ClinicalTrials.gg
Not yet recruitingNCT07756840Updated Nov 10, 2026

Combination Bevacizumab and PRGN-2012 in Adults With Recurrent Respiratory Papillomatosis (RRP)

A Phase 2 interventional study of PRGN-2012 and Bevacizumab in Respiratory Recurrent Papillomatosis (RRP), Human Papillomavirus (HPV) and Papillomavirus Infection, sponsored by National Cancer Institute (NCI). Not yet recruiting at 1 site in United States. Open to participants aged 18 Years to 120 Years. Per ClinicalTrials.gov, last updated 2026-11-10.

Sponsored by National Cancer Institute (NCI) · Phase 2, Interventional, and Treatment

Updated Nov 10, 2026Start date movedGo to Updates ↓
Phase
Phase 2
Study type
Interventional
Enrollment
50
Allocation
Not applicable
Ages
18 Years to 120 Years
Sex
All
01

Study summary

Background:

Recurrent respiratory papillomatosis (RRP) is a rare disease that causes wart-like growths called papillomas to grow in the airway, most often in the voice box, windpipe, or lungs. These growths can make it hard to speak or breathe. Surgery can remove the papillomas, but they often come back. In some cases, they can become cancerous.

Objective:

This study istesting whether two treatments used together (PRGN-2012, a vaccine-based treatment and bevacizumab, a drug that affects blood vessel growth) can help control RRP and reduce the chance that papillomas will grow back.

Eligibility:

Adults aged 18 years and older may be able to join the study if they have RRP and meet certain treatment history requirements. This may include people who have previously received PRGN-2012 or bevacizumab, or people who have needed more than 2 surgeries to remove papillomas.

Design:

Before starting treatment, participants will have screening tests to make sure the study is safe for them. These tests may include a physical exam with blood and urine tests, heart function testing, imaging scans, and an endoscopy. During an endoscopy, a thin, flexible tube with a small camera will look at the inside of the nose, throat, voice box, and upper windpipe.

Participants will receive study treatment during 7 clinic visits over about 6 months. Bevacizumab is given through a vein amd PRGEN-2012 is given as an injection under the skin of the arm or leg. Participants may receive 1 or both drugs at each visit.

After completing treatmen, participants will return for 4 follow-up visits over 1 year. These visits may include repeat imaging, blood and urine tests, and other exams. After that, the study team will contact participantsby phone or email every 3 months for 2 years.

If their RRP gets worse during the follow-up period, they may be able to receive a second course of treatment using the same schedule....

Read the detailed description

Background:

  • Recurrent respiratory papillomatosis (RRP) is a rare papillomatous disease of the respiratory tract caused by Human Papilloma Virus (HPV) types 6 or 11.
  • RRP can progress to cause severe voice disturbance, airway compromise, fatal pulmonary lesions, and, rarely, invasive cancers.
  • Our group conducted the pivotal phase 1/2 clinical study of PRGN-2012 (NCT04724980), a gorilla adenovirus vector-based gene therapy capable of eliciting HPV6/11-specific T cell immunity.
  • The study was found to be positive, and a Biologics License Application (BLA) submission for this agent was accepted by the US Food and Drug Administration (FDA). On August 15th, 2025, the FDA granted full approval of PRGN-2012, making it the first FDA-approved medical therapy for adult patients with RRP. Unfortunately, 50% of study participants did not achieve a complete response in the pivotal study, indicating that additional research into therapeutic strategies is still needed.
  • We are currently conducting a phase 2 clinical trial of bevacizumab (NCT00803062) to assess the safety and clinical benefit of this agent in adults with RRP.
  • Bevacizumab has demonstrated an acceptable safety profile with consistent and rapid clinical benefit by significantly reducing papillomatous disease burden and eliminating the need for clinical interventions in 20 consecutively treated patients. Unfortunately, disease regrowth occurs following cessation of bevacizumab therapy, and prolonged treatment can lead to systemic toxicity.
  • Community physicians will soon be using both PRGN-2012 and systemic bevacizumab in clinical practice, but the combined safety and appropriate sequencing of these agents has yet to be studied.

Objective:

-To determine the complete response rate, defined as the percentage of participants who do not require an intervention (either medical or surgical) in the 12 months following completion of treatment with combination systemic bevacizumab and PRGN-2012

Eligibility:

  • Histologically or cytologically confirmed diagnosis of RRP
  • Age >= 18 years old
  • A history of 2 or more surgeries or use of IV bevacizumab in the last 12 months to control laryngeal and/or tracheal RRP
  • Previous treatment with PRGN-2012 (zopapogene imadenovec [Papzimeos])

Design:

  • This is phase II, single-arm clinical trial evaluating the combination of systemic bevacizumab and PRGN-2012.
  • All participants will receive monotherapy with bevacizumab alone for every 3 weeks for 3 doses followed by bevacizumab in combination with PRGN-2012 (2 doses) and PRGN- 2012 alone (2 doses).
  • Participants will be assessed for papilloma recurrence at 6, 12, 24, 52 weeks, and every 3 months for an additional 2 years following completion of treatment (total follow-up of 3 years).
  • A total of 21 evaluable participants will be treated in the study.
02

Conditions studied

  • Respiratory Recurrent Papillomatosis (RRP)
  • Human Papillomavirus (HPV)
  • Papillomavirus Infection
  • Laryngeal Diseases
  • Tracheal Diseases
  • Respiratory Tract Neoplasm

Keywords

  • HPV Vaccine
  • Gardasil
  • Papzimeos (zopapogene imadenovec-drba)
  • Bevacizumab (Avastin)
03

In context

Recurrent respiratory papillomatosis

31 studies on the registry are indexed under Recurrent respiratory papillomatosis; 9 are open to participants now.

This study's planned enrollment of 50 is above the median of 24 across 22 interventional studies indexed under Recurrent respiratory papillomatosis.

Browse Recurrent respiratory papillomatosis studies →

Lead sponsor

National Cancer Institute (NCI) is the lead sponsor of 3,556 studies on the registry; 336 are open to participants now.

Of its 411 completed or terminated interventional studies of FDA-regulated products, 373 (91%) have results posted.

Counted across the registry records on this site, refreshed daily.

04

Who can participate

Ages eligible
18 Years to 120 Years
Sexes eligible
All
Accepts healthy volunteers
No

Go through the criteria one by one — yes, no or not sure — and take the list to your doctor or the study team. Kept in this browser only.

Inclusion criteria

  • Histological or cytological diagnosis of RRP confirmed by pathology report. Note: If there is no documentation or , a biopsy will be done to confirm the diagnosis.
  • Age >= 18 years old.
  • A history of 2 or more surgeries or use of IV bevacizumab in order to control laryngeal and/or tracheal RRP within 12 months prior to the study treatment initiation.
  • Previous treatment with PRGN-2012 (zopapogene imadenovec [Papzimeos]).
  • (ECOG) performance status of 0-1.
  • Participants must have an adequate organ and marrow function as defined below:

    • White blood cells (WBC) >2,000/mcL
    • (ANC) >= 1,000/mcL
    • > 9.0 g/dL
    • >= 100,000/mcL
    • Total \<= 1.5 mg/dL. Note: participants with Gilbert s Syndrome must have a total bilirubin \< 3.0 mg/dL
    • (AST) \<= 2.5 X institutional (ULN)
    • Alanine aminotransferase (ALT) \<=2.5 X institutional ULN
    • Creatinine within normal institutional limits OR (CrCl) >= 60 mL/min/1.73 m\^2 for participants with creatinine levels above institutional normal (calculated using the Cockcroft-Gault formula).
    • (PT) / International normalized ratio (INR) and Partial thromboplastin time (PTT) \<= 1 X institutional ULN. In participants on anticoagulation, coagulation tests should be within a therapeutic range.
    • Urinalysis Urine dipstick \< 2+ proteinuria. Participants with >= 2+ proteinuria on dipstick urinalysis should undergo a 24- hour urine collection and must demonstrate \<= 1g of protein in 24 hours to be eligible
  • Women of (WOCBP) must agree to use a highly effective method of (hormonal, intrauterine device (IUD), surgical sterilization, abstinence) for the duration of treatment and up to 6 months after completion of the study treatment.

Men must agree to use an effective method of contraception (barrier, surgical sterilization, abstinence) for the duration of treatment and up to 4 months after the last dose of study drugs. We also recommend men with partners of childbearing potential ask their partners to be on highly effective birth control (hormonal, IUD, surgical sterilization). Men must not freeze or donate sperm within the same period.

  • Women who are breastfeeding or plan to breastfeed must agree to discontinue breastfeeding from study treatment initiation.
  • Ability of participant to understand and sign a written document.

Exclusion criteria

EXCLUSION CRITERIA:

  • History of significant cardiovascular disease or thromboembolic event: cerebral vascular accident/stroke, myocardial infarction, unstable angina, congestive heart failure (>= Classification Class II) occurring within 12 months prior to the study treatment initiation
  • Serious cardiac arrhythmia requiring medication as assessed by (EKG) at screening.
  • Any agents within 4 weeks prior to the study treatment initiation.
  • Systemic medical RRP therapy within 4 weeks or 3 half-lives, whichever is longer prior to the study treatment initiation.
  • Participants with a condition requiring systemic treatment with either (> 10 mg daily prednisone equivalents) or other medications within 14 days prior to the study treatment initiation. Note: Inhaled, topical intranasal or intraocular steroids, and adrenal replacement doses \<10 mg daily prednisone equivalents are permitted in the absence of active disease.
  • History of abdominal fistula or gastrointestinal perforation within 12 months prior to the study treatment initiation.
  • Major surgery within 4 weeks prior to the study treatment initiation. Note: The surgery is considered major if a mesenchymal barrier is opened (pleural cavity, peritoneum, meninges).
  • Non-healing wounds, active ulcer, or untreated bone fracture.
  • History of hemoptysis (>2.5 mL of bright red blood per episode) within 1 month prior to the study treatment initiation.
  • History of serious hemorrhage ( Grade 4) within 12 months prior to the study treatment initiation.
  • Evidence of bleeding diathesis or significant coagulopathy (with or without current therapeutic anticoagulation).
  • Significant vascular disease (e.g., aortic aneurysm requiring surgical repair or recent peripheral arterial thrombosis) within 6 months prior to the study treatment initiation.
  • Inadequately controlled hypertension (defined as systolic blood pressure (BP) >150 mmHg and/or diastolic blood pressure > 100 mmHg). Note: an average of 3 BP readings on 2 sessions will be used to measure blood pressure if the initial reading indicates inadequately controlled hypertension. Anti-hypertensive therapy to achieve blood pressures below these parameters is allowed.
  • Prior history of hypertensive crisis or hypertensive encephalopathy.
  • Persisting toxicity related to prior therapy of Grade >1 per CTCAE. Note: Alopecia, sensory neuropathy Grade \<= 2 are acceptable.
  • Known, active alcohol or drug abuse.
  • History of allergy to study drug components.
  • History of >= Grade 3 per CTCAE infusion-related reaction to bevacizumab or PRGN-2012.
  • Pregnancy confirmed with beta-human chorionic gonadotropin (beta-HCG) serum or urine pregnancy test in at screening.
  • Uncontrolled symptomatic, intercurrent illness evaluated by medical history, physical exam, and labs, or social situations that would unacceptably increase risk for the participant or impair the ability to evaluate the endpoints of the study, or that would limit compliance with study requirements.
Terms in these criteria, in plain language(20)

Underlined terms in the criteria open these too. Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.

Biopsy and archival tissue

A biopsy takes a small piece of tissue to examine. “Archival tissue” is a sample already taken, for example at diagnosis, and kept by the hospital.

Whether a stored sample will do depends on when it was taken, how much there is and what the study needs. Ask whether the study accepts your stored sample or needs a new biopsy.

ECOG performance status

A scale of how much an illness limits everyday activity. For people being assessed to join a study, scores run from 0 (fully active) to 4; lower is more active.

0
Fully active, no restrictions.
1
Limited in strenuous activity, but walking and able to do light work, such as housework or office work.
2
Walking and able to look after yourself, but unable to work; up and about more than half of waking hours.
3
Able to look after yourself only in part; in bed or a chair more than half of waking hours.
4
Unable to look after yourself at all; in bed or a chair all day.

Studies most often ask for 0–1 or 0–2. Your doctor gives the score; the WHO scale uses the same steps. The full scale also has 5, which records death.

Absolute neutrophil count (ANC)

The number of neutrophils, white blood cells that help fight infection, in a given amount of blood. Too few raises the risk of infection.

It is a count, not a percentage of the white cells. Limits are written in units that mean the same: ≥ 1.5 × 10⁹/L is ≥ 1,500 per mm³ (µL). Each lab has its own reference range.

Hemoglobin (Hb)

The protein in red blood cells that carries oxygen. A low level is anaemia, which can cause tiredness and breathlessness. Measured in g/dL or g/L (9 g/dL is 90 g/L).

Platelets

Blood cells that help blood clot. Too few raises the risk of bleeding and bruising. A usual adult range is about 150–400 × 10⁹/L (150,000–400,000 per µL); each lab has its own reference range.

Bilirubin

A yellow substance made when red blood cells are broken down, which the liver clears. A high level can mean a problem with the liver or the bile ducts.

Criteria often allow more for people with Gilbert’s syndrome, a harmless inherited condition that raises bilirubin.

ALT and AST (liver enzymes)

Two enzymes measured in a routine blood test of the liver. Higher levels can mean the liver is under strain or damaged. SGPT and SGOT are older names for ALT and AST.

Criteria usually give a limit as a multiple of the upper limit of normal (ULN), often higher when cancer has spread to the liver.

ULN (upper limit of normal)

The top of the normal range for a blood test, as set by the laboratory that runs it. Each lab prints its own range next to your result.

“≤ 2.5 × ULN” means the result can be up to two and a half times that top value.

Creatinine clearance (CrCl)

How quickly the kidneys clear creatinine, a waste product, from the blood. A study may estimate it from a blood test with age, weight and sex (often by the Cockcroft–Gault formula), or measure it using blood and urine collected over a set time. Given in mL/min; higher is better.

INR, PT and aPTT (clotting tests)

Blood tests of how long blood takes to clot. The INR is the prothrombin time (PT) put on a common scale; about 1 is usual for someone not taking a blood thinner.

Criteria often make an exception for people on a blood thinner such as warfarin, whose INR is raised on purpose.

Childbearing potential

Able to become pregnant: from the first period until menopause, unless permanently unable to through surgery (removal of the womb, or of both ovaries or both fallopian tubes).

Criteria for people of childbearing potential usually ask for a negative pregnancy test and for contraception during the study and for a time after it.

Contraception

Ways of preventing pregnancy. “Highly effective” methods fail less than 1% of the time a year when used correctly — for example an IUD or an implant.

Criteria usually say which methods count and how long to keep using them after the last dose, sometimes for male participants too. Some studies accept a partner’s vasectomy if it was confirmed successful and that person is the participant’s only sexual partner.

Informed consent

Before you join, the study team explains what taking part involves — its purpose, what happens, the risks and possible benefits — and answers your questions, so you can decide freely. Consent is usually recorded on a form (the informed consent form, ICF) signed by you or, where the law allows, by someone legally authorised to decide for you.

You can keep asking questions during the study, you are told of new information that matters, and you can choose to leave at any time.

NYHA class (heart failure)

The New York Heart Association’s four classes of how much heart failure limits physical activity.

I
No limits: ordinary activity causes no undue tiredness or breathlessness.
II
Slight limits: comfortable at rest, ordinary activity causes symptoms.
III
Marked limits: comfortable at rest, less than ordinary activity causes symptoms.
IV
Symptoms even at rest; any activity makes them worse.

Studies set their own limit — many outside heart failure leave out class III–IV, while heart failure studies may ask for a particular class. Check the class this study names.

ECG (electrocardiogram)

A recording of the heart’s electrical activity, taken with stickers on the chest, arms and legs. It takes a few minutes and does not hurt.

Investigational drug or device

A drug or device being studied in a clinical trial.

It may be new, or already approved and being studied for another use, dose or form. Criteria often leave out people who took part in another study of one within a recent period, commonly 30 days or five half-lives.

Corticosteroids (steroids)

Anti-inflammatory medicines such as prednisone, prednisolone and dexamethasone — not the anabolic steroids used for muscle.

Studies differ in what they allow: check which steroid medicines, routes (tablets, injections, creams, inhalers, eye drops) and doses this study accepts.

Immunosuppression

A weakened immune system. It can come from an illness, such as HIV or some blood cancers, or from medicines that turn the immune system down, for example after an organ transplant or for an autoimmune disease; steroids at higher doses count.

Read whether the line is about a condition or about medicines, and which medicines and doses it means.

Autoimmune disease

A condition in which the immune system attacks the body’s own tissues, such as rheumatoid arthritis, lupus, psoriasis, type 1 diabetes or inflammatory bowel disease.

Immunotherapy studies often leave out active autoimmune disease, and some name exceptions, such as thyroid disease on replacement hormone. Check the exceptions this study lists.

CTCAE grade

The US National Cancer Institute’s scale of how severe an adverse event is — any unwanted medical event during a study, such as a symptom, an illness or an abnormal test result, whether or not a treatment caused it. Whether it did is judged separately.

1
Mild.
2
Moderate.
3
Severe.
4
Life-threatening.
5
Death due to the event.

“Side effects of earlier treatment resolved to grade 1 or less” means they have settled to mild or gone.

05

Study design

Phase
Phase 2
Primary purpose
Treatment
Allocation
Not applicable
Intervention model
Single group
Masking
None (open label)
Enrollment
50 participants (estimated)

Study arms

  • Experimental
    Arm 1

    Participants with RRP will be given Bevacizumab and PRGN-2012

    Drug: PRGN-2012 · Drug: Bevacizumab

Interventions

  • PRGN-2012 (5x10\^11 PU) will be administered on Days 85, 100, 128, and 170.

  • Administration of IV bevacizumab will be done on D1, D22, D43, D85, and D170 at a dose of 10 mg/kg during Course 1 (and Course 2 if applicable).

06

What researchers measure

Primary outcomes

  1. To determine the complete response rate, defined as the percentage of participants who do not require an intervention (either medical or surgical) in the 12 months following completion of treatment with combination systemic bevacizumab and PRGN-...

    Determined by measuring the number of participants (evaluable for clinical response) who do not require an intervention (either medical or surgical) in the 12 months following completion of treatment. This fraction of participants who are classified as having a complete response at 12 months will be reported along with 80% and 95% two-sided confidence intervals. For participants receiving re-treatment, any increase in their treatment-free interval following re-treatment will not be used for evaluation of the primary endpoint.

    Time frame: From baseline to 12 months after treatment

Secondary outcomes

  1. To determine the recurrence-free interval of laryngotracheal papillomatous disease after combination treatment

    The time to recurrence of papillomatous disease after completion of treatment will be recorded and reported descriptively.

    Time frame: Baseline through 3 years after treatment

  2. To determine the safety of the combination of bevacizumab and PRGN-2012

    AEs will be reported by type and grade.

    Time frame: Between the first dose of drug on D1 through 6 weeks, as well as on the 6-week safety follow-up visit. After 6-week safety follow-up visit, only adverse events that are serious and related to the study interventions

  3. To determine the treatment-free interval (either medical or surgical) after completion of treatment with combination systemic bevacizumab and PRGN-2012

    Reported descriptively by measuring the duration between completion of combination treatment and the time to the requirement of the first clinical intervention (either medical or surgical) following completion of protocol therapy.

    Time frame: Up to 3 years after treatment

  4. To determine the overall response rate (ORR) of pulmonary RRP defined as complete response (CR) and partial response (PR) by RECIST 1.1 in participants with measurable pulmonary disease after combination treatment

    The fraction of participants with a pulmonary RRP partial response and a pulmonary RRP complete response will be reported in all treated pulmonary participants, along with 95% confidence intervals for each.

    Time frame: Baseline and 6 weeks after completion of treatment

  5. To determine the treatment-free interval (either medical or surgical) after completion of retreatment with combination systemic bevacizumab and PRGN-2012

    Reported descriptively following completion of protocol retreatment.

    Time frame: Baseline through 3 years after treatment

07

Study locations

1 site
  • National Institutes of Health Clinical Center
    Bethesda, Maryland 20892, United States
    • NIH Clinical Center Office of Patient Recruitment (OPR) · Contactccopr@nih.gov · 800-411-1222
08

References and documents

Individual participant data

Plan to share: Yes — This study will comply with the NIH Data Management and Sharing (DMS) Policy, which applies to all new and ongoing NIH-funded research in the IRP, as of January 25, 2023, that is associated with a ZIA, with a clinical protocol that undergoes scientific review.

Supporting information: Study protocol, Statistical analysis plan, Informed consent form

Time frame: Data will be made available as soon as possible or at the time of associated publication. Data not published in a manuscript will be shared via public source once the data set completes QC.

Access criteria: Clinical data will be made available upon request and with the permission of the study PI.

09

Updates

32 registry updates since Sep 25, 2026
Start date
Sep 29, 2026→Nov 15, 2026
moved 32 times, Sep 25, 2026 – Nov 10, 2026
Show all 32 updates
  1. Nov 10, 2026
    Start date Nov 12, 2026→Nov 15, 2026
  2. Nov 9, 2026
    Start date Nov 11, 2026→Nov 12, 2026
  3. Nov 6, 2026
    Start date Nov 10, 2026→Nov 11, 2026
  4. Nov 5, 2026
    Start date Nov 9, 2026→Nov 10, 2026
  5. Nov 4, 2026
    Start date Nov 8, 2026→Nov 9, 2026
  6. Nov 3, 2026
    Start date Nov 5, 2026→Nov 8, 2026
  7. Nov 2, 2026
    Start date Nov 4, 2026→Nov 5, 2026
  8. Oct 30, 2026
    Start date Nov 3, 2026→Nov 4, 2026
  9. Oct 29, 2026
    Start date Nov 2, 2026→Nov 3, 2026
  10. Oct 28, 2026
    Start date Nov 1, 2026→Nov 2, 2026
  11. Oct 27, 2026
    Start date Oct 29, 2026→Nov 1, 2026
  12. Oct 26, 2026
    Start date Oct 28, 2026→Oct 29, 2026
  13. Oct 23, 2026
    Start date Oct 27, 2026→Oct 28, 2026
  14. Oct 22, 2026
    Start date Oct 26, 2026→Oct 27, 2026
  15. Oct 21, 2026
    Start date Oct 25, 2026→Oct 26, 2026
  16. Oct 20, 2026
    Start date Oct 22, 2026→Oct 25, 2026
  17. Oct 19, 2026
    Start date Oct 21, 2026→Oct 22, 2026
  18. Oct 16, 2026
    Start date Oct 20, 2026→Oct 21, 2026
  19. Oct 15, 2026
    Start date Oct 19, 2026→Oct 20, 2026
  20. Oct 14, 2026
    Start date Oct 18, 2026→Oct 19, 2026
  21. Oct 13, 2026
    Start date Oct 14, 2026→Oct 18, 2026
  22. Oct 9, 2026
    Start date Oct 13, 2026→Oct 14, 2026
  23. Oct 8, 2026
    Start date Oct 12, 2026→Oct 13, 2026
  24. Oct 7, 2026
    Start date Oct 11, 2026→Oct 12, 2026
  25. Oct 6, 2026
    Start date Oct 8, 2026→Oct 11, 2026
  26. Oct 5, 2026
    Start date Oct 7, 2026→Oct 8, 2026
  27. Oct 2, 2026
    Start date Oct 6, 2026→Oct 7, 2026
  28. Oct 1, 2026
    Start date Oct 5, 2026→Oct 6, 2026
  29. Sep 30, 2026
    Start date Oct 4, 2026→Oct 5, 2026
  30. Sep 29, 2026
    Start date Oct 1, 2026→Oct 4, 2026
  31. Sep 28, 2026
    Start date Sep 30, 2026→Oct 1, 2026
  32. Sep 25, 2026
    Start date Sep 29, 2026→Sep 30, 2026

From the registry record's own update history. This site started tracking changes on Sep 25, 2026; for anything earlier, see the record history on ClinicalTrials.gov ↗

10

Registry details

Key details

Study ID
NCT07756840
Responsible party
Sponsor
First posted
Aug 11, 2026
Start date
Nov 15, 2026 (estimated)
Primary completion
Jul 1, 2029 (estimated)
Completion
Jul 1, 2030 (estimated)
Last update
Nov 10, 2026

Study contacts

Shannon S Householder
Contact
shannon.householder@nih.gov
(240) 656-8771
Scott M Norberg, D.O.
Contact
scott.norberg@nih.gov
(301) 275-9668
Scott M Norberg, D.O.
principal investigator · National Cancer Institute (NCI)

Oversight

FDA-regulated drug
Yes
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

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Studies of the drug tested here: Zopapogene imadenovec

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