A Study of Zolbetuximab (IMAB362) Plus CAPOX Compared With Placebo Plus CAPOX as First-line Treatment of Subjects With Claudin (CLDN) 18.2-Positive, HER2-Negative, Locally Advanced Unresectable or Metastatic Gastric or Gastroesophageal Junction (GEJ) Adenocarcinoma

Phase 3

Active, not recruiting

• Conditions: Locally Advanced Unresectable Gastroesophageal Junction (GEJ) Adenocarcinoma or Cancer; Locally Advanced Unresectable Gastric Adenocarcinoma or Cancer; Metastatic Gastric Adenocarcinoma or Cancer; Metastatic Gastroesophageal Junction (GEJ) Adenocarcinoma
• Interventions: Drug: oxaliplatin; Drug: zolbetuximab; Drug: placebo; Drug: capecitabine

• Registration Number: NCT03653507
• Lead Sponsor: Astellas Pharma Global Development, Inc.

Brief Summary

The purpose of this study is to evaluate the efficacy of zolbetuximab plus capecitabine and oxaliplatin (CAPOX) compared with placebo plus CAPOX (as first-line treatment) as measured by Progression Free Survival (PFS). This study will also evaluate efficacy, physical function, safety, and tolerability of zolbetuximab, as well as its effects on quality of lif...

Detailed Description

The study consists of the following periods: screening; treatment; post-treatment follow up, safety follow up, long term and survival follow-up. After the marketing approval in Japan on 26 Mar 2024, this study continued as "post marketing clinical study" in Japan. In the rest of the countries which participated in this study, this study continued as clinical...

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: 2018-08-24
• Study First Submitted QC: 2018-08-29
• Study First Posted: 2018-08-31
• Study Start: 2018-11-28
• Primary Completion: 2022-10-25
• Disposition First Submitted: 2023-10-23
• Disposition First Posted: 2023-10-25
• Status Verified: 2024-09
• Last Update Submitted: 2024-10-01
• Last Update Posted: 2024-10-03
• Study Completion: 2025-03-31

Recruitment & Eligibility

• Status: ACTIVE_NOT_RECRUITING
• Sex: All
• Target Recruitment: 507

Inclusion Criteria

• A female subject is eligible to participate if she is not pregnant (negative serum pregnancy test at screening; female subjects with elevated serum beta human chorionic gonadotropin (βhCG) and a demonstrated non-pregnant status through additional testing are eligible) and at least 1 of the following conditions applies:

  • Not a woman of childbearing potential (WOCBP) OR
  • WOCBP who agrees to follow the contraceptive guidance throughout the treatment period and for 9 months after the final administration of oxaliplatin and 6 months after the final administration of all other study drugs.

• Female subject must agree not to breastfeed starting at screening and throughout the study period, and for 6 months after the final study treatment administration.

• Female subject must not donate ova starting at screening and throughout the study period, and for 9 months after the final administration of oxaliplatin and 6 months after the final administration of all other study drugs.

• A male subject with female partner(s) of childbearing potential:

  • must agree to use contraception during the treatment period and for 6 months after the final study treatment administration.

• A male subject must not donate sperm during the treatment period and for 6 months after the final study treatment administration.

• Male subject with a pregnant or breastfeeding partner(s) must agree to remain abstinent or use a condom for the duration of the pregnancy or time partner is breastfeeding throughout the study period and for 6 months after the final study treatment administration.

• Subject has histologically confirmed diagnosis of Gastric or GEJ adenocarcinoma.

• Subject has radiologically confirmed locally advanced unresectable or metastatic disease within 28 days prior to randomization.

• Subject has radiologically evaluable disease (measurable and/or non-measurable disease according to RECIST 1.1), per local assessment, ≤ 28 days prior to randomization. For subjects with only 1 evaluable lesion and prior radiotherapy ≤ 3 months before randomization, the lesion must either be outside the field of prior radiotherapy or have documented progression following radiation therapy.

• Subject's tumor expresses CLDN18.2 in ≥ 75% of tumor cells demonstrating moderate to strong membranous staining as determined by central IHC testing.

• Subject has a HER2-negative tumor as determined by local or central testing on a gastric or GEJ tumor specimen. (Unique to China: Subject has a known HER2-negative gastric or GEJ tumor.)

• Subject has ECOG performance status 0 or 1.

• Subject has predicted life expectancy ≥ 12 weeks.

• Subject must meet all of the following criteria based on the centrally or locally analyzed laboratory tests collected within 14 days prior to randomization. In the case of multiple sample collections within this period, the most recent sample collection with available results should be used to determine eligibility.

  • Hemoglobin (Hb) ≥ 9 g/dl. Subjects requiring transfusions are eligible if they have a post-transfusion Hgb ≥ 9 g/dL.
  • Absolute Neutrophil Count (ANC) ≥ 1.5x10^9/L
  • Platelets ≥ 100x10^9/L
  • Albumin ≥ 2.5 g/dL
  • Total Bilirubin ≤ 1.5 x upper limit of normal (ULN) without liver metastases (or < 3.0 x ULN if liver metastases are present)
  • Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) ≤ 2.5 x ULN without liver metastases (or ≤ 5 x ULN if liver metastases are present)
  • Estimated creatinine clearance ≥ 30 mL/min
  • Prothrombin time/international normalized ratio (PT/INR) and partial thromboplastin time (PTT) ≤ 1.5 x ULN (except for subjects receiving anticoagulation therapy)

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Exclusion Criteria

• Subject has received prior systemic chemotherapy for locally advanced unresectable or metastatic gastric or GEJ adenocarcinoma. However, subject may have received either neo-adjuvant or adjuvant chemotherapy, immunotherapy or other systemic anticancer therapies as long as it was completed at least 6 months prior to randomization.

• Subject has received radiotherapy for locally advanced unresectable or metastatic gastric or GEJ adenocarcinoma ≤ 14 days prior to randomization and has not recovered from any related toxicity.

• Subject has received treatment with herbal medications or other treatments that have known antitumor activity within 28 days prior to randomization.

• Subject has received systemic immunosuppressive therapy, including systemic corticosteroids within 14 days prior to randomization. Subjects using a physiologic replacement dose of hydrocortisone or its equivalent (defined as up to 30 mg per day of hydrocortisone or up to 10 mg per day of prednisone), receiving a single dose of systemic corticosteroids or receiving systemic corticosteroids as premedication for radiologic imaging contrast use are allowed.

• Subject has received other investigational agents or devices within 28 days prior to randomization.

• Subject has prior severe allergic reaction or intolerance to known ingredients of zolbetuximab or other monoclonal antibodies, including humanized or chimeric antibodies.

• Subject has known immediate or delayed hypersensitivity, intolerance or contraindication to any component of study treatment.

• Subject has prior severe allergic reaction or intolerance to any component of CAPOX.

• Subject has known dihydropyrimidine dehydrogenase (DPD) deficiency.

• Subject has a complete gastric outlet syndrome or a partial gastric outlet syndrome with persistent/recurrent vomiting.

• Subject has significant gastric bleeding and/or untreated gastric ulcers that exclude the subject from participation.

• Subject has a known history of a positive test for human immunodeficiency virus (HIV) infection or known active hepatitis B (positive hepatitis B surface antigen (HBs Ag)) or C infection. NOTE: Screening for these infections should be conducted per local requirements.

  • For subjects who are negative for HBs Ag, but hepatitis B core antibody (HBc Ab) positive, an HB deoxyribonucleic acid (DNA) test will be performed and if positive, the subject will be excluded.
  • Subjects with positive hepatitis C virus (HCV) serology, but negative HCV ribonucleic acid (RNA) test are eligible.
  • Subjects treated for HCV with undetectable viral load results are eligible.

• Subject has an active autoimmune disease that has required systemic treatment within the past 3 months prior to randomization.

• Subject has active infection requiring systemic therapy that has not completely resolved within 7 days prior to randomization.

• Subject has significant cardiovascular disease, including any of the following:

  • Congestive heart failure (defined as New York Heart Association Class III or IV), myocardial infarction, unstable angina, coronary angioplasty, stenting, coronary artery bypass graft, cerebrovascular accident (CVA) or hypertensive crisis within 6 months prior to randomization.
  • History of clinically significant ventricular arrhythmias (i.e., sustained ventricular tachycardia, ventricular fibrillation or Torsades de Pointes
  • QTc interval > 450 msec for male subjects; QTc interval > 470 msec for female subjects
  • History or family history of congenital long QT syndrome
  • Cardiac arrhythmias requiring anti-arrhythmic medications (Subject with rate controlled atrial fibrillation for > 1 month prior to randomization are eligible).

• Subject has a history of central nervous system (CNS) metastases and/or carcinomatous meningitis from gastric/GEJ cancer..

• Subject has known peripheral sensory neuropathy > grade 1 unless the absence of deep tendon reflexes is the sole neurological abnormality.

• Subject has had a major surgical procedure ≤ 28 days prior to randomization.

  • Subject is without complete recovery from a major surgical procedure ≤ 14 days prior to randomization.

• Subject has psychiatric illness or social situations that would preclude study compliance.

• Subject has another malignancy for which treatment is required.

• Subject has any concurrent disease, infection, or co-morbid condition that interferes with the ability of the subject to participate in the study, which places the subject at undue risk or complicates the interpretation of data.

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Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Arm B (Placebo plus CAPOX)	oxaliplatin	Participants will receive placebo starting at Cycle 1 Day 1 and every 3 weeks thereafter. Additionally, participants will receive CAPOX (capecitabine/oxaliplatin) treatment until IRC confirmed disease progression or a total of 8 treatments (each cycle is defined as 3 weeks = approximately 21 days). Oxaliplatin is administered on day 1 of each cycle, whereas capecitabine is taken twice daily on days 1 through 14. After a maximum of 8 treatments of Oxaplatin, subjects may continue to receive capecitabine twice daily on days 1 through 14 of each cycle at the investigator's discretion until the subject meets study treatment discontinuation criteria.
Arm B (Placebo plus CAPOX)	placebo	Participants will receive placebo starting at Cycle 1 Day 1 and every 3 weeks thereafter. Additionally, participants will receive CAPOX (capecitabine/oxaliplatin) treatment until IRC confirmed disease progression or a total of 8 treatments (each cycle is defined as 3 weeks = approximately 21 days). Oxaliplatin is administered on day 1 of each cycle, whereas capecitabine is taken twice daily on days 1 through 14. After a maximum of 8 treatments of Oxaplatin, subjects may continue to receive capecitabine twice daily on days 1 through 14 of each cycle at the investigator's discretion until the subject meets study treatment discontinuation criteria.
Arm A (zolbetuximab plus CAPOX)	oxaliplatin	Participants will receive a loading dose of zolbetuximab at Cycle 1 Day 1 followed by a lower dose in subsequent cycles every 3 weeks. Additionally, participants will receive CAPOX (capecitabine/oxaliplatin) treatment until IRC confirmed disease progression or a total of 8 treatments (each cycle is defined as 3 weeks = approximately 21 days). Oxaliplatin is administered on day 1 of each cycle, whereas capecitabine is taken twice daily on days 1 through 14. After a maximum of 8 treatments of Oxaplatin, subjects may continue to receive capecitabine twice daily on days 1 through 14 of each cycle at the investigator's discretion until the subject meets study treatment discontinuation criteria.
Arm A (zolbetuximab plus CAPOX)	zolbetuximab	Participants will receive a loading dose of zolbetuximab at Cycle 1 Day 1 followed by a lower dose in subsequent cycles every 3 weeks. Additionally, participants will receive CAPOX (capecitabine/oxaliplatin) treatment until IRC confirmed disease progression or a total of 8 treatments (each cycle is defined as 3 weeks = approximately 21 days). Oxaliplatin is administered on day 1 of each cycle, whereas capecitabine is taken twice daily on days 1 through 14. After a maximum of 8 treatments of Oxaplatin, subjects may continue to receive capecitabine twice daily on days 1 through 14 of each cycle at the investigator's discretion until the subject meets study treatment discontinuation criteria.
Arm A (zolbetuximab plus CAPOX)	capecitabine	Participants will receive a loading dose of zolbetuximab at Cycle 1 Day 1 followed by a lower dose in subsequent cycles every 3 weeks. Additionally, participants will receive CAPOX (capecitabine/oxaliplatin) treatment until IRC confirmed disease progression or a total of 8 treatments (each cycle is defined as 3 weeks = approximately 21 days). Oxaliplatin is administered on day 1 of each cycle, whereas capecitabine is taken twice daily on days 1 through 14. After a maximum of 8 treatments of Oxaplatin, subjects may continue to receive capecitabine twice daily on days 1 through 14 of each cycle at the investigator's discretion until the subject meets study treatment discontinuation criteria.
Arm B (Placebo plus CAPOX)	capecitabine	Participants will receive placebo starting at Cycle 1 Day 1 and every 3 weeks thereafter. Additionally, participants will receive CAPOX (capecitabine/oxaliplatin) treatment until IRC confirmed disease progression or a total of 8 treatments (each cycle is defined as 3 weeks = approximately 21 days). Oxaliplatin is administered on day 1 of each cycle, whereas capecitabine is taken twice daily on days 1 through 14. After a maximum of 8 treatments of Oxaplatin, subjects may continue to receive capecitabine twice daily on days 1 through 14 of each cycle at the investigator's discretion until the subject meets study treatment discontinuation criteria.

Primary Outcome Measures

Name	Time	Method
Progression Free Survival (PFS)	up to 13 months	PFS is defined as the time from the date of randomization until the date of radiological progressive disease (per Response Evaluation Criteria In Solid Tumors (RECIST) 1.1 by Independent Review Committee (IRC)) or death from any cause, whichever is earliest.

Secondary Outcome Measures

Name	Time	Method
Overall Survival (OS)	up to 23 months	OS is defined as the time from the date of randomization until the date of death from any cause.
Number of participants with vital signs abnormalities and or adverse events	up to 14 months	Number of participants with potentially clinically significant vital sign values.
Health Related Quality of Life (HRQoL) measured by the EuroQOL Five Dimensions Questionnaire 5L (EQ-5D-5L) questionnaire	up to 16 months	The EQ-5D-5L is a standardized instrument developed by the EuroQol Group for use as a generic, preference-based measure of health outcomes. The EQ-5D-5L is a 5-item self-reported measure of functioning and wellbeing, which assesses 5 dimensions of health, including mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. Each dimension...
Pharmacokinetics (PK) of zolbetuximab: Concentration Immediately Prior to Dosing at multiple dosing (Ctrough)	up to 16 months	Ctrough will be derived from the PK serum samples collected.
Objective Response Rate (ORR)	up to 13 months	ORR is defined as the proportion of participants who have a best overall response of Complete Response (CR) or Partial Response (PR) as assessed by Independent Review Committee (IRC) per RECIST 1.1.
Number of participants with electrocardiograms (ECG) abnormalities and or adverse events	up to 14 months	Number of participants with potentially clinically significant ECG values.
Duration Of Response (DOR)	up to 13 months	DOR, defined as the time from the date of the first response (CR/PR) until the date of progressive disease as assessed by IRC per RECIST 1.1 or date of death from any cause, whichever is earliest.
Number of anti-drug antibody (ADA) Positive Participants	up to 16 months	Immunogenicity will be measured by the number of participants that are ADA positive.
Number of participants with Eastern Cooperative Oncology Group (ECOG) performance status abnormalities and or adverse events	up to 13 months	Number of participants with potentially clinically significant ECOG performance status values. ECOG grades 0-5, where 0 = Fully active, able to carry on all pre-disease performance without restriction; 1 = Restricted in physically strenuous activity but ambulatory and able to carry out work of a light or sedentary nature, e.g., light house work, office work;...
Health Related Quality of Life (HRQoL) measured by the Global Pain (GP) questionnaire	up to 16 months	The GP instrument is a single assessment of overall pain where 0 equals no pain and 10 equals extreme pain. Low pain scores are considered a better outcome than a high pain score.
Time to confirmed deterioration (TTCD) in participant-reported physical functioning and Global Health Status/Quality of Life (GHS/QoL)	Up to 16 months	TTCD is measured by EORTC QLQ-C30 and QLQ-OG25 plus STO22 Belching subscale and defined as time to first confirmed deterioration; that is, time from randomization to first clinically meaningful deterioration that is confirmed at the next scheduled visit.
Safety and tolerability assessed by adverse events (AEs)	up to 16 months	An AE is any untoward medical occurrence in a subject, temporally associated with the use of a medicinal product, whether or not considered related to the medicinal product.
Number of participants with laboratory assessments abnormalities and or adverse events	up to 14 months	Number of participants with potentially clinically significant laboratory values.
Health Related Quality of Life (HRQoL) measured by the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire - Core Questionnaire (EORTC-QLQ-C30)	up to 16 months	EORTC-QLQ-C30 is a cancer-specific 30-item questionnaire. Participants rate items on a four-point scale, with 1 as "not at all" and 4 as "very much." A change of 5 - 10 points is considered a small change. A change of 10 - 20 points is considered a moderate change.
Health Related Quality of Life (HRQoL) measured by the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Oesophago-Gastric Module 25 (QLQ-OG25) questionnaire plus EORTC-QLQ-STO22 Belching subscale	up to 16 months	The EORTC-QLQ-OG25 instrument evaluates Gastric and Gastroesophageal Junction (GEJ) cancer-specific symptoms such as stomach discomfort, difficulties eating and swallowing and indigestion. It is a 25-item questionnaire. Participants rate items on a four-point scale, with 1 as "not at all" and 4 as "very much". To ensure relevant symptoms are adequately cover...

Trial Locations

Locations (165)

Parkland Hospital; 🇺🇸 Dallas, Texas, United States

University of Kansas Cancer Center and Medical Pavilion; 🇺🇸 Fairway, Kansas, United States

Site PT35109; 🇵🇹 Braga, Portugal

Site TW88603; 🇨🇳 Taichung, Taiwan

Site AR54009; 🇦🇷 Buenos Aires, Argentina

Site AR54004; 🇦🇷 San Miguel de Tucumán, Argentina

Site AR54003; 🇦🇷 Viedma, Argentina

Site GR30007; 🇬🇷 Rio Patras, Greece

Site IE35301; 🇮🇪 Dublin, Ireland

Site JP81009; 🇯🇵 Matsuyama, Japan

Site JP81011; 🇯🇵 Tsukiji, Japan

Site KR82008; 🇰🇷 Jeollanam-do, Korea, Republic of

Site AR54006; 🇦🇷 Pergamino, Argentina

Site AR54001; 🇦🇷 San Miguel De Tucuman, Argentina

Site HR38503; 🇭🇷 Zagreb, Croatia

Site GR30001; 🇬🇷 Athens, Greece

Site GR30004; 🇬🇷 Heraklion, Greece

Site GR30002; 🇬🇷 Thessaloniki, Greece

Site GR3006; 🇬🇷 Thessaloniki, Greece

Site JP81008; 🇯🇵 Akashi, Hyogo, Japan

Site KR82002; 🇰🇷 Daegu, Korea, Republic of

Site KR82014; 🇰🇷 Incheon, Korea, Republic of

Site KR82010; 🇰🇷 Jeonju-si, Korea, Republic of

Site KR82011; 🇰🇷 Seongnam-si, Korea, Republic of

Site MY60005; 🇲🇾 Kuala Lumpur, Malaysia

Site PT35111; 🇵🇹 Guimaraes, Portugal

Site KR82012; 🇰🇷 Seoul, Korea, Republic of

Site KR82015; 🇰🇷 Seoul, Korea, Republic of

Site MY60002; 🇲🇾 Kuala Lumpur, Malaysia

Site NL31004; 🇳🇱 Groningen, Netherlands

Site CA15003; 🇨🇦 Chicoutimi, Quebec, Canada

Site CA15004; 🇨🇦 Calgary, Canada

Site HR38501; 🇭🇷 Varazdin, Croatia

Site HR38502; 🇭🇷 Zagreb, Croatia

Site GR30003; 🇬🇷 Larissa, Greece

Site JP81005; 🇯🇵 Utsunomiya, Tochigi, Japan

Site KR82006; 🇰🇷 Goyang-si, Korea, Republic of

Site KR82007; 🇰🇷 Gyeonggi-do, Korea, Republic of

Site JP81003; 🇯🇵 Kawasaki, Kanagawa, Japan

Site KR82009; 🇰🇷 Suwon, Korea, Republic of

Site RO40005; 🇷🇴 Cluj-Napoca, Romania

Site RO40007; 🇷🇴 Cluj-Napoca, Romania

Site RO40001; 🇷🇴 Iasi, Romania

Site RO40006; 🇷🇴 Iasi, Romania

Site RO40008; 🇷🇴 Timisoara, Romania

Site TH66009; 🇹🇭 Bangkok, Thailand

Site TH66001; 🇹🇭 Muang, Thailand

Site TH66008; 🇹🇭 Watthana, Thailand

Site KR82013; 🇰🇷 Seoul, Korea, Republic of

Site JP81004; 🇯🇵 Kita-gun, Japan

Site JP81012; 🇯🇵 Koto-ku, Japan

Site MY60003; 🇲🇾 Kuala Lumpur, Malaysia

Site PT35102; 🇵🇹 Lisboa, Portugal

Site PT35101; 🇵🇹 Setubal, Portugal

Site KR82001; 🇰🇷 Seoul, Korea, Republic of

Site TH66011; 🇹🇭 Laksi, Thailand

Site TH66006; 🇹🇭 Pathumthani, Thailand

Site TH66004; 🇹🇭 Songkla, Thailand

Site TR90011; 🇹🇷 Malatya, Turkey

Site CA15002; 🇨🇦 Rimouski, Quebec, Canada

Site TH66002; 🇹🇭 Bangkok, Thailand

Site TH66005; 🇹🇭 Bangkok, Thailand

Site PT35106; 🇵🇹 Lisboa, Portugal

Site PT35108; 🇵🇹 Porto, Portugal

Site TR90012; 🇹🇷 Bornova, Turkey

Site TR90010; 🇹🇷 Istanbul, Turkey

Site TR90013; 🇹🇷 Konyaalti, Turkey

Site KR82003; 🇰🇷 Seoul, Korea, Republic of

Site TW88604; 🇨🇳 Taipei, Taiwan

Site MY60001; 🇲🇾 Georgetown, Malaysia

Site MY60004; 🇲🇾 Kota Kinabalu, Malaysia

Site NL31003; 🇳🇱 Tilburg, Netherlands

Site PT35110; 🇵🇹 Coimbra, Portugal

Site PT35104; 🇵🇹 Santa Maria da Feira, Portugal

Site TW88602; 🇨🇳 Kaohsiung, Taiwan

Site TH66003; 🇹🇭 Muang, Thailand

Site PT35107; 🇵🇹 Vila Real, Portugal

Site TR90003; 🇹🇷 Atakum, Turkey

Site TR90015; 🇹🇷 Istanbul, Turkey

Site TR90004; 🇹🇷 Balcali, Turkey

Site TR90007; 🇹🇷 Konya, Turkey

Site TR90001; 🇹🇷 Bursa, Turkey

Site TR90002; 🇹🇷 Istanbul, Turkey

Site CN86049; 🇨🇳 Changchun, China

Site CN86017; 🇨🇳 Shijiazhuang, China

Site CN86040; 🇨🇳 Tianjin, China

Site JP81006; 🇯🇵 Kashiwa, Japan

Site JP81002; 🇯🇵 Chiba, Japan

Site ES34004; 🇪🇸 Pamplona, Spain

Site TH66007; 🇹🇭 Bangkok, Thailand

Site TH66010; 🇹🇭 Pathumwan, Thailand

Site TR90008; 🇹🇷 Pendik, Istanbul, Turkey

Site GB44002; 🇬🇧 Bristol, United Kingdom

Site GB44004; 🇬🇧 Cardiff, United Kingdom

Site GB44001; 🇬🇧 London, United Kingdom

Prisma Health Cancer Institute; 🇺🇸 Boiling Springs, South Carolina, United States

Pacific Cancer Care; 🇺🇸 Monterey, California, United States

Weill Cornell Medical College (WCMC); 🇺🇸 New York, New York, United States

New Mexico Oncology Hematology; 🇺🇸 Albuquerque, New Mexico, United States

University of Texas Southwestern Medical Center; 🇺🇸 Dallas, Texas, United States

Houston Methodist Cancer Center and Institute of Academic Medicine - Oncology; 🇺🇸 Houston, Texas, United States

Site GB44005; 🇦🇷 Northwood, Argentina

Site CN86034; 🇨🇳 Fuzhou, Fujian, China

Site CN86032; 🇨🇳 Haikou, Hainan, China

Site CN86037; 🇨🇳 Fuzhou, Fujian, China

Site CN86012; 🇨🇳 Zhengzhou, Henan, China

Site CN86029; 🇨🇳 Changsha, Hunan, China

Site CN86043; 🇨🇳 Hengyang, Hunan, China

Site CN86027; 🇨🇳 Suzhou, Jiangsu, China

Site CN86046; 🇨🇳 Wuxi, Jiangsu, China

Site CN86007; 🇨🇳 Hangzhou, Zhejiang, China

Site CN86044; 🇨🇳 Baoding, China

Site CN86035; 🇨🇳 Beijing, China

Site CN86050; 🇨🇳 Beijing, China

Site CN86021; 🇨🇳 Changzhou, China

Site CN86025; 🇨🇳 Bengbu, China

Site CN86002; 🇨🇳 Changchun, China

Site CN86042; 🇨🇳 Guangzhou, China

Site CN86053; 🇨🇳 Changchun, China

Site CN86039; 🇨🇳 Chengdu, China

Site CN86052; 🇨🇳 Dalian, China

Site CN86054; 🇨🇳 Dalian, China

Site CN86051; 🇨🇳 Haebrin, China

Site CN86001; 🇨🇳 Guangzhou, China

Site CN86015; 🇨🇳 Fuzhou, China

Site CN86038; 🇨🇳 Linyi, China

Site CN86036; 🇨🇳 Hangzhou, China

Site CN86016; 🇨🇳 Nanjing, China

Site CN86045; 🇨🇳 Nanning, China

Site CN86014; 🇨🇳 Shanghai, China

Site CN86026; 🇨🇳 Shantou, China

Site CN86047; 🇨🇳 Shenyang, China

Site CN86009; 🇨🇳 Tianjin, China

Site CN86031; 🇨🇳 Urumchi, China

Site CN86004; 🇨🇳 Wuhan, China

Site CN86005; 🇨🇳 Wuhan, China

Site CN86013; 🇨🇳 Xi'an, China

Site CN86030; 🇨🇳 Xiamen, China

Site CN86011; 🇨🇳 Xuzhou, China

Site CN86024; 🇨🇳 Zhengzhou, China

Site GR30005; 🇬🇷 Neo Faliro, Piraeus, Greece

Site IE35302; 🇮🇪 Dublin, Ireland

Site JP81001; 🇯🇵 Yokohama, Kanagawa, Japan

Site JP81007; 🇯🇵 Fukuoka-shi, Fukuoka, Japan

Site JP81010; 🇯🇵 Suita, Osaka, Japan

Site PT35105; 🇵🇹 Porto, Portugal

Site RO40002; 🇷🇴 Bucharest, Romania

Site RO40003; 🇷🇴 Craiova, Romania

Site RO40004; 🇷🇴 Floresti, Romania

Site ES34009; 🇪🇸 Barcelona, Spain

Site ES34005; 🇪🇸 Coruña, Spain

Site ES34001; 🇪🇸 Elche, Spain

Site ES34008; 🇪🇸 Madrid, Spain

Site ES34002; 🇪🇸 Madrid, Spain

Site ES34003; 🇪🇸 Madrid, Spain

Site ES34013; 🇪🇸 Madrid, Spain

Site ES34007; 🇪🇸 Valencia, Spain

Site ES34012; 🇪🇸 Valencia, Spain

Site ES34011; 🇪🇸 Malaga, Spain

Site TW88605; 🇨🇳 Tianan, Taiwan

Site ES34006; 🇪🇸 Barcelona, Spain

Site ES34010; 🇪🇸 Barcelona, Spain

Ochsner Clinic CCOP; 🇺🇸 New Orleans, Louisiana, United States

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

Montefiore Medical Center (MMC); 🇺🇸 Bronx, New York, United States