in the study population. IV. To evaluate the frequency and severity of toxicities related to the combination therapy. V. Collect tissue and provide it to the ComboMATCH Registration protocol to assess concordance between the diagnostic tumor mutation profile generated by the designated laboratories, the pre-treatment biopsy mutation profile, and the pre-treatment circulating tumor deoxyribonucleic acid (ctDNA) mutation profile from plasma, as described in ComboMATCH Registration protocol. For this treatment substudy, the outcome objective will be to report the proportion of cases providing sufficient tissue for that integrated scientific activity in the ComboMATCH Registration protocol. TRANSLATIONAL MEDICINE OBJECTIVES: I. To conduct whole exome sequencing (WES) and ribonucleic acid (RNA) sequencing (RNAseq) analysis of tumors at baseline (mandatory), as well as PTEN expression analysis of tumors at baseline (2nd priority after nucleic acid for WES and RNAseq). II. To explore changes in plasma AKT mutation allelic burden and other molecular findings at baseline (mandatory) and upon progression (optional) using ctDNA and correlate changes with response/resistance to therapy. III. To perform comprehensive protein expression and function analysis on fresh frozen specimens (optional) collected at baseline and at progression to assess determinants of response and resistance to therapy. OUTLINE: Patients receive paclitaxel intravenously (IV) on days 1, 8, and 15 and ipatasertib orally (PO) on days 1-21. Treatment repeats every 28 days for up to 35 cycles in the absence of disease progression or unacceptable toxicity. Patients undergo a computed tomography (CT) or magnetic resonance imaging (MRI) and blood collection throughout the trial. Patients also undergo a tumor biopsy during screening and follow-up. After completion of study treatment, patients are followed until death or 3 years after registration, whichever occurs first.


Recruitment information / eligibility

Status Recruiting
Enrollment 33
Est. completion date August 31, 2025
Est. primary completion date August 31, 2025
Accepts healthy volunteers No
Gender All
Age group 18 Years and older
Eligibility Inclusion Criteria: - Patient must have enrolled onto EAY191 and must have been given a treatment assignment to ComboMATCH to EAY191-S3 based on the presence of an actionable mutation as defined in EAY191 - GENERAL COMBOMATCH EAY191 REGISTRATION INCLUSION CRITERIA: - Participants must be enrolled on the ComboMATCH Master Registration Trial EAY191 - Participants must have an activating AKT mutation (a known mutation in AKT1, AKT2, or AKT3, a single nucleotide variant, insertion, or deletion) as determined by the ComboMATCH screening assessment - GENERAL COMBOMATCH EAY191 REGISTRATION EXCLUSION CRITERIA: - Participants must not have an activating KRAS, NRAS, HRAS, or BRAF mutation (a single nucleotide variant, insertion, or deletion) as determined by the ComboMATCH screening assessment - Participants must have disease that can be safely biopsied and agree to a pre-treatment biopsy or have archival tissue available from within 12 months prior to the date of registration on the ComboMATCH Registration Trial (EAY191) - Participants must have a histologically confirmed non-breast solid malignancy - Participants must have locally advanced, unresectable, or metastatic disease in the opinion of the treating investigator - Participants must have measurable disease documented by CT or MRI. Measurable disease must be assessed within 28 days prior to registration. Non-measurable disease must be assessed within 42 days prior to registration. The CT from a combined positron emission tomography (PET)/CT may be used only if it is of diagnostic quality. All known sites of disease must be assessed and documented on the Baseline Tumor Assessment Form (Response Evaluation Criteria in Solid Tumors [RECIST] 1.1). Participants whose only measurable disease is within a previous radiation therapy port must demonstrate clearly progressive disease (in the opinion of the treating investigator) prior to registration - Participants with known brain metastases must have a CT/MRI scan to evaluate for central nervous system (CNS) disease and show no evidence of progression within 42 days prior to registration - Participants must have completed any CNS-directed therapy and/or local therapy for spinal cord compression at least 28 days prior to registration - Participants must not have spinal cord compression or brain metastases unless: (1) metastases have been locally treated and have remained clinically controlled and asymptomatic for at least 14 days prior to registration, AND (2) participant has no residual neurological dysfunction and has been off corticosteroids for at least 24 hours prior to registration - Participants must not have leptomeningeal disease - Participants must have progressed within 6 months of taxane-based therapy in the neoadjuvant/adjuvant or metastatic setting - Participants must not have received any prior AKT inhibitor (e.g., capivasertib or ipatasertib); prior PI3K/mTOR inhibitor is acceptable - Participants must not be planning to receive any concurrent chemotherapy, immunotherapy, biologic, radiation, or hormonal therapy for cancer treatment while receiving treatment on this study - Participants must be >= 18 years of age - Participants must be able to swallow oral medications whole - Participants must have a pre-study history and physical exam done within 28 days prior to registration - Participants must have a Zubrod performance status of 0-2 within 28 days prior to registration - Participants must have adverse events resolved =< grade 1 related to any prior therapy, except alopecia within 14 days prior to registration - Participants with neuropathy must have resolved to < grade 2 within 14 days prior to registration - Leukocytes >= 3 x 10^3/uL (within 28 days prior to registration) - Absolute neutrophil count >= 1.5 x 10^3/uL (within 28 days prior to registration) - Platelets >= 100 x 10^3/uL (within 28 days prior to registration) - Total bilirubin =< institutional upper limit of normal (ULN) unless history of Gilbert's disease. Participants with history of Gilbert's disease must have total bilirubin =< 5 x institutional ULN (within 28 days prior to registration) - Aspartate aminotransferase (AST) & alanine aminotransferase (ALT) =< 3 x institutional ULN (within 28 days prior to registration) - Participants must have adequate cardiac function, class IIB (2B) or better. Participants with known history or current symptoms of cardiac disease, or history of treatment with cardiotoxic agents, must have a clinical risk assessment of cardiac function using the New York Heart Association Functional Classification - Participants must have a measured OR calculated creatinine clearance >= 50 mL/min using the following Cockcroft-Gault formula. This specimen must have been drawn within 28 days prior to registration - Participants with known human immunodeficiency virus (HIV)-infection must be receiving anti-retroviral therapy and have an undetectable viral load test on the most recent test results obtained within 6 months prior to registration - Participants with evidence of chronic hepatitis B virus (HBV) infection must have undetectable HBV viral load on suppressive therapy within 28 days prior to registration - Participants with a history of hepatitis C virus (HCV) infection must have been treated and cured. Participants with HCV infection who are currently on treatment must have an undetectable HCV viral load within 28 days prior to registration - Participants must have an electrocardiography (ECG) performed (if clinically indicated with a corrected QTc interval of =< 470 msec) within 28 days prior to registration - Participants must not have a history of allergic reactions attributed to compounds of similar chemical or biologic composition to ipatasertib and/or paclitaxel - Participants must not have an active small/large bowel inflammation such as ulcerative colitis or Crohn's disease - Participants must not have grade 2 or higher uncontrolled intercurrent illness - NOTE: To receive an agent, participant must not have any uncontrolled intercurrent illness requiring antibiotic/antiviral/antifungal therapy or interventional procedures. Participants with infections unlikely to be resolved within 2 weeks following registration should not be considered for the trial - Participants must not have a known grade 2 or higher uncontrolled or untreated hypercholesterolemia or hypertriglyceridemia - Participants must not have any of the following: - Cirrhosis at a level of Child-Pugh B (or worse), - Cirrhosis (any degree) and a history of hepatic encephalopathy, or - Clinically meaningful ascites resulting from cirrhosis. Clinically meaningful ascites is defined as ascites from cirrhosis requiring diuretics or paracentesis - Participants must not be receiving any medications or substances that are inhibitors or inducers of CYP3A. Treatment with strong CYP3A inhibitors or strong CYP3A inducers within 2 weeks or 5 drug-elimination half-lives, whichever is longer, prior to initiation of study drug is prohibited. - NOTE: Because the lists of these agents are constantly changing, it is important to regularly consult a frequently updated medical reference. As part of the enrollment/informed consent procedures, the participant will be counseled on the risk of interactions with other agents, and what to do if new medications need to be prescribed or if the participant is considering a new over-the-counter medicine or herbal product. The participant wallet card should be presented to the participant - Participants must not have baseline fasting glucose (after 8-hour fast) > 160 mg/dL (8.9 mmol/L) within 28 days prior to registration - Participants with known diabetes mellitus must not require insulin therapy or have a baseline fasting glucose >150 mg/dL (8.3 mmol/L) or high glycosylated hemoglobin (Hb)A1c, (>= 8.0%), suggesting poorly controlled diabetes - Participants who are on a stable dose of oral diabetes medication >= 2 weeks prior to initiation of study drug treatment are eligible for enrollment - Participants with a prior or concurrent malignancy whose natural history or treatment (in the opinion of the treating physician) must not have a potential to interfere with the safety or efficacy assessment of the investigational regimen - Participants must not have lung disease requiring active systemic therapy or placing participants at increased risk of toxicity related to study-directed therapy including, but not limited to pneumonitis, interstitial lung disease, idiopathic pulmonary fibrosis, cystic fibrosis, aspergillosis, active tuberculosis, or history of opportunistic infections (pneumocystis pneumonia or cytomegalovirus pneumonia) - Participants must not be pregnant or nursing. Individuals who are of reproductive potential must have agreed to use an effective contraceptive method with details provided as a part of the consent process. A person who has had menses at any time in the preceding 12 consecutive months or who has semen likely to contain sperm is of "reproductive potential". In addition to routine contraceptive methods, "effective contraception" also includes surgery intended to prevent pregnancy (or with a side-effect of pregnancy prevention) including hysterectomy, bilateral oophorectomy, bilateral tubal ligation/occlusion, and vasectomy with testing showing no sperm in the semen - Participants must not have psychiatric illness/social situations that would limit compliance with study requirements

Study Design


Related Conditions & MeSH terms

  • Locally Advanced Malignant Solid Neoplasm
  • Metastatic Malignant Solid Neoplasm
  • Neoplasms
  • Unresectable Malignant Solid Neoplasm

Intervention

Procedure:
Biopsy
Undergo tumor biopsy
Biospecimen Collection
Undergo blood collection
Computed Tomography
Undergo CT scan
Drug:
Ipatasertib
Given PO
Procedure:
Magnetic Resonance Imaging
Undergo MRI
Drug:
Paclitaxel
Given IV

Locations

Country Name City State
Puerto Rico Centro Comprensivo de Cancer de UPR San Juan
United States UPMC Altoona Altoona Pennsylvania
United States Community Hospital of Anaconda Anaconda Montana
United States Mission Cancer and Blood - Ankeny Ankeny Iowa
United States Saint Joseph Mercy Hospital Ann Arbor Michigan
United States PCR Oncology Arroyo Grande California
United States Duluth Clinic Ashland Ashland Wisconsin
United States UM Sylvester Comprehensive Cancer Center at Aventura Aventura Florida
United States UH Seidman Cancer Center at UH Avon Health Center Avon Ohio
United States Advocate Good Shepherd Hospital Barrington Illinois
United States UHHS-Chagrin Highlands Medical Center Beachwood Ohio
United States Strecker Cancer Center-Belpre Belpre Ohio
United States Sanford Joe Lueken Cancer Center Bemidji Minnesota
United States National Institutes of Health Clinical Center Bethesda Maryland
United States Billings Clinic Cancer Center Billings Montana
United States University of Alabama at Birmingham Cancer Center Birmingham Alabama
United States Sanford Bismarck Medical Center Bismarck North Dakota
United States Saint Alphonsus Cancer Care Center-Boise Boise Idaho
United States Saint Luke's Cancer Institute - Boise Boise Idaho
United States Bozeman Deaconess Hospital Bozeman Montana
United States Lafayette Family Cancer Center-EMMC Brewer Maine
United States Saint Joseph Mercy Brighton Brighton Michigan
United States Trinity Health IHA Medical Group Hematology Oncology - Brighton Brighton Michigan
United States Bryn Mawr Hospital Bryn Mawr Pennsylvania
United States Roswell Park Cancer Institute Buffalo New York
United States Aurora Cancer Care-Southern Lakes VLCC Burlington Wisconsin
United States Saint Alphonsus Cancer Care Center-Caldwell Caldwell Idaho
United States Aultman Health Foundation Canton Ohio
United States Saint Joseph Mercy Canton Canton Michigan
United States Trinity Health IHA Medical Group Hematology Oncology - Canton Canton Michigan
United States Saint Joseph Mercy Chelsea Chelsea Michigan
United States Trinity Health IHA Medical Group Hematology Oncology - Chelsea Hospital Chelsea Michigan
United States Advocate Illinois Masonic Medical Center Chicago Illinois
United States John H Stroger Jr Hospital of Cook County Chicago Illinois
United States University of Chicago Comprehensive Cancer Center Chicago Illinois
United States Adena Regional Medical Center Chillicothe Ohio
United States Case Western Reserve University Cleveland Ohio
United States Kootenai Health - Coeur d'Alene Coeur d'Alene Idaho
United States Mount Carmel East Hospital Columbus Ohio
United States The Mark H Zangmeister Center Columbus Ohio
United States Mercy Hospital Coon Rapids Minnesota
United States UM Sylvester Comprehensive Cancer Center at Coral Gables Coral Gables Florida
United States AMG Crystal Lake - Oncology Crystal Lake Illinois
United States Aurora Saint Luke's South Shore Cudahy Wisconsin
United States UPMC Western Maryland Cumberland Maryland
United States Carle at The Riverfront Danville Illinois
United States Dayton Physician LLC-Miami Valley Hospital North Dayton Ohio
United States Beaumont Hospital - Dearborn Dearborn Michigan
United States Essentia Health - Deer River Clinic Deer River Minnesota
United States UM Sylvester Comprehensive Cancer Center at Deerfield Beach Deerfield Beach Florida
United States Medical Oncology and Hematology Associates-Des Moines Des Moines Iowa
United States Mercy Medical Center - Des Moines Des Moines Iowa
United States Advocate Good Samaritan Hospital Downers Grove Illinois
United States Essentia Health Cancer Center Duluth Minnesota
United States Duke University Medical Center Durham North Carolina
United States Fairview Southdale Hospital Edina Minnesota
United States Swedish Cancer Institute-Edmonds Edmonds Washington
United States Carle Physician Group-Effingham Effingham Illinois
United States Advocate Sherman Hospital Elgin Illinois
United States UPMC Hillman Cancer Center Erie Erie Pennsylvania
United States Sanford Broadway Medical Center Fargo North Dakota
United States Sanford Roger Maris Cancer Center Fargo North Dakota
United States Beaumont Hospital - Farmington Hills Farmington Hills Michigan
United States Genesee Cancer and Blood Disease Treatment Center Flint Michigan
United States Genesee Hematology Oncology PC Flint Michigan
United States Genesys Hurley Cancer Institute Flint Michigan
United States Hurley Medical Center Flint Michigan
United States Saint Luke's Cancer Institute - Fruitland Fruitland Idaho
United States Aurora Health Care Germantown Health Center Germantown Wisconsin
United States Aurora Cancer Care-Grafton Grafton Wisconsin
United States Benefis Healthcare- Sletten Cancer Institute Great Falls Montana
United States Aurora BayCare Medical Center Green Bay Wisconsin
United States UPMC Cancer Centers - Arnold Palmer Pavilion Greensburg Pennsylvania
United States Advocate South Suburban Hospital Hazel Crest Illinois
United States Essentia Health Hibbing Clinic Hibbing Minnesota
United States M D Anderson Cancer Center Houston Texas
United States Swedish Cancer Institute-Issaquah Issaquah Washington
United States Kalispell Regional Medical Center Kalispell Montana
United States Aurora Cancer Care-Kenosha South Kenosha Wisconsin
United States Kettering Medical Center Kettering Ohio
United States Kingman Regional Medical Center Kingman Arizona
United States Gundersen Lutheran Medical Center La Crosse Wisconsin
United States Fairfield Medical Center Lancaster Ohio
United States University of Michigan Health - Sparrow Lansing Lansing Michigan
United States OptumCare Cancer Care at Charleston Las Vegas Nevada
United States OptumCare Cancer Care at Fort Apache Las Vegas Nevada
United States University of Kentucky/Markey Cancer Center Lexington Kentucky
United States AMG Libertyville - Oncology Libertyville Illinois
United States Condell Memorial Hospital Libertyville Illinois
United States Trinity Health Saint Mary Mercy Livonia Hospital Livonia Michigan
United States Great Lakes Cancer Management Specialists-Macomb Medical Campus Macomb Michigan
United States University of Wisconsin Carbone Cancer Center Madison Wisconsin
United States Aurora Bay Area Medical Group-Marinette Marinette Wisconsin
United States Memorial Hospital Marysville Ohio
United States Carle Physician Group-Mattoon/Charleston Mattoon Illinois
United States UPMC Hillman Cancer Center at Rocco And Nancy Ortenzio Cancer Pavilion Mechanicsburg Pennsylvania
United States Riddle Memorial Hospital Media Pennsylvania
United States UH Seidman Cancer Center at Lake Health Mentor Campus Mentor Ohio
United States Saint Luke's Cancer Institute - Meridian Meridian Idaho
United States UM Sylvester Comprehensive Cancer Center at Kendall Miami Florida
United States University of Miami Miller School of Medicine-Sylvester Cancer Center Miami Florida
United States Aurora Cancer Care-Milwaukee Milwaukee Wisconsin
United States Aurora Saint Luke's Medical Center Milwaukee Wisconsin
United States Aurora Sinai Medical Center Milwaukee Wisconsin
United States Abbott-Northwestern Hospital Minneapolis Minnesota
United States Community Medical Hospital Missoula Montana
United States University of South Alabama Mitchell Cancer Institute Mobile Alabama
United States UPMC Hillman Cancer Center - Monroeville Monroeville Pennsylvania
United States Knox Community Hospital Mount Vernon Ohio
United States Saint Alphonsus Cancer Care Center-Nampa Nampa Idaho
United States Saint Luke's Cancer Institute - Nampa Nampa Idaho
United States UC Comprehensive Cancer Center at Silver Cross New Lenox Illinois
United States Mount Sinai Hospital New York New York
United States Licking Memorial Hospital Newark Ohio
United States Providence Newberg Medical Center Newberg Oregon
United States Advocate Christ Medical Center Oak Lawn Illinois
United States University of Oklahoma Health Sciences Center Oklahoma City Oklahoma
United States Saint Alphonsus Medical Center-Ontario Ontario Oregon
United States Saint Joseph Hospital - Orange Orange California
United States Providence Willamette Falls Medical Center Oregon City Oregon
United States University of Chicago Medicine-Orland Park Orland Park Illinois
United States Vince Lombardi Cancer Clinic - Oshkosh Oshkosh Wisconsin
United States Stanford Cancer Institute Palo Alto Palo Alto California
United States Paoli Memorial Hospital Paoli Pennsylvania
United States Advocate Lutheran General Hospital Park Ridge Illinois
United States Mercy Health Perrysburg Cancer Center Perrysburg Ohio
United States Thomas Jefferson University Hospital Philadelphia Pennsylvania
United States University of Pittsburgh Cancer Institute (UPCI) Pittsburgh Pennsylvania
United States UPMC-Passavant Hospital Pittsburgh Pennsylvania
United States UM Sylvester Comprehensive Cancer Center at Plantation Plantation Florida
United States Providence Portland Medical Center Portland Oregon
United States Providence Saint Vincent Medical Center Portland Oregon
United States Southern Ohio Medical Center Portsmouth Ohio
United States Kootenai Clinic Cancer Services - Post Falls Post Falls Idaho
United States Aurora Cancer Care-Racine Racine Wisconsin
United States Valley Medical Center Renton Washington
United States VCU Massey Cancer Center at Stony Point Richmond Virginia
United States Virginia Cancer Institute Richmond Virginia
United States Virginia Commonwealth University/Massey Cancer Center Richmond Virginia
United States Mayo Clinic in Rochester Rochester Minnesota
United States William Beaumont Hospital-Royal Oak Royal Oak Michigan
United States Park Nicollet Clinic - Saint Louis Park Saint Louis Park Minnesota
United States Regions Hospital Saint Paul Minnesota
United States United Hospital Saint Paul Minnesota
United States Kootenai Cancer Clinic Sandpoint Idaho
United States Essentia Health Sandstone Sandstone Minnesota
United States Saint John's Cancer Institute Santa Monica California
United States Swedish Medical Center-First Hill Seattle Washington
United States Vince Lombardi Cancer Clinic-Sheboygan Sheboygan Wisconsin
United States Sanford Cancer Center Oncology Clinic Sioux Falls South Dakota
United States Sanford USD Medical Center - Sioux Falls Sioux Falls South Dakota
United States VCU Community Memorial Health Center South Hill Virginia
United States Springfield Regional Cancer Center Springfield Ohio
United States Springfield Regional Medical Center Springfield Ohio
United States Aurora Medical Center in Summit Summit Wisconsin
United States Mercy Health - Saint Anne Hospital Toledo Ohio
United States William Beaumont Hospital - Troy Troy Michigan
United States Saint Luke's Cancer Institute - Twin Falls Twin Falls Idaho
United States Vince Lombardi Cancer Clinic-Two Rivers Two Rivers Wisconsin
United States Carle Cancer Center Urbana Illinois
United States Essentia Health Virginia Clinic Virginia Minnesota
United States Aurora Cancer Care-Milwaukee West Wauwatosa Wisconsin
United States Aurora West Allis Medical Center West Allis Wisconsin
United States Saint Ann's Hospital Westerville Ohio
United States Lankenau Medical Center Wynnewood Pennsylvania
United States North Star Lodge Cancer Center at Yakima Valley Memorial Hospital Yakima Washington
United States Huron Gastroenterology PC Ypsilanti Michigan
United States Trinity Health IHA Medical Group Hematology Oncology Ann Arbor Campus Ypsilanti Michigan
United States Genesis Healthcare System Cancer Care Center Zanesville Ohio

Sponsors (1)

Lead Sponsor Collaborator
National Cancer Institute (NCI)

Countries where clinical trial is conducted

United States,  Puerto Rico, 

Outcome

Type Measure Description Time frame Safety issue
Primary Objective response rate (ORR) The proportion of participants who have a partial or complete response (confirmed or unconfirmed) as best response. Up to 3 years
Secondary Progression free survival Response rates and associated confidence intervals will be calculated. Will be estimated using the method of Kaplan-Meier. The Brookmeyer-Crowley method will be used to calculate confidence intervals for median times. From date of registration to date of first documentation of progression or symptomatic deterioration, or death due to any cause, assessed up to 3 years
Secondary Overall survival Response rates and associated confidence intervals will be calculated. Will be estimated using the method of Kaplan-Meier. The Brookmeyer-Crowley method will be used to calculate confidence intervals for median times. From date of registration to date of death due to any cause, assessed up to 3 years
Secondary Duration of response Response rates and associated confidence intervals will be calculated. Will be estimated using the method of Kaplan-Meier. The Brookmeyer-Crowley method will be used to calculate confidence intervals for median times. From date of first documentation of response (complete response, partial response, confirmed or unconfirmed) to date of first documentation of progression or symptomatic deterioration, or death due to any cause, assessed up to 3 years
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