Trial Outcomes & Findings for Cisplatin vs. Doxorubicin/Cyclophosphamide in BrCa (NCT NCT01670500)

NCT ID: NCT01670500

Last Updated: 2025-04-09

Results Overview

Pathologic complete response (pCR) rate (determined by the Miller-Payne method) in doxorubicin-cyclophosphamide vs cisplatin arms.

Recruitment status

COMPLETED

Study phase

PHASE2

Target enrollment

118 participants

Primary outcome timeframe

3 years

Results posted on

2025-04-09

Participant Flow

The trial was conducted at 13 academic centers and participants were recruited from these locations. Accrual occurred between January 2012 and January 2019.

Participant milestones

Participant milestones
Measure
Doxorubicin-Cyclophosphamide
Doxorubicin q 2-3 wk x 4 Cyclophosphamide q 2-3 wk x 4 Cyclophosphamide: administered with doxorubicin intravenously every 2 or 3 weeks for 4 doses Doxorubicin: administered with Cyclophosphamide intravenously every 2 or 3 weeks for 4 doses
Cisplatin
Cisplatin q 3 wk x 4 Cisplatin: administered intravenously every 3 weeks for 4 doses
Overall Study
STARTED
58
60
Overall Study
COMPLETED
57
60
Overall Study
NOT COMPLETED
1
0

Reasons for withdrawal

Reasons for withdrawal
Measure
Doxorubicin-Cyclophosphamide
Doxorubicin q 2-3 wk x 4 Cyclophosphamide q 2-3 wk x 4 Cyclophosphamide: administered with doxorubicin intravenously every 2 or 3 weeks for 4 doses Doxorubicin: administered with Cyclophosphamide intravenously every 2 or 3 weeks for 4 doses
Cisplatin
Cisplatin q 3 wk x 4 Cisplatin: administered intravenously every 3 weeks for 4 doses
Overall Study
Withdrawal by Subject
1
0

Baseline Characteristics

Stromal TILS missing for 5 in Doxorubicin-Cyclophosphamide arm and 4 in the Cisplatin arm

Baseline characteristics by cohort

Baseline characteristics by cohort
Measure
Doxorubicin-Cyclophosphamide
n=58 Participants
Doxorubicin q 2-3 wk x 4 Cyclophosphamide q 2-3 wk x 4 Cyclophosphamide: administered with doxorubicin intravenously every 2 or 3 weeks for 4 doses Doxorubicin: administered with Cyclophosphamide intravenously every 2 or 3 weeks for 4 doses
Cisplatin
n=60 Participants
Cisplatin q 3 wk x 4 Cisplatin: administered intravenously every 3 weeks for 4 doses
Total
n=118 Participants
Total of all reporting groups
Age, Continuous
44 years
STANDARD_DEVIATION 10 • n=58 Participants
40 years
STANDARD_DEVIATION 9 • n=60 Participants
42 years
STANDARD_DEVIATION 10 • n=118 Participants
Sex: Female, Male
Female
58 Participants
n=58 Participants
59 Participants
n=60 Participants
117 Participants
n=118 Participants
Sex: Female, Male
Male
0 Participants
n=58 Participants
1 Participants
n=60 Participants
1 Participants
n=118 Participants
Ethnicity (NIH/OMB)
Hispanic or Latino
7 Participants
n=58 Participants
8 Participants
n=60 Participants
15 Participants
n=118 Participants
Ethnicity (NIH/OMB)
Not Hispanic or Latino
49 Participants
n=58 Participants
48 Participants
n=60 Participants
97 Participants
n=118 Participants
Ethnicity (NIH/OMB)
Unknown or Not Reported
2 Participants
n=58 Participants
4 Participants
n=60 Participants
6 Participants
n=118 Participants
Race (NIH/OMB)
American Indian or Alaska Native
0 Participants
n=58 Participants
0 Participants
n=60 Participants
0 Participants
n=118 Participants
Race (NIH/OMB)
Asian
2 Participants
n=58 Participants
2 Participants
n=60 Participants
4 Participants
n=118 Participants
Race (NIH/OMB)
Native Hawaiian or Other Pacific Islander
0 Participants
n=58 Participants
0 Participants
n=60 Participants
0 Participants
n=118 Participants
Race (NIH/OMB)
Black or African American
5 Participants
n=58 Participants
7 Participants
n=60 Participants
12 Participants
n=118 Participants
Race (NIH/OMB)
White
44 Participants
n=58 Participants
43 Participants
n=60 Participants
87 Participants
n=118 Participants
Race (NIH/OMB)
More than one race
2 Participants
n=58 Participants
3 Participants
n=60 Participants
5 Participants
n=118 Participants
Race (NIH/OMB)
Unknown or Not Reported
5 Participants
n=58 Participants
5 Participants
n=60 Participants
10 Participants
n=118 Participants
BRCA status
BRCA 1
37 Participants
n=58 Participants
44 Participants
n=60 Participants
81 Participants
n=118 Participants
BRCA status
BRCA 2
20 Participants
n=58 Participants
15 Participants
n=60 Participants
35 Participants
n=118 Participants
BRCA status
BRCA 1 and BRCA 2
1 Participants
n=58 Participants
1 Participants
n=60 Participants
2 Participants
n=118 Participants
Tumor size by imaging
2 centimeters
n=58 Participants
3 centimeters
n=60 Participants
2 centimeters
n=118 Participants
T Stage (Tumor Size)
T1
17 Participants
n=58 Participants
12 Participants
n=60 Participants
29 Participants
n=118 Participants
T Stage (Tumor Size)
T2
31 Participants
n=58 Participants
35 Participants
n=60 Participants
66 Participants
n=118 Participants
T Stage (Tumor Size)
T3
10 Participants
n=58 Participants
12 Participants
n=60 Participants
22 Participants
n=118 Participants
T Stage (Tumor Size)
unknown
0 Participants
n=58 Participants
1 Participants
n=60 Participants
1 Participants
n=118 Participants
N stage
N0
34 Participants
n=58 Participants
31 Participants
n=60 Participants
65 Participants
n=118 Participants
N stage
N1
19 Participants
n=58 Participants
24 Participants
n=60 Participants
43 Participants
n=118 Participants
N stage
N2
2 Participants
n=58 Participants
2 Participants
n=60 Participants
4 Participants
n=118 Participants
N stage
N3
3 Participants
n=58 Participants
3 Participants
n=60 Participants
6 Participants
n=118 Participants
Node status: biopsy before chemotherapy
positive
24 Participants
n=58 Participants
29 Participants
n=60 Participants
53 Participants
n=118 Participants
Node status: biopsy before chemotherapy
negative
34 Participants
n=58 Participants
31 Participants
n=60 Participants
65 Participants
n=118 Participants
Stage
I
15 Participants
n=58 Participants
8 Participants
n=60 Participants
23 Participants
n=118 Participants
Stage
II
34 Participants
n=58 Participants
40 Participants
n=60 Participants
74 Participants
n=118 Participants
Stage
III
9 Participants
n=58 Participants
12 Participants
n=60 Participants
21 Participants
n=118 Participants
Estrogen Receptor (ER)
Positive (>/= 1%)
20 Participants
n=58 Participants
20 Participants
n=60 Participants
40 Participants
n=118 Participants
Estrogen Receptor (ER)
Negative (< 1%)
38 Participants
n=58 Participants
40 Participants
n=60 Participants
78 Participants
n=118 Participants
Hormone receptor 1% cutoff
Triple Negative Breast Cancer (ER & PR < 1%)
36 Participants
n=58 Participants
40 Participants
n=60 Participants
76 Participants
n=118 Participants
Hormone receptor 1% cutoff
ER+ or PR+
22 Participants
n=58 Participants
20 Participants
n=60 Participants
42 Participants
n=118 Participants
Histology
Invasive ductal
52 Participants
n=58 Participants
57 Participants
n=60 Participants
109 Participants
n=118 Participants
Histology
Invasive lobular
2 Participants
n=58 Participants
2 Participants
n=60 Participants
4 Participants
n=118 Participants
Histology
Mixed
3 Participants
n=58 Participants
1 Participants
n=60 Participants
4 Participants
n=118 Participants
Histology
Other
1 Participants
n=58 Participants
0 Participants
n=60 Participants
1 Participants
n=118 Participants
Pre-chemotherapy tumor grade
1
1 Participants
n=58 Participants
2 Participants
n=60 Participants
3 Participants
n=118 Participants
Pre-chemotherapy tumor grade
2
12 Participants
n=58 Participants
11 Participants
n=60 Participants
23 Participants
n=118 Participants
Pre-chemotherapy tumor grade
3
45 Participants
n=58 Participants
46 Participants
n=60 Participants
91 Participants
n=118 Participants
Pre-chemotherapy tumor grade
unknown
0 Participants
n=58 Participants
1 Participants
n=60 Participants
1 Participants
n=118 Participants
Lymphovascular invasion
Present
11 Participants
n=58 Participants
12 Participants
n=60 Participants
23 Participants
n=118 Participants
Lymphovascular invasion
Absent
47 Participants
n=58 Participants
48 Participants
n=60 Participants
95 Participants
n=118 Participants
lymphocytic infiltrate
moderate/marked
22 Participants
n=58 Participants
21 Participants
n=60 Participants
43 Participants
n=118 Participants
lymphocytic infiltrate
absent/scant
33 Participants
n=58 Participants
36 Participants
n=60 Participants
69 Participants
n=118 Participants
lymphocytic infiltrate
unknown
3 Participants
n=58 Participants
3 Participants
n=60 Participants
6 Participants
n=118 Participants
Stromal TILs
10 percentage of stromal TILs
n=53 Participants • Stromal TILS missing for 5 in Doxorubicin-Cyclophosphamide arm and 4 in the Cisplatin arm
10 percentage of stromal TILs
n=56 Participants • Stromal TILS missing for 5 in Doxorubicin-Cyclophosphamide arm and 4 in the Cisplatin arm
10 percentage of stromal TILs
n=109 Participants • Stromal TILS missing for 5 in Doxorubicin-Cyclophosphamide arm and 4 in the Cisplatin arm

PRIMARY outcome

Timeframe: 3 years

Pathologic complete response (pCR) rate (determined by the Miller-Payne method) in doxorubicin-cyclophosphamide vs cisplatin arms.

Outcome measures

Outcome measures
Measure
Doxorubicin-Cyclophosphamide
n=57 Participants
Doxorubicin q 2-3 wk x 4 Cyclophosphamide q 2-3 wk x 4 Cyclophosphamide: administered with doxorubicin intravenously every 2 or 3 weeks for 4 doses Doxorubicin: administered with Cyclophosphamide intravenously every 2 or 3 weeks for 4 doses
Cisplatin
n=60 Participants
Cisplatin q 3 wk x 4 Cisplatin: administered intravenously every 3 weeks for 4 doses
Rate of Pathologic Complete Response (pCR)
0 Participants
0 Participants

SECONDARY outcome

Timeframe: 2 years

Residual Cancer Burden (RCB) rate of RCB 0 or 1 in participants receiving Doxorubicin-Cyclophosphamide vs participants receiving Cisplatin.

Outcome measures

Outcome measures
Measure
Doxorubicin-Cyclophosphamide
n=57 Participants
Doxorubicin q 2-3 wk x 4 Cyclophosphamide q 2-3 wk x 4 Cyclophosphamide: administered with doxorubicin intravenously every 2 or 3 weeks for 4 doses Doxorubicin: administered with Cyclophosphamide intravenously every 2 or 3 weeks for 4 doses
Cisplatin
n=60 Participants
Cisplatin q 3 wk x 4 Cisplatin: administered intravenously every 3 weeks for 4 doses
Rate of Residual Cancer Burden (RCB) 0/1
46 percentage of participants
33 percentage of participants

SECONDARY outcome

Timeframe: 3 years

Clinical response rate, defined as the number of partial and complete responses, after preoperative therapy with either cisplatin or AC in participants with germline BRCA mutation and breast cancer. Per Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.1) for target lesions and assessed by MRI or ultrasound: Complete Response (CR) = Disappearance of all target lesions; Partial Response (PR) is \>=30% decrease in the sum of the longest diameter of target lesions; Overall Response (OR) = CR + PR.

Outcome measures

Outcome measures
Measure
Doxorubicin-Cyclophosphamide
n=58 Participants
Doxorubicin q 2-3 wk x 4 Cyclophosphamide q 2-3 wk x 4 Cyclophosphamide: administered with doxorubicin intravenously every 2 or 3 weeks for 4 doses Doxorubicin: administered with Cyclophosphamide intravenously every 2 or 3 weeks for 4 doses
Cisplatin
n=60 Participants
Cisplatin q 3 wk x 4 Cisplatin: administered intravenously every 3 weeks for 4 doses
Clinical Response Rate
43 Participants
45 Participants

SECONDARY outcome

Timeframe: 2 years

Comparison of toxicities for cisplatin and AC preoperative chemotherapy in BRCA mutation carriers with newly diagnosed breast cancer, reported as number of all Grade 3 and 4 adverse events and number of non-hematologic Grade 3 and 4 adverse events.

Outcome measures

Outcome measures
Measure
Doxorubicin-Cyclophosphamide
n=57 Participants
Doxorubicin q 2-3 wk x 4 Cyclophosphamide q 2-3 wk x 4 Cyclophosphamide: administered with doxorubicin intravenously every 2 or 3 weeks for 4 doses Doxorubicin: administered with Cyclophosphamide intravenously every 2 or 3 weeks for 4 doses
Cisplatin
n=60 Participants
Cisplatin q 3 wk x 4 Cisplatin: administered intravenously every 3 weeks for 4 doses
Number of Grade 3 and Grade 4 Adverse Events
All Grade 3 & 4 Adverse Events
15 Adverse Events
16 Adverse Events
Number of Grade 3 and Grade 4 Adverse Events
Non-hematologic Grade 3 & 4 Adverse Events
4 Adverse Events
11 Adverse Events

SECONDARY outcome

Timeframe: 5 years

Biopsies collected for future analyses of biomarkers that predict for response to cisplatin or AC chemotherapy in BRCA mutation carriers. Pretreatment tumor biopsies will be analyzed using genome wide SNP profiling to determine number of regions of telomeric allelic imbalance (NtAI) and chromosome 15q26 copy number, and chromosome 8q22 copy number. Tumor sections will be examined for gene amplifications, losses and NtAI in tumors. Gene expression profiling will be performed to determine intrinsic subtype (basal-like, claudin-low, etc.) and to measure biomarker genes including BLM and FANCI associated with cisplatin sensitivity or LAPTM4B and YWHAZ associated with anthracycline resistance. Exploratory analysis will be performed to seek new measures of therapy response using the data from DNA copy number and gene expression profiles. In addition, we will plan to perform whole exome and possibly whole genome sequencing of tumors to identify potential modifiers of response to therapy.

Outcome measures

Outcome data not reported

Adverse Events

Doxorubicin-Cyclophosphamide

Serious events: 6 serious events
Other events: 55 other events
Deaths: 0 deaths

Cisplatin

Serious events: 5 serious events
Other events: 60 other events
Deaths: 0 deaths

Serious adverse events

Serious adverse events
Measure
Doxorubicin-Cyclophosphamide
n=57 participants at risk
Doxorubicin q 2-3 wk x 4 Cyclophosphamide q 2-3 wk x 4 Cyclophosphamide: administered with doxorubicin intravenously every 2 or 3 weeks for 4 doses Doxorubicin: administered with Cyclophosphamide intravenously every 2 or 3 weeks for 4 doses
Cisplatin
n=60 participants at risk
Cisplatin q 3 wk x 4 Cisplatin: administered intravenously every 3 weeks for 4 doses
Immune system disorders
Allergic Reaction
1.8%
1/57 • Adverse event information was collected from time of treatment start, during treatment, and until 30 days after the last dose of treatment, about 3 months on average per participant, an average of 2 years.
0.00%
0/60 • Adverse event information was collected from time of treatment start, during treatment, and until 30 days after the last dose of treatment, about 3 months on average per participant, an average of 2 years.
Metabolism and nutrition disorders
Dehydration
0.00%
0/57 • Adverse event information was collected from time of treatment start, during treatment, and until 30 days after the last dose of treatment, about 3 months on average per participant, an average of 2 years.
1.7%
1/60 • Adverse event information was collected from time of treatment start, during treatment, and until 30 days after the last dose of treatment, about 3 months on average per participant, an average of 2 years.
Vascular disorders
Thromboembolic event
0.00%
0/57 • Adverse event information was collected from time of treatment start, during treatment, and until 30 days after the last dose of treatment, about 3 months on average per participant, an average of 2 years.
3.3%
2/60 • Adverse event information was collected from time of treatment start, during treatment, and until 30 days after the last dose of treatment, about 3 months on average per participant, an average of 2 years.
Infections and infestations
Breast Infection
0.00%
0/57 • Adverse event information was collected from time of treatment start, during treatment, and until 30 days after the last dose of treatment, about 3 months on average per participant, an average of 2 years.
1.7%
1/60 • Adverse event information was collected from time of treatment start, during treatment, and until 30 days after the last dose of treatment, about 3 months on average per participant, an average of 2 years.
Investigations
Neutrophil Count Decreased
7.0%
4/57 • Adverse event information was collected from time of treatment start, during treatment, and until 30 days after the last dose of treatment, about 3 months on average per participant, an average of 2 years.
0.00%
0/60 • Adverse event information was collected from time of treatment start, during treatment, and until 30 days after the last dose of treatment, about 3 months on average per participant, an average of 2 years.
General disorders
Non-Cardiac Chest Pain
0.00%
0/57 • Adverse event information was collected from time of treatment start, during treatment, and until 30 days after the last dose of treatment, about 3 months on average per participant, an average of 2 years.
1.7%
1/60 • Adverse event information was collected from time of treatment start, during treatment, and until 30 days after the last dose of treatment, about 3 months on average per participant, an average of 2 years.
Investigations
Increased Creatinine
0.00%
0/57 • Adverse event information was collected from time of treatment start, during treatment, and until 30 days after the last dose of treatment, about 3 months on average per participant, an average of 2 years.
3.3%
2/60 • Adverse event information was collected from time of treatment start, during treatment, and until 30 days after the last dose of treatment, about 3 months on average per participant, an average of 2 years.
Blood and lymphatic system disorders
Febrile Neutropenia
1.8%
1/57 • Adverse event information was collected from time of treatment start, during treatment, and until 30 days after the last dose of treatment, about 3 months on average per participant, an average of 2 years.
0.00%
0/60 • Adverse event information was collected from time of treatment start, during treatment, and until 30 days after the last dose of treatment, about 3 months on average per participant, an average of 2 years.

Other adverse events

Other adverse events
Measure
Doxorubicin-Cyclophosphamide
n=57 participants at risk
Doxorubicin q 2-3 wk x 4 Cyclophosphamide q 2-3 wk x 4 Cyclophosphamide: administered with doxorubicin intravenously every 2 or 3 weeks for 4 doses Doxorubicin: administered with Cyclophosphamide intravenously every 2 or 3 weeks for 4 doses
Cisplatin
n=60 participants at risk
Cisplatin q 3 wk x 4 Cisplatin: administered intravenously every 3 weeks for 4 doses
General disorders
Fatigue
78.9%
45/57 • Adverse event information was collected from time of treatment start, during treatment, and until 30 days after the last dose of treatment, about 3 months on average per participant, an average of 2 years.
80.0%
48/60 • Adverse event information was collected from time of treatment start, during treatment, and until 30 days after the last dose of treatment, about 3 months on average per participant, an average of 2 years.
Gastrointestinal disorders
Nausea
70.2%
40/57 • Adverse event information was collected from time of treatment start, during treatment, and until 30 days after the last dose of treatment, about 3 months on average per participant, an average of 2 years.
86.7%
52/60 • Adverse event information was collected from time of treatment start, during treatment, and until 30 days after the last dose of treatment, about 3 months on average per participant, an average of 2 years.
Ear and labyrinth disorders
Tinnitus
0.00%
0/57 • Adverse event information was collected from time of treatment start, during treatment, and until 30 days after the last dose of treatment, about 3 months on average per participant, an average of 2 years.
53.3%
32/60 • Adverse event information was collected from time of treatment start, during treatment, and until 30 days after the last dose of treatment, about 3 months on average per participant, an average of 2 years.
Gastrointestinal disorders
Vomiting
15.8%
9/57 • Adverse event information was collected from time of treatment start, during treatment, and until 30 days after the last dose of treatment, about 3 months on average per participant, an average of 2 years.
21.7%
13/60 • Adverse event information was collected from time of treatment start, during treatment, and until 30 days after the last dose of treatment, about 3 months on average per participant, an average of 2 years.
Gastrointestinal disorders
Diarrhea
17.5%
10/57 • Adverse event information was collected from time of treatment start, during treatment, and until 30 days after the last dose of treatment, about 3 months on average per participant, an average of 2 years.
11.7%
7/60 • Adverse event information was collected from time of treatment start, during treatment, and until 30 days after the last dose of treatment, about 3 months on average per participant, an average of 2 years.
Investigations
Decreased Neutrophil Count
8.8%
5/57 • Adverse event information was collected from time of treatment start, during treatment, and until 30 days after the last dose of treatment, about 3 months on average per participant, an average of 2 years.
13.3%
8/60 • Adverse event information was collected from time of treatment start, during treatment, and until 30 days after the last dose of treatment, about 3 months on average per participant, an average of 2 years.
Investigations
Decreased White Blood Cell Count
8.8%
5/57 • Adverse event information was collected from time of treatment start, during treatment, and until 30 days after the last dose of treatment, about 3 months on average per participant, an average of 2 years.
6.7%
4/60 • Adverse event information was collected from time of treatment start, during treatment, and until 30 days after the last dose of treatment, about 3 months on average per participant, an average of 2 years.
Investigations
Decreased lymphocyte count
5.3%
3/57 • Adverse event information was collected from time of treatment start, during treatment, and until 30 days after the last dose of treatment, about 3 months on average per participant, an average of 2 years.
1.7%
1/60 • Adverse event information was collected from time of treatment start, during treatment, and until 30 days after the last dose of treatment, about 3 months on average per participant, an average of 2 years.
Skin and subcutaneous tissue disorders
Alopecia
54.4%
31/57 • Adverse event information was collected from time of treatment start, during treatment, and until 30 days after the last dose of treatment, about 3 months on average per participant, an average of 2 years.
6.7%
4/60 • Adverse event information was collected from time of treatment start, during treatment, and until 30 days after the last dose of treatment, about 3 months on average per participant, an average of 2 years.
Metabolism and nutrition disorders
Hyperglycemia
3.5%
2/57 • Adverse event information was collected from time of treatment start, during treatment, and until 30 days after the last dose of treatment, about 3 months on average per participant, an average of 2 years.
5.0%
3/60 • Adverse event information was collected from time of treatment start, during treatment, and until 30 days after the last dose of treatment, about 3 months on average per participant, an average of 2 years.
Nervous system disorders
Headache
12.3%
7/57 • Adverse event information was collected from time of treatment start, during treatment, and until 30 days after the last dose of treatment, about 3 months on average per participant, an average of 2 years.
6.7%
4/60 • Adverse event information was collected from time of treatment start, during treatment, and until 30 days after the last dose of treatment, about 3 months on average per participant, an average of 2 years.
Gastrointestinal disorders
Constipation
35.1%
20/57 • Adverse event information was collected from time of treatment start, during treatment, and until 30 days after the last dose of treatment, about 3 months on average per participant, an average of 2 years.
21.7%
13/60 • Adverse event information was collected from time of treatment start, during treatment, and until 30 days after the last dose of treatment, about 3 months on average per participant, an average of 2 years.
Blood and lymphatic system disorders
Anemia
22.8%
13/57 • Adverse event information was collected from time of treatment start, during treatment, and until 30 days after the last dose of treatment, about 3 months on average per participant, an average of 2 years.
25.0%
15/60 • Adverse event information was collected from time of treatment start, during treatment, and until 30 days after the last dose of treatment, about 3 months on average per participant, an average of 2 years.
Gastrointestinal disorders
Oral Mucositis
26.3%
15/57 • Adverse event information was collected from time of treatment start, during treatment, and until 30 days after the last dose of treatment, about 3 months on average per participant, an average of 2 years.
11.7%
7/60 • Adverse event information was collected from time of treatment start, during treatment, and until 30 days after the last dose of treatment, about 3 months on average per participant, an average of 2 years.
Nervous system disorders
Dysgeusia
24.6%
14/57 • Adverse event information was collected from time of treatment start, during treatment, and until 30 days after the last dose of treatment, about 3 months on average per participant, an average of 2 years.
10.0%
6/60 • Adverse event information was collected from time of treatment start, during treatment, and until 30 days after the last dose of treatment, about 3 months on average per participant, an average of 2 years.

Additional Information

Project Manager

DFCI

Phone: 617-632-2257

Results disclosure agreements

  • Principal investigator is a sponsor employee
  • Publication restrictions are in place