Veliparib With Carboplatin and Paclitaxel and as Continuation Maintenance Therapy in Adults With Newly Diagnosed Stage III or IV, High-grade Serous, Epithelial Ovarian, Fallopian Tube, or Primary Peritoneal Cancer
- Conditions
- Ovarian CancerOvarian Neoplasm
- Interventions
- Registration Number
- NCT02470585
- Lead Sponsor
- AbbVie
- Brief Summary
The primary objective of the study was to evaluate whether progression-free survival (PFS) was prolonged with the addition of veliparib to standard platinum-based chemotherapy (carboplatin/paclitaxel \[C/P\]) and continued as maintenance therapy compared with chemotherapy alone.
- Detailed Description
Participants were randomized in a 1:1:1 ratio to one of three arms. Randomization in the entire population was stratified according to the timing of surgery and residual disease status (any residual disease after primary surgery vs. no residual disease after primary surgery vs. interval surgery) and the paclitaxel schedule (weekly vs. every 3 -weeks), stage of disease (III vs. IV), geographic region (Japan vs. North America and rest of world \[ROW\]), and germline breast cancer susceptibility gene (BRCA) mutation status (positive versus negative or Unknown).
Cytoreductive surgery could be performed before randomization and the initiation of study treatment (primary) or after 3 cycles of study treatment (interval). The weekly or every-3-week paclitaxel schedule and the choice of primary or interval cytoreductive surgery were determined at the discretion of the investigator.
The primary objective was evaluated in the BRCA-deficient cohort, participants with homologous recombination deficiency (HRD), and the intention-to-treat (ITT) population. These populations were sequentially inclusive, with the HRD population including the BRCA-deficient population, and the ITT population including the HRD and BRCA-deficient populations. The BRCA-deficient population was defined as participants with either a germline (gBRCA) and/or tissue-based (tBRCA) deleterious or suspected deleterious mutation in BRCA1 or BRCA2 confirmed by centralized testing. The HRD population was defined as participants with HRD tumors based on HRD score or presence of a deleterious or suspected deleterious mutation in BRCA1 or BRCA2 as determined by centralized testing.
Recruitment & Eligibility
- Status
- TERMINATED
- Sex
- Female
- Target Recruitment
- 1140
- Histologic diagnosis of International Federation of Gynecology and Obstetrics (FIGO) Stage III or IV epithelial ovarian, fallopian tube, or primary peritoneal carcinoma, with the appropriate tissue available for histologic evaluation.
- High-grade serous adenocarcinoma
- Willing to undergo testing for gBRCA.
- Adequate hematologic, renal, and hepatic function.
- Neuropathy (sensory and motor) less than or equal to Grade 1.
- Eastern Cooperative Oncology Group (ECOG) performance status of 0, 1, or 2.
- Participants who undergo primary cytoreductive surgery must be entered between 1 and 12 weeks after surgery. Participants undergoing interval surgery must have a tumor sample confirming the histological diagnosis prior to enrollment.
- Participants with measurable disease or non-measurable disease are eligible. Participants may or may not have cancer-related symptoms.
- Participant has one of the following available for pharmacodynamic analyses including somatic BRCA testing: Archived diagnostic formalin-fixed paraffin embedded (FFPE) tumor tissue; or tumor tissue biopsy collected prior to Cycle 1 Day 1.
- Endometrioid adenocarcinoma, carcinosarcoma, undifferentiated carcinoma, mixed epithelial adenocarcinoma, adenocarcinoma not otherwise specified, mucinous adenocarcinoma, clear cell adenocarcinoma, low-grade serous adenocarcinoma, or malignant Brenner's tumor.
- Participants with synchronous primary endometrial cancer, or a past history of endometrial cancer unless all of the following conditions are met: endometrial cancer stage not greater than IA, no vascular or lymphatic invasion, no poorly differentiated subtypes including serous, clear cell, or other FIGO grade 3 lesions.
- Participants with any evidence of other invasive malignancy being present within the last 3 years (with the exception of non-melanoma skin cancer). Participants are also excluded if their previous cancer treatment contraindicates this protocol's therapy.
- Received prior radiotherapy to any portion of the abdominal cavity or pelvis.
- Received prior chemotherapy for any abdominal or pelvic tumor.
- Clinically significant uncontrolled condition(s).
- Known history of allergic reaction to Cremophor-paclitaxel, carboplatin, Azo-Colourant Tartrazine (also known as FD&C Yellow 5 or E102), Azo-Colourant Orange Yellow-S (also known as FD&C Yellow 6 or E110) or known contraindications to any study supplied drug.
- History or evidence upon physical examination of central nervous system (CNS) disease, including primary brain tumor, any brain metastases, or history of cerebrovascular accident (CVA, stroke), transient ischemic attack (TIA) within 6 months of Cycle 1 Day 1.
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Placebo + Carboplatin + Paclitaxel -> Placebo Placebo to Veliparib Participants will receive placebo to veliparib orally twice a day in combination with carboplatin/paclitaxel for six 21-day cycles followed by placebo monotherapy continuous dosing for an additional thirty 21-day cycles. Veliparib + Carboplatin + Paclitaxel -> Placebo Placebo to Veliparib Participants will receive 150 mg veliparib orally twice a day in combination with carboplatin/paclitaxel for six 21-day cycles followed by placebo monotherapy continuous dosing for an additional thirty 21-day cycles. Placebo + Carboplatin + Paclitaxel -> Placebo Carboplatin Participants will receive placebo to veliparib orally twice a day in combination with carboplatin/paclitaxel for six 21-day cycles followed by placebo monotherapy continuous dosing for an additional thirty 21-day cycles. Placebo + Carboplatin + Paclitaxel -> Placebo Paclitaxel Participants will receive placebo to veliparib orally twice a day in combination with carboplatin/paclitaxel for six 21-day cycles followed by placebo monotherapy continuous dosing for an additional thirty 21-day cycles. Veliparib + Carboplatin + Paclitaxel -> Placebo Veliparib Participants will receive 150 mg veliparib orally twice a day in combination with carboplatin/paclitaxel for six 21-day cycles followed by placebo monotherapy continuous dosing for an additional thirty 21-day cycles. Veliparib + Carboplatin + Paclitaxel -> Placebo Paclitaxel Participants will receive 150 mg veliparib orally twice a day in combination with carboplatin/paclitaxel for six 21-day cycles followed by placebo monotherapy continuous dosing for an additional thirty 21-day cycles. Veliparib + Carboplatin + Paclitaxel -> Placebo Carboplatin Participants will receive 150 mg veliparib orally twice a day in combination with carboplatin/paclitaxel for six 21-day cycles followed by placebo monotherapy continuous dosing for an additional thirty 21-day cycles. Veliparib + Carboplatin + Paclitaxel -> Veliparib Carboplatin Participants will receive 150 mg veliparib orally twice a day in combination with carboplatin/paclitaxel for six 21-day cycles followed by 300/400 mg veliparib monotherapy orally twice a day for an additional thirty 21-day cycles. Veliparib + Carboplatin + Paclitaxel -> Veliparib Veliparib Participants will receive 150 mg veliparib orally twice a day in combination with carboplatin/paclitaxel for six 21-day cycles followed by 300/400 mg veliparib monotherapy orally twice a day for an additional thirty 21-day cycles. Veliparib + Carboplatin + Paclitaxel -> Veliparib Paclitaxel Participants will receive 150 mg veliparib orally twice a day in combination with carboplatin/paclitaxel for six 21-day cycles followed by 300/400 mg veliparib monotherapy orally twice a day for an additional thirty 21-day cycles.
- Primary Outcome Measures
Name Time Method Progression-Free Survival (PFS) in the BRCA-deficient Population (Arm 3 vs Arm 1) From randomization until the primary analysis data cut-off date of 03 May 2019, the median duration of follow-up was 28 months. PFS was defined as the time from the date that the participant was randomized to the date the participant experienced an event of disease progression, according to Response Evaluation Criteria In Solid Tumors (RECIST) criteria version 1.1 (as determined by the investigator) or to the date of death if disease progression was not reached. If the participant did not have an event of disease progression or death prior to the analysis cut-off date, the participant's data were censored at the date of their last evaluable disease assessment. PFS was estimated using the Kaplan-Meier method. The analysis of PFS occurred when the protocol-specified number of PFS events was reached.
Progressive Disease (PD): At least a 20% increase in the size of target lesions, compared with the smallest size recorded since the treatment started, and an absolute increase of ≥ 5 mm, or unequivocal progression of existing non-target lesions or the appearance of new lesions.Progression-Free Survival (PFS) in the Homologous Recombination Deficiency Cohort (Arm 3 vs Arm 1) From randomization until the primary analysis data cut-off date of 03 May 2019, the median duration of follow-up was 28 months. PFS was defined as the time from the date that the participant was randomized to the date the participant experienced an event of disease progression, according to Response Evaluation Criteria In Solid Tumors (RECIST) criteria version 1.1 (as determined by the investigator) or to the date of death if disease progression was not reached. If the participant did not have an event of disease progression or death, the participant's data were censored at the date of their last evaluable disease assessment. PFS was estimated using the Kaplan-Meier method. The primary analysis of PFS occurred when the protocol-specified number of PFS events was reached and was performed in 3 sequentially inclusive populations.
Progressive Disease (PD): At least a 20% increase in the size of target lesions, compared with the smallest size recorded since the treatment started, and an absolute increase of ≥ 5 mm, or unequivocal progression of existing non-target lesions or the appearance of new lesions.
.Progression-Free Survival (PFS) in the Intention-to-treat Population (Arm 3 vs Arm 1) From randomization until the primary analysis data cut-off date of 03 May 2019, the median duration of follow-up was 28 months. PFS was defined as the time from the date that the participant was randomized to the date the participant experienced an event of disease progression, according to Response Evaluation Criteria In Solid Tumors (RECIST) criteria version 1.1 (as determined by the investigator) or to the date of death (all causes of mortality) if disease progression was not reached. If the participant did not have an event of disease progression according to RECIST criteria (as or death, the participant's data were censored at the date of their last evaluable disease assessment. PFS was estimated using the Kaplan-Meier method.
Progressive Disease (PD): At least a 20% increase in the size of target lesions, compared with the smallest size recorded since the treatment started, and an absolute increase of ≥ 5 mm, or unequivocal progression of existing non-target lesions or the appearance of new lesions.
The primary analysis of PFS occurred when the protocol-specified number of PFS events was reached.
- Secondary Outcome Measures
Name Time Method Progression-Free Survival (PFS) in the BRCA-deficient Population (Arm 2 vs Arm 1) From randomization until the primary analysis data cut-off date of 03 May 2019, the median duration of follow-up was 28 months. PFS was defined as the time from the date that the participant was randomized to the date the participant experienced an event of disease progression, according to Response Evaluation Criteria In Solid Tumors (RECIST) criteria version 1.1 (as determined by the investigator) or to the date of death if disease progression was not reached. If the participant did not have an event of disease progression or death prior to the analysis cut-off date, the participant's data were censored at the date of their last evaluable disease assessment. PFS was estimated using the Kaplan-Meier method. The analysis of PFS occurred when the protocol-specified number of PFS events was reached.
Progressive Disease (PD): At least a 20% increase in the size of target lesions, compared with the smallest size recorded since the treatment started, and an absolute increase of ≥ 5 mm, or unequivocal progression of existing non-target lesions or the appearance of new lesions.Progression-Free Survival (PFS) in the Homologous Recombination Deficiency Cohort (Arm 2 vs Arm 1) From randomization until the primary analysis data cut-off date of 03 May 2019, the median duration of follow-up was 28 months. PFS was defined as the time from the date that the participant was randomized to the date the participant experienced an event of disease progression, according to Response Evaluation Criteria In Solid Tumors (RECIST) criteria version 1.1 (as determined by the investigator) or to the date of death if disease progression was not reached. If the participant did not have an event of disease progression or death, the participant's data were censored at the date of their last evaluable disease assessment. PFS was estimated using the Kaplan-Meier method. The primary analysis of PFS occurred when the protocol-specified number of PFS events was reached and was performed in 3 sequentially inclusive populations.
Progressive Disease (PD): At least a 20% increase in the size of target lesions, compared with the smallest size recorded since the treatment started, and an absolute increase of ≥ 5 mm, or unequivocal progression of existing non-target lesions or the appearance of new lesions.
.Progression-Free Survival (PFS) in the Intention-to-treat Population (Arm 2 vs Arm 1) From randomization until the primary analysis data cut-off date of 03 May 2019, the median duration of follow-up was 28 months. PFS was defined as the time from the date that the participant was randomized to the date the participant experienced an event of disease progression, according to Response Evaluation Criteria In Solid Tumors (RECIST) criteria version 1.1 (as determined by the investigator) or to the date of death (all causes of mortality) if disease progression was not reached. If the participant did not have an event of disease progression according to RECIST criteria (as or death, the participant's data were censored at the date of their last evaluable disease assessment. PFS was estimated using the Kaplan-Meier method.
Progressive Disease (PD): At least a 20% increase in the size of target lesions, compared with the smallest size recorded since the treatment started, and an absolute increase of ≥ 5 mm, or unequivocal progression of existing non-target lesions or the appearance of new lesions.
The primary analysis of PFS occurred when the protocol-specified number of PFS events was reached.Overall Survival (OS) in the BRCA-deficient Population From the time of randomization to the end of the study, up to 98 months OS is defined as the time from the day the participant was randomized to the date of death, and was calculated using Kaplan-Meier methods. All events of death will be included, regardless of whether the event occurs while the participant is still taking study drug, or after discontinuation of study drug. If a participant has not died, then the data will be censored at the date the participant is last known to be alive.
Overall Survival (OS) in the Homologous Recombination Deficiency Population From the time of randomization to the end of the study, up to 98 months OS is defined as the time from the day the participant was randomized to the date of death, and was calculated using Kaplan-Meier methods. All events of death will be included, regardless of whether the event occurs while the participant is still taking study drug, or after discontinuation of study drug. If a participant has not died, then the data will be censored at the date the participant is last known to be alive.
Overall Survival (OS) in the Whole Population From the time of randomization to the end of the study, up to 98 months OS is defined as the time from the day the participant was randomized to the date of death, and was calculated using Kaplan-Meier methods. All events of death will be included, regardless of whether the event occurs while the participant is still taking study drug, or after discontinuation of study drug. If a participant has not died, then the data will be censored at the date the participant is last known to be alive.
Change From Baseline in Disease Related Symptom (DRS) Score in the BRCA-mutation Population Baseline and Day 1 of Cycles 3, 5, 7, 9, 11, 13, 15, 17, 19, 21, 23, 25, 27, 29, 31, 33, and 35 The Disease Related Symptom score is a subset of the National Comprehensive Cancer Network Functional Assessment of Cancer Therapy Ovarian Symptom Index-18 (NFOSI-18), which evaluates nine symptoms related to ovarian cancer. The NFOSI-18 DRS score ranges from 0 to 36, with higher scores indicating a lower burden of symptoms and a score of 0 being severely symptomatic. A 3-point difference was defined as clinically meaningful. A positive change from Baseline indicates improvement.
Change from Baseline was calculated using a used a mixed-model for repeated measures (MMRM) with treatment, stratification factors of residual disease and stage of disease, time point and treatment-by-time point interaction as fixed effect factors, and Baseline DRS score as a covariate.
DRS was not included in the fixed-sequence testing procedure.Change From Baseline in Disease Related Symptom (DRS) Score in the HRD Population Baseline and Day 1 of Cycles 3, 5, 7, 9, 11, 13, 15, 17, 19, 21, 23, 25, 27, 29, 31, 33, and 35 The Disease Related Symptom score is a subset of the National Comprehensive Cancer Network Functional Assessment of Cancer Therapy Ovarian Symptom Index-18 (NFOSI-18), which evaluates nine symptoms related to ovarian cancer. The NFOSI-18 DRS score ranges from 0 to 36, with higher scores indicating a lower burden of symptoms and a score of 0 being severely symptomatic. A 3-point difference was defined as clinically meaningful. A positive change from Baseline indicates improvement.
Change from Baseline was calculated using a used a mixed-model for repeated measures (MMRM) with treatment, stratification factors of residual disease and stage of disease, time point and treatment-by-time point interaction as fixed effect factors, and Baseline DRS score as a covariate.
DRS was not included in the fixed-sequence testing procedure.Change From Baseline in Disease Related Symptom (DRS) Score in the Whole Population Baseline and Day 1 of Cycles 3, 5, 7, 9, 11, 13, 15, 17, 19, 21, 23, 25, 27, 29, 31, 33, and 35 The Disease Related Symptom score is a subset of the National Comprehensive Cancer Network Functional Assessment of Cancer Therapy Ovarian Symptom Index-18 (NFOSI-18), which evaluates nine symptoms related to ovarian cancer. The NFOSI-18 DRS score ranges from 0 to 36, with higher scores indicating a lower burden of symptoms and a score of 0 being severely symptomatic. A 3-point difference was defined as clinically meaningful. A positive change from Baseline indicates improvement.
Change from Baseline was calculated using a used a mixed-model for repeated measures (MMRM) with treatment, stratification factors of residual disease, stage of disease, choice of paclitaxel dosing regimen and BRCA-deficient status, time point and treatment-by-time point interaction as fixed effect factors, and Baseline DRS score as a covariate.
DRS was not included in the fixed-sequence testing procedure.
Trial Locations
- Locations (210)
Sinai Hospital of Baltimore /ID# 141306
🇺🇸Baltimore, Maryland, United States
The Ohio State University - Columbus /ID# 138053
🇺🇸Columbus, Ohio, United States
Fox Chase Cancer Center /ID# 149479
🇺🇸Philadelphia, Pennsylvania, United States
Texas Oncology - Medical City Dallas /ID# 143809
🇺🇸Dallas, Texas, United States
Texas Oncology - Medical City Dallas /ID# 143812
🇺🇸Dallas, Texas, United States
University of Chicago /ID# 139612
🇺🇸Chicago, Illinois, United States
Cleveland Clinic Main Campus /ID# 139501
🇺🇸Cleveland, Ohio, United States
Univ Hosp Cleveland /ID# 139615
🇺🇸Cleveland, Ohio, United States
Weinberg Cancer Inst Franklin /ID# 138235
🇺🇸Rossville, Maryland, United States
University of Miami /ID# 139457
🇺🇸Miami, Florida, United States
Houston Methodist Hospital - Scurlock Tower /ID# 138232
🇺🇸Houston, Texas, United States
Memorial Hermann Hospital /ID# 138238
🇺🇸Houston, Texas, United States
Womens Cancer Center of Nevada /ID# 138092
🇺🇸Las Vegas, Nevada, United States
Duke University Medical Center /ID# 138048
🇺🇸Durham, North Carolina, United States
Arizona Oncology Associates, PC-HOPE /ID# 143806
🇺🇸Tucson, Arizona, United States
University of Cincinnati /ID# 139619
🇺🇸Cincinnati, Ohio, United States
University of California, Los Angeles /ID# 138179
🇺🇸Los Angeles, California, United States
SW Gynecologic Oncology Assoc /ID# 147097
🇺🇸Albuquerque, New Mexico, United States
Montefiore Medical Center /ID# 139585
🇺🇸Bronx, New York, United States
Atrium Health Carolinas Medical Center /ID# 139568
🇺🇸Charlotte, North Carolina, United States
Presbyterian Cancer Center /ID# 139590
🇺🇸Charlotte, North Carolina, United States
Icahn School of Med Mt. Sinai /ID# 139617
🇺🇸New York, New York, United States
Columbus NCORP /ID# 139587
🇺🇸Columbus, Ohio, United States
University of Pennsylvania /ID# 140079
🇺🇸Philadelphia, Pennsylvania, United States
Memorial Sloan Kettering Cancer Center /ID# 154464
🇺🇸New York, New York, United States
University of New Mexico /ID# 144220
🇺🇸Albuquerque, New Mexico, United States
Northwell Health /ID# 139572
🇺🇸Lake Success, New York, United States
Willamette Valley Cancer Institute /ID# 140318
🇺🇸Eugene, Oregon, United States
Columbia University Medical Center /ID# 138252
🇺🇸New York, New York, United States
Fairview Hospital /ID# 144403
🇺🇸Cleveland, Ohio, United States
Roswell Park Comprehensive Cancer Center /ID# 138052
🇺🇸Buffalo, New York, United States
Hillcrest Hospital /ID# 144404
🇺🇸Mayfield Heights, Ohio, United States
Women and Infants Hospital /ID# 138083
🇺🇸Providence, Rhode Island, United States
SUNY Upstate Medical University - Downtown /ID# 139513
🇺🇸Syracuse, New York, United States
Texas Oncology - Tyler /ID# 143810
🇺🇸Tyler, Texas, United States
Texas Oncology - Forth Worth /ID# 143811
🇺🇸Fort Worth, Texas, United States
Chattanoogas Program in Womens /ID# 139545
🇺🇸Chattanooga, Tennessee, United States
Reading Hospital /ID# 138057
🇺🇸Reading, Pennsylvania, United States
Sanford Research/USD /ID# 139624
🇺🇸Sioux Falls, South Dakota, United States
SUNY Downstate Medical Center /ID# 139533
🇺🇸Brooklyn, New York, United States
Oklahoma Cancer Specialists /ID# 138059
🇺🇸Tulsa, Oklahoma, United States
Women's Cancer Care Associates /ID# 138234
🇺🇸Albany, New York, United States
University of Pittsburgh MC /ID# 138054
🇺🇸Pittsburgh, Pennsylvania, United States
Multicare Institute for Research and Innovation /ID# 143485
🇺🇸Tacoma, Washington, United States
Royal Womens Hospital /ID# 145136
🇦🇺Parkville, Victoria, Australia
Yamagata University Hospital /ID# 153646
🇯🇵Yamagata-shi, Yamagata, Japan
St. Marianna Univ Hospital /ID# 149327
🇯🇵Kawasaki, Japan
Abington Memorial Hospital /ID# 138086
🇺🇸Abington, Pennsylvania, United States
Samsung Medical Center /ID# 136834
🇰🇷Seoul, Seoul Teugbyeolsi, Korea, Republic of
Hosp Univ 12 de Octubre /ID# 137299
🇪🇸Madrid, Spain
National Cancer Center /ID# 139404
🇰🇷Goyang, Gyeonggido, Korea, Republic of
Instituto Nacional de Câncer José de Alencar Gomes da Silva (INCA) /ID# 137155
🇧🇷Rio de Janeiro, Brazil
Shaare Zedek Medical Center /ID# 137435
🇮🇱Jerusalem, Israel
Texas Oncology - Bedford /ID# 143814
🇺🇸Bedford, Texas, United States
Texas Oncology - The Woodlands /ID# 142003
🇺🇸The Woodlands, Texas, United States
Centro de Referencia da Saude da Mulher - Hospital Perola Byington /ID# 137120
🇧🇷São Paulo, Sao Paulo, Brazil
HSHS St. Vincent Hospital /ID# 139453
🇺🇸Green Bay, Wisconsin, United States
University of Virginia /ID# 138088
🇺🇸Charlottesville, Virginia, United States
Skagit Valley Medical Center /ID# 139586
🇺🇸Mount Vernon, Washington, United States
Southern Medical Day Care Ctr /ID# 145133
🇦🇺Wollongong, New South Wales, Australia
Cabrini Health /ID# 145142
🇦🇺Malvern, Victoria, Australia
Hospital Clinic de Barcelona /ID# 137300
🇪🇸Barcelona, Spain
The Lady Davis Carmel MC /ID# 137537
🇮🇱Haifa, Israel
Kindai University Hospital /ID# 154947
🇯🇵Osaka-sayama, Osaka, Japan
The Cancer Institute Hosp JFCR /ID# 148436
🇯🇵Koto-ku, Tokyo, Japan
Hospital de Cancer de Barretos /ID# 137121
🇧🇷Barretos, Sao Paulo, Brazil
Gangnam Severance Hospital /ID# 136835
🇰🇷Seoul, Seoul Teugbyeolsi, Korea, Republic of
The Jikei Univ. Kashiwa Hosp. /ID# 149238
🇯🇵Kashiwa-shi, Japan
Hospital Duran i Reynals /ID# 137298
🇪🇸L'Hospitalet de Llobregat, Barcelona, Spain
Seoul National University Hospital /ID# 136909
🇰🇷Seoul, Korea, Republic of
Coffs Harbour Health Campus /ID# 145132
🇦🇺Coffs Harbour, New South Wales, Australia
Royal Brisbane and Women's Hospital /ID# 145135
🇦🇺Herston, Queensland, Australia
Westmead Hospital /ID# 145137
🇦🇺Westmead, New South Wales, Australia
Icon Cancer Centre /ID# 148208
🇦🇺South Brisbane, Queensland, Australia
Monash Health /ID# 145297
🇦🇺Clayton, Victoria, Australia
Ninewells Hospital /ID# 137967
🇬🇧Dundee, United Kingdom
Gosford Hospital /ID# 145299
🇦🇺Gosford, New South Wales, Australia
Niigata University Medical & Dental Hospital /ID# 149488
🇯🇵Niigata-shi, Niigata, Japan
National Hospital Organization Kyushu Cancer Center /ID# 149133
🇯🇵Fukuoka-shi, Fukuoka, Japan
Korea University Anam Hospital /ID# 136908
🇰🇷성북구, Gyeonggido, Korea, Republic of
Hospital Univ Vall d'Hebron /ID# 137297
🇪🇸Barcelona, Spain
Fundacion Inst Valenciano Onc /ID# 137403
🇪🇸Valencia, Spain
Oxford Univ Hosp NHS Trust /ID# 137973
🇬🇧Oxford, United Kingdom
Auckland City Hospital /ID# 145123
🇳🇿Auckland, New Zealand
The Jikei University Hospital /ID# 148691
🇯🇵Tokyo, Japan
NHO Kure Medical Center and Ch /ID# 148569
🇯🇵Kure, Japan
Hosp Univ Madrid Sanchinarro /ID# 137414
🇪🇸Madrid, Spain
James Paget University Hosp /ID# 137970
🇬🇧Great Yarmouth, United Kingdom
Univ Kansas Med Ctr /ID# 140322
🇺🇸Kansas City, Kansas, United States
St. John of God Subiaco Hosp /ID# 147742
🇦🇺Subiaco, Western Australia, Australia
Sir Charles Gairdner Hospital /ID# 145140
🇦🇺Nedlands, Western Australia, Australia
Hc Ufmg /Id# 137156
🇧🇷Belo Horizonte, Minas Gerais, Brazil
Hospital Sao Lucas da PUCRS /ID# 137157
🇧🇷Porto Alegre, Rio Grande Do Sul, Brazil
Univ Oklahoma HSC /ID# 138020
🇺🇸Oklahoma City, Oklahoma, United States
California Pacific Medical Ctr /ID# 138177
🇺🇸San Francisco, California, United States
University of Utah /ID# 138250
🇺🇸Salt Lake City, Utah, United States
Wayne State University /ID# 139601
🇺🇸Detroit, Michigan, United States
Regionshospitalet Herning /ID# 137260
🇩🇰Herning, Denmark
Kaiser Permanente, NW /ID# 138249
🇺🇸Portland, Oregon, United States
Keio University Hospital /ID# 148326
🇯🇵Shinjuku-ku, Tokyo, Japan
Norfolk and Norwich Univ Hosp /ID# 137969
🇬🇧Norwich, Norfolk, United Kingdom
Uniwersyteckie C. Kliniczne /ID# 138021
🇵🇱Gdańsk, Poland
Mayo Clinic - Rochester /ID# 139565
🇺🇸Rochester, Minnesota, United States
Shizuoka Cancer Center /ID# 147723
🇯🇵Sunto-gun, Shizuoka, Japan
Shikoku Cancer Center /ID# 148382
🇯🇵Matsuyama, Japan
Osaka International Cancer Institute /ID# 150778
🇯🇵Osaka, Japan
Hokkaido Cancer Center /ID# 148570
🇯🇵Sapporo, Japan
Asan Medical Center /ID# 136836
🇰🇷Seoul, Korea, Republic of
Memorial Sloan Kettering Cancer Center /ID# 138017
🇺🇸New York, New York, United States
Womens Cancer Center /ID# 138062
🇺🇸Kettering, Ohio, United States
Univ of Colorado Cancer Center /ID# 138016
🇺🇸Aurora, Colorado, United States
Moffitt Cancer Center /ID# 138061
🇺🇸Tampa, Florida, United States
Nebraska Methodist Hospital /ID# 139600
🇺🇸Omaha, Nebraska, United States
Froedtert & the Medical College of Wisconsin /ID# 139449
🇺🇸Milwaukee, Wisconsin, United States
UC Davis Comprehensive Cancer Center - Main /ID# 144439
🇺🇸Sacramento, California, United States
University of Alabama at Birmingham - Main /ID# 138087
🇺🇸Birmingham, Alabama, United States
Arizona Oncology Associates, PC-HOPE /ID# 142002
🇺🇸Tucson, Arizona, United States
University of South Alabama /ID# 138091
🇺🇸Mobile, Alabama, United States
Tennessee Valley Gyn-Onc /ID# 139548
🇺🇸Huntsville, Alabama, United States
Arizona Oncology Associates, PC-HOPE /ID# 143808
🇺🇸Tucson, Arizona, United States
Alaska Womens Cancer Care /ID# 138231
🇺🇸Anchorage, Alaska, United States
University of Arizona Cancer Center - North Campus /ID# 138084
🇺🇸Tucson, Arizona, United States
University of Arizona Cancer Center - North Campus /ID# 139495
🇺🇸Tucson, Arizona, United States
John Muir Medical Center /ID# 139618
🇺🇸Concord, California, United States
University of Arkansas for Medical Sciences /ID# 138253
🇺🇸Little Rock, Arkansas, United States
Ucsd /Id# 140323
🇺🇸La Jolla, California, United States
Long Beach Memorial Medical Ct /ID# 147526
🇺🇸Long Beach, California, United States
Kaiser Permanente /ID# 141305
🇺🇸Los Angeles, California, United States
Medical Oncology Care Assoc /ID# 139498
🇺🇸Orange, California, United States
Univ CA, Irvine Med Ctr /ID# 139613
🇺🇸Orange, California, United States
Kaiser Permanente - San Francisco /ID# 142051
🇺🇸San Francisco, California, United States
Univ California, San Francisco /ID# 138178
🇺🇸San Francisco, California, United States
Kaiser Permanente-Santa Clara /ID# 142053
🇺🇸Santa Clara, California, United States
Stanford University School of Med /ID# 139450
🇺🇸Stanford, California, United States
Kaiser Permanente Medical Ctr-Vallejo /ID# 139492
🇺🇸Vallejo, California, United States
Kaiser Permanente, Waterpark III Institute for Health Research /ID# 139499
🇺🇸Aurora, Colorado, United States
Hartford Healthcare /ID# 138184
🇺🇸New Britain, Connecticut, United States
Kaiser Permanente- Walnut Creek /ID# 142052
🇺🇸Walnut Creek, California, United States
Women's Cancer Associates /ID# 140321
🇺🇸Saint Petersburg, Florida, United States
Georgia Regents University /ID# 138085
🇺🇸Augusta, Georgia, United States
Sarasota Memorial Health Care /ID# 138180
🇺🇸Sarasota, Florida, United States
Kapiolani Medical Center /ID# 140319
🇺🇸Honolulu, Hawaii, United States
NorthShore University HealthSystem - Evanston Hospital /ID# 139451
🇺🇸Evanston, Illinois, United States
The Queens Medical Center /ID# 141709
🇺🇸Honolulu, Hawaii, United States
Sharma, Hinsdale, IL /ID# 140326
🇺🇸Hinsdale, Illinois, United States
Advocate Lutheran General Hosp /ID# 139489
🇺🇸Park Ridge, Illinois, United States
St. Joseph's/Candler /ID# 138090
🇺🇸Savannah, Georgia, United States
Rush University Medical Center /ID# 143491
🇺🇸Chicago, Illinois, United States
Saint Vincent /ID# 139537
🇺🇸Indianapolis, Indiana, United States
University of Iowa Hospitals and Clinics /ID# 138082
🇺🇸Iowa City, Iowa, United States
McFarland Clinic, PC /ID# 139455
🇺🇸Ames, Iowa, United States
Greater Baltimore Medical Ctr /ID# 138049
🇺🇸Baltimore, Maryland, United States
University of Kentucky Chandler Medical Center /ID# 138060
🇺🇸Lexington, Kentucky, United States
Baptist Health Lexington /ID# 139542
🇺🇸Lexington, Kentucky, United States
MMP Women's Health /ID# 139544
🇺🇸Portland, Maine, United States
UMass Memorial Medical Center /ID# 139458
🇺🇸Worcester, Massachusetts, United States
Baystate Medical Center /ID# 139456
🇺🇸Springfield, Massachusetts, United States
Henry Ford Health System /ID# 139536
🇺🇸Detroit, Michigan, United States
William Beaumont Hospital /ID# 139550
🇺🇸Royal Oak, Michigan, United States
Mmcorc /Id# 139534
🇺🇸Saint Louis Park, Minnesota, United States
St. Dominic Hospital /ID# 138241
🇺🇸Jackson, Mississippi, United States
Ellis Fischel Cancer Center /ID# 139571
🇺🇸Columbia, Missouri, United States
Ferrell-Duncan Clinic /ID# 143484
🇺🇸Springfield, Missouri, United States
MD Anderson Cancer Ctr at Coop /ID# 139616
🇺🇸Camden, New Jersey, United States
Renown Regional Medical Center /ID# 138237
🇺🇸Reno, Nevada, United States
Dartmouth-Hitchcock Medical Center /ID# 139502
🇺🇸Lebanon, New Hampshire, United States
Hope Womens Cancer Centers /ID# 139614
🇺🇸Asheville, North Carolina, United States
University of Vermont Medical Center /ID# 138251
🇺🇸Burlington, Vermont, United States
Carilion Roanoke Memorial Hosp /ID# 139602
🇺🇸Roanoke, Virginia, United States
MultiCare Regional Cancer Ctr /ID# 149872
🇺🇸Puyallup, Washington, United States
The Prince of Wales Hospital /ID# 145134
🇦🇺Randwick, New South Wales, Australia
Calvary Mater Newcastle /ID# 145139
🇦🇺Waratah, New South Wales, Australia
Northern Cancer Institute /ID# 145681
🇦🇺St Leonards, New South Wales, Australia
Newcastle Private Hospital /ID# 145834
🇦🇺Lambton Heights, New South Wales, Australia
Mater Misericordiae Limited /ID# 145682
🇦🇺South Brisbane, Queensland, Australia
Vejle Sygehus /ID# 137262
🇩🇰Vejle, Syddanmark, Denmark
Rambam Health Care Campus /ID# 137434
🇮🇱Haifa, Israel
Sheba Medical Center /ID# 137436
🇮🇱Ramat Gan, Israel
Meir Medical Center /ID# 139397
🇮🇱Kfar Saba, Israel
Kurume University Hospital /ID# 148697
🇯🇵Kurume-shi, Fukuoka, Japan
Iwate Medical University Hospital /ID# 147721
🇯🇵Shiwa-gun, Iwate, Japan
Kaplan Medical Center /ID# 137536
🇮🇱Rehovot, Israel
Aichi Cancer Center Hospital /ID# 148398
🇯🇵Nagoya-shi, Aichi, Japan
Mie University Hospital /ID# 149169
🇯🇵Tsu-shi, Mie, Japan
Kumamoto University Hospital /ID# 154169
🇯🇵Kumamoto-shi, Kumamoto, Japan
Tohoku University Hospital /ID# 149818
🇯🇵Sendai-shi, Miyagi, Japan
Hyogo Cancer Center /ID# 148327
🇯🇵Akashi, Japan
Kansai Rosai Hospital /ID# 149237
🇯🇵Amagasaki, Japan
Hospital Clin Univ San Carlos /ID# 137402
🇪🇸Madrid, Spain
IACT Health /ID# 138058
🇺🇸Columbus, Georgia, United States
Washington University-School of Medicine /ID# 138089
🇺🇸Saint Louis, Missouri, United States
Palo Alto Medical Foundation /ID# 139452
🇺🇸Sunnyvale, California, United States
Indiana Univ School Medicine /ID# 139610
🇺🇸Indianapolis, Indiana, United States
Memorial Health Univ Med Ctr /ID# 138019
🇺🇸Savannah, Georgia, United States
Cancer Research For the Ozarks /ID# 139538
🇺🇸Springfield, Missouri, United States
Thomas Jefferson University /ID# 138239
🇺🇸Philadelphia, Pennsylvania, United States
St George Hospital /ID# 145138
🇦🇺Kogarah, New South Wales, Australia
The Townsville Hospital /ID# 149163
🇦🇺Douglas, Queensland, Australia
Wake Forest Baptist Medical Center /ID# 139588
🇺🇸Winston-Salem, North Carolina, United States
Royal Adelaide Hospital /ID# 150071
🇦🇺Adelaide, South Australia, Australia
Hackensack Univ Med Ctr /ID# 143776
🇺🇸Hackensack, New Jersey, United States
Medical University of South Carolina /ID# 138181
🇺🇸Charleston, South Carolina, United States
Univ NC Chapel Hill /ID# 138547
🇺🇸Chapel Hill, North Carolina, United States
Yale University /ID# 138056
🇺🇸New Haven, Connecticut, United States
Norton Cancer Institute /ID# 139567
🇺🇸Louisville, Kentucky, United States
Texas Oncology - Austin Central /ID# 143817
🇺🇸Austin, Texas, United States
Texas Oncology - South Austin /ID# 143818
🇺🇸Austin, Texas, United States
Arizona Oncology Associates, PC-HOPE /ID# 143805
🇺🇸Tucson, Arizona, United States
Beatson west of scotland cancer center /ID# 137965
🇬🇧Glasgow, Scotland, United Kingdom
Imanova Limited, Hammersmith Hospital /ID# 137966
🇬🇧London, United Kingdom