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  • 1
    In: Global Spine Journal, SAGE Publications, Vol. 13, No. 7 ( 2023-09), p. 2007-2015
    Abstract: Questionnaire-based survey. Objectives Surgical site infection (SSI) is a common complication in spine surgery but universal guidelines for SSI prevention are lacking. The objectives of this study are to depict a global status quo on implemented prevention strategies in spine surgery, common themes of practice and determine key areas for future research. Methods An 80-item survey was distributed among spine surgeons worldwide via email. The questionnaire was designed and approved by an International Consensus Group on spine SSI. Consensus was defined as more than 60% of participants agreeing to a specific prevention strategy. Results Four hundred seventy-two surgeons participated in the survey. Screening for Staphylococcus aureus (SA) is not common, whereas preoperative decolonization is performed in almost half of all hospitals. Body mass index (BMI) was not important for surgery planning. In contrast, elevated HbA1c level and hypoalbuminemia were often considered as reasons to postpone surgery. Cefazoline is the common drug for antimicrobial prophylaxis. Alcohol-based chlorhexidine is mainly used for skin disinfection. Double-gloving, wound irrigation, and tissue-conserving surgical techniques are routine in the operating room (OR). Local antibiotic administration is not common. Wound closure techniques and postoperative wound dressing routines vary greatly between the participating institutions. Conclusions With this study we provide an international overview on the heterogeneity of SSI prevention strategies in spine surgery. We demonstrated a large heterogeneity for pre-, peri- and postoperative measures to prevent SSI. Our data illustrated the need for developing universal guidelines and for testing areas of controversy in prospective clinical trials.
    Type of Medium: Online Resource
    ISSN: 2192-5682 , 2192-5690
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2023
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  • 2
    In: Cancer Research, American Association for Cancer Research (AACR), Vol. 83, No. 5_Supplement ( 2023-03-01), p. PD4-02-PD4-02
    Abstract: Background: It is well known that immunological pathways are relevant for response to classical neoadjuvant chemotherapy as well as combined chemo-immunotherapy. In addition, it has been shown that combined chemo-immunotherapy significantly improves survival, even in the context of only moderate effects on pCR. Due to the window therapy with durvalumab-alone and the option to analyze multiple consecutive biopsies, the GeparNuevo trial offers the opportunity to 1) determine gene expression patterns for pCR and DDFS endpoints 2) identify pathways most relevant for pCR and DDFS 3) identify genes specifically regulated by immunotherapy (comparison of samples pre-and post-window) 4) identify genes specifically regulated by chemotherapy (comparison of samples pre-Tx and after 4 cycles of chemotherapy 5) identify longitudinal patterns of gene expression by comparison of up to four time points and 6) identify changes in the tumor microenvironment by spatial sequencing of tumor cell and stroma areas. Methods: 292 tumor samples were evaluated by gene expression analysis: 162 pretherapeutic core biopsies, 79 post-window biopsies, 32 biopsies during chemotherapy and 19 biopsies of the residual tumor after therapy. These samples were analyzed by HTG OBP panel targeting 2549 genes which are assigned to 25 different biological mechanisms or cellular pathways. In addition, spatial profiling was compared in a subset of pre-and post-window samples using Nanostring GeoMx spatial profiling system. Endpoints were pCR and DDFS. Results: A total of more than 600 genes were significantly associated with either the pCR or the DDFS endpoint in either the complete GeparNuevo cohort or one of the two therapy arms. Interestingly, there was a large number of predictive or prognostic genes (n=247 for pCR and n=179 for DDFS) in the durvalumab arm, while the number of genes in the placebo arm was considerably lower (n=113 for pCR and n=61 for DDFS). We used existing pathway information for HTG OBP panel to analyze the contribution of different cellular processes to pCR and DDFS signatures in different therapy arms. Immune pathways were particularly relevant for durvalumab signatures (pCR and DDFS), while cell cycle related gene expression patterns were particularly involved in signatures predictive of pCR in both therapy arms. To further assign genes to the cellular response to durvalumab-alone or chemotherapy-alone, we compared gene expression patterns in durvalumab arm before and after the window phase (gene expression patterns induced by one dose of durvalumab) with gene expression patterns in placebo arm before and after 4 cycles of chemotherapy. Further longitudinal alterations were analyzed by comparison of longitudinal samples for 4 different time-points (a: before NACT, n=162; b: after window phase, n=79; c: after 4 cycles, n=31 and d: at surgery, n=19). Using the Nanostring GeoMx spatial RNA profiling system guided by cytokeratine immunofluorescence, we compared areas with high tumor cell content with stromal areas with or without TILs. In combination with the HTG gene expression data, we were able allocate the changes induced by durvalumab vs chemotherapy to the stromal cell and tumor cell compartment, indicating a re-organization of the tumor-microenvironment. Conclusions: In our analysis, we show that immune gene signatures are particularly relevant for neoadjuvant response to durvalumab as well as prognosis after durvalumab treatment, while proliferation signatures are involved in pCR-signatures after durvalumab as well as chemotherapy. The spatial analysis showed that relevant changes occur in the stromal compartment, indicating a re-organization of the tumor microenvironment. The parallel targeting of immune- and proliferation pathways might explain why a combined immunotherapy-chemotherapy approach is more successful than each single therapy strategy alone. Citation Format: Carsten Denkert, Andreas Schneeweiss, Julia Rey, Akira Hattesohl, Thomas Karn, Michael Braun, Paul Jank, Jens Huober, Hans-Peter Sinn, Dirk-Michael Zahm, Claus Hanusch, Frederik Marmé, Jenny Furlanetto, Jörg Thomalla, Jens-Uwe Blohmer, Marion van Mackelenbergh, Thorsten Stiewe, Peter Staib, Christian Jackisch, Julia Teply-Szymanski, Peter A. Fasching, Bruno V. Sinn, Michael Untch, Karsten Weber, Sibylle Loibl. PD4-02 Spatial and temporal heterogeneity of predictive and prognostic signatures in triple-negative breast cancer treated with neoadjuvant combination immune-chemotherapy [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr PD4-02.
    Type of Medium: Online Resource
    ISSN: 1538-7445
    Language: English
    Publisher: American Association for Cancer Research (AACR)
    Publication Date: 2023
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  • 3
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 39, No. 15_suppl ( 2021-05-20), p. 519-519
    Abstract: 519 Background: About one third of patients with hormone-receptor-positive (HR+), HER2‐ primary breast cancer with residual invasive disease after neoadjuvant chemotherapy will relapse despite adjuvant endocrine therapy. Therapeutic inhibition of cyclin-dependent kinase 4 and 6 (CDK 4/6) by palbociclib combined with endocrine therapy demonstrated highly relevant efficacy in metastatic breast cancer. The phase III PENELOPE-B (NCT01864746) study did not show a significant benefit from palbociclib in women with centrally confirmed HR+, HER2- primary breast cancer without a pathological complete response after taxane‐containing neoadjuvant chemotherapy and at high-risk of relapse (CPS‐EG score ≥3 or 2 and ypN+) for the primary endpoint (Loibl et al. JCO 2021). Methods: After completion of neoadjuvant chemotherapy and locoregional therapy, PENELOPE-B patients were randomized (1:1) to receive 13 cycles (1 year) of palbociclib 125mg daily or placebo on days 1-21 in a 28d cycle in addition to standard endocrine therapy. Analysis of the primary endpoint of invasive disease-free survival (iDFS) was planned after 290 events. Secondary objective included iDFS in luminal-B group by treatment. Gene expression in post-neoadjuvant surgical residual tumor tissue samples was profiled using the HTG EdgeSeq Oncology Biomarker Panel targeting 2559 genes (HTG Molecular Diagnostics Inc.). Based on 91 genes of this panel the AIMS subtype (Paquet & Hallett, JNCI 2014) was calculated. Results: Gene expressions were measured in tumors from 906 of 1250 (72%) PENELOPE-B patients; 663 had LumA subtype, 64 LumB, 135 NormL, 16 BasalL, and 28 HER2E. Compared to LumA the LumB patients were older, had higher post-neoadjuvant Ki-67, higher risk status (CPS-EG), and higher grade; no significant correlation was found for the region of participating sites, cT, ypT, and ypN. Patients with LumB tumors had an estimated 3-year iDFS of 71.9% with palbociclib vs 44.8% with placebo HR = 0.50 (0.24-1.05); outcome was similar in patients with LumA tumors (3-year iDFS 83.9% vs 79.5%, HR = 0.93 (0.68-1.28), interaction p = 0.132); this was confirmed in multivariable analyses. Ki-67 by IHC and proliferation biomarkers from the HTG panel also showed no significant interaction with treatment. Conclusions: PENELOPE-B did not show a benefit from the addition of 1 year palbociclib to endocrine therapy compared to placebo in the total enrolled high-risk primary breast cancer population. However, the small group of luminal-B tumors (n = 64) derived benefit from palbociclib, although without a statistically significant interaction. Further investigation is required in a larger cohort to validate a palbociclib benefit that might be confined to this group.
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
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    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2021
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  • 4
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 39, No. 15_suppl ( 2021-05-20), p. TPS602-TPS602
    Abstract: TPS602 Background: Women with triple-negative breast cancer (TNBC) having residual disease after neoadjuvant chemotherapy (NACT) as well as HR-positive/HER2-negative breast cancer (BC) with a CPS (clinical and post treatment pathological stage) +EG (estrogen receptor status and grade) score ≥ 3 or score 2 and nodal involvement after NACT (ypN+) are at high risk of recurrence. Sacituzumab govitecan is approved for the treatment of patients with metastatic TNBC who received at least two prior therapies for metastatic disease and has shown activity in heavily pretreated patients with metastatic HR-positive/HER2-negative BC. Therefore, sacituzumab govitecan may represent a new option against the resistant residual disease after standard NACT. Methods: SASCIA is a phase III, prospective, international, multi-center, randomized, open label, parallel group study in patients with HER2-negative BC with residual disease after NACT (NCT04595565). Eligible patients must have received taxane-based NACT for 16 weeks, including at least 6 weeks of a taxane. Patients should be at high risk of recurrence after treatment, defined as having centrally confirmed HER2-negative BC (IHC score 0-1 or FISH negative according to ASCO/CAP guideline) assessed preferably on tissue from postneoadjuvant residual invasive disease of the breast and either HR-negative ( 〈 1% positive stained cells), with any residual invasive disease 〉 ypT1mi after NACT or HR-positive (≥1% positive stained cells), with a CPS+EG score ≥ 3 or CPS+EG score 2 and ypN+ using local ER and grade assessed on core biopsies taken before NACT. Radiotherapy should be delivered before the start of study treatment. Patients are randomized 1:1 to receive either sacituzumab govitecan 10 mg/kg body weight (days 1, 8 q3w for eight cycles) or treatment of physician´s choice (capecitabine 2000 mg/m² day 1-14 q21 or platinum-based chemotherapy i.e. carboplatin AUC 5 q3w or AUC 1.5 weekly for eight 3 weekly cycles or observation). Randomization is stratified by HR status (HR-positive vs negative) and nodal involvement after NACT (ypN+ vs ypN0). In patients with HR-positive BC, endocrine-based therapy will be administered according to local guidelines. The primary endpoint is invasive disease-free survival (iDFS). Secondary endpoints include comparison of overall survival (OS, key secondary endpoint), distant disease-free survival, locoregional recurrences-free interval, safety, compliance, iDFS and OS according to stratified and - predefined subgroups, patient reported outcome, and quality of life between treatment arms. As of February 2 2021, 7/1200 patients have been randomized in Germany. International study groups will join soon. Clinical trial information: NCT04595565.
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
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    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2021
    detail.hit.zdb_id: 2005181-5
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  • 5
    In: Blood, American Society of Hematology, Vol. 112, No. 11 ( 2008-11-16), p. 5442-5442
    Abstract: Presentation of leukemic antigens (LAA) can be improved by conversion of leukemic cells to leukemia derived DC (DCleu), thereby enabling the generation of leukemia specific CTL. DC/DCleu can be generated and quantified from every AML case with at least one of 3 different DC generating methods (Schmetzer 2007/2008). We want to enlight the role of the composition and quality of DC and (DC or blast trained) T cells to mediate leukemia cytotoxic reactions or to predict the clinical response to therapy. Autologous patients’, allogeneic donor T cells or T cells at relapse after SCT were trained with DC or blasts from 25 AML-cases in a ‘Mixed lymphocyte culture’ (MLC) and DC/T cell profiles and antileukemic Tcell cytotoxicity evaluated. We generated DC/mature DC/DCleu from every patient (Ø27/45/83%). DC training of T cells increased proliferating, CD4+ and memory T cells and decreased CD8+ T cells; blast training did not increase memory T cells. An antileukemic, very efficient T cell cytotoxicity was achieved in 47% of cases after DC/DCleu training but only in 24% after blast training of T cells. A comparison of cases with a gain of antileukemic T cell cytotoxicity to those without a lytic activity showed higher proportions of mature DC/DCleu and CD4/memory T cells and higher amounts of secreted IFNgamma and IL 6 in the lytically active, DC trained group. The differences were most distinct in the group with DC trained T cells prepared at relapse after SCT. Cases with a response to therapy showed higher proportions of DCleu, proliferating, memory or CD4+ T cells. We showed that & gt;67% of all cases gained an antileukemic T cell cytotoxicity after DC training if & gt;45% proliferating/ & gt;65% CD4+/ & gt;42% memory T cells or & gt;40% mature DC/ & gt;65% DCleu were in the DC training setting. Moreover, 90% of DC trained T cells gained a lytic activity if & gt;65% DCleu were in the MLC. AML patients presenting with a relapse after SCT showed better ex vivo convertibility of blasts to DCleu if they had responded to a GM CSF/DLI based therapy of their relapse after SCT compared to cases with no response (72 vs 36% blasts convertible to DCleu; 44 vs 29% generable DC). By spectratyping of the Vβ TCR region in an AML case we demonstrated a more extended clonal restriction of donor T cells after DC training of T cells compared to blast trained T cells. Moreover, the restricted pattern was also found in T cells from the patient after SCT. In summary, DC/DCleu can be generated in any given case independent from karyotype. A DC training of T cells improves the antileukaemic CTL, but can also mediate a T cell anergy. The composition of DC and T cells is predictive for the lytic efficiency of the trained T cells: A successful DC training of T cells is associated with high mature DC/DCleu counts and high rates of proliferating, CD4+ and memory T cells. Patients responding to a DLI/GM CSF based therapy are characterized by a better convertibility of blasts to DCleu and more mature DC. Identical clonal restrictions of T cells were found in blast trained and even more in DC trained T cells. Identical clonal patterns were found in ex vivo trained and in vivo selected T cells. We can contribute to understand biological mechanisms behind cytotoxic reactions and escape mechanisms and to develop adoptive immunotherapies with specific, antileukemia directed LAA specific T cells, e.g. selected by multimers from SCT donors or with specifically trained and selected T cells after DC training without side effects.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
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    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2008
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  • 6
    In: JAMA Oncology, American Medical Association (AMA), Vol. 8, No. 7 ( 2022-07-01), p. 1010-
    Type of Medium: Online Resource
    ISSN: 2374-2437
    Language: English
    Publisher: American Medical Association (AMA)
    Publication Date: 2022
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  • 7
    Online Resource
    Online Resource
    University of Chicago Press ; 2022
    In:  National Tax Journal Vol. 75, No. 1 ( 2022-03-01), p. 33-59
    In: National Tax Journal, University of Chicago Press, Vol. 75, No. 1 ( 2022-03-01), p. 33-59
    Type of Medium: Online Resource
    ISSN: 0028-0283 , 1944-7477
    Language: English
    Publisher: University of Chicago Press
    Publication Date: 2022
    detail.hit.zdb_id: 2032876-X
    detail.hit.zdb_id: 207077-7
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  • 8
    In: Blood, American Society of Hematology, Vol. 114, No. 22 ( 2009-11-20), p. 5122-5122
    Abstract: Abstract 5122 T-cells are the most important mediators of antileukemic reactions after allogeneic stemcelltransplantation (SCT) or donorlymphocyte-infusions (DLI) in patients (pts) with myeloid leukemias (AML,MDS), although relapses occur. Presentation of leukemic antigens (LAA) is improved by conversion of leukemic cells to leukemia derived DC (DCleu). Our hypothesis is, that myeloid blasts convert in vivo spontaneously to DCleu and prime CTL; moreover DCleu can be generated ex vivo from blasts and be used to prime T-cells enabling the generation of leukemia-specific CTL. Therefore (unprimed or primed) antileukemic effector T-cells have to be identified, characterized, optimized or selected. Results 1) Blast- and DC-characterization: Blasts can be characterized by blast phenotypes or LAA-RNA-PCR(WT1,PR1 or PRAME).An LAA-overexpression was found in 70-94% of 88AML-samples compared to healthy controls. Ex vivo DCleu can regularly be generated independent from karyotypes and quantified in every AML-case and used to prime T-cells(Schmetzer 2005-2009). 2) Effectorcell characterization : a)In 6 patients after preemptive DLI-therapy between 0.1 and 0.5% LAA-specific T-cells with a highly Vβ-restricted T-cellprofil were found(Tetramer/Spectratyping). B)Compared to unprimed T-cells (with no or low antileukemic ex vivo function) selected from a patient after SCT IFNg-selected unprimed and even more primed T-cells have an improved antileukemic function compared to non-IFNg-selected primed T-cells. C) DC-priming (more than blast-priming) increases the antileukemic T-cell reactivity (shown in 20 cases) and is associated with highest Vβ-restriction, but is not in every case successful C) By spectratyping identical clone was found after DC-priming ex vivo and in vivo prepared from patient proving the value of DC-culturing for ‘simulating’ in vivo reactions. 3)Predictive and prognostic significance: a)Composition of DC-subtypes (high proportions of mature and leukemia-derived DC) and of T-cells (ratios 〉 1 of CD4:CD8 and CD45RO:CD45RA)and microenvironment (high concentrations of CXCL8 and CCL2 in DC-culture supernatans,IL6 and IFNg in DC/T-MLC-supernatans) arepredictive for effectful antileukemic functionalityof primed T-cells b) Composition of DC-subtypes (high proportions of mature, leukemia-derived DC and convertibility of blasts to DC) predicts the clinical response to immunotherapy (SCT (n=18) or DLI-relapse therapy (n=17)):cases with higher proportions of mature DC/ DCleu /better blastconvertibility to DCleu had a higher chance to respond to immunotherapy (SCT/DLI) and had an improved overall survival. In summary blasts can be characterized (LAA/blast phenotype) and DC/DCleu be generated in any given case independent from karyotype. A DC priming of T cells improves the antileukemic CTL, but not in every case. The composition of DC and T cells and the microenvironment in MLC are predictive for the ex vivo lytic efficiency of DC-primed T cells and for patients' response to immunotherapy (SCT or DLI). Effector T-cells can be identified, characterized or selected by their Vβ-profil, their LAA-specifity or IFNg-release (before or after blast- or DC-priming). Although the reactive differences or the therapeutic benefit of those different T-cellsubsets are not clear at the moment we hope to contribute to understand biological mechanisms behind cytotoxic reactions, to identify reactive T-cells (and identify best stemcell donors), to learn about escape mechanisms and to develop adoptive immunotherapies with specific, antileukemia directed T-cells without side effects. Disclosures No relevant conflicts of interest to declare.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
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    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2009
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  • 9
  • 10
    In: Cancer Research, American Association for Cancer Research (AACR), Vol. 82, No. 4_Supplement ( 2022-02-15), p. OT1-02-01-OT1-02-01
    Abstract: Background: Women with triple-negative breast cancer (TNBC) with residual disease after neoadjuvant chemotherapy (NACT) or hormone-receptor (HR)-positive/HER2-negative breast cancer (BC) with a CPS (clinical and post treatment pathological stage) +EG (estrogen receptor status and grade) score ≥3 or score 2 and nodal involvement after NACT (ypN+) are at high risk of recurrence. SG is approved by the Food and Drug Administration for the treatment of patients with metastatic TNBC who received at least two prior therapies for metastatic disease and has shown activity in heavily pretreated patients with metastatic HR-positive/HER2-negative BC. SG may represent a new option against residual disease after NACT. Trial Design: SASCIA is a phase III, prospective, international, multicenter, randomized, open label, parallel group study (NCT04595565) of the GBG in collaboration with the AGO-B. Eligible patients must have received taxane-based NACT for 16 weeks, including 6 weeks of a taxane. Patients should have centrally confirmed HER2-negative BC (IHC score 0-1 or FISH negative) and either HR-negative ( & lt;1%), with any residual invasive disease & gt; ypT1mi or HR-positive (≥1%), with a CPS+EG score ≥3 or CPS+EG score 2 and ypN+ using local ER and grade assessed on core biopsies taken before NACT. Radiotherapy should be delivered before study treatment start. Patients are randomized 1:1 to receive either SG 10 mg/kg body weight (days 1, 8 q3w for eight cycles) or treatment of physician´s choice (capecitabine 2000 mg/m² day 1-14 q21 or platinum-based chemotherapy i.e. carboplatin AUC 5 q3w or AUC 1.5 weekly for eight 3 weekly cycles or observation). Randomization is stratified by HR status (positive, negative) and nodal involvement after NACT (ypN+, ypN0). Endocrine-based therapy will be administered according to local guidelines in patients with HR-positive BC. The primary endpoint is invasive disease-free survival (iDFS). Secondary endpoints include comparison of overall survival (OS, key secondary endpoint), distant disease-free survival, locoregional recurrences-free interval, safety, compliance, iDFS and OS according to stratified and - predefined subgroups, patient reported outcome, and quality of life between treatment arms. As of 21st June 2021, 57/1200 patients have been randomized in Germany. Citation Format: Frederik Marmé, Marcus Schmidt, Jenny Furlanetto, Carsten Denkert, Anthony Goncalves, Elmar Stickeler, Mattea Reinisch, Silvia Antolín, Toralf Reimer, Wolfgang Janni, Philippe Aftimos, Michael Untch, Laura Michel, Marija Balic, Bruno Sinn, Volker Möbus, Patrick Morris, Laura Schöllhorn, Sabine Schmatloch, Julia Rey, Sibylle Loibl. Phase III postneoadjuvant study evaluating sacituzumab govitecan (SG), an antibody drug conjugate in primary HER2-negative breast cancer patients with high relapse risk after standard neoadjuvant treatment - SASCIA [abstract]. In: Proceedings of the 2021 San Antonio Bre ast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr OT1-02-01.
    Type of Medium: Online Resource
    ISSN: 0008-5472 , 1538-7445
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    Language: English
    Publisher: American Association for Cancer Research (AACR)
    Publication Date: 2022
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    detail.hit.zdb_id: 1432-1
    detail.hit.zdb_id: 410466-3
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