{"id":63111,"date":"2026-05-15T19:03:49","date_gmt":"2026-05-15T17:03:49","guid":{"rendered":"https:\/\/pharma-trend.com\/en\/fda-approves-genentechs-tecentriq-for-adjuvant-muscle-invasive-bladder-cancer-with-ctdna-guided-treatment\/"},"modified":"2026-05-15T19:03:49","modified_gmt":"2026-05-15T17:03:49","slug":"fda-approves-genentechs-tecentriq-for-adjuvant-muscle-invasive-bladder-cancer-with-ctdna-guided-treatment","status":"publish","type":"post","link":"https:\/\/pharma-trend.com\/en\/fda-approves-genentechs-tecentriq-for-adjuvant-muscle-invasive-bladder-cancer-with-ctdna-guided-treatment\/","title":{"rendered":"FDA Approves Genentech\u2019s Tecentriq for Adjuvant Muscle-Invasive Bladder Cancer With ctDNA-Guided Treatment"},"content":{"rendered":"<div>\n<ul class=\"bwlistdisc\">\n<li>\n<i>First approved ctDNA MRD-guided therapy reinforcing Genentech\u2019s commitment to innovation and practice-changing precision medicine<\/i><\/li>\n<li>\n<i>New treatment approach enables healthcare professionals to tailor treatment with the goal of improving clinical benefit and reducing unnecessary intervention<\/i><\/li>\n<li>\n<i>Approval marks the eleventh indication for Tecentriq in the U.S., providing a new option for an aggressive form of cancer<\/i><\/li>\n<\/ul>\n<p>SOUTH SAN FRANCISCO, Calif.&#8211;(BUSINESS WIRE)&#8211;Genentech, a member of the Roche Group (SIX: RO, ROP; OTCQX: RHHBY), announced today that the U.S. Food and Drug Administration (FDA) has approved Tecentriq<sup>\u00ae<\/sup> (atezolizumab) and Tecentriq Hybreza<sup>\u00ae<\/sup> (atezolizumab and hyaluronidase-tqjs) as an adjuvant treatment for adult patients with muscle-invasive bladder cancer (MIBC) who have circulating tumor DNA molecular residual disease (ctDNA MRD) after cystectomy, as identified by Natera\u2019s Signatera\u2122 CDx personalized MRD assay.<\/p>\n<p><a href=\"https:\/\/mms.businesswire.com\/media\/20260519438065\/en\/2738585\/5\/GNE_Logo_Strapline_BLK_081525.jpg\"><img decoding=\"async\" src=\"https:\/\/mms.businesswire.com\/media\/20260519438065\/en\/2738585\/22\/GNE_Logo_Strapline_BLK_081525.jpg\"><\/a><br \/><a href=\"https:\/\/mms.businesswire.com\/media\/20260519438065\/en\/2738585\/5\/GNE_Logo_Strapline_BLK_081525.jpg\"><img decoding=\"async\" src=\"https:\/\/mms.businesswire.com\/media\/20260519438065\/en\/2738585\/21\/GNE_Logo_Strapline_BLK_081525.jpg\"><\/a><\/p>\n<p>\n\u201cCombining our cancer immunotherapy Tecentriq with state-of-the-art MRD testing allows more precise identification of patients who are candidates for intervention and those who might safely avoid unnecessary treatment,\u201d said Levi Garraway, M.D., Ph.D., chief medical officer and head of Global Product Development. \u201cWe look forward to delivering this first of its kind ctDNA-guided regulatory approval to bladder cancer physicians and patients in the U.S.\u201d<\/p>\n<p>\n\u201cFor the patients and families, the \u2018watch and wait\u2019 period after a cystectomy is often defined by uncertainty. This ctDNA-guided approach can enable doctors to use serial ctDNA MRD testing to identify who is at a higher risk of recurrence and move quickly toward immunotherapy for those who may benefit from it, while allowing others to safely avoid additional treatment and its associated side effects,\u201d said Meri-Margaret Deoudes, CEO of the Bladder Cancer Advocacy Network.<\/p>\n<p>\nThe FDA decision was based on positive results from the Phase III IMvigor011 study, which showed that Tecentriq reduced the risk of disease recurrence or death (DFS) by 36% and the risk of death (OS) by 41% in patients with detectable ctDNA MRD identified via serial testing within one year of cystectomy. The safety profile was generally consistent with previous studies of Tecentriq. IMvigor011 is the first prospective Phase III study to demonstrate that a ctDNA-guided approach to adjuvant therapy can significantly improve survival in MIBC.<\/p>\n<p>\nEach year, over 150,000 people worldwide are diagnosed with MIBC and undergo bladder removal surgery to treat this aggressive disease. Even after surgery, nearly half of these patients see their cancer return. This represents the first approval of a ctDNA-guided therapy, an innovative approach that is currently being investigated in other types of cancer. Historically, doctors have relied on tumor staging to determine who needs treatment after surgery. The IMvigor011 study utilized the Natera Signatera\u2122 personalized ctDNA assay to identify molecular evidence of cancer in the blood, before it becomes visible with standard imaging. This approach enabled adjuvant immunotherapy to be deployed selectively in patients who are at greatest risk of recurrence and most likely to benefit from it, while sparing others without molecular residual disease from the burden of treatment after surgery.<\/p>\n<p>\n<b>About the IMvigor011 study<\/b><\/p>\n<p>\nIMvigor011 [<a target=\"_blank\" href=\"https:\/\/cts.businesswire.com\/ct\/CT?id=smartlink&amp;url=https%3A%2F%2Fclinicaltrials.gov%2Fstudy%2FNCT04660344&amp;esheet=54535667&amp;newsitemid=20260519438065&amp;lan=en-US&amp;anchor=NCT04660344&amp;index=1&amp;md5=15a218fe8a25366090a7285ecae934cb\" rel=\"nofollow\" shape=\"rect\">NCT04660344<\/a>] is a global Phase III, randomized, placebo-controlled, double-blind study designed to evaluate the efficacy and safety of adjuvant treatment with Tecentriq<sup>\u00ae<\/sup> (atezolizumab) compared with placebo in adult patients with muscle-invasive bladder cancer (MIBC) who have circulating tumor DNA molecular residual disease (ctDNA MRD) after cystectomy. ctDNA status was determined using Natera\u2019s Signatera\u2122 technology in the U.S. and in China. The Signatera\u2122 CDx test received simultaneous authorization by the FDA for use as a companion diagnostic to Tecentriq. The surveillance phase of IMvigor011 included 761 people who underwent serial ctDNA testing for up to a year after surgery. Of these, 250 people who tested positive for ctDNA joined the treatment phase, where they received either Tecentriq or placebo. The primary endpoint is investigator-assessed disease-free survival (DFS). Secondary endpoints include overall survival (OS) and tolerability, amongst others.<\/p>\n<p>\n<b>About Tecentriq<sup>\u00ae<\/sup> (atezolizumab)<\/b><\/p>\n<p>\nTecentriq (atezolizumab) is a monoclonal antibody designed to bind with a protein called PD-L1, which is expressed on tumor cells and tumor-infiltrating immune cells, blocking its interactions with both PD-1 and B7.1 receptors. By inhibiting PD-L1, Tecentriq may enable the re-activation of T cells. Tecentriq may also affect normal cells.<\/p>\n<p>\n<b>What are Tecentriq and Tecentriq Hybreza?<\/b><\/p>\n<p>\nTecentriq (atezolizumab) and Tecentriq Hybreza (atezolizumab and hyaluronidase-tqjs) are prescription medicines used to treat:<\/p>\n<p>\n<b>Adults with a type of bladder cancer called muscle-invasive bladder cancer (MIBC) that has spread into the muscle layer of the bladder but not to other parts of the body. Tecentriq or Tecentriq Hybreza may be used alone as a treatment for their bladder cancer:<\/b><\/p>\n<ul class=\"bwlistdisc\">\n<li>\nto help prevent their bladder cancer from coming back after their bladder has been removed by surgery, <b>and<\/b><\/li>\n<li>\nsmall pieces of DNA from the tumor (called circulating tumor DNA [ctDNA]) were found in their blood, showing that cancer cells remain in the body (molecular residual disease). A healthcare provider will perform a test to make sure that Tecentriq or Tecentriq Hybreza is right for them.<\/li>\n<\/ul>\n<p>\nIt is not known if Tecentriq or Tecentriq Hybreza is safe and effective when used:<\/p>\n<ul class=\"bwlistdisc\">\n<li>\nIn children for the treatment of MIBC<\/li>\n<\/ul>\n<p>\n<b>Important Safety Information<\/b><\/p>\n<p>\n<b>What is the most important information about Tecentriq and Tecentriq Hybreza?<\/b><\/p>\n<p>\nTecentriq and Tecentriq Hybreza can cause the immune system to attack normal organs and tissues in any area of the body and can affect the way they work. These problems can sometimes become severe or life threatening and can lead to death. Patients can have more than one of these problems at the same time. These problems may happen anytime during their treatment or even after their treatment has ended.<\/p>\n<p>\n<b>Patients should call or see their healthcare provider right away if they develop any new or worsening signs or symptoms, including:<\/b><\/p>\n<p>\n<b>Lung problems<\/b><\/p>\n<ul class=\"bwlistdisc\">\n<li>\ncough<\/li>\n<li>\nshortness of breath<\/li>\n<li>\nchest pain<\/li>\n<\/ul>\n<p>\n<b>Intestinal problems<\/b><\/p>\n<ul class=\"bwlistdisc\">\n<li>\ndiarrhea (loose stools) or more frequent bowel movements than usual<\/li>\n<li>\nstools that are black, tarry, sticky, or have blood or mucus<\/li>\n<li>\nsevere stomach-area (abdomen) pain or tenderness<\/li>\n<\/ul>\n<p>\n<b>Liver problems<\/b><\/p>\n<ul class=\"bwlistdisc\">\n<li>\nyellowing of the skin or the whites of the eyes<\/li>\n<li>\nsevere nausea or vomiting<\/li>\n<li>\npain on the right side of their stomach area (abdomen)<\/li>\n<li>\ndark urine (tea colored)<\/li>\n<li>\nbleeding or bruising more easily than normal<\/li>\n<\/ul>\n<p>\n<b>Hormone gland problems<\/b><\/p>\n<ul class=\"bwlistdisc\">\n<li>\nheadaches that will not go away or unusual headaches<\/li>\n<li>\neye sensitivity to light<\/li>\n<li>\neye problems<\/li>\n<li>\nrapid heartbeat<\/li>\n<li>\nincreased sweating<\/li>\n<li>\nextreme tiredness<\/li>\n<li>\nweight gain or weight loss<\/li>\n<li>\nfeeling more hungry or thirsty than usual<\/li>\n<li>\nurinating more often than usual<\/li>\n<li>\nhair loss<\/li>\n<li>\nfeeling cold<\/li>\n<li>\nconstipation<\/li>\n<li>\ntheir voice gets deeper<\/li>\n<li>\ndizziness or fainting<\/li>\n<li>\nchanges in mood or behavior, such as decreased sex drive, irritability, or forgetfulness<\/li>\n<\/ul>\n<p>\n<b>Kidney problems<\/b><\/p>\n<ul class=\"bwlistdisc\">\n<li>\ndecrease in their amount of urine<\/li>\n<li>\nblood in their urine<\/li>\n<li>\nswelling of their ankles<\/li>\n<li>\nloss of appetite<\/li>\n<\/ul>\n<p>\n<b>Skin problems<\/b><\/p>\n<ul class=\"bwlistdisc\">\n<li>\nrash<\/li>\n<li>\nitching<\/li>\n<li>\nskin blistering or peeling<\/li>\n<li>\npainful sores or ulcers in their mouth or their nose, throat, or genital area<\/li>\n<li>\nfever or flu-like symptoms<\/li>\n<li>\nswollen lymph nodes<\/li>\n<\/ul>\n<p>\n<b>Problems can also happen in other organs.<\/b><\/p>\n<p>\n<b>These are not all of the signs and symptoms of immune system problems that can happen with Tecentriq or Tecentriq Hybreza. Patients should call or see their healthcare provider right away for any new or worsening signs or symptoms, including:<\/b><\/p>\n<ul class=\"bwlistdisc\">\n<li>\nChest pain, irregular heartbeat, shortness of breath, swelling of ankles<\/li>\n<li>\nConfusion, sleepiness, memory problems, changes in mood or behavior, stiff neck, balance problems, tingling or numbness of the arms or legs<\/li>\n<li>\nDouble vision, blurry vision, sensitivity to light, eye pain, changes in eyesight<\/li>\n<li>\nPersistent or severe muscle pain or weakness, muscle cramps<\/li>\n<li>\nLow red blood cells, bruising<\/li>\n<\/ul>\n<p>\n<b>Infusion reactions that can sometimes be severe or life-threatening. Signs and symptoms of infusion reactions may include:<\/b><\/p>\n<ul class=\"bwlistdisc\">\n<li>\nchills or shaking<\/li>\n<li>\nitching or rash<\/li>\n<li>\nflushing<\/li>\n<li>\nshortness of breath or wheezing<\/li>\n<li>\ndizziness<\/li>\n<li>\nfeeling like passing out<\/li>\n<li>\nfever<\/li>\n<li>\nback or neck pain<\/li>\n<\/ul>\n<p>\n<b>Rejection of a transplanted organ or tissue.<\/b> A healthcare provider should tell the patients what signs and symptoms they should report and monitor the patients depending on the type of organ or tissue transplant they have had.<\/p>\n<p>\n<b>Complications, including graft-versus-host disease (GVHD), in people who have received a bone marrow (stem cell) transplant that uses donor stem cells (allogeneic). <\/b>These complications can be serious and can lead to death. These complications may happen if patients undergo transplantation either before or after being treated with Tecentriq or Tecentriq Hybreza. A healthcare provider will monitor for these complications.<\/p>\n<p>\n<b>Getting medical treatment right away may help keep these problems from becoming more serious. <\/b>A healthcare provider will check patients for these problems during their treatment with Tecentriq or Tecentriq Hybreza. A healthcare provider may treat patients with corticosteroid or hormone replacement medicines. A healthcare provider may also need to delay or completely stop treatment with Tecentriq or Tecentriq Hybreza if patients have severe side effects.<\/p>\n<p>\n<b>Before receiving Tecentriq or Tecentriq Hybreza, patients should tell their healthcare provider about all of their medical conditions, including if they:<\/b><\/p>\n<ul class=\"bwlistdisc\">\n<li>\nhave immune system problems such as Crohn\u2019s disease, ulcerative colitis, or lupus<\/li>\n<li>\nhave received an organ or tissue transplant, including corneal transplant<\/li>\n<li>\nhave received or plan to receive a stem cell transplant that uses donor stem cells (allogeneic)<\/li>\n<li>\nhave received radiation treatment to their chest area<\/li>\n<li>\nhave a condition that affects their nervous system, such as myasthenia gravis or Guillain-Barr\u00e9 syndrome<\/li>\n<li>\nare pregnant or plan to become pregnant. Tecentriq and Tecentriq Hybreza can harm an unborn baby. Patients should tell their healthcare provider right away if they become pregnant or think they may be pregnant during treatment with Tecentriq or Tecentriq Hybreza.<b> Females who are able to become pregnant:<\/b><\/p>\n<ul class=\"bwlistcircle\">\n<li>\nA healthcare provider should do a pregnancy test before they start treatment with Tecentriq or Tecentriq Hybreza<\/li>\n<li>\nThey should use an effective method of birth control during their treatment and for at least 5 months after the last dose of Tecentriq or Tecentriq Hybreza<\/li>\n<\/ul>\n<\/li>\n<li>\nare breastfeeding or plan to breastfeed. It is not known if Tecentriq or Tecentriq Hybreza passes into the breast milk. Patients should not breastfeed during treatment and for at least 5 months after the last dose of Tecentriq or Tecentriq Hybreza<\/li>\n<\/ul>\n<p>\n<b>Patients should tell their healthcare provider about all the medicines they take, <\/b>including prescription and over-the-counter medicines, vitamins, and herbal supplements.<\/p>\n<p>\n<b>The most common side effects of Tecentriq when used alone include:<\/b><\/p>\n<ul class=\"bwlistdisc\">\n<li>\nfeeling tired or weak<\/li>\n<li>\ndecreased appetite<\/li>\n<li>\nnausea<\/li>\n<li>\ncough<\/li>\n<li>\nshortness of breath<\/li>\n<\/ul>\n<p>\n<b>The most common side effects of Tecentriq Hybreza when used alone include:<\/b><\/p>\n<ul class=\"bwlistdisc\">\n<li>\nfeeling tired or weak<\/li>\n<li>\nmuscle or bone pain<\/li>\n<li>\ncough<\/li>\n<li>\nshortness of breath<\/li>\n<li>\ndecreased appetite<\/li>\n<\/ul>\n<p>\nTecentriq and Tecentriq Hybreza may cause fertility problems in females, which may affect the ability to have children. Patients should talk to their healthcare provider if they have concerns about fertility.<\/p>\n<p>\nThese are not all the possible side effects of Tecentriq and Tecentriq Hybreza. Patients should ask their healthcare provider or pharmacist for more information about the benefits and side effects of Tecentriq and Tecentriq Hybreza.<\/p>\n<p>\nReport side effects to the FDA at 1-800-FDA-1088 or <a target=\"_blank\" href=\"https:\/\/cts.businesswire.com\/ct\/CT?id=smartlink&amp;url=http%3A%2F%2Fwww.fda.gov%2Fmedwatch&amp;esheet=54535667&amp;newsitemid=20260519438065&amp;lan=en-US&amp;anchor=http%3A%2F%2Fwww.fda.gov%2Fmedwatch&amp;index=2&amp;md5=115a5baa094354775655fa1abc7b718c\" rel=\"nofollow\" shape=\"rect\">http:\/\/www.fda.gov\/medwatch<\/a>.<\/p>\n<p>\nReport side effects to Genentech at 1-888-835-2555.<\/p>\n<p>\n<b>Please see full Prescribing Information for <\/b><a target=\"_blank\" href=\"https:\/\/cts.businesswire.com\/ct\/CT?id=smartlink&amp;url=https%3A%2F%2Fwww.gene.com%2Fdownload%2Fpdf%2Ftecentriq_prescribing.pdf&amp;esheet=54535667&amp;newsitemid=20260519438065&amp;lan=en-US&amp;anchor=Tecentriq&amp;index=3&amp;md5=727088962fab3bfaa00e31768d33c801\" rel=\"nofollow\" shape=\"rect\"><b>Tecentriq<\/b><\/a><b> and <\/b><a target=\"_blank\" href=\"https:\/\/cts.businesswire.com\/ct\/CT?id=smartlink&amp;url=https%3A%2F%2Fwww.gene.com%2Fdownload%2Fpdf%2Ftecentriq_hybreza_prescribing.pdf&amp;esheet=54535667&amp;newsitemid=20260519438065&amp;lan=en-US&amp;anchor=Tecentriq+Hybreza&amp;index=4&amp;md5=7e8507991ae2bb417e2a5edb1f5eb6a3\" rel=\"nofollow\" shape=\"rect\"><b>Tecentriq Hybreza<\/b><\/a><b> and the Medication Guides for <\/b><a target=\"_blank\" href=\"https:\/\/cts.businesswire.com\/ct\/CT?id=smartlink&amp;url=https%3A%2F%2Fwww.gene.com%2Fdownload%2Fpdf%2Ftecentriq_medguide.pdf&amp;esheet=54535667&amp;newsitemid=20260519438065&amp;lan=en-US&amp;anchor=Tecentriq&amp;index=5&amp;md5=03d47e8795038e256c809207abf44b32\" rel=\"nofollow\" shape=\"rect\"><b>Tecentriq<\/b><\/a><b> and <\/b><a target=\"_blank\" href=\"https:\/\/cts.businesswire.com\/ct\/CT?id=smartlink&amp;url=https%3A%2F%2Fwww.gene.com%2Fdownload%2Fpdf%2Ftecentriq_hybreza_medguide.pdf&amp;esheet=54535667&amp;newsitemid=20260519438065&amp;lan=en-US&amp;anchor=Tecentriq+Hybreza&amp;index=6&amp;md5=9076ac8be8d874f85b0b9c680eb545e2\" rel=\"nofollow\" shape=\"rect\"><b>Tecentriq Hybreza<\/b><\/a><b> for additional Important Safety Information.<\/b><\/p>\n<p>\n<b>About Genentech in cancer immunotherapy<\/b><\/p>\n<p>\nTo learn more about Genentech\u2019s scientific-led approach to cancer immunotherapy, please follow this link: <a target=\"_blank\" href=\"https:\/\/cts.businesswire.com\/ct\/CT?id=smartlink&amp;url=https%3A%2F%2Fwww.gene.com%2Fcancer-immunotherapy&amp;esheet=54535667&amp;newsitemid=20260519438065&amp;lan=en-US&amp;anchor=https%3A%2F%2Fwww.gene.com%2Fcancer-immunotherapy&amp;index=7&amp;md5=499594d1646cd39f3b45a7a901e8f9cb\" rel=\"nofollow\" shape=\"rect\">https:\/\/www.gene.com\/cancer-immunotherapy<\/a>.<\/p>\n<p>\n<b>About Genentech<\/b><\/p>\n<p>\nFounded 50 years ago, Genentech is a leading biotechnology company that discovers, develops, manufactures and commercializes medicines to treat patients with serious and life-threatening medical conditions. The company, a member of the Roche Group, has headquarters in South San Francisco, California. For additional information about the company, please visit <a target=\"_blank\" href=\"https:\/\/cts.businesswire.com\/ct\/CT?id=smartlink&amp;url=https%3A%2F%2Fwww.gene.com%2F&amp;esheet=54535667&amp;newsitemid=20260519438065&amp;lan=en-US&amp;anchor=http%3A%2F%2Fwww.gene.com&amp;index=8&amp;md5=dc4585cc64f528b154aa9e0fd9f4b6ec\" rel=\"nofollow\" shape=\"rect\">http:\/\/www.gene.com<\/a>.<\/p>\n<p> <b>Contacts<\/b> <\/p>\n<p>\nMedia Contact: Stella Belonwu (650) 467-6800<br \/>\n<br \/>Advocacy Contact: Mychalleah Werner (650) 296-6218<br \/>\n<br \/>Investor Contacts: Loren Kalm (650) 225-3217<br \/>\n<br \/>Bruno Eschli +41 61 68-75284<br \/>\n<br \/>Rebekka Schnell +41 79 20-52703<\/p>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>First approved ctDNA MRD-guided therapy reinforcing Genentech\u2019s commitment to innovation and practice-changing precision medicine New treatment approach enables healthcare professionals to tailor treatment with the goal of improving clinical benefit and reducing unnecessary intervention Approval marks the eleventh indication for Tecentriq in the U.S., providing a new option for an aggressive form of cancer SOUTH &#8230; <span class=\"more\"><a class=\"more-link\" href=\"https:\/\/pharma-trend.com\/en\/fda-approves-genentechs-tecentriq-for-adjuvant-muscle-invasive-bladder-cancer-with-ctdna-guided-treatment\/\">[Read more&#8230;]<\/a><\/span><\/p>\n","protected":false},"author":4,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[13],"tags":[],"class_list":{"0":"entry","1":"post","2":"publish","3":"author-business","4":"post-63111","6":"format-standard","7":"category-industry"},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.6 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>FDA Approves Genentech\u2019s Tecentriq for Adjuvant Muscle-Invasive Bladder Cancer With ctDNA-Guided Treatment - Pharma Trend<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/pharma-trend.com\/en\/fda-approves-genentechs-tecentriq-for-adjuvant-muscle-invasive-bladder-cancer-with-ctdna-guided-treatment\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"FDA Approves Genentech\u2019s Tecentriq for Adjuvant Muscle-Invasive Bladder Cancer With ctDNA-Guided Treatment - Pharma Trend\" \/>\n<meta property=\"og:description\" content=\"First approved ctDNA MRD-guided therapy reinforcing Genentech\u2019s commitment to innovation and practice-changing precision medicine New treatment approach enables healthcare professionals to tailor treatment with the goal of improving clinical benefit and reducing unnecessary intervention Approval marks the eleventh indication for Tecentriq in the U.S., providing a new option for an aggressive form of cancer SOUTH ... 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