Comparing Biospecimen Collection with Bone Marrow Aspiration for nodular ganglioneuroblastoma
Official title: Dinutuximab With Chemotherapy, Surgery and Stem Cell Transplantation for the Treatment of Children With Newly Diagnosed High Risk Neuroblastoma
A Phase 3 Study of Dinutuximab Added to Intensive Multimodal Therapy for Children With Newly Diagnosed High-Risk Neuroblastoma
- Phase 3
- 2 groups
- Sites in Québec, Calgary and 12 more cities
- Recruiting
Interventions (27)
- Medical procedure
Biospecimen Collection
Undergo blood and urine sample collection
- Medical procedure
Bone Marrow Aspiration
Undergo bone marrow aspiration
- Medical procedure
Bone Marrow Biopsy
Undergo bone marrow biopsy
- Medication
Carboplatin
Given IV
- Medication
Cisplatin
Given IV
- Medical procedure
Computed Tomography
Undergo CT scan
- Medication
Cyclophosphamide
Given IV
- Biological therapy
Dinutuximab
Given IV
- Medication
Doxorubicin
Given IV
- Medical procedure
Echocardiography Test
Undergo ECHO
- Medication
Etoposide
Given IV
- Medical procedure
FDG-Positron Emission Tomography and Computed Tomography Scan
Undergo FDG PET
- Medical procedure
Hematopoietic Cell Transplantation
Undergo stem cell infusion
- Medication
Irinotecan
Given IV
- Medication
Isotretinoin
Given PO
- Medical procedure
Leukapheresis
Undergo apheresis
- Medical procedure
Magnetic Resonance Imaging
Undergo MRI
- Medication
Melphalan
Given IV
- Medical procedure
Multigated Acquisition Scan
Undergo MUGA
- Radiation therapy
Radiation Therapy
Undergo radiation therapy
- Medical procedure
Radionuclide Imaging
Undergo I-MIBG scan
- Other intervention
Survey Administration
Ancillary studies
- Medication
Temozolomide
Given PO or via NG or G tube
- Medication
Thiotepa
Given IV
- Medication
Topotecan
Given IV
- Medical procedure
Tumor Resection
Undergo tumor resection surgery
- Medication
Vincristine
Given IV
Canadian Sites (15)
14 of 15 recruiting
- Recruiting
Alberta Children's Hospital
Calgary, Alberta
- Recruiting
University of Alberta Hospital
Edmonton, Alberta
- Recruiting
British Columbia Children's Hospital
Vancouver, British Columbia
- Recruiting
CancerCare Manitoba
Winnipeg, Manitoba
- Recruiting
Janeway Child Health Centre
St. John's, Newfoundland and Labrador
- Recruiting
IWK Health Centre
Halifax, Nova Scotia
- Recruiting
McMaster Children's Hospital at Hamilton Health Sciences
Hamilton, Ontario
- Recruiting
Children's Hospital
London, Ontario
- Recruiting
Children's Hospital of Eastern Ontario
Ottawa, Ontario
- Recruiting
Hospital for Sick Children
Toronto, Ontario
- Recruiting
CHU de Quebec-Centre Hospitalier de l'Universite Laval (CHUL)
Québec
- Recruiting
The Montreal Children's Hospital of the MUHC
Montreal, Quebec
- Recruiting
Centre Hospitalier Universitaire Sainte-Justine
Montreal, Quebec
- Recruiting
Centre Hospitalier Universitaire de Sherbrooke-Fleurimont
Sherbrooke, Quebec
- Paused
Jim Pattison Children's Hospital
Saskatoon, Saskatchewan
Eligibility Criteria
See who this study is looking for44 criteria
The trial’s own eligibility text, word for word from the registry. Only the trial site can say who takes part.
Inclusion
- +Age ≥ 547 days and INRG stage M regardless of biologic features (clinical MYCN testing not required prior to enrollmentEnrolmentThe number of participants a study plans to include, or has included.Read more →)
- +Human immunodeficiency virus (HIV) -infected patients on effective anti-retroviral therapy with undetectable viral load within 6 months are eligible for this trial
- +Patients must be enrolled on APEC14B1 and have consented to testing through the Molecular Characterization Initiative (MCI), prior to enrollment on ANBL2131
- +≤ 30 years at the time of initial diagnosis with high-risk disease
- +\* Must have a diagnosis of neuroblastoma (NBL) or ganglioneuroblastoma (nodular) verified by tumor pathology analysis or demonstration of clumps of tumor cells in bone marrow with elevated urinary catecholamines
- +Newly diagnosed, high risk neuroblastoma (HRNBL) defined as one of the following:
- +Any age with International Neuroblastoma Risk Group (INRG) Stage L2, MS, or M and MYCN amplification
- +Patients must have a body surface area (BSA) ≥ 0.25 m\^2
- +No prior anti-cancer therapy except as outlined below:
- +Patients initially recognized to have high-risk disease treated with topotecan/cyclophosphamide initiated on an emergent basis and within allowed timing, and with consentInformed consentThe process of being told what taking part involves, then choosing freely.Read more →
- +A serum creatinine based on age/sex as follows:
- +1 month to \< 6 months: Male 0.4 mg/dL and female 0.4mg/dL
- +6 months to \< 1 year: Male 0.5 mg/dL and female 0.5 mg/dL
- +1 to \< 2 years: Male 0.6 mg/dL and female 0.6 mg/dL
- +2 to \< 6 years: Male 0.8 mg/dL and female 0.8 mg/dL
- +6 to \< 10 years: Male 1 mg/dL and female 1 mg/dL
- +10 to \< 13 years: Male 1.2 mg/dL and female 1.2 mg/dL
- +13 to \< 16 years: Male 1.5 mg/dL and female 1.4 mg/dL
- +≥ 16 years: Male 1.7 mg/dL and female 1.4 mg/dL
- +The threshold creatinine values were derived from the Schwartz formula for estimating glomerular filtration rate (GFR) utilizing child length and stature data published by the Centers for Disease ControlControl groupThe group a new treatment is measured against.Read more → (CDC)
- +or a 24-hour urine creatinine clearance ≥ 70 mL/min/1.73 m\^2 or
- +or a GFR ≥ 70 mL/min/1.73 m\^2. GFR must be performed using direct measurement with a nuclear blood sampling method or direct small molecule clearance method (iothalamate or other molecule per institutional standard)
- +Note: Estimated GFR (eGFR) from serum creatinine, cystatin C or other estimates are not acceptable for determining eligibilityEligibility criteriaThe full list of requirements for taking part in a study.Read more →
- +Total bilirubin ≤ 1.5 x upper limit of normal (ULN) for age
- +Serum glutamic pyruvic transaminase (SGPT) (Alanine aminotransferase \[ALT\]) ≤ 10 x ULN\*
- +Note: For the purpose of this study, the ULN for SGPT (ALT) has been set to the value of 45 U/L
- +\* Shortening fraction of ≥ 27% by echocardiogram, or
- +Ejection fraction of ≥ 50% by echocardiogram or radionuclide angiogram
- +Ability to tolerate Peripheral Blood Stem Cell (PBSC) collection:
- +No known contraindication to PBSC collection. Examples of contraindications might be a weight or size less than the collecting institution finds feasible, or a physical condition that would limit the ability of the child to undergo apheresis catheter placement (if necessary) and/or the apheresis procedure
- +Any age initially diagnosed with INRG Stage L1 MYCN amplified NBL who have progressed to stage M without systemic chemotherapy
- +Age ≥ 547 days of age initially diagnosed with INRG Stage L1, L2, or MS who have progressed to stage M without systemic chemotherapy (clinical MYCN testing not required prior to enrollment)
- +Patients observed or treated with a single cycle of chemotherapy per a low or intermediate risk neuroblastoma regimen (e.g., as per ANBL0531, ANBL1232 or similar) for what initially appeared to be non-high-risk disease but subsequently found to meet the criteria
- +Patients who received localized emergency radiation to sites of life threatening or function-threatening disease prior to or immediately after establishment of the definitive diagnosis
Exclusion
- −Patients who are 365-546 days of age with INRG Stage M and MYCN non-amplified NBL, irrespective of additional biologic features
- −Patients on chronic immunosuppressive medications (e.g., tacrolimus, cyclosporine, corticosteroids) for reasons other than prevention/treatment of allergic reactions and adrenal replacement therapy are not eligible. Topical and inhaled corticosteroids are acceptable
- −All institutional, food and drug administration (FDA), and National Cancer Institute (NCI) requirements for human studies must be met
- −Patients ≥ 547 days of age with INRG Stage L2, MYCN non-amplified NBL, regardless of additional biologic features
- −Patients with known bone marrow failure syndromes
- −Patients with a primary immunodeficiency syndrome who require ongoing immune globulin replacement therapy
- −All patients and/or their parents or legal guardians must sign a written informed consentInformed consentThe process of being told what taking part involves, then choosing freely.Read more →
- −Female patients who are pregnant since fetal toxicities and teratogenic effects have been noted for several of the study drugs. A pregnancy test is required prior to enrollmentEnrolmentThe number of participants a study plans to include, or has included.Read more → for female patients of childbearing potential
- −Lactating females who plan to breastfeed their infants
- −Sexually active patients of reproductive potential who have not agreed to use an effective contraceptive method for the duration of their study participation
In plain language
Assembled directly from this trial’s registry record. Every sentence traces to a field below — nothing here is generated or interpreted.
What this study is
This study is testing a treatment for a condition.
Phase 3Phase 3A large study comparing a treatment against the current standard.Read more → — a large study comparing this against the current standard, usually across many hospitals.
From the trial registry
Built from these fields:
- designModule.designInfo.primaryPurpose
- designModule.phases
Who receives what
There are 2 groups in this study.
Group A, the comparison group, receives one or more of: Biospecimen Collection, Bone Marrow Aspiration, Bone Marrow Biopsy, Carboplatin, Cisplatin, Computed Tomography, Cyclophosphamide, Dinutuximab, Doxorubicin, Echocardiography Test, Etoposide, FDG-Positron Emission Tomography and Computed Tomography Scan, Hematopoietic Cell Transplantation, Irinotecan, Isotretinoin, Leukapheresis, Magnetic Resonance Imaging, Melphalan, Multigated Acquisition Scan, Radiation Therapy, Radionuclide Imaging, Survey Administration, Temozolomide, Thiotepa, Topotecan, Tumor Resection and Vincristine.
Registry label: A: Arm A (SOC treatment)
Group B receives Dinutuximab, together with one or more of: Biospecimen Collection, Bone Marrow Aspiration, Bone Marrow Biopsy, Carboplatin, Cisplatin, Computed Tomography, Cyclophosphamide, Doxorubicin, Echocardiography Test, Etoposide, FDG-Positron Emission Tomography and Computed Tomography Scan, Hematopoietic Cell Transplantation, Irinotecan, Isotretinoin, Leukapheresis, Magnetic Resonance Imaging, Melphalan, Multigated Acquisition Scan, Radiation Therapy, Radionuclide Imaging, Survey Administration, Temozolomide, Thiotepa, Topotecan, Tumor Resection and Vincristine.
Registry label: B: Arm B (Dinutuximab in induction)
From the trial registry
Built from these fields:
- armsInterventionsModule.armGroups[].label
- armsInterventionsModule.armGroups[].type
- armsInterventionsModule.armGroups[].interventionNames
How the study is run
Which group you would be placed in is decided by chance, like a coin flip — not by you and not by your doctor.
This study is open-labelOpen-labelEveryone knows which treatment is being given — nothing is hidden.Read more →: everyone knows which treatment is being given, including you and the study team.
From the trial registry
Built from these fields:
- designModule.designInfo.allocation
- designModule.designInfo.maskingInfo.masking
Is there a placebo?
This study does not list a placeboPlaceboA dummy treatment with no active medicine, used for comparison.Read more → group.
One group receives an existing treatment, so the two can be compared.
From the trial registry
Built from these fields:
- armsInterventionsModule.armGroups[].type
- armsInterventionsModule.armGroups[].interventionNames
Who the study is looking for
The study lists a maximum age of 30 years.
The study is open to people of any sex.
The study does not accept healthy volunteersHealthy volunteerSomeone without the condition being studied who takes part anyway.Read more →.
These are the criteria the study lists. Only the trial siteTrial siteA hospital or clinic where a study is actually run.Read more → can decide whether someone can take part.
From the trial registry
Built from these fields:
- eligibilityModule.maximumAge
- eligibilityModule.sex
- eligibilityModule.healthyVolunteers
How big and how long
The study aims to enrol about 478 people.
The study is currently expected to finish around December 2029.
The main measurement is taken over: Up to 3 years.
From the trial registry
Built from these fields:
- designModule.enrollmentInfo.count
- statusModule.completionDateStruct.date
- outcomesModule.primaryOutcomes[].timeFrame
What the study measures
Event free survival (EFS) — measured over Up to 3 years.
From the trial registry
Built from these fields:
- outcomesModule.primaryOutcomes[].measure
- outcomesModule.primaryOutcomes[].timeFrame
Source: NCT06172296 on ClinicalTrials.gov. The full registry text is further down this page — this summary never replaces it.
Not medical advice. What do these terms mean?
What is being tested — in plain terms
About Biospecimen CollectionProcedure
Undergo blood and urine sample collection
From the trial registry — its own words, unedited.
What a procedure is here: A surgery, technique or clinical procedure being studied.
Read the full explanation → · in clinical review
About Bone Marrow AspirationProcedure
Undergo bone marrow aspiration
From the trial registry — its own words, unedited.
What a procedure is here: A surgery, technique or clinical procedure being studied.
Read the full explanation → · in clinical review
About Bone Marrow BiopsyProcedure
Undergo bone marrow biopsy
From the trial registry — its own words, unedited.
What a procedure is here: A surgery, technique or clinical procedure being studied.
Read the full explanation → · in clinical review
About CarboplatinDrug
Given IV
From the trial registry — its own words, unedited.
What a drug is here: A medicine — a chemical or small-molecule treatment — given as the thing being studied.
Read the full explanation → · in clinical review
About CisplatinDrug
Given IV
From the trial registry — its own words, unedited.
What a drug is here: A medicine — a chemical or small-molecule treatment — given as the thing being studied.
Read the full explanation → · in clinical review
About Computed TomographyProcedure
Undergo CT scan
From the trial registry — its own words, unedited.
What a procedure is here: A surgery, technique or clinical procedure being studied.
Read the full explanation → · in clinical review
About CyclophosphamideDrug
Given IV
From the trial registry — its own words, unedited.
What a drug is here: A medicine — a chemical or small-molecule treatment — given as the thing being studied.
Read the full explanation → · in clinical review
About DinutuximabBiological
Given IV
From the trial registry — its own words, unedited.
What a biological is here: A treatment made from or by living systems — such as antibodies, vaccines, or cell-based therapies.
Read the full explanation → · in clinical review
About DoxorubicinDrug
Given IV
From the trial registry — its own words, unedited.
What a drug is here: A medicine — a chemical or small-molecule treatment — given as the thing being studied.
Read the full explanation → · in clinical review
About Echocardiography TestProcedure
Undergo ECHO
From the trial registry — its own words, unedited.
What a procedure is here: A surgery, technique or clinical procedure being studied.
Read the full explanation → · in clinical review
About EtoposideDrug
Given IV
From the trial registry — its own words, unedited.
What a drug is here: A medicine — a chemical or small-molecule treatment — given as the thing being studied.
Read the full explanation → · in clinical review
About FDG-Positron Emission Tomography and Computed Tomography ScanProcedure
Undergo FDG PET
From the trial registry — its own words, unedited.
What a procedure is here: A surgery, technique or clinical procedure being studied.
Read the full explanation → · in clinical review
About Hematopoietic Cell TransplantationProcedure
Undergo stem cell infusion
From the trial registry — its own words, unedited.
What a procedure is here: A surgery, technique or clinical procedure being studied.
Read the full explanation → · in clinical review
About IrinotecanDrug
Given IV
From the trial registry — its own words, unedited.
What a drug is here: A medicine — a chemical or small-molecule treatment — given as the thing being studied.
Read the full explanation → · in clinical review
About IsotretinoinDrug
Given PO
From the trial registry — its own words, unedited.
What a drug is here: A medicine — a chemical or small-molecule treatment — given as the thing being studied.
Read the full explanation → · in clinical review
About LeukapheresisProcedure
Undergo apheresis
From the trial registry — its own words, unedited.
What a procedure is here: A surgery, technique or clinical procedure being studied.
Read the full explanation → · in clinical review
About Magnetic Resonance ImagingProcedure
Undergo MRI
From the trial registry — its own words, unedited.
What a procedure is here: A surgery, technique or clinical procedure being studied.
Read the full explanation → · in clinical review
About MelphalanDrug
Given IV
From the trial registry — its own words, unedited.
What a drug is here: A medicine — a chemical or small-molecule treatment — given as the thing being studied.
Read the full explanation → · in clinical review
About Multigated Acquisition ScanProcedure
Undergo MUGA
From the trial registry — its own words, unedited.
What a procedure is here: A surgery, technique or clinical procedure being studied.
Read the full explanation → · in clinical review
About Radiation TherapyRadiation
Undergo radiation therapy
From the trial registry — its own words, unedited.
What a radiation is here: A form of radiotherapy or radiation-based treatment being studied.
Read the full explanation → · in clinical review
About Radionuclide ImagingProcedure
Undergo I-MIBG scan
From the trial registry — its own words, unedited.
What a procedure is here: A surgery, technique or clinical procedure being studied.
Read the full explanation → · in clinical review
About Survey AdministrationOther
Ancillary studies
From the trial registry — its own words, unedited.
What a other is here: An intervention the registry did not place in another category.
Read the full explanation → · in clinical review
About TemozolomideDrug
Given PO or via NG or G tube
From the trial registry — its own words, unedited.
What a drug is here: A medicine — a chemical or small-molecule treatment — given as the thing being studied.
Read the full explanation → · in clinical review
About ThiotepaDrug
Given IV
From the trial registry — its own words, unedited.
What a drug is here: A medicine — a chemical or small-molecule treatment — given as the thing being studied.
Read the full explanation → · in clinical review
About TopotecanDrug
Given IV
From the trial registry — its own words, unedited.
What a drug is here: A medicine — a chemical or small-molecule treatment — given as the thing being studied.
Read the full explanation → · in clinical review
About Tumor ResectionProcedure
Undergo tumor resection surgery
From the trial registry — its own words, unedited.
What a procedure is here: A surgery, technique or clinical procedure being studied.
Read the full explanation → · in clinical review
About VincristineDrug
Given IV
From the trial registry — its own words, unedited.
What a drug is here: A medicine — a chemical or small-molecule treatment — given as the thing being studied.
Read the full explanation → · in clinical review
Common questions
Answered from this trial’s registry record. Where the record doesn’t say, these answers say so rather than filling the gap.
Am I eligible for this trial?
Only the trial siteTrial siteA hospital or clinic where a study is actually run.Read more → can decide whether someone can take part. Concord cannot make that determination, and neither can any tool that has not examined you.
The full inclusionInclusion criteriaThe things you must have or be for a study to consider you.Read more → and exclusion criteriaExclusion criteriaThe things that would prevent someone from taking part.Read more → are published on this page, exactly as the study team wrote them.
The useful next step is to bring this trial to your doctor. Answering a few questions first gives them something concrete to review.
From the trial registry
- eligibilityModule.eligibilityCriteria
Is there a placebo?
This study does not list a placeboPlaceboA dummy treatment with no active medicine, used for comparison.Read more → group.
One group receives an existing treatment so the two can be compared.
From the trial registry
- armsInterventionsModule.armGroups[].type
Would I know which treatment I am getting?
This study is open-labelOpen-labelEveryone knows which treatment is being given — nothing is hidden.Read more →: everyone knows which treatment is being given, including you and the study team.
Which group you would be placed in is decided by chance, like a coin flip — not by you and not by your doctor.
From the trial registry
- designModule.designInfo.maskingInfo.masking
- designModule.designInfo.allocation
Who can join?
It is open to people of any sex.
It does not accept healthy volunteersHealthy volunteerSomeone without the condition being studied who takes part anyway.Read more →.
Only the trial siteTrial siteA hospital or clinic where a study is actually run.Read more → can confirm whether a particular person can take part.
From the trial registry
- eligibilityModule.sex
- eligibilityModule.healthyVolunteers
How long would this take?
The study's main measurement is taken over: Up to 3 years.
The study as a whole is currently expected to finish around 2029-12-31.
How long any one person takes part can differ from the study length. The study team can tell you what the schedule looks like in practice.
From the trial registry
- outcomesModule.primaryOutcomes[].timeFrame
- statusModule.completionDateStruct.date
How many people are taking part?
The study aims to enrol about 478 people.
From the trial registry
- designModule.enrollmentInfo.count
Where is this happening?
This study lists 33 locations, including: Québec, Canada; Calgary, Alberta, Canada; Edmonton, Alberta, Canada; Vancouver, British Columbia, Canada; Winnipeg, Manitoba, Canada; St. John's, Newfoundland and Labrador, Canada, and 27 more.
Sites can open and close during a study, so confirm with the team before travelling.
From the trial registry
- trial_locations
About This Trial
This phase III trial tests how well the addition of dinutuximab to Induction chemotherapy along with standard of care surgical resection of the primary tumor, radiation, stem cell transplantation, and immunotherapy works for treating children with newly diagnosed high-risk neuroblastoma. Dinutuximab is a monoclonal antibody that binds to a molecule called GD2, which is found on the surface of neuroblastoma cells, but is not present on many healthy or normal cells in the body. When dinutuximab binds to the neuroblastoma cells, it helps signal the immune system to kill the tumor cells. This helps the cells of the immune system kill the cancer cells, this is a type of immunotherapy. When chemotherapy and immunotherapy are given together, during the same treatment cycle, it is called chemoimmunotherapy. This clinical trial randomly assigns patients to receive either standard chemotherapy and surgery or chemoimmunotherapy (chemotherapy plus dinutuximab) and surgery during Induction therapy. Chemotherapy drugs administered during Induction include, cyclophosphamide, topotecan, cisplatin, etoposide, vincristine, and doxorubicin. These drugs work in different ways to stop the growth of cancer cells, either by killing the cells, by stopping them from dividing or by stopping them from spreading. Upon completion of 5 cycles of Induction therapy, a disease evaluation is completed to determine how well the treatment worked. If the tumor responds to therapy, patients receive a tandem transplantation with stem cell rescue. If the tumor has little improvement or worsens, patients receive chemoimmunotherapy on Extended Induction. During Extended Induction, dinutuximab is given with irinotecan, temozolomide. Patients with a good response to therapy move on to Consolidation therapy, when very high doses of chemotherapy are given at two separate points to kill any remaining cancer cells. Following, transplant, radiation therapy is given to the site where the cancer originated (primary site) and to any other areas that are still active at the end of Induction. The final stage of therapy is Post-Consolidation. During Post-Consolidation, dinutuximab is given with isotretinoin, with the goal of maintaining the response achieved with the previous therapy. Adding dinutuximab to Induction chemotherapy along with standard of care surgical resection of the primary tumor, radiation, stem cell transplantation, and immunotherapy may be better at treating children with newly diagnosed high-risk neuroblastoma.
Other Sites (21)
C S Mott Children's Hospital
Ann Arbor, Michigan, United States
Children's Hospital of Michigan
Detroit, Michigan, United States
Corewell Health Grand Rapids Hospitals - Helen DeVos Children's Hospital
Grand Rapids, Michigan, United States
Bronson Methodist Hospital
Kalamazoo, Michigan, United States
Corewell Health Children's
Royal Oak, Michigan, United States
Children's Hospitals and Clinics of Minnesota - Minneapolis
Minneapolis, Minnesota, United States
University of Minnesota/Masonic Cancer Center
Minneapolis, Minnesota, United States
Mayo Clinic in Rochester
Rochester, Minnesota, United States
Albany Medical Center
Albany, New York, United States
Roswell Park Cancer Institute
Buffalo, New York, United States
NYU Langone Hospital - Long Island
Mineola, New York, United States
The Steven and Alexandra Cohen Children's Medical Center of New York
New Hyde Park, New York, United States
Laura and Isaac Perlmutter Cancer Center at NYU Langone
New York, New York, United States
NYP/Columbia University Medical Center/Herbert Irving Comprehensive Cancer Center
New York, New York, United States
University of Rochester
Rochester, New York, United States
State University of New York Upstate Medical University
Syracuse, New York, United States
Montefiore Medical Center - Moses Campus
The Bronx, New York, United States
New York Medical College
Valhalla, New York, United States
Seattle Children's Hospital
Seattle, Washington, United States
Providence Sacred Heart Medical Center and Children's Hospital
Spokane, Washington, United States
And 1 more sites worldwide.
Think this trial might be right for you?
Complete a quick intake form and we will match you with this and other relevant trials based on your medical profile.
See if this trial could fit youThis page is for informational purposes only and does not constitute medical advice. Clinical trial eligibility can only be determined by the trial site after proper screening. Trial information is sourced from ClinicalTrials.gov and may not reflect the most current status. Always consult your healthcare provider before making decisions about clinical trial participation.