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Trial details imported from ClinicalTrials.gov
For full trial details, please see the original record at
https://clinicaltrials.gov/study/NCT04730869
Registration number
NCT04730869
Ethics application status
Date submitted
22/12/2020
Date registered
29/01/2021
Titles & IDs
Public title
Metabolic Therapy Program In Conjunction With Standard Treatment For Glioblastoma
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Scientific title
Feasibility, Safety, and Efficacy of a Metabolic Therapy Program in Conjunction With Standard Treatment for Glioblastoma
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Secondary ID [1]
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U1111-1262-0203
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Secondary ID [2]
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RD020132
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Universal Trial Number (UTN)
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Trial acronym
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Glioblastoma
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Condition category
Condition code
Cancer
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Brain
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
Other interventions - Standard Treatment Plus Metabolic Therapy Program
Experimental: Standard treatment in conjunction with MTP - Standard:
* Concurrent chemoradiation - Radiation (60-Gy in 30 fractions over 6 weeks) with daily oral temozolomide.
* Adjuvant chemotherapy - Daily oral temozolomide (5 days per 4-week cycle, starting 4 weeks after completion of chemoradiation, with at least 6 cycles intended).
MTP:
- Two 5-day fasts (allowing water, salt, tea, coffee, and a magnesium supplement) during chemoradiation followed by a 5-day fast during each adjuvant chemotherapy cycle, with a time-restricted modified ketogenic diet (one or two 1-hour eating windows per day, allowing oils, meats, vegetables, nuts, seeds, limited berries, and a multivitamin) between fasts.
Other interventions: Standard Treatment Plus Metabolic Therapy Program
See description under "Arms."
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Intervention code [1]
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Other interventions
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Comparator / control treatment
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Control group
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Outcomes
Primary outcome [1]
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Mean daily blood glucose-to-ketone ratio during chemoradiation
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Assessment method [1]
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Proportion of patients able to sustain functional ketosis (defined as a mean daily blood glucose-to-ketone ratio of =6) during chemoradiation (defined as the beginning of the first fast through to 3 weeks following completion of chemoradiation)
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Timepoint [1]
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9 weeks
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Secondary outcome [1]
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Mean daily blood glucose-to-ketone ratio during adjuvant chemotherapy
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Assessment method [1]
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Proportion of patients able to sustain functional ketosis during adjuvant chemotherapy (defined as the beginning of the first adjuvant chemotherapy fast through to completion of adjuvant chemotherapy)
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Timepoint [1]
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24 weeks
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Secondary outcome [2]
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Mean daily blood glucose-to-ketone ratio during the MTP, calculated separately on fasting and ketogenic diet days
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Assessment method [2]
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Proportion of patients able to sustain functional ketosis during the MTP (defined as the beginning of chemoradiation through to the end of adjuvant chemotherapy), calculated separately each fasting and ketogenic diet phase
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Timepoint [2]
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33 weeks
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Secondary outcome [3]
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Change in weight
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Assessment method [3]
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Weight (kg)
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Timepoint [3]
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33 weeks
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Secondary outcome [4]
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Safety as measured by National Cancer Institute Common Terminology Criteria for Adverse Events (version 4)
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Assessment method [4]
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Number of adverse events (of any grade)
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Timepoint [4]
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After each week (7 days) during chemoradiation, then after cycle 1 (28 days) of adjuvant chemotherapy, then after every 2 cycles (56 days) of adjuvant chemotherapy
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Secondary outcome [5]
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Change in performance status as measured by Eastern Cooperative Oncology Group Performance Status scale
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Assessment method [5]
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Eastern Cooperative Oncology Group Performance Status scale (scores range from 0 to 5, with higher scores indicating lower performance status)
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Timepoint [5]
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After each week (7 days) during chemoradiation, then after cycle 1 (28 days) of adjuvant chemotherapy, then after every 2 cycles (56 days) of adjuvant chemotherapy
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Secondary outcome [6]
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Change in leisure/exercise activity as measured by Godin Leisure-Time Exercise questionnaire
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Assessment method [6]
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Godin Leisure-Time Exercise questionnaire (scores range from 0 to no maximum, with higher scores indicating higher leisure/exercise activity)
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Timepoint [6]
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After each week (7 days) during chemoradiation, then after cycle 1 (28 days) of adjuvant chemotherapy, then after every 2 cycles (56 days) of adjuvant chemotherapy
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Secondary outcome [7]
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Change in quality of life as measured by Functional Assessment of Cancer Therapy - Brain questionnaire
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Assessment method [7]
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Functional Assessment of Cancer Therapy - Brain questionnaire (scores range from 0 to 200, with higher scores indicating higher quality of life)
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Timepoint [7]
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After each week (7 days) during chemoradiation, then after cycle 1 (28 days) of adjuvant chemotherapy, then after every 2 cycles (56 days) of adjuvant chemotherapy
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Secondary outcome [8]
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Progression-free survival
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Assessment method [8]
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Progression-free survival
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Timepoint [8]
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From date of biopsy-confirmed diagnosis to date of first documented progression, whichever came first, up to 33 weeks
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Secondary outcome [9]
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Overall survival
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Assessment method [9]
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Overall survival
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Timepoint [9]
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From date of biopsy-confirmed diagnosis to date of death from any cause, whichever came first, up to 33 weeks
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Eligibility
Key inclusion criteria
1. Age 18 years or greater.
2. Newly-diagnosed histologically-confirmed GBM.
3. ECOG Performance Status 0-2.
4. Planned for 6 weeks of standard chemoradiation for GBM.
5. If receiving dexamethasone, the dose must be = 4 mg daily (and not increasing) upon commencement of the MTP.
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Minimum age
18
Years
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Maximum age
No limit
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Sex
Both males and females
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Can healthy volunteers participate?
No
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Key exclusion criteria
1. Ineligible for standard treatment for GBM due to poor performance status, co-morbidities, or inability to give informed consent.
2. Type 1 diabetes.
3. A medical or psychiatric disorder that, in the opinion of the investigators, would make it unlikely that the patient could adhere to the MTP.
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Study design
Purpose of the study
Treatment
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Allocation to intervention
NA
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
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Masking / blinding
Open (masking not used)
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Who is / are masked / blinded?
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Intervention assignment
Single group
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Other design features
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Phase
NA
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Type of endpoint/s
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Statistical methods / analysis
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Recruitment
Recruitment status
Recruiting
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Data analysis
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Reason for early stopping/withdrawal
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Other reasons
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Date of first participant enrolment
Anticipated
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Actual
26/05/2021
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Date of last participant enrolment
Anticipated
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Actual
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Date of last data collection
Anticipated
1/12/2024
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Actual
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Sample size
Target
22
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Accrual to date
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Final
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Recruitment in Australia
Recruitment state(s)
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Recruitment outside Australia
Country [1]
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New Zealand
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State/province [1]
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Waikato
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Funding & Sponsors
Primary sponsor type
Other
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Name
Waikato Hospital
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Address
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Country
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Other collaborator category [1]
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Government body
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Name [1]
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Wellington Hospital
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Address [1]
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Country [1]
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Ethics approval
Ethics application status
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Summary
Brief summary
Glioblastoma (GBM), a very aggressive brain tumour, is one of the most malignant of all cancers and is associated with a poor prognosis. The majority of GBM cells display damaged mitochondria (the "batteries" of cells), so they rely on an alternate method for producing energy called the Warburg Effect, which relies nearly exclusively on glucose (in contrast, normal cells can use other molecules, such as fatty acids and fat-derived ketones, for energy). Metabolic interventions, such as fasting and ketogenic diets, target cancer cell metabolism by enhancing mitochondria function, decreasing blood glucose levels, and increasing blood ketone levels, creating an advantage for normal cells but a disadvantage for cancer cells. Preliminary experience at Waikato Hospital has shown that a metabolic therapy program (MTP) utilizing fasting and ketogenic diets is feasible and safe in people with advanced cancer, and may provide a therapeutic benefit. We aim to determine whether using an MTP concurrently with standard oncological treatment (chemoradiation followed by adjuvant chemotherapy) is feasible and safe in patients with GBM, and has treatment outcomes consistent with greater overall treatment efficacy than in published trials.
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Trial website
https://clinicaltrials.gov/study/NCT04730869
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Trial related presentations / publications
Rajaratnam V, Islam MM, Yang M, Slaby R, Ramirez HM, Mirza SP. Glioblastoma: Pathogenesis and Current Status of Chemotherapy and Other Novel Treatments. Cancers (Basel). 2020 Apr 10;12(4):937. doi: 10.3390/cancers12040937. Anjum K, Shagufta BI, Abbas SQ, Patel S, Khan I, Shah SAA, Akhter N, Hassan SSU. Current status and future therapeutic perspectives of glioblastoma multiforme (GBM) therapy: A review. Biomed Pharmacother. 2017 Aug;92:681-689. doi: 10.1016/j.biopha.2017.05.125. Epub 2017 Jun 3. Erratum In: Biomed Pharmacother. 2018 May;101:820. doi: 10.1016/j.biopha.2018.02.102. Seyfried BT, Kiebish M, Marsh J, Mukherjee P. Targeting energy metabolism in brain cancer through calorie restriction and the ketogenic diet. J Cancer Res Ther. 2009 Sep;5 Suppl 1:S7-15. doi: 10.4103/0973-1482.55134. Seyfried TN. Cancer as a mitochondrial metabolic disease. Front Cell Dev Biol. 2015 Jul 7;3:43. doi: 10.3389/fcell.2015.00043. eCollection 2015. Seyfried TN, Flores RE, Poff AM, D'Agostino DP. Cancer as a metabolic disease: implications for novel therapeutics. Carcinogenesis. 2014 Mar;35(3):515-27. doi: 10.1093/carcin/bgt480. Epub 2013 Dec 16. Phillips MCL. Fasting as a Therapy in Neurological Disease. Nutrients. 2019 Oct 17;11(10):2501. doi: 10.3390/nu11102501. Phillips MCL, Murtagh DKJ, Sinha SK, Moon BG. Managing Metastatic Thymoma With Metabolic and Medical Therapy: A Case Report. Front Oncol. 2020 May 5;10:578. doi: 10.3389/fonc.2020.00578. eCollection 2020.
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Public notes
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Contacts
Principal investigator
Name
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Matthew CL Phillips, FRACP
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Address
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Waikato Hospital
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Country
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Phone
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Fax
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Email
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Contact person for public queries
Name
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Matthew CL Phillips, FRACP
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Address
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Country
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Phone
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+64274057415
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Fax
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Email
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[email protected]
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Contact person for scientific queries
Data sharing statement
Will individual participant data (IPD) for this trial be available (including data dictionaries)?
Yes
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What data in particular will be shared?
Upon reasonable request for research purposes only, de-identified patient data may be shared with other investigators.
Supporting document/s available: Study protocol
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When will data be available (start and end dates)?
Starting immediately upon publication.
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Available to whom?
Upon reasonable request for research purposes.
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Available for what types of analyses?
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How or where can data be obtained?
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What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
No documents have been uploaded by study researchers.
Results not provided in
https://clinicaltrials.gov/study/NCT04730869