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Lechner A, Rai A, Rojas-Rudilla V, Kuang Y, Paweletz CP, Sholl LM, Dong F. Atypical Droplet Digital Polymerase Chain Reaction Patterns That Indicate Uncommon but Clinically Actionable EGFR Mutations in Lung Cancer. Arch Pathol Lab Med 2024; 148:553-558. [PMID: 37639432 DOI: 10.5858/arpa.2023-0088-oa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2023] [Indexed: 08/31/2023]
Abstract
CONTEXT Droplet digital polymerase chain reaction (ddPCR) is a sensitive method to detect common pathogenic EGFR mutations in non-small cell lung cancer. Although targeted assays have not been specifically designed to detect them, uncommon EGFR mutations have been linked to response to targeted therapy. OBJECTIVE To describe atypical ddPCR patterns that correspond to uncommon but clinically actionable EGFR mutations. DESIGN A cohort of 1134 consecutive non-small cell lung cancers that underwent targeted next-generation sequencing was reviewed. Uncommon EGFR mutations involving probe binding sites were evaluated by ddPCR. RESULTS Two hundred fifty-five of 1134 cancers (22.5%) harbored pathogenic EGFR mutations. One hundred eighty-six of 255 (72.9%) had canonical EGFR exon 19 deletion or exon 21 p.L858R variants designed for detection by ddPCR. An additional 25 of 255 cases (9.8%) had uncommon EGFR mutations within the probe-binding site, including 1 case with concurrent uncommon mutations in both exon 19 and exon 21. These mutations included uncommon EGFR exon 19 deletions (n = 6), EGFR exon 19 substitutions p.L747P (n = 3) and p.L747A (n = 1), dinucleotide substitutions leading to EGFR p.L858R (n = 5), EGFR exon 21 substitutions p.K860I (n = 1) and p.L861Q (n = 9), and EGFR p.[L858R;K860I] (n = 1). Droplet digital polymerase chain reaction generated atypical but reproducible signal for each of these uncommon variants. CONCLUSIONS Droplet digital polymerase chain reaction analysis of uncommon pathogenic EGFR variants can yield unique and reproducible results. Recognition of atypical patterns in EGFR ddPCR testing can prompt confirmatory molecular testing and aid appropriate targeted therapy selection for patients with non-small cell lung cancer.
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Affiliation(s)
- Adam Lechner
- From the Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts (Lechner, Rai, Rojas-Rudilla, Sholl, Dong)
- the University of Missouri School of Medicine, Columbia (Lechner)
| | - Anooja Rai
- From the Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts (Lechner, Rai, Rojas-Rudilla, Sholl, Dong)
| | - Vanesa Rojas-Rudilla
- From the Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts (Lechner, Rai, Rojas-Rudilla, Sholl, Dong)
| | - Yanan Kuang
- the Belfer Center for Applied Cancer Science, Dana Farber Cancer Institute, Boston, Massachusetts(Kuang)
- the Department of Medical Oncology, Dana Farber Cancer Institute, Boston, Massachusetts(Kuang, Paweletz)
| | - Cloud P Paweletz
- the Department of Medical Oncology, Dana Farber Cancer Institute, Boston, Massachusetts(Kuang, Paweletz)
| | - Lynette M Sholl
- From the Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts (Lechner, Rai, Rojas-Rudilla, Sholl, Dong)
| | - Fei Dong
- From the Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts (Lechner, Rai, Rojas-Rudilla, Sholl, Dong)
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2
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Murakami S, Shinada K, Otsutsumi Y, Komine F, Yuan Y, Nakamura J, Katakura S, Kondo T, Kato T, Yokose T, Saito H. Comparison between next-generation sequencing and multiplex polymerase chain reaction assays for nonsmall-cell lung cancer molecular diagnosis. Cancer Med 2024; 13:e7162. [PMID: 38572952 PMCID: PMC10993699 DOI: 10.1002/cam4.7162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 03/18/2024] [Accepted: 03/26/2024] [Indexed: 04/05/2024] Open
Abstract
PURPOSE Genetic mutation detection has become an important step in nonsmall-cell lung cancer (NSCLC) treatment because of the increasing number of drugs that target genomic rearrangements. A multiplex test that can detect multiple gene mutations prior to treatment is thus necessary. Currently, either next-generation sequencing (NGS)-based or polymerase chain reaction (PCR)-based tests are used. We evaluated the performance of the Oncomine Dx Target Test (ODxTT), an NGS-based multiplex biomarker panel test, and the AmoyDx Pan Lung Cancer PCR Panel (AmoyDx PLC panel), a real-time PCR-based multiplex biomarker panel test. MATERIALS AND METHODS Patients with histologically diagnosed NSCLC and a sufficient sample volume to simultaneously perform the AmoyDx PLC panel and ODxTT-M were included in the study. The success and detection rates of both tests were evaluated. RESULTS Biopsies revealed 116 cases of malignancies, 100 of which were NSCLC. Of these, 59 met the inclusion criteria and were eligible for analysis. The success rates were 100% and 98% for AmoyDx PLC panel and ODxTT-M, respectively. Nine driver mutations were detected in 35.9% and 37.3% of AmoyDx PLC and ODxTT-M panels, respectively. EGFR mutations were detected in 14% and 12% of samples using the AmoyDx PLC panel and ODxTT-M, respectively. Of the 58 cases in which both NGS and AmoyDx PLC panels were successful, discordant results were observed in seven cases. These differences were mainly due to different sensitivities of the detection methods used and the gene variants targeted in each test. DISCUSSION The AmoyDx PLC panel, a PCR-based multiplex diagnostic test, exhibits a high success rate. The frequency of the nine genes targeted for treatment detected by the AmoyDx PLC panel was comparable to the frequency of mutations detected by ODxTT-M. Clinicians should understand and use the AmoyDx PLC panel and ODxTT-M with respect to their respective performances and limitations.
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Affiliation(s)
- Shuji Murakami
- Department of Thoracic OncologyKanagawa Cancer CenterYokohamaKanagawaJapan
| | - Kanako Shinada
- Department of Thoracic OncologyKanagawa Cancer CenterYokohamaKanagawaJapan
| | - Yuka Otsutsumi
- Department of PathologyKanagawa Cancer CenterYokohamaKanagawaJapan
| | | | - Yuan Yuan
- Riken Genesis Co., Ltd.Shinagawa‐kuTokyoJapan
| | | | - Seigo Katakura
- Department of Thoracic OncologyKanagawa Cancer CenterYokohamaKanagawaJapan
| | - Tetsuro Kondo
- Department of Thoracic OncologyKanagawa Cancer CenterYokohamaKanagawaJapan
| | - Terufumi Kato
- Department of Thoracic OncologyKanagawa Cancer CenterYokohamaKanagawaJapan
| | - Tomoyuki Yokose
- Department of PathologyKanagawa Cancer CenterYokohamaKanagawaJapan
| | - Haruhiro Saito
- Department of Thoracic OncologyKanagawa Cancer CenterYokohamaKanagawaJapan
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3
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Le X, Nadler E, Costa DB, Heymach JV. EGFR Tyrosine Kinase Inhibitors for the Treatment of Metastatic Non-Small Cell Lung Cancer Harboring Uncommon EGFR Mutations: A Podcast. Target Oncol 2023; 18:807-817. [PMID: 37792237 PMCID: PMC10663258 DOI: 10.1007/s11523-023-00994-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2023] [Indexed: 10/05/2023]
Abstract
Supplementary file1 (MP4 21169 KB).
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Affiliation(s)
- Xiuning Le
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Eric Nadler
- Baylor University Medical Center, Dallas, TX, USA
| | - Daniel B Costa
- Division of Medical Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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4
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Yang LL, Luo XZ, Xie LL, Lei XZ, Zhu J. The treatment of patients with non-small cell lung cancer carrying uncommon EGFR mutations, HER2 mutations, or brain metastases: a systematic review of pre-clinical and clinical findings for dacomitinib. Transl Cancer Res 2023; 12:2197-2211. [PMID: 37701115 PMCID: PMC10493789 DOI: 10.21037/tcr-23-95] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 07/21/2023] [Indexed: 09/14/2023]
Abstract
Background Accumulating evidence has shown that dacomitinib has potential activities for patients with non-small cell lung cancer (NSCLC) harboring uncommon epidermal growth factor receptor (EGFR) mutations, human epidermal growth factor receptor 2 (HER2) mutations, or central nervous system (CNS) metastases. Methods This study aimed to give a systematic review on its potential applications in the above settings by searching MEDLINE/PubMed, Embase, Cochrane Library, American Society of Clinical Oncology.org, European Society for Medical Oncology.org, and ClinicalTrials.gov. Results The literature search yielded 649 publications in total. According to our findings, dacomitinib exhibited promising efficacy in patients with major uncommon EGFR mutations (including G719X, S768I, and L861Q). Both EGFR exon 20 insertional mutation (Ex20ins) and HER2 Ex20ins demonstrated significant internal heterogeneity in response to dacomitinib, among which specific subtypes (including EGFR D770delinsGY, A763_Y764insFQEA, and HER2 M774delinsWLV) were highly sensitive. Other uncommon EGFR mutations including 18del and L747P have also been shown responsive to dacomitinib. Interestingly, limited studies suggested dacomitinib application on certain first or third generation tyrosine kinase inhibitors (TKIs)' resistant secondary mutations. Last but not least, both pre-clinical and clinical data indicated that dacomitinib has an encouraging intracranial tumor control ability, regardless of uncommon mutations. Conclusions Dacomitinib demonstrated good disease control on patients with NSCLC harboring major uncommon EGFR mutations and specific EGFR or HER2 mutation subtypes, and selective clinical application of dacomitinib is considerable in this setting, especially for those with intracranial metastases.
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Affiliation(s)
- Li-Li Yang
- Department of Medical Oncology, Chengdu Shangjinnanfu Hospital, West China Hospital of Sichuan University, Chengdu, China
| | - Xiao-Zhen Luo
- Department of Medical Oncology, Chengdu Shangjinnanfu Hospital, West China Hospital of Sichuan University, Chengdu, China
| | - Ling-Ling Xie
- Department of Medical Oncology, Chengdu Shangjinnanfu Hospital, West China Hospital of Sichuan University, Chengdu, China
| | - Xiao-Zhen Lei
- Department of Medical Oncology, Chengdu Shangjinnanfu Hospital, West China Hospital of Sichuan University, Chengdu, China
| | - Jiang Zhu
- Department of Medical Oncology, West China Hospital of Sichuan University, Chengdu, China
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5
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Biochemical and structural basis for differential inhibitor sensitivity of EGFR with distinct exon 19 mutations. Nat Commun 2022; 13:6791. [PMID: 36357385 PMCID: PMC9649653 DOI: 10.1038/s41467-022-34398-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 10/19/2022] [Indexed: 11/11/2022] Open
Abstract
Tyrosine kinase inhibitors (TKIs) are used to treat non-small cell lung cancers (NSCLC) driven by epidermal growth factor receptor (EGFR) mutations in the tyrosine kinase domain (TKD). TKI responses vary across tumors driven by the heterogeneous group of exon 19 deletions and mutations, but the molecular basis for these differences is not understood. Using purified TKDs, we compared kinetic properties of several exon 19 variants. Although unaltered for the second generation TKI afatinib, sensitivity varied significantly for both the first and third generation TKIs erlotinib and osimertinib. The most sensitive variants showed reduced ATP-binding affinity, whereas those associated with primary resistance retained wild type ATP-binding characteristics (and low KM, ATP). Through crystallographic and hydrogen-deuterium exchange mass spectrometry (HDX-MS) studies, we identify possible origins for the altered ATP-binding affinity underlying TKI sensitivity and resistance, and propose a basis for classifying uncommon exon 19 variants that may have predictive clinical value.
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6
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Kanbe M, Sunaga N, Hara K, Sawada H, Wakamatsu I, Hara K, Muto S, Sawada Y, Masubuchi H, Sato M, Miura Y, Tsurumaki H, Yatomi M, Sakurai R, Koga Y, Ohtaki Y, Nagashima T, Okano N, Kubo N, Maeno T, Hisada T. Durable response to afatinib rechallenge in a long-term survivor of non-small cell lung cancer harboring EGFR L858R and L747V mutations. Thorac Cancer 2022; 13:3225-3228. [PMID: 36193787 PMCID: PMC9663673 DOI: 10.1111/1759-7714.14678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 09/16/2022] [Accepted: 09/17/2022] [Indexed: 01/07/2023] Open
Abstract
Epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitors are standard therapeutic agents for non-small cell lung cancer (NSCLC) patients with major EGFR mutations such as exon 19 deletions and a L858R mutation, whereas treatment strategies for cases with uncommon EGFR mutations remain to be fully established. Here, we report a long-term (≥20 years from initial diagnosis) NSCLC survivor carrying EGFR L858R and L747V mutations. The patient received gefitinib monotherapy, systemic chemotherapy/chemoimmunotherapy, and local consolidative therapies for oligometastatic lesions, and responded to afatinib rechallenge with a progression-free survival of 12 months. The current case suggests that afatinib is effective in NSCLC patients with EGFR L858R and L747V mutations and that a therapeutic approach combining appropriately timed systemic therapies with local consolidative therapies for oligometastatic lesions improves long-term survival.
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Affiliation(s)
- Mio Kanbe
- Department of Respiratory MedicineGunma University Graduate School of MedicineMaebashiGunmaJapan
| | - Noriaki Sunaga
- Department of Respiratory MedicineGunma University Graduate School of MedicineMaebashiGunmaJapan
| | - Kenichiro Hara
- Department of Respiratory MedicineGunma University Graduate School of MedicineMaebashiGunmaJapan
| | - Hiiru Sawada
- Department of Respiratory MedicineGunma University Graduate School of MedicineMaebashiGunmaJapan
| | - Ikuo Wakamatsu
- Department of Respiratory MedicineGunma University Graduate School of MedicineMaebashiGunmaJapan
| | - Kentaro Hara
- Department of Respiratory MedicineGunma University Graduate School of MedicineMaebashiGunmaJapan
| | - Sohei Muto
- Department of Respiratory MedicineGunma University Graduate School of MedicineMaebashiGunmaJapan
| | - Yuri Sawada
- Department of Respiratory MedicineGunma University Graduate School of MedicineMaebashiGunmaJapan
| | - Hiroaki Masubuchi
- Department of Respiratory MedicineGunma University Graduate School of MedicineMaebashiGunmaJapan
| | - Mari Sato
- Department of Respiratory MedicineGunma University Graduate School of MedicineMaebashiGunmaJapan
| | - Yosuke Miura
- Department of Respiratory MedicineGunma University Graduate School of MedicineMaebashiGunmaJapan
| | - Hiroaki Tsurumaki
- Department of Respiratory MedicineGunma University Graduate School of MedicineMaebashiGunmaJapan
| | - Masakiyo Yatomi
- Department of Respiratory MedicineGunma University Graduate School of MedicineMaebashiGunmaJapan
| | - Reiko Sakurai
- Oncology CenterGunma University HospitalMaebashiGunmaJapan
| | - Yasuhiko Koga
- Department of Respiratory MedicineGunma University Graduate School of MedicineMaebashiGunmaJapan
| | - Yoichi Ohtaki
- Department of General Surgical ScienceGunma University Graduate School of MedicineMaebashiGunmaJapan
| | - Toshiteru Nagashima
- Department of General Surgical ScienceGunma University Graduate School of MedicineMaebashiGunmaJapan
| | - Naoko Okano
- Department of Radiation OncologyGunma University Graduate School of MedicineMaebashiGunmaJapan
| | - Nobuteru Kubo
- Department of Radiation OncologyGunma University Graduate School of MedicineMaebashiGunmaJapan
| | - Toshitaka Maeno
- Department of Respiratory MedicineGunma University Graduate School of MedicineMaebashiGunmaJapan
| | - Takeshi Hisada
- Gunma University Graduate School of Health SciencesMaebashiGunmaJapan
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7
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Li Y, Guo W, Jiang B, Han C, Ye F, Wu J. Case Report: Dacomitinib is effective in lung adenocarcinoma with rare EGFR mutation L747P and brain metastases. Front Oncol 2022; 12:863771. [PMID: 36016627 PMCID: PMC9396254 DOI: 10.3389/fonc.2022.863771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 07/12/2022] [Indexed: 11/24/2022] Open
Abstract
Due to the low incidence of rare EGFR mutation, its response to EGFR-TKI has not been fully investigated. L747P is a rare EGFR mutation in EGFR exon 19. Previous case reports showed that patients with EGFR L747P mutation responded to afatinib treatment. However, we encountered a patient with EGFR L747P who was resistant to afatinib but responded to dacomitinib. It is the first case report of the effective application of dacomitinib in a patient with L747P mutation and BMS, and the efficacy of BMS achieved PR.
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Affiliation(s)
- Yibin Li
- Department of Medical Oncology, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Weixi Guo
- Department of Thoracic Surgery, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Bin Jiang
- Department of Neurology, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Chengkun Han
- Department of Radiology, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Feng Ye
- Department of Medical Oncology, The First Affiliated Hospital of Xiamen University, Xiamen, China
- *Correspondence: Jingxun Wu, ; Feng Ye,
| | - Jingxun Wu
- Department of Medical Oncology, The First Affiliated Hospital of Xiamen University, Xiamen, China
- *Correspondence: Jingxun Wu, ; Feng Ye,
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8
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Jiang W, Zhao T, Zhen X, Jin C, Li H, Ha J. Rapid Determination of 9 Tyrosine Kinase Inhibitors for the Treatment of Hepatocellular Carcinoma in Human Plasma by QuEChERS-UPLC-MS/MS. Front Pharmacol 2022; 13:920436. [PMID: 35800447 PMCID: PMC9253689 DOI: 10.3389/fphar.2022.920436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 05/11/2022] [Indexed: 11/13/2022] Open
Abstract
A reliable and rapid method employing QuEChERS (Quick, Easy, Cheap, Effective, Rugged, and Safe) pretreatment coupled with ultra-performance liquid chromatography–tandem mass spectrometry (UPLC–MS/MS) was successfully developed and validated for the analysis of nine tyrosine kinase inhibitors (TKIs) in human plasma. Biological samples were extracted with acetonitrile and salted out with 350 mg of anhydrous magnesium sulfate (MgSO4), followed by purification with 40 mg of ethyl enediamine-N-propylsilane (PSA) adsorbents. All analytes and internal standards (IS) were separated on the Hypersil GOLD VANQUISH C18 (2.1 mm × 100 mm, 1.9 μM) column using the mobile phases composed of acetonitrile (phase A) and 0.1% formic acid in water (phase B) for 8.0 min. Detection was performed by selection reaction monitoring (SRM) in the positive ion electrospray mode. Lenvatinib, sorafenib, cabozantinib, apatinib, gefitinib, regorafenib, and anlotinib rendered good linearity over the range of 0.1–10 ng/ml, and 1–100 ng/ml for tivantinib and galunisertib. All linear correlation coefficients for all standard curves were ≥ 0.9966. The limits of detection (LOD) and the limits of quantitation (LOQ) ranged from 0.003 to 0.11 ng/ml and 0.01–0.37 ng/ml, respectively. The method was deemed satisfactory with an accuracy of -7.34–6.64%, selectivity, matrix effect (ME) of 90.48–107.77%, recovery, and stability. The proposed method is simple, efficient, reliable, and applicable for the detection of TKIs in human plasma samples as well as for providing a reference for the clinical adjustment of drug administration regimen by monitoring the drug concentrations in the plasma of patients.
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Affiliation(s)
- Wen Jiang
- College of Chemistry and Pharmaceutical Engineering, Hebei University of Science and Technology, Shijiazhuang, China
| | - Tingting Zhao
- College of Pharmacy, Hebei Medical University, Shijiazhuang, China
| | - Xiaolan Zhen
- Hebei Institute of Drug and Medical Device Inspection, Shijiazhuang, China
| | - Chengcheng Jin
- College of Chemistry and Pharmaceutical Engineering, Hebei University of Science and Technology, Shijiazhuang, China
| | - Hui Li
- Hebei Institute of Drug and Medical Device Inspection, Shijiazhuang, China
- *Correspondence: Hui Li, ; Jing Ha,
| | - Jing Ha
- College of Chemistry and Pharmaceutical Engineering, Hebei University of Science and Technology, Shijiazhuang, China
- *Correspondence: Hui Li, ; Jing Ha,
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