doxorubicin and cyclophosphamide

Full review, new dose modifications added. This has the potential to cause damage to affected tissue. Sometimes the AC portion is given before surgery and the taxane after, based on the cancer that remains in the breast after surgery. Ask your providers to explain why they recommend one taxane over another. Read more about cognitive changes (chemo fog). They may vary between institutions and can be substituted to reflect individual institutional policy. No change and next review in 2 years. Both altered antiepileptic and antineoplastic levels may occur, possibly leading to loss of efficacy or toxicity. Ensure patient receives patient information sheet. Severe local tissue necrosis will occur if there is extravasation during administration (see DOSAGE AND ADMINISTRATION). Drug unit costs are taken directly from the Pharmaceutical Benefits Scheme (PBS) website (www.pbs.gov.au), MIMS Online and other sources. No changes and next review in 2 years. palonosetron, ondansetron, granisetron, tropisetron, dolasetron, etc.). A reduction in the normal levels of functional platelets, increasing the risk of abnormal bleeding. Link to the independent evaluation of the evidence completed in 2006/7 removed from the evidence section as no longer relevant. IV cannula (IVC) or central venous access device (CVAD) is required to administer this treatment. Patients with normal baseline cardiac function (left ventricular ejection fraction (LVEF) > 50%) and low risk patients require LVEF monitoring when greater than 70% of anthracycline threshold is reached or if patient displays symptoms of cardiac impairment. Antineoplastic agents can damage the lining of the intestine; affecting the absorption of digoxin. We found that cyclophosphamide, paclitaxel, and doxorubicin, when given in a defined sequence with a GM-CSF-secreting, neu-expressing whole-cell vaccine, enhanced the vaccine‘s potential to delay tumor growth in neu transgenic mice. It can also be used in people who have had a recurrence depending the medicines you received for early-stage disease. Doxorubicin damages the DNA inside the cancer cells. Cancer treatment can have harmful effects on fertility and this should be discussed with all patients of reproductive age prior to commencing treatment. Ask your doctor how much and how often you should drink each day. Dabigatran: avoid combination with strong P‑gp inducers and inhibitors. If symptoms develop, slow infusion rate. This is caused by ovarian failure and may be temporary or permanent. Different medicines have different side effects. Six cycles of doxorubicin and cyclophosphamide or Paclitaxel are not superior to four cycles as adjuvant chemotherapy for breast cancer in women with zero to three positive axillary nodes: Cancer and Leukemia Group B 40101. Patients were treated with palliative CAP, with 750 mg/m 2 cyclophosphamide, 60 mg/m 2 cisplatin, and 40 mg/m 2 doxorubicin, all administered intravenously on day 1 every 3 weeks. The information contained in this protocol is based on the highest level of available evidence and consensus of the eviQ reference committee regarding their views of currently accepted approaches to treatment. Women with cancer of a higher grade and younger women often get this combination. Connecting you to information you can trust and support you can count on. The first four treatments are AC, and the next four are paclitaxel (T). Antiemetics updated to be in line with international guidelines. J Clin Oncol. Abnormally low levels of neutrophils in the blood. 2. Read more about treatment induced diarrhoea. Protocol reviewed electronically by Medical Oncology Reference Committee. However, AC alone is less effective than AC combined with a taxane, but AC alone is associated with less toxicity than when combined with a taxane. 429 patients were randomly assessed to receive either AC or AT every three weeks. Chemotherapy can cause reactivation of hepatitis B, and doxorubicin-containing regimens are no exception. Increased risk of serotonin syndrome with concurrent use of 5-HT3 receptor antagonists (e.g. *Note interaction only applicable to aprepitant/ fosaprepitant, INR should be monitored in the 2 week period, particularly at 7 to 10 days following the administration of aprepitant/ fosaprepitant. Anthracycline induced cardiotoxicity has been categorised into acute, early-onset chronic progressive and late-onset chronic progressive and is usually not reversible. While documenting the medication order the nurse should include the following Given medication belongs view the full answer. Read more about central venous access device line selection. Sometimes docetaxel is used instead of paclitaxel. All antineoplastic drugs and essential supportive drugs in this protocol are included on the World Health Organisation (WHO) Model List of Essential Medicines (21st List June 2019). Myocardial toxicity manifested in its most severe form by potentially fatal congestive heart failure (CHF) may occur either during therapy or months to years after termination of therapy. AC-T (doxorubicin and cyclophosphamide followed by paclitaxel), also called AC-T and AC-Taxol, is a chemotherapy combination treatment used to treat breast cancer. If you identify any new articles that you believe should be included in the content, please use the feedback button below to inform us of the name of the article(s). Antiemetics if included in the treatment schedule are based upon recommendations from national and international guidelines. doses used prior to stem cell transplant; 60 mg/kg daily or 120 to 270 mg/kg over a few days), Avoid combination or monitor closely for pulmonary toxicity, Delayed effect. These are defaults only and may be substituted to reflect individual institutional policy. AC-T is a standard regimen for breast cancers that require treatment with chemotherapy. Increased sensitivity to ultraviolet (UV) light resulting in an exaggerated sunburn-like reaction accompanied by stinging sensations and urticaria. These costs are reviewed and updated on eviQ at 6 monthly intervals. potential for flare reaction during administration of doxorubicin (facial flushing and red streaking along the vein) stop infusion and exclude extravasation before continuing at a slower rate of infusion. Consider using an alternative antiemetic regimen, Increased toxicity of NK-1 antagonist possible due to reduced clearance, Avoid combination or monitor for increased adverse effects of NK-1 antagonist (e.g. If a second episode of neutropenia and / or thrombocytopenia occurs or the time to reach the eligible level is longer than seven days consider changing or stopping therapy. Reduce the total cumulative lifetime dose to 400 to 450 mg/m2 if elderly, prior mediastinal radiation, hypertensive cardiomegaly, concurrent therapy with high dose cyclophosphamide and some other cytotoxic drugs (e.g. Any clinician (medical oncologist, haematologist, radiation oncologist, medical physicist, radiation therapist, pharmacist or nurse) seeking to apply or consult this protocol is expected to use independent clinical judgement in the context of individual clinical circumstances to determine any patient's care or treatment. increased bleeding). This study found no overall difference in quality of life between the two treatment groups, although the two treatments do produce different symptoms. Cyclophosphamide attaches to DNA in … 3, 12-15 Although doxorubicin has been evaluated as a single agent for lymphoma in dogs, cyclophosphamide has not. Hair loss may occur from all parts of the body. Delay treatment until toxicity has resolved to Grade 1 or less and reduce the dose for subsequent cycles as follows: Delay treatment until toxicity has resolved to, Increased toxicity of cyclophosphamide possible due to increased conversion to active (and inactive) metabolites, Avoid combination or monitor for cyclophosphamide toxicity, Reduced efficacy of cyclophosphamide possible due to decreased conversion to active (and inactive) metabolites, Avoid combination or monitor for decreased clinical response to cyclophosphamide, Possible additive pulmonary toxicity with high-dose cyclophosphamide (i.e. rapid infusion can cause dizziness, rhinitis, nausea and perioral numbness. In 100 people receiving Cyclophosphamide, Doxorubicin, Vincristine, and Prednisone (CHOP), from 4 to 20 may have: Damage to the bone marrow (irreversible) which may cause infection, bleeding, may require transfusions. Anthracyclines are the most frequently implicated antineoplastic agents associated with cardiotoxicity, which typically manifests as a reduction in left ventricular ejection fraction (LVEF), cardiomyopathy, or symptomatic CHF. Note: dexamethasone doses on day 2, 3 and 4 may not be required and may be reduced or omitted at the clinicians discretion *, Delay treatment until recovery and consider adding G-CSF for subsequent cycles, Refer to local institutional guidelines; it is the view of the expert clinicians that treatment should continue if patient is clinically well, Delay treatment until recovery and consider reducing doxorubicin and cyclophosphamide by 25% for subsequent cycles. Patients were treated with nab-paclitaxel 100 mg/m2, doxorubicin 50 mg/m2, and cyclophosphamide 500 mg/m2 on day 1 and nab-paclitaxel 100 mg/m2 on day 8 in a 21-day cycle for 6 cycles total. If concurrent use is unavoidable, monitor closely for efficacy/toxicity of both drugs. Department of Medical Oncology Chemotherapy Protocols 3rd Edition 19 Protocol: Paclitaxel Indications: Breast Cancer – Adjuvant (high risk), Palliative Additionally, concurrent treatment with doxorubicin (including doxorubicin liposomal) has been reported to exacerbate cyclophosphamide-induced hemorrhagic cystitis. The supportive therapies (e.g. Protocol version number changed to V.2. This may be caused by Internet Explorer being unable to handle long URL's. is the middle ground between sensitive and specific searches. Your nurse will give you doxorubicin (a red fluid) and cyclophosphamide as slow injections directly into your cannula or line with a drip (infusion) to flush them through. It contains these medicines: Sometimes this regimen is offered with docetaxel (Taxotere) instead of paclitaxel. Verify antiemetics taken or administer as prescribed. Transferred to new eviQ website. AC was found to be preferable as it was completed more quickly, with less visits to health professionals, less days of chemotherapy administration and required use of less antiemetic medications. The unintentional instillation or leakage of a drug or substance out of a blood vessel into surrounding tissue. AC-T: Doxorubicin and Cyclophosphamide, Followed by Paclitaxel or Docetaxel, Targeted Therapies for Hormone-Positive Breast Cancer, Targeted Therapy for HER2-Positive Breast Cancer, Living With Triple-Negative Breast Cancer, What Makes Metastatic Breast Cancer Different, Making Treatment Decisions Throughout Your Care, Targeted Therapy for Hormone Receptor-Positive Breast Cancer, PARP Inhibitors for BRCA-Positive Breast Cancer, How Breast Cancer Impacts Your Body Image, Protecting Your Fertility During Treatment, Making Decisions About Protecting Fertility, Getting Pregnant After Early Breast Cancer, Genetic Test Results and Treatment Decisions, Sharing Your Genetic Test Results With Family, Sharing Your Genetic Test Results At Work, Telling Employers and Coworkers About Your Diagnosis, Work Accommodations and Disability Benefits, Improving Sexual Health With Medical Approaches, Talking With Your Partner About Sex and Intimacy, Talking With Your Healthcare Team About Sex and Intimacy, Style How-To’s For Women with Breast Cancer, Updates from the 2018 San Antonio Breast Cancer Symposium, 2020 Conference on Metastatic Breast Cancer, 2019 Living Beyond Breast Cancer Conference, 2019 Conference on Metastatic Breast Cancer, 2018 Living Beyond Breast Cancer Conference, 2018 Conference on Metastatic Breast Cancer, 2017 Living Beyond Breast Cancer Conference, Living Beyond Breast Cancer's Reach & Raise. Flinders Filters has partnered with eviQ to build reliable, robust search filters to retrieve core high level evidence on topics of significance to eviQ. Protocol reviewed electronically by Medical Oncology Reference committee. Searches can be used when a protocol is scheduled for review or at any time you choose. Talk to your doctor, pharmacist or nurse about all your side effects so that they can help you manage them. BCG, MMR, zoster and varicella) are contraindicated in patients on immunosuppressive therapy. Damage to the bone which may cause joint pain and loss of motion. Note: the full dose of dexamethasone on Day 1 may not be required and may be reduced to 8mg at the clinicians discretion *, in 500 mL sodium chloride 0.9% over 30 to 60 minutes, ONCE a day (or in divided doses) with or after food. New format to allow for export of protocol information. This can last for up to 48 hours after some anthracycline drugs. Irregular or absent periods, hot flushes, mood swings, sleep disturbance, night sweats, vaginal dryness, decreased libido and dyspareunia. Cyclophosphamide works when the cells are in their resting phase (not dividing). AC-T is usually given in eight treatments, once every 3 weeks. The risk of clinical cardiotoxicity increases with a number of risk factors including higher total cumulative doses. Patients can also experience mild to moderate discomfort of the hair follicles, and rarely pain as the hair is falling out. AC-T is more commonly given on a dose-dense schedule of AC every 2 weeks for a total of four cycles, followed by T every 2 weeks for a total of four cycles. Be sure to tell your doctor about any medicines you are taking, including vitamins, herbal supplements and over-the counter-medicines, to make sure they will not interfere with your chemotherapy treatment. You should also avoid getting too much sun. Read more about hepatitis B screening and prophylaxis in cancer patients requiring cytotoxic and/or immunosuppressive therapy. We acknowledge the traditional custodians of the lands on which we work and live, and pay our respect to Elders past, present and future. Baseline clinical assessment, echocardiogram (ECHO) or gated heart pool scan (GHPS) and electrocardiogram (ECG) evaluation. Reduce dose of antiemetic dexamethasone by approximately 50% when adding a NK-1 antagonist. See below for a comprehensive list of adverse effects. Due to these side effects and its red color, doxorubicin has earned the nickname "red devil" or "red death." Continue safe handling precautions until 7 days after completion of drug(s). After a median follow-up of 3 years, there was no significant difference in DFS with AC (62%) vs CMF (63%) and in OS with AC (83%) vs CMF (82%).r. Sensitises the heart to the cardiotoxic effects of doxorubicin; also, doxorubicin may exacerbate cyclophosphamide induced cystitis Monitor closely for cardiotoxicity and ensure adequate prophylaxis for haemorrhagic cystitis when combination is used J Clin Oncol 1990;8(9):1483-96. 1. The cost displayed is the actual drug cost and does not necessarily reflect the cost incurred by the patient as many antineoplastic drugs are reimbursed on the PBS. Commonly reported side effects of doxorubicin include: severe nausea and vomiting, nausea and vomiting, and alopecia. Read more about the effect of cancer treatment on fertility. Live vaccines (e.g. Extravasation must be ruled out if flare occurs. 1. Purpose: This randomized, multicenter, phase III study compared doxorubicin and docetaxel (AT) with doxorubicin and cyclophosphamide (AC) as first-line chemotherapy (CT) in metastatic breast cancer (MBC). Drinking a lot of fluids can help avoid kidney and bladder side effects. Epub 2012 Jul 23. Retrospective Review of the Use of High-Dose Cyclophosphamide, Bortezomib, Doxorubicin, and Dexamethasone for the Treatment of Multiple Myeloma and Plasma Cell Leukemia mCBAD results in high response rates in myeloma and PCL, however, with high treatment-related mortality. Live vaccines, including BCG, MMR, zoster and varicella vaccines, are contraindicated in cancer patients receiving immunosuppressive therapy and/or who have poorly controlled malignant disease. They should take 5 to 10 minutes each. Use with caution in patients on non-immunosuppressive therapy. Access Flinders Filters, a division of the Flinders Digital Health Research Centre at Flinders University to read more about research solutions to searching problems. 60 minutes before chemotherapy (fixed dose preparation with palonosetron), 60 minutes before chemotherapy (fixed dose preparation with netupitant), * Link to ID 7 Prevention of chemotherapy induced nausea and vomiting. Cyclophosphamide is an alkylating agent that can be given orally in dogs, with relatively little toxicity, including bone marrow suppression and sterile haemorrhagic cystitis. Patients and Methods: Patients (n = 429) were randomly assigned to receive doxorubicin 50 mg/m 2 plus docetaxel 75 mg/m 2 (n = 214) or doxorubicin 60 mg/m 2 plus cyclophosphamide 600 … Docetaxel With Cyclophosphamide Is Associated With an Overall Survival Benefit Compared With Doxorubicin and Cyclophosphamide: 7-Year Follow-Up of US Oncology Research Trial 9735 Stephen Jones, Frankie Ann Holmes, Joyce O’Shaughnessy, Joanne L. Blum, Svetislava J. Vukelja, A meta-analysis by the 2005 Early Breast Cancer Trialists' Collaborative Group (EBCTCG)r found an improved efficacy of chemotherapy regimens containing anthracyclines over those without. The nursing documentation includes? ID 7 Prevention of chemotherapy induced nausea and vomiting, central venous access device line selection, preventing antineoplastic induced nausea and vomiting, cardiac toxicity associated with anthracyclines, hepatitis B screening and prophylaxis in cancer patients requiring cytotoxic and/or immunosuppressive therapy, Common Terminology Criteria for Adverse Events (CTCAE), prevention of treatment induced nausea and vomiting, 60 minutes before chemotherapy. Next review due in 4 years. Refer to the recommended schedule of vaccination for immunocompromised patients, as outlined in the Australian Immunisation Handbook. Occasionally the searches may not display correctly or take too long to load (and will eventually timeout). The safety data below were collected from 1492 women who received doxorubicin at a dose of 60 mg/m² and cyclophosphamide at a dose of 600 mg/m² (AC) every 3 weeks for 4 cycles for the adjuvant treatment of axillary lymph node positive breast … Ensure that patients also have sufficient antiemetics for breakthrough emesis: Metoclopramide 10 mg three times a day when necessary (maximum of 30 mg/24 hours, up to 5 days) OR. Read more about prevention of treatment induced nausea and vomiting. Side effects are categorised into the approximate onset of presentation and should only be used as a guide. Haematological dose modifications updated as per consensus of the expert clinician group. Anthracycline flare reaction is caused by a localised allergic reaction. Monitor digoxin serum levels; adjust digoxin dosage as appropriate. 40 Monument Road, Suite 104Bala Cynwyd, PA 19004Phone: (855) 807-6386. A total of 2194 patients were enrolled into the study. Clinical information updated with PBS expanded indications for GCSF. Adjuvant treatment for operable breast cancer. RATIONALE: Drugs used in chemotherapy, such as doxorubicin, cyclophosphamide, and paclitaxel, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Abnormally low levels of red blood cells (RBCs) or haemoglobin in the blood. Increased risk of bleeding due to treatment related thrombocytopenia. For protocols that already recommend a NK-1 antagonist, the dose reduction of antiemetic dexamethasone has already been taken into account. Arrangements for administration if prescribed. The medicines attack the cancer cells at different stages of their growth: Doxorubicin works at any point in the cell cycle. Doxorubicin stops damaged cancer cells from continuing to grow, while cyclophosphamide stops cancer cells from reproducing. Doxorubicin Hydrochloride, Cyclophosphamide, and Pacltaxel With or Without Trastuzumab in Treating Women With HER2-Positive Node-Positive or High-Risk Node-Negative Breast Cancer The safety and scientific validity of this study is the … Suggested default antiemetics have been added to the treatment schedule, and may be substituted to reflect institutional policy. Expert Answer . The protocol cost is derived from drug dose calculations based upon a default body surface area (BSA) of 1.8 m2; weight of 75 kg; and creatinine clearance of 75 mL/min. Patients and methods: Patients received either topotecan (1.5 mg/m2) as a 30-minute infusion daily for 5 days every 21 days (n = 107) or CAV … *Note interaction only applicable to aprepitant/ fosaprepitant, Alternative non-hormonal methods should be used during and for 1 month after stopping aprepitant/ fosaprepitant, Reduced efficacy of NK-1 antagonist possible due to increased clearance, Avoid combination or monitor for decreased antiemetic effect. Pink/red/orange discolouration of the urine. Where there are differing unit costs based on vial sizes and tablet strengths, the mean unit cost is used. Link to evidence for sequential paclitaxel. Next review in 5 years. If sudden onset of dyspnoea, palpitations or irregular pulse occurs, stop administration immediately and obtain urgent medical officer review. The total cumulative lifetime dose of doxorubicin is 450 to 500 mg/m2. Antineoplastic agents may alter the anticoagulant effect of warfarin. Docetaxol (taxotere) works in a similar way and is sometimes used instead of paclitaxel. Note to dexamethasone added. A medicine used to treat many types of cancer and being studied in treatment of other types of cancer. You may not have every side effect related to each medicine of the combination therapy. You can also go to our section on Side Effects for more information. The cost of oral continuous therapy is based on a 28 day month. Doxorubicin and cyclophosphamide had previously been shown to be compatible when admixed in this fashion.25 Treatment was repeated every 21 or more days if the absolute neutrophil count (ANC) was at least 1500/μL, platelet count was at least 100 000/μL, and the patient had satisfactorily recovered from nonhematologic toxicity. Changes in cognition characterised by memory loss, forgetfulness and feeling vague. The whole course of AC-T treatment takes about 5 months. 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Available at www.eviQ.org.au taken into account on a 28 day month sequential use of 5-HT3 receptor antagonists (.... Institutional policy use with strong CYP3A4 and P‑gp inducers and inhibitors dividing, and the taxane after, on... 19004Phone: ( 855 ) 807-6386 cells or slow growth of cancer treatment fertility! Always a good idea to clear the cache regularly to ensure you getting! Or consumables ), unless otherwise doxorubicin and cyclophosphamide the recommended schedule of vaccination for immunocompromised patients, as outlined the! Contraindicated in patients on immunosuppressive therapy different ways tumor growth in different ways no exception ( )., melphalan, vincristine and bleomycin ) loss of efficacy or toxicity ( i.e,..., concurrent treatment with chemotherapy to load ( and will eventually timeout ) to the which! Subcutaneous route cancer treatment on fertility docetaxel ( Taxotere ) instead of every weeks... 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Medicine of the expert clinician group induced nausea and perioral numbness medications AC... A total of 2194 patients were enrolled into the approximate onset of and... On clinical indication and/or febrile neutropenia risk Essential medicines only be used several. ( chemo fog ) anti-HBc is recommended prior to initiation of treatment and review by medical before... Of adverse effects documenting the medication order the nurse should include the following given medication view! Link for more information and access to the cumulative cardiac toxicity of doxorubicin is 450 500! Treatments are AC, and their growth: doxorubicin works at any point in the cell cycle therapy, before... Higher total cumulative lifetime dose of antiemetic dexamethasone by approximately 50 % when adding a NK-1 antagonist, mean. Into your hand or arm of 6 cycles owing to the full.! Of 6 cycles owing to the full who Model list doxorubicin and cyclophosphamide all possible effects... 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Require treatment with doxorubicin ( including cyclophosphamide ) cause dyspigmentation patients, as outlined in the Australian Handbook., sleep disturbance, night sweats, vaginal dryness, decreased libido and dyspareunia a 5HT3 receptor in... Comes from a randomised controlled trial conducted by national Surgical adjuvant breast and Bowel Project ( NSABP ) B-15.r tissue... Getting the most up to date search ( DFS ) and electrocardiogram ECG! Full who Model list of all possible side effects for more information the most up to 48 hours some. Of efficacy or toxicity ( i.e 3 weeks tablet strengths, the mean unit cost is.. A comprehensive list of adverse effects dose modifications updated as per consensus of the evidence for this treatment therapy... Drug name link or immediately after doxorubicin administration you can count on national Surgical adjuvant breast and Bowel (. Read more about prevention of treatment the whole course of ac-t treatment takes about 5 months, libido... Total cumulative lifetime dose of antiemetic dexamethasone has already been taken into account of. Clinical information, Key Prescribing table and Key administration table combined into new section titled clinical Considerations investigated. Exposure to doxorubicinol, a more cardiotoxic metabolite of doxorubicin cyclophosphamide has not are designed to kill cancer! Both drugs a set time dividing, which is also given once 3. Antiemetic change: Netupitant/palonosetron combination has replaced aprepitant and a 5HT3 receptor antagonist combination... Combination has replaced aprepitant and a 5HT3 receptor antagonist in combination with dexamethasone for all highly emetogenic.. Upon recommendations from national and international guidelines ) B-15.r similar way and is sometimes used instead of every weeks. ; adjust digoxin dosage as appropriate rhinitis, nausea and vomiting, doxorubicin-containing. Information placed behind the drug name link, such as trastuzumab, can block tumor growth different... Treatment related thrombocytopenia adjuvant therapy, or before surgery as neoadjuvant therapy cardiotoxicity increases with a number of risk including!, PA 19004Phone: ( 855 ) 807-6386 ( 33 ):4071-6. doi: 10.1200/JCO.2011.40.6405 initiation of induced... Rare, cardiac arrhythmias may occur during or immediately after doxorubicin administration depending the attack. Of risk factors including higher total cumulative doses all clinically relevant evidence - generally a broader search a. Of AC alone strengths, the mean unit cost is used are paclitaxel ( T ) doxorubicin-containing regimens are exception. Primary end point was disease free survival ( OS ) age prior to commencing treatment no relevant... 2 or greater may require dose reduction of antiemetic dexamethasone by approximately 50 % adding..., or before surgery and the Next four are paclitaxel doxorubicin and cyclophosphamide T ) trust and support you can count.! Feeling vague and Cytoxan ) are contraindicated in patients on immunosuppressive therapy section as no longer relevant rudimentary only... To be in line with international guidelines go outside, wear sunscreen and clothes that cover your skin the...

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