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Trial details imported from ClinicalTrials.gov
For full trial details, please see the original record at
https://clinicaltrials.gov/study/NCT06383338
Registration number
NCT06383338
Ethics application status
Date submitted
21/03/2024
Date registered
25/04/2024
Titles & IDs
Public title
A Study Investigating the Change in Metabolism Phenotype in Paediatric, Adolescent & Young Adults With Hodgkin or Non-Hodgkin Lymphoma.
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Scientific title
A Prospective Feasibility Study Investigating PhEnoconversion of CYP3A4, CYP2C19 and CYP2D6 Genotype in Paediatric and Adolescent and Young Adult patientS With an acUte diagnosiS of Hodgkin or Non-Hodgkin Lymphoma.
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Secondary ID [1]
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PEGASUS
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Universal Trial Number (UTN)
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Trial acronym
PEGASUS
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Hodgkin Lymphoma
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Non Hodgkin Lymphoma
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Condition category
Condition code
Cancer
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Lymphoma (non Hodgkin's lymphoma) - High grade lymphoma
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Cancer
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Lymphoma (non Hodgkin's lymphoma) - Low grade lymphoma
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
Treatment: Drugs - Omeprazole
Treatment: Drugs - Dextromethorphan
Treatment: Drugs: Omeprazole
Sub-therapeutic probe drug administration to measure phenoconversion.
Treatment: Drugs: Dextromethorphan
Sub-therapeutic probe drug administration to measure phenoconversion.
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Intervention code [1]
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Treatment: Drugs
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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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Proportion of patients who consent to study and complete baseline and at least two longitudinal timepoints with successful measurement of probe drug MR (Metabolic ratio)
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Assessment method [1]
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This measure is to help inform whether future studies of this nature are feasible and identify if any procedures need to be adjusted to ensure study participant completion.
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Timepoint [1]
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12 months, 24 Months
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Secondary outcome [1]
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Percentage of participants completing all required longitudinal blood sampling
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Assessment method [1]
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This measure is to help inform whether future studies of this nature are feasible and identify if any procedures need to be adjusted to ensure study participant completion.
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Timepoint [1]
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Baseline through to 24 Months
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Secondary outcome [2]
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Proportion of participants with successful detection of probe drug overall and at each sampling timepoint
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Assessment method [2]
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This measure is to help inform whether future studies of this nature are feasible and identify if the method for probe drug detection requires improvement.
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Timepoint [2]
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Baseline through to 24 Months
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Secondary outcome [3]
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Proportion of participants where phenotype can be classified according to MR overall at each sampling timepoint
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Assessment method [3]
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This measure is to help inform whether future studies of this nature are feasible and identify if the phenotype can be clearly classified at each timepoint; (i) Prior to commencing first lymphoma chemotherapy cycle (ii) 2 months (week 8) (iii) 4 months (week 16) (iv) Completion of therapy (\> week 16) (v) Up to a maximum of 2 febrile neutropenic episodes and for how many patients.
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Timepoint [3]
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Baseline through to 24 Months
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Secondary outcome [4]
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The level of acceptability of participation in pharmacogenomic & phenoconversion testing using the PEGASUS specific survey tool (based on the Theoretical Framework of Acceptability [TFA])
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Assessment method [4]
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This measure is to help inform whether future studies of this nature are feasible and acceptable. Participants will complete the survey which asks 26 questions, with a numerical scale of 1-7 or a wording scale of 7 choices depending on the question.
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Timepoint [4]
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Baseline through to 24 Months
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Secondary outcome [5]
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Percentage of participants experiencing an adverse event (AE) during probe drug administration
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Assessment method [5]
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This measure is to help inform whether future studies of this nature are feasible and identify if/how many adverse events are experienced during probe drug administration.
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Timepoint [5]
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Baseline through to 24 Months
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Secondary outcome [6]
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Incidence of genotype and phenotype mismatch, overall and across longitudinal timepoints
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Assessment method [6]
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This measure is to help inform whether future studies of this nature are feasible and identify if genotype and phenotype mismatch occurs throughout each timepoint and the overall study.
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Timepoint [6]
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Baseline through to 24 Months
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Secondary outcome [7]
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Proportion of participants with disease staging and biomarkers of extent of disease
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Assessment method [7]
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This measure is to help inform whether future studies of this nature are feasible, to identify any variables that stand out and inform future research questions.
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Timepoint [7]
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Baseline through to 24 Months
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Secondary outcome [8]
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Proportion of participants with a systemic inflammatory state
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Assessment method [8]
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This measure is to help inform whether future studies of this nature are feasible, to identify any variables that stand out and inform future research questions.
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Timepoint [8]
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Baseline through to 24 Months
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Secondary outcome [9]
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Proportion of participants taking medications involving the CYP P450 pathway
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Assessment method [9]
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This measure is to help inform whether future studies of this nature are feasible, to identify any variables that stand out and inform future research questions.
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Timepoint [9]
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Baseline through to 24 Months
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Secondary outcome [10]
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Participant demographic information
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Assessment method [10]
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This measure is to help inform whether future studies of this nature are feasible, to identify any variables that stand out and inform future research questions.
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Timepoint [10]
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Baseline
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Secondary outcome [11]
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Proportion of participants with other environmental factors
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Assessment method [11]
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This measure is to help inform whether future studies of this nature are feasible, to identify any variables that stand out and inform future research questions.
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Timepoint [11]
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Baseline through to 24 Months
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Secondary outcome [12]
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Longitudinal inflammatory profile of participants with Hodgkin or non-Hodgkin Lymphoma as measured by a panel including serum levels of procalcitonin, c-reactive protein and cytokine analysis.
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Assessment method [12]
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This measure is to identify if there are fluctuations within the inflammatory profile of the patients which helps to inform whether future studies of this nature are feasible. The panel detects a comprehensive set of studied and biologically relevant inflammatory markers including those shown to be predictive of severe infection in children with cancer and febrile neutropenia when out of normal ranges.
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Timepoint [12]
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Baseline through to 24 Months
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Eligibility
Key inclusion criteria
* Age 6-25 years of age.
* New diagnosis of Hodgkin Lymphoma or Non-Hodgkin Lymphoma.
* Able to swallow and absorb oral or nasogastric tube (NGT) administration of probe drugs.
* Able to provide written informed consent.
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Minimum age
6
Years
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Maximum age
25
Years
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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
* Failure to comply with inclusion criteria.
* Has a known previous allergy to any of the probe medications (i.e., omeprazole or dextromethorphan).
* Common Terminology Criteria for Adverse Events (CTCAE) Grade IV end organ dysfunction (i.e., hepatic, renal, gastrointestinal).
* Had previous oncological treatment (not first cancer diagnosis).
* Is a clinically unstable patient requiring intensive care admission in high-risk circumstances will not be considered eligible for consent.
* Any patient requiring urgent initiation of anti-cancer treatment outside hours where a member of the study staff is unable to approach the parent/guardian or participant for consent prior to commencing anti-cancer therapy will be ineligible for consent.
* Unable to provide written informed consent.
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Study design
Purpose of the study
Other
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Allocation to intervention
Non-randomised trial
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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
Phase 1
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Type of endpoint/s
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Statistical methods / analysis
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Recruitment
Recruitment status
Not yet 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
1/03/2025
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Actual
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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
1/03/2026
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Actual
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Sample size
Target
10
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Accrual to date
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Final
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Recruitment in Australia
Recruitment state(s)
VIC
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Recruitment hospital [1]
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Peter MacCallum Cancer Centre - Melbourne
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Recruitment postcode(s) [1]
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3000 - Melbourne
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Funding & Sponsors
Primary sponsor type
Other
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Name
Murdoch Childrens Research Institute
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Address
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Country
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Ethics approval
Ethics application status
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Summary
Brief summary
PEGASUS aims to test acceptability and feasibility of studying phenoconversion (the change in metabolism phenotype) using probe medications in a paediatric oncology patient population. The study will be conducted in patients (6-25 years of age) with Hodgkin lymphoma or non-Hodgkin lymphoma as exemplar cohort, but with the understanding that cancer-directed and supportive care medicines of the CYP3A4, CYP2C19, and CYP2D6 metabolic pathways are commonly utilised for the treatment of many paediatric, adolescent, young adult, and adult cancers. The study involves administration of the probe medication at timepoints which align with pre-determined hospital visits for the treatment of lymphoma and subsequent blood draws to measure the metabolism of the probe medications. The acceptability and feasibility of this study will inform future studies in phenoconversion within the paediatric cancer population to direct more personalised precision medicine.
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Trial website
https://clinicaltrials.gov/study/NCT06383338
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Trial related presentations / publications
Helsby N, Yong M, Burns K, Findlay M, Porter D. Cyclophosphamide bioactivation pharmacogenetics in breast cancer patients. Cancer Chemother Pharmacol. 2021 Sep;88(3):533-542. doi: 10.1007/s00280-021-04307-0. Epub 2021 Jun 10. Burns KE, Goldthorpe MA, Porteus F, Browett P, Helsby NA. CYP2C19 genotype-phenotype discordance in patients with multiple myeloma leads to an acquired loss of drug-metabolising activity. Cancer Chemother Pharmacol. 2014 Mar;73(3):651-5. doi: 10.1007/s00280-014-2409-9. Epub 2014 Feb 12. Kim S, Ostor AJ, Nisar MK. Interleukin-6 and cytochrome-P450, reason for concern? Rheumatol Int. 2012 Sep;32(9):2601-4. doi: 10.1007/s00296-012-2423-3. Epub 2012 Mar 27. Rodieux F, Daali Y, Rollason V, Samer CF, Ing Lorenzini K. Practice of CYP450 genotyping and phenotyping in children in a real-life setting. Front Pharmacol. 2023 Feb 27;14:1130100. doi: 10.3389/fphar.2023.1130100. eCollection 2023. Bosilkovska M, Samer CF, Deglon J, Rebsamen M, Staub C, Dayer P, Walder B, Desmeules JA, Daali Y. Geneva cocktail for cytochrome p450 and P-glycoprotein activity assessment using dried blood spots. Clin Pharmacol Ther. 2014 Sep;96(3):349-59. doi: 10.1038/clpt.2014.83. Epub 2014 Apr 10. Lloret-Linares C, Rollason V, Lorenzini KI, Samer C, Daali Y, Gex-Fabry M, Aubry JM, Desmeules J, Besson M. Screening for genotypic and phenotypic variations in CYP450 activity in patients with therapeutic problems in a psychiatric setting, a retrospective study. Pharmacol Res. 2017 Apr;118:104-110. doi: 10.1016/j.phrs.2016.07.002. Epub 2016 Jul 1. Rollason V, Lloret-Linares C, Lorenzini KI, Daali Y, Gex-Fabry M, Piguet V, Besson M, Samer C, Desmeules J. Evaluation of Phenotypic and Genotypic Variations of Drug Metabolising Enzymes and Transporters in Chronic Pain Patients Facing Adverse Drug Reactions or Non-Response to Analgesics: A Retrospective Study. J Pers Med. 2020 Oct 27;10(4):198. doi: 10.3390/jpm10040198. Ing Lorenzini K, Desmeules J, Rollason V, Bertin S, Besson M, Daali Y, Samer CF. CYP450 Genotype-Phenotype Concordance Using the Geneva Micrococktail in a Clinical Setting. Front Pharmacol. 2021 Aug 26;12:730637. doi: 10.3389/fphar.2021.730637. eCollection 2021. Lenoir C, Niederer A, Rollason V, Desmeules JA, Daali Y, Samer CF. Prediction of cytochromes P450 3A and 2C19 modulation by both inflammation and drug interactions using physiologically based pharmacokinetics. CPT Pharmacometrics Syst Pharmacol. 2022 Jan;11(1):30-43. doi: 10.1002/psp4.12730. Epub 2021 Nov 17. Mandrioli R, Mercolini L, Protti M. Blood and Plasma Volumetric Absorptive Microsampling (VAMS) Coupled to LC-MS/MS for the Forensic Assessment of Cocaine Consumption. Molecules. 2020 Feb 26;25(5):1046. doi: 10.3390/molecules25051046. Doerflinger M, Haeusler GM, Li-Wai-Suen CSN, Clark JE, Slavin M, Babl FE, Allaway Z, Mechinaud F, Smyth GK, De Abreu Lourenco R, Phillips B, Pellegrini M, Thursky KA. Procalcitonin and Interleukin-10 May Assist in Early Prediction of Bacteraemia in Children With Cancer and Febrile Neutropenia. Front Immunol. 2021 May 20;12:641879. doi: 10.3389/fimmu.2021.641879. eCollection 2021.
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Public notes
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Contacts
Principal investigator
Name
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Rachel Conyers, MBBS (Hons)
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Address
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Murdoch Children's Research Institute
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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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Rachel Conyers, MBBS (Hons)
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Address
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Country
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Phone
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+61393455522
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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)?
Undecided
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No/undecided IPD sharing reason/comment
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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/NCT06383338