Trial Outcomes & Findings for Neoadjuvant Anti PD-1 Immunotherapy in Resectable Non-small Cell Lung Cancer (NCT NCT03197467)

NCT ID: NCT03197467

Last Updated: 2025-04-04

Results Overview

The definition for this endpoint was neoadjuvant pembrolizumab treatment followed by successful curative intent tumor resection.

Recruitment status

COMPLETED

Study phase

PHASE2

Target enrollment

30 participants

Primary outcome timeframe

From screening until surgery, ca. 6-8 weeks

Results posted on

2025-04-04

Participant Flow

Participant milestones

Participant milestones
Measure
Pembrolizumab
Pembrolizumab at fixed dose: 200 mg q3w i.v. for 2 cycles Pembrolizumab: Pembrolizumab at fixed dose: 200 mg q3w i.v. for 2 cycles
Overall Study
STARTED
30
Overall Study
COMPLETED
29
Overall Study
NOT COMPLETED
1

Reasons for withdrawal

Reasons for withdrawal
Measure
Pembrolizumab
Pembrolizumab at fixed dose: 200 mg q3w i.v. for 2 cycles Pembrolizumab: Pembrolizumab at fixed dose: 200 mg q3w i.v. for 2 cycles
Overall Study
Withdrawal by Subject
1

Baseline Characteristics

Neoadjuvant Anti PD-1 Immunotherapy in Resectable Non-small Cell Lung Cancer

Baseline characteristics by cohort

Baseline characteristics by cohort
Measure
Pembrolizumab
n=29 Participants
Pembrolizumab at fixed dose: 200 mg q3w i.v. for 2 cycles Pembrolizumab: Pembrolizumab at fixed dose: 200 mg q3w i.v. for 2 cycles
Age, Continuous
60 years
n=99 Participants
Sex: Female, Male
Female
16 Participants
n=99 Participants
Sex: Female, Male
Male
13 Participants
n=99 Participants
Race (NIH/OMB)
American Indian or Alaska Native
0 Participants
n=99 Participants
Race (NIH/OMB)
Asian
0 Participants
n=99 Participants
Race (NIH/OMB)
Native Hawaiian or Other Pacific Islander
0 Participants
n=99 Participants
Race (NIH/OMB)
Black or African American
1 Participants
n=99 Participants
Race (NIH/OMB)
White
28 Participants
n=99 Participants
Race (NIH/OMB)
More than one race
0 Participants
n=99 Participants
Race (NIH/OMB)
Unknown or Not Reported
0 Participants
n=99 Participants
Region of Enrollment
Germany
29 participants
n=99 Participants
ECOG status
ECOG 0
14 Participants
n=99 Participants
ECOG status
ECOG 1
15 Participants
n=99 Participants

PRIMARY outcome

Timeframe: From screening until surgery, ca. 6-8 weeks

The definition for this endpoint was neoadjuvant pembrolizumab treatment followed by successful curative intent tumor resection.

Outcome measures

Outcome measures
Measure
Pembrolizumab
n=29 Participants
Pembrolizumab at fixed dose: 200 mg q3w i.v. for 2 cycles Pembrolizumab: Pembrolizumab at fixed dose: 200 mg q3w i.v. for 2 cycles
Number of Patients Treated in Compliance With Protocol
29 Participants

PRIMARY outcome

Timeframe: From screening until pre-surgery radiologic assessment, ca. 6-8 weeks

Radiologic tumor assessments were performed at screening and pre-surgery.

Outcome measures

Outcome measures
Measure
Pembrolizumab
n=28 Participants
Pembrolizumab at fixed dose: 200 mg q3w i.v. for 2 cycles Pembrolizumab: Pembrolizumab at fixed dose: 200 mg q3w i.v. for 2 cycles
Tumor Response According to RECIST 1.1 Criteria
Complete response
0 Participants
Tumor Response According to RECIST 1.1 Criteria
Partial response
6 Participants
Tumor Response According to RECIST 1.1 Criteria
Stable disease
19 Participants
Tumor Response According to RECIST 1.1 Criteria
Progressive disease
3 Participants

PRIMARY outcome

Timeframe: From screening until surgery, ca. 6-8 weeks

Pathologic regression grading according to Junker criteria. The following grades are defined: Grade I No tumor regression or only spontaneous tumor regression in the sections of the primary tumor and mediastinal lymph nodes. Grade IIa Morphological signs of therapy-induced tumor regression in the sections of the primary tumor and/or mediastinal lymph nodes: More than 10% vital tumor tissue Grade IIb Morphological signs of therapy-induced tumor regression: Less than 10% vital tumor tissue Grade III Complete tumor regression, no evidence of vital tumor in the sections of the primary tumor and/or mediastinal lymph nodes. Regression grades IIb and III suggest a good response to neoadjuvant therapy. Reference: Junker K, Langner K, Klinke F, Bosse U, Thomas M. Grading of tumor regression in non-small cell lung cancer : morphology and prognosis. Chest 2001; 120:1584-91.

Outcome measures

Outcome measures
Measure
Pembrolizumab
n=29 Participants
Pembrolizumab at fixed dose: 200 mg q3w i.v. for 2 cycles Pembrolizumab: Pembrolizumab at fixed dose: 200 mg q3w i.v. for 2 cycles
Tumor Response Evaluation - Pathologic Response
Grade I
4 Participants
Tumor Response Evaluation - Pathologic Response
Grade IIa
18 Participants
Tumor Response Evaluation - Pathologic Response
Grade IIb
3 Participants
Tumor Response Evaluation - Pathologic Response
Grade III
4 Participants

PRIMARY outcome

Timeframe: From screening until pre-surgery radiologic assessment, ca. 6-8 weeks

Δ tumor size was defined as the difference \[mm\] between longest diameter at baseline and pre-surgery.

Outcome measures

Outcome measures
Measure
Pembrolizumab
n=28 Participants
Pembrolizumab at fixed dose: 200 mg q3w i.v. for 2 cycles Pembrolizumab: Pembrolizumab at fixed dose: 200 mg q3w i.v. for 2 cycles
Tumor Response Evaluation - Δ Tumor Size
-4.0 mm
Interval -13.5 to 0.0

PRIMARY outcome

Timeframe: From screening until pre-surgery radiologic assessment, ca. 6-8 weeks

Δ PET activity (standardized uptake value \[SUV\]). This method uses radiolabeled tracer 82-deoxy-2-\[18F\]fluoro-D-glucose, FDG) during PET imaging of the tumor and accumulation of radiolabeled FDG measured by the PET scanner. Accumulation of FDG relative to normal tissue is related to the proliferative activity of malignant tissue and to the number of viable tumor cells. The endpoint is based on per-patient changes in tumor maximal standardized uptake value during PET examinations of the tumor before the start of treatment and after 2 cycles of neoadjuvant immunotherapy, i.e. between screening and shortly before surgery. Reduction of proliferative activity or of the number of viable tumor cells results in negative values.

Outcome measures

Outcome measures
Measure
Pembrolizumab
n=28 Participants
Pembrolizumab at fixed dose: 200 mg q3w i.v. for 2 cycles Pembrolizumab: Pembrolizumab at fixed dose: 200 mg q3w i.v. for 2 cycles
Tumor Response - Δ PET Activity
-1 standardized uptake value [SUV]
Interval -7.0 to 2.0

SECONDARY outcome

Timeframe: 6 months after surgery, i.e. circa 8 months after treatment start

Probability of disease-free survival (DFS) was calculated using Kaplan-Meier statistics from date of surgery to the date until tumor recurrence or death. Follow-up was until 24 months after last-patient-out.

Outcome measures

Outcome measures
Measure
Pembrolizumab
n=29 Participants
Pembrolizumab at fixed dose: 200 mg q3w i.v. for 2 cycles Pembrolizumab: Pembrolizumab at fixed dose: 200 mg q3w i.v. for 2 cycles
Disease-free Survival at 6 Months
86.2 Probablity of DFS in %
Interval 67.3 to 94.6

SECONDARY outcome

Timeframe: 12 months after surgery, i.e. circa 14 months after treatment start

Probability of disease-free survival (DFS) was calculated from date of surgery until tumor recurrence or death using Kaplan-Meier statistics. Follow-up was until 24 months after last-patient-out.

Outcome measures

Outcome measures
Measure
Pembrolizumab
n=29 Participants
Pembrolizumab at fixed dose: 200 mg q3w i.v. for 2 cycles Pembrolizumab: Pembrolizumab at fixed dose: 200 mg q3w i.v. for 2 cycles
Disease-free Survival at 12 Months
86.2 Probablity of DFS in %
Interval 67.3 to 94.6

SECONDARY outcome

Timeframe: 12 months after surgery, i.e. circa 14 months after treatment start

Probability of overall survival (OS) was calculated from date of surgery until date of death using Kaplan-Meier statistics. Follow-up was until 24 months after last-patient-out.

Outcome measures

Outcome measures
Measure
Pembrolizumab
n=29 Participants
Pembrolizumab at fixed dose: 200 mg q3w i.v. for 2 cycles Pembrolizumab: Pembrolizumab at fixed dose: 200 mg q3w i.v. for 2 cycles
Overall Survival at 12 Months
93.1 Probability of OS in %
Interval 75.1 to 98.2

SECONDARY outcome

Timeframe: 18 months after surgery, i.e. circa 20 months after treatment start

Probability of overall survival (OS) was calculated from date of surgery until date of death using Kaplan-Meier statistics. Follow-up was until 24 months after last-patient-out.

Outcome measures

Outcome measures
Measure
Pembrolizumab
n=29 Participants
Pembrolizumab at fixed dose: 200 mg q3w i.v. for 2 cycles Pembrolizumab: Pembrolizumab at fixed dose: 200 mg q3w i.v. for 2 cycles
Overall Survival at 18 Months
89.7 Probability of OS in %
Interval 71.3 to 96.5

SECONDARY outcome

Timeframe: 24 months after surgery, i.e. circa 26 months after treatment start

Probability of overall survival (OS) was calculated from date of surgery until date of death using Kaplan-Meier statistics. Follow-up was until 24 months after last-patient-out.

Outcome measures

Outcome measures
Measure
Pembrolizumab
n=29 Participants
Pembrolizumab at fixed dose: 200 mg q3w i.v. for 2 cycles Pembrolizumab: Pembrolizumab at fixed dose: 200 mg q3w i.v. for 2 cycles
Overall Survival at 24 Months
86.2 Probability of OS in %
Interval 67.3 to 94.6

Adverse Events

Pembrolizumab

Serious events: 8 serious events
Other events: 21 other events
Deaths: 5 deaths

Serious adverse events

Serious adverse events
Measure
Pembrolizumab
n=29 participants at risk
Pembrolizumab at fixed dose: 200 mg q3w i.v. for 2 cycles Pembrolizumab: Pembrolizumab at fixed dose: 200 mg q3w i.v. for 2 cycles
Endocrine disorders
Hyperthyroidism
3.4%
1/29 • Number of events 1 • Adverse events were recorded from signing of informed consent until 90 days after last dose of IMP (total: 20-22 weeks) or for 6 weeks after surgery (total: 12-14 weeks) if the subject initiated new anticancer therapy. Deaths were recorded for up to 26 months after treatment initiation.
Note that deaths were recorded for up to 26 months after treatment initiation, but only for the purpose of collecting data for the overall survival efficacy endpoint. Of the total of 5 recorded deaths, only 1 fell within the time frame for safety reporting, and therefore, only 1 adverse event with fatal outcome is recorded in the safety database. This was a case of Acute Hepatic Failure reported as related to study treatment.
Gastrointestinal disorders
Colitis
3.4%
1/29 • Number of events 1 • Adverse events were recorded from signing of informed consent until 90 days after last dose of IMP (total: 20-22 weeks) or for 6 weeks after surgery (total: 12-14 weeks) if the subject initiated new anticancer therapy. Deaths were recorded for up to 26 months after treatment initiation.
Note that deaths were recorded for up to 26 months after treatment initiation, but only for the purpose of collecting data for the overall survival efficacy endpoint. Of the total of 5 recorded deaths, only 1 fell within the time frame for safety reporting, and therefore, only 1 adverse event with fatal outcome is recorded in the safety database. This was a case of Acute Hepatic Failure reported as related to study treatment.
Gastrointestinal disorders
Gastritis
3.4%
1/29 • Number of events 1 • Adverse events were recorded from signing of informed consent until 90 days after last dose of IMP (total: 20-22 weeks) or for 6 weeks after surgery (total: 12-14 weeks) if the subject initiated new anticancer therapy. Deaths were recorded for up to 26 months after treatment initiation.
Note that deaths were recorded for up to 26 months after treatment initiation, but only for the purpose of collecting data for the overall survival efficacy endpoint. Of the total of 5 recorded deaths, only 1 fell within the time frame for safety reporting, and therefore, only 1 adverse event with fatal outcome is recorded in the safety database. This was a case of Acute Hepatic Failure reported as related to study treatment.
Hepatobiliary disorders
Acute hepatic failure
3.4%
1/29 • Number of events 1 • Adverse events were recorded from signing of informed consent until 90 days after last dose of IMP (total: 20-22 weeks) or for 6 weeks after surgery (total: 12-14 weeks) if the subject initiated new anticancer therapy. Deaths were recorded for up to 26 months after treatment initiation.
Note that deaths were recorded for up to 26 months after treatment initiation, but only for the purpose of collecting data for the overall survival efficacy endpoint. Of the total of 5 recorded deaths, only 1 fell within the time frame for safety reporting, and therefore, only 1 adverse event with fatal outcome is recorded in the safety database. This was a case of Acute Hepatic Failure reported as related to study treatment.
Infections and infestations
Herpes zoster
3.4%
1/29 • Number of events 1 • Adverse events were recorded from signing of informed consent until 90 days after last dose of IMP (total: 20-22 weeks) or for 6 weeks after surgery (total: 12-14 weeks) if the subject initiated new anticancer therapy. Deaths were recorded for up to 26 months after treatment initiation.
Note that deaths were recorded for up to 26 months after treatment initiation, but only for the purpose of collecting data for the overall survival efficacy endpoint. Of the total of 5 recorded deaths, only 1 fell within the time frame for safety reporting, and therefore, only 1 adverse event with fatal outcome is recorded in the safety database. This was a case of Acute Hepatic Failure reported as related to study treatment.
Infections and infestations
Pneumonia
6.9%
2/29 • Number of events 2 • Adverse events were recorded from signing of informed consent until 90 days after last dose of IMP (total: 20-22 weeks) or for 6 weeks after surgery (total: 12-14 weeks) if the subject initiated new anticancer therapy. Deaths were recorded for up to 26 months after treatment initiation.
Note that deaths were recorded for up to 26 months after treatment initiation, but only for the purpose of collecting data for the overall survival efficacy endpoint. Of the total of 5 recorded deaths, only 1 fell within the time frame for safety reporting, and therefore, only 1 adverse event with fatal outcome is recorded in the safety database. This was a case of Acute Hepatic Failure reported as related to study treatment.
Skin and subcutaneous tissue disorders
Lichen planus
3.4%
1/29 • Number of events 2 • Adverse events were recorded from signing of informed consent until 90 days after last dose of IMP (total: 20-22 weeks) or for 6 weeks after surgery (total: 12-14 weeks) if the subject initiated new anticancer therapy. Deaths were recorded for up to 26 months after treatment initiation.
Note that deaths were recorded for up to 26 months after treatment initiation, but only for the purpose of collecting data for the overall survival efficacy endpoint. Of the total of 5 recorded deaths, only 1 fell within the time frame for safety reporting, and therefore, only 1 adverse event with fatal outcome is recorded in the safety database. This was a case of Acute Hepatic Failure reported as related to study treatment.
Gastrointestinal disorders
Gastric ulcer
3.4%
1/29 • Number of events 1 • Adverse events were recorded from signing of informed consent until 90 days after last dose of IMP (total: 20-22 weeks) or for 6 weeks after surgery (total: 12-14 weeks) if the subject initiated new anticancer therapy. Deaths were recorded for up to 26 months after treatment initiation.
Note that deaths were recorded for up to 26 months after treatment initiation, but only for the purpose of collecting data for the overall survival efficacy endpoint. Of the total of 5 recorded deaths, only 1 fell within the time frame for safety reporting, and therefore, only 1 adverse event with fatal outcome is recorded in the safety database. This was a case of Acute Hepatic Failure reported as related to study treatment.

Other adverse events

Other adverse events
Measure
Pembrolizumab
n=29 participants at risk
Pembrolizumab at fixed dose: 200 mg q3w i.v. for 2 cycles Pembrolizumab: Pembrolizumab at fixed dose: 200 mg q3w i.v. for 2 cycles
Endocrine disorders
Autoimmune thyreoditis
6.9%
2/29 • Number of events 2 • Adverse events were recorded from signing of informed consent until 90 days after last dose of IMP (total: 20-22 weeks) or for 6 weeks after surgery (total: 12-14 weeks) if the subject initiated new anticancer therapy. Deaths were recorded for up to 26 months after treatment initiation.
Note that deaths were recorded for up to 26 months after treatment initiation, but only for the purpose of collecting data for the overall survival efficacy endpoint. Of the total of 5 recorded deaths, only 1 fell within the time frame for safety reporting, and therefore, only 1 adverse event with fatal outcome is recorded in the safety database. This was a case of Acute Hepatic Failure reported as related to study treatment.
Endocrine disorders
Hyperthyroidism
6.9%
2/29 • Number of events 3 • Adverse events were recorded from signing of informed consent until 90 days after last dose of IMP (total: 20-22 weeks) or for 6 weeks after surgery (total: 12-14 weeks) if the subject initiated new anticancer therapy. Deaths were recorded for up to 26 months after treatment initiation.
Note that deaths were recorded for up to 26 months after treatment initiation, but only for the purpose of collecting data for the overall survival efficacy endpoint. Of the total of 5 recorded deaths, only 1 fell within the time frame for safety reporting, and therefore, only 1 adverse event with fatal outcome is recorded in the safety database. This was a case of Acute Hepatic Failure reported as related to study treatment.
Gastrointestinal disorders
Diarrhoea
10.3%
3/29 • Number of events 3 • Adverse events were recorded from signing of informed consent until 90 days after last dose of IMP (total: 20-22 weeks) or for 6 weeks after surgery (total: 12-14 weeks) if the subject initiated new anticancer therapy. Deaths were recorded for up to 26 months after treatment initiation.
Note that deaths were recorded for up to 26 months after treatment initiation, but only for the purpose of collecting data for the overall survival efficacy endpoint. Of the total of 5 recorded deaths, only 1 fell within the time frame for safety reporting, and therefore, only 1 adverse event with fatal outcome is recorded in the safety database. This was a case of Acute Hepatic Failure reported as related to study treatment.
Gastrointestinal disorders
Nausea
10.3%
3/29 • Number of events 3 • Adverse events were recorded from signing of informed consent until 90 days after last dose of IMP (total: 20-22 weeks) or for 6 weeks after surgery (total: 12-14 weeks) if the subject initiated new anticancer therapy. Deaths were recorded for up to 26 months after treatment initiation.
Note that deaths were recorded for up to 26 months after treatment initiation, but only for the purpose of collecting data for the overall survival efficacy endpoint. Of the total of 5 recorded deaths, only 1 fell within the time frame for safety reporting, and therefore, only 1 adverse event with fatal outcome is recorded in the safety database. This was a case of Acute Hepatic Failure reported as related to study treatment.
Gastrointestinal disorders
Vomiting
6.9%
2/29 • Number of events 2 • Adverse events were recorded from signing of informed consent until 90 days after last dose of IMP (total: 20-22 weeks) or for 6 weeks after surgery (total: 12-14 weeks) if the subject initiated new anticancer therapy. Deaths were recorded for up to 26 months after treatment initiation.
Note that deaths were recorded for up to 26 months after treatment initiation, but only for the purpose of collecting data for the overall survival efficacy endpoint. Of the total of 5 recorded deaths, only 1 fell within the time frame for safety reporting, and therefore, only 1 adverse event with fatal outcome is recorded in the safety database. This was a case of Acute Hepatic Failure reported as related to study treatment.
General disorders
Fatigue
13.8%
4/29 • Number of events 4 • Adverse events were recorded from signing of informed consent until 90 days after last dose of IMP (total: 20-22 weeks) or for 6 weeks after surgery (total: 12-14 weeks) if the subject initiated new anticancer therapy. Deaths were recorded for up to 26 months after treatment initiation.
Note that deaths were recorded for up to 26 months after treatment initiation, but only for the purpose of collecting data for the overall survival efficacy endpoint. Of the total of 5 recorded deaths, only 1 fell within the time frame for safety reporting, and therefore, only 1 adverse event with fatal outcome is recorded in the safety database. This was a case of Acute Hepatic Failure reported as related to study treatment.
General disorders
Pain
6.9%
2/29 • Number of events 2 • Adverse events were recorded from signing of informed consent until 90 days after last dose of IMP (total: 20-22 weeks) or for 6 weeks after surgery (total: 12-14 weeks) if the subject initiated new anticancer therapy. Deaths were recorded for up to 26 months after treatment initiation.
Note that deaths were recorded for up to 26 months after treatment initiation, but only for the purpose of collecting data for the overall survival efficacy endpoint. Of the total of 5 recorded deaths, only 1 fell within the time frame for safety reporting, and therefore, only 1 adverse event with fatal outcome is recorded in the safety database. This was a case of Acute Hepatic Failure reported as related to study treatment.
Infections and infestations
Pneumonia
10.3%
3/29 • Number of events 3 • Adverse events were recorded from signing of informed consent until 90 days after last dose of IMP (total: 20-22 weeks) or for 6 weeks after surgery (total: 12-14 weeks) if the subject initiated new anticancer therapy. Deaths were recorded for up to 26 months after treatment initiation.
Note that deaths were recorded for up to 26 months after treatment initiation, but only for the purpose of collecting data for the overall survival efficacy endpoint. Of the total of 5 recorded deaths, only 1 fell within the time frame for safety reporting, and therefore, only 1 adverse event with fatal outcome is recorded in the safety database. This was a case of Acute Hepatic Failure reported as related to study treatment.
General disorders
Decreased appetite
6.9%
2/29 • Number of events 2 • Adverse events were recorded from signing of informed consent until 90 days after last dose of IMP (total: 20-22 weeks) or for 6 weeks after surgery (total: 12-14 weeks) if the subject initiated new anticancer therapy. Deaths were recorded for up to 26 months after treatment initiation.
Note that deaths were recorded for up to 26 months after treatment initiation, but only for the purpose of collecting data for the overall survival efficacy endpoint. Of the total of 5 recorded deaths, only 1 fell within the time frame for safety reporting, and therefore, only 1 adverse event with fatal outcome is recorded in the safety database. This was a case of Acute Hepatic Failure reported as related to study treatment.
Nervous system disorders
Dizziness
10.3%
3/29 • Number of events 3 • Adverse events were recorded from signing of informed consent until 90 days after last dose of IMP (total: 20-22 weeks) or for 6 weeks after surgery (total: 12-14 weeks) if the subject initiated new anticancer therapy. Deaths were recorded for up to 26 months after treatment initiation.
Note that deaths were recorded for up to 26 months after treatment initiation, but only for the purpose of collecting data for the overall survival efficacy endpoint. Of the total of 5 recorded deaths, only 1 fell within the time frame for safety reporting, and therefore, only 1 adverse event with fatal outcome is recorded in the safety database. This was a case of Acute Hepatic Failure reported as related to study treatment.
Nervous system disorders
Paraesthesia
6.9%
2/29 • Number of events 2 • Adverse events were recorded from signing of informed consent until 90 days after last dose of IMP (total: 20-22 weeks) or for 6 weeks after surgery (total: 12-14 weeks) if the subject initiated new anticancer therapy. Deaths were recorded for up to 26 months after treatment initiation.
Note that deaths were recorded for up to 26 months after treatment initiation, but only for the purpose of collecting data for the overall survival efficacy endpoint. Of the total of 5 recorded deaths, only 1 fell within the time frame for safety reporting, and therefore, only 1 adverse event with fatal outcome is recorded in the safety database. This was a case of Acute Hepatic Failure reported as related to study treatment.
Respiratory, thoracic and mediastinal disorders
Cough
17.2%
5/29 • Number of events 5 • Adverse events were recorded from signing of informed consent until 90 days after last dose of IMP (total: 20-22 weeks) or for 6 weeks after surgery (total: 12-14 weeks) if the subject initiated new anticancer therapy. Deaths were recorded for up to 26 months after treatment initiation.
Note that deaths were recorded for up to 26 months after treatment initiation, but only for the purpose of collecting data for the overall survival efficacy endpoint. Of the total of 5 recorded deaths, only 1 fell within the time frame for safety reporting, and therefore, only 1 adverse event with fatal outcome is recorded in the safety database. This was a case of Acute Hepatic Failure reported as related to study treatment.

Additional Information

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  • Principal investigator is a sponsor employee
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