Journal of Oncology Pharmacy Practice最新文献

{"title":"Sjogren's syndrome due to immune checkpoint inhibitors (ICIs): Insights from a single-institution series and systematic review of the literature.","authors":"Abram Soliman, Ruba Hassan, Ion Codreanu, Steven C Plaxe, Constantin A Dasanu","doi":"10.1177/10781552241271753","DOIUrl":"10.1177/10781552241271753","url":null,"abstract":"<p><p>IntroductionCareful adverse event assessment and management are important when prescribing immune checkpoint inhibitors (ICIs) to cancer patients. Iatrogenic Sjogren's syndrome is a relatively rare immune-related adverse event (irAEs) that affects the moisture-producing glands.MethodsWe describe a series of four patients who developed Sjogren's syndrome while being treated with ICIs at a community cancer center in Southern California, USA (1/1/2017-12/31/2023). Patient, drug and disease-related data were collected by retrospective chart review. A systematic search of the PubMed database was performed to identify similar cases in the literature (1/1/2016-12/31//2023).ResultsOf 224 cancer patients at our center treated with ICIs, four (1.8%) developed iatrogenic Sjogren's syndrome. All of our patients were male; three received PD-1 inhibitors (nivolumab, pembrolizumab) and one received the PD-L1 inhibitor atezolizumab. The median time to development of Sjogren's syndrome was 24 weeks (range, 8-36 weeks); dry mouth symptoms were more prominent than dry eye symptoms. None of the patients had elevated SS-A, SS-B or antinuclear antibodies. One patient developed multiple tooth cavities and had several extractions, due to severe xerostomia. Management of all patients was primarily symptomatic. Two cases were irreversible; one was reversible and the 4^th case is undermined as he is still on ICI therapy. Our systematic review of the literature identified 80 cases in five articles. Incidence of xerostomia was twice of that of xerophthalmia. The male/female ratio was 1.5:1. SS-A, SS-B, or antinuclear antibodies were found in only 9% of patients. Steroids were reported to have had only a limited role in management.ConclusionsThe incidence of Sjogren's syndrome due to ICIs in our center was 1.8%. Details of clinical course and management in these patients are presented. Caring for patients with ICI-related Sjogren's syndrome is facilitated by a multidisciplinary effort including oncologists, otolaryngologists, dentists, ophthalmologists and rheumatologists. Expanding the knowledge base pertaining to iatrogenic Sjogren's syndrome in patients on ICIs will be helpful in promoting early detection and treatment, and improving outcomes.</p>","PeriodicalId":16637,"journal":{"name":"Journal of Oncology Pharmacy Practice","volume":" ","pages":"1029-1036"},"PeriodicalIF":0.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141902090","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":"Mosunetuzumab-associated fatal HHV-6 encephalitis in a patient with follicular lymphoma.","authors":"Victor M Samperio, Moza Hamoud, Constantin A Dasanu","doi":"10.1177/10781552251355433","DOIUrl":"10.1177/10781552251355433","url":null,"abstract":"<p><p>IntroductionMosunetuzumab is a CD3×CD20 bispecific antibody approved for relapsed/refractory follicular lymphoma. Although it was shown to achieve high response rates and durable remissions, immunosuppression with its use can be significant. Immune effector cell-associated neurotoxicity syndrome (ICANS) has been described with bispecific T-cell engager (BiTE) therapies, but human herpesvirus-6 (HHV-6) encephalitis has not been previously reported.CaseWe describe a 76-year-old woman with grade 3A follicular lymphoma treated with mosunetuzumab for twelve weeks. Ten days after the 4th cycle, she was admitted to the hospital with gradual onset of confusion and generalized weakness. Magnetic resonance imaging (MRI) showed bilateral mesial temporal T2/FLAIR hyperintensities. Cerebrospinal fluid (CSF) polymerase chain reaction (PCR) testing revealed HHV-6 infection.Management and outcomeICANS was initially suspected, and dexamethasone 10 mg IV daily was started. Following positive PCR testing for HHV-6, IV ganciclovir was commenced. Despite aggressive antiviral treatment, the patient's condition deteriorated and she died on hospital day 12.Discussion/conclusionSymptomatic HHV-6 reactivation has been recorded in the setting of allogeneic stem cell transplant and chimeric antigen receptor (CAR) T-cell therapy. This is the first instance of HHV-6 encephalitis associated with mosunetuzumab. The case underscores the importance of early CSF analysis and neuroimaging in patients with encephalopathy receiving T-cell-engaging therapies.</p>","PeriodicalId":16637,"journal":{"name":"Journal of Oncology Pharmacy Practice","volume":" ","pages":"1183-1187"},"PeriodicalIF":0.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144584225","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":"Impact of discordant preferred drug status between hospitals and payers for chemotherapeutic biosimilars.","authors":"Isha Rana, Zhili Fu, Erika N Brown, Rodrigo M De La Torre, Cynthia El Rahi","doi":"10.1177/10781552251355509","DOIUrl":"10.1177/10781552251355509","url":null,"abstract":"<p><p>BackgroundWith increasing numbers of FDA approved biosimilars, and the expected advantages of lowering United States (U.S.) healthcare and patient out of pocket costs, questions remain regarding the impact of payers designating their preferred formulary drug(s).ObjectiveTo assess the financial impact to health-systems of chemotherapeutic biosimilars, specifically trastuzumab and bevacizumab, and its reference product utilization when a payer designates their preferred product(s) that is(are) different than the health-system's preferred formulary product.MethodsThis study is a retrospective review of insurance denials for orders of trastuzumab, bevacizumab, and their respective biosimilars, prescribed based on National Comprehensive Cancer Network (NCCN) guidelines and standards. The primary outcome was the financial impact of utilizing multiple products due to the payer's preference measured by cost to the hospital. The secondary outcome was the turnaround time required due to resubmission process and new financial clearance once the initial biosimilar authorization was denied.Results18 patients out of 452 (4%) patients, who received trastuzumab or bevacizumab treatment, were denied for hospital preferred biosimilar product and switched to the patient's insurance mandated biosimilar product. This resulted in a 1.28% increase in hospital actual acquisition costs. Impact on administrative time included a total of additional 70 h of IT time, 10.5 h of pharmacist time, and 18 h of patient access coordinator processing time.ConclusionThe results of this study demonstrate the added burden to include financial and operational impacts on healthcare systems to continue to operate functionally for the utilization of multiple biosimilar products, as dictated by the patient's insurance plan. Further research is required to describe the impact to patients from their medical insurance plans that restrict biosimilar coverage to limited products.</p>","PeriodicalId":16637,"journal":{"name":"Journal of Oncology Pharmacy Practice","volume":" ","pages":"1159-1164"},"PeriodicalIF":0.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144649717","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":"Novel genetic structures associated with adverse response to chemotherapy in breast cancer.","authors":"Morteza Gholami, Mohsen Asouri, Ali Asghar Ahmadi, Mehrab Nasirikenari","doi":"10.1177/10781552241278312","DOIUrl":"10.1177/10781552241278312","url":null,"abstract":"<p><p><b>Introduction:</b> The role of genetic variants in response to chemotherapy has been investigated in several studies. This study aimed to investigate genetic variants associated with response to chemotherapy in breast cancer (BC) patients. <b>Methods:</b> Significant variants (p < 5 × 10^-8) associated with response to chemotherapy were obtained from GWA studies. Candidate variants were identified by haplotype analysis (r2 ≥ 0.9, D'≥0.9) using 1000Genome LD data. To determine the effects of the variants on gene expression, expression quantitative trait loci (eQTL) were evaluated. To compare the expression of the identified genes in tumor samples, expression levels were compared between TCGA tumor types and adjacent normal tissues. <b>Results:</b> Six rs3820706, rs147451859, rs4784750, rs17587029, rs16830728, and rs16972207 variants were significantly associated with response to chemotherapy in BC patients (p < 5 × 10^-8). Seven novel haplotypic structures were identified to be associated with adverse response to chemotherapy in BC patients. These haplotypes formed two genetic structures associated with neutropenia, leukopenia, chemotherapy-induced cytotoxicity (GAG-TTAT), and chemotherapy-induced alopecia (CC-CAACTCCCGTTGCGG). These variants are located on PPCDC, NLRC5, STAM2, and TNFSF13B genes, and the expression of these genes significantly changed in BC tissues than normal tissues (P ≤ 0.05), also showing gene-gene correlation (P ≤ 0.05). <b>Conclusions:</b> These genetic variants and their associated novel haplotypic structures can predict adverse response to chemotherapy in BC patients and could potentially form BC-associated genetic panel for adverse response to chemotherapy.</p>","PeriodicalId":16637,"journal":{"name":"Journal of Oncology Pharmacy Practice","volume":" ","pages":"1086-1093"},"PeriodicalIF":0.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142086121","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":"Recent developments on checkpoint inhibitors, CAR T cells, and beyond for T cell-based immunotherapeutic strategies against cancer.","authors":"Shaukat Ali, Mahnoor Arshad, Muhammad Summer, Maryam Zulfiqar, Shehzeen Noor, Laiba Nazakat, Muhammad Abdullah Javed","doi":"10.1177/10781552251324896","DOIUrl":"10.1177/10781552251324896","url":null,"abstract":"<p><p>ObjectiveThere was a dire need to construct a review of the recent developments on Immune checkpoint inhibitors (ICIs), CAR T Cells, and other approaches for T cell-based immunotherapeutic strategies against cancer as cancer has become one of the most fatal diseases that is responsible for causing several deaths per annum.Data sourcesMultiple published data was acquired from the high-impact factor journal articles.Data summaryMultiple clinical strategies have been in use today such as radiotherapy, chemotherapy and immunotherapy to treat cancer of different types. Among novel cancer management strategies, the role of cancer immunotherapy by T cells has become immensely important. Cancer immunotherapy has revolutionized treatment approaches and it basically utilizes the body's immune system to treat cancer. At the forefront of this revolution, T cells are considered as the fundamental components of immune system.ConclusionsThe current review explores the therapeutic potential of T cells in the fight against cancer by applying strategies such as various ICIs (PD-1/PD-L1, CTLA-4, TIGIT, BTLA, TIM3, LAG3) and adoptive cell therapy. ICIs stimulate the body's existing anti-tumor T-cell response by the way of removing immune system inhibitors. On the other hand, in adoptive cell therapy (ACT) patient's T cells are modified to identify and attack tumor cells. Furthermore, this review also highlights significant successes that are observed with these therapies, notably PD-1 blockade and CAR T-cell therapy for various tumors. Moreover, this review also explores the potential of therapeutic vaccination, bispecific antibodies and cytokine therapy to enhance the antitumor activity. Therapeutic vaccines expose immune system to various tumor-associated antigens and training it to identify and then attack cancer cells, showing promising results in different types of cancers such as prostate cancer and melanoma. While, cytokine therapy is accompanied by the use of cytokines such as interleukin-2 (IL-2) to stimulate immune cell activity and proliferation, thereby boosting the overall anti-tumor immune response. Lastly, the current review explores the promising future of T cell-based immunotherapy, envisioning advancements in CAR design and gene editing techniques that can enhance efficacy across a broader spectrum of cancers.</p>","PeriodicalId":16637,"journal":{"name":"Journal of Oncology Pharmacy Practice","volume":" ","pages":"1115-1144"},"PeriodicalIF":0.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143729930","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":"Subcutaneous nivolumab: Advancing operational efficiency and patient-centred care in the NHS.","authors":"Joanne Parkes","doi":"10.1177/10781552251346908","DOIUrl":"10.1177/10781552251346908","url":null,"abstract":"","PeriodicalId":16637,"journal":{"name":"Journal of Oncology Pharmacy Practice","volume":" ","pages":"1191-1193"},"PeriodicalIF":0.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144199422","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":"An update on the pharmacotherapy of penile cancer.","authors":"Victor M Samperio, Ifeoma Ike, Moza Hamoud, Constantin A Dasanu","doi":"10.1177/10781552251383790","DOIUrl":"https://doi.org/10.1177/10781552251383790","url":null,"abstract":"<p><p>ObjectiveTo review the current pharmacologic treatment landscape for penile squamous cell carcinoma (PSCC), with a focus on current pharmacotherapy and emerging therapeutic approaches.Data SourcesAn extensive Medline, Embase and Cochrane search of peer-reviewed sources reporting on pharmacotherapy of penile cancer was performed (1/1/2000-06/30/2025). Contribution of immune checkpoint inhibitors (ICIs) to the therapeutics of penile cancer was carefully considered.Data SummaryThis review highlights recent advances in the management of PSCC, covering key aspects of global epidemiology, molecular subtyping, guideline-based treatment by stage, and systemic therapeutic approaches. Particular attention is given to the growing role of immunotherapy in biomarker-selected populations and its potential to reshape the treatment landscape of this disease. For fit patients with advanced disease, platinum-based chemotherapy, particularly the paclitaxel-ifosfamide-cisplatin regimen (TIP), remains the standard first-line option, offering reasonable response rates albeit with significant toxicity. In contrast, ICIs have emerged as valuable alternatives. Cemiplimab and pembrolizumab have shown durable responses in this setting, with the added benefit of improved tolerability and quality of life.ConclusionsDespite its rarity, penile squamous cell carcinoma (PSCC) remains a therapeutically challenging malignancy. Randomized clinical trials with ICIs are being awaited. We believe that clinical trials to test the addition of these agents to a backbone of platinum-based chemotherapy are also warranted. Continued global collaboration and prospective trials are essential to refine stage-based management, improve access to specialized care, and integrate precision oncology to the bedside of patients with PSCC.</p>","PeriodicalId":16637,"journal":{"name":"Journal of Oncology Pharmacy Practice","volume":" ","pages":"10781552251383790"},"PeriodicalIF":0.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145206663","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":"Erratum to Suzetrigine: A potential alternative for palliative pain management in Pakistan's opioid-restricted healthcare system.","authors":"","doi":"10.1177/10781552251355823","DOIUrl":"10.1177/10781552251355823","url":null,"abstract":"","PeriodicalId":16637,"journal":{"name":"Journal of Oncology Pharmacy Practice","volume":" ","pages":"1195"},"PeriodicalIF":0.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144584208","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":"Assessment of chemotherapy-related adverse drug reactions among multiple myeloma patients at Kenyatta national hospital.","authors":"Epifania Amedeus Assenga, Amsalu Degu, Calvin A Omolo","doi":"10.1177/10781552241276438","DOIUrl":"10.1177/10781552241276438","url":null,"abstract":"<p><p>BackgroundDespite treatment modalities for multiple myeloma can cause adverse drug reactions (ADRs), data are scarce about the types, severity and preventability of chemotherapy-related ADRs in Kenya. This study aimed to assess the chemotherapy-related ADRs among multiple myeloma patients at Kenyatta National Hospital (KNH).MethodsA one-arm retrospective cohort study was carried out among all eligible adult patients with a documented diagnosis of multiple myeloma between 1^st January 2017 to 31^st December 2023. A data abstraction tool was used to assess sociodemographics, clinical characteristics and chemotherapy-related ADRs. The Schumock and Thornton scale and the modified Hartwig and Siegel severity scale were employed to evaluate the preventability and severity of ADRs, respectively. Data analysis was performed using the Statistical Package for Social Sciences (SPSS) version 29.0 software. The results were presented using mean, frequency and percentage. Binary logistic regression was employed to assess factors influencing ADRs. A p-value of less than 0.05 was considered statistically significant.ResultsThe prevalence of ADRs in this study was 81.5% with a total of 230 ADRs identified. The primary ADRs identified were peripheral neuropathy (21.7%), nausea and vomiting (14.8%), neutropenia (12.2%) and anemia (11.3%). The majority of the ADRs (51.7%) were moderate in severity, and 29.8% were of mild severity. Preventability assessments of the ADRs showed that most of them (68.2%) were definitely preventable and 13.2% were probably preventable. VRD (Bortezomib/Lenalidomide/Dexamethasone) and VCD (Bortezomib/Cyclophosphamide/Dexamethasone) treatment regimens were responsible for most of the ADRs. VRD (AOR = 11.1, 95% CI = 3.7-32.8, p < 0.001) and VCD treatment regimens (AOR = 4.8, 95% CI = 1.1-20.0, p = 0.033) were the significant factors affecting the occurrence of ADRs.ConclusionOverall, the incidence of chemotherapy-related ADRs in multiple myeloma patients at KNH was notably high (81.5%). Despite the moderate severity of the ADRs, their preventable nature highlights the potential for improved patient outcomes through careful regimen selection and monitoring.</p>","PeriodicalId":16637,"journal":{"name":"Journal of Oncology Pharmacy Practice","volume":" ","pages":"1051-1060"},"PeriodicalIF":0.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142132996","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 protective effect of nano curcumin supplementation on doxorubicin induced cardiotoxicity in breast cancer patients; a randomized, double-blind clinical trial\".","authors":"Mehdi Tohidi, Abolghasem Allahyari, Sajjad Ataei Azimi, Hedieh Alimi, Sepideh Elyasi, Farid Qoorchi Moheb Seraj, Hasan Mehrad-Majd","doi":"10.1177/10781552241277958","DOIUrl":"10.1177/10781552241277958","url":null,"abstract":"<p><p>BackgroundAnthracycline drugs play a fundamental role in breast cancer treatment; however, the cardiotoxicity side effects obscure the advantages of treatment. Curcumin has antioxidant and anti-inflammatory effects.Materials and MethodsIn this study, we investigated the effect of nanocurcumin supplementation on Doxorubicin induced Cardiotoxicity. In this randomized clinical trial, a week before starting the doxorubicin regimen for breast cancer patients, the control group received placebo and curcumin group received 80 mg daily dosage of nano curcumin capsules for six months. Echocardiography parameter changes before chemotherapy and after six months were evaluated.Results46 patients were included. Left ventricle (LV) ejection fraction significantly decreased and LV end diastolic volume significantly increased in control group but no significant changes were observed in the curcumin group (LVEF: 2.62 ± 59.35 to 4.23 ± 56.85, <i>p</i>-value: 0.014 vs 59.55 ± 1.91 to 58.46 ± 3.41, <i>p</i>-value:0.135; LVEDV: 77.09 ± 15.33 to 80.65 ± 14.54, <i>p</i>-value:0.023 vs 72.41 ± 15.34 74.00 ± 14.25, <i>p</i>-value: 0.294). Additionally, LVEF, LV end systolic diameter (LVESD), and end diastolic diameter (LVEDD) insignificantly more decreased in control group versus curcumin group (LVEF: 4.13 ± 2.50- vs 3.36 ± 1.08-, <i>p</i>-value: 0.223; LVESD: 0.27 ± 0.06-vs 0.120.45 ±, <i>p</i>-value:0.110; LVEDD: -0.44 ± 0.33 vs 0.070.33 ±, <i>p</i>-value:0.269). Furthermore, symptomatic cardiomyopathy and ejection fraction ratio less than 53% were not observed. The LVEF reduction >15% was observed was also high in the control group, (<i>p</i>-value = 0.020).ConclusionThis study shows the possible effect of nanocurcumin capsules to reduce the cardiotoxicity of anthracycline chemotherapy medications.</p>","PeriodicalId":16637,"journal":{"name":"Journal of Oncology Pharmacy Practice","volume":" ","pages":"1076-1085"},"PeriodicalIF":0.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142120094","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}