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Proof of Concept of TBio-4101, Lymphodepleting Chemo, IL-2 for Relapsed/Refractory Melanoma

Primary Purpose

Metastatic Melanoma, Unresectable Melanoma, Acral Melanoma

Status
Recruiting
Phase
Phase 1
Locations
United States
Study Type
Interventional
Intervention
TBio-4101
Cyclophosphamide
Fludarabine
Interleukin-2
Sponsored by
H. Lee Moffitt Cancer Center and Research Institute
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Metastatic Melanoma focused on measuring Melanoma

Eligibility Criteria

18 Years - 75 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria: Participants must have histologically confirmed, unresectable or metastatic melanoma as follows: Cutaneous, non-acral, melanoma (including melanoma of unknown primary) Cutaneous acral melanoma Mucosal melanoma Ocular melanoma (including uveal, iris, conjunctival melanoma) Participants must have failed, be refractory to, or unable to tolerate standard of care in the opinion of the Investigator. For participants with cutaneous non-acral melanoma, standard of care therapy includes a PD-1/L1 inhibitor, a CTLA-4 inhibitor, and if BRAF V600 activating mutation positive, a BRAF ± MEK inhibitor. Note: if treatment failure occurs during adjuvant therapy or within 6 months of adjuvant therapy completion, this will count as a failure of the applicable regimen as noted above. Any systemic therapy, including anti-cancer monoclonal antibodies, must have been completed at least 4 weeks from the start of lymphodepleting therapy (except for bridging therapy as defined below), and any prior therapy-related AEs must have resolved to Grade ≤ 1 except for alopecia and vitiligo. Neuropathy must have resolved to Grade ≤ 2. Participants must be between the ages of 18 and 75 years old. Additionally, participants who are ≥ 60 years of age must undergo a cardiology evaluation including a cardiac stress test after which they must be deemed to be low/acceptable risk. ECOG performance status of 0 or 1 Participants must have adequate organ and marrow function as defined below: Absolute neutrophil count ≥ 1,500/mcL (non-growth factor supported) Platelet count ≥ 100,000/mcL Hemoglobin ≥ 8.0 g/dL AST (SGOT)/ALT (SGPT) ≤ 3 times the institutional ULN; ≤ 5 times ULN if patient has liver metastasis Cockcroft-Gault estimated GFR ≥ 50 mL/min (creatinine) Total bilirubin ≤ 2.0 mg/dL (except in patients with Gilbert's Syndrome where the bilirubin must be ≤ 3 mg/dL) Seronegative for Human immunodeficiency virus (HIV) antibody, hepatitis B surface antigen, and hepatitis C (HCV) antibody (if HCV antibody positive, must be tested for HCV RNA, which must be negative to be eligible) Participants with brain metastases are eligible provided that the brain metastases have been successfully treated with stereotactic radiosurgery or resection and clinically stable for at least 1 month. Participants who have not undergone prior TIL harvest (i.e., the patient was not enrolled in the Banked TIL protocol MCC# <TBD>) must have at least 1 cm of tumor amenable for resection for TIL generation, in addition to, having at least one target lesion that can be used for response assessment by RECIST 1.1 criteria after TIL harvest. Participants who have undergone prior TIL harvest with the banking protocol (MCC# <TBD>) must have adequate numbers of cryopreserved TIL after the pre-REP to meet criteria for proceeding with TBio-4101 therapy. Participants must be willing and able to undergo an apheresis procedure Women of child-bearing potential must have a negative pregnancy test The effects of TBio-4101 on the developing human fetus are unknown. For this reason and because TIL agents, as well as other therapeutic agents used in this trial including IL-2 are known to be teratogenic, both males and females of child-bearing potential must be willing to practice birth control starting with screening through 1 year after the last study drug is administered for females or 6 months for males. Note: Women of child-bearing potential must have a negative serum pregnancy test. Contraception requirement: To prevent pregnancy, patients who are able to conceive or father children must use a highly effective contraception method during sexual activity starting with Screening through 1 year after the last study drug is administered for females or 6 months for males. Based on their mechanisms of action, the NMA-LD chemotherapy, aldesleukin (IL-2), can cause fetal harm when administered to a pregnant woman. Effects of TBio-4101 on fetal development are unknown. Definition of Non-Reproductive Potential: For this trial, male patients will be considered to be of non-reproductive potential if they have azoospermia (whether due to having had a vasectomy or due to an underlying medical condition). Female patients will be considered of non-reproductive potential if they are either: (a) postmenopausal (defined as at least 12 months with no menses without an alternative medical cause; in women < 45 years of age, a high follicle stimulating hormone (FSH) level in the postmenopausal range may be used to confirm a post-menopausal state in women not using hormonal contraception or hormonal replacement therapy. In the absence of 12 months of amenorrhea, a single follicle FSHH measurement is insufficient); (b) Or have had a hysterectomy and/or bilateral oophorectomy, bilateral salpingectomy or bilateral tubal ligation/occlusion, at least 6 weeks prior to screening; (c) Or has a congenital or acquired condition that prevents childbearing. Definition of Highly Effective Contraception: The following are examples of acceptable contraception methods to prevent pregnancy. This list may not be comprehensive for all regions, so the Investigator must discuss sexual activity and contraception usage with the patient. Hormonal contraceptive: oral contraceptive pill (estrogen/progestin pill or progestin-only pill), contraceptive skin patch, vaginal contraceptive ring, or subcutaneous contraceptive injection, Intrauterine device (IUD), Intrauterine hormone releasing system (IUS), Bilateral tubal occlusion, Vasectomized partner. Should a woman become pregnant or suspect she is pregnant while she or her partner are participating in this study, she should inform her treating physician immediately. Ability to understand and the willingness to sign a written informed consent document. Exclusion Criteria: Participants, regardless of age, who have a current or past medical history of ischemic heart disease, or clinically significant atrial or ventricular rhythm abnormality are excluded unless they undergo a cardiac stress test and cardiology clearance examination and are determined to be low or acceptable risk. Note: Participants with any clinically significant cardiac wall movement abnormality are excluded. Participants who have received prior cell therapy. Participants with either a primary immunodeficiency disorder (i.e., severe combined immunodeficiency syndrome) or acquired immunodeficiency disorders (such as HIV/AIDS) Pregnant women are excluded from this study because the agents used in this study have teratogenic or abortifacient effects. Because there is an unknown but potential risk for adverse events in nursing infants secondary to treatment of the mother with TBio-4101 or the other agents in the study, breastfeeding should be discontinued if the mother is enrolled in the study. Participants taking systemic steroid therapy (other than replacement therapy) or therapy with any immunosuppressive medications such as mycophenolate mofetil (MMF). Participants who require dapsone for pneumocystis pneumonia (PCP) prophylaxis during TIL therapy are eligible. Participants who have a history of severe immediate hypersensitivity reaction to the study agents including cyclophosphamide, fludarabine, or aldesleukin/ IL-2 or any of their constituents Participants with a left ventricular ejection fraction (LVEF) ≤ 45% or New York Heart Association (NYHA) functional classification > 1 Forced expiratory volume (FEV1) ≤ 60% of predicted value and DLCO (corrected) < 60% of predicted value Participants who, in the opinion of the Investigator, have a medical condition that would subject the patient to prohibitive risk by participation in this study, or who may be unable to safely complete the apheresis, tumor harvest, lymphodepletion regimen, TIL infusion, or aldesleukin/ IL-2 administration Participants with active infections requiring parenteral antibiotics Participants with autoimmune disease currently or within the past 6 months requiring systemic treatment with immunosuppressive doses of corticosteroids (>10 mg of prednisone-equivalent daily dosing), immunosuppressive biologic agents, or disease modifying antirheumatic drug agents (DMARDs). Note: Participants with autoimmune thyroiditis on replacement thyroid medication are eligible. Participants requiring chronic anti-coagulant therapy that cannot either be discontinued or changed to an anti-coagulant such as a low molecular weight heparin, which has a relatively short half-life, if clinically indicated during the period of thrombocytopenia resulting from the lymphodepletion regimen Has evidence of impeding perforation, obstruction or bleeding (requiring transfusion) due to the tumor.

Sites / Locations

  • Moffitt Cancer CenterRecruiting

Arms of the Study

Arm 1

Arm Type

Experimental

Arm Label

Infusion of TBio-4101 TIL

Arm Description

TBio-4101 is a tumor-infiltrating lymphocyte (TIL) product: participants tumor tissue is surgically removed and immune T-cells are taken out of the tumor and multiplied, or grown, in the laboratory. TIL product infused intravenously over 20 to 30 minutes within 2 to 4 days after the last dose of fludarabine Participants will also receive: Cyclophosphamide dose 60 mg/kg/day for 2 days administered IV in 250 mL dextrose 5% in water infused simultaneously with Mesna 15 mg/kg/day delivered over 1 hour per day for 2 days. Fludarabine 25 mg/m2/day is delivered by intravenous piggyback daily over 15-30 minutes for 5 days. Interleukin-2 (IL-2)- will be given to participants through IV after they receive the infusion of the TIL. IL-2 is administered at a dose of 600,000 IU/kg (based on actual body weight) IV every 8-12 hours beginning within 24 hours of TIL infusion for a maximum of 6 doses.

Outcomes

Primary Outcome Measures

Percentage of Participants that Successfully Receive TBio-4101
Percentage of participants who undergo tumor resection that successfully receive TBio-4101

Secondary Outcome Measures

Objective Response Rate (OOR)
ORR will be calculated using irRECIST and RECIST v1.1
6 Month Overall Survival (OS)
OS is defined as the time from enrollment to death
12 Month Overall Survival (OS)
OS is defined as the time from enrollment to death
6 Month Progression Free Survival (PFS)
PFS is defined as the time from study enrollment until disease progression or death.
12 Month Progression Free Survival (PFS)
PFS is defined as the time from study enrollment until disease progression or death.
Durable Response Rate (DRR)
DRR is defined as a continuous response, beginning within 12 months of treatment and lasting > 6 months

Full Information

First Posted
November 14, 2022
Last Updated
September 21, 2023
Sponsor
H. Lee Moffitt Cancer Center and Research Institute
Collaborators
Turnstone Biologics, Corp.
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1. Study Identification

Unique Protocol Identification Number
NCT05628883
Brief Title
Proof of Concept of TBio-4101, Lymphodepleting Chemo, IL-2 for Relapsed/Refractory Melanoma
Official Title
A Proof of Concept Study of TBio-4101 (an Autologous Selected and Expanded Tumor Infiltrating Lymphocyte [TIL] Therapy) Using Short-Term Cultured, Selected Autologous TIL Following a Lymphodepleting Chemotherapy Regimen and Followed by IL-2 for Patients With Relapsed or Refractory Melanoma (Phase 1)
Study Type
Interventional

2. Study Status

Record Verification Date
September 2023
Overall Recruitment Status
Recruiting
Study Start Date
November 22, 2022 (Actual)
Primary Completion Date
January 31, 2024 (Anticipated)
Study Completion Date
December 31, 2024 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
H. Lee Moffitt Cancer Center and Research Institute
Collaborators
Turnstone Biologics, Corp.

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
Yes

5. Study Description

Brief Summary
The purpose of this first in human study is to evaluate the feasibility, safety, and efficacy of administering TBio-4101 (tumor infiltrating lymphocytes [TIL]) after receiving a lymphodepleting chemotherapy regimen and before receiving interleukin-2 (IL-2) in participants with unresectable or metastatic melanoma.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Metastatic Melanoma, Unresectable Melanoma, Acral Melanoma, Mucosal Melanoma, Cutaneous Melanoma, Ocular Melanoma, Uveal Melanoma, Iris Melanoma, Conjunctival Melanoma, Non-Cutaneous Melanoma
Keywords
Melanoma

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1
Interventional Study Model
Single Group Assignment
Masking
None (Open Label)
Allocation
N/A
Enrollment
25 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Infusion of TBio-4101 TIL
Arm Type
Experimental
Arm Description
TBio-4101 is a tumor-infiltrating lymphocyte (TIL) product: participants tumor tissue is surgically removed and immune T-cells are taken out of the tumor and multiplied, or grown, in the laboratory. TIL product infused intravenously over 20 to 30 minutes within 2 to 4 days after the last dose of fludarabine Participants will also receive: Cyclophosphamide dose 60 mg/kg/day for 2 days administered IV in 250 mL dextrose 5% in water infused simultaneously with Mesna 15 mg/kg/day delivered over 1 hour per day for 2 days. Fludarabine 25 mg/m2/day is delivered by intravenous piggyback daily over 15-30 minutes for 5 days. Interleukin-2 (IL-2)- will be given to participants through IV after they receive the infusion of the TIL. IL-2 is administered at a dose of 600,000 IU/kg (based on actual body weight) IV every 8-12 hours beginning within 24 hours of TIL infusion for a maximum of 6 doses.
Intervention Type
Biological
Intervention Name(s)
TBio-4101
Other Intervention Name(s)
Tumor-Infiltrating Lymphocyte
Intervention Description
TBio-4101 is a tumor-infiltrating lymphocyte (TIL) product that involves the use of special immune cells called T-cells. A T-cell is a type of lymphocyte, or white blood cell.
Intervention Type
Drug
Intervention Name(s)
Cyclophosphamide
Other Intervention Name(s)
Cytoxan, Neosar
Intervention Description
Participants will receive Cyclophosphamide 60 mg/kg/day intravenously (IV) in 250 mL over approximately 1 hour per day for 2 days.
Intervention Type
Drug
Intervention Name(s)
Fludarabine
Other Intervention Name(s)
Fludara
Intervention Description
Participants will receive an intravenously (IV) infusion of Fludarabine 25 mg/m2 for approximately 15 to 30 minutes for 5 days, prior to T-Cell infusion
Intervention Type
Drug
Intervention Name(s)
Interleukin-2
Other Intervention Name(s)
IL-2
Intervention Description
Participants will receive Interleukin-2 (IL-2) 600 000 IU/kg intravenously every 8 to 12 hours beginning within 24 hours after T-cell infusion.
Primary Outcome Measure Information:
Title
Percentage of Participants that Successfully Receive TBio-4101
Description
Percentage of participants who undergo tumor resection that successfully receive TBio-4101
Time Frame
Day 7
Secondary Outcome Measure Information:
Title
Objective Response Rate (OOR)
Description
ORR will be calculated using irRECIST and RECIST v1.1
Time Frame
2 years after receiving TIL Transfer
Title
6 Month Overall Survival (OS)
Description
OS is defined as the time from enrollment to death
Time Frame
at 6 Months
Title
12 Month Overall Survival (OS)
Description
OS is defined as the time from enrollment to death
Time Frame
at 12 Months
Title
6 Month Progression Free Survival (PFS)
Description
PFS is defined as the time from study enrollment until disease progression or death.
Time Frame
at 6 Months
Title
12 Month Progression Free Survival (PFS)
Description
PFS is defined as the time from study enrollment until disease progression or death.
Time Frame
at 12 Months
Title
Durable Response Rate (DRR)
Description
DRR is defined as a continuous response, beginning within 12 months of treatment and lasting > 6 months
Time Frame
Up to 6 Months after 12 months of Treatment

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
75 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Participants must have histologically confirmed, unresectable or metastatic melanoma as follows: Cutaneous, non-acral, melanoma (including melanoma of unknown primary) Cutaneous acral melanoma Mucosal melanoma Ocular melanoma (including uveal, iris, conjunctival melanoma) Participants must have failed, be refractory to, or unable to tolerate standard of care in the opinion of the Investigator. For participants with cutaneous non-acral melanoma, standard of care therapy includes a PD-1/L1 inhibitor, a CTLA-4 inhibitor, and if BRAF V600 activating mutation positive, a BRAF ± MEK inhibitor. Note: if treatment failure occurs during adjuvant therapy or within 6 months of adjuvant therapy completion, this will count as a failure of the applicable regimen as noted above. Any systemic therapy, including anti-cancer monoclonal antibodies, must have been completed at least 4 weeks from the start of lymphodepleting therapy (except for bridging therapy as defined below), and any prior therapy-related AEs must have resolved to Grade ≤ 1 except for alopecia and vitiligo. Neuropathy must have resolved to Grade ≤ 2. Participants must be between the ages of 18 and 75 years old. Additionally, participants who are ≥ 60 years of age must undergo a cardiology evaluation including a cardiac stress test after which they must be deemed to be low/acceptable risk. ECOG performance status of 0 or 1 Participants must have adequate organ and marrow function as defined below: Absolute neutrophil count ≥ 1,500/mcL (non-growth factor supported) Platelet count ≥ 100,000/mcL Hemoglobin ≥ 8.0 g/dL AST (SGOT)/ALT (SGPT) ≤ 3 times the institutional ULN; ≤ 5 times ULN if patient has liver metastasis Cockcroft-Gault estimated GFR ≥ 50 mL/min (creatinine) Total bilirubin ≤ 2.0 mg/dL (except in patients with Gilbert's Syndrome where the bilirubin must be ≤ 3 mg/dL) Seronegative for Human immunodeficiency virus (HIV) antibody, hepatitis B surface antigen, and hepatitis C (HCV) antibody (if HCV antibody positive, must be tested for HCV RNA, which must be negative to be eligible) Participants with brain metastases are eligible provided that the brain metastases have been successfully treated with stereotactic radiosurgery or resection and clinically stable for at least 1 month. Participants who have not undergone prior TIL harvest (i.e., the patient was not enrolled in the Banked TIL protocol MCC# <TBD>) must have at least 1 cm of tumor amenable for resection for TIL generation, in addition to, having at least one target lesion that can be used for response assessment by RECIST 1.1 criteria after TIL harvest. Participants who have undergone prior TIL harvest with the banking protocol (MCC# <TBD>) must have adequate numbers of cryopreserved TIL after the pre-REP to meet criteria for proceeding with TBio-4101 therapy. Participants must be willing and able to undergo an apheresis procedure Women of child-bearing potential must have a negative pregnancy test The effects of TBio-4101 on the developing human fetus are unknown. For this reason and because TIL agents, as well as other therapeutic agents used in this trial including IL-2 are known to be teratogenic, both males and females of child-bearing potential must be willing to practice birth control starting with screening through 1 year after the last study drug is administered for females or 6 months for males. Note: Women of child-bearing potential must have a negative serum pregnancy test. Contraception requirement: To prevent pregnancy, patients who are able to conceive or father children must use a highly effective contraception method during sexual activity starting with Screening through 1 year after the last study drug is administered for females or 6 months for males. Based on their mechanisms of action, the NMA-LD chemotherapy, aldesleukin (IL-2), can cause fetal harm when administered to a pregnant woman. Effects of TBio-4101 on fetal development are unknown. Definition of Non-Reproductive Potential: For this trial, male patients will be considered to be of non-reproductive potential if they have azoospermia (whether due to having had a vasectomy or due to an underlying medical condition). Female patients will be considered of non-reproductive potential if they are either: (a) postmenopausal (defined as at least 12 months with no menses without an alternative medical cause; in women < 45 years of age, a high follicle stimulating hormone (FSH) level in the postmenopausal range may be used to confirm a post-menopausal state in women not using hormonal contraception or hormonal replacement therapy. In the absence of 12 months of amenorrhea, a single follicle FSHH measurement is insufficient); (b) Or have had a hysterectomy and/or bilateral oophorectomy, bilateral salpingectomy or bilateral tubal ligation/occlusion, at least 6 weeks prior to screening; (c) Or has a congenital or acquired condition that prevents childbearing. Definition of Highly Effective Contraception: The following are examples of acceptable contraception methods to prevent pregnancy. This list may not be comprehensive for all regions, so the Investigator must discuss sexual activity and contraception usage with the patient. Hormonal contraceptive: oral contraceptive pill (estrogen/progestin pill or progestin-only pill), contraceptive skin patch, vaginal contraceptive ring, or subcutaneous contraceptive injection, Intrauterine device (IUD), Intrauterine hormone releasing system (IUS), Bilateral tubal occlusion, Vasectomized partner. Should a woman become pregnant or suspect she is pregnant while she or her partner are participating in this study, she should inform her treating physician immediately. Ability to understand and the willingness to sign a written informed consent document. Exclusion Criteria: Participants, regardless of age, who have a current or past medical history of ischemic heart disease, or clinically significant atrial or ventricular rhythm abnormality are excluded unless they undergo a cardiac stress test and cardiology clearance examination and are determined to be low or acceptable risk. Note: Participants with any clinically significant cardiac wall movement abnormality are excluded. Participants who have received prior cell therapy. Participants with either a primary immunodeficiency disorder (i.e., severe combined immunodeficiency syndrome) or acquired immunodeficiency disorders (such as HIV/AIDS) Pregnant women are excluded from this study because the agents used in this study have teratogenic or abortifacient effects. Because there is an unknown but potential risk for adverse events in nursing infants secondary to treatment of the mother with TBio-4101 or the other agents in the study, breastfeeding should be discontinued if the mother is enrolled in the study. Participants taking systemic steroid therapy (other than replacement therapy) or therapy with any immunosuppressive medications such as mycophenolate mofetil (MMF). Participants who require dapsone for pneumocystis pneumonia (PCP) prophylaxis during TIL therapy are eligible. Participants who have a history of severe immediate hypersensitivity reaction to the study agents including cyclophosphamide, fludarabine, or aldesleukin/ IL-2 or any of their constituents Participants with a left ventricular ejection fraction (LVEF) ≤ 45% or New York Heart Association (NYHA) functional classification > 1 Forced expiratory volume (FEV1) ≤ 60% of predicted value and DLCO (corrected) < 60% of predicted value Participants who, in the opinion of the Investigator, have a medical condition that would subject the patient to prohibitive risk by participation in this study, or who may be unable to safely complete the apheresis, tumor harvest, lymphodepletion regimen, TIL infusion, or aldesleukin/ IL-2 administration Participants with active infections requiring parenteral antibiotics Participants with autoimmune disease currently or within the past 6 months requiring systemic treatment with immunosuppressive doses of corticosteroids (>10 mg of prednisone-equivalent daily dosing), immunosuppressive biologic agents, or disease modifying antirheumatic drug agents (DMARDs). Note: Participants with autoimmune thyroiditis on replacement thyroid medication are eligible. Participants requiring chronic anti-coagulant therapy that cannot either be discontinued or changed to an anti-coagulant such as a low molecular weight heparin, which has a relatively short half-life, if clinically indicated during the period of thrombocytopenia resulting from the lymphodepletion regimen Has evidence of impeding perforation, obstruction or bleeding (requiring transfusion) due to the tumor.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Yvonne Nguyen
Phone
813-745-6869
Email
Yvonne.Nguyen@moffitt.org
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Amod Sarnaik, MD
Organizational Affiliation
Moffitt Cancer Center
Official's Role
Principal Investigator
Facility Information:
Facility Name
Moffitt Cancer Center
City
Tampa
State/Province
Florida
ZIP/Postal Code
33612
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Yvonne Nguyen
Phone
813-745-6869
Email
Yvonne.Nguyen@moffitt.org
First Name & Middle Initial & Last Name & Degree
Amod Sarnaik, MD
First Name & Middle Initial & Last Name & Degree
Veron Sondak, MD

12. IPD Sharing Statement

Plan to Share IPD
Undecided
Links:
URL
https://moffitt.org/clinicaltrialssearch?DiseaseSite=&q=21707
Description
Moffitt Clinical Trial Search

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Proof of Concept of TBio-4101, Lymphodepleting Chemo, IL-2 for Relapsed/Refractory Melanoma

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