A Study of Atezolizumab and Paclitaxel Versus Placebo and Paclitaxel in Participants With Previously Untreated Locally Advanced or Metastatic Triple Negative Breast Cancer (TNBC)
- Conditions
- Triple-Negative Breast Cancer
- Interventions
- Registration Number
- NCT03125902
- Lead Sponsor
- Hoffmann-La Roche
- Brief Summary
This Phase 3, multicenter, randomized, double-blind, placebo controlled study is designed to evaluate the efficacy and safety of atezolizumab (MPDL3280A, an anti-programmed death-ligand 1 \[PD-L1\] antibody) administered in combination with paclitaxel compared with placebo in combination with paclitaxel in participants with previously untreated, inoperable locally advanced or metastatic, centrally confirmed TNBC. Participants will be randomized in a 2:1 ratio to receive atezolizumab or placebo plus paclitaxel until disease progression or unacceptable toxicity or end of study, whichever occurs first (maximum up to approximately 40 months). In addition, the Sponsor may decide to terminate the study at any time.
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 653
- Participants with locally advanced or metastatic, histologically documented TNBC (absence of human epidermal growth factor receptor 2 [HER2], estrogen receptor [ER], and progesterone receptor [PR] expression), not amenable to surgical therapy
- Participants eligible for taxane monotherapy
- No prior chemotherapy or targeted systemic therapy (including endocrine therapy) for inoperable locally advanced or metastatic TNBC
- Availability of formalin-fixed paraffin-embedded (FFPE) tumor block (preferred) or at least 17 unstained slides, collected ≤3 months prior to randomization, with an associated pathology report, if available. If a tumour sample taken within 3 months before randomisation is not available and a tumour biopsy is not clinically feasible, the primary surgical resection sample or the most recent FFPE tumour biopsy sample may be used. Of these additional options, the most recent sample should be used.
- Eastern Cooperative Oncology Group performance status of 0 or 1
- Life expectancy at least 12 weeks
- Measurable disease, as defined by RECIST v1.1
- Adequate hematologic and end-organ function
- Negative human immunodeficiency virus (HIV) test at screening.
- Negative hepatitis B surface antigen (HBsAg) test at screening
- Negative total hepatitis B core antibody (HBcAb) test at screening, or positive HBcAb test followed by a negative hepatitis B virus (HBV) DNA test at screening. The HBV DNA test will be performed only for patients who have a positive HBcAb test.
- Negative hepatitis C virus (HCV) antibody test at screening, or positive HCV antibody test followed by a negative HCV RNA test at screening. The HCV RNA test will be performed only for patients who have a positive HCV antibody test.
- Women of child bearing potential must have a negative serum pregnancy test result within 7 days prior to initiation of study drug
- For men and women of child bearing potential: agreement to remain abstinent or use protocol defined contraceptive measures during the treatment period and for at least 5 months after the last dose of atezolizumab/placebo, or for at least 6 months after the last dose of paclitaxel
- Spinal cord compression not definitively treated with surgery and/or radiation, or previously diagnosed and treated spinal cord compression without evidence that disease has been clinically stable for at least 2 weeks prior to randomization
- Known central nervous system (CNS) disease, except for treated asymptomatic CNS metastases
- Leptomeningeal disease
- Uncontrolled pleural effusion, pericardial effusion, or ascites
- Uncontrolled tumor-related pain, or uncontrolled hypercalcemia or clinically significant (symptomatic) hypercalcemia
- Malignancies other than TNBC within 5 years prior to randomization, with the exception of those with a negligible risk of metastasis or death and treated with expected curative outcome (such as adequately treated carcinoma in situ of the cervix, non-melanoma skin carcinoma, or Stage I uterine cancer)
- Pregnant or breast-feeding women, or intending to become pregnant during the study
- Evidence of significant uncontrolled concomitant disease that could affect compliance with the protocol or interpretation of results, including significant liver disease, cardiovascular disease, and presence of an abnormal electrocardiogram (ECG)
- Serious infection requiring antibiotics within 2 weeks prior to randomization, including but not limited to infections requiring hospitalization or IV antibiotics, such as bacteremia, or severe pneumonia
- Major surgical procedure within 4 weeks prior to randomization or anticipation of the need for a major surgical procedure during the study other than for diagnosis
- Treatment with investigational therapy within 30 days prior to initiation of study treatment
- History of hypersensitivity reactions to study drug or any component of the study drug formulation
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Atezolizumab and Paclitaxel Atezolizumab Placebo Participants will receive atezolizumab at a dose of 840 milligrams (mg) via intravenous (IV) infusion on Days 1 and 15 (± 3 days) of every 28-day cycle along with paclitaxel administered at a dose of 90 mg per square meter (mg/m\^2) via IV infusion on Days 1, 8, and 15 of every 28-day cycle until disease progression or unacceptable toxicity. Placebo and Paclitaxel Atezolizumab (MPDL3280A), an engineered anti-PDL1 antibody Participants will receive placebo matching to atezolizumab via IV infusion on Days 1 and 15 (± 3 days) of every 28-day cycle along with paclitaxel administered at a dose of 90 mg/m\^2 via IV infusion on Days 1, 8, and 15 of every 28-day cycle until disease progression or unacceptable toxicity. Placebo and Paclitaxel Paclitaxel Participants will receive placebo matching to atezolizumab via IV infusion on Days 1 and 15 (± 3 days) of every 28-day cycle along with paclitaxel administered at a dose of 90 mg/m\^2 via IV infusion on Days 1, 8, and 15 of every 28-day cycle until disease progression or unacceptable toxicity. Atezolizumab and Paclitaxel Paclitaxel Participants will receive atezolizumab at a dose of 840 milligrams (mg) via intravenous (IV) infusion on Days 1 and 15 (± 3 days) of every 28-day cycle along with paclitaxel administered at a dose of 90 mg per square meter (mg/m\^2) via IV infusion on Days 1, 8, and 15 of every 28-day cycle until disease progression or unacceptable toxicity.
- Primary Outcome Measures
Name Time Method Progression-Free Survival (PFS) Assessed Using Response Evaluation Criteria in Solid Tumors Version 1.1 (RECIST v1.1) in the Intent-to-Treat (ITT) Population From Day 1 to disease progression (PD) or death from any cause, assessed up to primary completion date (approximately 26 months) PFS is defined as the time from randomization to the first occurrence of PD, as determined by the investigator using RECIST v1.1, or death from any cause during the study, whichever occurs first. PD is defined as greater than or equal to (\>/=) 20 percent (%) relative increase and \>/=5 millimeter (mm) of absolute increase in the sum of diameters (SD) of target lesions (TLs), taking as reference the smallest SD recorded since treatment started, or appearance of 1 or more new lesions.
Progression-Free Survival (PFS) Assessed Using Response Evaluation Criteria in Solid Tumors Version 1.1 (RECIST v1.1) in the Subpopulation With Programmed Death-Ligand 1 (PD-L1)-Positive Tumour Status From Day 1 to disease progression (PD) or death from any cause, assessed up to primary completion date (approximately 26 months) PFS is defined as the time from randomization to the first occurrence of PD, as determined by the investigator using RECIST v1.1, or death from any cause during the study, whichever occurs first. PD is defined as greater than or equal to (\>/=) 20 percent (%) relative increase and \>/=5 millimeter (mm) of absolute increase in the sum of diameters (SD) of target lesions (TLs), taking as reference the smallest SD recorded since treatment started, or appearance of 1 or more new lesions.
- Secondary Outcome Measures
Name Time Method Percentage of Participants With Objective Response Assessed Using RECIST v1.1 in the PD-L1-Positive Population (Unconfirmed, Investigator-Assessed) From Day 1 to PD, assessed up to primary completion date (approximately 26 months) Objective response is defined as complete response (CR) or partial response (PR), as determined by the investigator using RECIST v1.1 criteria. CR is defined as the disappearance of all TLs and SA reduction to less than (\<) 10mm for nodal TLs/ non-TLs. PR is defined as \>/=30% decrease in SD of TLs, taking as reference the baseline SD.
Percentage of Participants With Objective Response Assessed Using RECIST v1.1 in the Response-Evaluable Population (Unconfirmed, Investigator-Assessed ) From Day 1 to PD, assessed up to primary completion date (approximately 26 months) Objective response is defined as complete response (CR) or partial response (PR), as determined by the investigator using RECIST v1.1 criteria. CR is defined as the disappearance of all TLs and SA reduction to less than (\<) 10mm for nodal TLs/ non-TLs. PR is defined as \>/=30% decrease in SD of TLs, taking as reference the baseline SD.
Overall Survival (OS) in the ITT Population From Day 1 to death from any cause, assessed up to end of study (up to approximately 36 months) OS is defined as the time from randomization to death from any cause. Results from a pre-specified interim analysis.
Percentage of Participants With Objective Response Assessed Using RECIST v1.1 in the Response-Evaluable Population (Confirmed, Investigator-Assessed ) From Day 1 to PD, assessed up to primary completion date (approximately 26 months) Objective response is defined as complete response (CR) or partial response (PR), as determined by the investigator using RECIST v1.1 criteria. CR is defined as the disappearance of all TLs and SA reduction to less than (\<) 10mm for nodal TLs/ non-TLs. PR is defined as \>/=30% decrease in SD of TLs, taking as reference the baseline SD. Responses were confirmed after 8 weeks if within first 12 months or after 12 weeks if later.
Progression Free Survival by PD-L1 Status, Intent to Treat Population From Day 1 up to primary completion date (approximately 26 months) Duration of Confirmed Response (C-DoR) in (C-DoR)-Evaluable Population From objective response to PD, assessed up to primary completion date (approximately 26 months) C-DoR is defined as the time from the first occurrence of a documented confirmed response (CR or PR) in C-DOR evaluable population until the date of disease progression per RECIST v1.1 or death from any cause, whichever occurs first. Responses were confirmed after 8 weeks if within first 12 months or after 12 weeks if later.
Overall Survival (OS) in the PD-L1-Positive Subpopulation From Day 1 to death from any cause, assessed up 36 months OS is defined as the time from randomization to death from any cause. Results from a pre-specified interim analysis.
Percentage of Participants With Objective Response Assessed Using RECIST v1.1 in the PD-L1-Positive Population (Confirmed, Investigator-Assessed ) From Day 1 to PD, assessed up to primary completion date (approximately 26 months) Objective response is defined as complete response (CR) or partial response (PR), as determined by the investigator using RECIST v1.1 criteria. CR is defined as the disappearance of all TLs and SA reduction to less than (\<) 10mm for nodal TLs/ non-TLs. PR is defined as \>/=30% decrease in SD of TLs, taking as reference the baseline SD. Responses were confirmed after 8 weeks if within first 12 months or after 12 weeks if later.
Duration of Objective Response (DOR) Assessed Using RECIST v1.1 in DOR-evaluable Population (Unconfirmed) From objective response to PD, assessed up to primary completion date (approximately 26 months) DOR is defined as the time period from the date of initial CR or PR until the date of PD or death from any cause, whichever occurs first. CR is defined as the disappearance of all TLs and SA reduction to \<10mm for nodal TLs/ non-TLs. PR is defined as \>/=30% decrease in SD of TLs, taking as reference the baseline SD. PD is defined as \>/=20% relative increase and \>/=5 mm of absolute increase in the SD of TLs, taking as reference the smallest SD recorded since treatment started, or appearance of 1 or more new lesions.
Percentage of Participants With Clinical Benefit Assessed Using RECIST v1.1 in Response-evaluable Population From Day 1 to PD, assessed up to primary completion date (approximately 26 months) Clinical benefit is defined as the achievement of CR, PR, or stable disease according to RECIST v1.1 that lasts for at least 6 months. CR is defined as the disappearance of all TLs and SA reduction to \<10mm for nodal TLs/ non-TLs. PR is defined as \>/=30% decrease in SD of TLs, taking as reference the baseline SD. PD is defined as \>/=20% relative increase and \>/=5 mm of absolute increase in the SD of TLs, taking as reference the smallest SD recorded since treatment started, or appearance of 1 or more new lesions. Stable disease is defined as neither sufficient shrinkage to qualify for PR nor sufficient increase to qualify for PD taking as reference smallest SD since treatment started.
Maximum Observed Serum Concentration (Cmax) of Atezolizumab in PK-evaluable Population C1D1 30 min postdose Percentage of Participants With Adverse Events (AEs) and Serious AEs (SAEs) From Day 1 From baseline up to 64 months Investigator text for AEs is coded using MedDRA version 25.1
Percentage of Participants Who Are Alive at 12 and 18 Months From Day 1 to death from any cause, assessed up to 12 and 18 months Time to Deterioration (TTD) in Global Health Status/ Health Related Quality of Life (HRQoL) in the PRO Evaluable Population From Day 1 to deterioration, assessed up 64 months Deterioration in Global Health Status/HRQoL is defined as a decrease of at least 10 points on the Global Health Status /HRQoL scale (comprised of 2 items: 29 and 30) of the European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30). The 2 items use 7-point scale (1 = very poor to 7 = Excellent). Scores are averaged, transformed to 0-100 scale; where higher score=better level of functioning or greater degree of symptoms.
Percentage of Participants Who Are Alive Without Progression Event at Month 12 Assessed Using RECIST v1.1 From Day 1 to PD or death from any cause, assessed up to 12 months PD is defined as \>/=20% relative increase and \>/=5 mm of absolute increase in the SD of TLs, taking as reference the smallest SD recorded since treatment started, or appearance of 1 or more new lesions.
Minimum Observed Plasma Concentration (Cmin) of Paclitaxel Pre-dose (0 hours) on Day 1 of Cycle 3 (1 Cycle = 28 days) Maximum Observed Plasma Concentration (Cmax) of Paclitaxel Pre-dose (0 hours), 5-10 min before and after paclitaxel infusion, 60 min after paclitaxel infusion on Day 1 of Cycles 1 and 3 (paclitaxel infusion duration= 60 min) (1 Cycle = 28 days) Percentage of Participants With Anti-Drug Antibodies' (ADAs) Against Atezolizumab in ADA Evaluable Population Pre-dose (0 hours) on Day 1 of Cycles 1, 2, 3, 4, 8, 12, 16, and at every 8 cycles thereafter until TD, at TD, and at 90-150 days after TD (maximum up to 45 months) (1 Cycle = 28 days) Overall Survival by PD-L1 Status, Intent to Treat Population From Day 1 up to 66 months Minimum Observed Serum Concentration (Cmin) of Atezolizumab in PK Evaluable Population Pre-dose (0 hours) on Day 1 of Cycles 2-4 and at treatment discontinuation (TD), (approximately 9 months).
Trial Locations
- Locations (161)
Magee-Woman's Hospital
🇺🇸Pittsburgh, Pennsylvania, United States
Fakultni nemocnice Olomouc; Onkologicka klinika
🇨🇿Olomouc, Czechia
Narodny Onkologicky Ustav; Oddelenie klinickej onkologie A
🇸🇰Bratislava, Slovakia
Sandton Oncology Medical Group
🇿🇦Sandton, South Africa
Izmir Ataturk Training and Research Hospital
🇹🇷Izmir, Turkey
Christie Hospital
🇬🇧Manchester, United Kingdom
Hospital Sao Lucas - PUCRS
🇧🇷Porto Alegre, RS, Brazil
Florida Cancer Specialists; Department of Oncology
🇺🇸Fort Myers, Florida, United States
Florida Cancer Specialist, North Region
🇺🇸Saint Petersburg, Florida, United States
The Valley Hospital
🇺🇸Paramus, New Jersey, United States
Santa Casa de Misericordia de Salvador
🇧🇷Salvador, BA, Brazil
Centro Oncologico Riojano Integral (CORI)
🇦🇷La Rioja, Argentina
Hospital Araujo Jorge; Departamento de Ginecologia E Mama
🇧🇷Goiania, GO, Brazil
Hopital du Saint Sacrement
🇨🇦Quebec City, Quebec, Canada
Universitätsklinik Tübingen; Frauenklinik
🇩🇪Tübingen, Germany
Tel Aviv Sourasky Medical Ctr; Oncology
🇮🇱Tel Aviv, Israel
Hospital San Raffaele
🇮🇹Milano, Lombardia, Italy
POKO Poprad; Department of Oncology
🇸🇰Poprad, Slovakia
Dicle Uni Medical Faculty; Internal Medicine
🇹🇷Diyarbakir, Turkey
Naha-nishi Clinic
🇯🇵Okinawa, Japan
Goztepe Prof.Dr. Suleyman Yalcin City Hospital; Clinical Oncology
🇹🇷Kadiköy, Turkey
K hospital
🇻🇳Hanoi, Vietnam
Hopital Tenon
🇫🇷Paris, France
Max Super Speciality Hospital; Medical Oncology
🇮🇳North WEST Delhi, Delhi, India
Rajiv Gandhi Cancer Inst.&Research Center; Medical Oncology
🇮🇳New Delhi, Delhi, India
Apollo Speciality Hospital
🇮🇳Chennai, Tamil NADU, India
Sagara Hospital
🇯🇵Kagoshima, Japan
Stanford Cancer Center
🇺🇸Stanford, California, United States
Northwest Georgia Oncology Centers PC - Marietta
🇺🇸Marietta, Georgia, United States
Centro de Pesquisas Clinicas em Oncologia - CPCO
🇧🇷Cachoeiro de Itapemirim, ES, Brazil
Hospital Perola Byington
🇧🇷Sao Paulo, SP, Brazil
Hospital Nossa Senhora da Conceicao
🇧🇷Porto Alegre, RS, Brazil
Cross Cancer Institute
🇨🇦Edmonton, Alberta, Canada
Tom Baker Cancer Centre-Calgary
🇨🇦Calgary, Alberta, Canada
Kingston General Hospital
🇨🇦Kingston, Ontario, Canada
Grand River Hospital
🇨🇦Kitchener, Ontario, Canada
London Regional Cancer Centre
🇨🇦London, Ontario, Canada
McGill University; Glen Site; Oncology
🇨🇦Montreal, Quebec, Canada
Sunnybrook Odette Cancer Centre
🇨🇦Toronto, Ontario, Canada
Beijing Union Hospital
🇨🇳Beijing, China
Cancer Hospital Chinese Academy of Medical Sciences.
🇨🇳Beijing, China
Sun Yat-sen Memorial Hospital
🇨🇳Guangzhou, China
Harbin Medical University Cancer Hospital
🇨🇳Harbin, China
West China Hospital, Sichuan University; Department of Breast
🇨🇳Chengdu, China
Shandong Cancer Hospital
🇨🇳Jinan, China
Jiangsu Province Hospital (the First Affiliated Hospital With Nanjing Medical University)
🇨🇳Nanjing City, China
Jiangsu Cancer Hospital
🇨🇳Nanjing City, China
Fudan University Shanghai Cancer Center
🇨🇳Shanghai City, China
Shanghai Jiao Tong University School of Medicine (SJTUSM) - Ruijin Hospital (GuangCi Hospital)
🇨🇳Shanghai, China
Liaoning cancer Hospital & Institute
🇨🇳Shenyang, China
Hebei Medical University Fourth Hospital;(Tumor Hospital of Hebei Province)
🇨🇳Shijiazhuang, China
The Second Affiliated Hospital of Xi'an Jiao Tong University
🇨🇳Xi'an City, China
Tianjin Medical University Cancer Institute & Hospital
🇨🇳Tianjin, China
First Affiliated Hospital of Medical College of Xi'an Jiaotong University
🇨🇳Xi'an, China
Zhejiang Cancer Hospital
🇨🇳Zhejiang, China
Henan Cancer Hospital
🇨🇳Zhengzhou, China
Fakultni Nemocnice Hradec Kralove; Dept of Radiotherapy & Oncology
🇨🇿Hradec Kralove, Czechia
Clinical Hospital Centre Zagreb
🇭🇷Zagreb, Croatia
Fakultni nemocnice Ostrava; Klinika onkologicka FNO a LF OU
🇨🇿Ostrava-Poruba, Czechia
Clinique Sainte Catherine; Hopital De Semaine
🇫🇷Avignon, France
HOPITAL JEAN MINJOZ; Oncologie
🇫🇷Besancon, France
Fakultni Poliklinika Vseobecne Fakultni Niemocnice; Onkologicka Klinika
🇨🇿Praha 2, Czechia
Polyclinique Bordeaux Nord Aquitaine
🇫🇷Bordeaux, France
CHD Les Oudairies
🇫🇷La Roche Sur Yon, France
Hopital Morvan
🇫🇷Brest, France
Centre Oscar Lambret; Senologie
🇫🇷Lille, France
Centre Leon Berard; Departement Oncologie Medicale
🇫🇷Lyon, France
Centre D'Oncologie de Gentilly; Oncology
🇫🇷Nancy, France
Hopital Caremeau; Hematologie Oncologie
🇫🇷Nimes, France
Hopital Saint Louis, Service D Oncologie Medicale
🇫🇷Paris, France
Institut Curie; Oncologie Medicale
🇫🇷Paris, France
Ch Pitie Salpetriere; Oncologie Medicale
🇫🇷Paris, France
Centre Eugene Marquis; Service d'oncologie
🇫🇷Rennes, France
Institut Claudius Regaud; Departement Oncologie Medicale
🇫🇷Toulouse, France
Centre Paul Strauss; Oncologie Medicale
🇫🇷Strasbourg, France
Ambulantes Tumorzentrum Spandau; Dres. Benno Mohr und Uwe Peters
🇩🇪Berlin, Germany
Onkologische Schwerpunktpraxis Bielefeld
🇩🇪Bielefeld, Germany
Institut Gustave Roussy; Sitep
🇫🇷VILLEJUIF Cedex, France
Nationales Centrum für Tumorerkrankungen (NCT) ; Gyn. Onk. Frauenklinik; Uniklinikum Heidelberg
🇩🇪Heidelberg, Germany
HOPA im Struensee-Haus, Dres. Erik Engel, Wiebke Hollburg
🇩🇪Hamburg, Germany
Klinikum Essen-Mitte Ev. Huyssens-Stiftung / Knappschafts GmbH; Klinik für Senologie / Brustzentrum
🇩🇪Essen, Germany
St. Elisabeth Krankenhaus Köln GmbH; Gynäkologie und Geburtshilfe
🇩🇪Koeln, Germany
Universitätsmedizin Mainz; Klinik u. Poliklinik f. Geburtshilfe u. Frauenheilkunde
🇩🇪Mainz, Germany
OnkoNet Marburg GmbH
🇩🇪Marburg, Germany
Klinik & Poliklinik für Frauenheilkunde und Geburtshilfe, Campus Innenstadt
🇩🇪München, Germany
Gemeinschaftspraxis für Hämatologie und Onkologie
🇩🇪Münster, Germany
Klinikum Ernst von Bergmann; Frauenklinik
🇩🇪Potsdam, Germany
Dres. Helmut Forstbauer, Carsten Ziske und Kollegen; Onkologische Schwerpunktpraxis
🇩🇪Troisdorf, Germany
Anticancer Hospital Ag. Savas ; 2Nd Dept. of Oncology - Internal Medicine
🇬🇷Athens, Greece
Yashoda Hospital
🇮🇳Hyderabad, Andhra Pradesh, India
ARETAIEION UNIVERSITY HOSPITAL; oncology unit
🇬🇷Athens, Greece
Agioi Anargyroi Cancer Hospital; 2Nd Oncology Dept.
🇬🇷Kifisia, Greece
Papageorgiou General Hospital; Medical Oncology
🇬🇷Thessaloniki, Greece
Manipal Hospital; Department of Oncology
🇮🇳Bangalore, Karnataka, India
Tata Memorial Hospital; Dept of Medical Oncology
🇮🇳Mumbai, Maharashtra, India
Apollo Gleneagles Hospitals
🇮🇳Kolkata, WEST Bengal, India
TATA Medical Centre; Medical Oncology
🇮🇳Kolkata, WEST Bengal, India
Jehangir Hospital
🇮🇳Pune, Maharashtra, India
Hadassah Ein Karem Hospital; Oncology Dept
🇮🇱Jerusalem, Israel
MAX Balaji Hospital
🇮🇳Delhi, India
Rabin MC; Davidof Center - Oncology Institute
🇮🇱Petach Tikva, Israel
Sheba Medical Center
🇮🇱Ramat Gan, Israel
Rambam Health Corporation; Oncology Institute
🇮🇱Rambam, Israel
Kaplan Medical Center
🇮🇱Rehovot, Israel
Assaf Harofeh; Oncology
🇮🇱Zerifin, Israel
Fondazione Università G. D'Annunzio; Clinical Research Center (CRC); Centro Studi (CESI)
🇮🇹Chieti, Abruzzo, Italy
Azienda Ospedaliero - Universitaria di Modena Policlinico
🇮🇹Modena, Emilia-Romagna, Italy
Azienda Ospedaliera Universitaria Federico II
🇮🇹Napoli, Campania, Italy
Presidio Ospedaliero S. Giovanni Di Dio; U.O. Di Oncologia
🇮🇹Frattamaggiore, Campania, Italy
Istituto Nazionale Tumori Fondazione G. Pascale
🇮🇹Napoli, Campania, Italy
Universita Campus Bio-Medico di Roma (UCBM)
🇮🇹Roma, Lazio, Italy
Azienda Policlinico Umberto I
🇮🇹Roma, Lazio, Italy
IRCCS Istituto Regina Elena (IFO); Oncologia Medica B
🇮🇹Roma, Lazio, Italy
A.O. Universitaria S. Martino Di Genova
🇮🇹Genova, Liguria, Italy
Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII (Presidio Papa Giovanni XXIII)
🇮🇹Bergamo, Lombardia, Italy
Asst Degli Spedali Civili Di Brescia
🇮🇹Brescia, Lombardia, Italy
Fondazione IRCCS Istituto Nazionale dei Tumori
🇮🇹Milano, Lombardia, Italy
IEO Istituto Europeo di Oncologia;Divisione Oncologia Medica
🇮🇹Milano, Lombardia, Italy
Fondazione Del Piemonte Per L'oncologia IRCC Di Candiolo
🇮🇹Candiolo, Piemonte, Italy
Ospedale S. Vincenzo; Oncologia Medica
🇮🇹Taormina, Sicilia, Italy
Azienda Ospedaliero-Universitaria Careggi; SOD Radioterapia
🇮🇹Firenze, Toscana, Italy
IRCCS Istituto Clinico Humanitas; Oncologia
🇮🇹Rozzano (MI), Lombardia, Italy
Ospedale Civile; Unita Operativa Di Oncologia Medica
🇮🇹Livorno, Toscana, Italy
IOV - Istituto Oncologico Veneto - IRCCS; Oncologia Medica II
🇮🇹Padova, Veneto, Italy
Gunma Prefectural Cancer Center
🇯🇵Gunma, Japan
Hiroshima City Hiroshima Citizens Hospital
🇯🇵Hiroshima, Japan
Kanagawa Cancer Center
🇯🇵Kanagawa, Japan
Tokai University Hospital
🇯🇵Kanagawa, Japan
Niigata Cancer Center Hospital
🇯🇵Niigata, Japan
Osaka International Cancer Institute
🇯🇵Osaka, Japan
Saitama Cancer Center
🇯🇵Saitama, Japan
The Cancer Institute Hospital of JFCR
🇯🇵Tokyo, Japan
Centre Hospitalier Universitaire Mohamed VI; Oncologie-Hématologie
🇲🇦Marrakech, Morocco
Institut National D'oncologie Sidi Mohammed Ben Abdellah; Anatomopathologie
🇲🇦Rabat, Morocco
Prof. Dr. I. Chiricuta Institute of Oncology
🇷🇴Cluj Napoca, Romania
Centrul de Oncologie Sfantul Nectarie
🇷🇴Craiova, Romania
Petrov Research Inst. of Oncology
🇷🇺Sankt Petersburg, Russian Federation
Russian Oncology Research Center n.a. N.N. Blokhin
🇷🇺Moscow, Moskovskaja Oblast, Russian Federation
King Fahad Specialist Hospital; Oncology
🇸🇦Dammam, Saudi Arabia
International Medical Center (IMC)
🇸🇦Jeddah, Saudi Arabia
King Fahad Medical City; Gastroentrology
🇸🇦Riyadh, Saudi Arabia
Wilgers Oncology Centre
🇿🇦Pretoria, South Africa
Private Oncology Centre
🇿🇦Pretoria, South Africa
Complejo Hospitalario Universitario A Coruña (CHUAC); Servicio de Oncologia
🇪🇸A Coruña, LA Coruña, Spain
Hospital Universitario Virgen Macarena; Servicio de Oncologia
🇪🇸Sevilla, Spain
Hospital Clínic i Provincial; Servicio de Hematología y Oncología
🇪🇸Barcelona, Spain
Hospital Universitario Virgen del Rocio; Servicio de Oncologia
🇪🇸Sevilla, Spain
Hospital Universitario de Fuenlabrada; Servicio de Oncologia
🇪🇸Madrid, Spain
Adana Baskent University Medical Faculty; Oncology
🇹🇷Adana, Turkey
Ankara Bilkent City Hospital
🇹🇷Ankara, Turkey
Uludag University Medical Faculty; Internal Medicine
🇹🇷Bursa, Turkey
Trakya Universitesi Tip Fakultesi, Medikal Onkoloji Bilim Dali, Balkan Yerleskesi
🇹🇷Edirne, Turkey
Kocaeli University Faculty of Medicine; Medical oncology
🇹🇷Izmit, Turkey
Guys and St Thomas NHS Foundation Trust, Guys Hospital
🇬🇧London, United Kingdom
Mount Vernon Cancer Centre
🇬🇧Northwood, United Kingdom
Hochiminh city oncology hospital
🇻🇳Hochiminh city, Vietnam
Centre Hospitalier Universitaire de Sherbrooke - Hopital Fleurimont
🇨🇦Sherbrooke, Quebec, Canada
HCA Midwest Health
🇺🇸Kansas City, Missouri, United States
Tennessee Oncology; Sarah Cannon Research Institute
🇺🇸Nashville, Tennessee, United States
Indraprastha Apollo Hospitals
🇮🇳New Delhi, Delhi, India
Dr. B L Kapur Memorial Hospital; BLK Cancer Centre
🇮🇳New Delhi, Delhi, India