Current oncology最新文献

{"title":"Real-World Treatment Patterns and Survival Outcomes of Patients with Relapsed/Refractory Multiple Myeloma Treated with a Selinexor-Containing Triplet-Based Regimen.","authors":"Andrew Whiteley, Stephen C Ijioma, David Ray, Spencer S Langerman, Ellen Hu, Amy Pierre, Tomer Mark, Habte Yimer","doi":"10.3390/curroncol32050268","DOIUrl":"https://doi.org/10.3390/curroncol32050268","url":null,"abstract":"<p><p>Treatment for relapsed/refractory multiple myeloma (RRMM) is complex, with several classes of drugs that can be combined into doublet, triplet, or quadruplet regimens. Real-world studies can help to determine the optimal treatment sequences and dosing through observed usage of drugs outside of clinical trials. Previous clinical trials have demonstrated high rates of durable responses in the treatment of patients with triple-class-exposed RRMM with regimens containing selinexor, a first-in-class, orally available selective exportin 1 inhibitor. This study analyzed real-world treatment patterns and survival outcomes using a nationwide electronic health record-derived, deidentified database of patients with RRMM treated with an eligible selinexor-containing, triplet-based regimen, including combinations with dexamethasone and pomalidomide, bortezomib, carfilzomib, or daratumumab. Patients had a real-world overall survival (rwOS) of 14.7 months (95% CI: 10.6, 20.9) and a derived progression-free survival (dPFS) of 4.7 months (95% CI: 3.4, 6.7). Patients with previous exposure to anti-CD38 monoclonal antibodies (mAbs) in the most recent regimen prior to the selinexor treatment had numerically higher survival outcomes (rwOS, 20.9; dPFS, 8.7 months). These data suggest that, in the real-world setting, the use of selinexor triplet regimens is effective in patients with RRMM, especially those with prior exposure to an anti-CD38 mAb in the immediate prior line of therapy.</p>","PeriodicalId":11012,"journal":{"name":"Current oncology","volume":"32 5","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144149782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment Patterns, Clinical Outcomes and Quality of Life in BRCA1/2-Associated Breast Cancer Patients: A Retrospective Analysis.","authors":"Anna-Maria Parger, Paulina Gebhart, Daniela Muhr, Christian F Singer, Yen Y Tan","doi":"10.3390/curroncol32050269","DOIUrl":"https://doi.org/10.3390/curroncol32050269","url":null,"abstract":"<p><p><b>Background</b>: Breast cancer (BC) patients with germline BRCA1/2 pathogenic variants (PVs) often face unique challenges compared to non-carriers. However, the impact of PVs on treatment patterns, clinical outcomes, and quality of life (QoL) remains insufficiently explored. This study aims to assess these factors in these individuals. <b>Methods</b>: A retrospective analysis was conducted using data from the Medical University of Vienna Center for Familial Breast and Ovarian Cancer between 2011 and 2021. Among 1285 individuals identified, 338 were included (120 BRCA1 PVs, 47 BRCA2 PVs, and 171 non-carriers). Clinical data including treatment patterns and outcomes were collected; QoL was assessed in BRCA1/2 PV carriers using the SF-12 questionnaire. <b>Results</b>: Among 338 BC patients, BRCA1 PV carriers were significantly younger at disease onset and more likely to present with triple-negative BC, with higher Ki-67 (>10%) than BRCA2 or non-carriers. Platinum-based chemotherapy was more frequently administered to BRCA PV carriers for neoadjuvant treatment (OR 7.7, <i>p</i> < 0.001), and therapeutic bilateral mastectomy was more common in BRCA1 carriers (44.7%) compared to BRCA2 (37.8%, <i>p</i> = 0.114) and non-carriers (25.2%, <i>p</i> = 0.003). Epirubicin was the primary agent for adjuvant chemotherapy across all groups compared to other chemotherapeutic agents. QoL assessments revealed significant physical health challenges, particularly among those who underwent neoadjuvant chemotherapy and surgery, while mental health scores remained relatively high. <b>Conclusions</b>: This study highlights the distinct treatment patterns and tumor characteristics associated with BRCA1/2 carriers, including the impact of treatments on quality of life. Nevertheless, our findings ought to be interpreted with caution due to the small sample size. Larger prospective studies with more complete treatment data, including PARP inhibitor use, and further research on supportive care strategies are needed for this high-risk population.</p>","PeriodicalId":11012,"journal":{"name":"Current oncology","volume":"32 5","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144149407","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Burdens of Breast Cancer and Projections for 2030 Among Women in Asia: Findings from the 2021 Global Burden of Disease Study.","authors":"Feng Wang, Sixuan Liu, Jianwei Li, Yuzhen Shi, Zhaohui Geng, Yajie Ji, Jie Zheng","doi":"10.3390/curroncol32050267","DOIUrl":"https://doi.org/10.3390/curroncol32050267","url":null,"abstract":"<p><p><b><i>Background</i>:</b> Employing the most recent dataset from the Global Burden of Disease (GBD) Study 2021, this report sought to delineate the current epidemiologic landscape of breast cancer in Asian women. <b><i>Methods</i>:</b> We examined the evolving trends in disease prevalence and explored the correlations between breast cancer and factors such as age, temporal periods, and generational cohorts. We utilized an autoregressive integrated moving average (ARIMA) model to predict the incidence and deaths of breast cancer in Asia. <b><i>Results</i>:</b> From 1990 to 2021, the age-standardized incidence rate (ASIR), age-standardized DALYs rate (ASDR), and age-standardized mortality rate showed an overall upward trend for Asian women with breast cancer. In 2021, the high-income Asia Pacific region had the highest ASIR value, while South Asia had the lowest ASIR value. The highest age-standardized mortality rate and ASDR values in 2021 occurred in Southeast Asia, while the lowest values for these metrics were in East Asia. In 2021, breast cancer incidence and DALYs were highest in the 50-54 age group, with deaths peaking in the 55-59 age group. The leading risk factor attributed to breast cancer deaths in Asia in 1990 and 2021 was a \"diet high in red meat\". Breast cancer incidence and mortality rates are expected to continue to rise in Asia over the next 10 years. <b><i>Conclusions</i>:</b> The burden of breast cancer in Asian women is increasing, especially in low SDI countries. This study highlighted the differences between populations and regions and predicted the incidence and mortality rates of breast cancer in Asia over the next decade using an ARIMA model. An increased awareness of breast cancer risk factors and prevention strategies is necessary to reduce breast cancer burden in the future.</p>","PeriodicalId":11012,"journal":{"name":"Current oncology","volume":"32 5","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144149667","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient-Reported Outcome Measures (PROMS) in Lymphoma.","authors":"Neha Akkad, Christopher R Flowers","doi":"10.3390/curroncol32050265","DOIUrl":"https://doi.org/10.3390/curroncol32050265","url":null,"abstract":"<p><p>Patient-reported outcome measures (PROMs) are often used to evaluate the impact of treatment and clinical decisions on the patient experience for patients with lymphoma. Regulatory agencies have provided guidance on the use of PROMs for patient-focused drug development. Though PROMs are increasingly utilized, the way in which they are used, analyzed, and reported is heterogeneous. This systematic evidence-based review will focus on how PROMs are currently used for patients with lymphoma, what domains PROMs measure, their clinical significance, links to clinical outcomes, and what gaps need to be filled to better incorporate PROMs as endpoints in clinical trials and clinical decision-making.</p>","PeriodicalId":11012,"journal":{"name":"Current oncology","volume":"32 5","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144149703","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pilot Randomized Controlled Trial of iCanWork: Theory-Guided Return-to-Work Intervention for Individuals Touched by Cancer.","authors":"Christine Maheu, Maureen Parkinson, Kyla Johnson, Wing Lam Tock, Naomi Dolgoy, Simon-Pierre Dupuis, Mina Singh","doi":"10.3390/curroncol32050266","DOIUrl":"https://doi.org/10.3390/curroncol32050266","url":null,"abstract":"<p><strong>Background: </strong>Recent systematic reviews report a limited number of return-to-work (RTW) interventions for individuals touched by cancer (ITBC), with many falling short in effectiveness and lacking an integrated work-health approach. In response, iCanWork-a theoretically informed, multidisciplinary RTW intervention integrating vocational rehabilitation (VR) and occupational therapy (OT)-was conceptualized and developed to address the gap identified in recent reviews for robust, work-health-focused RTW interventions.</p><p><strong>Methods: </strong>A pilot randomized controlled trial was conducted to explore the feasibility, acceptability, and preliminary work-related outcomes of the iCanWork intervention among 23 ITBC participants randomized to either the intervention or control group. Feasibility was assessed through recruitment, retention, and engagement benchmarks; acceptability was measured using a participant satisfaction survey. Preliminary work-health-related outcomes included RTW status, work ability index (WAI) scores, and health-related quality of life (QoL) domains.</p><p><strong>Results: </strong>Feasibility benchmarks were achieved, with 92% recruitment, 83% retention, and 100% completing at least one VR session. Adherence to the session delivery benchmarks was met by 75% of participants before RTW and 41.7% after RTW. Participants rated the intervention highly for its tailored and supportive approach. Compared to the control group, the iCanWork group showed modest improvements in RTW status, WAI scores (mean change: +2.54), and QoL domains, including fatigue, social roles, and pain interference. Given the small sample size, these exploratory findings should be interpreted as preliminary signals to inform outcome selection for a future trial.</p><p><strong>Conclusions: </strong>iCanWork is a feasible and acceptable RTW intervention for ITBC with early indications of benefit. These findings inform the design and outcome selection for a future, larger trial aimed at evaluating the intervention's potential to improve RTW outcomes for ITBC.</p>","PeriodicalId":11012,"journal":{"name":"Current oncology","volume":"32 5","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144149704","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ADCs and TCE in SCLC Therapy: The Beginning of a New Era?","authors":"Paola Muscolino, Fausto Omero, Desirèe Speranza, Carla Infurna, Silvana Parisi, Vincenzo Cianci, Massimiliano Berretta, Alessandro Russo, Mariacarmela Santarpia","doi":"10.3390/curroncol32050261","DOIUrl":"https://doi.org/10.3390/curroncol32050261","url":null,"abstract":"<p><p>The therapeutic landscape for small cell lung cancer (SCLC) has remained stationary for decades, with chemotherapy representing the sole treatment strategy, with a modest survival benefit. The addition of immune checkpoint inhibitors (ICIs) to standard first-line chemotherapy for SCLC was a considerable milestone. However, despite high overall response rates, this strategy failed to deliver long-term benefits for most patients, who continue to face a poor prognosis. Over the last few years, a deeper knowledge of the molecular biology of SCLC and the impressive advancements in drug development, have led to the generation of novel classes of systemic therapies that promise to revolutionize the current therapeutic scenario. Among the various therapeutic approaches in development, T-cell Engagers (TCE) and antibody-drug conjugates (ADCs) stand out due to their unique structural characteristics and mechanisms of action. These therapies represent a paradigm shift from traditional monoclonal antibody (mAb) and chemotherapy regimens, allowing direct engagement of multiple targets associated with tumor progression. In this review, we provide an overview of current drug development in SCLC, specifically focusing on these new agents, summarizing available evidence, and tracking future directions.</p>","PeriodicalId":11012,"journal":{"name":"Current oncology","volume":"32 5","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144149545","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Role of Immunotherapy in the Treatment of Hepatocellular Carcinoma.","authors":"Irina Y Dobrosotskaya, Rashmi Kumar, Timothy L Frankel","doi":"10.3390/curroncol32050264","DOIUrl":"https://doi.org/10.3390/curroncol32050264","url":null,"abstract":"<p><p>Hepatocellular carcinoma is the most common primary liver tumor and is strongly related to underlying liver cirrhosis. Common etiologies include viral hepatitis, elevated alcohol consumption and metabolic diseases, all of which result in liver inflammation and scarring. Previously, systemic therapies for locally advanced or metastatic disease were limited to tyrosine kinase inhibitors with poor efficacy and rare cures. Recent advances have harnessed the power of the immune system to combat disease, resulting in improved outcomes and occasional cures. Here, we describe the recent clinical trials in immunotherapies for the treatment of hepatocellular carcinoma as first- and second-line therapies and in combination with other drug classes.</p>","PeriodicalId":11012,"journal":{"name":"Current oncology","volume":"32 5","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144149757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk Factors for Recurrence in Serous Borderline Ovarian Tumors and Early-Stage Low-Grade Serous Ovarian Carcinoma.","authors":"Jingjing Zhang, Ming Wang, Yumei Wu","doi":"10.3390/curroncol32050263","DOIUrl":"https://doi.org/10.3390/curroncol32050263","url":null,"abstract":"<p><strong>Background: </strong>Tumor recurrence significantly impacts the quality of life and fertility of patients with serous borderline ovarian tumors (SBOT) and early-stage low-grade serous ovarian carcinoma (LGSOC). This study aims to characterize recurrence patterns, identify independent risk factors for recurrence, and develop a nomogram to predict recurrence-free survival (RFS).</p><p><strong>Methods: </strong>We conducted a retrospective case-control study to investigate recurrence in patients undergoing fertility-sparing surgery (FSS) and radical surgery (RS). Logistic regression and Cox regression were used to identify risk factors. Kaplan-Meier analysis was applied to evaluate RFS. A nomogram was developed based on identified variables to predict RFS.</p><p><strong>Results: </strong>Tumor capsule disruption and micropapillary were associated with higher recurrence risk in the FSS group. Non-invasive implants were associated with higher recurrence risk in the RS group. The nomogram prediction model was developed based on identified risk factors. The area under the curve (AUC) for RFS predictions was 0.74 (95% CI: 0.62-0.85) at 3 years and 0.78 (95% CI: 0.67-0.89) at 5 years for the FSS group and 0.87 (95% CI: 0.76-0.98) at 3 years and 0.81 (95% CI: 0.65-0.97) at 5 years for the RS group.</p><p><strong>Conclusions: </strong>We identified the risk factors for recurrence of SBOT and early-stage LGSOC following FSS and RS procedures and developed a predictive model for forecasting RFS. This model provides valuable guidance for patients and clinicians in predicting recurrence risk for patients.</p>","PeriodicalId":11012,"journal":{"name":"Current oncology","volume":"32 5","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144149754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spontaneous Dramatic Regression of Clear Cell Renal Cell Carcinoma After Pazopanib-Induced Severe Systemic Inflammatory Syndrome: A Case Report and Literature Review.","authors":"Chi Hyuk Oh, Hong Jun Kim","doi":"10.3390/curroncol32050260","DOIUrl":"https://doi.org/10.3390/curroncol32050260","url":null,"abstract":"<p><p>Renal cell carcinoma (RCC) is the most common type of kidney cancer, accounting for a significant proportion of all cancer cases in Korea. This case report presents a unique instance of spontaneous dramatic tumor regression in a 42-year-old Korean male diagnosed with clear cell RCC. The patient initially presented with right lower back pain, weight loss, and a loss of appetite. Following systemic immunotherapy with nivolumab and ipilimumab, and right radical nephrectomy, the patient was diagnosed with metastatic clear cell RCC, with new metastatic lesions detected in the liver, and on the chest wall on follow-up imaging. Second-line systemic treatment with pazopanib was initiated. Shortly thereafter, the patient developed severe systemic inflammatory syndrome, resulting in a mental stupor and acute kidney failure. Intensive care, including continuous renal replacement therapy and high-dose immunosuppressants, was administered. The patient's condition improved significantly with the intensive care regimen, leading to unintended tumor regression. These potentially fatal side effects occurred without infection, as confirmed by negative blood and urine cultures, and were attributed to the recent introduction of pazopanib. Follow-up imaging showed a significant reduction in hepatic metastatic lesions and the disappearance of chest wall nodules. This is the first reported case of RCC tumor regression following the side effects of pazopanib, underscoring the need for further studies into the immune mechanisms involved in RCC treatment and highlighting potential therapeutic strategies that leverage innate immune responses.</p>","PeriodicalId":11012,"journal":{"name":"Current oncology","volume":"32 5","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144149807","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Spatial Proximity of CD8⁺ FoxP3⁺PD-1⁺ Cells to Tumor Cells: A More Accurate Predictor of Immunotherapy Outcomes in Advanced Non-Small-Cell Lung Cancer.","authors":"Zijuan Hu, Zhihuang Hu, Keji Chen, Huixia Huang, Xinyang Zhong, Yaxian Wang, Jiayu Chen, Xuefeng He, Di Shi, Yupeng Zeng, Jiwei Li, Xiaoyan Zhou, Ping Wei","doi":"10.3390/curroncol32050262","DOIUrl":"https://doi.org/10.3390/curroncol32050262","url":null,"abstract":"<p><strong>Background: </strong>To optimize precision immunotherapy for advanced NSCLC, comprehensive tumor immune microenvironment (TIME) characterization is crucial for efficacy prediction.</p><p><strong>Methods: </strong>Pretreatment tumor samples from 46 advanced NSCLC patients treated with PD-1/PD-L1 inhibitors were analyzed. The subregional abundance and spatial proximity scores of TIME cell subpopulations in 27 samples were assessed via multiplex immunohistochemistry (mIHC) targeting pan-CK, CD163, CD8, FoxP3, PD-1, and PD-L1. Correlations between the TIME features, clinicopathologic factors, treatment response, and prognosis were evaluated.</p><p><strong>Results: </strong>CD8⁺FoxP3⁺ cells were identified in NSCLC tissues, predominantly expressing PD-1/PD-L1. The PD-L1 TPS subgroups showed significant immune cell density/proximity differences, but CD8⁺FoxP3⁺PD-1⁺ infiltration was PD-L1 TPS-independent. Responders had higher CD8⁺FoxP3⁺PD-1^high density (<i>p</i> = 0.0497) and proximity scores (<i>p</i> = 0.0099) than non-responders. The CD8⁺FoxP3⁺PD-1⁺ presence and tumor proximity were essential for favorable outcomes. In low-PD-L1 TPS patients, the CD8⁺FoxP3⁺PD-1⁺ abundance and proximity scores strongly predicted the response (AUC: 0.79 and 0.75 vs. PD-L1 TPS AUC = 0.58). A survival analysis linked the presence and proximity score of CD8⁺FoxP3⁺PD-1⁺ cells to prolonged overall survival (OS) and progression-free survival (PFS). Notably, a low proximity score of CD8⁺FoxP3⁺PD-1⁺ cells emerged as an independent risk factor for a shorter PFS (HR = 6.16, 95% CI: 2.12-17.93, <i>p</i> = 0.001).</p><p><strong>Conclusion: </strong>The CD8⁺FoxP3⁺PD-1⁺ spatial proximity to tumor cells robustly predicts improved immunotherapy outcomes in advanced NSCLC.</p>","PeriodicalId":11012,"journal":{"name":"Current oncology","volume":"32 5","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144149319","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}