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Pitiyarachchi O, Lee YC, Sim HW, Srirangan S, Mapagu C, Kirk J, Harnett PR, Balleine RL, Bowtell DDL, Samimi G, Brand AH, Marsh DJ, Beale P, Anderson L, Bouantoun N, Provan P, Ramus SJ, DeFazio A, Friedlander M. Older age should not be a barrier to testing for somatic variants in homologous recombination DNA repair-related genes in patients with high-grade serous ovarian carcinoma. Transl Oncol 2023; 31:101638. [PMID: 36805919 PMCID: PMC9971549 DOI: 10.1016/j.tranon.2023.101638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 01/29/2023] [Accepted: 02/08/2023] [Indexed: 02/20/2023] Open
Abstract
BACKGROUND Somatic pathogenic variants (PVs) in homologous recombination DNA repair (HR)-related genes found in high-grade serous ovarian carcinomas (HGSC) are not well-characterised in older patients (≥70 years). This may reflect low testing rates in older patients. METHODS Data from 1210 HGSC patients in AACR Project GENIE and 324 patients in an independent dataset INOVATe were analysed. Cases where somatic variants could be distinguished from germline variants were included, and analysis was restricted to those with a somatic TP53 variant, to ensure cases were HGSC. RESULTS Of 1210 patients in GENIE, 27% (n = 325) were aged ≥70 years at testing. Patients with somatic-only PVs in BRCA2 were older compared with BRCA1 (median 71 vs 60 years, p = 0.002). Median age for 21 patients with somatic-only PVs in 11 other HR-related genes ranged from 40 to 67 years. In older patients, 7% (n = 22) had somatic BRCA1/2 PVs, and 1% (n = 2) had PVs other HR-related genes; this rate was not significantly different to younger patients (<70 years), 7% (n = 62) BRCA1/2 and 2% (n = 19) other HR-related genes (p = 0.36). The overall frequency of somatic BRCA1/2 PVs was similar in INOVATe (n = 25; 7.7%) and somatic-only BRCA2 PVs were again found in older patients compared with BRCA1 (median age: at testing, 70 vs 63 years; at diagnosis, 68 vs 60 years). CONCLUSIONS The overall frequency of somatic-only PVs in HR-related genes was similar in older and younger patients with HGSC, highlighting the importance of somatic testing irrespective of age. Limiting somatic testing by age may exclude patients who could benefit from maintenance poly(ADP-ribose) polymerase (PARP) inhibitors.
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Affiliation(s)
- Omali Pitiyarachchi
- School of Biomedical Sciences, Faculty of Medicine and Health, UNSW Sydney, Sydney, NSW, Australia.
| | - Yeh Chen Lee
- School of Clinical Medicine, Faculty of Medicine and Health, UNSW Sydney, Sydney, NSW, Australia; Department of Medical Oncology, Prince of Wales and Royal Hospital for Women, Randwick, NSW, Australia
| | - Hao-Wen Sim
- School of Clinical Medicine, Faculty of Medicine and Health, UNSW Sydney, Sydney, NSW, Australia; NHMRC Clinical Trials Centre, The University of Sydney, Camperdown, NSW, Australia; Department of Medical Oncology, The Kinghorn Cancer Centre, Darlinghurst, NSW, Australia; Department of Medical Oncology, Chris O'Brien Lifehouse, Camperdown, NSW, Australia; Garvan Institute of Medical Research, Sydney, NSW, Australia
| | - Sivatharsny Srirangan
- Centre for Cancer Research, Westmead Institute for Medical Research, Westmead, NSW, Australia; Department of Gynaecological Oncology, Westmead Hospital, Westmead, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Cristina Mapagu
- Centre for Cancer Research, Westmead Institute for Medical Research, Westmead, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Illawarra and Shoalhaven Cancer Care Centres, Wollongong and Nowra, NSW, Australia
| | - Judy Kirk
- Centre for Cancer Research, Westmead Institute for Medical Research, Westmead, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; The Crown Princess Mary Cancer Centre, Westmead Hospital, Westmead, NSW, Australia
| | - Paul R Harnett
- Centre for Cancer Research, Westmead Institute for Medical Research, Westmead, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; The Crown Princess Mary Cancer Centre, Westmead Hospital, Westmead, NSW, Australia
| | - Rosemary L Balleine
- Centre for Cancer Research, Westmead Institute for Medical Research, Westmead, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - David D L Bowtell
- Research Division, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Sir Peter MacCallum Cancer Centre Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
| | - Goli Samimi
- National Cancer Institute, Bethesda, Maryland, United States of America
| | - Alison H Brand
- Department of Gynaecological Oncology, Westmead Hospital, Westmead, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Deborah J Marsh
- Translational Oncology Group, School of Life Sciences, Faculty of Science, University of Technology Sydney, NSW, Australia; Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Philip Beale
- Department of Medical Oncology, Chris O'Brien Lifehouse, Camperdown, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Lyndal Anderson
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; NSW Health Pathology, NSW, Australia; Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Natalie Bouantoun
- Centre for Cancer Research, Westmead Institute for Medical Research, Westmead, NSW, Australia; Department of Gynaecological Oncology, Westmead Hospital, Westmead, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Pamela Provan
- Centre for Cancer Research, Westmead Institute for Medical Research, Westmead, NSW, Australia; Department of Gynaecological Oncology, Westmead Hospital, Westmead, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | | | - Susan J Ramus
- School of Clinical Medicine, Faculty of Medicine and Health, UNSW Sydney, Sydney, NSW, Australia; Adult Cancer Program, Lowy Cancer Research Centre, UNSW Sydney, Sydney, NSW, Australia
| | - Anna DeFazio
- Centre for Cancer Research, Westmead Institute for Medical Research, Westmead, NSW, Australia; Department of Gynaecological Oncology, Westmead Hospital, Westmead, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, NSW, Australia
| | - Michael Friedlander
- School of Clinical Medicine, Faculty of Medicine and Health, UNSW Sydney, Sydney, NSW, Australia; Department of Medical Oncology, Prince of Wales and Royal Hospital for Women, Randwick, NSW, Australia
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Moujaber T, Etemadmoghadam D, Kennedy CJ, Chiew YE, Balleine RL, Saunders C, Wain GV, Gao B, Hogg R, Srirangan S, Kan C, Fereday S, Traficante N, Patch AM, Pearson JV, Waddell N, Grimmond SM, Dobrovic A, Bowtell DD, Harnett PR, deFazio A. BRAF Mutations in Low-Grade Serous Ovarian Cancer and Response to BRAF Inhibition. JCO Precis Oncol 2018; 2:1-14. [DOI: 10.1200/po.17.00221] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Low-grade serous ovarian carcinoma (LGSC) responds poorly to chemotherapy and is characterized by activating mutations in the Ras sarcoma–mitogen-activated protein kinase (RAS-MAPK) pathway, including oncogenic BRAF. However, response to BRAF inhibitors is tumor-type specific. Significant improvement in survival is seen in patients with BRAF-mutant melanoma, but other cancer types, such as colorectal cancers, are generally less sensitive. We examined the frequency and characteristics of BRAF-mutated LGSC and described the response to treatment with BRAF inhibitors. Patients and Methods Mutations were assessed in LGSC (N = 65) by using targeted, exome, and whole-genome sequencing. Patient characteristics, treatment, and clinical outcome were assessed, and the median follow-up time was more than 5 years. BRAF inhibitors were trialed in two patients with a somatic BRAF V600E mutation: one patient received dabrafenib monotherapy and was monitored clinically, biochemically (cancer antigen [CA]-125 levels), and with positron emission tomography (PET) imaging. Expression of the BRAF V600E protein in this patient was assessed by immunohistochemistry. Results Among patients with LGSC, nine (13.8%) of 65 had a somatic BRAF mutation. Of the nine patients with BRAF mutation–positive LGSC, four experienced progressive disease that did not respond to conventional chemotherapy. Two of the patients experienced progression quickly and died as a result of disease progression, and two received targeted treatment. Two patients with BRAF V600E mutation received BRAF inhibitors at relapse and both achieved durable responses. Conclusion BRAF mutations are not uncommon in patients with LGSC and should be routinely tested, because BRAF inhibitors can be an effective treatment for these patients. The results highlight the need for targeted treatment in this rare tumor type, and a prospective study is needed to formally assess the response rate and clinical benefit.
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Affiliation(s)
- Tania Moujaber
- Tania Moujaber, Catherine J. Kennedy, Yoke-Eng Chiew, Rosemary L. Balleine, Bo Gao, Sivatharsny Srirangan, Casina Kan, Paul R. Harnett, and Anna deFazio, Westmead Institute for Medical Research; Tania Moujaber, Catherine J. Kennedy, Yoke-Eng Chiew, Rosemary L. Balleine, Catherine Saunders, Russell Hogg, Paul R. Harnett, and Anna DeFazio, University of Sydney; Tania Moujaber, Catherine J. Kennedy, Yoke-Eng Chiew, Rosemary L. Balleine, Catherine Saunders, Gerard V. Wain, Bo Gao, Paul R. Harnett, and Anna
| | - Dariush Etemadmoghadam
- Tania Moujaber, Catherine J. Kennedy, Yoke-Eng Chiew, Rosemary L. Balleine, Bo Gao, Sivatharsny Srirangan, Casina Kan, Paul R. Harnett, and Anna deFazio, Westmead Institute for Medical Research; Tania Moujaber, Catherine J. Kennedy, Yoke-Eng Chiew, Rosemary L. Balleine, Catherine Saunders, Russell Hogg, Paul R. Harnett, and Anna DeFazio, University of Sydney; Tania Moujaber, Catherine J. Kennedy, Yoke-Eng Chiew, Rosemary L. Balleine, Catherine Saunders, Gerard V. Wain, Bo Gao, Paul R. Harnett, and Anna
| | - Catherine J. Kennedy
- Tania Moujaber, Catherine J. Kennedy, Yoke-Eng Chiew, Rosemary L. Balleine, Bo Gao, Sivatharsny Srirangan, Casina Kan, Paul R. Harnett, and Anna deFazio, Westmead Institute for Medical Research; Tania Moujaber, Catherine J. Kennedy, Yoke-Eng Chiew, Rosemary L. Balleine, Catherine Saunders, Russell Hogg, Paul R. Harnett, and Anna DeFazio, University of Sydney; Tania Moujaber, Catherine J. Kennedy, Yoke-Eng Chiew, Rosemary L. Balleine, Catherine Saunders, Gerard V. Wain, Bo Gao, Paul R. Harnett, and Anna
| | - Yoke-Eng Chiew
- Tania Moujaber, Catherine J. Kennedy, Yoke-Eng Chiew, Rosemary L. Balleine, Bo Gao, Sivatharsny Srirangan, Casina Kan, Paul R. Harnett, and Anna deFazio, Westmead Institute for Medical Research; Tania Moujaber, Catherine J. Kennedy, Yoke-Eng Chiew, Rosemary L. Balleine, Catherine Saunders, Russell Hogg, Paul R. Harnett, and Anna DeFazio, University of Sydney; Tania Moujaber, Catherine J. Kennedy, Yoke-Eng Chiew, Rosemary L. Balleine, Catherine Saunders, Gerard V. Wain, Bo Gao, Paul R. Harnett, and Anna
| | - Rosemary L. Balleine
- Tania Moujaber, Catherine J. Kennedy, Yoke-Eng Chiew, Rosemary L. Balleine, Bo Gao, Sivatharsny Srirangan, Casina Kan, Paul R. Harnett, and Anna deFazio, Westmead Institute for Medical Research; Tania Moujaber, Catherine J. Kennedy, Yoke-Eng Chiew, Rosemary L. Balleine, Catherine Saunders, Russell Hogg, Paul R. Harnett, and Anna DeFazio, University of Sydney; Tania Moujaber, Catherine J. Kennedy, Yoke-Eng Chiew, Rosemary L. Balleine, Catherine Saunders, Gerard V. Wain, Bo Gao, Paul R. Harnett, and Anna
| | - Catherine Saunders
- Tania Moujaber, Catherine J. Kennedy, Yoke-Eng Chiew, Rosemary L. Balleine, Bo Gao, Sivatharsny Srirangan, Casina Kan, Paul R. Harnett, and Anna deFazio, Westmead Institute for Medical Research; Tania Moujaber, Catherine J. Kennedy, Yoke-Eng Chiew, Rosemary L. Balleine, Catherine Saunders, Russell Hogg, Paul R. Harnett, and Anna DeFazio, University of Sydney; Tania Moujaber, Catherine J. Kennedy, Yoke-Eng Chiew, Rosemary L. Balleine, Catherine Saunders, Gerard V. Wain, Bo Gao, Paul R. Harnett, and Anna
| | - Gerard V. Wain
- Tania Moujaber, Catherine J. Kennedy, Yoke-Eng Chiew, Rosemary L. Balleine, Bo Gao, Sivatharsny Srirangan, Casina Kan, Paul R. Harnett, and Anna deFazio, Westmead Institute for Medical Research; Tania Moujaber, Catherine J. Kennedy, Yoke-Eng Chiew, Rosemary L. Balleine, Catherine Saunders, Russell Hogg, Paul R. Harnett, and Anna DeFazio, University of Sydney; Tania Moujaber, Catherine J. Kennedy, Yoke-Eng Chiew, Rosemary L. Balleine, Catherine Saunders, Gerard V. Wain, Bo Gao, Paul R. Harnett, and Anna
| | - Bo Gao
- Tania Moujaber, Catherine J. Kennedy, Yoke-Eng Chiew, Rosemary L. Balleine, Bo Gao, Sivatharsny Srirangan, Casina Kan, Paul R. Harnett, and Anna deFazio, Westmead Institute for Medical Research; Tania Moujaber, Catherine J. Kennedy, Yoke-Eng Chiew, Rosemary L. Balleine, Catherine Saunders, Russell Hogg, Paul R. Harnett, and Anna DeFazio, University of Sydney; Tania Moujaber, Catherine J. Kennedy, Yoke-Eng Chiew, Rosemary L. Balleine, Catherine Saunders, Gerard V. Wain, Bo Gao, Paul R. Harnett, and Anna
| | - Russell Hogg
- Tania Moujaber, Catherine J. Kennedy, Yoke-Eng Chiew, Rosemary L. Balleine, Bo Gao, Sivatharsny Srirangan, Casina Kan, Paul R. Harnett, and Anna deFazio, Westmead Institute for Medical Research; Tania Moujaber, Catherine J. Kennedy, Yoke-Eng Chiew, Rosemary L. Balleine, Catherine Saunders, Russell Hogg, Paul R. Harnett, and Anna DeFazio, University of Sydney; Tania Moujaber, Catherine J. Kennedy, Yoke-Eng Chiew, Rosemary L. Balleine, Catherine Saunders, Gerard V. Wain, Bo Gao, Paul R. Harnett, and Anna
| | - Sivatharsny Srirangan
- Tania Moujaber, Catherine J. Kennedy, Yoke-Eng Chiew, Rosemary L. Balleine, Bo Gao, Sivatharsny Srirangan, Casina Kan, Paul R. Harnett, and Anna deFazio, Westmead Institute for Medical Research; Tania Moujaber, Catherine J. Kennedy, Yoke-Eng Chiew, Rosemary L. Balleine, Catherine Saunders, Russell Hogg, Paul R. Harnett, and Anna DeFazio, University of Sydney; Tania Moujaber, Catherine J. Kennedy, Yoke-Eng Chiew, Rosemary L. Balleine, Catherine Saunders, Gerard V. Wain, Bo Gao, Paul R. Harnett, and Anna
| | - Casina Kan
- Tania Moujaber, Catherine J. Kennedy, Yoke-Eng Chiew, Rosemary L. Balleine, Bo Gao, Sivatharsny Srirangan, Casina Kan, Paul R. Harnett, and Anna deFazio, Westmead Institute for Medical Research; Tania Moujaber, Catherine J. Kennedy, Yoke-Eng Chiew, Rosemary L. Balleine, Catherine Saunders, Russell Hogg, Paul R. Harnett, and Anna DeFazio, University of Sydney; Tania Moujaber, Catherine J. Kennedy, Yoke-Eng Chiew, Rosemary L. Balleine, Catherine Saunders, Gerard V. Wain, Bo Gao, Paul R. Harnett, and Anna
| | - Sian Fereday
- Tania Moujaber, Catherine J. Kennedy, Yoke-Eng Chiew, Rosemary L. Balleine, Bo Gao, Sivatharsny Srirangan, Casina Kan, Paul R. Harnett, and Anna deFazio, Westmead Institute for Medical Research; Tania Moujaber, Catherine J. Kennedy, Yoke-Eng Chiew, Rosemary L. Balleine, Catherine Saunders, Russell Hogg, Paul R. Harnett, and Anna DeFazio, University of Sydney; Tania Moujaber, Catherine J. Kennedy, Yoke-Eng Chiew, Rosemary L. Balleine, Catherine Saunders, Gerard V. Wain, Bo Gao, Paul R. Harnett, and Anna
| | - Nadia Traficante
- Tania Moujaber, Catherine J. Kennedy, Yoke-Eng Chiew, Rosemary L. Balleine, Bo Gao, Sivatharsny Srirangan, Casina Kan, Paul R. Harnett, and Anna deFazio, Westmead Institute for Medical Research; Tania Moujaber, Catherine J. Kennedy, Yoke-Eng Chiew, Rosemary L. Balleine, Catherine Saunders, Russell Hogg, Paul R. Harnett, and Anna DeFazio, University of Sydney; Tania Moujaber, Catherine J. Kennedy, Yoke-Eng Chiew, Rosemary L. Balleine, Catherine Saunders, Gerard V. Wain, Bo Gao, Paul R. Harnett, and Anna
| | - Ann-Marie Patch
- Tania Moujaber, Catherine J. Kennedy, Yoke-Eng Chiew, Rosemary L. Balleine, Bo Gao, Sivatharsny Srirangan, Casina Kan, Paul R. Harnett, and Anna deFazio, Westmead Institute for Medical Research; Tania Moujaber, Catherine J. Kennedy, Yoke-Eng Chiew, Rosemary L. Balleine, Catherine Saunders, Russell Hogg, Paul R. Harnett, and Anna DeFazio, University of Sydney; Tania Moujaber, Catherine J. Kennedy, Yoke-Eng Chiew, Rosemary L. Balleine, Catherine Saunders, Gerard V. Wain, Bo Gao, Paul R. Harnett, and Anna
| | - John V. Pearson
- Tania Moujaber, Catherine J. Kennedy, Yoke-Eng Chiew, Rosemary L. Balleine, Bo Gao, Sivatharsny Srirangan, Casina Kan, Paul R. Harnett, and Anna deFazio, Westmead Institute for Medical Research; Tania Moujaber, Catherine J. Kennedy, Yoke-Eng Chiew, Rosemary L. Balleine, Catherine Saunders, Russell Hogg, Paul R. Harnett, and Anna DeFazio, University of Sydney; Tania Moujaber, Catherine J. Kennedy, Yoke-Eng Chiew, Rosemary L. Balleine, Catherine Saunders, Gerard V. Wain, Bo Gao, Paul R. Harnett, and Anna
| | - Nicola Waddell
- Tania Moujaber, Catherine J. Kennedy, Yoke-Eng Chiew, Rosemary L. Balleine, Bo Gao, Sivatharsny Srirangan, Casina Kan, Paul R. Harnett, and Anna deFazio, Westmead Institute for Medical Research; Tania Moujaber, Catherine J. Kennedy, Yoke-Eng Chiew, Rosemary L. Balleine, Catherine Saunders, Russell Hogg, Paul R. Harnett, and Anna DeFazio, University of Sydney; Tania Moujaber, Catherine J. Kennedy, Yoke-Eng Chiew, Rosemary L. Balleine, Catherine Saunders, Gerard V. Wain, Bo Gao, Paul R. Harnett, and Anna
| | - Sean M. Grimmond
- Tania Moujaber, Catherine J. Kennedy, Yoke-Eng Chiew, Rosemary L. Balleine, Bo Gao, Sivatharsny Srirangan, Casina Kan, Paul R. Harnett, and Anna deFazio, Westmead Institute for Medical Research; Tania Moujaber, Catherine J. Kennedy, Yoke-Eng Chiew, Rosemary L. Balleine, Catherine Saunders, Russell Hogg, Paul R. Harnett, and Anna DeFazio, University of Sydney; Tania Moujaber, Catherine J. Kennedy, Yoke-Eng Chiew, Rosemary L. Balleine, Catherine Saunders, Gerard V. Wain, Bo Gao, Paul R. Harnett, and Anna
| | - Alexander Dobrovic
- Tania Moujaber, Catherine J. Kennedy, Yoke-Eng Chiew, Rosemary L. Balleine, Bo Gao, Sivatharsny Srirangan, Casina Kan, Paul R. Harnett, and Anna deFazio, Westmead Institute for Medical Research; Tania Moujaber, Catherine J. Kennedy, Yoke-Eng Chiew, Rosemary L. Balleine, Catherine Saunders, Russell Hogg, Paul R. Harnett, and Anna DeFazio, University of Sydney; Tania Moujaber, Catherine J. Kennedy, Yoke-Eng Chiew, Rosemary L. Balleine, Catherine Saunders, Gerard V. Wain, Bo Gao, Paul R. Harnett, and Anna
| | - David D.L. Bowtell
- Tania Moujaber, Catherine J. Kennedy, Yoke-Eng Chiew, Rosemary L. Balleine, Bo Gao, Sivatharsny Srirangan, Casina Kan, Paul R. Harnett, and Anna deFazio, Westmead Institute for Medical Research; Tania Moujaber, Catherine J. Kennedy, Yoke-Eng Chiew, Rosemary L. Balleine, Catherine Saunders, Russell Hogg, Paul R. Harnett, and Anna DeFazio, University of Sydney; Tania Moujaber, Catherine J. Kennedy, Yoke-Eng Chiew, Rosemary L. Balleine, Catherine Saunders, Gerard V. Wain, Bo Gao, Paul R. Harnett, and Anna
| | - Paul R. Harnett
- Tania Moujaber, Catherine J. Kennedy, Yoke-Eng Chiew, Rosemary L. Balleine, Bo Gao, Sivatharsny Srirangan, Casina Kan, Paul R. Harnett, and Anna deFazio, Westmead Institute for Medical Research; Tania Moujaber, Catherine J. Kennedy, Yoke-Eng Chiew, Rosemary L. Balleine, Catherine Saunders, Russell Hogg, Paul R. Harnett, and Anna DeFazio, University of Sydney; Tania Moujaber, Catherine J. Kennedy, Yoke-Eng Chiew, Rosemary L. Balleine, Catherine Saunders, Gerard V. Wain, Bo Gao, Paul R. Harnett, and Anna
| | - Anna deFazio
- Tania Moujaber, Catherine J. Kennedy, Yoke-Eng Chiew, Rosemary L. Balleine, Bo Gao, Sivatharsny Srirangan, Casina Kan, Paul R. Harnett, and Anna deFazio, Westmead Institute for Medical Research; Tania Moujaber, Catherine J. Kennedy, Yoke-Eng Chiew, Rosemary L. Balleine, Catherine Saunders, Russell Hogg, Paul R. Harnett, and Anna DeFazio, University of Sydney; Tania Moujaber, Catherine J. Kennedy, Yoke-Eng Chiew, Rosemary L. Balleine, Catherine Saunders, Gerard V. Wain, Bo Gao, Paul R. Harnett, and Anna
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