Enhanced Dermatological Care to Reduce Rash and Paronychia in Epidermal Growth Factor Receptor (EGRF)-Mutated Non-Small Cell Lung Cancer (NSCLC) Treated First-line With Amivantamab Plus Lazertinib

Phase 2

Recruiting

• Conditions: Carcinoma, Non-Small-Cell Lung
• Interventions: Drug: Amivantamab; Drug: Lazertinib; Drug: Doxycycline; Drug: Minocycline; Drug: Clindamycin; Drug: Chlorhexidine; Other: Noncomedogenic skin moisturizer

• Registration Number: NCT06120140
• Lead Sponsor: Janssen Research & Development, LLC

Brief Summary

The purpose of this study is to evaluate whether enhanced dermatologic management can reduce incidence of grade greater than or equal to (\>=) 2 dermatologic adverse events of interest (DAEIs) when compared with standard-of-care skin management in participants with locally advanced or metastatic stage IIIB/C-IV epidermal growth factor receptor (EGFR)-mutated non-small cell lung cancer (NSCLC) treated first-line with amivantamab and lazertinib.

Detailed Description

Not available

Basic Information
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Recruitment & Eligibility
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Study & Design
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Trial Locations
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Related News

Study Timeline

• Study First Submitted: 2023-11-02
• Study First Submitted QC: 2023-11-02
• Study First Posted: 2023-11-07
• Study Start: 2024-02-16
• Status Verified: 2024-12
• Last Update Submitted: 2024-12-04
• Last Update Posted: 2024-12-05
• Primary Completion: 2025-07-03
• Study Completion: 2026-03-31

Recruitment & Eligibility

• Status: RECRUITING
• Sex: All
• Target Recruitment: 200

Inclusion Criteria

• Have histologically or cytologically confirmed, locally advanced or metastatic non-small cell lung cancer (NSCLC); Is treatment naive and not amenable to curative therapy including surgical resection or (chemo) radiation. Adjuvant or neoadjuvant therapy for Stage I, Stage II or Stage IIIA disease is allowed if last dose administered more than 12 months prior to the development of locally advanced or metastatic disease
• Have a tumor that harbors an epidermal growth factor receptor (EGFR) exon 19del or exon 21 L858R substitution, as detected by an Food and Drug Administration (FDA)-approved or other validated test in a clinical laboratory improvement amendments (CLIA)-certified laboratory (sites in the United States) or an accredited local laboratory (sites outside of the United States) in accordance with site standard of care
• A participant with asymptomatic or previously treated and stable brain metastases may participate in this study. Participants with a history of symptomatic brain metastases must have had all lesions treated as clinically indicated (that is, no current indication for further definitive local therapy). Any definitive local therapy to brain metastases must have been completed at least 14 days prior to randomization, and the participant can be receiving no greater than 10 milligram (mg) prednisone or equivalent daily for the treatment of intracranial disease
• Can have prior or concurrent second malignancy (other than the disease under study)which natural history or treatment is unlikely to interfere with any study endpoints, safety, or the efficacy of the study treatment(s)
• Have an eastern cooperative oncology group (ECOG) performance status of 0 to 1

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Exclusion Criteria

• History of uncontrolled illness, including but not limited to uncontrolled diabetes; ongoing or active infection (includes infection requiring treatment with antimicrobial therapy [participants will be required to complete antibiotics 1 week prior to starting background anticancer treatment] or diagnosed or suspected viral infection); active bleeding diathesis; impaired oxygenation requiring continuous oxygen supplementation; refractory nausea and vomiting, chronic gastrointestinal diseases, inability to swallow the formulated product, or previous significant bowel resection that would preclude adequate absorption of background anticancer treatment or doxycycline/minocycline; psychiatric illness, social situation, or any other circumstances that would limit compliance with study requirements; any ophthalmologic condition that is clinically unstable; pre-existing skin condition that would prevent adequate evaluations of dermatologic toxicity, as determined by the investigator
• Medical history of interstitial lung disease (ILD), including drug-induced ILD or radiation pneumonitis
• Known allergy, hypersensitivity, or intolerance to the excipients of amivantamab, lazertinib, or to tetracyclines, doxycycline, minocycline, or their excipients or to any component of the enhanced dermatologic management
• Participant has received any prior systemic treatment at any time for locally advanced stage III B/C or metastatic stage IV disease (adjuvant or neoadjuvant therapy for stage I, II or IIIA disease is allowed if last dose administered more than 12 months prior to the development of locally advanced or metastatic disease)
• Participant has an active or past medical history of leptomeningeal disease

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Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Arm A and Subcutaneous (SC) Expansion Cohort: Enhanced Dermatologic Management	Doxycycline	Participants will receive enhanced dermatologic management to reduce toxicities in skin and nail with doxycycline tablet or minocycline capsule (100 milligrams \[mg\] twice daily for 12 weeks), clindamycin 1 percent (%) topical lotion, chlorhexidine 4% topical solution, and noncomedogenic skin moisturizer (once daily) during background anticancer treatment of advanced or metastatic epidermal growth factor receptor (EGFR)-mutated non-small cell lung cancer (NSCLC) with amivantamab (1050 mg for body weight \[BW\] less than 80 kilograms \[kg\] and 1400 mg for BW greater than or equal to \[\>=\] 80 kg as IV infusion \[Arm A\], once weekly for the first 4 weeks, then once every 2 weeks) and subcutaneously (expansion cohort) (cycle 1: 1600 mg or 2240 mg once weekly based on BW; cycles 2 onwards: 3520 mg or 4640 mg based on BW on Day 1 of each 28-day cycle) with lazertinib (240 mg, tablet, once daily) until documented disease progression using Response Evaluation Criteria in Solid Tumors version 1.1).
Arm A and Subcutaneous (SC) Expansion Cohort: Enhanced Dermatologic Management	Noncomedogenic skin moisturizer	Participants will receive enhanced dermatologic management to reduce toxicities in skin and nail with doxycycline tablet or minocycline capsule (100 milligrams \[mg\] twice daily for 12 weeks), clindamycin 1 percent (%) topical lotion, chlorhexidine 4% topical solution, and noncomedogenic skin moisturizer (once daily) during background anticancer treatment of advanced or metastatic epidermal growth factor receptor (EGFR)-mutated non-small cell lung cancer (NSCLC) with amivantamab (1050 mg for body weight \[BW\] less than 80 kilograms \[kg\] and 1400 mg for BW greater than or equal to \[\>=\] 80 kg as IV infusion \[Arm A\], once weekly for the first 4 weeks, then once every 2 weeks) and subcutaneously (expansion cohort) (cycle 1: 1600 mg or 2240 mg once weekly based on BW; cycles 2 onwards: 3520 mg or 4640 mg based on BW on Day 1 of each 28-day cycle) with lazertinib (240 mg, tablet, once daily) until documented disease progression using Response Evaluation Criteria in Solid Tumors version 1.1).
Arm B: Standard-of-Care Dermatologic Management	Amivantamab	Participants will receive standard care for dermatologic management according to local practice to reduce dermatologic toxicities in skin and nail during background anticancer treatment of advanced or metastatic EGFR-mutated NSCLC with amivantamab administered as intravenous (IV) infusion plus lazertinib, dose and dosing schedule as same as experimental arm.
Arm A and Subcutaneous (SC) Expansion Cohort: Enhanced Dermatologic Management	Lazertinib	Participants will receive enhanced dermatologic management to reduce toxicities in skin and nail with doxycycline tablet or minocycline capsule (100 milligrams \[mg\] twice daily for 12 weeks), clindamycin 1 percent (%) topical lotion, chlorhexidine 4% topical solution, and noncomedogenic skin moisturizer (once daily) during background anticancer treatment of advanced or metastatic epidermal growth factor receptor (EGFR)-mutated non-small cell lung cancer (NSCLC) with amivantamab (1050 mg for body weight \[BW\] less than 80 kilograms \[kg\] and 1400 mg for BW greater than or equal to \[\>=\] 80 kg as IV infusion \[Arm A\], once weekly for the first 4 weeks, then once every 2 weeks) and subcutaneously (expansion cohort) (cycle 1: 1600 mg or 2240 mg once weekly based on BW; cycles 2 onwards: 3520 mg or 4640 mg based on BW on Day 1 of each 28-day cycle) with lazertinib (240 mg, tablet, once daily) until documented disease progression using Response Evaluation Criteria in Solid Tumors version 1.1).
Arm A and Subcutaneous (SC) Expansion Cohort: Enhanced Dermatologic Management	Clindamycin	Participants will receive enhanced dermatologic management to reduce toxicities in skin and nail with doxycycline tablet or minocycline capsule (100 milligrams \[mg\] twice daily for 12 weeks), clindamycin 1 percent (%) topical lotion, chlorhexidine 4% topical solution, and noncomedogenic skin moisturizer (once daily) during background anticancer treatment of advanced or metastatic epidermal growth factor receptor (EGFR)-mutated non-small cell lung cancer (NSCLC) with amivantamab (1050 mg for body weight \[BW\] less than 80 kilograms \[kg\] and 1400 mg for BW greater than or equal to \[\>=\] 80 kg as IV infusion \[Arm A\], once weekly for the first 4 weeks, then once every 2 weeks) and subcutaneously (expansion cohort) (cycle 1: 1600 mg or 2240 mg once weekly based on BW; cycles 2 onwards: 3520 mg or 4640 mg based on BW on Day 1 of each 28-day cycle) with lazertinib (240 mg, tablet, once daily) until documented disease progression using Response Evaluation Criteria in Solid Tumors version 1.1).
Arm A and Subcutaneous (SC) Expansion Cohort: Enhanced Dermatologic Management	Minocycline	Participants will receive enhanced dermatologic management to reduce toxicities in skin and nail with doxycycline tablet or minocycline capsule (100 milligrams \[mg\] twice daily for 12 weeks), clindamycin 1 percent (%) topical lotion, chlorhexidine 4% topical solution, and noncomedogenic skin moisturizer (once daily) during background anticancer treatment of advanced or metastatic epidermal growth factor receptor (EGFR)-mutated non-small cell lung cancer (NSCLC) with amivantamab (1050 mg for body weight \[BW\] less than 80 kilograms \[kg\] and 1400 mg for BW greater than or equal to \[\>=\] 80 kg as IV infusion \[Arm A\], once weekly for the first 4 weeks, then once every 2 weeks) and subcutaneously (expansion cohort) (cycle 1: 1600 mg or 2240 mg once weekly based on BW; cycles 2 onwards: 3520 mg or 4640 mg based on BW on Day 1 of each 28-day cycle) with lazertinib (240 mg, tablet, once daily) until documented disease progression using Response Evaluation Criteria in Solid Tumors version 1.1).
Arm B: Standard-of-Care Dermatologic Management	Lazertinib	Participants will receive standard care for dermatologic management according to local practice to reduce dermatologic toxicities in skin and nail during background anticancer treatment of advanced or metastatic EGFR-mutated NSCLC with amivantamab administered as intravenous (IV) infusion plus lazertinib, dose and dosing schedule as same as experimental arm.
Arm A and Subcutaneous (SC) Expansion Cohort: Enhanced Dermatologic Management	Chlorhexidine	Participants will receive enhanced dermatologic management to reduce toxicities in skin and nail with doxycycline tablet or minocycline capsule (100 milligrams \[mg\] twice daily for 12 weeks), clindamycin 1 percent (%) topical lotion, chlorhexidine 4% topical solution, and noncomedogenic skin moisturizer (once daily) during background anticancer treatment of advanced or metastatic epidermal growth factor receptor (EGFR)-mutated non-small cell lung cancer (NSCLC) with amivantamab (1050 mg for body weight \[BW\] less than 80 kilograms \[kg\] and 1400 mg for BW greater than or equal to \[\>=\] 80 kg as IV infusion \[Arm A\], once weekly for the first 4 weeks, then once every 2 weeks) and subcutaneously (expansion cohort) (cycle 1: 1600 mg or 2240 mg once weekly based on BW; cycles 2 onwards: 3520 mg or 4640 mg based on BW on Day 1 of each 28-day cycle) with lazertinib (240 mg, tablet, once daily) until documented disease progression using Response Evaluation Criteria in Solid Tumors version 1.1).
Arm A and Subcutaneous (SC) Expansion Cohort: Enhanced Dermatologic Management	Amivantamab	Participants will receive enhanced dermatologic management to reduce toxicities in skin and nail with doxycycline tablet or minocycline capsule (100 milligrams \[mg\] twice daily for 12 weeks), clindamycin 1 percent (%) topical lotion, chlorhexidine 4% topical solution, and noncomedogenic skin moisturizer (once daily) during background anticancer treatment of advanced or metastatic epidermal growth factor receptor (EGFR)-mutated non-small cell lung cancer (NSCLC) with amivantamab (1050 mg for body weight \[BW\] less than 80 kilograms \[kg\] and 1400 mg for BW greater than or equal to \[\>=\] 80 kg as IV infusion \[Arm A\], once weekly for the first 4 weeks, then once every 2 weeks) and subcutaneously (expansion cohort) (cycle 1: 1600 mg or 2240 mg once weekly based on BW; cycles 2 onwards: 3520 mg or 4640 mg based on BW on Day 1 of each 28-day cycle) with lazertinib (240 mg, tablet, once daily) until documented disease progression using Response Evaluation Criteria in Solid Tumors version 1.1).

Primary Outcome Measures

Name	Time	Method
Number of Participants With Grade Greater Than or Equal to (>=) 2 Dermatologic Adverse Events of Interest (DAEIs) Within 12 Weeks After Initiation of Anticancer Treatment	Up to 12 weeks after initiation of anticancer treatment	Number of participants with Grade \>= 2 DAEIs within 12 weeks after initiation of anticancer treatment based on National Cancer Institute Common Toxicity Criteria for Adverse Events (NCI CTCAE) Version (v) 5.0 will be reported. DAEIs includes rash, dermatitis acneiform, pruritus, skin fissures, acne, folliculitis, erythema, eczema, rash maculo-papular, skin exfoliation, skin lesion, skin irritation, dermatitis, rash erythematous, rash macular, rash popular, rash pruritic, rash pustular, dermatitis contact, dermatitis exfoliative generalized, drug eruption, dyshidrotic eczema, eczema asteatotic and paronychia. As per NCI CTCAE v 5.0, severity scale ranges from Grade 1 (mild) to Grade 5 (death). Grade 1= mild, Grade 2= moderate, Grade 3= severe, Grade 4= life-threatening, and Grade 5= death related to adverse event.

Secondary Outcome Measures

Name	Time	Method
Number of Participants With DAEIs by Severity Based on NCI CTCAE v 5.0	Up to 12 weeks after initiation of anticancer treatment	Number of participants with DAEIs by severity based on NCI CTCAE v 5.0 will be reported.
Number of Participants With Grade >=2 DAEIs Within 6 Months After Initiation of Anticancer Treatment Based on NCI CTCAE v 5.0	Up to 6 months after initiation of anticancer treatment	Number of participants with Grade \>=2 DAEIs within 6 months after initiation of anticancer treatment based on NCI CTCAE v 5.0 will be reported.
Number of Grade >= 2 DAEI Per Participants	Up to 12 months	Number of grade \>= 2 DAEI per participants will be reported.
Time to First Occurrence of Grade >=2 DAEI	Up to 12 months	Time to first occurrence of Grade \>=2 DAEI will be reported.
Time to Resolution of Grade >= 2 DAEI	Up to 12 months	Time to resolution of Grade \>= 2 DAEI will be reported.
Number of Participants With Paronychia by Severity Based on NCI CTCAE v 5.0	Up to 6 months after initiation of anticancer treatment	Number of participants with paronychia by severity based on NCI CTCAE v 5.0 will be reported.
Number of Participants With Scalp Rash by Severity Based on NCI CTCAE v 5.0	Up to 12 months after initiation of anticancer treatment	Number of participants with scalp rash by severity based on NCI CTCAE v 5.0 will be reported.
Change From Baseline in Skindex Symptoms Domain Score up to 12 Months	Baseline, up to Month 12	Change from baseline in skindex symptoms domain score up to 12 months will be reported. The score of quality of life will be assessed using the Skindex-16 questionnaire. Skindex-16 is used for participants to rate skin conditions.
Change From Baseline in Patient's Global Impression-Severity (PGI-S) Rash up to 12 Months	Baseline, up to Month 12	Change from baseline in PGI-S rash up to 12 months will be reported. Participant quality of life will be evaluated using PGI-S Rash. PGI-S is a single-item questionnaire assessing participants disease severity on a 7-point response scale.
Change From Baseline in European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC-QLQ-C30) Score up to 12 Months	Baseline, up to Month 12	Change from baseline in EORTC-QLQ-C30 score up to 12 months will be reported. EORTC-QLQ-C30 is a core 30-item questionnaire for evaluating the health-related quality of life (HRQoL) of participants participating in cancer clinical studies.
Change From Baseline in EuroQol 5 - Dimension (EQ-5D) Patient-reported Outcome (PRO) up to 12 Months (for Amivantamab Subcutaneous Expansion Cohort Only)	Baseline, up to Month 12	The EQ-5D questionnaire is a brief, generic HRQOL assessment that can that can also be used to incorporate participant preferences into health economic evaluations. The EQ-5D questionnaire assesses HRQOL in terms of degree of limitation on 5 health dimensions (mobility, self-care, usual activities, pain/discomfort, anxiety/depression) and as overall health using a visual analog scale with response options ranging from 0 (worst imaginable health) to 100 (best imaginable health). Lower scores indicate worsening. EQ-5D scores include EQ-5D valuation index score (a weighted scoring of the 5 dimension scores with a possible range from 0 to 1), EQ-5D visual analog scale (VAS) is a vertical VAS with scores ranging from 0 (worst imaginable health) to 100 (perfect health), and EQ5D descriptive system scores (five scores reflecting each of the 5 EQ-5D health dimensions ranging from 0 \[no limitation\] to 4 \[incapacity\]).
Percentage of Participants With Dose Reductions, Dose Interruptions, and Dose Discontinuations of Anticancer Treatment due to DAEIs	Up to 12 months	Percentage of participants with dose reductions, dose interruptions, and dose discontinuations of anticancer treatment due to DAEIs will be reported.
Relative Dose Intensity (RDI) of Anticancer Treatment	Up to 12 months	Relative dose intensity of anticancer treatment will be reported. The relative dose intensity is defined as the ratio of total actually received dose versus total prescribed dose.
Percentage of Participants With Venous Thromboembolism (VTE) Adverse Events (AEs) by Severity Based on NCI CTCAE v 5.0	Up to 12 months	Percentage of participants with VTE AEs (pulmonary embolism and deep vein thrombosis) by severity based on NCI CTCAE v 5.0 will be reported. An AE is any untoward medical occurrence in a clinical study participant administered a medicinal (investigational or non-investigational) product. An AE does not necessarily have a causal relationship with the intervention.
Percentage of Participants With Adverse Events (AEs) by Severity Based on NCI CTCAE v 5.0	Up to 12 months	Percentage of participants with AEs by severity based on NCI CTCAE v 5.0 will be reported. An AE is any untoward medical occurrence in a clinical study participant administered a medicinal (investigational or non-investigational) product. An AE does not necessarily have a causal relationship with the intervention.
Progression Free Survival (PFS)	Up to 12 months	PFS is defined as the time from the date of randomization to the date of first documented disease progression, as defined in the Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1, or death due to any cause, whichever occurs first.
Overall Response Rate (ORR)	Up to 12 months	ORR is defined as the percentage of participants who achieve a partial response (PR) or better response using RECIST v1.1 as assessed by the investigator.
Duration of Response (DoR)	Up to 12 months	DOR will be calculated among responders (with a PR or better response) from the date of initial documentation of a response (PR or better) to the date of first documented evidence of progressive disease, as defined in the RECIST v1.1 response criteria.

Trial Locations

Locations (93)

USC Norris Oncology Hematology Newport Beach; 🇺🇸 Newport Beach, California, United States

Kaiser Permanente Oakland Medical Center; 🇺🇸 Oakland, California, United States

Kaiser Permanente Roseville Medical Center; 🇺🇸 Roseville, California, United States

Kaiser Permanente San Francisco Medical Center; 🇺🇸 San Francisco, California, United States

Kaiser Permanente Santa Clara Medical Center; 🇺🇸 Santa Clara, California, United States

City of Hope South Pasadena; 🇺🇸 South Pasadena, California, United States

Kaiser Permanente Northern California; 🇺🇸 Vallejo, California, United States

Kaiser Permanente Walnut Creek Medical Center; 🇺🇸 Walnut Creek, California, United States

Hope and Healing Care; 🇺🇸 Hinsdale, Illinois, United States

Sichuan Cancer Hospital; 🇨🇳 Chengdu, China

The First Affiliated Hospital Sun Yat sen University; 🇨🇳 Guang Zhou, China

The First Affiliated Hospital Zhejiang University College of Medicine; 🇨🇳 Hangzhou, China

Harbin medical university cancer hospital; 🇨🇳 Harbin, China

Huizhou Municipal Central Hospital; 🇨🇳 Huizhou, China

Zhongda Hospital Southeast University; 🇨🇳 Nanjing, China

Fudan University Shanghai Cancer Center; 🇨🇳 ShangHai, China

The First Affiliated Hospital of Xian Jiaotong University; 🇨🇳 Xi'an, China

Henan Cancer Hospital; 🇨🇳 Zhengzhou, China

Hopital Nord; 🇫🇷 Marseille Cedex 20, France

Hopital PASTEUR; 🇫🇷 Nice, France

Institut Curie; 🇫🇷 Paris, France

Universitaetsklinikum der RWTH Aachen; 🇩🇪 Aachen, Germany

Kliniken Essen-Mitte; 🇩🇪 Essen, Germany

Universitaetsklinikum Giessen und Marburg GmbH; 🇩🇪 Giessen, Germany

Thoraxklinik am Universitatsklinikum Heidelberg; 🇩🇪 Heidelberg, Germany

Klinikum Kassel GmbH; 🇩🇪 Kassel, Germany

Universitaetsklinikum Schleswig Holstein Campus Kiel; 🇩🇪 Kiel, Germany

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

Gachon University Gil Hospital; 🇰🇷 Incheon, Korea, Republic of

Severance Hospital Yonsei University Health System; 🇰🇷 Seoul, Korea, Republic of

Hospital Pulau Pinang; 🇲🇾 Georgetown, Malaysia

University Malaya Medical Centre; 🇲🇾 Kuala Lumpur, Malaysia

Hospital Tengku Ampuan Afzan; 🇲🇾 Kuantan, Malaysia

Hospital Umum Sarawak; 🇲🇾 Kuching, Malaysia

Hosp. Gral. Univ. de Alicante; 🇪🇸 Alicante, Spain

Hosp. Univ. Quiron Dexeus; 🇪🇸 Barcelona, Spain

Hosp Univ Vall D Hebron; 🇪🇸 Barcelona, Spain

Hosp. Univ. de Jaen; 🇪🇸 Jaen, Spain

Hosp. Univ. Lucus Augusti; 🇪🇸 Lugo, Spain

Hosp. Gral. Univ. Gregorio Maranon; 🇪🇸 Madrid, Spain

Hosp. Ntra. Sra. de Valme; 🇪🇸 Sevilla, Spain

National Taiwan University Hospital Hsin Chu Branch; 🇨🇳 Hsin Chu, Taiwan

Chang Kung Memorial Hospital; 🇨🇳 Kaohsiung City, Taiwan

Taichung Veterans General Hospital; 🇨🇳 Taichung City, Taiwan

National Taiwan University Hospital; 🇨🇳 Taipei, Taiwan

Linkou Chang Gung Memorial Hospital; 🇨🇳 Taoyuan City, Taiwan

Adana City Hospital; 🇹🇷 Adana, Turkey

Gulhane Training and Research Hospital; 🇹🇷 Ankara, Turkey

Gazi University Hospital; 🇹🇷 Ankara, Turkey

Ankara Bilkent City Hospital; 🇹🇷 Ankara, Turkey

Bakirkoy Training and Research Hospital; 🇹🇷 Istanbul, Turkey

I A U VM Medical Park Florya Hastanesi; 🇹🇷 Istanbul, Turkey

Ege University Medical Faculty; 🇹🇷 Izmir, Turkey

Ondokuz Mayis University; 🇹🇷 Samsun, Turkey

Ironwood Cancer and Research Center; 🇺🇸 Chandler, Arizona, United States

Los Angeles Cancer Network; 🇺🇸 Glendale, California, United States

University Cancer & Blood Center; 🇺🇸 Athens, Georgia, United States

Renown Health Medical Oncology; 🇺🇸 Reno, Nevada, United States

Hosp Univ A Coruna; 🇪🇸 A Coruna, Spain

Hosp Regional Univ de Malaga; 🇪🇸 Malaga, Spain

City of Hope; 🇺🇸 Duarte, California, United States

Providence Fullerton; 🇺🇸 Fullerton, California, United States

City of Hope Seacliff; 🇺🇸 Huntington Beach, California, United States

City of Hope Orange County Lennar Foundation Cancer Center; 🇺🇸 Irvine, California, United States

City of Hope Long Beach Elm; 🇺🇸 Long Beach, California, United States

Cancer and Blood Specialty Clinic; 🇺🇸 Los Alamitos, California, United States

Keck Hospital of USC; 🇺🇸 Los Angeles, California, United States

Oncology Hematology Associates; 🇺🇸 Springfield, Missouri, United States

Hunterdon Hematology Oncology; 🇺🇸 Flemington, New Jersey, United States

Clinical Research Alliance Inc; 🇺🇸 Westbury, New York, United States

Regional Medical Oncology Center; 🇺🇸 Wilson, North Carolina, United States

University Hospitals Cleveland Medical Center; 🇺🇸 Cleveland, Ohio, United States

Virginia Cancer Specialists; 🇺🇸 Fairfax, Virginia, United States

Valley Medical Center; 🇺🇸 Renton, Washington, United States

Gundersen Health System; 🇺🇸 W. Salem, Wisconsin, United States

Hospital Italiano de Buenos Aires; 🇦🇷 Buenos Aires, Argentina

IADT Instituto Argentino de Diagnostico y Tratamiento; 🇦🇷 Caba, Argentina

Centro Medico Austral; 🇦🇷 Capital Federal, Argentina

Hospital Italiano de La Plata; 🇦🇷 La Plata, Argentina

Hospital Privado de la Comunidad; 🇦🇷 Mar del Plata, Argentina

CTO Centro De Tratamento Oncologico LTDA; 🇧🇷 Belem, Brazil

Santa Casa de Misericordia de Belo Horizonte; 🇧🇷 Belo Horizonte, Brazil

Liga Paranaense de Combate ao Cancer; 🇧🇷 Curitiba, Brazil

Fundacao Doutor Amaral Carvalho; 🇧🇷 Jaú, Brazil

Hospital Nossa Senhora da Conceicao S A; 🇧🇷 Porto Alegre, Brazil

Nucleo de Oncologia da Bahia Oncoclinicas; 🇧🇷 Salvador, Brazil

Hospital Ana Nery Santa Cruz do Sul; 🇧🇷 Santa Cruz do Sul, Brazil

Fundacao Faculdade de Medicina - Instituto do Cancer do Estado de Sao Paulo; 🇧🇷 Sao Paulo, Brazil

Fundacao Antonio Prudente A C Camargo Cancer Center; 🇧🇷 Sao Paulo, Brazil

Servicos de Tratamento ao Cancer de Taubate LTDA - Instituto do Cancer Brasil Unidade Taubate; 🇧🇷 Taubate, Brazil

Associacao Feminina de Educacao e Combate ao Cancer Hospital Santa Rita de Cassia; 🇧🇷 Vitoria, Brazil

Changzhou No 2 Peoples Hospital; 🇨🇳 Changzhou, China

West China Hospital; 🇨🇳 Chengdou, China