Study of Dato-DXd Plus Pembrolizumab vs Pembrolizumab Alone in the First-line Treatment of Subjects With Advanced or Metastatic NSCLC Without Actionable Genomic Alterations

Phase 3

Recruiting

• Conditions: Metastatic Non Small Cell Lung Cancer
• Interventions: Drug: Datopotamab Deruxtecan; Drug: Pembrolizumab

• Registration Number: NCT05215340
• Lead Sponsor: Daiichi Sankyo

Brief Summary

This study is designed to assess the efficacy and safety of datopotamab deruxtecan (Dato-DXd) in combination with pembrolizumab versus pembrolizumab alone in participants with advanced or metastatic non-small cell lung cancer (NSCLC) of non-squamous histology.

Detailed Description

The primary objective of the study is to compare the efficacy of Dato-DXd and pembrolizumab with pembrolizumab alone in terms of either Progression Free Survival (PFS) by BICR or Overall Survival (OS) for participants with advanced or metastatic NSCLC with non-squamous histology without actionable genomic alterations whose tumor has high programmed death-ligand 1 (PD-L1) expression (tumor proportion score; TPS ≥50%) and who have not previously received systemic therapy for advanced or metastatic NSCLC.

Eligible participants will be randomized in a 1:1 ratio to the control arm (pembrolizumab alone) or the experimental arm (Dato-DXd and pembrolizumab). The study will be divided into 4 periods: Tissue Screening Period, Screening Period, Treatment Period, and Follow-up Period.

Study Timeline

• Study First Submitted: 2022-01-18
• Study First Submitted QC: 2022-01-18
• Study First Posted: 2022-01-31
• Study Start: 2022-03-04
• Status Verified: 2025-05
• Last Update Submitted: 2025-05-20
• Last Update Posted: 2025-05-22
• Primary Completion: 2028-02-29
• Study Completion: 2028-04-30

Recruitment & Eligibility

• Status: RECRUITING
• Sex: All
• Target Recruitment: 740

Inclusion Criteria

Participants eligible for inclusion in the study must meet all inclusion criteria within 28 days of randomization into the study.

• Sign and date the Tissue Screening and Main Informed Consent Forms, prior to the start of any study-specific qualification procedures.

• Adults ≥18 years or the minimum legal adult age (whichever is greater) at the time of informed consent.

• Histologically documented non-squamous NSCLC that meets all of the following criteria (Note: Subjects with squamous histology were eligible prior to Protocol Version 5.0. After Protocol Version 5.0, subjects with squamous histology are not eligible. Subjects with mixed histology, including those with a squamous component, remain eligible the study even after Protocol Version 5.0):

  1. Stage IIIB or IIIC disease and not candidates for surgical resection or definitive chemoradiation, or Stage IV NSCLC disease at the time of randomization (based on the American Joint Committee on Cancer, Eighth Edition). Participants with early-stage NSCLC who have relapsed should be restaged during screening to ensure their eligibility for the study.
  2. Documented negative test results for epidermal growth factor receptor (EGFR), lymphoma kinase (ALK), and proto-oncogene1 (ROS1) actionable genomic alterations (AGAs) based on analysis of tumor tissue. If test results for EGFR, ALK, and ROS1 are not available, subjects are required to undergo testing performed locally for these genomic alterations.
  3. No known AGAs in neurotrophic tyrosine receptor kinase (NTRK), proto-oncogene B-raf (BRAF), rearranged during transfection (RET), mesenchymal-epithelial transition factor (MET), or other actionable driver kinases with locally approved therapies. (Testing for genomic alterations besides EGFR, ALK, and ROS1 is not required prior to randomization). Subjects whose tumors harbor KRAS mutations are eligible for the study.

• Has provided a formalin-fixed tumor tissue sample for the measurement of trophoblast cell surface protein 2 (TROP2) protein expression and for the assessment of other exploratory biomarkers.

• Tumor has high programmed death receptor-1 (PD-L1) expression (TPS ≥50%) as determined by PD-L1 immunohistochemistry (IHC) 22C3 pharmDx assay by central testing (minimum of 6 slides).

• Has an adequate treatment washout period before Cycle 1 Day 1.

• Measurable disease based on local imaging assessment using RECIST Version 1.1.

• Has left ventricular ejection fraction (LVEF) ≥50% by either an echocardiogram (ECHO) or multigated acquisition scan (MUGA) within 28 days before randomization.

• Eastern Cooperative Oncology Group (ECOG) performance status (PS) of 0 or 1 at screening.

• Has a life expectancy of at least 3 months.

• Adequate bone marrow function within 7 days before randomization.

Exclusion Criteria

• Has received prior systemic treatment for advanced or metastatic NSCLC.

• Has received prior treatment for NSCLC with any of the following, including in the adjuvant/neoadjuvant setting:

  1. Any agent, including an antibody-drug conjugate, containing a chemotherapeutic agent targeting topoisomerase I.
  2. TROP2-targeted therapy.
  3. Any anti-programmed death receptor-1 (PD-1), anti-PD-L1, or anti-PD-ligand 2 (L2) agent or with an agent directed to another stimulatory or co-inhibitory T-cell receptor (eg, CTLA-4, OX40, CD137).
  4. Any other immune checkpoint inhibitors. Participants who received adjuvant or neoadjuvant therapy OTHER than those listed above, are eligible if the adjuvant/neoadjuvant therapy was completed at least 6 months prior to the diagnosis of advanced/metastatic disease.

• Has spinal cord compression or active and untreated central nervous system (CNS) metastases and/or carcinomatous meningitis. Participants with previously treated brain metastases and who are asymptomatic may participate provided they are radiologically stable.

• Has received prior radiotherapy < 4 weeks of start of study intervention or more than 30 Gy (unit of ionizing radiation dose in the International System of Units) to the lung within 6 months of Cycle 1 Day 1.

• History of another primary malignancy (beyond NSCLC) except for:

  1. Malignancy treated with curative intent and with no known active disease ≥3 years before the first dose of study treatment and of low potential risk for recurrence.
  2. Adequately treated non-melanoma skin cancer or lentigo maligna without evidence of disease.
  3. Adequately treated carcinoma in situ without evidence of disease.
  4. Participants with a history of prostate cancer (tumor/node/metastasis stage) of Stage ≤T2cN0M0 without biochemical recurrence or progression and who in the opinion of the Investigator are not deemed to require active intervention.

• Has a history of (non-infectious) interstitial lung disease (ILD)/pneumonitis including radiation pneumonitis that required steroids, has current ILD/pneumonitis, or where suspected ILD/pneumonitis cannot be ruled out by imaging at screening.

• Clinically severe pulmonary compromise, as judged by the investigator, resulting from intercurrent pulmonary illnesses including, but not limited to, any underlying pulmonary disorder, or any autoimmune, connective tissue or inflammatory disorders with pulmonary involvement or prior complete pneumonectomy.

• Uncontrolled or significant cardiovascular disease, including:

  1. Mean QT interval corrected for heart rate using Fridericia's formula (QTcF) interval >470 ms regardless of sex (based on the average of the 12-lead electrocardiogram determination at screening).
  2. Myocardial infarction within 6 months prior to randomization.
  3. Uncontrolled angina pectoris within 6 months prior to randomization.
  4. LVEF <50% by ECHO or MUGA scan within 28 days before randomization.
  5. New York Heart Association Class 2 to 4 congestive heart failure (CHF) at screening.
  6. Uncontrolled hypertension (resting systolic blood pressure >180 mmHg or diastolic blood pressure >110 mmHg) within 28 days before randomization.

Participants with a history of Class 2 to 4 CHF prior to screening, must have returned to Class 1 CHF and have LVEF ≥50% (by either an ECHO or MUGA scan within 28 days before randomization) in order to be eligible.

• Clinically significant corneal disease.
• Has received a live vaccine or live-attenuated vaccine (messenger ribonucleic acid and replication-incompetent adenoviral vaccines are not considered attenuated live vaccines) within 30 days prior to the first dose of study drug. For any participant receiving an approved severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) vaccine, please follow the vaccine label and/or local guidance.
• Active, known, or suspected autoimmune disease (has an active autoimmune disease that has required systemic treatment in the past 2 years).
• Has a diagnosis of immunodeficiency or is receiving chronic systemic steroid therapy (in dosage >10 mg daily of prednisone equivalent) or any other form of immunosuppressive therapy ≤7 days prior to the first dose of study drug.
• Has known human immunodeficiency virus (HIV) infection that is not well controlled.
• Has an active hepatitis or uncontrolled hepatitis B or active hepatitis C infection.
• Has an uncontrolled infection requiring IV antibiotics, antivirals, or antifungals.
• Had an allogeneic tissue/solid organ transplant.
• Has a history of severe hypersensitivity reactions to either the drug or inactive ingredients (including but not limited to polysorbate 80) of Dato-DXd or pembrolizumab.

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Pembrolizumab + Datopotamab Deruxtecan (Dato-DXd)	Datopotamab Deruxtecan	Participants will be randomized to receive 200 mg pembrolizumab followed by 6.0mg/kg Dato-DXd.
Pembrolizumab + Datopotamab Deruxtecan (Dato-DXd)	Pembrolizumab	Participants will be randomized to receive 200 mg pembrolizumab followed by 6.0mg/kg Dato-DXd.
Pembrolizumb	Pembrolizumab	Participants will be randomized to receive 200 mg pembrolizumab.

Primary Outcome Measures

Name	Time	Method
Progression-free Survival Based on Blinded Independent Central Review in Participants With Non-Squamous Histology Who Were Administered Dato-DXd in Combination With Pembrolizumab Compared With Pembrolizumab	From randomization until disease progression or death (whichever occurs first), up to approximately 44 months	Progression-free Survival (PFS) is defined as the time from randomization to the first documented radiographic disease progression or death due to any cause, whichever occurs first, assessed by blinded independent central review (BICR) per Response Evaluation Criteria in Solid Tumors (RECIST), Version 1.1.
Overall Survival (OS) in Participants With Non-Squamous Histology Who Were Administered Dato-DXd in Combination With Pembrolizumab Compared With Pembrolizumab	From randomization until date of death due to any cause, up to approximately 71 months	Overall Survival (OS) is defined as the time from randomization to death due to any cause.

Secondary Outcome Measures

Name	Time	Method
OS in All Randomized Participants, Including Participants With Squamous and Non-Squamous Histology	From randomization until date of death due to any cause, up to approximately 71 months	Overall Survival (OS) is defined as the time from randomization to death due to any cause.
PFS Based on BICR in All Randomized Participants, Including Participants With Squamous and Non-Squamous Histology	From randomization until disease progression or death (whichever occurs first), up to approximately 44 months	PFS is defined as the time from randomization to the first documented radiographic disease progression or death due to any cause, whichever occurs first, assessed by BICR per Response Evaluation Criteria in Solid Tumors (RECIST), Version 1.1.
Progression-free Survival by Investigator in Participants with Non-Squamous Histology, and Separately for All Randomized Participants	From randomization until disease progression or death (whichever occurs first), up to approximately 44 months	Progression-free Survival (PFS) is defined as the time from randomization to the first documented radiographic disease progression or death due to any cause, whichever occurs first, assessed by the Investigator per RECIST Version 1.1.
Progression-free Survival 2 in Participants with Non-Squamous Histology, and Separately for All Randomized Participants	From randomization until disease progression on the next line of therapy or death (whichever occurs first), up to approximately 71 months	Progression-free Survival 2 (PFS2) is defined as the time from date of randomization to the first documented disease progression on next-line therapy or death due to any cause, whichever occurs first.
ORR by BICR and Investigator in Participants with Non-Squamous Histology, and Separately for All Randomized Participants	From randomization to first confirmed response, up to approximately 44 months	Objective Response Rate (ORR) is defined as the proportion of participants who achieved a best overall response (BOR) of confirmed complete response (CR) or confirmed partial response (PR), assessed by BICR and by the Investigator per RECIST Version 1.1.
Duration of Response by BICR and Investigator in Participants with Non-Squamous Histology, and Separately for All Randomized Participants	From date of first objective response (CR or PR) to date of first radiographic disease progression or death due to any cause (whichever occurs first), up to approximately 44 months	Duration of Response (DoR) is defined as the time from the date of the first documentation of objective response (confirmed CR or confirmed PR) to the date of the first radiographic disease progression or death due to any cause, whichever occurs first, assessed by BICR and by the Investigator per RECIST Version 1.1.
Time to Response by BICR and Investigator in Participants with Non-Squamous Histology, and Separately for All Randomized Participants	From randomization to date of first objective response (CR or PR), up to approximately 44 months	Time to Response (TTR) is defined as the time from randomization to the date of the first documentation of objective response (confirmed CR or confirmed PR) in responding participants, assessed by BICR and by the Investigator per RECIST Version 1.1.
Disease Control Rate by BICR and Investigator in Participants with Non-Squamous Histology, and Separately for All Randomized Participants	From randomization until disease progression or death (whichever occurs first), up to approximately 44 months	Disease Control Rate (DCR) is defined as the proportion of participants who achieved a BOR of confirmed CR, confirmed PR, or stable disease (SD), assessed by BICR and by the Investigator per RECIST Version 1.1.
Time to Deterioration in Participants with Non-Squamous Histology, and Separately for All Randomized Participants	From randomization until disease progression or death (whichever occurs first), up to 71 months	Time to Deterioration (TTD) is defined as the time from randomization to first onset of a ≥10-point increase in cough, chest pain, or dyspnea, confirmed by a second adjacent ≥10-point increase from randomization in the same symptom, or confirmed by death within 21 days of a ≥10-point increase from randomization, assessed the European Organization for Research and Treatment of Cancer Lung cancer module (EORTC-QLQ-LC13).
Number of Participants With Treatment-emergent Adverse Events (TEAE) with Non-Squamous Histology, and Separately for All Randomized Participants	Up to 71 months	A TEAE is defined as an AE with a start or worsening date on or after the start date of study treatment until 37 days after the end date of study treatment.
Proportion of Participants Who Are Anti-Drug Antibody (ADA)-Positive (Baseline and Post-Baseline) and Proportion of Participants Who Have Treatment-emergent ADA for Participants with Non-Squamous Histology, and Separately for All Randomized Participants	Baseline and up to 71 months	The immunogenicity of Dato-DXd in combination with pembrolizumab will be assessed.

Trial Locations

Locations (239)

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

UCLA HemOnc - Clinical Research Unit; 🇺🇸 Los Angeles, California, United States

Compassionate Cancer Care Medical Group; 🇺🇸 Riverside, California, United States

Ospedale San Luca; 🇮🇹 Lucca, Italy

UCSF Helen Diller Family Comprehensive Cancer Center; 🇺🇸 San Francisco, California, United States

Ridley-Tree Cancer Center; 🇺🇸 Santa Barbara, California, United States

PIH Health Whittier Hospital; 🇺🇸 Whittier, California, United States

The Oncology Institute of Hope and Innovation; 🇺🇸 Whittier, California, United States

Uch-Mhs D/B/A Memorial Health System; 🇺🇸 Colorado Springs, Colorado, United States

Johns Hopkins University; 🇺🇸 Baltimore, Maryland, United States

American Oncology Partners of Maryland; 🇺🇸 Bethesda, Maryland, United States

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

Beth Israel Deaconess Medical Center; 🇺🇸 Boston, Massachusetts, United States

DFCI - Steward St. Elizabeth's Medical Center; 🇺🇸 Boston, Massachusetts, United States

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

Dana Farber Cancer Institute - Milford Medical Center; 🇺🇸 Milford, Massachusetts, United States

DFCI - South Shore Hospital; 🇺🇸 South Weymouth, Massachusetts, United States

Dartmouth Hitchcock Medical Center; 🇺🇸 Lebanon, New Hampshire, United States

Astera Cancer Care; 🇺🇸 East Brunswick, New Jersey, United States

Regional Cancer Care Associates LLC; 🇺🇸 Freehold, New Jersey, United States

Cooperman Barnabas Medical Center; 🇺🇸 New Brunswick, New Jersey, United States

The Valley Hospital; 🇺🇸 Paramus, New Jersey, United States

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

Arizona Oncology NAHOA; 🇺🇸 Irving, Texas, United States

Cancer Care Center of Brevard; 🇺🇸 Irving, Texas, United States

Illinois Cancer Specialists; 🇺🇸 Irving, Texas, United States

Maryland Oncology Hematology; 🇺🇸 Irving, Texas, United States

Southern Cancer Center; 🇺🇸 Irving, Texas, United States

Texas Oncology - Northeast Texas; 🇺🇸 Irving, Texas, United States

Texas Oncology Gulf Coast; 🇺🇸 Irving, Texas, United States

Texas Oncology McAllen; 🇺🇸 Irving, Texas, United States

Woodlands Medical; 🇺🇸 Irving, Texas, United States

University of Texas Health Science Center San Antonio; 🇺🇸 San Antonio, Texas, United States

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

Providence Regional Cancer System; 🇺🇸 Lacey, Washington, United States

VA Puget Sound Health Care System - VAPSHCS; 🇺🇸 Seattle, Washington, United States

Medical College of Wisconsin; 🇺🇸 Milwaukee, Wisconsin, United States

Fundacion CENIT para la investigación en Neurociencias; 🇦🇷 Ciudad Autonoma de Buenos Aire, Argentina

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

Centro de Investigación Pergamino S. A.; 🇦🇷 Pergamino, Argentina

Instituto de Oncología de Rosario; 🇦🇷 Rosario, Argentina

Sanatorio Parque; 🇦🇷 Rosario, Argentina

Sanatorio Británico de Rosario; 🇦🇷 Rosario, Argentina

CER SAN JUAN - Centro Polivalente de Asistencia e Investigación Clínica; 🇦🇷 San Juan, Argentina

Clinica Viedma SA; 🇦🇷 Viedma, Argentina

Austin Hospital; 🇦🇺 Heidelberg, Victoria, Australia

Peninsula and South Eastern Haematology and Oncology Group; 🇦🇺 Mount Waverley, Victoria, Australia

Chris Obrien Lifehouse; 🇦🇺 Camperdown, Australia

The Queen Elizabeth Hospital; 🇦🇺 Woodville South, Australia

Klinikum Klagenfurt am Wörthersee Abteilung für Lungenkrankheiten; 🇦🇹 Klagenfurt, Austria

Karl-Landsteiner Institute for Lung Research and Pulmonary Oncology c/o Klinik Floridsdorf; 🇦🇹 Vienna, Austria

Onze-Lieve-Vrouwziekenhuis Olvz - Campus Aalst; 🇧🇪 Aalst, Belgium

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

Az Maria Middelares - Campus Maria Middelares; 🇧🇪 Gent, Belgium

AZ Nikolaas; 🇧🇪 Sint-Niklaas, Belgium

Instituto de Pesquisas em Saúde - IPS; 🇧🇷 Caxias Do Sul, Brazil

Hospital Erasto Gaertner; 🇧🇷 Curitiba, Brazil

Oncosite - Centro de Pesquisa Clinica Oncologia; 🇧🇷 Ijui, Brazil

Clínica de Neoplasias Litoral; 🇧🇷 Itajaí, Brazil

UPCO - Unidade de Pesquisas Clínicas em Oncologia - Clinica Lacks; 🇧🇷 Pelotas, Brazil

Santa Casa de Misericordia de Porto Alegre; 🇧🇷 Porto Alegre, Brazil

Instituto Nacional de Câncer - INCA; 🇧🇷 Rio De Janeiro, Brazil

Centro de Estudos e Pesquisa de Hematologia e Oncologia - CEPHO; 🇧🇷 Santo Andre, Brazil

Instituto de Ensino e Pesquisas Sao Lucas; 🇧🇷 Sao Paulo, Brazil

Instituto do Cancer Brasil - Unidade Taubate; 🇧🇷 Taubate, Brazil

McGill University Health Centre; 🇨🇦 Montreal, Canada

Santa Cabrini Hospital; 🇨🇦 Montréal, Canada

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

Oncovida; 🇨🇱 Santiago, Chile

Fundación Arturo Pérez López; 🇨🇱 Santiago, Chile

Orlandi Oncología; 🇨🇱 Santiago, Chile

Centro de Investigaciones Clinicas Vina Del Mar; 🇨🇱 Vina Del Mar, Chile

Guangxi Medical University Affiliated Tumor Hospital; 🇨🇳 Nanning, Guangxi, China

Henan Cancer Hospital; 🇨🇳 Zhengzhou, Henan, China

Jilin Cancer Hospital; 🇨🇳 Changchun, Jilin, China

Sichuan Cancer Hospital; 🇨🇳 Chengdu, Sichuan, China

Peking University Peoples Hospital; 🇨🇳 Beijing, China

Peking University Cancer Hospital; 🇨🇳 Beijing, China

Cangzhou People's Hospital; 🇨🇳 Cangzhou, China

Hunan Cancer Hospital; 🇨🇳 Changsha, China

Army Medical Center of PLA; 🇨🇳 Chongqing, China

Affiliated Cancer Hospital and Institute of Guangzhou Medical University; 🇨🇳 Guangzhou, China

Haikou People's Hospital; 🇨🇳 Haikou, China

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

Zhejiang Cancer Hospital; 🇨🇳 Hangzhou, China

Harbin Medical University Cancer Hospital; 🇨🇳 Harbin, China

Inner Mongolia Medical University- the Affiliated Hospital; 🇨🇳 Hohhot, China

Jiamusi Tumor and Tuberculosis Hospital; 🇨🇳 Jiamusi, China

Yunnan Cancer Hospital; 🇨🇳 Kunming, China

Linyi Cancer Hospital; 🇨🇳 Linyi, China

The First Affiliated Hospital of Nanchang University; 🇨🇳 Nanchang, China

Jiangsu Province Hospital; 🇨🇳 Nanjing, China

The Second People's Hospital of Neijiang; 🇨🇳 Neijiang, China

Fudan University Shanghai Cancer Center; 🇨🇳 Shanghai Shi, China

Shanghai Pulmonary Hospital; 🇨🇳 Shanghai, China

Liaoning Cancer Hospital& Institute; 🇨🇳 Shenyang City, China

The First Hospital of China Medical University; 🇨🇳 Shenyang, China

Tianjin Medical University General Hospital; 🇨🇳 Tianjin, China

Union Hospital Affiliated With Tongji Medical College Huazhong University of Science and Technology; 🇨🇳 Wuhan, China

Hubei Cancer Hospital; 🇨🇳 Wuhan, China

The First Affiliate Hospitalof Xi'An Jiaotong University; 🇨🇳 Xi'an, China

The First Affiliated Hospital Xiamen University; 🇨🇳 Xiamen, China

Xiangyang Central Hospital- 5 Lumen Avenue; 🇨🇳 Xiangyang, China

Xinjiang Tumor Hospital; 🇨🇳 Ürümqi, China

Sainte-Catherine Institut du Cancer Avignon-Provence (ICAP); 🇫🇷 Avignon, France

Bordeaux University Hospital - Hopital Saint Andre; 🇫🇷 Bordeaux, France

Institut Bergonie; 🇫🇷 Bordeaux, France

Centre Hospitalier Universitaire de Lille; 🇫🇷 Lille, France

Centre Leon Berard; 🇫🇷 Lyon, France

Institut Paoli-Calmettes; 🇫🇷 Marseille Cedex 9, France

APHM - Hopital Nord; 🇫🇷 Marseille, France

Centre Hospitalier Universitaire de Montpellier; 🇫🇷 Montpellier, France

Hopital prive du Confluent; 🇫🇷 Nantes Cedex 2, France

CHU de Nantes; 🇫🇷 Nantes, France

AP-HP - Hopital Tenon; 🇫🇷 Paris, France

CHU de Poitier Pole Regional de Cancerologie; 🇫🇷 Poitiers, France

Hopital FOCH; 🇫🇷 Suresnes, France

Evangelische Lungenklinik Berlin; 🇩🇪 Berlin, Germany

Klinikum Esslingen GmbH; 🇩🇪 Esslingen, Germany

LungenClinic Grosshansdorf; 🇩🇪 Grosshansdorf, Germany

Klinikum der Universitaet Muenchen; 🇩🇪 Muenchen, Germany

Metropolitan Hospital; 🇬🇷 Neo Faliro, Greece

Sotiria General Hosptial of Chest Diseases; 🇬🇷 Athens, Greece

University Hospital of Ioannina Uhi; 🇬🇷 Ioannina, Greece

Bioclinic Thessaloniki; 🇬🇷 Thessaloniki, Greece

Prince of Wales Hospital / The Chinese University of Hong Kong 99999; 🇭🇰 Hong Kong, Hong Kong

Queen Elizabeth Hospital; 🇭🇰 Hong Kong, Hong Kong

Queen Mary Hospital; 🇭🇰 Pok Fu Lam, Hong Kong

Semmelweis University Department of Pulmonology; 🇭🇺 Budapest, Hungary

Veszprem Megyei Tudogyogyintezet Farkasgyepu; 🇭🇺 Farkasgyepű, Hungary

Bkmk Hospital; 🇭🇺 KecskemĂŠt, Hungary

Fejer Megyei Szent Gyorgy Egyetemi Oktato Korhaz; 🇭🇺 Szekesfehervar, Hungary

Pulmonology Hospital Torokbalint; 🇭🇺 Torokbalint, Hungary

IRCCS Istituto Oncologico Giovanni Paolo II; 🇮🇹 Bari, Italy

UOC Oncologia; 🇮🇹 Chieti, Italy

IRCCS Ospedale San Raffaele; 🇮🇹 Milano, Italy

Irccs Istituto Europeo Di Oncologia; 🇮🇹 Milano, Italy

Azienda Ospedaliera dei Colli; 🇮🇹 Naples, Italy

A.O. Perugia Santa Maria della Misericordia; 🇮🇹 Perugia, Italy

Policlinico Tor Vergata; 🇮🇹 Rome, Italy

Ifo Regina Elena; 🇮🇹 Rome, Italy

Asst Sette Laghi Ospedale di Circolo e Fondazione Macchi; 🇮🇹 Varese, Italy

Aomori Prefectural Central Hospital; 🇯🇵 Aomori-shi, Aomori, Japan

National Cancer Center Hospital East; 🇯🇵 Kashiwa-shi, Chiba, Japan

NHO Shikoku Cancer Center; 🇯🇵 Matsuyama-shi, Ehime, Japan

National Hospital Organization Kyushu Cancer Center; 🇯🇵 Fukuoka-shi, Fukuoka, Japan

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

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

Kanazawa University Hospital; 🇯🇵 Kanazawa-shi, Ishikawa, Japan

Kanagawa Cancer Center; 🇯🇵 Yokohama-shi, Kanagawa, Japan

Saiseikai Kumamoto Hospital; 🇯🇵 Kumamoto-shi, Kumamoto, Japan

Matsusaka Municipal Hospital; 🇯🇵 Matsusaka-shi, Mie, Japan

Sendai Kousei Hospital; 🇯🇵 Sendai-shi, Miyagi, Japan

Niigata Cancer Center Hospital; 🇯🇵 Niigata-shi, Niigata, Japan

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

Osaka International Cancer Institute; 🇯🇵 Osaka-shi, Osaka, Japan

NHO Kinki-Chuo Chest Medical Center; 🇯🇵 Sakai-shi, Osaka, Japan

Saitama Cancer Center; 🇯🇵 Ina-machi, Saitama, Japan

Dokkyo Medical University Hospital; 🇯🇵 Shimotsuga-gun, Tochigi, Japan

Juntendo University Hospital; 🇯🇵 Bunkyo-ku, Tokyo, Japan

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

The Cancer Institute Hospital of JFCR; 🇯🇵 Koto-ku, Toyko, Japan

Toho University Omori Medical Center; 🇯🇵 Ota-ku, Toyko, Japan

NHO Iwakuni Clinical Center; 🇯🇵 Iwakuni-shi, Yamaguchi, Japan

Yamaguchi-Ube Medical Center; 🇯🇵 Ube-shi, Yamaguchi, Japan

Yamanashi Prefectural Central Hospital; 🇯🇵 Kofu-shi, Japan

University Hospital Kyoto Prefectural University of Medicine; 🇯🇵 Kyoto-shi, Japan

Osaka Toneyama Medical Center; 🇯🇵 Osaka, Japan

Teine Keijinkai Hospital; 🇯🇵 Sapporo, Japan

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

Seoul National University Bundang Hospital; 🇰🇷 Seongnam, Gyeonggi-do, Korea, Republic of

Gyeongsang National University Hospital; 🇰🇷 Jinju-si, Gyeongsangnam-do, Korea, Republic of

Kyungpook National University Chilgok Hospital; 🇰🇷 Daegu, Korea, Republic of

National Cancer Center; 🇰🇷 Goyang-si, Korea, Republic of

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

The Catholic Univ. of Korea, Seoul St. Mary'S Hospital; 🇰🇷 Seoul, Korea, Republic of

Asan Medical Center; 🇰🇷 Songpa-gu, Korea, Republic of

Cryptex Investigacion Clinica Sa de Cv; 🇲🇽 Cuauhtémoc, Mexico

Hospital Civil de Guadalajara Fray Antonio Alcalde; 🇲🇽 Guadalajara, Mexico

Hospital Universitario Dr. Jose Eleuterio Gonzalez; 🇲🇽 Monterrey, Mexico

Centro de Investigacion Clinica de Oaxaca (CICLO); 🇲🇽 Oaxaca de Juarez, Mexico

Oncologico Potosino; 🇲🇽 San Luis Potosí, Mexico

Rijnstate Ziekenhuis; 🇳🇱 Arnhem, Gelderland, Netherlands

Amsterdam Umc, Location Vumc; 🇳🇱 Amsterdam, Netherlands

Leiden University Medical Center; 🇳🇱 Leiden, Netherlands

Jeroen Bosch Ziekenhuis J BZ Hieronymus Bosch Hospital; 🇳🇱 s-Hertogenbosch, Netherlands

Instytut Centrum Zdrowia Matki Polki; 🇵🇱 Lodz, Iodzkie, Poland

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

Dom Lekarski SA; 🇵🇱 Szczecin, Zachodniopomorskie, Poland

II Klinika Chorob Pluc I Gruzlicy; 🇵🇱 Bialystok, Poland

MS Pneumed Janusz Milanowski, Katarzyna Szmygin-Milanowska Sp. Jawna; 🇵🇱 Lublin, Poland

Centro Clinico Champalimau; 🇵🇹 Lisboa, Portugal

Centro Hospitalar e Universitário do Porto; 🇵🇹 Porto, Portugal

Hospital CUF Porto; 🇵🇹 Porto, Portugal

Instituto Portuguas de Oncologia do Porto Francisco Gentil; 🇵🇹 Porto, Portugal

Centro Hospitalar Universitário de São João; 🇵🇹 Porto, Portugal

Onco Clinic Consult SA; 🇷🇴 Craiova, Romania

Centrul de Oncologie Sf Nectarie S.R.L.; 🇷🇴 Craiova, Romania

Sc Sigmedical Services Srl; 🇷🇴 Suceava, Romania

Oncocenter-Oncologie Clinica SRL; 🇷🇴 Timisoara, Romania

SC Oncomed SRL; 🇷🇴 Timisoara, Romania

Hospital Clinic i Provincial de Barcelona; 🇪🇸 Barcelona, Spain

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

Hospital Universitario Arnau de Vilanova - Lleida; 🇪🇸 Lleida, Spain

Hospital General Universitario Gregorio Marañon; 🇪🇸 Madrid, Spain

Hospital Clinico San Carlos; 🇪🇸 Madrid, Spain

Hospital Universitario Fundacion Jimenez Diaz; 🇪🇸 Madrid, Spain

Hospital Regional Universitario Malaga; 🇪🇸 Malaga, Spain

CHUO; 🇪🇸 Ourense, Spain

Hospital Universitario Virgen Macarena; 🇪🇸 Sevilla, Spain

Hospital Universitario de Valme; 🇪🇸 Sevilla, Spain

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

Hospital Universitario Miguel Servet; 🇪🇸 Zaragoza, Spain

Kantonsspital Baden; 🇨🇭 Baden, Switzerland

University Hospital Basel; 🇨🇭 Basel, Switzerland

Kantonsspital Baselland; 🇨🇭 Liestal, Switzerland

Kantonsspital St. Gallen; 🇨🇭 St.Gallen, Switzerland

E-Da Hospital; 🇨🇳 Kaohsiung City, Taiwan

Chang Gung Memorial Hospital Cgmh - Kaohsiung Branch; 🇨🇳 Kaohsiung, Taiwan

Chung Shan Medical University Hospital; 🇨🇳 Taichung, Taiwan

Taichung Veterans General Hospital; 🇨🇳 Taichung, Taiwan

National Cheng Kung University Hospital Nckuh; 🇨🇳 Tainan, Taiwan

Taipei Veterans General Hospital; 🇨🇳 Taipei City, Taiwan

National Taiwan University Hospital; 🇨🇳 Taipei, Taiwan

Koo Foundation Sun Yat-Sen Cancer Center; 🇨🇳 Taipei, Taiwan

Chang Gung Memorial Hospital LinKou; 🇨🇳 Taoyuan, Taiwan

Srinagarind Hospital; 🇹🇭 Muaeng, Khon Kaen, Thailand

Prince of Songkla University PSU - Faculty of Medicine; 🇹🇭 Hat Yai, Songkhla, Thailand

Faculty of Medicine Chulalongkorn University; 🇹🇭 Bangkok, Thailand

Siriraj Hospital; 🇹🇭 Bangkok, Thailand

Adana Acibadem Hospital; 🇹🇷 Adana, Turkey

Akdeniz University Hospital; 🇹🇷 Antalya, Turkey

Ege University; 🇹🇷 Bornova-İzmir, Turkey

Memorial Ankara Hospital Ankara; 🇹🇷 Cankaya, Turkey

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

Medical Park Seyhan Hospital; 🇹🇷 Seyhan /Adana, Turkey

Birmingham Heartlands Hospital; 🇬🇧 Birmingham, United Kingdom

Beatson West of Scotland Cancer Centre; 🇬🇧 Glasgow, United Kingdom

Nottingham University Hospitals; 🇬🇧 Nottingham, United Kingdom