Amivantamab – Uses, Dosage, Side Effects, Interactions

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Amivantamab - Uses, Dosage, Side Effects, Interactions
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Amivantamab, also known as JNJ-61186372, is an anti-EGFR-MET bispecific antibody, derived from Chinese hamster ovary cells, approved for the treatment of adult patients with locally advanced or metastatic non-small cell lung cancer (NSCLC) with epidermal growth factor receptor (EGFR) exon 20 insertion mutations, as detected...

For severe symptoms, danger signs, pregnancy, child illness, or sudden worsening, seek urgent medical care.

বাংলা রোগী নোট এখনো যোগ করা হয়নি। পোস্ট এডিটরে “RX Bangla Patient Mode” বক্স থেকে সহজ বাংলা সারাংশ যোগ করুন।

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Article Summary

Amivantamab, also known as JNJ-61186372, is an anti-EGFR-MET bispecific antibody, derived from Chinese hamster ovary cells, approved for the treatment of adult patients with locally advanced or metastatic non-small cell lung cancer (NSCLC) with epidermal growth factor receptor (EGFR) exon 20 insertion mutations, as detected by an FDA-approved test, whose disease has progressed on or after platinum-based chemotherapy.[rx,rx] Patients with NSCLC often develop resistance to...

Key Takeaways

  • This article explains Mechanism of action in simple medical language.
  • This article explains Indications in simple medical language.
  • This article explains Use in Cancer in simple medical language.
  • This article explains Contraindication in simple medical language.
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  • Any symptom that feels urgent, unusual, or unsafe for the patient.
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Definition

Amivantamab, also known as JNJ-61186372, is an anti-EGFR-MET bispecific antibody, derived from Chinese hamster ovary cells, approved for the treatment of adult patients with locally advanced or metastatic non-small cell lung cancer (NSCLC) with epidermal growth factor receptor (EGFR) exon 20 insertion mutations, as detected by an FDA-approved test, whose disease has progressed on or after platinum-based chemotherapy.[rx,rx] Patients with NSCLC often develop resistance to drugs that target EGFR and MET individually, so amivantamab was developed to attack both targets, reducing the chance of resistance developing.[rx,rx] Amivantamab was found to be more effective than the EGFR inhibitor erlotinib or the MET inhibitor crizotinib in vivo.[rx,rx] Patients with NSCLC with exon 20 insertion mutations in EGFR do not respond to tyrosine kinase inhibitors and were generally treated with platinum-based therapy.[rx]

Amivantamab was granted FDA approval on 21 May 2021,[rx] followed by the approval by the EMA on 9 December 2021 [rx] and Health Canada on 30 March 2022.[rx]

Mechanism of action

Mesenchymal-epithelial transition factor (MET) is a receptor with tyrosine kinase activity expressed on epithelial cells that, upon signaling, dimerizes and activates downstream pathways that signal cell division.[rx,rx] The Epidermal Growth Factor Receptor (EGFR) is a transmembrane protein with tyrosine kinase activity that can further activate downstream pathways that signal cell division, survival, and angiogenesis.[rx,rx] Patients with NSCLC with exon 20 insertion mutations in EGFR do not respond to tyrosine kinase inhibitors and are generally treated with platinum-based therapy.[rx] Exon 20 insertion mutations in EGFR also lead to conformational changes that activate EGFR.[rx]

Amivantamab targets both EGFR and MET, preventing ligands from binding to the receptors, blocking signalling, marking the cancerous cells for antibody-dependant cellular cytotoxicity by natural killer cells, and allowing macrophages to perform trogocytosis.[rx]

Amivantamab’s binding to the EGFR H epitope shares some of the same amino acids that cetuximab binds to.[rx]

Amivantamab’s binding to the alpha chain of MET stabilizes the Sema domain loop 1 to 2 in a position 6 Angstroms away from the position it would be in under normal binding, preventing its interaction with the hepatocyte growth factor’s (HGF) beta chain.1 Another smaller conformational change in the MET Sema domain loop 1 to 3 also contributes to preventing the interaction of the MET Sema domain with HGF’s beta chain.[rx] HGF is no longer able to bind to MET, preventing downstream signaling.[rx]

Amivantamab’s Fc portion contains 90% less fucose than normal antibodies, allowing for increased binding to the FcγRIIIa region.[rx] Binding of the Fc portion of Amivantamab signals the complement system and innate immune system to target the bound cells for complement-dependent cytotoxicity, antibody-dependent cell-mediated cytotoxicity, and antibody-dependent cellular phagocytosis.[rx] Binding of amivantamab to the Fc receptor also leads to an increase in levels of IFNγ.[rx]

Amivantamab also significantly downregulates the expression of EGFR and MET on NSCLC cell surfaces, further reducing downstream signaling.[rx,rx] EGFR and MET on the cell surface are internalized, and possibly degrading by fusing endosomes with lysosomes.[rx] Alternatively, EGFR and MET are the subjects of monocyte-dependent trogocytosis.[rx] Trogocytosis allows monocytes to internalize and break down EGFR and MET from the NSCLC cells without cytotoxicity, downmodulating EGFR and MET receptors.[rx]

Indications

  • Amivantamab is indicated in the treatment of adult patients with locally advanced or metastatic non-small cell lung cancer (NSCLC) with epidermal growth factor receptor (EGFR) exon 20 insertion mutations, whose disease has progressed on or after platinum-based chemotherapy.[rx]
  • Locally Advanced Non-Small Cell Lung Cancer
  • Metastatic Non-Small Cell Lung Cancer

Use in Cancer

Amivantamab-view is approved to treat:

Amivantamab-vmjw is approved under FDA’s Accelerated Approval Program. As a condition of approval, confirmatory trial(s) must show that it provides a clinical benefit to these patients.

Amivantamab-vmjw is also being studied in the treatment of other types of cancer.

Contraindication

  • Patients should not take amivantamab if they are pregnant or breastfeeding.
  • Mesenchymal-epithelial transition factor (MET) is a receptor with tyrosine kinase activity expressed on epithelial cells that, upon signaling, dimerizes and activates downstream pathways that signal cell division.

Dosage

Strengths: vmjw 50 mg/mL

Non-Small Cell Lung Cancer

Body weight at baseline (NOTE: dose adjustments are not required for subsequent body weight changes after baseline measurement):

  • Less than 80 kg: 1050 mg IV once a week for 4 weeks (with the initial dose as a split infusion in Week 1 on Day 1 and Day 2) then every 2 weeks thereafter until disease progression or unacceptable toxicity
  • Greater than or equal to 80 kg: 1400 mg IV once a week for 4 weeks (with the initial dose as a split infusion in Week 1 on Day 1 and Day 2) then every 2 weeks thereafter until disease progression or unacceptable toxicity

INFUSION RATES FOR THE 1050 MG DOSE
WEEK 1 (split dose infusion)

  • Week 1 Day 1: 350 mg IV at 50 mL/hr initially; increase the initial rate to the subsequent rate of 75 mL/hr after 2 hours in the absence of infusion-related reactions
  • Week 1 Day 2: 700 mg IV at 50 mL/hr initially; increase the initial rate to the subsequent rate of 75 mL/hr after 2 hours in the absence of infusion-related reactions

WEEK 2: 1050 mg IV at 85 mL/hr both initially and subsequently
WEEK 3: 1050 mg IV at 125 mL/hr both initially and subsequently
WEEK 4: 1050 mg IV at 125 mL/hr both initially and subsequently
SUBSEQUENT WEEKS (after Week 4 patients are dosed every 2 weeks): 1050 mg IV at 125 mL/hr

INFUSION RATES FOR THE 1400 MG DOSE
WEEK 1 (split dose infusion)

  • Week 1 Day 1: 350 mg IV at 50 mL/hr initially; increase the initial rate to the subsequent rate of 75 mL/hr after 2 hours in the absence of infusion-related reactions
  • Week 1 Day 2: 1050 mg IV at 35 mL/hr initially; increase the initial rate to the subsequent rate of 50 mL/hr after 2 hours in the absence of infusion-related reactions

WEEK 2: 1400 mg IV at 65 mL/hr both initially and subsequently
WEEK 3: 1400 mg IV at 85 mL/hr both initially and subsequently
WEEK 4: 1400 mg IV at 125 mL/hr both initially and subsequently
SUBSEQUENT WEEKS (after Week 4 patients are dosed every 2 weeks): 1400 mg IV at 125 mL/hr

PREMEDICATION

Prior to initial infusion of this drug (Week 1, Days 1 and 2), administer premedication to reduce the risk of infusion-related reactions:
ANTIHISTAMINE (required at all doses):
Diphenhydramine (25 to 50 mg) or equivalent:

  • IV: Administer 15 to 30 minutes before administering this drug.
  • Oral: Administer 30 to 60 minutes before administering this drug.

ANTIPYRETIC (required at all doses):
Acetaminophen (650 to 1000 mg):

  • IV: Administer 15 to 30 minutes before administering this drug.
  • Oral: Administer 30 to 60 minutes before administering this drug.

GLUCOCORTICOID (required at initial dose [Week 1, Days 1 and 2]; optional for subsequent doses):
Dexamethasone (10 mg) or methylprednisolone (40 mg) or equivalent:

  • IV: Administer 45 to 60 minutes before administering this drug.

NOTE: Administer both antihistamine and antipyretic prior to all infusions. Glucocorticoid administration required for Week 1, Days 1 and 2 doses only and as necessary for subsequent infusions.

Use: For patients with locally advanced or metastatic non-small cell lung cancer (NSCLC) with epidermal growth factor receptor (EGFR) exon 20 insertion mutations, as detected by an FDA-approved test, whose disease has progressed on or after platinum-based chemotherapy

Dose Adjustments

DOSE ADJUSTMENTS FOR ADVERSE REACTIONS
Body weight less than 80 kg at baseline:

  • Initial dose: 1050 mg
  • First dose reduction: 700 mg
  • Second dose reduction: 350 mg
  • Third dose reduction: Discontinue therapy.

Body weight 80 kg or greater at baseline:

  • Initial dose: 1400 mg
  • First dose reduction: 1050 mg
  • Second dose reduction: 700 mg
  • Third dose reduction: Discontinue therapy.

INFUSION-RELATED REACTIONS (IRRs)

  • Grade 1 or 2: Interrupt the infusion if IRR is suspected until resolved; resume at 50% of the infusion rate at which the reaction occurred; if no additional symptoms after 30 minutes, the infusion rate may be escalated as described in the adult dosing section; include corticosteroid with premedications for subsequent dose as described in the adult dosing section.
  • Grade 3: Interrupt the infusion and administer supportive care medications; monitor until resolved; resume the infusion at 50% of the infusion rate at which the reaction occurred; if no additional symptoms after 30 minutes, the infusion rate may be escalated as described in the adult dosing section.

INTERSTITIAL LUNG DISEASE (ILD)/PNEUMONITIS

  • Any Grade: Withhold therapy if ILD/pneumonitis is suspected; permanently discontinue therapy if ILD/pneumonitis is confirmed.

DERMATOLOGIC ADVERSE REACTIONS (e.g., dermatitis acneiform, pruritus, dry skin)

  • Grade 2: Initiate supportive care; reassess after 2 weeks; if rash does not improve, consider dose reduction.
  • Grade 3 (e.g., severe bullous, blistering, or exfoliating skin conditions [i.e., toxic epidermal necrolysis]): Withhold therapy and initiate supportive care; upon recovery to Grade 2 or less, resume at reduced dose; if no improvement within 2 weeks, permanently discontinue therapy.
  • Grade 4: Permanently discontinue therapy.

OTHER ADVERSE REACTIONS:

  • Grade 3: Withhold therapy until recovery to Grade 1 or less or baseline; resume at the same dose if recovery occurs within 1 week; resume at reduced dose if recovery occurs after 1 week but within 4 weeks; permanently discontinue therapy if recovery does not occur within 4 weeks.
  • Grade 4: Withhold therapy until recovery to Grade 1 or less or baseline; resume at reduced dose if recovery occurs within 4 weeks; permanently discontinue therapy if recovery does not occur within 4 weeks or for recurrent Grade 4 reactions.

Administration advice:

  • Select patients for treatment with this drug based on the presence of EGFR exon 20 insertion mutations.
  • The diluted solution should be administered within 10 hours (including infusion time) at room temperature 59F to 77F (15C to 25C).
  • Administer by IV infusion using an infusion set fitted with a flow regulator and with an in-line, sterile, non-pyrogenic, low protein-binding polyethersulfone (PES) filter (pore size 0.2 micrometer) primed with diluent only.
  • Administration sets should be made of either polyurethane (PU), polybutadiene (PBD) PVC, PP, or PE.
  • Administer this drug via a peripheral line on Week 1 and Week 2 due to the high incidence of infusion-related reactions during initial treatment; it may be administered via central line for subsequent weeks.
  • Do not infuse this drug concomitantly in the same IV line with other agents.

Reconstitution/preparation techniques:

  • Dilute and prepare this drug for IV infusion before administration.
  • Verify that the solution is colorless to pale yellow.
  • Do not use if discoloration or visible particles are present.
  • For the initial infusion, prepare this drug as close to administration time as possible to allow for the possibility of extended infusion time in the event of an infusion-related reaction.
  • The manufacturer’s product information should be consulted.

IV compatibility:

  • This drug is compatible with 5% dextrose solution or 0.9% sodium chloride solution.

Side Effects

The Most Common

  • swelling, pain, or changes in the fingernails or toenails
  • unusual tiredness or weakness
  • swelling of the face, lips, or eyes
  • swelling of the hands, feet, ankles, or lower legs
  • bone, muscle, joint, arm, leg, neck, or pain: Back pain means pain in the spine, muscles, discs, joints, or nerves of the back. সহজ বাংলা: পিঠ/কোমরের ব্যথা।" data-rx-term="back pain" data-rx-definition="Back pain means pain in the spine, muscles, discs, joints, or nerves of the back. সহজ বাংলা: পিঠ/কোমরের ব্যথা।">back pain
  • muscle aches, cramps, or stiffness
  • pain in the arms or legs
  • pain in the joints
  • redness, swelling, or soreness of the tongue
  • scaling, redness, burning, pain, or other signs of infection, or irritation, often causing pain, swelling, heat, or redness. সহজ বাংলা: শরীরের প্রদাহ; ব্যথা, ফোলা বা লালভাব হতে পারে।" data-rx-term="inflammation" data-rx-definition="Inflammation is the body’s response to injury, infection, or irritation, often causing pain, swelling, heat, or redness. সহজ বাংলা: শরীরের প্রদাহ; ব্যথা, ফোলা বা লালভাব হতে পারে।">inflammation of the lips
  • stomach pain
  • swelling or infection, or irritation, often causing pain, swelling, heat, or redness. সহজ বাংলা: শরীরের প্রদাহ; ব্যথা, ফোলা বা লালভাব হতে পারে।" data-rx-term="inflammation" data-rx-definition="Inflammation is the body’s response to injury, infection, or irritation, often causing pain, swelling, heat, or redness. সহজ বাংলা: শরীরের প্রদাহ; ব্যথা, ফোলা বা লালভাব হতে পারে।">inflammation of the mouth
  • mouth sores
  • nausea
  • vomiting
  • diarrhea
  • constipation
  • stomach pain
  • decreased appetite
  • numbness, tingling, pain, or burning in arms or legs
  • pain in the head or upper neck. সহজ বাংলা: মাথাব্যথা।" data-rx-term="headache" data-rx-definition="Headache means pain in the head or upper neck. সহজ বাংলা: মাথাব্যথা।">headache
  • dizziness

More Common

  • new or worsening cough, shortness of breath, fever, or chest pain
  • burning, crawling, itching, numbness, painful, prickling, “pins and needles”, or tingling feelings
  • eye pain
  • dry, red, teary, itchy, or painful eyes
  • blurred vision
  • vision changes
  • sensitivity of eyes to light
  • easy bruising or bleeding
  • bleeding from gums or nose
  • blood in urine or stool
  • coughing up blood

Rare

  • bleeding gums
  • blistering, crusting, irritation, itching, or reddening of the skin
  • blood in the urine
  • bloody nose
  • chest pain or tightness
  • chills
  • cough
  • coughing or spitting up blood
  • cracked, dry, or scaly skin
  • dry, itching skin
  • fever
  • flushing
  • headache
  • loosening of the fingernails
  • muscle or bone pain
  • nausea and vomiting
  • nerve pain
  • rash with flat lesions or small raised lesions on the skin
  • redness or soreness around the fingernails
  • sneezing
  • swelling
  • trouble breathing
  • unsteadiness or awkwardness
  • weakness in the arms, hands, legs, or feet

Drug Interactions

 

Pregnancy and Lactation

US FDA pregnancy category: Not assigned.

Pregnancy

Based on the mechanism of action and findings in animal models, RYBREVANT can cause fetal harm when administered to a pregnant woman. There are no available data on the use of RYBREVANT in pregnant women or animal data to assess the risk of RYBREVANT in pregnancy. Disruption or depletion of EGFR in animal models resulted in impairment of embryo-fetal development including effects on placental, lung, cardiac, skin, and neural development. The absence of EGFR or MET signaling has resulted in embryolethality, malformations, and post-natal death in animalsAdvise pregnant women of the potential risk to a fetus.

In the U.S. general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2% to 4% and 15% to 20%, respectively.

Lactation

There are no data on the presence of amivantamab in human milk on milk production or its effects on the breastfed child. Because of the potential for serious adverse reactions from RYBREVANT in breastfed infants, advise women not to breastfeed during treatment with RYBREVANT and for 3 months after the final dose.

RYBREVANT can cause fetal harm when administered to a pregnant woman. Verify the pregnancy status of females of reproductive potential prior to initiating RYBREVANT. Advise females of reproductive potential to use effective contraception during treatment and for 3 months after the final dose of RYBREVANT.

What special precautions should I follow?

Before receiving amivantamab-vmjw injection,

  • tell your doctor and pharmacist if you are allergic to amivantamab-vmjw, any other medications, or any of the ingredients in amivantamab-vmjw injection. Ask your pharmacist for a list of the ingredients.
  • tell your doctor and pharmacist what other prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
  • tell your doctor if you have or have ever had a lung disease other than lung cancer, or breathing problems.
  • tell your doctor if you are pregnant or plan to become pregnant. You should not become pregnant while you are receiving amivantamab-vmjw injection. You will need to have a pregnancy test before you begin receiving this medication. Use effective birth control during your treatment with amivantamab-vmjw injection and for 3 months after your final dose. If you become pregnant while receiving amivantamab-vmjw injection, call your doctor. Amivantamab-vmjw injection may harm the fetus.
  • tell your doctor if you are breastfeeding. Your doctor will tell you not to breastfeed during your treatment with amivantamab-vmjw injection and for 3 months after your final dose.
  • you should know that amivantamab-vmjw may cause skin reactions, including some that may be severe. You should plan to avoid unnecessary or prolonged exposure to sunlight and to wear protective clothing, sunglasses, and sunscreen during your treatment with amivantamab-vmjw injection and for 2 months after your final dose. Your doctor may tell you to use an alcohol-free moisturizer if you develop dry or irritated skin. If you experience any of the following symptoms, call your doctor immediately: rash, itching, dry or cracking skin, or blistering, peeling, or shedding skin

References

 

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Safety note: This is not a prescription or diagnosis. For severe symptoms, pregnancy danger signs, children with serious illness, chest pain, breathing difficulty, stroke-like weakness, or major injury, seek urgent care.

Which doctor may help?

Start with a registered doctor or the nearest qualified health center.

What to tell the doctor

  • Write when the problem started and how it changed.
  • Bring old prescriptions, investigation reports, and current medicines.
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  • Bring one family member if the patient is weak, elderly, confused, or a child.

Questions to ask

  • What is the most likely cause of my symptoms?
  • Which danger signs mean I should go to hospital quickly?
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  • How should I take medicines safely and what side effects should I watch for?
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Tests to discuss

  • Vital signs: temperature, pulse, blood pressure, oxygen saturation
  • Basic physical examination by a clinician
  • CBC, urine test, blood sugar, or imaging only when clinically needed

Avoid these mistakes

  • Do not use antibiotics, steroid tablets/injections, or strong painkillers without proper medical advice.
  • Do not hide pregnancy, kidney disease, ulcer, allergy, or blood thinner use.
  • Do not delay emergency care when danger signs are present.

Medicine safety and first-aid guide

This section is for patient education only. It does not replace a doctor, pharmacist, or emergency care.

Safe first steps

  • Avoid heavy lifting, sudden bending, and prolonged bed rest.
  • Use comfortable posture and gentle movement as tolerated.
  • Discuss physiotherapy, X-ray, or MRI only when clinically needed.

OTC medicine safety

  • For mild back pain, pain-relief medicine may be discussed with a doctor or pharmacist.
  • Avoid repeated painkiller use if you have kidney disease, stomach ulcer, uncontrolled blood pressure, or are taking blood thinners.

Avoid these mistakes

  • Do not start antibiotics without a proper medical decision.
  • Do not use steroid tablets or injections casually for quick relief.
  • Do not delay emergency care because of home remedies.

Get urgent help if

  • Back pain with leg weakness, numbness around private area, loss of urine/stool control, fever, cancer history, or major injury needs urgent care.
Medicine names, dose, and timing must be decided by a qualified clinician or pharmacist after checking age, pregnancy, allergy, other diseases, and current medicines.

For rural patients and family caregivers

Patient health record and symptom diary

Write your symptoms, medicines already taken, test results, and questions before visiting a doctor. This note stays on your device unless you print or copy it.

Doctor to discuss: Orthopedic / spine specialist, physical medicine doctor, or qualified clinician
Tests to discuss with doctor
  • Neurological examination for leg power, sensation, reflexes, and straight leg raise
  • X-ray only if injury, deformity, long-lasting pain, or doctor suspects bone problem
  • MRI discussion if severe nerve symptoms, weakness, bladder/bowel problem, or persistent symptoms
Questions to ask
  • What is the most likely cause of my symptoms?
  • Which warning signs mean I should go to emergency care?
  • Which tests are really needed now?
  • Which medicines are safe for my age, pregnancy status, allergy, kidney/liver/stomach condition, and current medicines?
  • Is physiotherapy, posture correction, or activity modification needed?

Emergency warning signs such as chest pain, severe breathing difficulty, sudden weakness, confusion, severe dehydration, major injury, or loss of bladder/bowel control need urgent medical care. Do not wait for online information.

Safe pathway to proper treatment

Care roadmap for: Amivantamab – Uses, Dosage, Side Effects, Interactions

Use this simple roadmap to understand the next safe steps. It is educational and does not replace examination by a doctor.

Go to emergency care if you notice:
  • Severe or rapidly worsening symptoms
  • Breathing difficulty, chest pain, fainting, confusion, severe weakness, major injury, or severe dehydration
Doctor / service to discuss: Qualified healthcare provider; specialist depends on symptoms and examination.
  1. Step 1

    Check danger signs first

    If danger signs are present, seek emergency care and do not wait for online information.

  2. Step 2

    Record the symptom story

    Write when symptoms started, severity, medicines already taken, allergies, pregnancy status, and test results.

  3. Step 3

    Visit a qualified clinician

    A doctor, nurse, or qualified healthcare provider can examine you and decide which tests or treatment are needed.

  4. Step 4

    Do only useful tests

    Do tests after clinical assessment. Avoid unnecessary tests, random antibiotics, or repeated medicines without diagnosis.

  5. Step 5

    Follow up and return early if worse

    If symptoms worsen, new warning signs appear, or treatment is not helping, return for review quickly.

Rural patient practical tips
  • Take a written symptom diary and all previous prescriptions/test reports.
  • Do not hide medicines already taken, even herbal or over-the-counter medicines.
  • Ask which warning signs mean urgent referral to hospital.

This roadmap is for education. A real diagnosis and treatment plan requires history, examination, and clinical judgment.

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Frequently Asked Questions

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