Study to Evaluate Ibrutinib Combination Therapy in Patients With Selected Gastrointestinal and Genitourinary Tumors
- Conditions
- Metastatic Renal Cell CarcinomaAdvanced Gastric AdenocarcinomaAdvanced Urothelial CarcinomaMetastatic Colorectal Adenocarcinoma
- Interventions
- Registration Number
- NCT02599324
- Lead Sponsor
- Pharmacyclics LLC.
- Brief Summary
The purpose of this study is to evaluate the safety, tolerability, and efficacy of single agent ibrutinib or the combination treatments of ibrutinib with everolimus, paclitaxel, docetaxel, pembrolizumab or cetuximab in selected advance gastrointestinal and genitourinary tumors.
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 263
RCC (clear cell), urothelial carcinoma (UC) (transitional cell), gastric or gastro-esophageal junctional (GEJ) adenocarcinoma, or K-RAS or N-RAS wild-type EGFR expressing CRC For cohort 1 RCC: minimum of 1 and maximum of 4 prior regimens, one or more of which must have included a VEGF-TKI For UC cohort 2: minimum of 1 and maximum of 2 prior regimens, one of which must have included a platinum-based regimen For UC cohort 5: Minimum of 1 and maximum of 2 prior regimens, one of which must have included a checkpoint inhibitor.
For UC cohort 6:
Locally advanced or mUC who are not eligible for cisplatin chemo with a PDL-1 score (CPS) of ≥ 10 without prior treatment.
Locally advanced or mUC who have progressed on platinum chemo or within 12 months of neo- or adjuvant therapy with a platinum chemotherapy. A minimum of 1 and maximum of 2 prior therapies.
For cohort 3 gastric or GEJ adenocarcinoma: minimum of 1 and maximum of 3 prior regimens one of which must have included a fluoropyrimidine regimen For cohort 4 CRC: minimum of 2 and maximum of 4 prior regimens, which must have included both an irinotecan and an oxaliplatin based regimen unless unable to tolerate irinotecan chemotherapy
Laboratory:
Adequate hematologic function:
Absolute neutrophil count ≥1500 cells/mm3 (1.5 x 109/L) Platelet count >80,000 cells/mm3 (80 x 109/L) for cohort 1 (RCC) Platelet counts >100,000 cells/mm3 (100 x 109/L) for all UC cohorts Hemoglobin ≥8.0 g/dL. for cohort 1 (RCC),all UC cohorts, and cohort 3 (GC) Hemoglobin ≥9.0 g/dL for cohort 4 (CRC)
Adequate hepatic and renal function defined as:
Serum aspartate transaminase (AST) and/or alanine transaminase (ALT) ≤5.0 x upper limit of normal (ULN) if liver metastases, or ≤3 x ULN without liver metastases Alkaline phosphatase <3.0 x ULN or ≤5.0 x ULN if liver or bone metastases present Bilirubin ≤1.5 x ULN (unless bilirubin rise is due to Gilbert's syndrome or of non-hepatic origin, such as hemolysis) with the exception of subjects in the GC cohort where docetaxel is administered, these subjects must have bilirubin within normal limits (WNL) Estimated Creatinine Clearance ≥30 mL/min (Cockcroft-Gault)
Exclusion Criteria
Prior treatment with:
Everolimus or temsirolimus (RCC cohort 1) Any taxane (UC cohort of ibrutinib + paclitaxel) (cohort 2) Checkpoint inhibitors (UC cohort 6) Any taxane (GC cohort 3) Cetuximab or panitumumab (CRC cohort 4)
For all Cohorts:
Concomitant use of warfarin or other Vitamin K antagonists History of stroke or intracranial hemorrhage within 6 months prior to enrollment Major surgery within 4 weeks of first dose of study drug Requires treatment with strong CYP3A inhibitors known bleeding disorders or hemophilia
UC cohort 6 only:
Subjects who have an active, known or suspected autoimmune disease. Evidence of clinically significant interstitial lung disease or active, noninfectious pneumonitis.
Non-steroid immunosuppressive medications within 14 days before the first dose of ibrutinib and pembrolizumab.
Subjects in whom prior anti PD-1 / anti-PD-L1 therapy was intolerable and required discontinuation of treatment.
Not provided
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Cohort 3: Gastric Adenocarcinoma (GA or GC) ibrutinib Phase 1b: Participants receive ibrutinib at various dose levels in combination with a fixed dose of docetaxel to determine the RP2D of ibrutinib. (The RP2D was determined for each cohort separately.) Phase 2: Participants receive docetaxel at the RP2D determined in Phase 1b in combination with docetaxel. Cohort 1: Renal Cell Carcinoma (RCC) everolimus Phase 1b: Participants receive ibrutinib at various dose levels in combination with a fixed dose of everolimus to determine the recommended phase 2 dose (RP2D) of ibrutinib. (The RP2D was determined for each cohort separately.) Phase 2: Participants receive ibrutinib at the RP2D determined in phase 1b in combination with everolimus. Cohort 4: Colorectal Adenocarcinoma (CRC) ibrutinib Phase 1b: Participants receive ibrutinib at various dose levels in combination with a fixed dose of cetuximab to determine RP2D of ibrutinib. (The RP2D was determined for each cohort separately.) Phase 2: Participants receive ibrutinib at the RP2D determined in Phase 1b in combination with cetuximab. Cohort 1: Renal Cell Carcinoma (RCC) ibrutinib Phase 1b: Participants receive ibrutinib at various dose levels in combination with a fixed dose of everolimus to determine the recommended phase 2 dose (RP2D) of ibrutinib. (The RP2D was determined for each cohort separately.) Phase 2: Participants receive ibrutinib at the RP2D determined in phase 1b in combination with everolimus. Cohort 2: Urothelial Carcinoma (UC) ibrutinib Phase 1b: Participants receive ibrutinib at various dose levels in combination with a fixed dose of paclitaxel to determine the RP2D of ibrutinib. (The RP2D was determined for each cohort separately.) Phase 2: Participants receive ibrutinib at the RP2D determined in Phase 1b in combination with paclitaxel. Cohort 3: Gastric Adenocarcinoma (GA or GC) docetaxel Phase 1b: Participants receive ibrutinib at various dose levels in combination with a fixed dose of docetaxel to determine the RP2D of ibrutinib. (The RP2D was determined for each cohort separately.) Phase 2: Participants receive docetaxel at the RP2D determined in Phase 1b in combination with docetaxel. Cohort 2: Urothelial Carcinoma (UC) paclitaxel Phase 1b: Participants receive ibrutinib at various dose levels in combination with a fixed dose of paclitaxel to determine the RP2D of ibrutinib. (The RP2D was determined for each cohort separately.) Phase 2: Participants receive ibrutinib at the RP2D determined in Phase 1b in combination with paclitaxel. Cohort 6: Urothelial Carcinoma (UC) With Pembrolizumab pembrolizumab Phase 1b: Participants receive ibrutinib at various dose levels in combination with a fixed dose of pembrolizumab to determine the RP2D of ibrutinib. (The RP2D was determined for each cohort separately.) Phase 2: Participants receive ibrutinib at the RP2D determined in Phase 1b in combination with pembrolizumab. Cohort 4: Colorectal Adenocarcinoma (CRC) cetuximab Phase 1b: Participants receive ibrutinib at various dose levels in combination with a fixed dose of cetuximab to determine RP2D of ibrutinib. (The RP2D was determined for each cohort separately.) Phase 2: Participants receive ibrutinib at the RP2D determined in Phase 1b in combination with cetuximab. Cohort 5: Urothelial Carcinoma (UC) Ibrutinib ibrutinib Phase 1b: Participants receive ibrutinib at various dose levels to determine the RP2D of ibrutinib.(The RP2D was determined for each cohort separately.) Phase 2: Participants receive ibrutinib at the RP2D determined in Phase 1b. Cohort 6: Urothelial Carcinoma (UC) With Pembrolizumab ibrutinib Phase 1b: Participants receive ibrutinib at various dose levels in combination with a fixed dose of pembrolizumab to determine the RP2D of ibrutinib. (The RP2D was determined for each cohort separately.) Phase 2: Participants receive ibrutinib at the RP2D determined in Phase 1b in combination with pembrolizumab.
- Primary Outcome Measures
Name Time Method Phase 1b: Number of Participants With Dose-Limiting Toxicities (DLTs) in Cohorts 1 to 6 21 days after the initiation of therapy at the start of Cycle 1 A DLT was defined as any Grade 3 (severe) or higher non-hematologic or Grade 4 (life-threatening) hematologic adverse event (AE) occurring during the DLT observation period that was considered to be at least possibly related to the study treatment (ibrutinib or drug combination).
Phase 1b/2 RP2D: Progression-Free Survival (PFS) as Assessed by Investigator in Cohorts 1 and 2 Maximum time on study for Cohort 1 (Phase 1b/2 RP2D) was 37.4 months; for Cohort 2 (Phase 1b/2 RP2D) was 44.7 months. PFS is defined as the time from the date of first dose of study treatment to the date of first documentation of progressive disease (PD) or date of death from any cause, whichever occurs first, regardless of the use of subsequent anti-cancer treatment. PD was defined in accordance with Response Evaluation Criteria In Solid Tumors (RECIST) criteria version 1.1. PD: At least a 20% increase in the sum of diameters of target lesions, taking as reference the smallest sum on study (this includes the baseline sum if that is the smallest on study), and an absolute increase of ≥ 5 mm, or unequivocal progression of existing non-target lesions or the appearance of new lesions.
Phase 1b/2 RP2D: Overall Response Rate (ORR) as Assessed by Investigator in Cohorts 3 to 6 Maximum time on study (Phase 1b/2 RP2D) for Cohort 3 was 41.9 months; for Cohort 4 was 23.5 months; for Cohort 5 was 17.3 months; for Cohort 6 was 20.1 months. ORR is defined as the percentage of participants who have a best response of partial response (PR) or complete response (CR) to therapy in accordance with RECIST 1.1 criteria. CR: The disappearance of all target and non-target lesions. Any pathological lymph nodes (whether target or non-target) must have reduction in short axis to \< 10 mm. Normalization of tumor marker level, if relevant. All lymph nodes must be non-pathological in size (\< 10 mm short axis). PR: At least a 30% decrease in the sum of diameters of target lesions, taking as reference the baseline sum diameters.
- Secondary Outcome Measures
Name Time Method Phase 1b: ORR in Cohorts 1 to 6 Maximum time on study (Phase 1b only) for Cohort 1 was 37.4 months; for Cohort 2 was 44.7 months; for Cohort 3 was 41.9 months; for Cohort 4 was 34.2 months; for Cohort 5 was 17.3 months; for Cohort 6 was 20.1 months. ORR is defined as the percentage of participants who have a best response of partial response (PR) or complete response (CR) to therapy in accordance with RECIST 1.1 criteria. CR: The disappearance of all target and non-target lesions. Any pathological lymph nodes (whether target or non-target) must have reduction in short axis to \< 10 mm. Normalization of tumor marker level, if relevant. All lymph nodes must be non-pathological in size (\< 10 mm short axis). PR: At least a 30% decrease in the sum of diameters of target lesions, taking as reference the baseline sum diameters.
Phase 1b: Time to Cmax (Tmax) for Ibrutinib and Its Metabolite PCI-45227 in Cohorts 1 to 4 Cycle 2 Day 1: predose, 1 h ± 15 min, 2 h ± 15 min, 4 h ± 15 min, 6 h ± 15 min postdose Actual collection times relative to ibrutinib administration were used for the calculation of pharmacokinetic parameters of ibrutinib and PCI-45227. For actual predose collection times that were \< 0, these values were set equal to 0. Predose concentrations were applied as 24 hour concentrations in order to calculate steady-state (Cycle 2 Day 1) pharmacokinetic parameters for ibrutinib and PCI-45227. The tmax was noted as observed.
Phase 1b: Area Under the Concentration-Time Curve From Time 0 to Hour 24 (AUC0-24h) for Ibrutinib and Its Metabolite PCI-45227 in Cohorts 1 to 4 Cycle 2 Day 1: predose, 1 h ± 15 min, 2 h ± 15 min, 4 h ± 15 min, 6 h ± 15 min postdose Actual collection times relative to ibrutinib administration were used for the calculation of pharmacokinetic parameters of ibrutinib and PCI-45227. For actual predose collection times that were \< 0, these values were set equal to 0. Predose concentrations were applied as 24 hour concentrations in order to calculate steady-state (Cycle 2 Day 1) pharmacokinetic parameters for ibrutinib and PCI-45227. The AUC0-24h was calculated by the linear trapezoidal method.
Phase 1b: Area Under the Concentration-Time Curve to Last Observed Time Point (AUClast) for Ibrutinib and Its Metabolite PCI-45227 in Cohorts 1 to 4 Cycle 2 Day 1: predose, 1 h ± 15 min, 2 h ± 15 min, 4 h ± 15 min, 6 h ± 15 min postdose Actual collection times relative to ibrutinib administration were used for the calculation of pharmacokinetic parameters of ibrutinib and PCI-45227. For actual predose collection times that were \< 0, these values were set equal to 0. Predose concentrations were applied as 24 hour concentrations in order to calculate steady-state (Cycle 2 Day 1) pharmacokinetic parameters for ibrutinib and PCI-45227. The AUClast was calculated by the linear trapezoidal method.
Phase 1b: Disease Control Rate (DCR) in Cohorts 1 to 6 Maximum time on study (Phase 1b only) for Cohort 1 was 37.4 months; for Cohort 2 was 44.7 months; for Cohort 3 was 41.9 months; for Cohort 4 was 34.2 months; for Cohort 5 was 17.3 months; for Cohort 6 was 20.1 months. DCR is is defined as the percentage of participants who have a best response of PR, CR, or stable disease (SD) to therapy in accordance with RECIST 1.1 criteria. CR: The disappearance of all target and non-target lesions. Any pathological lymph nodes (whether target or non-target) must have reduction in short axis to \< 10 mm. Normalization of tumor marker level, if relevant. All lymph nodes must be non-pathological in size (\< 10 mm short axis). PR: At least a 30% decrease in the sum of diameters of target lesions, taking as reference the baseline sum diameters. SD: Neither sufficient shrinkage to qualify for PR nor sufficient increase to qualify for PD, taking as reference the smallest SOD since the treatment started (baseline or after). For SD, tthere was no need for confirmation by a subsequent imaging assessment.
Phase 1b/2 RP2D: PFS in Cohorts 3 to 6 Maximum time on study (Phase 1b/2 RP2D) for Cohort 3 was 41.9 months; for Cohort 4 was 23.5 months; for Cohort 5 was 17.3 months; for Cohort 6 was 20.1 months. (Reverse Kaplan-Meier estimates) PFS is defined as the time from the date of first dose of study treatment to the date of first documentation of PD or date of death from any cause, whichever occurs first, regardless of the use of subsequent anti-cancer treatment. PD was defined in accordance with RECIST 1.1 criteria.
Phase 1b/2 RP2D: ORR in Cohorts 1 and 2 Maximum time on study for Cohort 1 (Phase 1b/2 RP2D) was 37.4 months; for Cohort 2 (Phase 1b/2 RP2D) was 44.7 months. (Reverse Kaplan-Meier estimates) ORR is defined as the percentage of participants who have a best response to therapy of PR or CR in accordance with RECIST 1.1 criteria. CR: The disappearance of all target and non-target lesions. Any pathological lymph nodes (whether target or non-target) must have reduction in short axis to \< 10 mm. Normalization of tumor marker level, if relevant. All lymph nodes must be non-pathological in size (\< 10 mm short axis). PR: At least a 30% decrease in the sum of diameters of target lesions, taking as reference the baseline sum diameters.
Phase 1b/2 RP2D: Duration of Response (DOR) in Cohorts 1 to 6 Maximum time on study (Phase 1b/2 RP2D) for Cohort 1 was 37.4 months; for Cohort 2 was 44.7 months; for Cohort 3 was 41.9 months; for Cohort 4 was 23.5 months; for Cohort 5 was 17.3 months; for Cohort 6 was 20.1 months. (Reverse Kaplan-Meier estimates) DOR is defined for confirmed responders (PR or better) as time from the date of initial response (PR or better) to the date of first documentation of PD (according to RECIST 1.1) or death, whichever occurs first, regardless of use of subsequent anti-cancer treatment. Confirmed responders without documentation of PD or death or with unknown status at the data extraction were censored at the last adequate post-baseline disease assessment showing no evidence of PD. PD was defined as at least a 20% increase in the size of target lesions with an absolute increase of at least 5 mm, unequivocal progression of existing non-target lesions, or the appearance of one or more new lesions.
Per protocol, participants in Phase 1b receiving the Phase 2 RP2D and participants in Phase 2 RP2D were analyzed together.Phase 1b/2 RP2D: DCR in Cohorts 1 to 6 Maximum time on study (Phase 1b/2 RP2D) for Cohort 1 was 37.4 months; for Cohort 2 was 44.7 months; for Cohort 3 was 41.9 months; for Cohort 4 was 23.5 months; for Cohort 5 was 17.3 months; for Cohort 6 was 20.1 months. (Reverse Kaplan-Meier estimates) DCR is is defined as the percentage of participants who have a best response of PR, CR, or SD to therapy in accordance with RECIST 1.1 criteria. CR: The disappearance of all target and non-target lesions. Any pathological lymph nodes (whether target or non-target) must have reduction in short axis to \< 10 mm. Normalization of tumor marker level, if relevant. All lymph nodes must be non-pathological in size (\< 10 mm short axis). PR: At least a 30% decrease in the sum of diameters of target lesions, taking as reference the baseline sum diameters. SD: Neither sufficient shrinkage to qualify for PR nor sufficient increase to qualify for PD, taking as reference the smallest SOD since the treatment started (baseline or after). For SD, tthere was no need for confirmation by a subsequent imaging assessment.
Phase 1b/2 RP2D: Overall Survival (OS) in Cohorts 1 to 6 Maximum time on study (Phase 1b/2 RP2D) for Cohort 1 was 37.4 months; for Cohort 2 was 44.7 months; for Cohort 3 was 41.9 months; for Cohort 4 was 23.5 months; for Cohort 5 was 17.3 months; for Cohort 6 was 20.1 months. (Reverse Kaplan-Meier estimates) OS is defined as the time from the date of first dose of study treatment to the date of death from any cause. Subjects who were not known to have died at the data extraction will be censored at date last known alive.
Phase 1b: Observed Maximum Concentration (Cmax) for Ibrutinib and Its Metabolite PCI-45227 in Cohorts 1 to 4 Cycle 2 Day 1: predose, 1 h ± 15 min, 2 h ± 15 min, 4 h ± 15 min, 6 h ± 15 min postdose Actual collection times relative to ibrutinib administration were used for the calculation of pharmacokinetic parameters of ibrutinib and PCI-45227. For actual predose collection times that were \< 0, these values were set equal to 0. Predose concentrations were applied as 24 hour concentrations in order to calculate steady-state (Cycle 2 Day 1) pharmacokinetic parameters for ibrutinib and PCI-45227. The Cmax was noted as observed.
Phase 1b: Time of Last Observed Concentration (Tlast) for Ibrutinib and Its Metabolite PCI-45227 in Cohorts 1 to 4 Cycle 2 Day 1: predose, 1 h ± 15 min, 2 h ± 15 min, 4 h ± 15 min, 6 h ± 15 min postdose Actual collection times relative to ibrutinib administration were used for the calculation of pharmacokinetic parameters of ibrutinib and PCI-45227. For actual predose collection times that were \< 0, these values were set equal to 0. Predose concentrations were applied as 24 hour concentrations in order to calculate steady-state (Cycle 2 Day 1) pharmacokinetic parameters for ibrutinib and PCI-45227. The tlast was noted as observed.
Phase 1b: Terminal Elimination Rate Constant (λz) for Ibrutinib and Its Metabolite PCI-45227 in Cohorts 1 to 4 Cycle 2 Day 1: predose, 1 h ± 15 min, 2 h ± 15 min, 4 h ± 15 min, 6 h ± 15 min postdose Actual collection times relative to ibrutinib administration were used for the calculation of pharmacokinetic parameters of ibrutinib and PCI-45227. For actual predose collection times that were \< 0, these values were set equal to 0. Predose concentrations were applied as 24 hour concentrations in order to calculate steady-state (Cycle 2 Day 1) pharmacokinetic parameters for ibrutinib and PCI-45227. The λz is the apparent elimination rate constant obtained by linear regression of three or more log-transformed data points in the terminal phase (not including Cmax).
Phase 1b: Terminal Elimination Half-Life (t1/2term) for Ibrutinib and Its Metabolite PCI-45227 in Cohorts 1 to 4 Cycle 2 Day 1: predose, 1 h ± 15 min, 2 h ± 15 min, 4 h ± 15 min, 6 h ± 15 min postdose Actual collection times relative to ibrutinib administration were used for the calculation of pharmacokinetic parameters of ibrutinib and PCI-45227. For actual predose collection times that were \< 0, these values were set equal to 0. Predose concentrations were applied as 24 hour concentrations in order to calculate steady-state (Cycle 2 Day 1) pharmacokinetic parameters for ibrutinib and PCI-45227. The apparent t1/2term was calculated by ln(2)/λz, where λz is the apparent elimination rate constant obtained by linear regression of three or more log-transformed data points in the terminal phase (not including Cmax).
Phase 1b: Apparent Total Clearance at Steady-State (CLss/F) for Ibrutinib in Cohorts 1 to 4 Cycle 2 Day 1: predose, 1 h ± 15 min, 2 h ± 15 min, 4 h ± 15 min, 6 h ± 15 min postdose Actual collection times relative to ibrutinib administration were used for the calculation of pharmacokinetic parameters of ibrutinib and PCI-45227. For actual predose collection times that were \< 0, these values were set equal to 0. Predose concentrations were applied as 24 hour concentrations in order to calculate steady-state (Cycle 2 Day 1) pharmacokinetic parameters for ibrutinib and PCI-45227. Apparent total CLss/F (Cycle 2 Day 1) was calculated as dose/AUC0-24h.
Trial Locations
- Locations (65)
Whittingham Cancer Center at Norwalk Hospital /ID# 1128-0411
🇺🇸Norwalk, Connecticut, United States
Sarah Cannon Research Institute /ID# 1128-1079
🇬🇧London, England, United Kingdom
Franciscan Health Indianapolis /ID# 1128-1125
🇺🇸Indianapolis, Indiana, United States
University of Washington /ID# 1128-1382
🇺🇸Seattle, Washington, United States
San Juan Oncology Associates /ID# 1128-1020
🇺🇸Farmington, New Mexico, United States
Banner MD Anderson Cancer Center /ID# 1128-0802
🇺🇸Gilbert, Arizona, United States
Premiere Oncology, A Medical Corporation /ID# 1128-1085
🇺🇸Santa Monica, California, United States
UC Irvine Medical Center - Chao Family Comprehensive Cancer Center /ID# 1128-0008
🇺🇸Orange, California, United States
Salinas Valley Memorial Hosp /ID# 1128-0482
🇺🇸Salinas, California, United States
St Marys Medical Center /ID# 1128-0969
🇺🇸Daly City, California, United States
Duplicate_University of California San Diego/ Moores Cancer Center /ID# 1128-0241
🇺🇸La Jolla, California, United States
Central Care Cancer Center /ID# 1128-1596
🇺🇸Bolivar, Missouri, United States
Memorial Sloan Kettering Cancer Center-Koch Center /ID# 1128-0091
🇺🇸New York, New York, United States
The University of Texas Medical Branch (UTMB) - Cancer Center - Galves /ID# 1128-0974
🇺🇸Galveston, Texas, United States
Confluence Health /ID# 1128-0894
🇺🇸Wenatchee, Washington, United States
Virginia Mason Medical Center /ID# 1128-0005
🇺🇸Seattle, Washington, United States
The University of Kansas Cancer Center /ID# 1128-0706
🇺🇸Fairway, Kansas, United States
Hospital Universitario Vall d'Hebron /ID# 1128-0534
🇪🇸Barcelona, Spain
University of Iowa Hospitals and Clinics /ID# 1128-0766
🇺🇸Iowa City, Iowa, United States
Capital Region Medical Center /ID# 1128-1412
🇺🇸Jefferson City, Missouri, United States
Duplicate_Virginia Cancer Specialists - Fairfax Office /ID# 1128-0972
🇺🇸Fairfax, Virginia, United States
Hospital Universitario Ramon y Cajal /ID# 1128-0874
🇪🇸Madrid, Spain
Hospital Universitario 12 de Octubre /ID# 1128-0864
🇪🇸Madrid, Spain
Duplicate_Oxford University Hospitals NHS Trust /ID# 1128-0814
🇬🇧Oxford, United Kingdom
Samsung Medical Center /ID# 1128-0925
🇰🇷Seoul, Korea, Republic of
Hospital Universitario Virgen del Rocio /ID# 1128-0863
🇪🇸Sevilla, Spain
The Christie Hospital /ID# 1128-0030
🇬🇧Manchester, United Kingdom
Henry Ford Hospital /ID# 1128-0195
🇺🇸Detroit, Michigan, United States
Vanderbilt Infectious Disease Clinic /ID# 1128-0024
🇺🇸Nashville, Tennessee, United States
Hospital Clinic de Barcelona /ID# 1128-0533
🇪🇸Barcelona, Spain
Hospital Universitario La Paz /ID# 1128-0921
🇪🇸Madrid, Spain
University of Arizona Cancer Center - Tucson /ID# 1128-1546
🇺🇸Tucson, Arizona, United States
Duplicate_Tufts Medical Center /ID# 1128-0016
🇺🇸Boston, Massachusetts, United States
Wake Forest Univ HS /ID# 1128-0975
🇺🇸Winston-Salem, North Carolina, United States
Clearview Cancer Institute /ID# 1128-0965
🇺🇸Huntsville, Alabama, United States
Alta Bates Comprehensive Cancer Center /ID# 1128-0135
🇺🇸Berkeley, California, United States
USC Norris Cancer Center /ID# 1128-0209
🇺🇸Los Angeles, California, United States
St. Joseph Health /ID# 1128-1462
🇺🇸Santa Rosa, California, United States
VA Long Beach Healthcare System /ID# 1128-0480
🇺🇸Long Beach, California, United States
Duplicate_Cancer Specialist of North Florida (CSNF) ( R ) /ID# 1128-1093
🇺🇸Jacksonville, Florida, United States
IACT Health-Columbus /ID# 1128-1389
🇺🇸Columbus, Georgia, United States
Georgetown University Hospital /ID# 1128-0824
🇺🇸Washington, District of Columbia, United States
Northshore Kellogg Cancer Center /ID# 1128-0484
🇺🇸Evanston, Illinois, United States
East Jefferson General Hospital /ID# 1128-1084
🇺🇸Metairie, Louisiana, United States
Barbara Ann Karmanos Cancer In /ID# 1128-0130
🇺🇸Detroit, Michigan, United States
Duplicate_New Mexico Cancer Care Alliance /ID# 1128-0938
🇺🇸Albuquerque, New Mexico, United States
Abramson Cancer Center of the Univ. of Pennsylvania /ID# 1128-0402
🇺🇸Philadelphia, Pennsylvania, United States
Penn State Hershey Medical Ctr /ID# 1128-0220
🇺🇸Hershey, Pennsylvania, United States
Chonnam National University Hwasun Hospital /ID# 1128-0916
🇰🇷Jeonnam, Korea, Republic of
Seoul National University Bundang Hospital /ID# 1128-0982
🇰🇷Seongnam, Gyeonggido, Korea, Republic of
Yonsei University Health System Severance Hospital /ID# 1128-0927
🇰🇷Seoul, Seoul Teugbyeolsi, Korea, Republic of
Korea University Guro Hospital /ID# 1128-0924
🇰🇷Seoul, Korea, Republic of
Nebraska Methodist Hospital /ID# 1128-0229
🇺🇸Omaha, Nebraska, United States
Asan Medical Center /ID# 1128-0963
🇰🇷Seoul, Korea, Republic of
New Jersey Center for Cancer Research /ID# 1128-0493
🇺🇸Brick, New Jersey, United States
Oregon Health & Science University /ID# 1128-0251
🇺🇸Portland, Oregon, United States
Seoul National University Hospital /ID# 1128-0926
🇰🇷Seoul, Korea, Republic of
Hospital Unversitario Marques de Valdecilla /ID# 1128-0973
🇪🇸Santander, Cantabria, Spain
Duplicate_Beatson west of scotland cancer center /ID# 1128-0652
🇬🇧Glasgow, Scotland, United Kingdom
The Catholic University of Korea, Seoul St. Mary's Hospital /ID# 1128-0928
🇰🇷Seoul, Korea, Republic of
Instituto Catalan de Oncologia (ICO) Badalona /ID# 1128-0984
🇪🇸Badalona, Barcelona, Spain
Duplicate_Scott & White Mem Hosp & Clin /ID# 1128-0046
🇺🇸Temple, Texas, United States
Horizon Oncology Research Center /ID# 1128-0337
🇺🇸Lafayette, Indiana, United States
The Royal Marsden NHS Foundation Trust /ID# 1128-0543
🇬🇧London, United Kingdom
Gregory Smith, MD (Private Practice) /ID# 1128-0419
🇺🇸Saint Helena, California, United States