DS-8201a in HER2-positive Gastric Cancer That Cannot Be Surgically Removed or Has Spread (DESTINY-Gastric02)

• ClinicalTrials.gov Identifier: NCT04014075
• Recruitment Status: Completed
• First Posted: July 10, 2019
• Results First Posted: January 12, 2022
• Last Update Posted: April 9, 2024
• Sponsor: Daiichi Sankyo
• Collaborator: AstraZeneca
• Information provided by (Responsible Party): Daiichi Sankyo

• Study Type: Interventional
• Study Design: Allocation: N/A; Intervention Model: Single Group Assignment; Masking: None (Open Label); Primary Purpose: Treatment
• Conditions: Adenocarcinoma Gastric Stage IV With Metastases; Adenocarcinoma - GEJ
• Intervention: Drug: Trastuzumab deruxtecan
• Enrollment: 79

Participant Flow

Recruitment Details

A total of 79 participants who met all inclusion criteria and no exclusion criteria were enrolled and treated at clinic centers in United States, Spain, Italy, United Kingdom, and Belgium. Results reported is from baseline up to data cut-off date of 08 Nov 2021. The results presented are based on primary analysis up to 16 months (09 Apr 2021) and data cut-off date of 08 Nov 2021. Data collection is still on-going and additional results will be provided after study completion.

Pre-assignment Details

Arm/Group Title	Trastuzumab Deruxtecan
Arm/Group Description	Participants who have centrally confirmed HER2-positive gastric or gastro-esophageal junction cancer received an intravenous (IV) infusion 6.4 mg/kg dose of trastuzumab deruxtecan every 3 weeks, until progression of disease or withdrawal from treatment for other reasons.
Period Title: Overall Study
Started	79
Completed [1]	10
Not Completed	69
Reason Not Completed
Progressive Disease	48
Adverse Event	11
Clinical Progression	4
Death	2
Withdrawal by Subject	2
Miscellaneous	1
Physician Decision	1
[1] Completed = Participants ongoing treatment as of 08 Nov 2021, Not Completed = Participants who discontinued treatment

Baseline Characteristics

Arm/Group Title		Trastuzumab Deruxtecan
Arm/Group Description		Participants who have centrally confirmed HER2-positive gastric or gastro-esophageal junction cancer treated with trastuzumab deruxtecan by intravenous (IV) infusion every 3 weeks, until progression of disease or withdrawal from treatment for other reasons.
Overall Number of Baseline Participants		79
Baseline Analysis Population Description		[Not Specified]
Age, Categorical; Measure Type: Count of Participants; Unit of measure: Participants
	Number Analyzed	79 participants
	<=18 years	0 0.0%
	Between 18 and 65 years	46 58.2%
	>=65 years	33 41.8%
Age, Continuous; Median (Full Range); Unit of measure: Years
	Number Analyzed	79 participants
		60.7; (20.3 to 77.8)
Sex: Female, Male; Measure Type: Count of Participants; Unit of measure: Participants
	Number Analyzed	79 participants
	Female	22 27.8%
	Male	57 72.2%
Race (NIH/OMB); Measure Type: Count of Participants; Unit of measure: Participants
	Number Analyzed	79 participants
	American Indian or Alaska Native	0 0.0%
	Asian	4 5.1%
	Native Hawaiian or Other Pacific Islander	1 1.3%
	Black or African American	1 1.3%
	White	69 87.3%
	More than one race	0 0.0%
	Unknown or Not Reported	4 5.1%
Region of Enrollment; Measure Type: Number; Unit of measure: Participants	Number Analyzed	79 participants
Belgium		4
United States		34
Italy		20
United Kingdom		17
Spain		4

Outcome Measures

1. Primary Outcome

Title	Percentage of Participants With Objective Response Rate (ORR) Based on Independent Central Review Following Treatment With DS8201a in Participants With HER2-Positive Unresectable or Metastatic Gastric or Gastro-Esophageal Junction (GEJ) Adenocarcinoma
Description	The Objective Response Rate (ORR) was the defined as the percentage of participants who achieved a best overall response of confirmed Complete Response (CR) or Partial Response (PR), assessed by independent central review (ICR) committee based on RECIST version 1.1. CR was defined as a disappearance of all target lesions and PR was defined as at least a 30% decrease in the sum of diameters of target lesions. Confirmed ORR based on ICR is reported.
Time Frame	Up to 16 months (data cut-off)

Outcome Measure Data

Analysis Population Description

Objective response rate was assessed in the Full Analysis Set at data cut-off date of 09 April 2021.

Arm/Group Title	Trastuzumab Deruxtecan
Arm/Group Description:	Participants who have centrally confirmed HER2-positive gastric or gastro-esophageal junction cancer received an intravenous (IV) infusion 6.4 mg/kg dose of trastuzumab deruxtecan every 3 weeks, until progression of disease or withdrawal from treatment for other reasons.
Overall Number of Participants Analyzed	79
Measure Type: Number; Number (95% Confidence Interval); Unit of Measure: Percentage of Participants
	38.0; (27.3 to 49.6)

2. Primary Outcome

Title	Percentage of Participants With Objective Response Rate (ORR) Based on Independent Central Review Following Treatment With DS8201a in Participants With HER2-Positive Unresectable or Metastatic Gastric or Gastro-Esophageal Junction (GEJ) Adenocarcinoma
Description	The Objective Response Rate (ORR) was the defined as the percentage of participants who achieved a best overall response of confirmed Complete Response (CR) or Partial Response (PR), assessed by independent central review (ICR) committee based on RECIST version 1.1. CR was defined as a disappearance of all target lesions and PR was defined as at least a 30% decrease in the sum of diameters of target lesions. Confirmed ORR based on ICR is reported.
Time Frame	Up to 23 months (data cut-off)

Outcome Measure Data

Analysis Population Description

Objective response rate was assessed in the Full Analysis Set at data cut-off date of 08 Nov 2021.

Arm/Group Title	Trastuzumab Deruxtecan
Arm/Group Description:	Participants who have centrally confirmed HER2-positive gastric or gastro-esophageal junction cancer received an intravenous (IV) infusion 6.4 mg/kg dose of trastuzumab deruxtecan every 3 weeks, until progression of disease or withdrawal from treatment for other reasons.
Overall Number of Participants Analyzed	79
Measure Type: Number; Number (95% Confidence Interval); Unit of Measure: Percentage of Participants
	41.8; (30.8 to 53.4)

3. Secondary Outcome

Title	Progression-Free Survival (PFS) Based on Independent Central Review Following Treatment With DS8201a in Participants With HER2-Positive Unresectable or Metastatic Gastric or Gastro-Esophageal Junction (GEJ) Adenocarcinoma
Description	Progression-free survival (PFS) by independent central review was defined as the time from the date of enrollment to the earlier of the dates of the first objective documentation of disease progression (as per RECIST v1.1) or death due to any cause. Progressive disease was defined as at least a 20% increase in the sum of diameters of target lesions.
Time Frame	Up to 16 months (data cut-off)

Outcome Measure Data

Analysis Population Description

Progression-free survival (PFS) was assessed in the Full Analysis Set at data cut-off date of 09 April 2021.

Arm/Group Title	Trastuzumab Deruxtecan
Arm/Group Description:	Participants who have centrally confirmed HER2-positive gastric or gastro-esophageal junction cancer received an intravenous (IV) infusion 6.4 mg/kg dose of trastuzumab deruxtecan every 3 weeks, until progression of disease or withdrawal from treatment for other reasons.
Overall Number of Participants Analyzed	79
Median (95% Confidence Interval); Unit of Measure: months
	5.5; (4.2 to 7.3)

4. Secondary Outcome

Title	Progression-Free Survival (PFS) Based on Independent Central Review Following Treatment With DS8201a in Participants With HER2-Positive Unresectable or Metastatic Gastric or Gastro-Esophageal Junction (GEJ) Adenocarcinoma
Description	Progression-free survival (PFS) by independent central review was defined as the time from the date of enrollment to the earlier of the dates of the first objective documentation of disease progression (as per RECIST v1.1) or death due to any cause. Progressive disease was defined as at least a 20% increase in the sum of diameters of target lesions.
Time Frame	Up to 23 months (data cut-off)

Outcome Measure Data

Analysis Population Description

Progression-free survival (PFS) was assessed in the Full Analysis Set data at cut-off date of 08 Nov 2021

Arm/Group Title	Trastuzumab Deruxtecan
Arm/Group Description:	Participants who have centrally confirmed HER2-positive gastric or gastro-esophageal junction cancer received an intravenous (IV) infusion 6.4 mg/kg dose of trastuzumab deruxtecan every 3 weeks, until progression of disease or withdrawal from treatment for other reasons.
Overall Number of Participants Analyzed	79
Median (95% Confidence Interval); Unit of Measure: months
	5.6; (4.2 to 8.3)

5. Secondary Outcome

Title	Progression-Free Survival (PFS) Based on Investigator Assessment Following Treatment With DS8201a in Participants With HER2-Positive Unresectable or Metastatic Gastric or Gastro-Esophageal Junction (GEJ) Adenocarcinoma
Description	Progression-free survival (PFS) by investigator assessment was defined as the time from the date of enrollment to the earlier of the dates of the first objective documentation of disease progression (as per RECIST v1.1) or death due to any cause. Progressive disease was defined as at least a 20% increase in the sum of diameters of target lesions.
Time Frame	Up to 16 months (data cut-off)

Outcome Measure Data

Analysis Population Description

Progression-free survival (PFS) was assessed in the Full Analysis Set at data cut-off date of 09 April 2021.

Arm/Group Title	Trastuzumab Deruxtecan
Arm/Group Description:	Participants who have centrally confirmed HER2-positive gastric or gastro-esophageal junction cancer received an intravenous (IV) infusion 6.4 mg/kg dose of trastuzumab deruxtecan every 3 weeks, until progression of disease or withdrawal from treatment for other reasons.
Overall Number of Participants Analyzed	79
Median (95% Confidence Interval); Unit of Measure: months
	5.5; (4.1 to 6.9)

6. Secondary Outcome

Title	Objective Response Rate (ORR) Based on Investigator Assessment Following Treatment With DS8201a in Participants With HER2-Positive Unresectable or Metastatic Gastric or Gastro-Esophageal Junction (GEJ) Adenocarcinoma
Description	The Objective Response Rate (ORR) was defined as the percentage of participants who achieved a best overall response of confirmed Complete Response (CR) or Partial Response (PR), assessed by investigator assessment based on RECIST version 1.1. CR was defined as a disappearance of all target lesions and PR was defined as at least a 30% decrease in the sum of diameters of target lesions. Confirmed ORR based on investigator assessment is reported.
Time Frame	Up to 16 months (data cut-off)

Outcome Measure Data

Analysis Population Description

Objective response rate was assessed in the Full Analysis Set at data cut-off date of 09 April 2021.

Arm/Group Title	Trastuzumab Deruxtecan
Arm/Group Description:	Participants who have centrally confirmed HER2-positive gastric or gastro-esophageal junction cancer received an intravenous (IV) infusion 6.4 mg/kg dose of trastuzumab deruxtecan every 3 weeks, until progression of disease or withdrawal from treatment for other reasons.
Overall Number of Participants Analyzed	79
Measure Type: Number; Number (95% Confidence Interval); Unit of Measure: Percentage of Participants
	34.2; (23.9 to 45.7)

7. Secondary Outcome

Title	Objective Response Rate (ORR) Based on Investigator Assessment Following Treatment With DS8201a in Participants With HER2-Positive Unresectable or Metastatic Gastric or Gastro-Esophageal Junction (GEJ) Adenocarcinoma
Description	The Objective Response Rate (ORR) was defined as the percentage of participants who achieved a best overall response of confirmed Complete Response (CR) or Partial Response (PR), assessed by investigator assessment based on RECIST version 1.1. CR was defined as a disappearance of all target lesions and PR was defined as at least a 30% decrease in the sum of diameters of target lesions. Confirmed ORR based on investigator assessment is reported.
Time Frame	Up to 23 months (data cut-off)

Outcome Measure Data

Analysis Population Description

Objective response rate was assessed in the Full Analysis Set at data cut-off date of 08 Nov 2021.

Arm/Group Title	Trastuzumab Deruxtecan
Arm/Group Description:	Participants who have centrally confirmed HER2-positive gastric or gastro-esophageal junction cancer received an intravenous (IV) infusion 6.4 mg/kg dose of trastuzumab deruxtecan every 3 weeks, until progression of disease or withdrawal from treatment for other reasons.
Overall Number of Participants Analyzed	79
Measure Type: Number; Number (95% Confidence Interval); Unit of Measure: Percentage of Participants
	36.7; (26.1 to 48.3)

8. Secondary Outcome

Title	Overall Survival (OS) Following Treatment With DS8201a in Participants With HER2-Positive Unresectable or Metastatic Gastric or Gastro-Esophageal Junction (GEJ) Adenocarcinoma
Description	Overall survival (OS) was defined as the time from the date of first dose of study drug to the date of death due to any cause.
Time Frame	Up to 16 months (data cut-off)

Outcome Measure Data

Analysis Population Description

Overall survival (OS) was assessed in the Full Analysis Set at data cut-off date of 09 April 2021.

Arm/Group Title	Trastuzumab Deruxtecan
Arm/Group Description:	Participants who have centrally confirmed HER2-positive gastric or gastro-esophageal junction cancer received an intravenous (IV) infusion 6.4 mg/kg dose of trastuzumab deruxtecan every 3 weeks, until progression of disease or withdrawal from treatment for other reasons.
Overall Number of Participants Analyzed	79
Median (95% Confidence Interval); Unit of Measure: months
	NA [1]; (11.5 to NA)

[1]

Median OS and upper limit of 95% Confidence Interval (CI) was not estimable due to insufficient number of OS events.

9. Secondary Outcome

Title	Overall Survival (OS) Following Treatment With DS8201a in Participants With HER2-Positive Unresectable or Metastatic Gastric or Gastro-Esophageal Junction (GEJ) Adenocarcinoma
Description	Overall survival (OS) was defined as the time from the date of first dose of study drug to the date of death due to any cause.
Time Frame	Up to 23 months (data cut-off)

Outcome Measure Data

Analysis Population Description

Overall survival (OS) was assessed in the Full Analysis Set at data cut-off date of 08 Nov 2021.

Arm/Group Title	Trastuzumab Deruxtecan
Arm/Group Description:	Participants who have centrally confirmed HER2-positive gastric or gastro-esophageal junction cancer received an intravenous (IV) infusion 6.4 mg/kg dose of trastuzumab deruxtecan every 3 weeks, until progression of disease or withdrawal from treatment for other reasons.
Overall Number of Participants Analyzed	79
Median (95% Confidence Interval); Unit of Measure: months
	12.1; (9.4 to 15.4)

10. Secondary Outcome

Title	Duration of Response (DoR) Following Treatment With DS8201a in Participants With HER2-Positive Unresectable or Metastatic Gastric or Gastro-Esophageal Junction (GEJ) Adenocarcinoma
Description	Duration of Response (DOR) was defined as the time from the date of the first documentation of objective response (complete response [CR] or partial response [PR]) to the date of the first objective documentation of progressive disease (PD) or death due to any cause. DoR based on independent central review.
Time Frame	Up to 16 months (data cut-off)

Outcome Measure Data

Analysis Population Description

Duration of Response (DOR) was assessed in the Full Analysis Set at data cut-off date of 09 April 2021.

Arm/Group Title	Trastuzumab Deruxtecan
Arm/Group Description:	Participants who have centrally confirmed HER2-positive gastric or gastro-esophageal junction cancer received an intravenous (IV) infusion 6.4 mg/kg dose of trastuzumab deruxtecan every 3 weeks, until progression of disease or withdrawal from treatment for other reasons.
Overall Number of Participants Analyzed	79
Median (95% Confidence Interval); Unit of Measure: months
	8.1 [1]; (4.1 to NA)

[1]

The upper limit was not estimable due to the reason that the curve representing the upper confidence limits for the survivor function lies above 0.5.

11. Secondary Outcome

Title	Duration of Response (DoR) Following Treatment With DS8201a in Participants With HER2-Positive Unresectable or Metastatic Gastric or Gastro-Esophageal Junction (GEJ) Adenocarcinoma
Description	Duration of Response (DOR) was defined as the time from the date of the first documentation of objective response (complete response [CR] or partial response [PR]) to the date of the first objective documentation of progressive disease (PD) or death due to any cause. DoR based on independent central review.
Time Frame	Up to 23 months (data cut-off)

Outcome Measure Data

Analysis Population Description

Duration of Response (DOR) was assessed in the Full Analysis Set at data cut-off date of 08 Nov 2021.

Arm/Group Title	Trastuzumab Deruxtecan
Arm/Group Description:	Participants who have centrally confirmed HER2-positive gastric or gastro-esophageal junction cancer received an intravenous (IV) infusion 6.4 mg/kg dose of trastuzumab deruxtecan every 3 weeks, until progression of disease or withdrawal from treatment for other reasons.
Overall Number of Participants Analyzed	79
Median (95% Confidence Interval); Unit of Measure: months
	8.1 [1]; (5.9 to NA)

[1]

The upper limit was not estimable due to the reason that the curve representing the upper confidence limits for the survivor function lies above 0.5.

Adverse Events

Time Frame	Adverse events (AE) were collected from the date of signing the informed consent form up to 47 days after last dose of the study drug, up to 23 months.
Adverse Event Reporting Description	A Treatment-emergent adverse event (TEAE) is defined as an AE that occurs, having been absent before the first dose of study drug, or has worsened in severity or seriousness after the initiating the study drug until 47 days after last dose of the study drug.
Arm/Group Title	Trastuzumab Deruxtecan
Arm/Group Description	Participants who have centrally confirmed HER2-positive gastric or gastro-esophageal junction cancer received an intravenous (IV) infusion 6.4 mg/kg dose of trastuzumab deruxtecan every 3 weeks, until progression of disease or withdrawal from treatment for other reasons.
All-Cause Mortality
	Trastuzumab Deruxtecan
	Affected / at Risk (%)
Total	46/79 (58.23%)
Serious Adverse Events
	Trastuzumab Deruxtecan
	Affected / at Risk (%)
Total	33/79 (41.77%)
Gastrointestinal disorders
Nausea † 1	4/79 (5.06%)
Vomiting † 1	3/79 (3.80%)
Abdominal Pain † 1	2/79 (2.53%)
Colitis † 1	1/79 (1.27%)
Diarrhoea † 1	1/79 (1.27%)
Dysphagia † 1	1/79 (1.27%)
Enteritis † 1	1/79 (1.27%)
Haematemesis † 1	1/79 (1.27%)
Intestinal Obstruction † 1	1/79 (1.27%)
General disorders
Disease Progression † 1	2/79 (2.53%)
Hyperpyrexia † 1	1/79 (1.27%)
Hepatobiliary disorders
Bile Duct Stenosis † 1	1/79 (1.27%)
Hepatotoxicity † 1	1/79 (1.27%)
Infections and infestations
Covid-19 † 1	2/79 (2.53%)
Pneumonia † 1	2/79 (2.53%)
Bacterial Sepsis † 1	1/79 (1.27%)
Covid-19 Pneumonia † 1	1/79 (1.27%)
Device Related Infection † 1	1/79 (1.27%)
Staphylococcal Infection † 1	1/79 (1.27%)
Urinary Tract Infection † 1	2/79 (2.53%)
Wound Infection † 1	1/79 (1.27%)
Catheter Site Infection † 1	1/79 (1.27%)
Injury, poisoning and procedural complications
Animal Bite † 1	1/79 (1.27%)
Exposure To Communicable Disease † 1	1/79 (1.27%)
Neoplasms benign, malignant and unspecified (incl cysts and polyps)
Malignant Neoplasm Progression † 1	2/79 (2.53%)
Lymphangiosis Carcinomatosa † 1	1/79 (1.27%)
Tumour Haemorrhage † 1	1/79 (1.27%)
Nervous system disorders
Basal Ganglia Infarction † 1	1/79 (1.27%)
Cerebrovascular Accident † 1	1/79 (1.27%)
Generalised Tonic-Clonic Seizure † 1	1/79 (1.27%)
Product Issues
Device Occlusion † 1	1/79 (1.27%)
Renal and urinary disorders
Acute Kidney Injury † 1	2/79 (2.53%)
Hydronephrosis † 1	1/79 (1.27%)
Urinary Tract Obstruction † 1	1/79 (1.27%)
Respiratory, thoracic and mediastinal disorders
Interstitial Lung Disease † 1	2/79 (2.53%)
Pneumonitis † 1	1/79 (1.27%)
Pulmonary Embolism † 1	1/79 (1.27%)
1 Term from vocabulary, MedDRA (23.0); † Indicates events were collected by systematic assessment
Other (Not Including Serious) Adverse Events
Frequency Threshold for Reporting Other Adverse Events	5%
	Trastuzumab Deruxtecan
	Affected / at Risk (%)
Total	79/79 (100.00%)
Blood and lymphatic system disorders
Anaemia † 1	30/79 (37.97%)
Neutropenia † 1	8/79 (10.13%)
Thrombocytopenia † 1	5/79 (6.33%)
Gastrointestinal disorders
Nausea † 1	51/79 (64.56%)
Vomiting † 1	35/79 (44.30%)
Diarrhoea † 1	29/79 (36.71%)
Constipation † 1	23/79 (29.11%)
Abdominal Pain † 1	11/79 (13.92%)
Gastrooesophageal Reflux Disease † 1	8/79 (10.13%)
Ascites † 1	5/79 (6.33%)
Dysphagia † 1	5/79 (6.33%)
Abdominal Pain Upper † 1	5/79 (6.33%)
Flatulence † 1	4/79 (5.06%)
General disorders
Fatigue † 1	33/79 (41.77%)
Asthenia † 1	12/79 (15.19%)
Pyrexia † 1	9/79 (11.39%)
Oedema Peripheral † 1	4/79 (5.06%)
Mucosal Inflammation † 1	4/79 (5.06%)
Infections and infestations
Covid-19 † 1	5/79 (6.33%)
Device Related Infection † 1	4/79 (5.06%)
Urinary Tract Infection † 1	4/79 (5.06%)
Investigations
Weight Decreased † 1	28/79 (35.44%)
Platelet Count Decreased † 1	14/79 (17.72%)
Neutrophil Count Decreased † 1	13/79 (16.46%)
Aspartate Aminotransferase Increased † 1	13/79 (16.46%)
White Blood Cell Count Decreased † 1	9/79 (11.39%)
Alanine Aminotransferase Increased † 1	8/79 (10.13%)
Blood Alkaline Phosphatase Increased † 1	9/79 (11.39%)
Blood Bilirubin Increased † 1	5/79 (6.33%)
Weight Increased † 1	5/79 (6.33%)
Blood Creatinine Increased † 1	4/79 (5.06%)
Metabolism and nutrition disorders
Decreased Appetite † 1	26/79 (32.91%)
Hypokalaemia † 1	13/79 (16.46%)
Hypoalbuminaemia † 1	8/79 (10.13%)
Hyponatraemia † 1	6/79 (7.59%)
Hypophosphataemia † 1	4/79 (5.06%)
Musculoskeletal and connective tissue disorders
Back Pain † 1	7/79 (8.86%)
Nervous system disorders
Headache † 1	7/79 (8.86%)
Dizziness † 1	6/79 (7.59%)
Psychiatric disorders
Insomnia † 1	5/79 (6.33%)
Depression † 1	4/79 (5.06%)
Renal and urinary disorders
Urinary Retention † 1	5/79 (6.33%)
Acute Kidney Injury † 1	4/79 (5.06%)
Respiratory, thoracic and mediastinal disorders
Dyspnoea † 1	7/79 (8.86%)
Cough † 1	9/79 (11.39%)
Epistaxis † 1	8/79 (10.13%)
Interstitial Lung Disease † 1	4/79 (5.06%)
Pneumonitis † 1	5/79 (6.33%)
Skin and subcutaneous tissue disorders
Alopecia † 1	19/79 (24.05%)
Vascular disorders
Hypotension † 1	6/79 (7.59%)
1 Term from vocabulary, MedDRA (23.0); † Indicates events were collected by systematic assessment

Limitations and Caveats

[Not Specified]

More Information

Certain Agreements

Principal Investigators are NOT employed by the organization sponsoring the study.

There is NOT an agreement between Principal Investigators and the Sponsor (or its agents) that restricts the PI's rights to discuss or publish trial results after the trial is completed.

Results Point of Contact

• Name/Title: Contact for Clinical Trial Information
• Organization: Daiichi Sankyo
• Phone: 1-908-992-6400
• EMail: CTRinfo@dsi.com

• Responsible Party: Daiichi Sankyo
• ClinicalTrials.gov Identifier: NCT04014075
• Other Study ID Numbers: DS8201-A-U205; 2019-001512-34 ( EudraCT Number )
• First Submitted: July 8, 2019
• First Posted: July 10, 2019
• Results First Submitted: December 14, 2021
• Results First Posted: January 12, 2022
• Last Update Posted: April 9, 2024