Trial Outcomes & Findings for SU011248 In The Treatment Of Patients With Bevacizumab (Avastin)-Refractory Metastatic Renal Cell Carcinoma (NCT NCT00089648)

NCT ID: NCT00089648

Last Updated: 2010-01-12

Results Overview

Objective disease response = subjects with confirmed complete response (CR) or partial response (PR) according to RECIST. A CR was defined as the disappearance of all target lesions. A PR was defined as a ≥ 30% decrease in the sum of the longest dimensions of the target lesions taking as a reference the baseline sum longest dimensions.

Recruitment status

COMPLETED

Study phase

PHASE2

Target enrollment

61 participants

Primary outcome timeframe

4 week treatment cycles up to 1 year in absence of withdrawal criteria requiring discontinuation including 28 day post study follow up

Results posted on

2010-01-12

Participant Flow

Participant milestones

Participant milestones
Measure
Sunitinib
50 milligram/day for 4 consecutive weeks followed by a 2-week off-treatment period (6-week treatment cycle).
Overall Study
STARTED
61
Overall Study
COMPLETED
20
Overall Study
NOT COMPLETED
41

Reasons for withdrawal

Reasons for withdrawal
Measure
Sunitinib
50 milligram/day for 4 consecutive weeks followed by a 2-week off-treatment period (6-week treatment cycle).
Overall Study
Adverse Event
7
Overall Study
Withdrawal by Subject
1
Overall Study
Lack of Efficacy
33

Baseline Characteristics

SU011248 In The Treatment Of Patients With Bevacizumab (Avastin)-Refractory Metastatic Renal Cell Carcinoma

Baseline characteristics by cohort

Baseline characteristics by cohort
Measure
Sunitinib
n=61 Participants
50 milligram/day for 4 consecutive weeks followed by a 2-week off-treatment period (6-week treatment cycle).
Age, Customized
< 65 years
43 participants
n=5 Participants
Age, Customized
> = 65 years
18 participants
n=5 Participants
Sex: Female, Male
Female
27 Participants
n=5 Participants
Sex: Female, Male
Male
34 Participants
n=5 Participants

PRIMARY outcome

Timeframe: 4 week treatment cycles up to 1 year in absence of withdrawal criteria requiring discontinuation including 28 day post study follow up

Population: Intent-to-treat (ITT)=all subjects enrolled in the study that received at least 1 dose of study medication.

Objective disease response = subjects with confirmed complete response (CR) or partial response (PR) according to RECIST. A CR was defined as the disappearance of all target lesions. A PR was defined as a ≥ 30% decrease in the sum of the longest dimensions of the target lesions taking as a reference the baseline sum longest dimensions.

Outcome measures

Outcome measures
Measure
Sunitinib
n=61 Participants
50 milligram/day for 4 consecutive weeks followed by a 2-week off-treatment period (6-week treatment cycle).
Number of Subjects With Overall Confirmed Objective Disease Response According to the Response Evaluation Criteria in Solid Tumors (RECIST)
14 participants

SECONDARY outcome

Timeframe: 4 week treatment cycles up to 1 year in absence of withdrawal criteria requiring discontinuation including 28 day post study follow up

Population: ITT. 20 subjects were censored.

TTP was defined as the time from the date of first dose of study medication to the date of the first documentation of tumor progression. If tumor progression data included more than 1 date, the first date was used. TTP (in weeks) was calculated as (first event date minus first dose date +1)/7. Kaplan-Meier method was used.

Outcome measures

Outcome measures
Measure
Sunitinib
n=61 Participants
50 milligram/day for 4 consecutive weeks followed by a 2-week off-treatment period (6-week treatment cycle).
Time to Tumor Progression (TTP)
30.4 weeks
Interval 18.3 to 36.7

SECONDARY outcome

Timeframe: 4 week treatment cycles up to 1 year in absence of withdrawal criteria requiring discontinuation including 28 day post study follow up

Population: ITT subjects (i.e, all subjects enrolled in the study that received at least 1 dose of study medication) who had a confirmed CR or PR. 14 subjects who had a response were analyzed for DR.

DR was defined as the time from start of the first documentation of objective tumor response (CR or PR) to the first documentation of objective tumor progression or to death due to to any cause that occurred within 28 days after the last dose of study medication, whichever occurred first. If tumor progression data included more than 1 date, the first date was used. DR was only calculated for the subgroup of subjects with a confirmed objective response. DR was calculated as \[the end date for DR minus first CR or PR that was subsequently confirmed +1\]/7. Kaplan-Meier method was used.

Outcome measures

Outcome measures
Measure
Sunitinib
n=61 Participants
50 milligram/day for 4 consecutive weeks followed by a 2-week off-treatment period (6-week treatment cycle).
Duration of Response (DR)
36.1 weeks
Interval 25.0 to 999.0

SECONDARY outcome

Timeframe: 4 week treatment cycles up to 1 year in absence of withdrawal criteria requiring discontinuation including 28 day post study follow up

Population: ITT

OS was defined as the time from start of study treatment to date of death due to any cause. OS (in weeks) was calculated as \[date of death minus first dose date +1\]/7. For a subject not expiring, the OS time was censored on the last date of known contact that they were known to be alive. Subjects lacking data beyond the day of the first dose had their OS times censored at 1 day. Kaplan-Meier method was used.

Outcome measures

Outcome measures
Measure
Sunitinib
n=61 Participants
50 milligram/day for 4 consecutive weeks followed by a 2-week off-treatment period (6-week treatment cycle).
Overall Survival (OS)
47.1 weeks
Interval 36.9 to 69.7

SECONDARY outcome

Timeframe: 4 week treatment cycles up to 1 year in absence of withdrawal criteria requiring discontinuation including 28 day post study follow up

Population: ITT. 20 subjects were censored.

PFS was defined as the time from start of study medication to first documentation of objective tumor progression or to death due to any cause that occurred on treatment including within 28 days after the last dose of study medication, whichever occurred first. If tumor progression data included more than 1 date, the first date was used. PFS (in weeks) was calculated as (first event date minus first dose date +1)/7. Kaplan-Meier method was used.

Outcome measures

Outcome measures
Measure
Sunitinib
n=61 Participants
50 milligram/day for 4 consecutive weeks followed by a 2-week off-treatment period (6-week treatment cycle).
Progression Free Survival (PFS)
30.4 weeks
Interval 18.3 to 36.7

SECONDARY outcome

Timeframe: Day 28 of Cycle 1 to Cycle 4

Population: ITT

Outcome measures

Outcome measures
Measure
Sunitinib
n=59 Participants
50 milligram/day for 4 consecutive weeks followed by a 2-week off-treatment period (6-week treatment cycle).
Trough Plasma Concentrations (Cmin) of Sunitinib
Cycle 1, Day 28 (n=20)
52.05 ng/mL
Interval 29.8 to 91.4
Trough Plasma Concentrations (Cmin) of Sunitinib
Cycle 2, Day 28 (n=23)
43.50 ng/mL
Interval 8.69 to 93.0
Trough Plasma Concentrations (Cmin) of Sunitinib
Cycle 3, Day 28 (n=10)
46.10 ng/mL
Interval 24.8 to 72.0
Trough Plasma Concentrations (Cmin) of Sunitinib
Cycle 4, Day 28 (n=16)
44.90 ng/mL
Interval 13.1 to 103.0

SECONDARY outcome

Timeframe: Day 28 of Cycle 1 to Cycle 4

Population: ITT

Outcome measures

Outcome measures
Measure
Sunitinib
n=59 Participants
50 milligram/day for 4 consecutive weeks followed by a 2-week off-treatment period (6-week treatment cycle).
Trough Plasma Concentrations (Cmin) of SU012662
Cycle 1, Day 28 (n=20)
30.50 ng/mL
Interval 14.1 to 64.0
Trough Plasma Concentrations (Cmin) of SU012662
Cycle 2, Day 28 (n=23)
21.40 ng/mL
Interval 5.51 to 55.2
Trough Plasma Concentrations (Cmin) of SU012662
Cycle 3, Day 28 (n=10)
22.10 ng/mL
Interval 8.49 to 40.7
Trough Plasma Concentrations (Cmin) of SU012662
Cycle 4, Day 28 (n=16)
23.75 ng/mL
Interval 11.4 to 47.8

SECONDARY outcome

Timeframe: Day 28 of Cycle 1 to Cycle 4

Population: ITT

Outcome measures

Outcome measures
Measure
Sunitinib
n=59 Participants
50 milligram/day for 4 consecutive weeks followed by a 2-week off-treatment period (6-week treatment cycle).
Trough Plasma Concentrations (Cmin) of Total Drug (Sunitinib + SU012662)
Cycle 1, Day 28 (n=20)
85.40 ng/mL
Interval 43.9 to 141.7
Trough Plasma Concentrations (Cmin) of Total Drug (Sunitinib + SU012662)
Cycle 2, Day 28 (n=23)
66.60 ng/mL
Interval 18.32 to 129.4
Trough Plasma Concentrations (Cmin) of Total Drug (Sunitinib + SU012662)
Cycle 3, Day 28 (n=10)
68.40 ng/mL
Interval 41.29 to 106.1
Trough Plasma Concentrations (Cmin) of Total Drug (Sunitinib + SU012662)
Cycle 4, Day 28 (n=16)
68.15 ng/mL
Interval 29.2 to 126.0

SECONDARY outcome

Timeframe: Cycle 1 (Days 1, 14, and 28), Cycle 2 (Day 1)

Population: ITT

Plasma concentrations of VEGF-A that may be associated with tumor proliferation or angiogenesis collected from a subset of subjects were analyzed by ELISA analysis. Samples below the limit of quantitation and samples with insufficient volume available were excluded.

Outcome measures

Outcome measures
Measure
Sunitinib
n=61 Participants
50 milligram/day for 4 consecutive weeks followed by a 2-week off-treatment period (6-week treatment cycle).
Plasma Concentration of Vascular Endothelial Growth Factor-A (VEGF-A)
Cycle 1, Day 1 (Baseline) (n=59)
567.4 pg/mL
Interval 57.0 to 3692.0
Plasma Concentration of Vascular Endothelial Growth Factor-A (VEGF-A)
Cycle 1, Day 14 (n=57)
1320.6 pg/mL
Interval 104.5 to 4751.0
Plasma Concentration of Vascular Endothelial Growth Factor-A (VEGF-A)
Cycle 1, Day 28 (n=55)
1212.3 pg/mL
Interval 105.2 to 6137.0
Plasma Concentration of Vascular Endothelial Growth Factor-A (VEGF-A)
Cycle 2, Day 1 (n=54)
316.2 pg/mL
Interval 56.9 to 1724.0

SECONDARY outcome

Timeframe: Cycle 1 (Days 1, 14, and 28), Cycle 2 (Day 1)

Population: ITT

Plasma concentrations of sVEGFR-3 that may be associated with tumor proliferation or angiogenesis collected from a subset of subjects were analyzed by ELISA analysis. Samples below the limit of quantitation and samples with insufficient volume available were excluded.

Outcome measures

Outcome measures
Measure
Sunitinib
n=61 Participants
50 milligram/day for 4 consecutive weeks followed by a 2-week off-treatment period (6-week treatment cycle).
Plasma Concentration of Soluble VEGF Receptor-3 (sVEGFR-3)
Cycle 1, Day 1 (Baseline) (n=54)
54170.4 pg/mL
Interval 21300.0 to 202900.0
Plasma Concentration of Soluble VEGF Receptor-3 (sVEGFR-3)
Cycle 1, Day 14 (n=32)
37747.0 pg/mL
Interval 21500.0 to 122900.0
Plasma Concentration of Soluble VEGF Receptor-3 (sVEGFR-3)
Cycle 1, Day 28 (n=22)
46891.0 pg/mL
Interval 22700.0 to 109700.0
Plasma Concentration of Soluble VEGF Receptor-3 (sVEGFR-3)
Cycle 2, Day 1 (n=46)
51280.0 pg/mL
Interval 21700.0 to 122900.0

SECONDARY outcome

Timeframe: Cycle 1 (Days 1, 14, and 28)

Population: ITT

Plasma concentrations of PlGF that may be associated with tumor proliferation or angiogenesis collected from a subset of subjects were analyzed by ELISA analysis. Samples below the limit of quantitation and samples with insufficient volume available were excluded.

Outcome measures

Outcome measures
Measure
Sunitinib
n=61 Participants
50 milligram/day for 4 consecutive weeks followed by a 2-week off-treatment period (6-week treatment cycle).
Plasma Concentration of Placental Growth Factor (PlGF)
Cycle 1, Day 1 (Baseline) (n=37)
55.0 pg/mL
Interval 24.4 to 257.0
Plasma Concentration of Placental Growth Factor (PlGF)
Cycle 1, Day 14 (n=58)
146.1 pg/mL
Interval 44.8 to 408.0
Plasma Concentration of Placental Growth Factor (PlGF)
Cycle 1, Day 28 (n=53)
137.9 pg/mL
Interval 28.2 to 490.0

SECONDARY outcome

Timeframe: Cycle 1 (Days 1, 14, and 28)

Population: ITT

Plasma concentrations of VEGF-C that may be associated with tumor proliferation or angiogenesis collected from a subset of subjects were analyzed by ELISA analysis. Samples below the limit of quantitation and samples with insufficient volume available were excluded.

Outcome measures

Outcome measures
Measure
Sunitinib
n=61 Participants
50 milligram/day for 4 consecutive weeks followed by a 2-week off-treatment period (6-week treatment cycle).
Plasma Concentration of VEGF-C
Cycle 1, Day 1 (Baseline) (n=57)
833.0 pg/mL
Interval 332.0 to 3167.0
Plasma Concentration of VEGF-C
Cycle 1, Day 14 (n=57)
688.0 pg/mL
Interval 284.5 to 1353.0
Plasma Concentration of VEGF-C
Cycle 1, Day 28 (n=54)
566.5 pg/mL
Interval 213.0 to 1391.0

SECONDARY outcome

Timeframe: 1 year

Plasma concentrations of sVEGFR-2 that may be associated with tumor proliferation or angiogenesis collected from a subset of subjects were to have been analyzed by ELISA analysis; however, no data were collected.

Outcome measures

Outcome data not reported

Adverse Events

Sunitinib

Serious events: 30 serious events
Other events: 60 other events
Deaths: 0 deaths

Serious adverse events

Serious adverse events
Measure
Sunitinib
n=61 participants at risk
50 milligram/day for 4 consecutive weeks followed by a 2-week off-treatment period (6-week treatment cycle).
Blood and lymphatic system disorders
Anaemia
3.3%
2/61
Cardiac disorders
Angina pectoris
1.6%
1/61
Cardiac disorders
Atrial fibrillation
1.6%
1/61
Cardiac disorders
Pericardial effusion
1.6%
1/61
Endocrine disorders
Adrenal insufficiency
3.3%
2/61
Endocrine disorders
Hypothyroidism
1.6%
1/61
Gastrointestinal disorders
Nausea
6.6%
4/61
Gastrointestinal disorders
Vomiting
6.6%
4/61
Gastrointestinal disorders
Abdominal pain
3.3%
2/61
Gastrointestinal disorders
Ascites
3.3%
2/61
Gastrointestinal disorders
Diarrhoea
3.3%
2/61
Gastrointestinal disorders
Gastrointestinal haemorrhage
3.3%
2/61
Gastrointestinal disorders
Abdominal distension
1.6%
1/61
Gastrointestinal disorders
Abdominal pain lower
1.6%
1/61
Gastrointestinal disorders
Haemorrhoidal haemorrhage
1.6%
1/61
General disorders
Disease progression
8.2%
5/61
General disorders
Fatigue
6.6%
4/61
General disorders
Pyrexia
3.3%
2/61
General disorders
Chest pain
1.6%
1/61
General disorders
Generalised oedema
1.6%
1/61
General disorders
Oedema
1.6%
1/61
General disorders
Pain
1.6%
1/61
Infections and infestations
Diverticulitis
3.3%
2/61
Infections and infestations
Pneumonia
3.3%
2/61
Infections and infestations
Wound infection
3.3%
2/61
Infections and infestations
Abdominal abscess
1.6%
1/61
Infections and infestations
Appendicitis
1.6%
1/61
Injury, poisoning and procedural complications
Accidental overdose
1.6%
1/61
Investigations
Activated partial thromboplastin time prolonged
1.6%
1/61
Investigations
Electrocardiogram QT corrected interval prolonged
1.6%
1/61
Metabolism and nutrition disorders
Dehydration
4.9%
3/61
Metabolism and nutrition disorders
Anorexia
3.3%
2/61
Metabolism and nutrition disorders
Hyponatraemia
1.6%
1/61
Musculoskeletal and connective tissue disorders
Arthralgia
1.6%
1/61
Musculoskeletal and connective tissue disorders
Back pain
1.6%
1/61
Musculoskeletal and connective tissue disorders
Buttock pain
1.6%
1/61
Musculoskeletal and connective tissue disorders
Muscular weakness
1.6%
1/61
Musculoskeletal and connective tissue disorders
Pain in extremity
1.6%
1/61
Neoplasms benign, malignant and unspecified (incl cysts and polyps)
Malignant pleural effusion
1.6%
1/61
Nervous system disorders
Cerebral haemorrhage
1.6%
1/61
Nervous system disorders
Depressed level of consciousness
1.6%
1/61
Nervous system disorders
Loss of consciousness
1.6%
1/61
Nervous system disorders
Spinal cord compression
1.6%
1/61
Nervous system disorders
Syncope
1.6%
1/61
Psychiatric disorders
Confusional state
1.6%
1/61
Psychiatric disorders
Psychotic disorder
1.6%
1/61
Respiratory, thoracic and mediastinal disorders
Dyspnoea
8.2%
5/61
Respiratory, thoracic and mediastinal disorders
Pleural effusion
3.3%
2/61
Respiratory, thoracic and mediastinal disorders
Haemoptysis
1.6%
1/61
Respiratory, thoracic and mediastinal disorders
Pulmonary embolism
1.6%
1/61
Skin and subcutaneous tissue disorders
Angioneurotic oedema
1.6%
1/61
Vascular disorders
Deep vein thrombosis
3.3%
2/61

Other adverse events

Other adverse events
Measure
Sunitinib
n=61 participants at risk
50 milligram/day for 4 consecutive weeks followed by a 2-week off-treatment period (6-week treatment cycle).
Nervous system disorders
Peripheral sensory neuropathy
6.6%
4/61
Psychiatric disorders
Anxiety
9.8%
6/61
Blood and lymphatic system disorders
Anaemia
26.2%
16/61
Blood and lymphatic system disorders
Thrombocytopenia
6.6%
4/61
Endocrine disorders
Hypothyroidism
23.0%
14/61
Eye disorders
Lacrimation increased
8.2%
5/61
Gastrointestinal disorders
Abdominal distension
6.6%
4/61
Gastrointestinal disorders
Abdominal pain
16.4%
10/61
Gastrointestinal disorders
Cheilitis
13.1%
8/61
Gastrointestinal disorders
Constipation
41.0%
25/61
Gastrointestinal disorders
Diarrhoea
68.9%
42/61
Gastrointestinal disorders
Dry mouth
9.8%
6/61
Gastrointestinal disorders
Dyspepsia
32.8%
20/61
Gastrointestinal disorders
Eructation
6.6%
4/61
Gastrointestinal disorders
Flatulence
11.5%
7/61
Gastrointestinal disorders
Gastrooesophageal reflux disease
16.4%
10/61
Gastrointestinal disorders
Glossodynia
6.6%
4/61
Gastrointestinal disorders
Haemorrhoids
11.5%
7/61
Gastrointestinal disorders
Nausea
60.7%
37/61
Gastrointestinal disorders
Stomatitis
45.9%
28/61
Gastrointestinal disorders
Vomiting
47.5%
29/61
General disorders
Chest pain
13.1%
8/61
General disorders
Chills
19.7%
12/61
General disorders
Fatigue
88.5%
54/61
General disorders
Mucosal inflammation
34.4%
21/61
General disorders
Oedema peripheral
32.8%
20/61
General disorders
Pain
8.2%
5/61
General disorders
Pyrexia
21.3%
13/61
Infections and infestations
Sinusitis
13.1%
8/61
Infections and infestations
Upper respiratory tract infection
8.2%
5/61
Infections and infestations
Urinary tract infection
16.4%
10/61
Infections and infestations
Excoriation
6.6%
4/61
Investigations
Alanine aminotransferase increased
9.8%
6/61
Investigations
Aspartate aminotransferase increased
13.1%
8/61
Investigations
Blood creatinine increased
14.8%
9/61
Investigations
Blood glucose increased
6.6%
4/61
Investigations
Blood phosphorus decreased
6.6%
4/61
Investigations
Blood uric acid increased
6.6%
4/61
Investigations
Ejection fraction decreased
11.5%
7/61
Investigations
Haemoglobin decreased
8.2%
5/61
Investigations
Lipase increased
8.2%
5/61
Investigations
Neutrophil count decreased
13.1%
8/61
Investigations
Platelet count decreased
8.2%
5/61
Investigations
Weight decreased
18.0%
11/61
Investigations
Weight increased
8.2%
5/61
Investigations
White blood cell count decreased
11.5%
7/61
Metabolism and nutrition disorders
Anorexia
60.7%
37/61
Metabolism and nutrition disorders
Dehydration
14.8%
9/61
Metabolism and nutrition disorders
Hyperglycaemia
9.8%
6/61
Metabolism and nutrition disorders
Hyperuricaemia
6.6%
4/61
Metabolism and nutrition disorders
Hypokalaemia
8.2%
5/61
Metabolism and nutrition disorders
Hyponatraemia
9.8%
6/61
Metabolism and nutrition disorders
Hypophosphataemia
6.6%
4/61
Musculoskeletal and connective tissue disorders
Arthralgia
13.1%
8/61
Musculoskeletal and connective tissue disorders
Back pain
23.0%
14/61
Musculoskeletal and connective tissue disorders
Flank pain
6.6%
4/61
Musculoskeletal and connective tissue disorders
Muscle spasms
6.6%
4/61
Musculoskeletal and connective tissue disorders
Muscular weakness
6.6%
4/61
Musculoskeletal and connective tissue disorders
Musculoskeletal chest pain
6.6%
4/61
Musculoskeletal and connective tissue disorders
Musculoskeletal pain
8.2%
5/61
Musculoskeletal and connective tissue disorders
Myalgia
13.1%
8/61
Musculoskeletal and connective tissue disorders
Neck pain
8.2%
5/61
Musculoskeletal and connective tissue disorders
Pain in extremity
32.8%
20/61
Nervous system disorders
Dizziness
19.7%
12/61
Nervous system disorders
Dysgeusia
55.7%
34/61
Nervous system disorders
Headache
23.0%
14/61
Psychiatric disorders
Confusional state
6.6%
4/61
Psychiatric disorders
Insomnia
21.3%
13/61
Respiratory, thoracic and mediastinal disorders
Cough
32.8%
20/61
Respiratory, thoracic and mediastinal disorders
Dysphonia
8.2%
5/61
Respiratory, thoracic and mediastinal disorders
Dyspnoea
36.1%
22/61
Respiratory, thoracic and mediastinal disorders
Epistaxis
16.4%
10/61
Respiratory, thoracic and mediastinal disorders
Haemoptysis
6.6%
4/61
Respiratory, thoracic and mediastinal disorders
Nasal congestion
6.6%
4/61
Respiratory, thoracic and mediastinal disorders
Pharyngolaryngeal pain
14.8%
9/61
Respiratory, thoracic and mediastinal disorders
Rhinitis allergic
8.2%
5/61
Skin and subcutaneous tissue disorders
Alopecia
6.6%
4/61
Skin and subcutaneous tissue disorders
Dry skin
19.7%
12/61
Skin and subcutaneous tissue disorders
Exfoliative rash
8.2%
5/61
Skin and subcutaneous tissue disorders
Hair colour changes
13.1%
8/61
Skin and subcutaneous tissue disorders
Palmar-plantar erythrodysaesthesia syndrome
36.1%
22/61
Skin and subcutaneous tissue disorders
Periorbital oedema
13.1%
8/61
Skin and subcutaneous tissue disorders
Pruritus
8.2%
5/61
Skin and subcutaneous tissue disorders
Rash
19.7%
12/61
Skin and subcutaneous tissue disorders
Skin discolouration
39.3%
24/61
Skin and subcutaneous tissue disorders
Skin reaction
18.0%
11/61
Vascular disorders
Hypertension
32.8%
20/61
Vascular disorders
Hypotension
8.2%
5/61

Additional Information

Pfizer ClinicalTrials.gov Call Center

Pfizer, Inc.

Phone: 1-800-718-1021

Results disclosure agreements

  • Principal investigator is a sponsor employee Pfizer has the right to review disclosures, requesting a delay of \< 60 days. Investigator will postpone single center publications until after disclosure of pooled data (all sites), \< 12 months from study completion/termination at all participating sites. Investigator may not disclose previously undisclosed confidential information other than study results.
  • Publication restrictions are in place

Restriction type: OTHER