Pancreatic neuroendocrine tumor

disease
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Also known as islet cell tumorislet cell tumors - pancreasislet cell tumors of the pancreasislet cell tumourislet cell tumours - pancreasislet cell tumours of the pancreasneuroendocrine tumour of pancreaspancreatic endocrine tumorpancreatic endocrine tumourpancreatic NETPANETwell differentiated pancreatic endocrine neoplasmwell differentiated pancreatic endocrine tumorwell differentiated pancreatic endocrine tumourwell-differentiated NEN of pancreaswell-differentiated neuroendocrine neoplasm of pancreaswell-differentiated pancreatic NENwell-differentiated pancreatic neuroendocrine neoplasm

Summary

Pancreatic neuroendocrine tumor (MONDO:0019954) is a cancer (an umbrella term covering 11 Mondo subtypes) with 2 cohort genes (2 CIViC-evidence somatic drivers; 2 ClinVar predisposition records) and 93 clinical trials. Top therapeutic interventions include everolimus, cabozantinib, and octreotide.

At a glance

  • Classification: Cancer
  • Prevalence: 1-9 / 100 000 (Japan) [Orphanet-validated]
  • Umbrella term: 11 Mondo subtypes
  • Cohort genes: 2
  • ClinVar variants: 2
  • Clinical trials: 93

Clinical features

Epidemiology

Prevalence records

7 prevalence record(s), Orphanet:

TypeClassValueGeographyValidation
Annual incidence1-9 / 1 000 0000.21EuropeValidated
Annual incidence1-9 / 1 000 0000.22United StatesValidated
Annual incidence1-9 / 100 0001.27JapanValidated
Annual incidence1-9 / 1 000 0000.21FranceValidated
Point prevalence1-9 / 100 0002.69JapanValidated
Point prevalence1-5 / 10 00027.5United StatesValidated
Point prevalence1-5 / 10 000EuropeNot yet validated

Identifiers

Disease identifiers

FieldValue
Canonical namepancreatic neuroendocrine tumor
Mondo IDMONDO:0019954
EFOEFO:1000045
Orphanet97253
NCITC27720
UMLSC1337011
MedGen277875
GARD0013034
Is cancer (heuristic)yes

Also known as: islet cell tumor · islet cell tumors - pancreas · islet cell tumors of the pancreas · islet cell tumour · islet cell tumours - pancreas · islet cell tumours of the pancreas · neuroendocrine tumour of pancreas · pancreatic endocrine tumor · pancreatic endocrine tumour · pancreatic NET · pancreatic neuroendocrine tumor · PANET · well differentiated pancreatic endocrine neoplasm · well differentiated pancreatic endocrine tumor · well differentiated pancreatic endocrine tumour · well-differentiated NEN of pancreas · well-differentiated neuroendocrine neoplasm of pancreas · well-differentiated pancreatic NEN · well-differentiated pancreatic neuroendocrine neoplasm

Data availability: 2 ClinVar variants · 1 cell line · 10 intOGen driver records.

Disease family

An umbrella term covering 11 Mondo subtypes.

Classification path: disease › human disease › disease by body system or component › digestive system disorderdigestive system neuroendocrine neoplasmdigestive system neuroendocrine tumor, grade 1/2pancreatic neuroendocrine tumor

Related subtypes (9): small intestine neuroendocrine tumor, well differentiated, low or intermediate grade, gastrin-producing neuroendocrine tumor, esophageal neuroendocrine tumor, L-cell glucagon-like peptide-producing neuroendocrine tumor, gastric neuroendocrine tumor, well differentiated, low or intermediate grade, neuroendocrine tumor of the colon, well differentiated, low or intermediate grade tumor, rectal neuroendocrine tumor, gallbladder neuroendocrine tumor, grade 1/2, intestinal neuroendocrine tumor G1

Subtypes (11): pancreatic delta cell neuroendocrine tumor, pancreatic gastrin-producing neuroendocrine tumor, non-functional pancreatic neuroendocrine tumor, pancreatic insulin-producing neuroendocrine tumor, somatostatinoma, GRFoma, PPoma, glucagonoma, VIPoma, pancreatic neuroendocrine tumor G1, functional pancreatic neuroendocrine tumor

Genetics & variants

GWAS landscape

No GWAS associations recorded — common-variant (GWAS) studies don’t cover this disease (typical for Mendelian / rare diseases). See the curated gene cohort and Mendelian overlap below.

Variant details and genetic-evidence tiers

ClinVar germline variants

2 retrieved; paginated sample, class counts are floors:

2 pathogenic

ClinVarVariant (HGVS)GeneClassificationReview
52925NM_000059.4(BRCA2):c.994dup (p.Ile332fs)BRCA2Pathogenicreviewed by expert panel
560018NM_024675.4(PALB2):c.778C>T (p.Gln260Ter)PALB2Pathogeniccriteria provided, multiple submitters, no conflicts

Genes & proteins

Mendelian disease overlap and somatic drivers

GenCC: 0 · Orphanet: 17 · OMIM-shared: 0 · Dual-evidence (GWAS+Mendelian): 0

Somatic driver evidence (intOGen + CIViC, cohort fanout)

GeneintOGen roleCancer typesCIViC
BRCA2LoFBLCA,BRCA,CESC,CHOL,HCC,HNSC,LUSC,MBL,OVT,PAAD,PRAD,PROSTATE,RCC,VULVACIViC #7
PALB2LoFOVTCIViC #15013

Orphanet rare-disease linkage (cohort genes)

GeneOrphanet IDRare disease
BRCA2Orphanet:1331Familial prostate cancer
BRCA2Orphanet:1333Familial pancreatic carcinoma
BRCA2Orphanet:145Hereditary breast and/or ovarian cancer syndrome
BRCA2Orphanet:178Chordoma
BRCA2Orphanet:227535Hereditary breast cancer
BRCA2Orphanet:319462Inherited cancer-predisposing syndrome due to biallelic BRCA2 mutations
BRCA2Orphanet:440437Familial colorectal cancer Type X
BRCA2Orphanet:654Nephroblastoma
BRCA2Orphanet:667662Breast implant-associated anaplastic large cell lymphoma
BRCA2Orphanet:694963Inflammatory breast cancer
BRCA2Orphanet:70567Cholangiocarcinoma
BRCA2Orphanet:84Fanconi anemia
PALB2Orphanet:1333Familial pancreatic carcinoma
PALB2Orphanet:145Hereditary breast and/or ovarian cancer syndrome
PALB2Orphanet:178Chordoma
PALB2Orphanet:227535Hereditary breast cancer
PALB2Orphanet:84Fanconi anemia

Cohort genes → proteins

2 cohort genes, 2 distinct canonical proteins.

Evidence partition

SubsetGenes
multi_evidence2

Cohort genes (full)

SymbolHGNCEnsemblUniProtNameEvidence
BRCA2HGNC:1101ENSG00000139618P51587Breast cancer type 2 susceptibility proteinclinvar
PALB2HGNC:26144ENSG00000083093Q86YC2Partner and localizer of BRCA2clinvar

Cohort function summary

Lead sentence per gene, UniProt-curated.

SymbolProtein nameFunction (lead sentence)
BRCA2Breast cancer type 2 susceptibility proteinInvolved in double-strand break repair and/or homologous recombination.
PALB2Partner and localizer of BRCA2Plays a critical role in homologous recombination repair (HRR) through its ability to recruit BRCA2 and RAD51 to DNA breaks.

Protein-family classification

Druggable: 0 · Difficult: 1 · Unknown: 1 · Druggable fraction: 0.0

Family distribution

Cohort families vs a genome-wide background (hypergeometric, BH-FDR; fold = observed/expected). Counts kept; sorted by enrichment, so the catch-all Other/Unknown bucket no longer leads.

FamilyGenesFoldFDR
Scaffold/PPI18.6×0.225
Other/Unknown10.9×0.805

Per-gene assignment

SymbolFamilyDruggable?ECInterPro (top 3)
BRCA2Other/UnknownnoBRCA2_repeat, NA-bd_OB-fold, BRCA2_OB_1
PALB2Scaffold/PPInoWD40/YVTN_repeat-like_dom_sf, PALB2_WD40, WD40_repeat_dom_sf

Expression context

Cohort genes with no expression data: 0.

1 cohort gene are a single-cell marker in ≥1 SCXA experiment.

Breadth distribution (Bgee present_calls)

BucketGenes
narrow (1-5 tissues)0
moderate (6-20)0
broad (>20)2
unknown0

Top tissues across cohort

TissueCohort genes
secondary oocyte2
male germ line stem cell (sensu Vertebrata) in testis1
ventricular zone1
buccal mucosa cell1
oocyte1

Per-gene tissue summary (top 30)

SymbolBgee breadthFANTOM5 breadthSCXATop tissues
BRCA2184ubiquitousmarkermale germ line stem cell (sensu Vertebrata) in testis, secondary oocyte, ventricular zone
PALB2232ubiquitousyessecondary oocyte, buccal mucosa cell, oocyte

Protein interactions among cohort

Intra-cohort edges: 1.

Hub genes (top 10 by interactor count)

SymbolInteractor count
PALB25,641
BRCA24,839

Intra-cohort edges

ABSources
BRCA2PALB2biogrid_interaction, intact, string_interaction

Structural data

PDB: 2 · AlphaFold-only: 0 · No structure: 0

Cohort genes with PDB structures (top 30)

SymbolUniProtPDB entries
BRCA2P5158714
PALB2Q86YC24

Function

Pathway analysis

Distinct Reactome pathways touched by cohort: 29. Enrichment computed across 2 evidence-associated genes (2 with Reactome annotation).

Pathways by enrichment

Over-representation of cohort genes vs the genome-wide background (hypergeometric test, Benjamini-Hochberg FDR; fold = observed/expected over 2 annotated cohort genes). Counts and members are kept as ground-truth; sorted by enrichment.

PathwayCohort genesFoldFDRSample cohort genes
Impaired BRCA2 binding to PALB22456.8×3e-05BRCA2, PALB2
Defective homologous recombination repair (HRR) due to BRCA1 loss of function2423.0×3e-05BRCA2, PALB2
Defective HDR through Homologous Recombination Repair (HRR) due to PALB2 loss of BRCA1 binding function2423.0×3e-05BRCA2, PALB2
Defective HDR through Homologous Recombination Repair (HRR) due to PALB2 loss of BRCA2/RAD51/RAD51C binding function2423.0×3e-05BRCA2, PALB2
Resolution of D-loop Structures through Synthesis-Dependent Strand Annealing (SDSA)2393.8×3e-05BRCA2, PALB2
Homologous DNA Pairing and Strand Exchange2380.7×3e-05BRCA2, PALB2
Resolution of D-loop Structures through Holliday Junction Intermediates2300.5×4e-05BRCA2, PALB2
HDR through Homologous Recombination (HRR)2190.3×1e-04BRCA2, PALB2
Impaired BRCA2 translocation to the nucleus11903.3×0.002BRCA2
Impaired BRCA2 binding to SEM1 (DSS1)11903.3×0.002BRCA2
Defective homologous recombination repair (HRR) due to PALB2 loss of function1475.8×0.005BRCA2
HDR through MMEJ (alt-NHEJ)1439.2×0.005BRCA2
Diseases of DNA Double-Strand Break Repair1407.9×0.005BRCA2
Defective homologous recombination repair (HRR) due to BRCA2 loss of function1407.9×0.005BRCA2
Resolution of D-Loop Structures1317.2×0.006BRCA2
Diseases of DNA repair1285.5×0.006BRCA2
Homology Directed Repair1154.3×0.010BRCA2
HDR through Homologous Recombination (HRR) or Single Strand Annealing (SSA)1154.3×0.010BRCA2
Impaired BRCA2 binding to RAD511154.3×0.010BRCA2
Meiosis1142.8×0.010BRCA2
Presynaptic phase of homologous DNA pairing and strand exchange1135.9×0.010BRCA2
DNA Double-Strand Break Repair1124.1×0.011BRCA2
Reproduction195.2×0.013BRCA2
Meiotic recombination164.9×0.019BRCA2
KEAP1-NFE2L2 pathway160.1×0.019PALB2
DNA Repair149.2×0.023BRCA2
Neddylation123.7×0.045PALB2
Cell Cycle118.0×0.057BRCA2
Disease16.5×0.147BRCA2

GO biological processes by enrichment

Over-representation of cohort genes vs the genome-wide background (hypergeometric test, Benjamini-Hochberg FDR; fold = observed/expected over 2 annotated cohort genes). Counts and members are kept as ground-truth; sorted by enrichment.

GO termCohort genesFoldFDRSample cohort genes
inner cell mass cell proliferation2991.3×3e-05BRCA2, PALB2
double-strand break repair via homologous recombination2156.0×7e-04BRCA2, PALB2
mitotic recombination-dependent replication fork processing14213.0×0.003BRCA2
negative regulation of mammary gland epithelial cell proliferation11685.2×0.005BRCA2
establishment of protein localization to telomere11053.2×0.007BRCA2
response to UV-C1842.6×0.007BRCA2
telomere maintenance via recombination1766.0×0.007BRCA2
regulation of DNA damage checkpoint1561.7×0.007BRCA2
centrosome duplication1468.1×0.007BRCA2
response to X-ray1443.5×0.007BRCA2
female gonad development1401.2×0.007BRCA2
post-anal tail morphogenesis1366.4×0.007PALB2
hematopoietic stem cell proliferation1324.1×0.007BRCA2
oocyte maturation1300.9×0.007BRCA2
male meiosis I1290.6×0.007BRCA2
response to gamma radiation1290.6×0.007BRCA2
mesoderm development1263.3×0.007PALB2
intrinsic apoptotic signaling pathway in response to DNA damage by p53 class mediator1247.8×0.007BRCA2
embryonic organ development1240.7×0.007PALB2
positive regulation of mitotic cell cycle1234.1×0.007BRCA2
regulation of cytokinesis1210.7×0.008BRCA2
cellular response to ionizing radiation1205.5×0.008BRCA2
nucleotide-excision repair1191.5×0.008BRCA2
somitogenesis1187.2×0.008PALB2
DNA damage response, signal transduction by p53 class mediator1179.3×0.008BRCA2
cellular senescence1147.8×0.009BRCA2
double-strand break repair1101.5×0.013BRCA2
animal organ morphogenesis195.8×0.013PALB2
multicellular organism growth168.5×0.018PALB2
brain development139.8×0.029BRCA2

Therapeutics

Drugs indicated for this disease

3 approved, 4 in late-stage (phase 3) trials. Disease-direct ChEMBL indications, not inferred from the associated-gene cohort below.

DrugDevelopment status
BelzutifanApproved (phase 4)
EverolimusApproved (phase 4)
SunitinibApproved (phase 4)
CapecitabinePhase 3 (in late-stage trials)
OctreotidePhase 3 (in late-stage trials)
SomatostatinPhase 3 (in late-stage trials)
SurufatinibPhase 3 (in late-stage trials)

Earlier-phase candidates (phase 2, investigational — efficacy not yet established): Abemaciclib, Dacarbazine, Dactolisib, Metformin, Palbociclib, Tegafur, Temozolomide, Thalidomide.

Drug target analysis

Approved (phase 4): 0 · Phase ≥3: 0 · Phased (≥1): 0 · Undrugged: 2

Druggability breadth: 0 of 2 evidence-associated genes (0%) have a ChEMBL target (buckets above are over the deeply-mined display cohort).

Top cohort targets by molecule count

SymbolMoleculesMax phase
BRCA200
PALB200

Bioactivity and enzyme data

Enzyme cohort genes (≥1 EC): 0.

Pharmacogenomics

Cohort genes with a PharmGKB record: 2; with CPIC/DPWG dosing guidelines: 0.

No cohort gene has a CPIC/DPWG genotype-guided dosing guideline (PharmGKB).

Drug repurposing candidates

0 approved/phased drugs hit cohort targets but don’t yet appear in disease-level clinical trials. Target-inhibition rationale is strongest for cancer driver genes; a bioactivity hit is a screening signal, not a treatment claim.

Druggability pyramid

Cohort genes binned by druggability tier (high → low):

TierDefinitionGenesSymbols
AApproved (phase 4 drug)0
BPhased (≥1) drug, not yet approved0
CDruggable family + PDB, no drug0
DDruggable family + AlphaFold only, no drug0
EDifficult family or no structure, no drug2BRCA2, PALB2

Undrugged target profiles

2 cohort genes are undrugged. Ranked by ‘starting-point quality’ (assay depth + drugged-partner adjacency).

SymbolChEMBL assaysDrugged partners (top 3)
BRCA20
PALB20

Clinical trials & evidence

Clinical trials

Clinical trials: 93.

Phase distribution (across all retrieved trials)

PhaseTrials
Not specified37
PHASE230
PHASE117
PHASE33
PHASE1/PHASE23
PHASE2/PHASE32
PHASE41

Top trials by phase / activity

NCTPhaseStatusTitle
NCT02842749PHASE4COMPLETEDPhase IV Study of the Safety and Efficacy of Everolimus in Adult Patients With Progressive pNET in China
NCT03375320PHASE3ACTIVE_NOT_RECRUITINGTesting Cabozantinib in Patients With Advanced Pancreatic Neuroendocrine and Carcinoid Tumors
NCT05477576PHASE3RECRUITINGStudy of RYZ101 Compared With SOC in Pts w Inoperable SSTR+ Well-differentiated GEP-NET That Has Progressed Following 177Lu-SSA Therapy
NCT06943755PHASE2/PHASE3RECRUITINGZanzalintinib Versus Everolimus in Participants With Locally Advanced or Metastatic Neuroendocrine Tumors
NCT07591493PHASE3NOT_YET_RECRUITINGAdjuvant Trial in Pancreatic Neuroendocrine Tumors
NCT00227617PHASE2/PHASE3TERMINATEDCombination Chemotherapy and Bevacizumab in Treating Patients With Advanced Neuroendocrine Tumors
NCT03074513PHASE2ACTIVE_NOT_RECRUITINGAtezolizumab and Bevacizumab in Treating Patients With Rare Solid Tumors
NCT03600233PHASE2ACTIVE_NOT_RECRUITINGStudy of CVM-1118 for Patients With Advanced Neuroendocrine Tumors
NCT03891784PHASE2ACTIVE_NOT_RECRUITINGAbemaciclib in Treating Patients With Advanced, Refractory, and Unresectable Digestive System Neuroendocrine Tumors
NCT04924075PHASE2RECRUITINGBelzutifan/MK-6482 for the Treatment of Advanced Pheochromocytoma/Paraganglioma (PPGL), Pancreatic Neuroendocrine Tumor (pNET), Von Hippel-Lindau (VHL) Disease-Associated Tumors, Advanced Gastrointestinal Stromal Tumor (wt GIST), or Solid Tumors With HIF-2α Related Genetic Alterations (MK-6482-015)
NCT05040360PHASE2RECRUITINGTesting the Use of Chemotherapy After Surgery for High-Risk Pancreatic Neuroendocrine Tumors
NCT05247905PHASE2ACTIVE_NOT_RECRUITINGComparing Capecitabine and Temozolomide in Combination to Lutetium Lu 177 Dotatate in Patients With Advanced Pancreatic Neuroendocrine Tumors
NCT05988918PHASE2ACTIVE_NOT_RECRUITINGMulticenter Trial of ESK981 in Patients With Select Solid Tumors
NCT05997056PHASE2RECRUITINGTrial of Nab-sirolimus in Patients With Well-differentiated Neuroendocrine Tumors (NETs) of the Gastrointestinal Tract, Lung, or Pancreas Who Have Not Received Prior Treatment With mTOR Inhibitors
NCT06158516PHASE2NOT_YET_RECRUITINGA Study of Surufatinib as Adjuvant Therapy for Pancreatic Neuroendocrine Tumors
NCT07121478PHASE2ENROLLING_BY_INVITATIONPatients With High-grade Pancreatic Neuroendocrine Tumors
NCT00017199PHASE2COMPLETEDPS-341 in Treating Patients With Metastatic Neuroendocrine Tumors
NCT00019786PHASE2COMPLETEDIsolated Hepatic Perfusion With Melphalan in Treating Patients With Primary Unresectable Liver Cancer or Liver Metastases
NCT00027638PHASE2COMPLETEDThalidomide in Treating Patients With Metastatic Neuroendocrine Tumors
NCT00416767PHASE2COMPLETEDCombination Chemotherapy as First-Line Therapy in Treating Patients With Locally Advanced or Metastatic Neuroendocrine Tumors of the Duodenum or Pancreas That Cannot Be Removed By Surgery
NCT00427349PHASE2COMPLETEDAMG 706 and Octreotide in Treating Patients With Low-Grade Neuroendocrine Tumors
NCT00434109PHASE2COMPLETEDPhase II Study of Sunitinib Malate Following Hepatic Artery Embolization
NCT00466856PHASE2TERMINATEDInternal Radiation Therapy in Treating Patients With Liver Metastases From Neuroendocrine Tumors
NCT00576680PHASE1/PHASE2COMPLETEDRAD001 and Temozolomide in Patients With Advanced Pancreatic Neuroendocrine Tumors
NCT00602082PHASE2COMPLETEDCapecitabine and Streptozocin With or Without Cisplatin in Treating Patients With Unresectable or Metastatic Neuroendocrine Tumors
NCT00947167PHASE2TERMINATEDA Phase II Study of Pertuzumab and Erlotinib for Metastatic or Unresectable Neuroendocrine Tumors
NCT01024387PHASE2COMPLETEDAMG 479 in Advanced Carcinoid and Pancreatic Neuroendocrine Tumors
NCT01121562PHASE2COMPLETEDEfficacy And Safety Of Sunitinib In Patients With Advanced Well-Differentiated Pancreatic Neuroendocrine Tumors
NCT01229943PHASE2COMPLETEDEverolimus and Octreotide Acetate With or Without Bevacizumab in Treating Patients With Locally Advanced or Metastatic Pancreatic Neuroendocrine Tumors That Cannot Be Removed by Surgery
NCT01374451PHASE2TERMINATEDEfficacy of Everolimus Alone or in Combination With Pasireotide LAR in Advanced PNET
NCT01466036PHASE2COMPLETEDCabozantinib in Advanced Pancreatic Neuroendocrine and Carcinoid Tumors
NCT01648465PHASE2TERMINATEDStudy of Everolimus Treatment in Newly-diagnosed Patients With Advanced Gastrointestinal Neuroendocrine Tumors
NCT02038738PHASE1/PHASE2UNKNOWN68Ga-DOTATATE PET Scan Imaging in Patients With Neuroendocrine Tumors
NCT02294006PHASE2UNKNOWNActivity and Safety of Everolimus+Octreotide LAR+Metformin in Advanced Pancreatic Well-differentiated NETs
NCT02575300PHASE2COMPLETEDPhase II Study of Ibrutinib in Advanced Carcinoid and Pancreatic Neuroendocrine Tumors
NCT03204019PHASE2UNKNOWNA Study of Tegafur Combined With Temozolomide Versus Tegafur Combined With Temozolomide and Thalidomide in Subjects With Advanced Pancreatic Neuroendocrine Tumor
NCT04505553PHASE2COMPLETEDOral Cryotherapy Plus Acupressure and Acupuncture Versus Oral Cryotherapy for Decreasing Chemotherapy-Induced Peripheral Neuropathy From Oxaliplatin-Based Chemotherapy in Patients With Gastrointestinal Cancer
NCT05568017PHASE2TERMINATEDNeoadjuvant PRRT With Y-90-DOTATOC in pNET
NCT05610826PHASE1/PHASE2WITHDRAWNPreoperative PRRT Versus Surgical Cytoreduction in Metastatic Pancreatic Neuroendocrine Tumors to the Liver
NCT04119024PHASE1RECRUITINGGene Modified Immune Cells After Conditioning Regimen for the Treatment of Stage IIIC or IV Melanoma or Metastatic Solid Tumors

Drugs tested across these trials (top 30)

MoleculeMax phaseTrials referencing
EVEROLIMUS49
CABOZANTINIB45
OCTREOTIDE45
LUTETIUM OXODOTREOTIDE LU-17743
SUNITINIB43
ABEMACICLIB41
BELZUTIFAN41
BEVACIZUMAB41
INDIUM IN 111 PENTETREOTIDE41
LANREOTIDE41
LEUCOVORIN41
OXALIPLATIN41
PASIREOTIDE41
PERTUZUMAB41
STREPTOZOCIN41
TEGAFUR41
ACTINIUM AC 225 DOTATATE31
EVOFOSFAMIDE31
INCOMPLETE FREUND’S ADJUVANT31
SURUFATINIB31
ZANZALINTINIB31
EDOTREOTIDE YTTRIUM Y-9022
FOSLINANIB21
SAPANISERTIB21
SVN53-67/M57-KLH PEPTIDE VACCINE21
ZENIDOLOL21
PAC-111
CHEMBL335003702
CHEMBL407987701
CHEMBL452583301