Study of Chemoradiotherapy With or Without Pembrolizumab (MK-3475) For The Treatment of Locally Advanced Cervical Cancer (MK-3475-A18/KEYNOTE-A18/ENGOT-cx11/GOG-3047)

Phase 3

Active, not recruiting

• Conditions: Uterine Cervical Neoplasms
• Interventions: Biological: Pembrolizumab; Drug: Placebo for pembrolizumab; Drug: Cisplatin; Radiation: External Beam Radiotherapy (EBRT); Radiation: Brachytherapy

• Registration Number: NCT04221945
• Lead Sponsor: Merck Sharp & Dohme LLC

Brief Summary

The purpose of this study is to evaluate the efficacy and safety of pembrolizumab plus concurrent chemoradiotherapy compared to placebo plus concurrent chemoradiotherapy in participants with locally advanced cervical cancer.

The primary hypotheses are that pembrolizumab plus concurrent chemoradiotherapy is superior to placebo plus concurrent chemoradiotherapy with respect to progression-free survival and overall survival.

Once the study objectives have been met or the study has ended, participants will be discontinued from this study and will be enrolled in an extension study to continue protocol-defined assessments and treatment.

Detailed Description

Not available

Study Timeline

• Study First Submitted: 2019-12-23
• Study First Submitted QC: 2020-01-07
• Study First Posted: 2020-01-09
• Study Start: 2020-05-12
• Status Verified: 2024-11
• Last Update Submitted: 2024-11-22
• Last Update Posted: 2024-11-26
• Primary Completion: 2025-01-07
• Study Completion: 2026-01-17

Recruitment & Eligibility

• Status: ACTIVE_NOT_RECRUITING
• Sex: Female
• Target Recruitment: 980

Inclusion Criteria

• Has high-risk locally advanced cervical cancer (LACC): The International Federation of Gynecology and Obstetrics (FIGO) 2014 Stage IB2-IIB (with node-positive disease) or FIGO 2014 Stages III-IVA
• Has histologically-confirmed squamous cell carcinoma, adenocarcinoma, or adenosquamous carcinoma of the cervix
• Has not previously received any definitive surgical, radiation, or systemic therapy for cervical cancer, including investigational agents, and is immunotherapy-naïve
• Female participants must not be pregnant or breastfeeding and agree to use highly effective contraception during the treatment period and for at least 120 days after the last dose of pembrolizumab or placebo and 180 days following the end of chemoradiotherapy and agrees not to donate eggs (ova, oocytes) to others or freeze/store for her own use for the purpose of reproduction during this period.
• Female participants must abstain from breastfeeding during the study intervention period and for at least 120 days after the last dose of pembrolizumab or placebo and 180 days following the end of chemoradiotherapy
• Has an Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1 within 7 days prior to the first dose of study treatment
• Has provided a tissue sample from a core incisional or excisional biopsy of a tumor lesion
• Has radiographically evaluable disease, either measurable or non-measurable per RECIST 1.1, as assessed by the local site investigator/radiology
• Has adequate organ function within 7 days prior to the start of study treatment.

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Exclusion Criteria

• Has excluded subtypes of LACC
• Has FIGO 2014 Stage IVB disease
• Has undergone a previous hysterectomy defined as removal of the entire uterus or will have a hysterectomy as part of their initial cervical cancer therapy
• Has bilateral hydronephrosis, unless at least one side has been stented or resolved by positioning of nephrostomy or considered mild and not clinically significant in the opinion of the investigator
• Has anatomy or tumor geometry or any other reason or contraindication that cannot be treated with intracavitary brachytherapy or a combination of intracavitary and interstitial brachytherapy
• Has received a live vaccine within 30 days prior to the first dose of study treatment
• Has received treatment with systemic immunostimulatory agents, colony stimulating factors, interferons, interleukins and vaccine combinations within 6 weeks or 5 half-lives of the drug, whichever is shorter, prior to Cycle 1, Day 1
• Has received prior therapy with an anti-programmed cell death receptor 1 (PD-1), anti-programmed cell death receptor ligand 1 (PD-L1), or anti-programmed cell death receptor ligand 2 (PD-L2) agent or with an agent directed to another stimulatory or co-inhibitory T-cell receptor (eg, cytotoxic T-lymphocyte-associated protein 4 (CTLA-4), OX-40, CD137)
• Has received prior systemic anticancer therapy including investigational agents within 4 weeks prior to randomization
• Is currently participating in or has participated in a study of an investigational agent or has used an investigational device within 4 weeks prior to randomization
• Has any contraindication to the use of cisplatin
• Has a diagnosis of immunodeficiency or is receiving chronic systemic steroid therapy (in dosing exceeding 10 mg daily of prednisone equivalent) or any other form of immunosuppressive therapy within 7 days prior to the first dose of study treatment
• Has a known additional malignancy that is progressing or has required active treatment within the past 3 years
• Has severe hypersensitivity to pembrolizumab and/or any of its excipients
• Has an active autoimmune disease that has required systemic treatment in past 2 years
• Has a history of (non-infectious) pneumonitis/interstitial lung disease that required steroids or has current pneumonitis/interstitial lung disease
• Has an active infection requiring systemic therapy
• Has a known history of Human Immunodeficiency Virus (HIV) infection
• Has a known history of Hepatitis B or known active Hepatitis C virus infection
• Has a history or current evidence of any condition, therapy, lab abnormality, or other circumstance that may increase the risk associated with study participation or study treatment administration or may interfere with the interpretation of study results, and in the judgment of the investigator or Sponsor, would make the participant inappropriate for entry into this study
• Has a known psychiatric or substance abuse disorder that would interfere with the participant's ability to cooperate with the requirements of the study
• Has had an allogenic tissue/solid organ transplant
• Has evidence of metastatic disease per RECIST 1.1 including lymph nodes above the first lumbar vertebra (L1) cephalad body, in the inguinal region

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Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
chemoradiotherapy + pembrolizumab	Pembrolizumab	Participants receive pembrolizumab 200 mg intravenously (IV) on Day 1 of each 3-week cycle (Q3W) for 5 cycles followed by pembrolizumab 400 mg IV on Day 1 of each 6-week cycle (Q6W) for an additional 15 cycles. During the Q3W dosing period of pembrolizumab, participants receive concurrent chemoradiotherapy. The standard of care chemoradiotherapy regimen includes cisplatin 40 mg/m\^2 IV once per week (QW) for 5 or 6 weeks plus external beam radiotherapy (EBRT) followed by brachytherapy with minimum total radiotherapy dose of 80 Gray Units (Gy) for volume-directed and 75 Gy for point-directed given with the total duration of radiation treatment not to exceed 50 days (with an extension to a maximum of 56 days for unforeseen delays).
chemoradiotherapy + pembrolizumab	External Beam Radiotherapy (EBRT)	Participants receive pembrolizumab 200 mg intravenously (IV) on Day 1 of each 3-week cycle (Q3W) for 5 cycles followed by pembrolizumab 400 mg IV on Day 1 of each 6-week cycle (Q6W) for an additional 15 cycles. During the Q3W dosing period of pembrolizumab, participants receive concurrent chemoradiotherapy. The standard of care chemoradiotherapy regimen includes cisplatin 40 mg/m\^2 IV once per week (QW) for 5 or 6 weeks plus external beam radiotherapy (EBRT) followed by brachytherapy with minimum total radiotherapy dose of 80 Gray Units (Gy) for volume-directed and 75 Gy for point-directed given with the total duration of radiation treatment not to exceed 50 days (with an extension to a maximum of 56 days for unforeseen delays).
chemoradiotherapy + pembrolizumab	Brachytherapy	Participants receive pembrolizumab 200 mg intravenously (IV) on Day 1 of each 3-week cycle (Q3W) for 5 cycles followed by pembrolizumab 400 mg IV on Day 1 of each 6-week cycle (Q6W) for an additional 15 cycles. During the Q3W dosing period of pembrolizumab, participants receive concurrent chemoradiotherapy. The standard of care chemoradiotherapy regimen includes cisplatin 40 mg/m\^2 IV once per week (QW) for 5 or 6 weeks plus external beam radiotherapy (EBRT) followed by brachytherapy with minimum total radiotherapy dose of 80 Gray Units (Gy) for volume-directed and 75 Gy for point-directed given with the total duration of radiation treatment not to exceed 50 days (with an extension to a maximum of 56 days for unforeseen delays).
chemoradiotherapy + placebo for pembrolizumab	External Beam Radiotherapy (EBRT)	Participants receive placebo for pembrolizumab IV on Day 1 of each 3-week cycle (Q3W) for 5 cycles followed by placebo IV on Day 1 of each 6-week cycle (Q6W) for an additional 15 cycles. During the Q3W dosing period of placebo, participants receive concurrent chemoradiotherapy. The standard of care chemoradiotherapy regimen includes cisplatin 40 mg/m\^2 IV once per week (QW) for 5 or 6 weeks plus external beam radiotherapy (EBRT) followed by brachytherapy with minimum total radiotherapy dose of 80 Gray Units (Gy) for volume-directed and 75 Gy for point-directed given with the total duration of radiation treatment not to exceed 50 days (with an extension to a maximum of 56 days for unforeseen delays).
chemoradiotherapy + placebo for pembrolizumab	Brachytherapy	Participants receive placebo for pembrolizumab IV on Day 1 of each 3-week cycle (Q3W) for 5 cycles followed by placebo IV on Day 1 of each 6-week cycle (Q6W) for an additional 15 cycles. During the Q3W dosing period of placebo, participants receive concurrent chemoradiotherapy. The standard of care chemoradiotherapy regimen includes cisplatin 40 mg/m\^2 IV once per week (QW) for 5 or 6 weeks plus external beam radiotherapy (EBRT) followed by brachytherapy with minimum total radiotherapy dose of 80 Gray Units (Gy) for volume-directed and 75 Gy for point-directed given with the total duration of radiation treatment not to exceed 50 days (with an extension to a maximum of 56 days for unforeseen delays).
chemoradiotherapy + placebo for pembrolizumab	Placebo for pembrolizumab	Participants receive placebo for pembrolizumab IV on Day 1 of each 3-week cycle (Q3W) for 5 cycles followed by placebo IV on Day 1 of each 6-week cycle (Q6W) for an additional 15 cycles. During the Q3W dosing period of placebo, participants receive concurrent chemoradiotherapy. The standard of care chemoradiotherapy regimen includes cisplatin 40 mg/m\^2 IV once per week (QW) for 5 or 6 weeks plus external beam radiotherapy (EBRT) followed by brachytherapy with minimum total radiotherapy dose of 80 Gray Units (Gy) for volume-directed and 75 Gy for point-directed given with the total duration of radiation treatment not to exceed 50 days (with an extension to a maximum of 56 days for unforeseen delays).
chemoradiotherapy + pembrolizumab	Cisplatin	Participants receive pembrolizumab 200 mg intravenously (IV) on Day 1 of each 3-week cycle (Q3W) for 5 cycles followed by pembrolizumab 400 mg IV on Day 1 of each 6-week cycle (Q6W) for an additional 15 cycles. During the Q3W dosing period of pembrolizumab, participants receive concurrent chemoradiotherapy. The standard of care chemoradiotherapy regimen includes cisplatin 40 mg/m\^2 IV once per week (QW) for 5 or 6 weeks plus external beam radiotherapy (EBRT) followed by brachytherapy with minimum total radiotherapy dose of 80 Gray Units (Gy) for volume-directed and 75 Gy for point-directed given with the total duration of radiation treatment not to exceed 50 days (with an extension to a maximum of 56 days for unforeseen delays).
chemoradiotherapy + placebo for pembrolizumab	Cisplatin	Participants receive placebo for pembrolizumab IV on Day 1 of each 3-week cycle (Q3W) for 5 cycles followed by placebo IV on Day 1 of each 6-week cycle (Q6W) for an additional 15 cycles. During the Q3W dosing period of placebo, participants receive concurrent chemoradiotherapy. The standard of care chemoradiotherapy regimen includes cisplatin 40 mg/m\^2 IV once per week (QW) for 5 or 6 weeks plus external beam radiotherapy (EBRT) followed by brachytherapy with minimum total radiotherapy dose of 80 Gray Units (Gy) for volume-directed and 75 Gy for point-directed given with the total duration of radiation treatment not to exceed 50 days (with an extension to a maximum of 56 days for unforeseen delays).

Primary Outcome Measures

Name	Time	Method
Progression-Free Survival (PFS) Per Response Evaluation Criteria in Solid Tumors Version 1.1 (RECIST 1.1) as Assessed by the Investigator	Up to approximately 38 months	PFS is defined as the time from randomization to the first documented progressive disease (PD) or death due to any cause, whichever occurs first. Per RECIST 1.1, or by histopathologic confirmation of suspected disease progression, PD is defined as ≥20% increase in the sum of diameters of target lesions. In addition to the relative increase of 20%, the sum must also demonstrate an absolute increase of ≥5 mm. The appearance of one or more new lesions is also considered PD. Unequivocal progression of non-target lesions is also considered PD.
Overall Survival (OS)	Up to approximately 46 months	OS is the time from randomization to death due to any cause.

Secondary Outcome Measures

Name	Time	Method
Complete Response (CR) Rate Per Response Evaluation Criteria In Solid Tumors Version 1.1 (RECIST 1.1) at Week 12 as Assessed by Blinded Independent Central Review (BICR)	Up to approximately 38 months	For participants who demonstrated a confirmed Complete Response (CR: Disappearance of all target and non-target lesions and also includes reduction of all nodal lesions to \<10mm) per RECIST 1.1, CR rate is defined as the percentage of participants who experienced a CR. CR data will be cumulated to a certain cut-off date and the analysis will be performed to estimate the CR rate at Week 12 using the entire CR data up to the cut-off date. The cut-off date is estimated to be approximately 38 months.
Progression-Free Survival (PFS) Per Response Evaluation Criteria in Solid Tumors Version 1.1 (RECIST 1.1) in Programmed Cell Death 1 Ligand 1 (PD-L1) Positive Participants as Assessed by Blinded Independent Central Review (BICR)	Up to approximately 38 months	PFS is defined as the time from randomization to the first documented progressive disease (PD) or death due to any cause, whichever occurs first. Per RECIST 1.1, PD is defined as ≥20% increase in the sum of diameters of target lesions. In addition to the relative increase of 20%, the sum must also demonstrate an absolute increase of ≥5 mm. The appearance of one or more new lesions is also considered PD. Unequivocal progression of non-target lesions is also considered PD.
Overall Survival (OS) in Programmed Cell Death 1 Ligand 1 (PD-L1) Positive Participants as Assessed by the Investigator	Up to approximately 46 months	OS is the time from randomization to death due to any cause.
Overall Survival (OS) in Programmed Cell Death 1 Ligand 1 (PD-L1) Positive Participants as Assessed by Blinded Independent Central Review (BICR)	Up to approximately 46 months	OS is the time from randomization to death due to any cause.
Progression-Free Survival (PFS) After Next-Line Treatment (PFS 2) Following Discontinuation of Study Treatment	Up to approximately 46 months	PFS is defined as the time from randomization to the first documented progressive disease (PD) on next-line treatment or death due to any cause, whichever occurs first, as assessed by the investigator.
Objective Response Rate (ORR) Per Response Evaluation Criteria in Solid Tumors Version 1.1 (RECIST 1.1) as Assessed by the Investigator	Up to approximately 46 months	ORR is defined as the percentage of participants who have a Complete Response (CR: Disappearance of all target and non-target lesions and also includes reduction of all nodal lesions to \<10mm) or a Partial Response (PR: At least a 30% decrease in the sum of diameters of target lesions and includes no unequivocal progression in non-target lesions) per RECIST 1.1.
Objective Response Rate (ORR) Per Response Evaluation Criteria in Solid Tumors Version 1.1 (RECIST 1.1) as Assessed by Blinded Independent Central Review (BICR)	Up to approximately 46 months	ORR is defined as the percentage of participants who have a Complete Response (CR: Disappearance of all target and non-target lesions and also includes reduction of all nodal lesions to \<10mm) or a Partial Response (PR: At least a 30% decrease in the sum of diameters of target lesions and includes no unequivocal progression in non-target lesions) per RECIST 1.1.
Change from Baseline in European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30) Global Health Status Score	Baseline and up to approximately 46 months	The EORTC QLQ-C30 is a questionnaire that rates the overall quality of life in cancer participants. The first 28 questions use a 4-point scale (1=not at all to 4=very much) for evaluating function (physical, role, social, cognitive, emotional), symptoms (diarrhea, fatigue, dyspnea, appetite loss, insomnia, nausea/vomiting, constipation, and pain) and financial difficulties. The last 2 questions use a 7-point scale (1=very poor to 7=excellent) to evaluate overall health and quality of life. Global scores are converted to a score of 0 to 100, with a higher score indicating improved health status. The change from baseline in EORTC QLQ-C30 score will be presented.
Change from Baseline in European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30) Physical Function Score	Baseline and up to approximately 46 months	The EORTC QLQ-C30 is a questionnaire to assess the overall quality of life of cancer patients. Participant responses to 5 questions about their physical functioning are scored on a 4-point scale (1=not at all to 4=very much). Using linear transformation, raw scores are standardized, so that scores range from 0 to 100. A higher score indicates a better quality of life. The change from baseline in physical function (EORTC QLQ-C30 Items 1-5) score will be presented.
Change from Baseline in European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Symptom Specific Scale for Cervical Cancer (EORTC QLQ-CX24) Score	Baseline and up to approximately 46 months	The EORTC QLQ-CX24 is a questionnaire that rates the symptoms common to women with cervical cancer and evaluates the impact of disease and/or treatments. The 24 items use a 4-point scale (1=not at all to 4=very much) and are classified into 3 multi-item scales, 11 items with symptom experience, 3 items with body image, and 4 items with sexual/ vaginal functioning. The other items of the questionnaire are lymphedema, peripheral neuropathy, menopausal symptom, sexual worry, sexual activity, and sexual enjoyment. The change from baseline in EORTC QLQ-CX24 score will be presented.
Number of Participants Who Experience One or More Adverse Events (AEs)	Up to approximately 46 months	An AE is defined as any unfavorable and unintended sign, symptom, disease, or worsening of preexisting condition temporally associated with study treatment and irrespective of causality to study treatment.
Progression-Free Survival (PFS) Per Response Evaluation Criteria in Solid Tumors Version 1.1 (RECIST 1.1) as Assessed by Blinded Independent Central Review (BICR)	Up to approximately 38 months	PFS is defined as the time from randomization to the first documented progressive disease (PD) or death due to any cause, whichever occurs first. Per RECIST 1.1, PD is defined as ≥20% increase in the sum of diameters of target lesions. In addition to the relative increase of 20%, the sum must also demonstrate an absolute increase of ≥5 mm. The appearance of one or more new lesions is also considered PD. Unequivocal progression of non-target lesions is also considered PD.
Progression-Free Survival (PFS) Per Response Evaluation Criteria in Solid Tumors Version 1.1 (RECIST 1.1) at Month 24 as Assessed by the Investigator	Up to approximately 38 months	PFS is defined as the time from randomization to the first documented progressive disease (PD) or death due to any cause, whichever occurs first. Per RECIST 1.1, or by histopathologic confirmation of suspected disease progression, PD is defined as ≥20% increase in the sum of diameters of target lesions. In addition to the relative increase of 20%, the sum must also demonstrate an absolute increase of ≥5 mm. The appearance of one or more new lesions is also considered PD. Unequivocal progression of non-target lesions is also considered PD. PFS data will be cumulated to a certain cut-off date and the analysis will be performed via Kaplan-Meier approach to estimate the PFS rate at Month 24 using the entire PFS data up to the cut-off date. The cut-off date is event-driven and estimated to be approximately 38 months.
Progression-Free Survival (PFS) Per Response Evaluation Criteria in Solid Tumors Version 1.1 (RECIST 1.1) at Month 24 as Assessed by Blinded Independent Central Review (BICR)	Up to approximately 38 months	PFS is defined as the time from randomization to the first documented progressive disease (PD) or death due to any cause, whichever occurs first. Per RECIST 1.1, PD is defined as ≥20% increase in the sum of diameters of target lesions. In addition to the relative increase of 20%, the sum must also demonstrate an absolute increase of ≥5 mm. The appearance of one or more new lesions is also considered PD. Unequivocal progression of non-target lesions is also considered PD. PFS data will be cumulated to a certain cut-off date and the analysis will be performed via Kaplan-Meier approach to estimate the PFS rate at Month 24 using the entire PFS data up to the cut-off date. The cut-off date is event-driven and estimated to be approximately 38 months.
Overall Survival (OS) at Month 36	Up to approximately 46 months	OS is the time from randomization to death due to any cause. OS data will be cumulated to a certain cut-off date and the analysis will be performed via Kaplan-Meier approach to estimate the OS rate at Month 36 using the entire OS data up to the cut-off date. The cut-off date is event-driven and estimated to be approximately 46 months.
Complete Response (CR) Rate Per Response Evaluation Criteria In Solid Tumors Version 1.1 (RECIST 1.1) at Week 12 as Assessed by the Investigator	Up to approximately 38 months	For participants who demonstrated a confirmed Complete Response (CR: Disappearance of all target and non-target lesions and also includes reduction of all nodal lesions to \<10mm) per RECIST 1.1, CR rate is defined as the percentage of participants who experienced a CR. CR data will be cumulated to a certain cut-off date and the analysis will be performed to estimate the CR rate at Week 12 using the entire CR data up to the cut-off date. The cut-off date is estimated to be approximately 38 months.
Progression-Free Survival (PFS) Per Response Evaluation Criteria in Solid Tumors Version 1.1 (RECIST 1.1) in Programmed Cell Death 1 Ligand 1 (PD-L1) Positive Participants as Assessed by the Investigator	Up to approximately 38 months	PFS is defined as the time from randomization to the first documented progressive disease (PD) or death due to any cause, whichever occurs first. Per RECIST 1.1, or by histopathologic confirmation of suspected disease progression, PD is defined as ≥20% increase in the sum of diameters of target lesions. In addition to the relative increase of 20%, the sum must also demonstrate an absolute increase of ≥5 mm. The appearance of one or more new lesions is also considered PD. Unequivocal progression of non-target lesions is also considered PD.
Number of Participants Who Discontinue Study Treatment Due to an Adverse Event (AE)	Up to approximately 46 months	An AE is defined as any unfavorable and unintended sign, symptom, disease, or worsening of preexisting condition temporally associated with study treatment and irrespective of causality to study treatment.

Trial Locations

Locations (176)

Hospital das Clinicas da UFMG ( Site 0172); 🇧🇷 Belo Horizonte, Minas Gerais, Brazil

St John of God Subiaco Hospital ( Site 0969); 🇦🇺 Subiaco, Western Australia, Australia

General Hospital of Patras. St Andrews ( Site 0473); 🇬🇷 Patras, Achaia, Greece

Fundacion Centro de Investigacion Clinica CIC ( Site 0231); 🇨🇴 Medellin, Antioquia, Colombia

Cork University Hospital ( Site 0504); 🇮🇪 Cork, Ireland

I.U. Cerrahpasa Medical Faculty ( Site 0755); 🇹🇷 Istambul, Istanbul, Turkey

Instituto Nacional de Cancerologia E.S.E ( Site 0228); 🇨🇴 Bogota, Distrito Capital De Bogota, Colombia

UZ Leuven ( Site 0354); 🇧🇪 Leuven, Vlaams-Brabant, Belgium

C.I.U. Hopital Ambroise Pare ( Site 0353); 🇧🇪 Mons, Hainaut, Belgium

Clinica San Gabriel ( Site 0296); 🇵🇪 San Miguel, Lima, Peru

Chelyabinsk Regional Clinical Center Oncology and Nuclear Medicine ( Site 0741); 🇷🇺 Chelyabinsk, Chelyabinskaya Oblast, Russian Federation

Krasnoyarsk Regional Clinical Oncological Dispensary ( Site 0729); 🇷🇺 Krasnoyarsk, Krasnoyarskiy Kray, Russian Federation

Yaroslavl Regional SBIH Clinical Oncology Hospital ( Site 0734); 🇷🇺 Yaroslavl, Yaroslavskaya Oblast, Russian Federation

Centro Medico Integral De Cancerología (CEMIC) ( Site 0322); 🇬🇹 Quetzaltenango, Guatemala

Orszagos Onkologiai Intezet ( Site 0846); 🇭🇺 Budapest, Hungary

Ramathibodi Hospital, Mahidol University ( Site 1131); 🇹🇭 Rajthevee, Krung Thep Maha Nakhon, Thailand

HonorHealth Research Institute - Biltmore ( Site 8009); 🇺🇸 Phoenix, Arizona, United States

University of Colorado Health Sciences Center and Hospital ( Site 0028); 🇺🇸 Denver, Colorado, United States

Legacy Good Samaritan Medical Center ( Site 0013); 🇺🇸 Portland, Oregon, United States

Núcleo de Pesquisa Clínica da Rede São Camilo ( Site 0166); 🇧🇷 São Paulo, Sao Paulo, Brazil

Anhui Provincial Hospital ( Site 1029); 🇨🇳 Hefei, Anhui, China

Anhui Provincial Cancer Hospital ( Site 1007); 🇨🇳 Hefei, Anhui, China

Peking Union Medical College Hospital ( Site 1001); 🇨🇳 Beijing, Beijing, China

Chongqing Cancer Hospital ( Site 1030); 🇨🇳 Chongqing, Chongqing, China

The First Affiliated Hospital of Xiamen University ( Site 1025); 🇨🇳 Xiamen, Fujian, China

The First Affiliated Hospital.Sun Yat-sen University ( Site 1005); 🇨🇳 Guangzhou, Guangdong, China

Affiliated Cancer Hospital of Guangxi Medical University ( Site 1036); 🇨🇳 Nanning, Guangxi, China

Harbin Medical University Cancer Hospital ( Site 1013); 🇨🇳 Harbin, Heilongjiang, China

Shanghai First Maternity and Infant Hospital-Gynecology department ( Site 1039); 🇨🇳 Shanghai, Shanghai, China

Shanghai Cancer Hospital ( Site 1000); 🇨🇳 Shanghai, Shanghai, China

The First Affiliated Hospital of Xinjiang Medical University ( Site 1012); 🇨🇳 Urumqi, Xinjiang, China

Fundacion Valle del Lili ( Site 0230); 🇨🇴 Cali, Valle Del Cauca, Colombia

Fakultni nemocnice Ostrava ( Site 0909); 🇨🇿 Ostrava, Moravskoslezsky Kraj, Czechia

Fakultni nemocnice Kralovske Vinohrady ( Site 0913); 🇨🇿 Praha 10, Czechia

CHU Jean Minjoz ( Site 0411); 🇫🇷 Besancon, Doubs, France

Universitaetsklinikum Freiburg ( Site 0454); 🇩🇪 Freiburg, Baden-Wurttemberg, Germany

Universitätsmedizin Mannheim-Department of Obstetrics and Gynecology ( Site 0443); 🇩🇪 Mannheim, Baden-Wurttemberg, Germany

Klinikum der Universitaet in Muenchen ( Site 0446); 🇩🇪 Muenchen, Bayern, Germany

Universitaetsklinik Leipzig ( Site 0456); 🇩🇪 Leipzig, Sachsen, Germany

Euromedica General Clinic of Thessaloniki ( Site 0474); 🇬🇷 Thessaloniki, Greece

Istituto di Candiolo - IRCCS ( Site 0546); 🇮🇹 Candiolo, Piemonte, Italy

A.O. Universitaria Policlinico S. Orsola-Malpighi ( Site 0541); 🇮🇹 Bologna, Italy

Fondazione IRCCS Istituto Nazionale dei Tumori di Milano ( Site 0542); 🇮🇹 Milano, Italy

Istituto Nazionale Tumori Regina Elena ( Site 0540); 🇮🇹 Rome, Roma, Italy

Karmanos Cancer Institute ( Site 0018); 🇺🇸 Detroit, Michigan, United States

Japanese Foundation for Cancer Research-Gynecologic Oncology ( Site 1171); 🇯🇵 Tokyo, Japan

Srinagarind Hospital. Khon Kaen University ( Site 1132); 🇹🇭 Mueang, Khon Kaen, Thailand

Songklanagarind Hospital ( Site 1130); 🇹🇭 Hatyai, Songkhla, Thailand

Acibadem Adana Hastanesi ( Site 0756); 🇹🇷 Adana, Turkey

Baskent Universitesi Ankara Hastanesi ( Site 0754); 🇹🇷 Ankara, Turkey

Maharaj Nakorn Chiang Mai Hospital ( Site 1133); 🇹🇭 Chiang Mai, Thailand

Grigoriev Institute for medical Radiology NAMS of Ukraine ( Site 0876); 🇺🇦 Kharkiv, Kharkivska Oblast, Ukraine

ROYAL MARSDEN HOSPITAL (CHELSEA) ( Site 0701); 🇬🇧 London, London, City Of, United Kingdom

Royal Marsden Hospital (Sutton)-Gynaecology Unit ( Site 0696); 🇬🇧 London, Surrey, United Kingdom

Our Lady of the Lake Regional Medical Center. ( Site 0031); 🇺🇸 Baton Rouge, Louisiana, United States

Klinikum Rechts der Isar. Technischen Universitaet Muenchen ( Site 0453); 🇩🇪 Muenchen, Bayern, Germany

UCLA Hematology/Oncology - Westwood (Building 200 Suite 120) ( Site 0027); 🇺🇸 Los Angeles, California, United States

Hoag Memorial Hospital Presbyterian ( Site 0038); 🇺🇸 Newport Beach, California, United States

Parkview Research Center at Parkview Regional Medical Center ( Site 0026); 🇺🇸 Fort Wayne, Indiana, United States

University of Kentucky Markey Cancer Center ( Site 0015); 🇺🇸 Lexington, Kentucky, United States

Women's Cancer Care ( Site 0039); 🇺🇸 Covington, Louisiana, United States

Minnesota Oncology Hematology, PA ( Site 8007); 🇺🇸 Minneapolis, Minnesota, United States

University of New Mexico Comprehensive Cancer Center-Clinical Research Office ( Site 0019); 🇺🇸 Albuquerque, New Mexico, United States

Sanford Bismarck Medical Center ( Site 0046); 🇺🇸 Bismarck, North Dakota, United States

The James Cancer Hospital and Solove Research Institute at The Ohio State University Comprehensive C; 🇺🇸 Columbus, Ohio, United States

Willamette Valley Cancer Institute and Research Center ( Site 8000); 🇺🇸 Eugene, Oregon, United States

Allegheny Health Network West Penn Hospital-Gynecologic Oncology ( Site 0030); 🇺🇸 Pittsburgh, Pennsylvania, United States

Texas Oncology-Fort Worth Cancer Center ( Site 8001); 🇺🇸 Fort Worth, Texas, United States

Sanford Gynecology Oncology ( Site 0003); 🇺🇸 Sioux Falls, South Dakota, United States

Texas Oncology-San Antonio Medical Center ( Site 8002); 🇺🇸 San Antonio, Texas, United States

UVA Health System ( Site 0005); 🇺🇸 Charlottesville, Virginia, United States

Westmead Hospital ( Site 0973); 🇦🇺 Westmead, New South Wales, Australia

Texas Oncology-The Woodlands ( Site 8003); 🇺🇸 The Woodlands, Texas, United States

Royal Brisbane and Women s Hospital ( Site 0972); 🇦🇺 Herston, Queensland, Australia

Monash Health-Monash Medical Centre ( Site 0970); 🇦🇺 Clayton, Victoria, Australia

Peter MacCallum Cancer Centre ( Site 0971); 🇦🇺 Melbourne, Victoria, Australia

Medizinische Universitat Graz ( Site 0569); 🇦🇹 Graz, Steiermark, Austria

Medizinische Universität Wien ( Site 0567); 🇦🇹 Vienna, Wien, Austria

Medizinische Universitat Innsbruck ( Site 0566); 🇦🇹 Innsbruck, Tirol, Austria

UZA University Hospital Antwerp ( Site 0351); 🇧🇪 Edegem, Antwerpen, Belgium

GZA Sint Augustinus ( Site 0356); 🇧🇪 Wilrijk, Antwerpen, Belgium

AZ St Lucas ( Site 0349); 🇧🇪 Gent, Oost-Vlaanderen, Belgium

OLV Ziekenhuis ( Site 0352); 🇧🇪 Aalst, Oost-Vlaanderen, Belgium

Hospital de Clínicas de Ribeirão Preto ( Site 0171); 🇧🇷 Ribeirão Preto, Sao Paulo, Brazil

Instituto Nacional Do Cancer II ( Site 0173); 🇧🇷 Rio de Janeiro, Brazil

Princess Margaret Cancer Centre ( Site 0102); 🇨🇦 Toronto, Ontario, Canada

Centre Hospitalier de l Universite de Montreal - CHUM ( Site 0101); 🇨🇦 Montreal, Quebec, Canada

Centro Investigación del Cáncer James Lind ( Site 0194); 🇨🇱 Temuco, Araucania, Chile

McGill University Health Centre ( Site 0105); 🇨🇦 Montreal, Quebec, Canada

Centre intégré de cancérologie du CHU de Québec Université Laval, Hôpital de l'Enfant-Jésus ( Site 0; 🇨🇦 Quebec City, Quebec, Canada

Sociedad Oncovida S.A. ( Site 0196); 🇨🇱 Santiago, Region M. De Santiago, Chile

Iram Cancer Research ( Site 0198); 🇨🇱 Santiago, Region M. De Santiago, Chile

Oncocentro ( Site 0195); 🇨🇱 Vina del Mar, Valparaiso, Chile

Zhejiang Provincial People's Hospital ( Site 1021); 🇨🇳 Hangzhou, Zhejiang, China

Hunan Cancer Hospital ( Site 1015); 🇨🇳 Changsha, Hunan, China

Xiangya Hospital Central-South University ( Site 1009); 🇨🇳 Changsha, Hunan, China

Sichuan Cancer Hospital ( Site 1018); 🇨🇳 Chengdu, Sichuan, China

Fakultni Nemocnice Brno Bohunice ( Site 0912); 🇨🇿 Brno, Brno-mesto, Czechia

Centro Medico Imbanaco de Cali S.A ( Site 0227); 🇨🇴 Cali, Valle Del Cauca, Colombia

Zhejiang Cancer Hospital ( Site 1004); 🇨🇳 Hangzhou, Zhejiang, China

Institut Claudius Regaud ( Site 0417); 🇫🇷 Toulouse, Haute-Garonne, France

Centre Hospitalier Lyon Sud ( Site 0413); 🇫🇷 Pierre Benite, Rhone, France

Universitaetsklinikum Carl Gustav Carus der Technischen Univ ( Site 0452); 🇩🇪 Dresden, Sachsen, Germany

Universitaetsklinikum Hamburg-Eppendorf ( Site 0445); 🇩🇪 Hamburg, Germany

Charite Universitaetsmedizin Berlin ( Site 0442); 🇩🇪 Berlin, Germany

Alexandra General Hospital ( Site 0477); 🇬🇷 Athens, Attiki, Greece

Grupo Angeles SA ( Site 0319); 🇬🇹 Guatemala, Guatemala

Hospital Hygeia ( Site 0478); 🇬🇷 Athens, Attiki, Greece

Centro de Investigaciones Clinicas de Latinoamerica S.A. - CELAN ( Site 0321); 🇬🇹 Guatemala, Guatemala

Oncologika S.A. ( Site 0323); 🇬🇹 Guatemala, Guatemala

Oncomedica ( Site 0320); 🇬🇹 Guatemala, Guatemala

Medi-K Cayala ( Site 0318); 🇬🇹 Guatemala, Guatemala

Debreceni Egyetem Klinikai Kozpont ( Site 0845); 🇭🇺 Debrecen, Hungary

St James Hospital ( Site 0505); 🇮🇪 Dublin, Ireland

Chaim Sheba Medical Center ( Site 0814); 🇮🇱 Ramat Gan, Israel

Hadassah Medical Center. Ein Kerem ( Site 0816); 🇮🇱 Jerusalem, Israel

Rambam Medical Center ( Site 0815); 🇮🇱 Haifa, Israel

Sourasky Medical Center ( Site 0819); 🇮🇱 Tel Aviv, Israel

Istituto Europeo di Oncologia ( Site 0536); 🇮🇹 Milan, Milano, Italy

Ospedale Vito Fazzi ( Site 0547); 🇮🇹 Lecce, Italy

IRCCS Ospedale San Raffaele ( Site 0539); 🇮🇹 Milano, Italy

Fondazione Giovanni Pascale Di Napoli ( Site 0544); 🇮🇹 Napoli, Italy

Policlinico Universitario Gemelli ( Site 0538); 🇮🇹 Roma, Italy

Aichi Cancer Center Hospital ( Site 1155); 🇯🇵 Nagoya, Aichi, Japan

National Cancer Center Hospital East ( Site 1159); 🇯🇵 Kashiwa, Chiba, Japan

A.O.U. Citta della Salute e della Scienza di Torino ( Site 0535); 🇮🇹 Torino, Italy

Ehime University Hospital ( Site 1157); 🇯🇵 Toon, Ehime, Japan

National Hospital Organization Shikoku Cancer Center ( Site 1162); 🇯🇵 Matsuyama, Ehime, Japan

Kurume University Hospital ( Site 1164); 🇯🇵 Kurume, Fukuoka, Japan

Hokkaido University Hospital ( Site 1163); 🇯🇵 Sapporo, Hokkaido, Japan

Iwate Medical University Hospital ( Site 1165); 🇯🇵 Shiwa-gun, Iwate, Japan

Saitama Medical University International Medical Center ( Site 1168); 🇯🇵 Hidaka, Saitama, Japan

University of the Ryukyus Hospital ( Site 1156); 🇯🇵 Nakagami-gun, Okinawa, Japan

Saitama Cancer Center ( Site 1169); 🇯🇵 Kitaadachi-gun, Saitama, Japan

Kyorin University Hospital ( Site 1158); 🇯🇵 Mitaka, Tokyo, Japan

National Hospital Organization Kyushu Cancer Center ( Site 1167); 🇯🇵 Fukuoka, Japan

Kagoshima City Hospital ( Site 1166); 🇯🇵 Kagoshima, Japan

Keio University Hospital ( Site 1170); 🇯🇵 Tokyo, Japan

National Cancer Center Hospital ( Site 1172); 🇯🇵 Tokyo, Japan

Osaka International Cancer Institute ( Site 1161); 🇯🇵 Osaka, Japan

Keimyung University Dongsan Medical Center ( Site 1066); 🇰🇷 Daegu, Taegu-Kwangyokshi, Korea, Republic of

National Cancer Center ( Site 1065); 🇰🇷 Goyang-si, Kyonggi-do, Korea, Republic of

Severance Hospital ( Site 1063); 🇰🇷 Seoul, Korea, Republic of

Asan Medical Center ( Site 1062); 🇰🇷 Seoul., Seoul, Korea, Republic of

Samsung Medical Center ( Site 1064); 🇰🇷 Seoul, Korea, Republic of

Oslo Universitetssykehus Radiumhospitalet ( Site 0600); 🇳🇴 Oslo, Norway

Centro Medico Monte Carmelo ( Site 0289); 🇵🇪 Arequipa, Ariqipa, Peru

Helse Bergen HF Haukeland Universitetssjukehus ( Site 0601); 🇳🇴 Bergen, Hordaland, Norway

Hospital de Alta Complejidad de La Libertad Virgen de La Puerta ( Site 0287); 🇵🇪 Trujillo, La Libertad, Peru

Hospital Nacional Arzobispo Loayza ( Site 0292); 🇵🇪 Lima, Peru

Hospital Nacional Guillermo Almenara Irigoyen ( Site 0291); 🇵🇪 Lima, Peru

Hospital Nacional Daniel Alcides Carrion ( Site 0293); 🇵🇪 Callao, Lima, Peru

Instituto de Oncologia y Radioterapia Clinica Ricardo Palma ( Site 0290); 🇵🇪 Lima, Peru

MSROI named after P.A. Hertsen branch of FSBI NMRC Radiology ( Site 0722); 🇷🇺 Moscow, Moskva, Russian Federation

National Medical Research Center of Oncology N.A. N.N. Petrov ( Site 0725); 🇷🇺 St. Petersburg, Sankt-Peterburg, Russian Federation

Hosp Clin Univ de Santiago ( Site 0629); 🇪🇸 Santiago de Compostela, La Coruna, Spain

GBUZ SPb CRPCstmc(o) ( Site 0746); 🇷🇺 Saint Petersburg, Sankt-Peterburg, Russian Federation

Hospital Universitari Vall d Hebron ( Site 0634); 🇪🇸 Barcelona, Spain

HOSPITAL UNIVERSITARIO QUIRONSALUD MADRID-ONCOLOGIA MEDICA ( Site 0638); 🇪🇸 Pozuelo de Alarcon, Madrid, Spain

Hospital Germans Trias i Pujol-Instituto Catalán de Oncología de Badalona ( Site 0637); 🇪🇸 Badalona, Barcelona, Spain

Karolinska Universitetssjukhuset ( Site 0784); 🇸🇪 Stockholm, Stockholms Lan, Sweden

Linkou Chang Gung Memorial Hospital ( Site 1097); 🇨🇳 Taoyuan, Taiwan

Hospital Clinico Universitario Lozano Blesa ( Site 0630); 🇪🇸 Zaragoza, Spain

Complejo Hospitalario de Jaen ( Site 0632); 🇪🇸 Jaen, Spain

National Taiwan University Hospital ( Site 1095); 🇨🇳 Taipei, Taiwan

Mackay Memorial Hospital ( Site 1094); 🇨🇳 Taipei, Taiwan

Royal Devon and Exeter Foundation Trust Hospital ( Site 0699); 🇬🇧 Exeter, England, United Kingdom

Lviv State Oncology Regional Treatment and Diagnostic Center ( Site 0882); 🇺🇦 Lviv, Lvivska Oblast, Ukraine

Virginia Commonwealth University ( Site 0024); 🇺🇸 Richmond, Virginia, United States

UC Davis Comprehensive Cancer Center ( Site 0017); 🇺🇸 Sacramento, California, United States

Smilow Cancer Center at Yale-New Haven ( Site 0023); 🇺🇸 New Haven, Connecticut, United States

AdventHealth Orlando-AdventHealth Medical Group Gynecological Oncology ( Site 0009); 🇺🇸 Orlando, Florida, United States

University of North Carolina at Chapel Hill ( Site 0025); 🇺🇸 Chapel Hill, North Carolina, United States

Hollings Cancer Center ( Site 0007); 🇺🇸 Charleston, South Carolina, United States

Texas Oncology-Austin Central ( Site 8006); 🇺🇸 Austin, Texas, United States

Liga Norte Riograndense Contra o Cancer ( Site 0170); 🇧🇷 Natal, Rio Grande Do Norte, Brazil