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A Study of CA-4948 in Patients With Relapsed or Refractory Primary Central Nervous System Lymphoma

Primary Purpose

Relapsed Hematologic Malignancy, Refractory Hematologic Malignancy, Relapsed Primary Central Nervous System Lymphoma

Status
Recruiting
Phase
Phase 1
Locations
International
Study Type
Interventional
Intervention
Emavusertib
ibrutinib
Sponsored by
Curis, Inc.
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Relapsed Hematologic Malignancy focused on measuring DLBCL, MCL, MYD88, IRAK4, NHL, AML, MZL, PCNSL

Eligibility Criteria

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

Inclusion Criteria:

  1. Males and females greater than or equal to 18 years of age
  2. Life expectancy of at least 3 months
  3. Eastern Cooperative Oncology Group (ECOG) Performance Status of ≤ 1
  4. For Part A1: Diagnosis of histopathologically confirmed B-cell hematological malignancy (as per the World Health Organization [WHO] 2016 classification; Swedow 2016); eligible subtypes include follicular lymphoma, MZL, DLBCL, mantle cell lymphoma, and WM/LPL without the urgent need for treatment hyperviscosity.

For Part A2: Diagnosis of histopathologically confirmed B-cell NHL, as per the WHO 2016 classification (Swerdlow et al. 2016). Eligible NHL subtypes include follicular lymphoma, MZL, mantle cell lymphoma, DLBCL(including extranodal lymphomas of leg-, testicular-, or NOS type), and primary or secondary CNS lymphoma.

For Part B: Diagnosis of histopathologically confirmed B-cell NHLs, including applicable confirmation as per the WHO 2016 classification (Swerdlow et al. 2016):

  • Cohort 1: Marginal zone lymphoma
  • Cohort 2: ABC-DLBCL, or extranodal subtypes: Leg-, testicular-, or NOS-type. The population will be enriched for MYD88 L265P mutations. As this occurs more frequently in the ABC-DLBCL(activated B-cell (Hans et al. 2004) subtype, all patients with this subtype qualify for enrollment. If the MYD88 mutation status is unknown at baseline, the lymphoma will be tested for MYD88 mutations.
  • Cohort 3: Primary CNS Lymphoma (PCNSL) only. If the MYD88 mutation status is unknown at baseline, the lymphoma will be tested for MYD88 mutations.
  • Cohort 4: Patients receiving ibrutinib monotherapy who have developed adaptive, secondary resistance. Indications include:

    • MCL, MZL
    • Indications for which ibrutinib is NCCN-listed (e.g., PCNSL)
    • Patients with NHL and known myddosome mutations
    • Patients may be candidates for maintaining ibrutinib while emavusertib will be added for resistance reversal. A brief gap of ibrutinib therapy of <3 weeks is acceptable.

Exclusion Criteria:

  1. Patient with active central nervous system (CNS) involvement other than PCNSL at study entry are ineligible.
  2. Radiotherapy delivered to non-target lesions involving >25% of bone marrow within one week prior to starting study treatment or delivered to target lesions that will be followed on the study (NOTE: prior sites of radiation will be recorded)
  3. Any prior anti-cancer treatment such as chemotherapy, immunomodulatory drug therapy, etc., received within 14 days prior to start of study treatment (with the exception of ibrutinib for Parts A2 and B, which may be continued as part of this study without interruption)
  4. Current or planned glucocorticoid therapy, with the following exceptions:

    1. Doses ≤ 10 mg/day prednisolone or equivalent is allowed, provided that the steroid dose has been stable or tapering for at least 14 days prior to the first dose of study treatment
    2. Inhaled, intranasal, intraarticular and topical steroids are permitted
  5. Use of any investigational agent within 21 days or 5 half-lives, whichever is shorter, prior to start of study treatment
  6. Presence of an acute or chronic toxicity resulting from prior anti-cancer therapy, with the exception of alopecia, that has not resolved to Grade ≤ 1 within 7 days prior to start of study treatment unless approved by the Medical Monitor
  7. Known allergy or hypersensitivity to any component of the formulation of emavusertib (or ibrutinib for entry into Parts A2 or B) used in this study
  8. B-cell NHL of the following subtypes:

    1. Burkitt lymphoma
    2. Lymphoblastic lymphoma or leukemia
    3. Post-transplantation lymphoproliferative disorder
    4. Known primary mediastinal, ocular, or epidural, DLBCL
    5. WM and LPL
    6. CLL/SLL

Sites / Locations

  • Mayo ClinicRecruiting
  • UCLA Department of Medicine - Hematology/Oncology
  • Smilow Cancer Hospital at Yale-New HavenRecruiting
  • Mayo ClinicRecruiting
  • Mayo ClinicRecruiting
  • Fred and Pamela Buffett Cancer CenterRecruiting
  • Hackensack University Medical CenterRecruiting
  • Memorial Sloan Kettering Cancer CenterRecruiting
  • Hospital of the University of Pennsylvania
  • University of Tennessee Medical CenterRecruiting
  • UT Southwestern Medical CenterRecruiting
  • Swedish Cancer Institute
  • Všeobecná fakultní nemocnice v Praze
  • Institut Curie Hospital
  • Hematology Department Soroka UMC / Heanatology Department
  • Hadassah Medical Center / Ein-Carem
  • Università di Torino Croce e Carle
  • SODc Ematologia Azienda Ospedaliera Universitaria Careggi
  • IRST - Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori
  • IRCCS San Raffaele Scientific Institute
  • Uniwersyteckie Centrum Kliniczne Osrodek Badan Klinicznych Wczesnych FazRecruiting
  • Oddzial Kliniczny HematologiiRecruiting
  • NarodowyInstytutu Onkologii im. Marii Sklodowskiej-Curie-Panstwowy Instytutu BadawczyRecruiting
  • MD Anderson Cancer Center MadridRecruiting
  • Hospital Universitario Virgen del RocioRecruiting

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm Type

Experimental

Experimental

Experimental

Arm Label

Emavusertib (CA-4948) dose escalation

Emavusertib (CA-4948) and ibrutinib dose escalation

Emavusertib (CA-4948) and ibrutinib dose expansion

Arm Description

Part A1: Dose-level cohorts with up to approximately 6 patients each will be used to define the Maximum Tolerated Dose (MTD) for emavusertib.

Part A2: Evaluate escalating dose levels of oral emavusertib in combination with 560 mg daily (QD) of oral ibrutinib. The starting dose of emavusertib to be used in combination will be 200 mg twice a day (BID). It is anticipated that 12 to 20 patients at a potential dose level will be required to establish optimal combination dosing.

In two PCNSL Expansion Cohorts (Part B), emavusertib in combination with ibrutinib will be administered in patients with PCNSL. In Cohort 1, emavusertib 100 mg BID will be administered with ibrutinib 560 mg QD consecutively in a 28-day cycle in approximately 6 to 9 patients. In Cohort 2, CA-4948 200 mg BID will be administered with ibrutinib in at least 9 patients.

Outcomes

Primary Outcome Measures

Part A: To determine the safety and tolerability of emavusertib as a monotherapy and in combination with ibrutinib: dose-limiting toxicity (DLT)
The number of patients with a dose-limiting toxicity (DLT) in the first treatment cycle
Part A: Maximum tolerated dose (MTD) of emavusertib as a monotherapy and in combination with ibrutinib measured by dose-limiting toxicities (DLTs)
MTD determined by the highest dose level studied at which fewer than 2 out of 6 subjects (<33%) experience a dose limiting toxicity.
Part A: Recommended Phase 2 Dose (RP2D) of emavusertib as a monotherapy and in combination with ibrutinib based on overall tolerability data
RP2D selected based on overall tolerability data from all patients treated at different dose levels and will not exceed the MTD.
Part B: To assess safety of emavusertib in combination with ibrutinib by incidence of AEs in patients with PCNSL.
Assessed by incidence of AEs

Secondary Outcome Measures

Pharmacokinetic (PK) profile of emavusertib and ibrutinib measured by AUC
Area Under the concentration-time curve (AUC)
Pharmacokinetic (PK) profile of emavusertib and ibrutinib measured by Cmax
Maximum plasma concentration (Cmax)
Pharmacokinetic (PK) profile of emavusertib and ibrutinib measured by Cmin
Minimum plasma concentration (Cmin)
Pharmacokinetic (PK) profile of emavusertib and ibrutinib measured by Tmax
Time to maximum plasma concentration (Tmax)
Pharmacokinetic (PK) profile of emavusertib and ibrutinib measured by plasma terminal half-life
Plasma terminal elimination half-life (T 1/2)
To assess efficacy of emavusertib as a monotherapy and in combination with ibrutinib measured by overall response rate (ORR)
Assessed by ORR
To assess efficacy of emavusertib as a monotherapy and in combination with ibrutinib measured by duration of response (DOR)
Assessed by DOR
To assess efficacy of emavusertib as a monotherapy and in combination with ibrutinib measured by disease control rate (DCR)
Assessed by DCR
To assess efficacy of emavusertib as a monotherapy and in combination with ibrutinib measured by progression free survival (PFS)
Assessed by PFS
To assess efficacy of emavusertib as a monotherapy and in combination with ibrutinib measured by overall survival (OS)
Assessed by OS
Part B: To estimate the blood-brain barrier penetration in CNS lymphoma patients
CNS liquor with be sampled from an Ommaya reservoir or with a spinal puncture about 3 hours after oral dosing of emavusertib. At approximately the same timepoint, a peripheral blood sample will be taken to obtain a plasma sample. The respective emavusertib concentrations will be measured in the liquor and in plasma samples. The liquor vs plasma concentration ratio will provide a rough estimate of the blood-brain barrier (BBB) penetration of emavusertib following oral dosing.

Full Information

First Posted
October 17, 2017
Last Updated
September 11, 2023
Sponsor
Curis, Inc.
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1. Study Identification

Unique Protocol Identification Number
NCT03328078
Brief Title
A Study of CA-4948 in Patients With Relapsed or Refractory Primary Central Nervous System Lymphoma
Official Title
An Open-Label, Dose Escalation and Dose Expansion Trial Evaluating the Safety, Pharmacokinetics, Pharmacodynamics, and Clinical Activity of Orally Administered CA-4948 in Patients With Relapsed or Refractory Primary Central Nervous System Lymphoma
Study Type
Interventional

2. Study Status

Record Verification Date
September 2023
Overall Recruitment Status
Recruiting
Study Start Date
December 28, 2017 (Actual)
Primary Completion Date
August 2026 (Anticipated)
Study Completion Date
August 2026 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Curis, Inc.

4. Oversight

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

5. Study Description

Brief Summary
This is a multi-center, open-label trial to evaluate the safety, pharmacokinetics (PK), and anti-cancer activity of oral administration of emavusertib (CA-4948) in adult patients with relapsed or refractory (R/R) hematologic malignancies. Part A will evaluate the safety and tolerability of escalating doses of emavusertib as monotherapy (Part A1), and in combination with ibrutinib. In Protocol Version (v) 1.0 through v6.0, patients with Waldenström macroglobulinemia/ lymphoplasmacytic lymphoma (WM/LPL) and chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL) were also enrolled at ibrutinib doses of 420 mg (Part A2). Enrollment into Parts A1 and A2 has been closed. Part B will comprise 2 cohorts to assess safety and efficacy of emavusertib in combination with ibrutinib in patients with primary central nervous system lymphoma (PCNSL).

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Relapsed Hematologic Malignancy, Refractory Hematologic Malignancy, Relapsed Primary Central Nervous System Lymphoma, Refractory Primary Central Nervous System Lymphoma
Keywords
DLBCL, MCL, MYD88, IRAK4, NHL, AML, MZL, PCNSL

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 1, Phase 2
Interventional Study Model
Sequential Assignment
Model Description
Part A will evaluate escalating doses of emavusertib (CA-4948) either as monotherapy (Part A1) or in combination with ibrutinib (Part A2). Enrollment is closed for Part A1 and A2. Part B will comprise two expansion cohorts to assess efficacy and safety of emavusertib and ibrutinib in PCNSL.
Masking
None (Open Label)
Allocation
Non-Randomized
Enrollment
80 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Emavusertib (CA-4948) dose escalation
Arm Type
Experimental
Arm Description
Part A1: Dose-level cohorts with up to approximately 6 patients each will be used to define the Maximum Tolerated Dose (MTD) for emavusertib.
Arm Title
Emavusertib (CA-4948) and ibrutinib dose escalation
Arm Type
Experimental
Arm Description
Part A2: Evaluate escalating dose levels of oral emavusertib in combination with 560 mg daily (QD) of oral ibrutinib. The starting dose of emavusertib to be used in combination will be 200 mg twice a day (BID). It is anticipated that 12 to 20 patients at a potential dose level will be required to establish optimal combination dosing.
Arm Title
Emavusertib (CA-4948) and ibrutinib dose expansion
Arm Type
Experimental
Arm Description
In two PCNSL Expansion Cohorts (Part B), emavusertib in combination with ibrutinib will be administered in patients with PCNSL. In Cohort 1, emavusertib 100 mg BID will be administered with ibrutinib 560 mg QD consecutively in a 28-day cycle in approximately 6 to 9 patients. In Cohort 2, CA-4948 200 mg BID will be administered with ibrutinib in at least 9 patients.
Intervention Type
Drug
Intervention Name(s)
Emavusertib
Other Intervention Name(s)
CA-4948
Intervention Description
Emavusertib (formulated for oral administration for BID dosing)
Intervention Type
Drug
Intervention Name(s)
ibrutinib
Intervention Description
560 mg QD of oral ibrutinib
Primary Outcome Measure Information:
Title
Part A: To determine the safety and tolerability of emavusertib as a monotherapy and in combination with ibrutinib: dose-limiting toxicity (DLT)
Description
The number of patients with a dose-limiting toxicity (DLT) in the first treatment cycle
Time Frame
12 months
Title
Part A: Maximum tolerated dose (MTD) of emavusertib as a monotherapy and in combination with ibrutinib measured by dose-limiting toxicities (DLTs)
Description
MTD determined by the highest dose level studied at which fewer than 2 out of 6 subjects (<33%) experience a dose limiting toxicity.
Time Frame
12 months
Title
Part A: Recommended Phase 2 Dose (RP2D) of emavusertib as a monotherapy and in combination with ibrutinib based on overall tolerability data
Description
RP2D selected based on overall tolerability data from all patients treated at different dose levels and will not exceed the MTD.
Time Frame
12 months
Title
Part B: To assess safety of emavusertib in combination with ibrutinib by incidence of AEs in patients with PCNSL.
Description
Assessed by incidence of AEs
Time Frame
24- 36 months
Secondary Outcome Measure Information:
Title
Pharmacokinetic (PK) profile of emavusertib and ibrutinib measured by AUC
Description
Area Under the concentration-time curve (AUC)
Time Frame
24- 36 months
Title
Pharmacokinetic (PK) profile of emavusertib and ibrutinib measured by Cmax
Description
Maximum plasma concentration (Cmax)
Time Frame
24- 36 months
Title
Pharmacokinetic (PK) profile of emavusertib and ibrutinib measured by Cmin
Description
Minimum plasma concentration (Cmin)
Time Frame
24- 36 months
Title
Pharmacokinetic (PK) profile of emavusertib and ibrutinib measured by Tmax
Description
Time to maximum plasma concentration (Tmax)
Time Frame
24- 36 months
Title
Pharmacokinetic (PK) profile of emavusertib and ibrutinib measured by plasma terminal half-life
Description
Plasma terminal elimination half-life (T 1/2)
Time Frame
24- 36 months
Title
To assess efficacy of emavusertib as a monotherapy and in combination with ibrutinib measured by overall response rate (ORR)
Description
Assessed by ORR
Time Frame
24- 36 months
Title
To assess efficacy of emavusertib as a monotherapy and in combination with ibrutinib measured by duration of response (DOR)
Description
Assessed by DOR
Time Frame
24- 36 months
Title
To assess efficacy of emavusertib as a monotherapy and in combination with ibrutinib measured by disease control rate (DCR)
Description
Assessed by DCR
Time Frame
24- 36 months
Title
To assess efficacy of emavusertib as a monotherapy and in combination with ibrutinib measured by progression free survival (PFS)
Description
Assessed by PFS
Time Frame
24- 36 months
Title
To assess efficacy of emavusertib as a monotherapy and in combination with ibrutinib measured by overall survival (OS)
Description
Assessed by OS
Time Frame
24 - 36 months
Title
Part B: To estimate the blood-brain barrier penetration in CNS lymphoma patients
Description
CNS liquor with be sampled from an Ommaya reservoir or with a spinal puncture about 3 hours after oral dosing of emavusertib. At approximately the same timepoint, a peripheral blood sample will be taken to obtain a plasma sample. The respective emavusertib concentrations will be measured in the liquor and in plasma samples. The liquor vs plasma concentration ratio will provide a rough estimate of the blood-brain barrier (BBB) penetration of emavusertib following oral dosing.
Time Frame
1 day

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Males and females greater than or equal to 18 years of age Life expectancy of at least 3 months Eastern Cooperative Oncology Group (ECOG) Performance Status of 0, 1 or 2 Histopathologically confirmed diagnosis of PCNSL (medical record is acceptable). Cerebral biopsies are not required if imaging reveals typical images of PCNSL. Patients with parenchymal lesions must have unequivocal evidence (e.g., presence of at least 1 bi-dimensionally measurable target lesion on brain magnetic resonance imaging (MRI) or head CT or a new lesion with CSF involvement) of disease progression on imaging within 28 days prior to Cycle 1 Day 1. For patients with leptomeningeal disease only, CSF cytology must document lymphoma cells or monotypic cells on flowcytometry, and/or imaging findings consistent with CSF disease within 28 days prior to Cycle 1 Day 1 (at the discretion of the Investigator). Exclusion Criteria for Part B - PCNSL Expansion Cohorts of Combination Therapy Patients with only intraocular PCNSL without brain lesion or CSF involvement or T-cell lymphoma or systemic presence of lymphoma, or non-CNS lymphoma metastatic to the CNS Prior history of malignancies other than lymphoma (except for basal cell or squamous cell carcinoma of the skin or carcinoma in situ of the cervix or breast) or prior history of systemic lymphoma, unless the patient has been free of the disease for ≥ 3 years. Active malignancy other than PCNSL requiring systemic therapy History of Grade ≥ 3 rhabdomyolysis without complete recovery Patient has received external beam radiation therapy to the CNS within 28 days prior to Cycle 1 Day 1. Prior investigational drugs (including treatment in clinical research, unapproved combination products, and new dosage forms) within 28 days or 5 half-lives, whichever is shorter, prior to Cycle 1 Day 1; allogeneic hematopoietic stem cell transplant (HSCT) within 60 days prior to C1D1; or clinically significant graft-versus-host disease (GVHD) requiring ongoing up-titration of immunosuppressive medications prior to Screening Note: The use of a stable or tapering dose of immunosuppressive therapy post-HSCT and/or topical steroids for ongoing skin GVHD is permitted with Sponsor Medical Monitor approval Any prior systemic anti-cancer treatment such as chemotherapy, immunomodulatory drug therapy, etc., received within 14 days or 5 half-lives, whichever is shorter, prior to Cycle 1 Day 1 (with the exception of ibrutinib, which may be continued as part of this study without interruption) Prior history of hypersensitivity or anaphylaxis to emavusertib or ibrutinib or any excipients.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Reinhard von Roemeling, MD
Phone
617-503-6500
Email
clinicaltrials@curis.com
Facility Information:
Facility Name
Mayo Clinic
City
Phoenix
State/Province
Arizona
ZIP/Postal Code
85054
Country
United States
Individual Site Status
Recruiting
Facility Name
UCLA Department of Medicine - Hematology/Oncology
City
Santa Monica
State/Province
California
ZIP/Postal Code
90404
Country
United States
Individual Site Status
Withdrawn
Facility Name
Smilow Cancer Hospital at Yale-New Haven
City
New Haven
State/Province
Connecticut
ZIP/Postal Code
06510
Country
United States
Individual Site Status
Recruiting
Facility Name
Mayo Clinic
City
Jacksonville
State/Province
Florida
ZIP/Postal Code
32224
Country
United States
Individual Site Status
Recruiting
Facility Name
Mayo Clinic
City
Rochester
State/Province
Minnesota
ZIP/Postal Code
55905
Country
United States
Individual Site Status
Recruiting
Facility Name
Fred and Pamela Buffett Cancer Center
City
Omaha
State/Province
Nebraska
ZIP/Postal Code
68198
Country
United States
Individual Site Status
Recruiting
Facility Name
Hackensack University Medical Center
City
Hackensack
State/Province
New Jersey
ZIP/Postal Code
07601
Country
United States
Individual Site Status
Recruiting
Facility Name
Memorial Sloan Kettering Cancer Center
City
New York
State/Province
New York
ZIP/Postal Code
10065
Country
United States
Individual Site Status
Recruiting
Facility Name
Hospital of the University of Pennsylvania
City
Philadelphia
State/Province
Pennsylvania
ZIP/Postal Code
19104
Country
United States
Individual Site Status
Completed
Facility Name
University of Tennessee Medical Center
City
Knoxville
State/Province
Tennessee
ZIP/Postal Code
37920
Country
United States
Individual Site Status
Recruiting
Facility Name
UT Southwestern Medical Center
City
Dallas
State/Province
Texas
ZIP/Postal Code
75235
Country
United States
Individual Site Status
Recruiting
Facility Name
Swedish Cancer Institute
City
Seattle
State/Province
Washington
ZIP/Postal Code
98104
Country
United States
Individual Site Status
Completed
Facility Name
Všeobecná fakultní nemocnice v Praze
City
Prague
Country
Czechia
Individual Site Status
Not yet recruiting
Facility Name
Institut Curie Hospital
City
Paris
Country
France
Individual Site Status
Not yet recruiting
Facility Name
Hematology Department Soroka UMC / Heanatology Department
City
Be'er Sheva
Country
Israel
Individual Site Status
Not yet recruiting
Facility Name
Hadassah Medical Center / Ein-Carem
City
Jerusalem
Country
Israel
Individual Site Status
Not yet recruiting
Facility Name
Università di Torino Croce e Carle
City
Cuneo
Country
Italy
Individual Site Status
Not yet recruiting
Facility Name
SODc Ematologia Azienda Ospedaliera Universitaria Careggi
City
Firenze
Country
Italy
Individual Site Status
Not yet recruiting
Facility Name
IRST - Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori
City
Meldola
Country
Italy
Individual Site Status
Not yet recruiting
Facility Name
IRCCS San Raffaele Scientific Institute
City
Milano
Country
Italy
Individual Site Status
Not yet recruiting
Facility Name
Uniwersyteckie Centrum Kliniczne Osrodek Badan Klinicznych Wczesnych Faz
City
Gdańsk
Country
Poland
Individual Site Status
Recruiting
Facility Name
Oddzial Kliniczny Hematologii
City
Kraków
Country
Poland
Individual Site Status
Recruiting
Facility Name
NarodowyInstytutu Onkologii im. Marii Sklodowskiej-Curie-Panstwowy Instytutu Badawczy
City
Warsaw
Country
Poland
Individual Site Status
Recruiting
Facility Name
MD Anderson Cancer Center Madrid
City
Madrid
Country
Spain
Individual Site Status
Recruiting
Facility Name
Hospital Universitario Virgen del Rocio
City
Sevilla
Country
Spain
Individual Site Status
Recruiting

12. IPD Sharing Statement

Learn more about this trial

A Study of CA-4948 in Patients With Relapsed or Refractory Primary Central Nervous System Lymphoma

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