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DOCETAXEL ANHYDROUS INJECTION, SOLUTION (docetaxel injection, USP) Clinical Studies

14 CLINICAL STUDIES

14.1 Locally Advanced or Metastatic Breast Cancer

The efficacy and safety of docetaxel have been evaluated in locally advanced or metastatic breast cancer after failure of previous chemotherapy (alkylating agent-containing regimens or anthracycline-containing regimens).

Randomized Trials

In one randomized trial, patients with a history of prior treatment with an anthracycline-containing regimen were assigned to treatment with docetaxel (100 mg/m2 every 3 weeks) or the combination of mitomycin (12 mg/m2 every 6 weeks) and vinblastine (6 mg/m2 every 3 weeks). Two hundred three patients were randomized to docetaxel and 189 to the comparator arm. Most patients had received prior chemotherapy for metastatic disease; only 27 patients on the docetaxel arm and 33 patients on the comparator arm entered the study following relapse after adjuvant therapy. Three-quarters of patients had measurable, visceral metastases. The primary endpoint was time to progression. The following table summarizes the study results (see Table 12).

Table 12: Efficacy of Docetaxel in the Treatment of Breast Cancer Patients Previously Treated with an Anthracycline-Containing Regimen (Intent-to-Treat Analysis)
Efficacy Parameter Docetaxel
(n=203)
Mitomycin/Vinblastine
(n=189)
p-value
*
For the risk ratio, a value less than 1.00 favors docetaxel.
Median Survival 11.4 months 8.7 months p=0.01
Log Rank
Risk Ratio*, Mortality
(Docetaxel: Control)
0.73
95% CI (Risk Ratio) 0.58–0.93
Median Time to Progression 4.3 months 2.5 months p=0.01
Log Rank
Risk Ratio*, Progression
(Docetaxel: Control)
0.75
95% CI (Risk Ratio) 0.61–0.94
Overall Response Rate 28.1% 9.5% p<0.0001
Complete Response Rate 3.4% 1.6% Chi Square

In a second randomized trial, patients previously treated with an alkylating-containing regimen were assigned to treatment with docetaxel (100 mg/m2) or doxorubicin (75 mg/m2) every 3 weeks. One hundred sixty-one patients were randomized to docetaxel and 165 patients to doxorubicin. Approximately one-half of patients had received prior chemotherapy for metastatic disease, and one-half entered the study following relapse after adjuvant therapy. Three-quarters of patients had measurable, visceral metastases. The primary endpoint was time to progression. The study results are summarized below (see Table 13).

Table 13: Efficacy of Docetaxel in the Treatment of Breast Cancer Patients Previously Treated with an Alkylating-Containing Regimen (Intent-to-Treat Analysis)
Efficacy Parameter Docetaxel
(n=161)
Doxorubicin
(n=165)
p-value
*
For the risk ratio, a value less than 1.00 favors docetaxel.
Median Survival 14.7 months 14.3 months p=0.39
Log Rank
Risk Ratio*, Mortality
(Docetaxel: Control)
0.89
95% CI (Risk Ratio) 0.68–1.16
Median Time to Progression 6.5 months 5.3 months p=0.45
Log Rank
Risk Ratio*, Progression
(Docetaxel: Control)
0.93
95% CI (Risk Ratio) 0.71–1.16
Overall Response Rate 45.3% 29.7% p=0.004
Complete Response Rate 6.8% 4.2% Chi Square

In another multicenter open-label, randomized trial (TAX313), in the treatment of patients with advanced breast cancer who progressed or relapsed after one prior chemotherapy regimen, 527 patients were randomized to receive docetaxel monotherapy 60 mg/m2 (n=151), 75 mg/m2 (n=188) or 100 mg/m2 (n=188). In this trial, 94% of patients had metastatic disease and 79% had received prior anthracycline therapy. Response rate was the primary endpoint. Response rates increased with docetaxel dose: 19.9% for the 60 mg/m2 group compared to 22.3% for the 75 mg/m2 and 29.8% for the 100 mg/m2 group; pair-wise comparison between the 60 mg/m2 and 100 mg/m2 groups was statistically significant (p=0.037).

Single Arm Studies

Docetaxel at a dose of 100 mg/m2 was studied in six single arm studies involving a total of 309 patients with metastatic breast cancer in whom previous chemotherapy had failed. Among these, 190 patients had anthracycline-resistant breast cancer, defined as progression during an anthracycline-containing chemotherapy regimen for metastatic disease, or relapse during an anthracycline-containing adjuvant regimen. In anthracycline-resistant patients, the overall response rate was 37.9% (72/190; 95% CI: 31.0–44.8) and the complete response rate was 2.1%.

Docetaxel was also studied in three single arm Japanese studies at a dose of 60 mg/m2, in 174 patients who had received prior chemotherapy for locally advanced or metastatic breast cancer. Among 26 patients whose best response to an anthracycline had been progression, the response rate was 34.6% (95% CI: 17.2–55.7), similar to the response rate in single arm studies of 100 mg/m2.

14.2 Adjuvant Treatment of Breast Cancer

A multicenter, open-label, randomized trial (TAX316) evaluated the efficacy and safety of docetaxel for the adjuvant treatment of patients with axillary-node-positive breast cancer and no evidence of distant metastatic disease. After stratification according to the number of positive lymph nodes (1–3, 4+), 1491 patients were randomized to receive either docetaxel 75 mg/m2 administered 1-hour after doxorubicin 50 mg/m2 and cyclophosphamide 500 mg/m2 (TAC arm), or doxorubicin 50 mg/m2 followed by fluorouracil 500 mg/m2 and cyclophosphamide 500 mg/m2 (FAC arm). Both regimens were administered every 3 weeks for 6 cycles. Docetaxel was administered as a 1-hour infusion; all other drugs were given as intravenous bolus on day 1. In both arms, after the last cycle of chemotherapy, patients with positive estrogen and/or progesterone receptors received tamoxifen 20 mg daily for up to 5 years. Adjuvant radiation therapy was prescribed according to guidelines in place at participating institutions and was given to 69% of patients who received TAC and 72% of patients who received FAC.

Results from a second interim analysis (median follow-up 55 months) are as follows: In study TAX316, the docetaxel-containing combination regimen TAC showed significantly longer disease-free survival (DFS) than FAC (hazard ratio=0.74; 2-sided 95% CI=0.60, 0.92, stratified log rank p=0.0047). The primary endpoint, disease-free survival, included local and distant recurrences, contralateral breast cancer and deaths from any cause. The overall reduction in risk of relapse was 25.7% for TAC-treated patients (see Figure 1).

At the time of this interim analysis, based on 219 deaths, overall survival was longer for TAC than FAC (hazard ratio=0.69, 2-sided 95% CI=0.53, 0.90) (see Figure 2). There will be further analysis at the time survival data mature.

Figure 1
Figure 2

The following table describes the results of subgroup analyses for DFS and OS (see Table 14).

Table 14: Subset Analyses-Adjuvant Breast Cancer Study
Disease Free Survival Overall Survival
Patient subset Number of patients Hazard ratio* 95% CI Hazard ratio* 95% CI
*
A hazard ratio of less than 1 indicates that TAC is associated with a longer disease free survival or overall survival compared to FAC.
No. of positive nodes
Overall 744 0.74 (0.60, 0.92) 0.69 (0.53, 0.90)
1–3 467 0.64 (0.47, 0.87) 0.45 (0.29, 0.70)
4+ 277 0.84 (0.63, 1.12) 0.93 (0.66, 1.32)
Receptor status
Positive 566 0.76 (0.59, 0.98) 0.69 (0.48, 0.99)
Negative 178 0.68 (0.48, 0.97) 0.66 (0.44, 0.98)

14.3 Non-small Cell Lung Cancer (NSCLC)

The efficacy and safety of docetaxel has been evaluated in patients with unresectable, locally advanced or metastatic non-small cell lung cancer whose disease has failed prior platinum-based chemotherapy or in patients who are chemotherapy-naïve.

Monotherapy with Docetaxel for NSCLC Previously Treated with Platinum-Based Chemotherapy

Two randomized, controlled trials established that a docetaxel dose of 75 mg/m2 was tolerable and yielded a favorable outcome in patients previously treated with platinum-based chemotherapy (see below). Docetaxel at a dose of 100 mg/m2, however, was associated with unacceptable hematologic toxicity, infections, and treatment-related mortality and this dose should not be used [see Boxed Warning, Dosage and Administration (2.7), Warnings and Precautions (5.3)].

One trial (TAX317), randomized patients with locally advanced or metastatic non-small cell lung cancer, a history of prior platinum-based chemotherapy, no history of taxane exposure, and an ECOG performance status ≤2 to docetaxel or best supportive care. The primary endpoint of the study was survival. Patients were initially randomized to docetaxel 100 mg/m2 or best supportive care, but early toxic deaths at this dose led to a dose reduction to docetaxel 75 mg/m2. A total of 104 patients were randomized in this amended study to either docetaxel 75 mg/m2 or best supportive care.

In a second randomized trial (TAX320), 373 patients with locally advanced or metastatic non-small cell lung cancer, a history of prior platinum-based chemotherapy, and an ECOG performance status ≤2 were randomized to docetaxel 75 mg/m2, docetaxel 100 mg/m2 and a treatment in which the investigator chose either vinorelbine 30 mg/m2 days 1, 8, and 15 repeated every 3 weeks or ifosfamide 2 g/m2 days 1–3 repeated every 3 weeks. Forty percent of the patients in this study had a history of prior paclitaxel exposure. The primary endpoint was survival in both trials. The efficacy data for the docetaxel 75 mg/m2 arm and the comparator arms are summarized in Table 15 and Figures 3 and 4 showing the survival curves for the two studies.

Table 15: Efficacy of Docetaxel in the Treatment of Non-small Cell Lung Cancer Patients Previously Treated with a Platinum-Based Chemotherapy Regimen (Intent-to-Treat Analysis)
TAX317 TAX320
Docetaxel
75 mg/m2
n=55
Best Supportive Care
n=49
Docetaxel
75 mg/m2
n=125
Control (V/I*)
n=123
*
Vinorelbine/Ifosfamide
a value less than 1.00 favors docetaxel
p≤0.05
§
uncorrected for multiple comparisons
Overall Survival Log-rank Test p=0.01 p=0.13
Risk Ratio, Mortality
(Docetaxel: Control)
95% CI (Risk Ratio)
0.56
(0.35, 0.88)
0.82
(0.63, 1.06)
Median Survival
95% CI
7.5 months
(5.5, 12.8)
4.6 months
(3.7, 6.1)
5.7 months
(5.1, 7.1)
5.6 months
(4.4, 7.9)
% 1-year Survival
95% CI
37%§
(24, 50)
12%
(2, 23)
30%§
(22, 39)
20%
(13, 27)
Time to Progression
95% CI
12.3 weeks
(9.0, 18.3)
7.0 weeks
(6.0, 9.3)
8.3 weeks
(7.0, 11.7)
7.6 weeks
(6.7, 10.1)
Response Rate
95% CI
5.5%
(1.1, 15.1)
Not Applicable 5.7%
(2.3, 11.3)
0.8%
(0.0, 4.5)

Only one of the two trials (TAX317) showed a clear effect on survival, the primary endpoint; that trial also showed an increased rate of survival to one year. In the second study (TAX320) the rate of survival at one year favored docetaxel 75 mg/m2.

Figure 3
Figure 4

Patients treated with docetaxel at a dose of 75 mg/m2 experienced no deterioration in performance status and body weight relative to the comparator arms used in these trials.

Combination Therapy with Docetaxel for Chemotherapy-Naïve NSCLC

In a randomized controlled trial (TAX326), 1218 patients with unresectable stage IIIB or IV NSCLC and no prior chemotherapy were randomized to receive one of three treatments: docetaxel 75 mg/m2 as a 1 hour infusion immediately followed by cisplatin 75 mg/m2 over 30 to 60 minutes every 3 weeks; vinorelbine 25 mg/m2 administered over 6 - 10 minutes on days 1, 8, 15, 22 followed by cisplatin 100 mg/m2 administered on day 1 of cycles repeated every 4 weeks; or a combination of docetaxel and carboplatin.

The primary efficacy endpoint was overall survival. Treatment with docetaxel+cisplatin did not result in a statistically significantly superior survival compared to vinorelbine+cisplatin (see table below). The 95% confidence interval of the hazard ratio (adjusted for interim analysis and multiple comparisons) shows that the addition of docetaxel to cisplatin results in an outcome ranging from a 6% inferior to a 26% superior survival compared to the addition of vinorelbine to cisplatin. The results of a further statistical analysis showed that at least (the lower bound of the 95% confidence interval) 62% of the known survival effect of vinorelbine when added to cisplatin (about a 2-month increase in median survival; Wozniak et al. JCO, 1998) was maintained. The efficacy data for the docetaxel+cisplatin arm and the comparator arm are summarized in Table 16.

Table 16: Survival Analysis of Docetaxel in Combination Therapy for Chemotherapy-Naïve NSCLC
Comparison Docetaxel + Cisplatin n=408 Vinorelbine + Cisplatin n=405
*
From the superiority test (stratified log rank) comparing docetaxel+cisplatin to vinorelbine+cisplatin
Hazard ratio of docetaxel+cisplatin versus vinorelbine+cisplatin. A hazard ratio of less than 1 indicates that docetaxel+cisplatin is associated with a longer survival.
Adjusted for interim analysis and multiple comparisons.
Kaplan-Meier Estimate of Median Survival 10.9 months 10.0 months
p-value* 0.122
Estimated Hazard Ratio 0.88
Adjusted 95% CI (0.74, 1.06)

The second comparison in the same three-arm study, vinorelbine+cisplatin versus docetaxel+carboplatin, did not demonstrate superior survival associated with the docetaxel arm (Kaplan-Meier estimate of median survival was 9.1 months for docetaxel+carboplatin compared to 10.0 months on the vinorelbine+cisplatin arm) and the docetaxel+carboplatin arm did not demonstrate preservation of at least 50% of the survival effect of vinorelbine added to cisplatin. Secondary endpoints evaluated in the trial included objective response and time to progression. There was no statistically significant difference between docetaxel+cisplatin and vinorelbine+cisplatin with respect to objective response and time to progression (see Table 17).

Table 17: Response and TTP Analysis of Docetaxel in Combination Therapy for Chemotherapy-Naïve NSCLC
Endpoint Docetaxel + Cisplatin Vinorelbine + Cisplatin p-value
*
Adjusted for multiple comparisons.
Kaplan-Meier estimates.
Objective Response Rate
(95% CI)*
31.6%
(26.5%, 36.8%)
24.4%
(19.8%, 29.2%)
Not Significant
Median Time to Progression
(95% CI)*
21.4 weeks
(19.3, 24.6)
22.1 weeks
(18.1, 25.6)
Not Significant

14.4 Castration-Resistant Prostate Cancer

The safety and efficacy of docetaxel in combination with prednisone in patients with metastatic castration-resistant prostate cancer were evaluated in a randomized multicenter active control trial. A total of 1006 patients with Karnofsky Performance Status (KPS) ≥60 were randomized to the following treatment groups:

  • Docetaxel 75 mg/m2 every 3 weeks for 10 cycles.
  • Docetaxel 30 mg/m2 administered weekly for the first 5 weeks in a 6-week cycle for 5 cycles.
  • Mitoxantrone 12 mg/m2 every 3 weeks for 10 cycles.

All 3 regimens were administered in combination with prednisone 5 mg twice daily, continuously.

In the docetaxel every three week arm, a statistically significant overall survival advantage was demonstrated compared to mitoxantrone. In the docetaxel weekly arm, no overall survival advantage was demonstrated compared to the mitoxantrone control arm. Efficacy results for the docetaxel every 3 week arm versus the control arm are summarized in Table 18 and Figure 5.

Table 18: Efficacy of Docetaxel in the Treatment of Patients with Metastatic Castration-Resistant Prostate Cancer (Intent-to-Treat Analysis)
Docetaxel + Prednisone
every 3 weeks
Mitoxantrone + Prednisone
every 3 weeks
*
Stratified log-rank test. Threshold for statistical significance = 0.0175 because of 3 arms.
Number of patients 335 337
Median survival (months) 18.9 16.5
95% CI (17.0–21.2) (14.4–18.6)
Hazard ratio 0.761
95% CI (0.619–0.936)
p-value* 0.0094
Figure 5

14.5 Gastric Adenocarcinoma

A multicenter, open-label, randomized trial was conducted to evaluate the safety and efficacy of Docetaxel Injection for the treatment of patients with advanced gastric adenocarcinoma, including adenocarcinoma of the gastroesophageal junction, who had not received prior chemotherapy for advanced disease. A total of 445 patients with KPS >70 were treated with either Docetaxel Injection (T) (75 mg/m2 on day 1) in combination with cisplatin (C) (75 mg/m2 on day 1) and fluorouracil (F) (750 mg/m2 per day for 5 days) or cisplatin (100 mg/m2 on day 1) and fluorouracil (1000 mg/m2 per day for 5 days). The length of a treatment cycle was 3 weeks for the TCF arm and 4 weeks for the CF arm. The demographic characteristics were balanced between the two treatment arms. The median age was 55 years, 71% were male, 71% were Caucasian, 24% were 65 years of age or older, 19% had a prior curative surgery and 12% had palliative surgery. The median number of cycles administered per patient was 6 (with a range of 1–16) for the TCF arm compared to 4 (with a range of 1–12) for the CF arm. Time to progression (TTP) was the primary endpoint and was defined as time from randomization to disease progression or death from any cause within 12 weeks of the last evaluable tumor assessment or within 12 weeks of the first infusion of study drugs for patients with no evaluable tumor assessment after randomization. The hazard ratio (HR) for TTP was 1.47 (CF/TCF, 95% CI: 1.19–1.83) with a significantly longer TTP (p=0.0004) in the TCF arm. Approximately 75% of patients had died at the time of this analysis. Overall survival was significantly longer (p=0.0201) in the TCF arm with a HR of 1.29 (95% CI: 1.04–1.61). Efficacy results are summarized in Table 19 and Figures 6 and 7.

Table 19: Efficacy of Docetaxel Injection in the Treatment of Patients with Gastric Adenocarcinoma
Endpoint TCF
n=221
CF
n=224
Subgroup analyses were consistent with the overall results across age, gender and race.
*
For the hazard ratio (TCF/CF), values less than 1.00 favor the Docetaxel Injection arm.
Unstratified log-rank test
Median TTP (months) 5.6 3.7
(95% CI) (4.86–5.91) (3.45–4.47)
Hazard ratio* 0.68
(95% CI) (0.55–0.84)
p-value 0.0004
Median survival (months) 9.2 8.6
(95% CI) (8.38–10.58) (7.16–9.46)
Hazard ratio* 0.77
(95% CI) (0.62–0.96)
p-value 0.0201
Overall Response Rate (CR+PR) (%) 36.7 25.4
p-value 0.0106
Figure 6
Figure 7

14.6 Head and Neck Cancer

Induction Chemotherapy Followed by Radiotherapy (TAX323)

The safety and efficacy of Docetaxel Injection in the induction treatment of patients with squamous cell carcinoma of the head and neck (SCCHN) was evaluated in a multicenter, open-label, randomized trial (TAX323). In this study, 358 patients with inoperable locally advanced SCCHN, and WHO performance status 0 or 1, were randomized to one of two treatment arms. Patients on the Docetaxel Injection arm received Docetaxel Injection (T) 75 mg/m2 followed by cisplatin (P) 75 mg/m2 on Day 1, followed by fluorouracil (F) 750 mg/m2 per day as a continuous infusion on Days 1–5. The cycles were repeated every three weeks for 4 cycles. Patients whose disease did not progress received radiotherapy (RT) according to institutional guidelines (TPF/RT). Patients on the comparator arm received cisplatin (P) 100 mg/m2 on Day 1, followed by fluorouracil (F) 1000 mg/m2/day as a continuous infusion on Days 1–5. The cycles were repeated every three weeks for 4 cycles. Patients whose disease did not progress received RT according to institutional guidelines (PF/RT). At the end of chemotherapy, with a minimal interval of 4 weeks and a maximal interval of 7 weeks, patients whose disease did not progress received radiotherapy (RT) according to institutional guidelines. Locoregional therapy with radiation was delivered either with a conventional fraction regimen (1.8 Gy–2.0 Gy once a day, 5 days per week for a total dose of 66 to 70 Gy) or with an accelerated/hyperfractionated regimen (twice a day, with a minimum interfraction interval of 6 hours, 5 days per week, for a total dose of 70 to 74 Gy, respectively). Surgical resection was allowed following chemotherapy, before or after radiotherapy.

The primary endpoint in this study, progression-free survival (PFS), was significantly longer in the TPF arm compared to the PF arm, p=0.0077 (median PFS: 11.4 vs. 8.3 months, respectively) with an overall median follow-up time of 33.7 months. Median overall survival with a median follow-up of 51.2 months was also significantly longer in favor of the TPF arm compared to the PF arm (median OS: 18.6 vs. 14.2 months, respectively). Efficacy results are presented in Table 20 and Figures 8 and 9.

Table 20: Efficacy of Docetaxel Injection in the Induction Treatment of Patients with Inoperable Locally Advanced SCCHN (Intent-to-Treat Analysis)
Endpoint Docetaxel Injection + Cisplatin + Fluorouracil
n=177
Cisplatin + Fluorouracil
n=181
A hazard ratio of less than 1 favors Docetaxel Injection+cisplatin+fluorouracil
*
Stratified log-rank test based on primary tumor site
Stratified log-rank test, not adjusted for multiple comparisons
Chi square test, not adjusted for multiple comparisons
Median progression free survival (months) 11.4 8.3
(95% CI) (10.1–14.0) (7.4–9.1)
Adjusted Hazard ratio 0.71
(95% CI) (0.56–0.91)
*p-value 0.0077
Median survival (months) 18.6 14.2
(95% CI) (15.7–24.0) (11.5–18.7)
Hazard ratio 0.71
(95% CI) (0.56–0.90)
p-value 0.0055
Best overall response (CR + PR) to chemotherapy (%)
(95% CI)
p-value
67.8
(60.4–74.6)
53.6
(46.0–61.0)
0.006
Best overall response (CR + PR) to study treatment [chemotherapy +/- radiotherapy] (%)
(95% CI)
p-value
72.3
(65.1–78.8)
58.6
(51.0–65.8)
0.006
Figure 8
Figure 9

Induction Chemotherapy Followed by Chemoradiotherapy (TAX324)

The safety and efficacy of Docetaxel Injection in the induction treatment of patients with locally advanced (unresectable, low surgical cure, or organ preservation) SCCHN was evaluated in a randomized, multicenter open-label trial (TAX324). In this study, 501 patients, with locally advanced SCCHN, and a WHO performance status of 0 or 1, were randomized to one of two treatment arms. Patients on the Docetaxel Injection arm received Docetaxel Injection (T) 75 mg/m2 by intravenous infusion on day 1 followed by cisplatin (P) 100 mg/m2 administered as a 30-minute to three-hour intravenous infusion, followed by the continuous intravenous infusion of fluorouracil (F) 1000 mg/m2/day from day 1 to day 4. The cycles were repeated every 3 weeks for 3 cycles. Patients on the comparator arm received cisplatin (P) 100 mg/m2 as a 30-minute to three-hour intravenous infusion on day 1 followed by the continuous intravenous infusion of fluorouracil (F) 1000 mg/m2/day from day 1 to day 5. The cycles were repeated every 3 weeks for 3 cycles.

All patients in both treatment arms who did not have progressive disease were to receive 7 weeks of chemoradiotherapy (CRT) following induction chemotherapy 3 to 8 weeks after the start of the last cycle. During radiotherapy, carboplatin (AUC 1.5) was given weekly as a one-hour intravenous infusion for a maximum of 7 doses. Radiation was delivered with megavoltage equipment using once daily fractionation (2 Gy per day, 5 days per week for 7 weeks for a total dose of 70–72 Gy). Surgery on the primary site of disease and/or neck could be considered at anytime following completion of CRT.

The primary efficacy endpoint, overall survival (OS), was significantly longer (log-rank test, p = 0.0058) with the Docetaxel Injection-containing regimen compared to PF [median OS: 70.6 versus 30.1 months respectively, hazard ratio (HR) = 0.70, 95% confidence interval (CI) = 0.54–0.90]. Overall survival results are presented in Table 21 and Figure 10.

Table 21: Efficacy of Docetaxel Injection in the Induction Treatment of Patients with Locally Advanced SCCHN (Intent-to-Treat Analysis)
Endpoint Docetaxel Injection + Cisplatin + Fluorouracil
n=255
Cisplatin + Fluorouracil
n=246
A hazard ratio of less than 1 favors Docetaxel Injection+cisplatin+fluorouracil
NE - not estimable
*
unadjusted log-rank test
Median overall survival (months)
(95% CI)
70.6
(49.0–NE)
30.1
(20.9–51.5)
Hazard ratio:
(95% CI)
*p-value
0.70
(0.54–0.90)
0.0058
Figure 10

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