Clinical Trial of Lurbinectedin As Single-agent or in Combination with Irinotecan Versus Topotecan or Irinotecan in Patients with Relapsed Small-cell Lung Cancer (LAGOON)

Phase 3

Active, not recruiting

• Conditions: Relapsed Small Cell Lung Cancer
• Interventions: Drug: Lurbinectedin; Drug: Irinotecan; Drug: Topotecan

• Registration Number: NCT05153239
• Lead Sponsor: PharmaMar

Brief Summary

Multicenter, open-label, randomized, controlled phase III clinical trial to evaluate and compare the activity and safety of two experimental arms consisting of lurbinectedin as single agent (Group A) or the combination of lurbinectedin with irinotecan (Group B) versus Investigator's Choice (topotecan or irinotecan) as control arm (Group C), in Small-cell Lung Cancer (SCLC) patients who failed one prior platinum-containing line.

Detailed Description

Approximately 705 Adult SCLC patients with Eastern Cooperative Oncology Group (ECOG) performance status (PS) ≤ 2 who have failed one prior platinum-containing line with CTFI ≥ 30 days and controlled asymptomatic and pretreated Central Nervous System metastases will be enrolled and assigned to each treatment arm.

Central randomization will be implemented; patients will be assigned to each treatment arm at a 1:1:1 ratio.

An Independent Data Monitoring Committee (IDMC) will oversee the conduct of the study. The IDMC should have access to unblinded efficacy and safety data throughout the trial to enable timely and informed judgments about risks and benefits.

Study Timeline

• Study First Submitted: 2021-11-29
• Study First Submitted QC: 2021-11-29
• Study First Posted: 2021-12-10
• Study Start: 2022-07-22
• Status Verified: 2025-01
• Last Update Submitted: 2025-01-29
• Last Update Posted: 2025-01-30
• Primary Completion: 2026-04
• Study Completion: 2026-04

Recruitment & Eligibility

• Status: ACTIVE_NOT_RECRUITING
• Sex: All
• Target Recruitment: 705

Inclusion Criteria

1. Voluntary written informed consent of the patient obtained before any study-specific procedure

2. Age≥18 years

3. Histologically or cytologically confirmed diagnosis of SCLC.

4. One prior line of platinum-containing chemotherapy with/without anti-PD-1 or anti-PD-L1 (Note: at least 70% of patients included in the study have to be pretreated with anti-PD-1 or anti-PD-L1)

5. Chemotherapy-free interval (CTFI, time from the last dose of first-line platinum-containing chemotherapy to the occurrence of progressive disease) ≥ 30 days (independent of the immunotherapy maintenance, if applicable)

6. Patients with history of Central Nervous System (CNS) metastases can participate provided they are pretreated and radiologically stable (i.e., without evidence of progression) for at least 4 weeks by repeated imaging (note: repeated imaging should be performed during study screening), asymptomatic, and without requirement of steroid treatment for at least 7 days before the first dose of study treatment

7. Eastern Cooperative Oncology Group (ECOG) PS ≤ 2

8. Adequate hematological, renal, metabolic and hepatic function:

   1. Hemoglobin ≥ 9.0 g/dL [patients may have received prior red blood cell (RBC) transfusion, if clinically indicated]; absolute neutrophil count (ANC) ≥ 2.0 x 10^9/L, and platelet count ≥ 100 x 10^9/L.
   2. Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) ≤ 3.0 x upper limit of normal (ULN).
   3. Total bilirubin ≤ 1.5 x ULN or direct bilirubin ≤ ULN.
   4. Albumin ≥ 3.0 g/dL.
   5. Calculated creatinine clearance (CrCL) ≥ 30 mL/min (using Cockcroft and Gault's formula).

9. At least three weeks since last prior antineoplastic treatment and recovery to grade ≤ 1 from any adverse event (AE) related to previous anticancer treatment (excluding sensory neuropathy, immune-related hypothyroidism, anemia, asthenia and alopecia, all grade ≤ 2) according to the National Cancer InstituteCommon Terminology Criteria for Adverse Events (NCICTCAE) v.5.

10. Prior radiotherapy (RT): At least two weeks since completion of prophylactic cranial irradiation (PCI), and to any other site not previously specified.

11. Evidence of non-childbearing status for women of childbearing potential (WOCBP). WOCBP must agree to use a highly effective contraceptive measure up to seven months after treatment discontinuation. Fertile male patients with WOCBP partners should use condoms during treatment and for four months following the last investigational medicinal product (IMP) dose.

Exclusion Criteria

1. Platinum-naïve patients or patients pretreated with more than one prior chemotherapy regimen (including patients re-challenged with same initial regimen).

2. Prior treatment with lurbinectedin, trabectedin, PM14, or topoisomerase I inhibitors (irinotecan, topotecan, etc.).

3. Active or untreated CNS metastases and/or carcinomatous meningitis.

4. Patients with limited-stage disease who are candidates for local or regional therapy, including PCI, thoracic RT or both, must have been offered that option and completed treatment or refused it prior to randomization.

5. Concomitant diseases/conditions:

   1. History or presence of unstable angina, myocardial infarction, congestive heart failure, or clinically significant valvular heart disease within last year.
   2. Symptomatic arrhythmia or any uncontrolled arrhythmia requiring ongoing treatment.
   3. Ongoing chronic alcohol consumption or cirrhosis with Child-Pugh score B or C.
   4. Known Gilbert's disease.
   5. Active uncontrolled infection. Serious non-healing wound, ulcer or bone fracture. Presence of external drainages.
   6. Ongoing, treatment-requiring, non-neoplastic chronic liver disease of any origin. For Hepatitis B, this includes positive tests for both Hepatitis B surface antigen (HBsAg) and quantitative Hepatitis B polymerase chain reaction (PCR). For Hepatitis C, this includes positive tests for both Hepatitis C antibody and quantitative Hepatitis C PCR. Subjects taking hepatitis related antiviral therapy within six months prior to the first dose of study drugs will also be excluded.
   7. Intermittent or continuous oxygen requirement within two weeks prior to randomization. Patients with confirmed or suspected diagnosis of diffuse interstitial lung disease or pulmonary fibrosis.
   8. Patients with a second invasive malignancy treated with chemotherapy and/or RT. Patients with a previous malignancy that was completely resected with curative intention three or more years prior to randomization, except treated in situ carcinoma of the cervix, basal or squamous cell skin carcinoma, and in situ transitional cell bladder carcinoma and who has been continuously in remission since then will be permitted.
   9. Limitation of the patient's ability to comply with the treatment or to follow the protocol.
   10. Documented or suspected invasive fungal infections requiring systemic treatment within 12 weeks of randomization.
   11. Known human immunodeficiency virus (HIV) infection.
   12. Any past or present chronic inflammatory colon and/or liver disease, past intestinal obstruction, pseudo or subocclusion or paralysis.
   13. Evident symptomatic pleural or cardiac effusion rapidly increasing and/or necessitating prompt local treatment within seven days.
   14. Any other major illness that, in the Investigator's judgment, will substantially increase the risk associated with the patient's participation in this study (e.g.; COVID-19 disease).

6. RT in more than 35% of the bone marrow.

7. History of previous bone marrow and/or stem cell transplantation and allogenic transplant.

8. Patient has received a live or live-attenuated vaccine within 30 days before the first dose of study intervention. Administration of inactivated vaccines is allowed.

9. Impending need for RT (e.g., painful bone metastasis and/or risk of spinal cord compression).

10. History of allergy or hypersensitivity to any of the study drugs or any of their excipients.

11. Women who are pregnant or breast feeding and fertile patients (men and women) who are not able to use a highly effective method of contraception

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Lurbinectedin	Lurbinectedin	Patients will consecutively receive lurbinectedin on Day 1 q3wk (every three weeks = one treatment cycle)
Lurbinectedin plus Irinotecan	Irinotecan	Patients will consecutively receive the following q3wk (every three weeks = one treatment cycle): * Irinotecan (Day 1 and Day 8) * Lurbinectedin (Day 1)
Lurbinectedin plus Irinotecan	Lurbinectedin	Patients will consecutively receive the following q3wk (every three weeks = one treatment cycle): * Irinotecan (Day 1 and Day 8) * Lurbinectedin (Day 1)
Control arm	Topotecan	Best Investigator's choice prior to randomization between: * Irinotecan on Day 1 q3wk * Topotecan on Days 1-5 q3wk
Control arm	Irinotecan	Best Investigator's choice prior to randomization between: * Irinotecan on Day 1 q3wk * Topotecan on Days 1-5 q3wk

Primary Outcome Measures

Name	Time	Method
Overall survival	From the date of randomization to the date of death or last contact, up to 39 months	Overall survival (OS) will be calculated from the date of randomization to the date of death or last contact (in this case, survival will be censored on that date).

Secondary Outcome Measures

Name	Time	Method
Progression-free survival by IRC (Independent Review Committee)	From the date of randomization to the date of progressive disease, death or last tumor assessment or further anticancer treatment, up to 39 months	Progression-free survival (PFS) will be calculated from the date of randomization to the date of documented progression per RECIST v.1.1 (Progressive disease is declared when there is an increase in sum of target disease ≥ 20%) or death (regardless of the cause of death). If the patient receives further antitumor therapy, withdraws from the study, or is lost to follow-up before progressive disease (PD), PFS will be censored at the date of last evaluable tumor assessment before the date of subsequent antitumor therapy.
Overall response rate by IRC	From the date of randomization to the date of death or last contact, up to 39 months	Overall response rate (ORR) will be the percentage of patients with complete or partial response as the best response obtained in any evaluation according to RECIST v.1.1. Progressive disease is declared when there is an increase in sum of target disease ≥ 20%, stable disease when the change is \> -30% and ≤ 20%, partial response when there is a decrease in sum of target disease ≥ 30%, and complete response when all lesions have disappeared or all lesions have disappeared and all nodal disease is \< 10 mm each.
Overall response rate by IA	From the date of randomization to the date of death or last contact, up to 39 months	Overall response rate (ORR) will be the percentage of patients with complete or partial response as the best response obtained in any evaluation according to RECIST v.1.1. Progressive disease is declared when there is an increase in sum of target disease ≥ 20%, stable disease when the change is \> -30% and ≤ 20%, partial response when there is a decrease in sum of target disease ≥ 30%, and complete response when all lesions have disappeared or all lesions have disappeared and all nodal disease is \< 10 mm each.
Progression-free survival rate at 12 months by IRC	At 12 months	Progression-free survival rate at 12 months is defined as the percentage of people who remain free from progression at 12 months after randomization
Progression-free survival by IA (Investigator Assessment)	From the date of randomization to the date of progressive disease, death or last tumor assessment or further anticancer treatment, up to 39 months	Progression-free survival (PFS) will be calculated from the date of randomization to the date of documented progression per RECIST v.1.1 (Progressive disease is declared when there is an increase in sum of target disease ≥ 20%) or death (regardless of the cause of death). If the patient receives further antitumor therapy, withdraws from the study, or is lost to follow-up before progressive disease (PD), PFS will be censored at the date of last evaluable tumor assessment before the date of subsequent antitumor therapy.
Overall survival rate at 12 months	At 12 months	Overall survival rate at 12 months is defined as the percentage of people who are still alive at 12 months after randomization.
Overall survival rate at 24 months	At 24 months	Overall survival rate at 24 months is defined as the percentage of people who are still alive at 24 months after randomization.
Progression-free survival rate at 6 months by IRC	At 6 months	Progression-free survival rate at 6 months is defined as the percentage of people who remain free from progression at 6 months after randomization
Progression-free survival rate at 6 months by IA	At 6 months	Progression-free survival rate at 6 months is defined as the percentage of people who remain free from progression at 6 months after randomization
Progression-free survival rate at 12 months by IA	At 12 months	Progression-free survival rate at 12 months is defined as the percentage of people who remain free from progression at 12 months after randomization
Duration of response by IRC	From the date of first documentation of complete or partial response to the date of documented progression disease, death or last contact, up to 39 months	Duration of response (DoR) will be calculated from the date of first documentation of response per RECIST v.1.1 (complete or partial response, whichever occurs first) to the date of documented PD or death. Progressive disease is declared when there is an increase in sum of target disease ≥ 20%, stable disease when the change is \> -30% and ≤ 20%, partial response when there is a decrease in sum of target disease ≥ 30%, and complete response when all lesions have disappeared or all lesions have disappeared and all nodal disease is \< 10 mm each.
Duration of response by IA	From the date of first documentation of complete or partial response to the date of documented progression disease, death or last contact, up to 39 months	Duration of response (DoR) will be calculated from the date of first documentation of response per RECIST v.1.1 (complete or partial response, whichever occurs first) to the date of documented PD or death. Progressive disease is declared when there is an increase in sum of target disease ≥ 20%, stable disease when the change is \> -30% and ≤ 20%, partial response when there is a decrease in sum of target disease ≥ 30%, and complete response when all lesions have disappeared or all lesions have disappeared and all nodal disease is \< 10 mm each.
Patient-reported outcomes	At baseline and every six weeks (± one week) until end of treatment, up to 39 months	To measure the quality of life of patients, the Lung Cancer Symptom Scale (LCSS) questionnaire will be analyzed.

Trial Locations

Locations (209)

Vejle Hospital; 🇩🇰 Vejle, Denmark

Hopital Jean Minjoz; 🇫🇷 Besancon, France

AssAP-HP - Hopital Ambroise-Pare; 🇫🇷 Boulogne-Billancourt, France

Hopital Morvan CHU de Brest; 🇫🇷 Brest, France

Centre François Baclesse; 🇫🇷 Caen, France

CHU de Caen - Hopital Cote de Nacre; 🇫🇷 Caen, France

Centre Hospitalier Intercommunal de Creteil (CHIC); 🇫🇷 Créteil, France

Centre Hospitalier Universitaire CHU De Limoges; 🇫🇷 Limoges, France

CHU de Nantes; 🇫🇷 Nantes, France

Bichat-Claude Bernard Hospital; 🇫🇷 Paris, France

CHU Reims - Hpital Maison Blanche; 🇫🇷 Reims, France

Hopital Civil / Nouvel Hopital Civil; 🇫🇷 Strasbourg, France

Hospital Foch; 🇫🇷 Suresnes, France

Gustave Roussy; 🇫🇷 Villejuif, France

High Technology Hospital Medcenter; 🇬🇪 Batumi, Georgia

Todua Clinic; 🇬🇪 Tbilisi, Georgia

New Hospitals; 🇬🇪 Tbilisi, Georgia

Institute Of Clinical Oncology; 🇬🇪 Tbilisi, Georgia

JSC Evex Hospitals "Caraps Medline"; 🇬🇪 Tbilisi, Georgia

LTD Cancer Research Centre; 🇬🇪 Tbilisi, Georgia

Evangelische Lungenklinik Berlin; 🇩🇪 Berlin, Germany

Helios St. Johannes Klinikum; 🇩🇪 Duisburg, Germany

Klinikum Esslingen GmbH; 🇩🇪 Esslingen, Germany

Universittsklinikum Freiburg; 🇩🇪 Freiburg, Germany

Thoraxclinic Heidelberg GmbH; 🇩🇪 Heidelberg, Germany

Asklepios Fachklinik München-Gauting; 🇩🇪 Gauting, Germany

Krankenhaus Martha-Maria Halle gGmbH; 🇩🇪 Halle (saale), Germany

Vincentius-Diakonissen-Kliniken gAG Karlsruhe; 🇩🇪 Karlsruhe, Germany

Staedtisches Klinikum München - Bogenhausen; 🇩🇪 München, Germany

Klinik Loewenstein gGmbH; 🇩🇪 Löwenstein, Germany

Universitaetsmedizin Mannheim; 🇩🇪 Mannheim, Germany

Sana Klinikum Offenbach; 🇩🇪 Offenbach, Germany

Debreceni Egyetem - Klinikai Kozpont; 🇭🇺 Debrecen, Hungary

Bacs-Kiskun County Hospital; 🇭🇺 Kecskemét, Hungary

Hetenyi G Korhaz, Onkologiai Kozpont; 🇭🇺 Szolnok, Hungary

Pulmonology Hospital Torokbalint; 🇭🇺 Törökbálint, Hungary

Rambam Health Care Campu; 🇮🇱 Haifa, Israel

Rabin Medical Center; 🇮🇱 Petah tikva, Israel

The Chaim Sheba Medical Center; 🇮🇱 Ramat Gan, Israel

Azienda Ospedaliero Universitaria delle Marche; 🇮🇹 Ancona, Italy

IRCCS Centro di Riferimento Oncologico; 🇮🇹 Aviano, Italy

ASL 3 Genovese Oncologia Medica Villa Scassi; 🇮🇹 Genova, Italy

IRCCS Istituto Clinico Humanitas - Cancer Center; 🇮🇹 Milan, Italy

Universita degli Studi della Campania Luigi Vanvitelli; 🇮🇹 Napoli, Italy

Ospedale Maggiore di Novara; 🇮🇹 Novara, Italy

Azienda Ospedaliero-Universitaria San Luigi Gonzaga; 🇮🇹 Orbassano, Italy

Oncologia Medica II Istituto Oncologico Veneto IRCCS; 🇮🇹 Padova, Italy

Azienda USL di Piacenza; 🇮🇹 Piacenza, Italy

Irccs-Crob; 🇮🇹 Rionero In Vulture, Italy

IFO Regina Elena; 🇮🇹 Roma, Italy

ASST Valtellina e Alto Lario Ospedale di Sondrio; 🇮🇹 Sondrio, Italy

ASST Sette Laghi; 🇮🇹 Varese, Italy

Hirosaki University Hospital; 🇯🇵 Hirosaki, Aomori, Japan

Kyushu University Hospital; 🇯🇵 Fukuoka-shi, Fukuoka, Japan

Kobe City Medical Center General Hospital; 🇯🇵 Kobe, Hyogo, Japan

Izumi City General Hospital; 🇯🇵 Izumi, Osaka, Japan

Kanagawa Cancer Center; 🇯🇵 Izumi, Osaka, Japan

Kishiwada City Hospital; 🇯🇵 Kishiwada, Osaka, Japan

Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital; 🇯🇵 Bunkyō-Ku, Tokyo, Japan

The Cancer Institute Hospital Of JFCR; 🇯🇵 Koto-Ku, Tokyo, Japan

Szpitale Pomorskie Sp. z o.o., Oddzial Onkologii K; 🇵🇱 Gdynia, Poland

Specjalistyczna Praktyka Lekarska Slawomir Mandziuka; 🇵🇱 Lublin, Poland

Szpital Specjalistyczny w Prabutach Sp. z o.o; 🇵🇱 Prabuty, Poland

Mrukmed. Lekarz Beata Madej-Mruk i Partner. Sp.p; 🇵🇱 Rzeszów, Poland

Specjalistyczny Szpital Onkologiczny NU-MED sp. Z; 🇵🇱 Tomaszów Mazowiecki, Poland

Wojewódzkie Wielospecjalistyczne Centrum Onkologii; 🇵🇱 Łódź, Poland

Sc Oncopremium Team Srl; 🇷🇴 Baia Mare, Romania

Medisprof srl; 🇷🇴 Cluj-Napoca, Romania

Oncolab SRL; 🇷🇴 Craiova, Romania

Centrul de Oncologie Sfantu Nectarie; 🇷🇴 Craiova, Romania

Ovidius Clinical Hospital; 🇷🇴 Ovidiu, Romania

Oncocenter Oncologie clinica S.R.L; 🇷🇴 Timişoara, Romania

Hospital Teresa Herrera C.H.U.A.; 🇪🇸 A Coruña, Spain

Hospital Universitari Vall d'Hebron; 🇪🇸 Barcelona, Spain

Hospital Universitario Reina Sofía; 🇪🇸 Córdoba, Spain

Hospital Universitario Lucus Augusti; 🇪🇸 Lugo, Spain

Sønderborg Sygehus; 🇩🇰 Sønderborg, Denmark

Kangbuk Samsung Hospital; 🇰🇷 Seoul, Korea, Republic of

Instituto Nacional de Cancer - Ministrio da Sade; 🇧🇷 Rio De Janeiro, Brazil

Clinica Alemana de Santiago; 🇨🇱 Santiago de Chile, Chile

Fundación Arturo López Pérez; 🇨🇱 Santiago de Chile, Chile

Aalborg University Hospital; 🇩🇰 Aalborg, Denmark

Sjællands Universitetshospital; 🇩🇰 Næstved, Denmark

Hospital Universitario La Paz; 🇪🇸 Madrid, Spain

MD Anderson Cancer Center; 🇪🇸 Madrid, Spain

Hospital Universitario Fundación Jimenez Díaz; 🇪🇸 Madrid, Spain

Hospital Universitario 12 de Octubre; 🇪🇸 Madrid, Spain

Hospital Universitario HM Sanchinarro; 🇪🇸 Madrid, Spain

Hospital Regional Universitario Málaga Hospital Civil; 🇪🇸 Málaga, Spain

Hospital Universitario Virgen del Rocío; 🇪🇸 Sevilla, Spain

Hospital Universitari i Politècnic La Fe; 🇪🇸 Valencia, Spain

Hospital Clínico Universitario Lozano Bleza; 🇪🇸 Zaragoza, Spain

University Hospital Basel; 🇨🇭 Basel, Switzerland

Spital Thurgau - Kantonspital Frauenfeld; 🇨🇭 Frauenfeld, Switzerland

Kantonsspital Baselland; 🇨🇭 Liestal, Switzerland

Spital Thurgau - Kantonsspital Muensterlingen; 🇨🇭 Münsterlingen, Switzerland

HFR Freiburg Kantonsspital; 🇨🇭 Villars-sur-Glâne, Switzerland

Buddhist Dalin Tzu Chi Hospital; 🇨🇳 Dalin, Chiayi, Taiwan

Medicalpark Seyhan Hospital; 🇹🇷 Seyhan, Adana, Turkey

Bagcilar Medipol Mega University Hospital; 🇹🇷 Bagcilar, Istambul, Turkey

Kocaeli University Hospital; 🇹🇷 İzmit, Kocaeli, Turkey

Belfast Health and Social Care Trust; 🇬🇧 Belfast, United Kingdom

The Princess Alexandra Hospital; 🇬🇧 Harlow, United Kingdom

Guys and St Thomas NHS Foundation Trust; 🇬🇧 London, United Kingdom

Austin Hospital- Medical Oncology Unit; 🇦🇺 Heidelberg, Australia

St John of God Murdoch Hospital; 🇦🇺 Murdoch, Australia

Cancer Care Wollongong; 🇦🇺 Wollongong, Australia

University Hospital Salzburg; 🇦🇹 Salzburg, Austria

Medizinische Universitaet Wien; 🇦🇹 Vienna, Austria

Clínica Santa María; 🇨🇱 Santiago de Chile, Chile

Asan Medical Center; 🇰🇷 Seoul, Korea, Republic of

Hospital Clinico Universidad de Chile; 🇨🇱 Santiago de Chile, Chile

Ironwood Cancer & Research Centers; 🇺🇸 Chandler, Arizona, United States

Genesis Cancer and Blood; 🇺🇸 Hot Springs, Arkansas, United States

Florida Cancer Specialists - South; 🇺🇸 Fort Myers, Florida, United States

Florida Cancer Specialists - North; 🇺🇸 Saint Petersburg, Florida, United States

Florida Cancer Specialists - Panhandle; 🇺🇸 Tallahassee, Florida, United States

Florida Cancer Specialists - East; 🇺🇸 West Palm Beach, Florida, United States

Duly Health and Care; 🇺🇸 Joliet, Illinois, United States

Norton Cancer Institue, Downtown; 🇺🇸 Louisville, Kentucky, United States

Dana-Farber Cancer Institute; 🇺🇸 Boston, Massachusetts, United States

Oncology Hematology West, PC (Grand Island); 🇺🇸 Grand Island, Nebraska, United States

Oncology Hematology West, PC dba Nebraska Cancer Specialists; 🇺🇸 Omaha, Nebraska, United States

FirstHealth Outpatient Cancer Center; 🇺🇸 Pinehurst, North Carolina, United States

Utah Cancer Specialists; 🇺🇸 Salt Lake City, Utah, United States

MultiCare Regional Cancer Center - Tacoma; 🇺🇸 Tacoma, Washington, United States

Froedtert Hospital/Medical College of Wisconsin; 🇺🇸 Milwaukee, Wisconsin, United States

The Chris Obrien Lifehouse; 🇦🇺 Camperdown, New South Wales, Australia

BRICC - Ballarat Health Services; 🇦🇺 Ballarat Central, Victoria, Australia

Box Hill Hospital Eastern Health Clinical School; 🇦🇺 Box Hill, Victoria, Australia

Northern Beaches Hospital; 🇦🇺 Frenchs Forest, Australia

Gosford Hospital GH - Central Coast Cancer Centre; 🇦🇺 Gosford, Australia

Antwerp University Hospital; 🇧🇪 Edegem, Antwerp, Belgium

Algemeen Ziekenhuis AZ Klina - Borstkliniek; 🇧🇪 Brasschaat, Belgium

Grand Hopital de Charleroi GHdC - Hopital Saint Joseph; 🇧🇪 Charleroi, Belgium

Centre Hospitalier Chretien CHC - MontLegia; 🇧🇪 Liège, Belgium

CHR de la Citadelle; 🇧🇪 Liège, Belgium

CHU Liege; 🇧🇪 Liège, Belgium

Az Sint Maarten Mechelen; 🇧🇪 Mechelen, Belgium

Centre Hospitalier Universitaire (CHU) Ambroise Pare; 🇧🇪 Mons, Belgium

Oncocentro-Centro de Oncologia do Parana; 🇧🇷 Curitiba, Parana, Brazil

UPCO - Hospital de Clinicas de Porto Alegre; 🇧🇷 Santa Cecília, Porto Alegre, Brazil

Nucleo de Oncologia da Bahia - NOB; 🇧🇷 Ondina, Salvador, Brazil

Fundacao Pio XII - Hospital de Cancer de Barretos - Hospital de Amor; 🇧🇷 Barretos, Brazil

ONCOSITE - Centro de Pesquisa Clinica em Oncologia Ltda; 🇧🇷 Ijuí, Brazil

Irmandade daSanta Casa de Misericordia de Porto Alegre; 🇧🇷 Porto Alegre, Brazil

Hospital Sao Lucas da PUCRS; 🇧🇷 Porto Alegre, Brazil

Multiprofile Hospital for Active Treatment - Uni Hospital OOD Department of Medical Oncology; 🇧🇬 Panagyurishte, Bulgaria

Complex Oncology Center - Plovdiv EOOD, First Department of Medical Oncology and Oncological Diseases in Gastroenterology; 🇧🇬 Plovdiv, Bulgaria

Specialized hospital for active treatment of oncological diseases; 🇧🇬 Sofia, Bulgaria

Multiprofile Hospital for Active Treatment Serdika EOOD Second Department of Medical Oncology; 🇧🇬 Sofia, Bulgaria

Hamilton Health Sciences -Juravinski Cancer Centre; 🇨🇦 Hamilton, Ontario, Canada

Southlake Regional Health Centre; 🇨🇦 Newmarket, Ontario, Canada

Hôpital de la Cité-de-la- Santé; 🇨🇦 Laval, Quebec, Canada

CISSS de la Montérégie-Centre - Hôpital Charles LeMoyne; 🇨🇦 Longueuil, Quebec, Canada

McGill University Health Centre (MUHC); 🇨🇦 Montréal, Canada

University Health Network - Princess Margaret Hospital; 🇨🇦 Toronto, Canada

Centro de Estudios Clínicos SAGA; 🇨🇱 Santiago de Chile, Chile

James Lind Centro de Investigación del Cáncer; 🇨🇱 Temuco, Araucania, Chile

Clinical Research Chile SpA; 🇨🇱 Valdivia, Los Ríos, Chile

LungenClinic Grosshansdorf; 🇩🇪 Großhansdorf, Schleswig Holstein, Germany

Universitaetsklinikum Halle Saale; 🇩🇪 Halle, Germany

Klinikum Kassel - Medizinische Klinik IV; 🇩🇪 Kassel, Germany

Veszprem Megyei Tudogyogyintezet Farkasgyepu; 🇭🇺 Farkasgyepű, Hungary

Zentralklinik Bad Berka GmbH; 🇩🇪 Bad Berka, Germany

Klinikum Bremen Ost; 🇩🇪 Bremen, Germany

Shaare Zedek Medical Center; 🇮🇱 Jerusalem, Israel

Tel Aviv Sourasky Medical Center; 🇮🇱 Tel Aviv, Israel

A.O. SS. Antonio e Biagio e Cesare Arrigo di Alessandria; 🇮🇹 Alessandria, Italy

IRCCS Azienda Ospedaliero-Universitaria di Bologna Policlinico S. Orsola Malpighi Oncologia medica; 🇮🇹 Bologna, Italy

Azienda Ospedaliera Univ. Policlinico G Rodolico San Marco; 🇮🇹 Catania, Italy

A.O. Santa Croce e Carle, Ospedale Carle; 🇮🇹 Cuneo, Italy

AOU Careggi; 🇮🇹 Florence, Italy

Fondazione Policlinico Universitario Campus Bio-Medico; 🇮🇹 Roma, Italy

Kanazawa University Hospital; 🇯🇵 Kanazawa, Ishikawa, Japan

Sendai Kousei Hospital; 🇯🇵 Sendai, Miyagi, Japan

Ohara HealthCare Foundation Kurashiki Central Hospital; 🇯🇵 Kurashiki, Okayama, Japan

Osaka Habikino Medical Center; 🇯🇵 Habikino, Osaka-Fu, Japan

Kansai Medical University Hospital; 🇯🇵 Hirakata-shi, Osaka, Japan

Center Hospital of the National Center for Global Health and Medicine; 🇯🇵 Shinjuku-Ku, Tokyo, Japan

Chungbuk National University Hospital; 🇰🇷 Cheongju-si, Korea, Republic of

CHA Bundang Medical Center, CHA University; 🇰🇷 Gyeonggi-do, Korea, Republic of

The Catholic University of Korea, St.Vincents Hospital; 🇰🇷 Gyeonggi-do, Korea, Republic of

Gachon University Gil Medical Center; 🇰🇷 Incheon, Korea, Republic of

Inha University Hospital; 🇰🇷 Incheon, Korea, Republic of

The Catholic University of Korea, Seoul St. Mary's Hospital; 🇰🇷 Seoul, Korea, Republic of

Seoul Metropolitan Government-Seoul National University Boramae Medical Center; 🇰🇷 Seoul, Korea, Republic of

II Klinika Chorob Pluc i Gruzlicy; 🇵🇱 Białystok, Poland

Institut Català d Oncologia (ICO) - Hospital Germans Trias i Pujol; 🇪🇸 Badalona, Barcelona, Spain

Institut Catala d'Oncologia (ICO) - Hospital Duran i Reynals; 🇪🇸 L'Hospitalet De Llobregat, Barcelona, Spain

Hospital Universitario Marqués de Valdecilla; 🇪🇸 Santander, Cantabria, Spain

Complejo Hospitalario Materno-Insular de Gran Canaria; 🇪🇸 Las Palmas De Gran Canaria, Gran Canaria, Spain

Clínica Universidad de Navarra; 🇪🇸 Madrid, Spain

Complexo Hospitalario Universitario De Vigo (CHUVI) - Hospital Xeral; 🇪🇸 Vigo, Pontevedra, Spain

Hospital General Universitario Gregorio Marañón; 🇪🇸 Madrid, Spain

Hospital Universitario Ramón y Cajal; 🇪🇸 Madrid, Spain

Hospital Clínico San Carlos; 🇪🇸 Madrid, Spain

Hospital Clínico Universitario de Valladolid; 🇪🇸 Valladolid, Spain

Istituto Oncologico della Svizzera Italiana; 🇨🇭 Bellinzona, Switzerland

Centre Hospitalier Universitaire Vaudois; 🇨🇭 Lausanne, Switzerland

Changhua Christian Hospital; 🇨🇳 Chang Hua, Taiwan

Kaohsiung Chang Gung Memorial Hospital; 🇨🇳 Kaohsiung, Taiwan

National Taiwan University Cancer Center; 🇨🇳 Taipei, Taiwan

Liv Hospital Ankara; 🇹🇷 Çankaya, Ankara, Turkey

Goztepe Prof. Dr. Suleyman Yalcin City Hospital; 🇹🇷 Kadıköy, Istambul, Turkey

The Christie NHS Foundation Trust; 🇬🇧 Manchester, United Kingdom

Nottingham University Hospitals NHS Trust; 🇬🇧 Nottingham, United Kingdom

Clatterbridge Hospital; 🇬🇧 Wirral, United Kingdom

The Royal Wolverhampton NHS Trust; 🇬🇧 Wolverhampton, United Kingdom