Tailored Axillary Surgery With or Without Axillary Lymph Node Dissection Followed by Radiotherapy in Patients With Clinically Node-positive Breast Cancer (TAXIS)

NCT ID: NCT03513614

Last Updated: 2025-02-03

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

1500 participants

Study Classification

INTERVENTIONAL

Study Start Date

2018-08-07

Study Completion Date

2036-12-31

Brief Summary

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RATIONALE: The use of tailored axillary dissection as a tailored procedure will avoid surgical overtreatment by selectively removing the lymph nodes that are affected by the cancer, thereby sparing many women the unnecessary complications of a radical surgery, providing a better quality of life while keeping the same efficacy.

PURPOSE: The phase III trial is evaluating the optimal treatment for breast cancer patients in terms of surgery and radiotherapy.

Detailed Description

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The removal of all lymph nodes in the armpit through conventional axillary dissection has been standard care for all patients with breast cancer for almost a century. In the nineties, the sentinel lymph node procedure, which involves the selective removal of the first few affected lymph nodes, was introduced in clinical practice. Today, conventional axillary dissection is still performed on many women with breast cancer that has spread to the nodes. It is the cause for relevant morbidity in the form of lymphedema, impairment of shoulder mobility, sensation disorders and chronic pain in as much as one third of all women undergoing the procedure.

The TAXIS trial will evaluate the optimal treatment for breast cancer patients in terms of surgery and radiotherapy. In particular, it will investigate the value of tailored axillary surgery (TAS), a new technique that aims at selectively removing the positive lymph nodes. TAS combines the removal of palpably suspicious nodes with the sentinel procedure. TAS is a promising procedure that may significantly decrease morbidity in breast cancer patients by avoiding surgical overtreatment.

This trial has the potential to establish a new worldwide treatment standard with hopefully less side effects and a better quality of life, while keeping the same efficacy as provided by radical surgery.

The main objective of the trial is to show that TAS and axillary radiotherapy (RT) is non-inferior to ALND in terms of disease-free survival of node positive breast cancer patients at high risk of recurrence in the era of effective systemic therapy and extended regional nodal irradiation.

Conditions

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Node-positive Breast Cancer

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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ALND

Tailored axillary surgery followed by axillary lymph node dissection (ALND) and regional nodal irradiation excluding the dissected axilla.

Group Type ACTIVE_COMPARATOR

Tailored axillary surgery - both Arms

Intervention Type PROCEDURE

Axillary lymph node dissection - Arm A

Radiotherapy - Arm A

Intervention Type RADIATION

Regional nodal irradiation excluding the dissected axilla - Arm A

No ALND

Tailored axillary surgery followed by regional nodal irradiation including the full axilla.

Group Type ACTIVE_COMPARATOR

Tailored axillary surgery - both Arms

Intervention Type PROCEDURE

Axillary lymph node dissection - Arm A

Radiotherapy - Arm B

Intervention Type RADIATION

Regional nodal irradiation including the full axilla - Arm B

Interventions

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Tailored axillary surgery - both Arms

Axillary lymph node dissection - Arm A

Intervention Type PROCEDURE

Radiotherapy - Arm A

Regional nodal irradiation excluding the dissected axilla - Arm A

Intervention Type RADIATION

Radiotherapy - Arm B

Regional nodal irradiation including the full axilla - Arm B

Intervention Type RADIATION

Eligibility Criteria

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Inclusion Criteria

* Written informed consent according to ICH/GCP regulations prior to any trial specific procedures.
* Breast cancer, node positive detected by palpation or imaging (with or without planned neoadjuvant treatment)
* Female or male aged ≥ 18 years
* Ability to complete the Quality of Life questionnaires


* Node-positive breast cancer (histologically or cytologically proven both in primary tumor and in lymph node) AJCC/UICC \[42\] stage II-III (all molecular subtypes allowed):

* Node-positivity detected by imaging (iN+) and confirmed by pathology
* Node-positivity detected by palpation (cN1-3) and confirmed by pathology
* Occult breast cancer is allowed, if biopsy-proven axillary lymphatic metastasis is present
* Eligible for primary ALND or sentinel lymph node (SLN) procedure with frozen section and either:

* Newly diagnosed
* Isolated in-breast recurrence or second ipsilateral breast cancer after previous breast conserving surgery and sentinel procedure and at least 3 years disease free and no prior axillary dissection or axillary RT
* Most suspicious axillary lymph node clipped
* Baseline Quality of Life questionnaire has been completed
* WHO performance status 0-2
* Adequate condition for general anesthesia and breast cancer surgery
* Women with child-bearing potential are using effective contraception, are not pregnant or lactating and agree not to become pregnant during trial treatment and thereafter during the time recommended by the guidelines for adjuvant systemic therapies. A negative pregnancy test before inclusion into the trial is required for all women with child-bearing potential.
* Men agree not to father a child during trial treatment and thereafter during 6 months.


* Node-positive breast cancer (histologically or cytologically proven both in primary tumor and in lymph node) AJCC/UICC stage II-III (all molecular subtypes allowed):

* Node-positivity initially detected by imaging and non-palpable and residual disease confirmed by pathology\*\* (including residual ITCs) in SLN or non SLN in case of prior neoadjuvant treatment
* Node-positivity initially palpable and residual disease confirmed by pathology\*\* (including residual ITCs) in case of prior neoadjuvant treatment

* Note: patients with ypN0(i+) can be included (the AJCC stage II-III refers to the stage before neoadjuvant treatment) \*\*Note: If the fine needle aspiration or core biopsy of the clipped node after neoadjuvant treatment unequivocally shows cancer, repeated confirmation of residual disease by intraoperative frozen section is not mandatory

Exclusion Criteria

Any potential patient who meets any of the following criteria has to be excluded from entering the trial.

* Stage IV breast cancer
* Clinical N3c breast cancer (clinical N3a and clinical N3b are allowed)
* Clinical N2b breast cancer (clinical N2a is allowed)
* Contralateral breast cancer within 3 years Note: Contralateral Ductal Carcinoma In Situ (DCIS) is allowed if prior treatment does not interfere with or compromise the trial treatment
* Prior axillary surgery (except prior sentinel node procedure in case of in- breast recurrence)
* Prior regional radiotherapy
* History of hematologic or primary solid tumor malignancy, unless in remission for at least 3 years from pre-registration with the exception of adequately treated cervical carcinoma in situ or localized non-melanoma skin cancer.
* Treatment with any experimental drug within 30 days of pre-registration
* Any other serious underlying medical, psychiatric, psychological, familial or geographical condition, which in the judgment of the investigator may interfere with the planned staging, treatment and follow-up, affect patient compliance or place the patient at high risk from treatment-related complications.


Any potential patient who meets any of the following criteria has to be excluded from the trial.

* Absence of clip in the specimen radiography
* Palpable disease left behind in the axilla after Tailored Axillary Surgery (TAS)
* No SLN identified in the axilla
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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ETOP IBCSG Partners Foundation

NETWORK

Sponsor Role collaborator

Austrian Breast Cancer Study Group

OTHER

Sponsor Role collaborator

University Hospital, Basel, Switzerland

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Walter P. Weber, Prof.

Role: STUDY_CHAIR

University Hospital, Basel, Switzerland

Locations

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Walter Reed National Military Medical Center

Bethesda, Maryland, United States

Site Status RECRUITING

Duke University/Duke Cancer Center

Durham, North Carolina, United States

Site Status RECRUITING

Swedish Cancer Institute

Seattle, Washington, United States

Site Status RECRUITING

Sanatorio Parque Breast Cancer Center

Rosario, Santa Fe Province, Argentina

Site Status RECRUITING

Institute of Oncology "Angel H. Roffo

Buenos Aires, , Argentina

Site Status RECRUITING

Krankenhaus Dornbirn

Dornbirn, , Austria

Site Status RECRUITING

Landeskrankenhaus Feldkirch

Feldkirch, , Austria

Site Status RECRUITING

Medical University of Innsbruck, Department of Gynecology

Innsbruck, , Austria

Site Status RECRUITING

Ordens Kinikum Linz, Barmherzige Schwestern

Linz, , Austria

Site Status RECRUITING

Universitätsklinik für Frauenheilkunde und Geburtshilfe; Landeskrankenhaus Salzburg der PMU

Salzburg, , Austria

Site Status NOT_YET_RECRUITING

Medizinische Universität Wien - Klinik für Chirurgie

Vienna, , Austria

Site Status RECRUITING

Medizinische Universität Wien - Universitätsklinik für Frauenheilkunde

Vienna, , Austria

Site Status RECRUITING

Hanusch Hospital Vienna

Vienna, , Austria

Site Status RECRUITING

Klinikum Wels-Grieskrichen GmbH

Wels, , Austria

Site Status RECRUITING

CIUSSS du Centre Ouest-de-l'Île-de-Montréal, Jewish General Hospital

Montreal, , Canada

Site Status RECRUITING

Breast Centre of Clinical Hospital

Rijeka, , Croatia

Site Status RECRUITING

HRUHC Sestre milosdrnice

Zagreb, , Croatia

Site Status RECRUITING

Ev. Waldkrankenhaus Spandau

Berlin, , Germany

Site Status WITHDRAWN

KEM | Evang. Kliniken Essen-Mitte gGmbH

Essen, , Germany

Site Status RECRUITING

Niels-Stensen-Kliniken Franziskus-Hospital Harderberg

Georgsmarienhütte, , Germany

Site Status RECRUITING

Universitätsklinikum Heidelberg, Sektion Senologie

Heidelberg, , Germany

Site Status RECRUITING

ViDia Christliche Kliniken Karlsruhe, Diakonissenkrankenhaus

Karlsruhe, , Germany

Site Status RECRUITING

Onkologie Rheinsieg

Troisdorf, , Germany

Site Status WITHDRAWN

Helios University Hospital Wuppertal

Wuppertal, , Germany

Site Status RECRUITING

Attikon University Hospital

Chaïdári, Athens, Greece

Site Status RECRUITING

University Hospital of Heraklion

Heraklion, Crete, Greece

Site Status RECRUITING

Alexandra General Hospital

Athens, , Greece

Site Status RECRUITING

Larissa General University Hospital

Larissa, , Greece

Site Status RECRUITING

Iaso Maternity Hospital

Marousi, , Greece

Site Status RECRUITING

Athens Medical Center Iatriko

Marousi, , Greece

Site Status RECRUITING

University Hospital of Patras

Pátrai, , Greece

Site Status RECRUITING

National Institute of Oncology

Budapest, , Hungary

Site Status RECRUITING

Bacs-Kiskun Country Hospital

Kecskemét, , Hungary

Site Status TERMINATED

University of Szeged

Szeged, , Hungary

Site Status TERMINATED

Ospedale MultiMedica Castellanza

Castellanza, , Italy

Site Status TERMINATED

Fondazione Policlinico Universitario "Agostino Gemelli" di Roma

Rome, , Italy

Site Status RECRUITING

Pauls Stradinš Clinical University Hospital

Riga, , Latvia

Site Status RECRUITING

National Cancer Institut

Vilnius, , Lithuania

Site Status RECRUITING

Gangnam Severance Hospital

Seoul, , South Korea

Site Status RECRUITING

Samsung Medical Center

Seoul, , South Korea

Site Status RECRUITING

Kantonsspital Aarau

Aarau, , Switzerland

Site Status RECRUITING

Brustzentrum Basel und Netzwerk

Allschwil, , Switzerland

Site Status TERMINATED

Kantonsspital Baden

Baden, , Switzerland

Site Status RECRUITING

Universitätsspital Basel

Basel, , Switzerland

Site Status RECRUITING

Bethesda Spital Basel, Gynäkologie und Geburtshilfe

Basel, , Switzerland

Site Status RECRUITING

St. Claraspital AG

Basel, , Switzerland

Site Status WITHDRAWN

Brustzentrum Bern, Lindenhofgruppe Centerclinic

Bern, , Switzerland

Site Status RECRUITING

Clinique de Grangettes

Chêne-Bougeries, , Switzerland

Site Status RECRUITING

Kantonsspital Graubünden

Chur, , Switzerland

Site Status ACTIVE_NOT_RECRUITING

Brustzentrum Thurgau

Frauenfeld, , Switzerland

Site Status RECRUITING

Breast center Fribourg

Fribourg, , Switzerland

Site Status RECRUITING

HUG - Hôpitaux Universitaires de Genève

Geneva, , Switzerland

Site Status RECRUITING

Clinique de Genolier

Genolier, , Switzerland

Site Status RECRUITING

Hôpital Neuchâtelois

La Chaux-de-Fonds, , Switzerland

Site Status RECRUITING

Centre Hospitalier Universitaire Vaudois CHUV

Lausanne, , Switzerland

Site Status RECRUITING

Luzerner Kantonsspital - Brustzentrum

Lucerne, , Switzerland

Site Status RECRUITING

Hirslanden Klinik St. Anna

Lucerne, , Switzerland

Site Status RECRUITING

Centro di Senologia della Svizzera Italiana CSSI

Lugano, , Switzerland

Site Status RECRUITING

Kantonsspital St. Gallen

Sankt Gallen, , Switzerland

Site Status RECRUITING

Tumor-and Breast centre Ostschweiz

Sankt Gallen, , Switzerland

Site Status RECRUITING

Spital Limmattal

Schlieren, , Switzerland

Site Status RECRUITING

Hôpital du Valais / Hôpital de Sion

Sion, , Switzerland

Site Status RECRUITING

Kantonsspital Winterthur, Brustzentrum

Winterthur, , Switzerland

Site Status RECRUITING

Spital Zollikerberg

Zollikerberg, , Switzerland

Site Status RECRUITING

Brust-Zentrum Zürich (Seefeld)

Zurich, , Switzerland

Site Status RECRUITING

Stadtspital Triemli

Zurich, , Switzerland

Site Status RECRUITING

Universitäts Spital Zürich

Zurich, , Switzerland

Site Status RECRUITING

Countries

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United States Argentina Austria Canada Croatia Germany Greece Hungary Italy Latvia Lithuania South Korea Switzerland

Central Contacts

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Walter P. Weber, Prof.

Role: CONTACT

+41 61 328 61 49

Alexandra Schulz

Role: CONTACT

+41 61 328 5401

Facility Contacts

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Nealeigh Matt

Role: primary

Maggie DiNome

Role: primary

Angelena Crown

Role: primary

Luciano Mignini

Role: primary

Eduardo Gonzalez, MD

Role: primary

Christopher Hager, MD

Role: primary

+43 5572 303 2490

Burghard Abendstein, MD

Role: primary

+43 5522 303 2200

Daniel Egle, MD

Role: primary

+43 5050 423 073

Dietmar Heck, MD

Role: primary

+43 7327 677 7300

Roland Reitsamer, Prof. Dr. med.

Role: primary

+43 5 7255 27302

Ruth Exner, MD

Role: primary

+43 676 92 32 885

Christian Singer, Prof

Role: primary

+43 140 400 280 10

Arik Galid, MD

Role: primary

Klaus Reisenberger, MD

Role: primary

+43 7242 415 3452

Stephanie Wong

Role: primary

Ana Car Peterko, MD

Role: primary

Ivan Milas

Role: primary

Sherko Kümmel, Prof. Dr. med.

Role: primary

+49 201 174 33002

Ulrike Beckmann, MD

Role: primary

+49 6221 56 5947

Jörg Heil, Prof

Role: primary

+49 6221 56 7901

Sibylle Perez, MD

Role: primary

+49 721 8898 314

Vesna Bjelic-Radisic, Prof

Role: primary

+49 202 896 1401

Vassilis Kouloulias, MD

Role: primary

Eelco de Bree, MD

Role: primary

George Pissakas, MD

Role: primary

Antigoni Poultsidi

Role: primary

Xepapadakis Grigorios

Role: primary

Fiorita Poulakaki

Role: primary

Marianna Argentou

Role: primary

Ákos Sávolt, Prof.

Role: primary

+36 70 550 1268

Gianluca Franceschini

Role: primary

Jeļena Maksimenko

Role: primary

Valerijus Ostapenko, Prof

Role: primary

+370 5 278 68 14

Sung Gwe Ahn

Role: primary

Role: backup

Jai Min Ryu

Role: primary

Dimitri Sarlos, MD

Role: primary

+41 62 838 50 65

Cornelia Leo, MD

Role: primary

+41 56 486 36 36

Walter Weber, Prof

Role: primary

+41 61 328 61 49

Janna Krol, Prof

Role: backup

+41 61 328 57 64

Dieter Johann Mueller, Dr. med.

Role: primary

+41 61 823 77 00

Gilles Berclaz, MD

Role: primary

+41 31 309 95 30

Conny Vrieling, MD

Role: primary

+41 22 545 80 80

Mathias Fehr, Prof

Role: primary

+41 52 723 72 56

Karine Clerc, MD

Role: primary

+41 26 919 64 64

Giang Thanh Lam, MD

Role: primary

+41 22 372 40 14

Magdalena Kohlik, MD

Role: primary

+41 22 362 60 00

Alexis Léger, MD

Role: primary

+41 32 967 26 34

Loïc Lelièvre, MD

Role: primary

+41 21 314 32 69

Susanne Bucher, MD

Role: primary

+41 41 205 28 00

Peter Dubsky, MD

Role: primary

+41 41 208 37 54

Maria Luisa Gasparri

Role: primary

+41 91 811 61 54

Inga Bekes, PD Dr. med.

Role: primary

+41 71 494 11 11

Michael Knauer, Prof.

Role: primary

+41 71 552 33 33

Kathrin Kimmig, MD

Role: primary

+41 44 736 83 33

Colin Simonson, MD

Role: primary

+41 27 603 45 01

Rok Satler, MD

Role: primary

+41 52 266 48 91

Hisham Fansa, MD

Role: primary

+41 44 397 38 61

Christoph Tausch, Prof.

Role: primary

+41 44 380 76 60

Natalie Gabriel, MD

Role: primary

+41 44 416 20 04

Heike Frauchiger-Heuer, MD

Role: primary

+41 43 253 97 13

References

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Weber WP, Matrai Z, Hayoz S, Tausch C, Henke G, Zwahlen DR, Gruber G, Zimmermann F, Seiler S, Maddox C, Ruhstaller T, Muenst S, Ackerknecht M, Kuemmel S, Bjelic-Radisic V, Kurzeder C, Ujhelyi M, Vrieling C, Satler R, Meyer I, Becciolini C, Bucher S, Simonson C, Fehr PM, Gabriel N, Maraz R, Sarlos D, Dedes KJ, Leo C, Berclaz G, Dubsky P, Exner R, Fansa H, Hager C, Reisenberger K, Singer CF, Reitsamer R, Reinisch M, Winkler J, Lam GT, Fehr MK, Naydina T, Kohlik M, Clerc K, Ostapenko V, Fitzal F, Nussbaumer R, Maggi N, Schulz A, Markellou P, Lelievre L, Egle D, Heil J, Knauer M. Tailored axillary surgery in patients with clinically node-positive breast cancer: Pre-planned feasibility substudy of TAXIS (OPBC-03, SAKK 23/16, IBCSG 57-18, ABCSG-53, GBG 101). Breast. 2021 Dec;60:98-110. doi: 10.1016/j.breast.2021.09.004. Epub 2021 Sep 8.

Reference Type RESULT
PMID: 34555676 (View on PubMed)

Weber WP, Heidinger M, Hayoz S, Matrai Z, Tausch C, Henke G, Zwahlen DR, Gruber G, Zimmermann F, Montagna G, Andreozzi M, Goldschmidt M, Schulz A, Mueller A, Ackerknecht M, Tampaki EC, Bjelic-Radisic V, Kurzeder C, Savolt A, Smanyko V, Hagen D, Muller DJ, Gnant M, Loibl S, Fitzal F, Markellou P, Bekes I, Egle D, Heil J, Knauer M. Impact of Imaging-Guided Localization on Performance of Tailored Axillary Surgery in Patients with Clinically Node-Positive Breast Cancer: Prospective Cohort Study Within TAXIS (OPBC-03, SAKK 23/16, IBCSG 57-18, ABCSG-53, GBG 101). Ann Surg Oncol. 2024 Jan;31(1):344-355. doi: 10.1245/s10434-023-14404-4. Epub 2023 Oct 30.

Reference Type DERIVED
PMID: 37903951 (View on PubMed)

Tausch C, Daster K, Hayoz S, Matrai Z, Fitzal F, Henke G, Zwahlen DR, Gruber G, Zimmermann F, Andreozzi M, Goldschmidt M, Schulz A, Maggi N, Saccilotto R, Heidinger M, Mueller A, Tampaki EC, Bjelic-Radisic V, Savolt A, Smanyko V, Hagen D, Muller DJ, Gnant M, Loibl S, Markellou P, Bekes I, Egle D, Ruhstaller T, Muenst S, Kuemmel S, Vrieling C, Satler R, Becciolini C, Bucher S, Kurzeder C, Simonson C, Fehr PM, Gabriel N, Maraz R, Sarlos D, Dedes KJ, Leo C, Berclaz G, Fansa H, Hager C, Reisenberger K, Singer CF, Montagna G, Reitsamer R, Winkler J, Lam GT, Fehr MK, Naydina T, Kohlik M, Clerc K, Ostapenko V, Lelievre L, Heil J, Knauer M, Weber WP. Trends in use of neoadjuvant systemic therapy in patients with clinically node-positive breast cancer in Europe: prospective TAXIS study (OPBC-03, SAKK 23/16, IBCSG 57-18, ABCSG-53, GBG 101). Breast Cancer Res Treat. 2023 Sep;201(2):215-225. doi: 10.1007/s10549-023-06999-9. Epub 2023 Jun 25.

Reference Type DERIVED
PMID: 37355526 (View on PubMed)

Henke G, Knauer M, Ribi K, Hayoz S, Gerard MA, Ruhstaller T, Zwahlen DR, Muenst S, Ackerknecht M, Hawle H, Fitzal F, Gnant M, Matrai Z, Ballardini B, Gyr A, Kurzeder C, Weber WP. Tailored axillary surgery with or without axillary lymph node dissection followed by radiotherapy in patients with clinically node-positive breast cancer (TAXIS): study protocol for a multicenter, randomized phase-III trial. Trials. 2018 Dec 4;19(1):667. doi: 10.1186/s13063-018-3021-9.

Reference Type DERIVED
PMID: 30514362 (View on PubMed)

Provided Documents

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Document Type: Informed Consent Form

View Document

Other Identifiers

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2018-000372-14

Identifier Type: EUDRACT_NUMBER

Identifier Source: secondary_id

2018-00838; ch20Weber2

Identifier Type: -

Identifier Source: org_study_id

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