Evaluate Risk/Benefit of Nab Paclitaxel in Combination With Gemcitabine and Carboplatin Compared to Gemcitabine and Carboplatin in Triple Negative Metastatic Breast Cancer (or Metastatic Triple Negative Breast Cancer)
- Conditions
- Triple-negative Metastatic Breast CancerMetastatic Breast CancerHER2- Negative Breast CancerRecurrent Breast CancerCancer of the BreastProgesterone Receptor- Negative Breast CancerStage IV Breast CancerTriple-negative Breast CancerBreast TumorBreast Cancer
- Interventions
- Registration Number
- NCT01881230
- Lead Sponsor
- Celgene
- Brief Summary
The purpose of this study is to compare the safety and efficacy of nab-paclitaxel in combination with either gemcitabine or carboplatin to the combination of gemcitabine and carboplatin as first line treatment in female subjects with triple negative metastatic breast cancer (TNMBC) or metastatic triple negative breast cancer.
- Detailed Description
ABI-007-MBC- 001 is a Phase 2/3, multicenter, open-label, randomized, study that will compare the safety and efficacy of weekly nab-paclitaxel in combination with gemcitabine or carboplatin to the combination of gemcitabine and carboplatin as first line therapy in female subjects with Estrogen Receptor (ER), Progesterone Receptor (PgR), and human epidermal growth factor receptor 2 (HER2) negative (triple negative) metastatic breast cancer (TNMBC) or metastatic triple negative breast cancer. In the phase 2 portion of the study, the combinations of nab-paclitaxel plus gemcitabine and nab-paclitaxel plus carboplatin will be evaluated, and a comparator arm of gemcitabine combined with carboplatin will be used. In the phase 3 portion of the study, the selected nab-paclitaxel combination treatment will be compared to gemcitabine combined with carboplatin to evaluate progression free survival, safety and tolerability, overall survival, disease control rate and duration of response in women with metastatic triple negative breast cancer.
Due to changes in the treatment landscape since the initiation of this trial, the decision was made not to proceed to the Phase 3 portion of the study.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- Female
- Target Recruitment
- 191
A subject will be eligible for inclusion in this study only if all of the following criteria are met:
-
Female subjects, age ≥ 18 years at the time informed consent is signed
-
Pathologically confirmed adenocarcinoma of the breast
-
Pathologically confirmed as triple negative, source documented, defined as both of the following
- Estrogen Receptor (ER) and Progesterone Receptor (PgR) negative: < 1% of tumor cell nuclei are immunoreactive in the presence of evidence that the sample can express ER or PgR (positive intrinsic controls)
- Human Epidermal Growth Factor Receptor 2 (HER2) negative as per American Society of Clinical Oncology - College of American Pathologists (ASCO/CAP) guidelines i. Immunohistochemistry (IHC) 0 or 1 Fluorescence In Situ Hybridization (FISH) negative (or equivalent negative test). Subjects with IHC 2 must have a negative by Fluorescence In Situ Hybridization (FISH),, (or equivalent negative test).
-
Subjects with prior breast cancer history of different phenotypes (ie, ER/PgR/HER2 positive) must have pathologic confirmation of triple negative disease in at least one of the current sites of metastasis
-
Subjects must have received prior adjuvant or neoadjuvant anthracycline therapy; unless (a) anthracycline treatment was not indicated or was not the best treatment option for the subject in the opinion of the treating physician; and (b) anthracycline treatment remains not indicated or, in the opinion of the treating physician, is not the best treatment option for the subject's metastatic disease.
a. Newly diagnosed subjects presenting with TNMBC are eligible for the study if anthracycline treatment is not indicated or is not the best treatment option for the subject in the opinion of the treating physician.
-
Subjects with measurable metastatic disease, defined by Response Evaluation Criteria in Solid Tumors 1.1 (RECIST 1.1) guidelines
-
Life expectancy ≥ 16 weeks from randomization
-
No prior cytotoxic chemotherapy for metastatic breast cancer. Prior immunotherapy and/or monoclonal antibody therapy are acceptable. Prior treatments must have been discontinued at least 30 days prior to start of study treatment and all related toxicities must have resolved to Grade 1 or less.
-
Prior neoadjuvant or adjuvant chemotherapy, if given, must have been completed at least 6 months before randomization with all related toxicities resolved, and documented evidence of disease progression per RECIST 1.1 guidelines is required.
a. If prior neoadjuvant or adjuvant chemotherapy contained taxane, gemcitabine, or platinum agents, the treatment must have completed at least 12 months before randomization
-
Prior radiotherapy must have completed before randomization, with full recovery from acute radiation side effects. At least one measurable lesion must be completely outside the radiation portal or there must be unequivocal radiologic or clinical exam proof of progressive disease within the radiation portal, in accordance with RECIST 1.1 guidelines
-
At least 30 days from major surgery before randomization, with full recovery
-
Eastern Cooperative Oncology Group (ECOG) performance status 0-1
-
Subject has the following blood counts at screening:
- Absolute Neutrophil Count (ANC) ≥ 1500/mm^2 ;
- Platelets ≥ 100,000/mm^2 ;
- Hemoglobin (Hgb) ≥ 9 g/dL
-
Subject has the following blood chemistry levels at screening:
- Aspartate aminotransferase (AST) Serum glutamic-oxaloacetic transaminase (SGOT), Alanine Aminotransferase (ALT ) Serum Glutamic Pyruvate Transaminase (SGPT) ≤ 2.5 x upper limit of normal range (ULN); if hepatic metastases present ≤ 5.0 x ULN
- Total serum bilirubin ≤ ULN; or total bilirubin ≤ 3.0 × ULN with direct bilirubin within normal range in subjects with documented Gilbert's Syndrome
- Creatinine clearance > 60 mL/min (by Cockcroft-Gault)
-
Females of child-bearing potential [defined as a sexually mature women who (1) have not undergone hysterectomy (the surgical removal of the uterus) or bilateral oophorectomy (the surgical removal of both ovaries) or (2) have not been naturally postmenopausal for at least 24 consecutive months (i.e., has had menses at any time during the preceding 24 consecutive months)] must:
- Demonstrate a negative serum pregnancy test result at screening (performed by central lab) confirmed by local negative urine pregnancy dipstick within 72 hours prior to the first dose of IP); pregnancy test with sensitivity of at least 25 mIU/mL; and
- Either commit to true abstinence* from heterosexual contact (which must be reviewed on a monthly basis) or agree to use, and be able to comply with, two physician approved effective contraception methods (oral, injectable, or implantable hormonal contraceptive; tubal ligation; intra-uterine device; barrier contraceptive with spermicide; or vasectomized partner) without interruption for 28 days or longer as required by local guidelines, prior to starting study drug, during the study therapy (including dose interruptions), and for 28 days after discontinuation of the study or longer as required by local guidelines
-
Females must abstain from breastfeeding starting at randomization, during study participation and for 28 days or longer as required by local guidelines, after IP discontinuation
-
Understand and voluntarily sign an informed consent document prior to any study related assessments/procedures are conducted
-
Able to adhere to the study visit schedule and other protocol requirements
A subject will not be eligible for inclusion in this study if any of the following criteria apply:
- Male subjects
- Concurrent chemotherapy or any other anti tumor therapy for breast cancer. Prior immunotherapy & monoclonal antibody therapy are acceptable.
- Subjects who received prior cytotoxic chemotherapy after incomplete resection of locoregional recurrent disease
- History of, or known current evidence of brain metastasis, including leptomeningeal involvement.
- Subjects with bone as the only site of metastatic disease
- Subjects with regional lymph node as the only site of metastatic disease
- Serious intercurrent medical or psychiatric illness, including serious active infection
- History of class II-IV congestive heart failure or myocardial infarction within 6 months of randomization
- History of other primary malignancy in the last 5 years prior to randomization. Subjects with prior breast cancer history are eligible, however, the most recently obtained biopsy must demonstrate triple negative disease (source documented). Subjects with prior history of in situ cancer or basal or localized squamous cell skin cancer are eligible.
- Subjects with a history of interstitial lung disease, history of slowly progressive dyspnea and unproductive cough, sarcoidosis, silicosis, idiopathic pulmonary fibrosis, pulmonary hypersensitivity pneumonitis or multiple uncontrolled or unstable allergies which, in the opinion of the investigator, may lead to serious complications
- Peripheral neuropathy Grade ≥ 2 by National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE) v4.0
- Subjects who have received an investigational product within the previous 4 weeks prior to randomization
- Subject is currently enrolled, or will enroll in a different clinical study in which investigational therapeutic procedures are performed or investigational therapies are administered while participating in this study
- Pregnant or nursing women
- Subjects with prior hypersensitivity to nab-paclitaxel, gemcitabine, carboplatin or any other platin, or nucleoside analogue agents
- Any significant medical condition, laboratory abnormality, or psychiatric illness that would prevent the subject from participating in the study
- Any condition including the presence of laboratory abnormalities, which places the subject at unacceptable risk if she were to participate in the study
- Any condition that confounds the ability to interpret data from the study
- History of seropositive human immunodeficiency virus (HIV)
- Subjects who are receiving immunosuppressive or myelosuppressive medications that would, in the opinion of the investigator, increase the risk of serious neutropenic complications
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description nab-Paclitaxel plus Gemcitabine nab-Paclitaxel Treatment Arm A: nab-Paclitaxel 125 mg/m\^2 by intravenous (IV) administration over 30 minutes, followed by gemcitabine 1000 mg/m\^2 on Days 1 and 8 of each 21-day cycle by IV administration over 30 minutes nab-Paclitaxel plus Carboplatin nab-Paclitaxel Treatment Arm B: nab-Paclitaxel 125 mg/m\^2 on Days 1 and 8 by IV administration followed by carboplatin at an Area Under the Curve (AUC) of 2 on Days 1 and 8 of each 21-day cycle by IV administration nab-Paclitaxel plus Gemcitabine Gemcitabine Treatment Arm A: nab-Paclitaxel 125 mg/m\^2 by intravenous (IV) administration over 30 minutes, followed by gemcitabine 1000 mg/m\^2 on Days 1 and 8 of each 21-day cycle by IV administration over 30 minutes nab-Paclitaxel plus Carboplatin Carboplatin Treatment Arm B: nab-Paclitaxel 125 mg/m\^2 on Days 1 and 8 by IV administration followed by carboplatin at an Area Under the Curve (AUC) of 2 on Days 1 and 8 of each 21-day cycle by IV administration Gemcitabine plus Carboplatin Carboplatin Treatment Arm C: Gemcitabine 1000 mg/m\^2 on Days 1 and 8 by IV administration followed by carboplatin AUC 2 on Days 1 and 8 of each 21-day cycle by IV administration Gemcitabine plus Carboplatin Gemcitabine Treatment Arm C: Gemcitabine 1000 mg/m\^2 on Days 1 and 8 by IV administration followed by carboplatin AUC 2 on Days 1 and 8 of each 21-day cycle by IV administration
- Primary Outcome Measures
Name Time Method Kaplan-Meier Estimates of Progression-Free Survival (PFS) Based on Investigator Assessment. From date of randomization to data cut-off date of 16 December 2016; total length of time on study was 31 months for Arm A, 34 months for Arm B and 35 months for Arm C PFS was defined as the time from the date of randomization to the date of disease progression or death from any cause on or prior to the data cutoff date for the statistical analysis, whichever occurred earlier. Tumor responses were assessed every 6 weeks using, Response Evaluation Criteria in Solid Tumors (RECIST 1.1) and defined as: Complete response (CR) is the disappearance of all target lesions; Partial response (PR) occurs when at least a 30% decrease in the sum of diameters of target lesions from baseline; Stable disease is neither sufficient shrinkage to qualify for a PR nor sufficient increase of lesions to qualify for Progressive disease (PD); Progressive Disease- is at least a 20% increase in the sum of diameters of target lesions from nadir.
- Secondary Outcome Measures
Name Time Method Percentage of Participants Who Initiated Cycle 6 Receiving Doublet Combination Therapy Cycle 6 The percentage of participants who initiated Cycle 6 receiving doublet combination therapy regardless of the need for dose modifications.
Percentage of Participants With an Objective Complete or Partial Overall Response by Investigator Assessment. Disease response was assessed every 6 weeks; from date of randomization to data cut-off date of 16 December 2016; total length of time on study was 31 months for Arm A, 34 months for Arm B and 35 months for Arm C Percentage of participants with an Objective Complete or Partial Overall Response according to RECIST 1.1 and defined as: Complete response-disappearance of all target lesions; partial response at least a 30% decrease in the sum of diameters of target lesions from baseline; stable disease-neither sufficient shrinkage to qualify for PR nor sufficient increase of lesions to qualify for Progressive disease (PD)• Progressive Disease- At least a 20% increase in the sum of diameters of target lesions from nadir.
Kaplan-Meier Estimates of Overall Survival From date of randomization to data cut-off date of 16 December 2016; total length of time on study was 31 months for Arm A, 34 months for Arm B and 35 months for Arm C Overall survival was defined as the time from the date of randomization to the date of death (from any cause).
Percentage of Participants Who Discontinued From All Study Treatment Due to TEAEs From randomization through to 28 days after the last dose of IP; up to data-cut off of date of 16 Dec 2016; maximum treatment duration of study drug exposure was 108.3 weeks for Arm A, 83 weeks for Arm B, 110.1 weeks for Arm C Treatment-emergent adverse events (TEAEs) were defined as any AEs that begin or worsen with an onset date on or after the date of the first dose of IP through 28 days after the last dose.
Number of Participants With Treatment Emergent Adverse Events (TEAEs) From randomization through to 28 days after the last dose of IP; up to data cut off date of 16 Dec 2016; maximum treatment duration of study drug exposure was 108.3 weeks for Arm A, 83 weeks for Arm B, 110.1 weeks for Arm C Treatment-emergent adverse events (TEAEs) were defined as any AEs that began or worsened with the onset date on or after the date of the first dose of IP through 28 days after the last dose. A serious AE (SAE) = any AE which results in death; is life-threatening; requires inpatient hospitalization or prolongation of existing hospitalization; results in persistent or significant disability/incapacity; is a congenital anomaly/birth defect; constitutes an important medical event. The severity of AEs was graded based on the participant's symptoms according to the Common Terminology Criteria for Adverse Events (CTCAE, Version 4.0); AEs were evaluated for severity as follows: Grade 1 = Mild - transient or mild discomfort; no medical intervention required; Grade 2 = Moderate - mild to moderate limitation in activity; Grade 3 = Severe; Grade 4 = Life threatening; Grade 5 = Death.
Percentage of Participants Experiencing Dose Modifications (Reductions and Interruptions) From randomization through to 28 days after the last dose of IP; up to data-cut off of date of 16 Dec 2016; maximum treatment duration of study drug exposure was 108.3 weeks for Arm A, 83 weeks for Arm B, 110.1 weeks for Arm C The number of participants with dose modifications occurring during the treatment period. Dose reductions and interruptions are typically caused by clinically significant laboratory abnormalities and /or treatment emergent adverse events/toxicities.
Trial Locations
- Locations (138)
South Carolina Oncology Associates
🇺🇸Columbia, South Carolina, United States
UT Physicians General Medicine
🇺🇸Houston, Texas, United States
Centro de Oncologia Da Bahia
🇧🇷Salvador, Bahia, Brazil
Alan Blair Cancer Centre at Pasqua Hosptial
🇨🇦Regina, Saskatchewan, Canada
IASO General
🇬🇷Athens, Greece
Ironwood Cancer and Research Center
🇺🇸Chandler, Arizona, United States
Arizona Cancer Research Alliance
🇺🇸Scottsdale, Arizona, United States
Pacific Cancer Medical Center Inc
🇺🇸Anaheim, California, United States
University of California San Diego Moores Cancer Center
🇺🇸La Jolla, California, United States
Central Coast Medical Oncology Corporation
🇺🇸Santa Maria, California, United States
California Cancer Associates for Research and Excellence cCARE
🇺🇸Escondido, California, United States
Wilshire Oncology Medical Group, Inc
🇺🇸La Verne, California, United States
Translational Research Management
🇺🇸Los Angeles, California, United States
Coastal Integrative Cancer Care
🇺🇸San Luis Obispo, California, United States
Redwood Regional Medical Group, INC
🇺🇸Santa Rosa, California, United States
Center for Hematology-Oncology
🇺🇸Boca Raton, Florida, United States
Memorial Breast Cancer Center
🇺🇸Hollywood, Florida, United States
Mayo Clinic - Jacksonville
🇺🇸Jacksonville, Florida, United States
Florida Cancer Specialists
🇺🇸West Palm Beach, Florida, United States
Joliet Oncology-Hematology Associates, Ltd
🇺🇸Joliet, Illinois, United States
Carle Cancer Center
🇺🇸Urbana, Illinois, United States
University of South Alabama Mitchell Cancer Institute
🇺🇸Lafayette, Louisiana, United States
University of Maryland School of Med
🇺🇸Baltimore, Maryland, United States
Missouri Baptist Medical Center
🇺🇸Saint Louis, Missouri, United States
New Hampshire Oncology Hematology
🇺🇸Hooksett, New Hampshire, United States
Hematology Oncology Associates of CNY
🇺🇸East Syracuse, New York, United States
Dartmouth Hitchcock Medical Center Norris Cotton Cancer Center
🇺🇸Lebanon, New Hampshire, United States
NYU Langone Arena Oncology
🇺🇸Lake Success, New York, United States
Mark H Zangmeister Center
🇺🇸Columbus, Ohio, United States
Alamance Regional Medical Cancer Center
🇺🇸Burlington, North Carolina, United States
Clinical Research Alliance
🇺🇸New York, New York, United States
Cancer Centers of Southwest Oklahoma
🇺🇸Lawton, Oklahoma, United States
North Bend Medical Center
🇺🇸Coos Bay, Oregon, United States
Toledo Community Oncology Program
🇺🇸Toledo, Ohio, United States
Magee Women's Hospital
🇺🇸Pittsburgh, Pennsylvania, United States
Chattanooga Oncology Hematology Associates
🇺🇸Chattanooga, Tennessee, United States
St Mary Medical Center
🇺🇸Langhorne, Pennsylvania, United States
The Center for Cancer and Blood Disorders
🇺🇸Fort Worth, Texas, United States
Texas Oncology, PA
🇺🇸Dallas, Texas, United States
Texas Oncology, PA- Dallas
🇺🇸Dallas, Texas, United States
Texas Oncology P.A.- Tyler
🇺🇸Tyler, Texas, United States
Hematology Oncology Associates of Fredericksburg
🇺🇸Fredericksburg, Virginia, United States
Delta Hematologyoncology Associates
🇺🇸Portsmouth, Virginia, United States
Virginia Cancer Institute
🇺🇸Richmond, Virginia, United States
Medical Oncology Associates
🇺🇸Spokane, Washington, United States
Saint Vincent Hospital
🇺🇸Green Bay, Wisconsin, United States
Edwards Comprehensive Cancer Center
🇺🇸Huntington, West Virginia, United States
Frankston Hospital Oncology Research
🇦🇺Frankston, Victoria, Australia
Canberra Hospital
🇦🇺Garran, Australian Capital Territory, Australia
Universitaetsklinik Innsbruck
🇦🇹Innsbruck, Austria
Sir Charles Gairdner Hospital
🇦🇺Nedlands, Australia
Border Medical Oncology
🇦🇺Wodonga, Victoria, Australia
Medizinische Universitat Wien
🇦🇹Vienna, Austria
Salzburger Landkliniken St. Johanns-Spital
🇦🇹Salzburg, Austria
Liga Paranaense de Combate Ao Cancer
🇧🇷Curitiba, Paraná, Brazil
Instituto Ribeiraopretano de Combate Ao Cancer
🇧🇷Ribeirao Preto, Brazil
ONCOCLINIC Clinica de Oncologia LTDA
🇧🇷Fortaleza, Brazil
Hospital Bruno Born
🇧🇷Rio Grande Do Sul, Brazil
Hospital das Clinicas da Faculdade de Medicina da USP
🇧🇷Ribeirao Preto, Brazil
Hospital Albert Einstein Sociedade Beneficente Israelita Brasileira
🇧🇷Sao Paulo, Brazil
Instituto Brasileiro de Controle Do Cancer IBCC
🇧🇷São Paulo, Brazil
CHUM - Notre Dame
🇨🇦Montreal, Quebec, Canada
Sociedade Beneficente de Senhoras Hospital Sirio Libanes
🇧🇷São Paulo, Brazil
Ottawa General Hospital
🇨🇦Ottawa, Ontario, Canada
Hospital du Saint Scarement Sacrement Laboratory
🇨🇦Quebec City, Quebec, Canada
Sankt Gertrauden-Krankenhaus
🇩🇪Berlin, Germany
Agaplesion Markus Krankenhaus
🇩🇪Frankfurt, Germany
Praxis fur interdisziplinare Onkologie & Hamatologie
🇩🇪Freiburg, Germany
Universitaetsklinikum Heidelberg
🇩🇪Heidelberg, Germany
LMU Klinikum der Universitat
🇩🇪München, Germany
Krankenanstalt Mutterhaus der Borromaerinnen
🇩🇪Trier, Germany
Universitatsklinikum Ulm
🇩🇪Ulm, Germany
University General Hospital of Heraklion
🇬🇷Heraklion, Greece
University General Hospital of Patras
🇬🇷Rio Patras, Greece
Metropolitan Hospital
🇬🇷Faliro, Greece
Azienda Ospedaliera Universitaria Federico II
🇮🇹Napoli, Campania, Italy
Azienda Ospedaliera San Gerardo
🇮🇹Monza, Italy
Istituto Oncologico Veneto
🇮🇹Padova, Italy
Policlinico Universitario A Gemelli
🇮🇹Roma, Italy
Istituto Nazionale Tumori Regina Elena
🇮🇹Roma, Italy
Istituto Clinico Humanitas
🇮🇹Rozzano (MI), Italy
Hospital Espirito Santo
🇵🇹Evora, Portugal
Azienda Ospedaliera Treviglio-Caravaggio
🇮🇹Treviglio, Italy
Hospital de Santa Maria
🇵🇹Lisboa, Portugal
Hospital Da Luz
🇵🇹Lisboa, Portugal
Instituto Portugues de Oncologia do Porto, Francisco Gentil
🇵🇹Porto, Portugal
Hospital Universitario Vall D Hebron
🇪🇸Barcelona, Spain
Hospital Universitario Reina Sofia
🇪🇸Cordoba, Spain
Clinic Barcelona Hospital Universitari
🇪🇸Barcelona, Spain
Hospital General Gregorio Maranon
🇪🇸Madrid, Spain
Onkologikoa - Kutxaren Institutu Onkologikoa
🇪🇸San Sebastian, Spain
Hospital Clinico Universitario de Santiago
🇪🇸Santiago de Compostela, Spain
Hospital Universitario Virgen Macarena
🇪🇸Sevilla, Spain
Sarah Cannon Research Institute UK
🇬🇧London, United Kingdom
Hospital Universitario Miguel Servet
🇪🇸Zaragoza, Spain
Royal United Hospital
🇬🇧Bath, United Kingdom
The Christie NHS Foundation Trust
🇬🇧Manchester, United Kingdom
The East and North Hertfordshire NHS Trust
🇬🇧Middlesex, United Kingdom
Sheffield Teaching Hospitals NHS Foundation Trust
🇬🇧Sheffield South Yorkshire, United Kingdom
University of Miami School of Medicine
🇺🇸Miami, Florida, United States
Investigative Clinical Research of Indiana, LLC
🇺🇸Indianapolis, Indiana, United States
Henry Ford Medical Center - New Center One
🇺🇸Detroit, Michigan, United States
Minnesota Oncology Hematology, PA
🇺🇸Minneapolis, Minnesota, United States
University of Cincinnatti
🇺🇸Cincinnati, Ohio, United States
Oncology Hematology Care
🇺🇸Cincinnati, Ohio, United States
Cancer Care Centers of South Texas - Loop
🇺🇸San Antonio, Texas, United States
Sarah Cannon Cancer Center
🇺🇸Nashville, Tennessee, United States
Englewood Hospital and Medical Center
🇺🇸Englewood, New Jersey, United States
Instituto Nacional de Cancer - INCA
🇧🇷Rio De Janerio, Rio De Janeiro, Brazil
Associacao Hospitalar Moinhos de Vento Hospital Moinhos de Vento
🇧🇷Porto Alegre, Rio Grande Do Sul, Brazil
Hospital Sao Lucas - PUCRS
🇧🇷Porto Alegre, Rio Grande Do Sul, Brazil
Schwerpunktpraxis fur Gynakologische Onkologie
🇩🇪Köln, Germany
IRCCS AziendaOspedaliera Universitaria San Martino
🇮🇹Genova, Italy
Azienda Ospedaliera Sant Andrea
🇮🇹Roma, Italy
Center for Cancer and Blood Disorders, PC
🇺🇸Bethesda, Maryland, United States
Mayo Clinic
🇺🇸Rochester, Minnesota, United States
Northwest Cancer Specialists, P.C. - Hoyt
🇺🇸Portland, Oregon, United States
Providence Portland Medical Center
🇺🇸Portland, Oregon, United States
Columbia St Marys Cancer Center
🇺🇸Milwaukee, Wisconsin, United States
Midwest Physicians Group
🇺🇸Kansas City, Missouri, United States
Hospital de Base Da Faculdade de Medicina de
🇧🇷Sao Jose Do Rio Preto, Brazil
Centre Jean Perrin
🇫🇷Clermont-Ferrand, France
Frauenarzte am Bahnhofsplatz
🇩🇪Hildesheim, Germany
University of Athens Medical school - Regional General Hospital
🇬🇷Athens, Greece
Azienda Ospedaliera Ospedali Riuniti Papardo-Piemonte
🇮🇹Messina, Italy
Istituto Nazionale Per Lo Studio E La Cura Dei Tumori Fondazione Giovanni Pascale
🇮🇹Napoli, Campania, Italy
Arizona Center for Cancer Care
🇺🇸Glendale, Arizona, United States
Fundacao Pio XII - Hospital de Cancer de Barretos
🇧🇷Barretos, São Paulo, Brazil
Facharztpraxis fur Gynakologie und Geburtshilfe
🇩🇪Bonn, Germany
Hospital Dr. Amaral Carvalho/ Hospital Amaral Carvalho Jaú
🇧🇷Jau/SP, São Paulo, Brazil
Azienda Ospedaliero-Universitaria di Ferrara Arcispedale Sant' Anna
🇮🇹Ferrara, Italy
Azienda Ospedaliera Citta della Salute e della Scienza di Torino
🇮🇹Torino, Piemonte, Italy
Mayo Clinic Arizona
🇺🇸Scottsdale, Arizona, United States
Highlands Oncology Group
🇺🇸Fayetteville, Arkansas, United States
CSSS de Rimouski Neigette
🇨🇦Rimouski, Quebec, Canada
Azienda Ospedaliero-Universitaria di Bologna - Policlinico S.Orsola-Malpighi
🇮🇹Bologna, Emilia-Romagna, Italy
Presidio Ospedaliero della Misericordia
🇮🇹Grosseto, Italy
Arcispedale Santa Maria Nuova
🇮🇹Reggio Emilia, Italy