A Study Comparing Teclistamab Monotherapy Versus Pomalidomide, Bortezomib, Dexamethasone (PVd) or Carfilzomib, Dexamethasone (Kd) in Participants With Relapsed or Refractory Multiple Myeloma
- Conditions
- Relapsed or Refractory Multiple Myeloma
- Interventions
- Registration Number
- NCT05572515
- Lead Sponsor
- Janssen Research & Development, LLC
- Brief Summary
The purpose of this study is to compare the efficacy of teclistamab with PVd/Kd in Part 1 and to further characterize safety and efficacy of an alternative dosing for teclistamab in Part 2 in participants with relapsed or refractory multiple myeloma.
- Detailed Description
Multiple myeloma is an incurable, malignant, plasma cell disorder. Teclistamab (JNJ-64007957) is a full-size, Immunoglobulin G (IgG) 4 proline, alanine, and alanine (PAA) bispecific antibody that targets the cluster of differentiation (CD3) receptor expressed on the surface of T cells and B cell maturation antigen (BCMA). With its dual binding sites, teclistamab is able to draw CD3 positive T cells in close proximity to BCMA positive cells, resulting in T-cell activation and subsequent lysis of BCMA positive cells. Pomalidomide is a third-generation immunomodulatory imide drug (IMiD) that exerts potent, direct tumoricidal and immune-enhancing effects and Carfilzomib is a second-generation proteasome inhibitor that inhibits proteasome which results in disruption of protein turnover and induces apoptosis. The primary hypothesis of this study is that teclistamab monotherapy (Arm A) will significantly improve progression free survival (PFS) compared with investigator's choice of PVd or Kd (Arm B) in participants with relapsed or refractory multiple myeloma who have received 1 to 3 prior lines of therapy, including an anti-CD38 monoclonal antibody and lenalidomide. The study will include a screening phase, treatment phase, and follow-up phase. Safety will be assessed by physical examinations, neurologic examinations, eastern cooperative oncology group (ECOG) performance status, clinical laboratory tests, vital signs, and AE monitoring. The overall duration of the study will be up to 9 years.
Recruitment & Eligibility
- Status
- RECRUITING
- Sex
- All
- Target Recruitment
- 650
- Documented diagnosis of multiple myeloma as defined by the criteria below: (a)Multiple myeloma diagnosis according to International Myeloma Working Group (IMWG) diagnostic criteria (b) Measurable disease at screening as defined by any of the following: (1) Serum M-protein level greater than or equal to (>=)0.5 grams per deciliter (g/dL) (central laboratory); or (2) Urine M-protein level >=200 milligrams (mg)/24 hours (central laboratory); or (3) Serum immunoglobulin free light chain >=10 milligrams per deciliter (mg/dL) (central laboratory) and abnormal serum immunoglobulin kappa lambda free light chain ratio
- Received 1 to 3 prior lines of antimyeloma therapy including a minimum of 2 consecutive cycles of an anti- cluster of differentiation 38 (CD38) monoclonal antibody at the approved dosing regimen in any prior line and 2 consecutive cycles of lenalidomide in any prior line
- Documented evidence of progressive disease or failure to achieve a response to last line of therapy based on investigator's determination of response by International myeloma working group (IMWG) criteria
- Have an Eastern Cooperative Oncology Group (ECOG) performance status score of 0 to 2
- A female participant must agree not to be pregnant, breast-feeding, or plan to become pregnant while enrolled in this study or within 6 months after the last dose of study treatment
- Must be willing and able to adhere to the lifestyle restrictions specified in this protocol
- Received any prior B cell maturation antigen (BCMA)-directed therapy
- A participant is not eligible to receive PVd as control therapy if any of the following are present: (1) Received prior pomalidomide therapy, (2) Does not meet criteria for bortezomib retreatment (3) Contraindications or life-threatening allergies, hypersensitivity, or intolerance to pomalidomide or bortezomib, (4) Grade 1 peripheral neuropathy with pain or Grade greater than or equal to (>=) 2 peripheral neuropathy as defined by National Cancer Institute Common Terminology Criteria for Adverse Events (NCI-CTCAE) Version 5.0, (5) Received a strong cytochrome P (CYP) 3A4 inducer within 5 half-lives prior to randomization; A participant is not eligible to receive Kd as control therapy if any of the following are present:(1) Received prior carfilzomib therapy, (2) Uncontrolled hypertension, defined as an average systolic blood pressure greater than (>)159 millimeters of mercury (mmHg) or diastolic blood pressure >99 mmHg despite optimal treatment (3) Grade 2 peripheral neuropathy with pain or Grade >=3 peripheral neuropathy as defined by NCI-CTCAE Version 5.0, (4) Contraindications or life-threatening allergies, hypersensitivity, or intolerance to carfilzomib (intolerance defined as prior therapy discontinued due to any adverse event [AE] related to carfilzomib)
- Received a maximum cumulative dose of corticosteroids of >=140 mg of prednisone or equivalent within 14 days prior to randomization
- Received a live, attenuated vaccine within 4 weeks before randomization
- Central nervous system (CNS) involvement or clinical signs of meningeal involvement of multiple myeloma
- Plasma cell leukemia at the time of screening, Waldenstrom's macroglobulinemia, polyneuropathy, organomegaly, endocrinopathy, M-protein (POEMS) syndrome and skin changes, or primary amyloid light chain amyloidosis
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Teclistamab Teclistamab Participants will receive teclistamab monotherapy in Part 1 and an alternative dosing regimen of teclistamab in Part 2. Pomalidomide, Bortezomib and Dexamethasone (PVd) or Carfilzomib and Dexamethasone (Kd) Pomalidomide Participants will receive either PVd or Kd based on principal investigator's choice during Part 1 of the study. Pomalidomide, Bortezomib and Dexamethasone (PVd) or Carfilzomib and Dexamethasone (Kd) Bortezomib Participants will receive either PVd or Kd based on principal investigator's choice during Part 1 of the study. Pomalidomide, Bortezomib and Dexamethasone (PVd) or Carfilzomib and Dexamethasone (Kd) Dexamethasone Participants will receive either PVd or Kd based on principal investigator's choice during Part 1 of the study. Pomalidomide, Bortezomib and Dexamethasone (PVd) or Carfilzomib and Dexamethasone (Kd) Carfilzomib Participants will receive either PVd or Kd based on principal investigator's choice during Part 1 of the study.
- Primary Outcome Measures
Name Time Method Part 1: Progression-free Survival (PFS) Up to 9 years PFS is defined as the time from the date of randomization to the date of first documented disease progression, as defined in the International myeloma working group (IMWG) 2016 response criteria, or death due to any cause, whichever occurs first.
Part 2: Number of Participants Reporting Cytokine Release Syndrome (CRS) Cases by Severity Up to 9 years Severity for CRS will be graded as follows: Grade 1: Fever (Temperature greater than or equal to \[\>=\] 38°C); Grade 2: Fever (Temperature \>=38°C) with either: hypotension and/or hypoxia requiring low-flow nasal cannula or blow-by; Grade 3: Fever (Temperature \>=38°C) with either: hypotension and/or hypoxia requiring high-flow nasal cannula, facemask, nonrebreather mask, or Venturi mask; Grade 4: Fever (Temperature \>=38°C) with either: hypotension requiring multiple vasopressors (excluding vasopressin), and/or hypoxia requiring positive pressure and Grade 5: Death.
- Secondary Outcome Measures
Name Time Method Part 1 and 2: Overall Response (Partial Response [PR] or Better) Up to 9 years Overall response (PR or better) is defined as participants who have a PR or better prior to subsequent antimyeloma therapy in accordance with the IMWG 2016 criteria.
Part 1 and 2: Very Good Partial Response (VGPR) or Better Response Up to 9 years VGPR or better (Stringent Complete Response \[sCR\]+Complete Response \[CR\]+VGPR) is defined as participants who achieve a VGPR or better response prior to subsequent antimyeloma therapy in accordance with the IMWG 2016 criteria.
Part 1 and 2: Complete Response (CR) or Better Response Up to 9 years CR or better response is defined as participants who achieve a CR or better response prior to subsequent antimyeloma therapy in accordance with the IMWG 2016 criteria.
Part 1: Duration of Response (DOR) Up to 9 years DOR is defined as the time interval between the date of initial documentation of a response (PR or better) to the date of first documented evidence of progressive disease according to the IMWG 2016 response criteria or death due to any cause, whichever occurs first.
Part 1: Time to Next Treatment (TTNT) Up to 9 years TTNT is defined as the time from randomization to the start of subsequent antimyeloma treatment.
Part 1: Progression-free Survival on Next-line Therapy (PFS2) Up to 9 years PFS2 is defined as the time interval between the date of randomization and date of event, which is defined as progressive disease as assessed by investigator on the first subsequent line of antimyeloma therapy, or death from any cause, whichever occurs first.
Part 1: Overall Survival (OS) Up to 9 years OS is defined as the time from the date of randomization to the date of the participant's death due to any cause.
Part 1 and 2: Number of Participants with Adverse Events (AEs) by Severity Up to 9 years Number of participants with AEs by Severity will be reported.
Part 1 and 2: Number of Participants with Serious Adverse Events (SAEs) by Severity Up to 9 years Number of participants with SAEs by Severity will be reported.
Part 1 and 2: Number of Participants with Abnormal Laboratory Results Up to 9 years Number of participants with abnormal laboratory results (such as hematology and chemistry) will be reported.
Part 1 and 2: Serum Concentrations of Teclistamab Up to 9 years Serum concentrations of teclistamab will be reported.
Part 1 and 2: Number of Participants with Anti-drug Antibodies (ADAs) to Teclistamab Up to 9 years Number of participants with ADAs to teclistamab will be reported.
Part 1: Change from Baseline in Symptoms, Functioning, and Overall Health-related Quality of Life (HRQoL) as Assessed by European Organization for Research and Treatment of Cancer Quality-of-life Questionnaire Core 30 (EORTC-QLQ-C30) Baseline up to 9 years Change from baseline in symptoms, functioning, and overall HRQoL assessed by EORTC QLQ-C30 score version 3 will be reported. The EORTC- QLQ-C30 Version 3 includes 30 items that make up 5 functional scales (physical, role, emotional, cognitive, and social), 1 global health status scale, 3 symptom scales (pain, fatigue, and nausea/vomiting), and 6 single symptom items (dyspnea, insomnia, appetite loss, constipation, diarrhea, and financial difficulties). The item and scale scores are transformed to a 0 to 100 scale. A high scale score represents a higher response level. Thus, a high score for a functional scale represents a high/healthy level of functioning and a high score for the global health status represents high HRQoL, but a high score for a symptom scale/item represents a high level of symptomatology/problems.
Part 1: Change from Baseline in Symptoms, Functioning, and Overall HRQoL as Assessed by Multiple Myeloma Symptom and Impact Questionnaire (MySIm-Q) Scale Score Baseline up to 9 years Change from baseline in symptoms, functioning, and overall HRQoL assessed by MySIm-Q will be reported. The MySIm-Q is a disease-specific PRO assessment complementary to the EORTC-QLQ-C30. It includes 17 items resulting in a symptom subscale and an impact subscale. The recall period is the "past 7 days", and responses are reported on a 5-point verbal rating scale.
Part 1: Change from Baseline in Symptoms, Functioning, and Overall HRQoL as Assessed by Patient-reported Outcomes Version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE) Baseline up to 9 years Change from baseline in symptoms, functioning, and overall HRQoL assessed by PRO-CTCAE will be reported. The National Cancer Institute's (NCI's) PRO-CTCAE is an item library of common adverse events experienced by people with cancer that are appropriate for self-reporting of treatment tolerability. Each symptom selected for inclusion can be rated by up to 3 attributes characterizing the presence/frequency, severity, and/or interference of the AEs. It ranges from 0 to 4 with higher scores indicating higher frequency or greater severity/impact.
Part 1: Change from Baseline in Symptoms, Functioning, and Overall HRQoL as Assessed by EuroQol Five Dimension Questionnaire 5-Level (EQ-5D-5L) Baseline up to 9 years Change from baseline in symptoms, functioning, and overall HRQoL assessed by EQ-5D-5L will be reported. The EQ-5D-5L is a generic measure of health status. The EQ-5D-5L is a 5-item questionnaire that assesses 5 domains including mobility, self-care, usual activities, pain/discomfort, and anxiety/depression plus a visual analog scale rating "health today" with anchors ranging from 0 (worst imaginable health state) to 100 (best imaginable health state).
Part 1: Time to Worsening in Symptoms, Functioning, and Overall HRQoL Up to 9 years Time to worsening in symptoms, functioning, and overall HRQoL will be measured as the interval from the date of randomization to the start date of meaningful change.
Part 1: PFS in Participants in High-risk Molecular Features Up to 9 years PFS in participants in high-risk molecular features will be reported. PFS is defined as the time from the date of randomization to the date of first documented disease progression, as defined in the IMWG 2016 response criteria, or death due to any cause, whichever occurs first.
Part 1: Depth of Response in Participants in High-risk Molecular Features Up to 9 years Depth of response in participants in high-risk molecular features will be reported.
Trial Locations
- Locations (209)
Banner MD Anderson Cancer Center
🇺🇸Gilbert, Arizona, United States
CHR de la Citadelle
🇧🇪Liege, Belgium
Hospitais Integradaos da Gavea S/A - DF Star
🇧🇷Brasilia, Brazil
Clinica Medica Sao Germano LTDA
🇧🇷Sao Paulo, Brazil
Wuhan Union Hospital
🇨🇳Wuhan, China
Wuxi People s Hospital
🇨🇳Wuxi, China
Centre Hospitalier du Mans
🇫🇷Le Mans, France
Hopital Saint Vincent de Paul
🇫🇷Lille, France
CHU de Montpellier Hopital Saint Eloi
🇫🇷Montpellier, France
CHU Nantes
🇫🇷Nantes Cedex 1, France
Hopital Saint-Antoine
🇫🇷Paris, France
Hopital de la Pitie Salpetriere
🇫🇷Paris, France
Hopital Necker Enfants Malades
🇫🇷Paris, France
Institut Universitaire du Cancer Toulouse Oncopole
🇫🇷Toulouse, France
Hospital Queen Elizabeth
🇲🇾Kota Kinabalu, Malaysia
University Malaya Medical Centre
🇲🇾Kuala Lumpur, Malaysia
Subang Jaya Medical Centre
🇲🇾Subang Jaya, Malaysia
Meander Medisch Centrum
🇳🇱Amersfoort, Netherlands
VUMC Amsterdam
🇳🇱Amsterdam, Netherlands
Uls Braga - Hosp. Braga
🇵🇹Braga, Portugal
Champalimaud Foundation Champalimaud Centre
🇵🇹Lisbon, Portugal
Instituto Portugues de Oncologia
🇵🇹Porto, Portugal
Uls Gaia Espinho
🇵🇹Vila Nova de Gaia, Portugal
Hosp. Univ. Germans Trias I Pujol
🇪🇸Badalona, Spain
Institut Catala d Oncologia L Hospitalet
🇪🇸Hospitalet de Llobregat, Spain
Hosp. de Jerez de La Frontera
🇪🇸Jerez de la Frontera, Spain
Hosp. de Leon
🇪🇸Leon, Spain
Hosp. Univ. Infanta Leonor
🇪🇸Madrid, Spain
Hosp. Univ. Ramon Y Cajal
🇪🇸Madrid, Spain
Hosp. Univ. 12 de Octubre
🇪🇸Madrid, Spain
Hosp. Gral. Univ. J.M. Morales Meseguer
🇪🇸Murcia, Spain
Alaska Oncology and Hematology LLC
🇺🇸Anchorage, Alaska, United States
Alta Bates Comprehensive Cancer Center
🇺🇸Berkeley, California, United States
MemorialCare Long Beach Medical Center
🇺🇸Long Beach, California, United States
University of California Irvine
🇺🇸Orange, California, United States
PIH Health Hospital
🇺🇸Whittier, California, United States
Rocky Mountain Cancer Centers
🇺🇸Aurora, Colorado, United States
University of Connecticut
🇺🇸Farmington, Connecticut, United States
University of Miami Sylvester Cancer Center
🇺🇸Miami, Florida, United States
Orlando Health Cancer Institute
🇺🇸Orlando, Florida, United States
Cleveland Clinic Florida
🇺🇸Weston, Florida, United States
Mission Cancer Blood
🇺🇸Des Moines, Iowa, United States
East Jefferson General Hospital Bone Marrow Transport Clinic
🇺🇸Metairie, Louisiana, United States
Walter Reed National Military Medical Center
🇺🇸Bethesda, Maryland, United States
Maryland Oncology Hematology P A
🇺🇸Silver Spring, Maryland, United States
Boston University Medical Center
🇺🇸Boston, Massachusetts, United States
Saint Lukes Hospital Saint Lukes Cancer Specialists
🇺🇸Chesterfield, Missouri, United States
Cooper Health System MD Anderson Cancer Center at Cooper
🇺🇸Camden, New Jersey, United States
Herbert Irving Comprehensive Cancer Center Columbia University Medical Center
🇺🇸New York, New York, United States
Durham VAMC
🇺🇸Durham, North Carolina, United States
Penn Medicine Lancaster General Health
🇺🇸Lancaster, Pennsylvania, United States
Brooke Army Medical Center
🇺🇸Fort Sam Houston, Texas, United States
Baylor College of Medicine
🇺🇸Houston, Texas, United States
Michael E DeBakey VA Medical Center
🇺🇸Houston, Texas, United States
Harris Health Smith Clinic
🇺🇸Houston, Texas, United States
Utah Cancer Specialists
🇺🇸Salt Lake City, Utah, United States
Alexander T. Augusta Military Medical Center
🇺🇸Fort Belvoir, Virginia, United States
Virginia Oncology Associates
🇺🇸Norfolk, Virginia, United States
NorthWest Medical Specialties, PLLC
🇺🇸Tacoma, Washington, United States
Blacktown Hospital
🇦🇺Blacktown, Australia
St Vincents Hospital Melbourne
🇦🇺Fitzroy, Australia
Box Hill Hospital
🇦🇺Melbourne, Australia
Fiona Stanley Hospital
🇦🇺Murdoch, Australia
Sir Charles Gairdner Hospital
🇦🇺Nedlands, Australia
LKH - Universitätsklinikum der PMU Salzburg
🇦🇹Salzburg, Austria
Medical University Vienna MUV
🇦🇹Vienna, Austria
Algemeen Ziekenhuis Klina
🇧🇪Brasschaat, Belgium
Jolimont
🇧🇪Haine-St-Paul, Belgium
Az Groeninge
🇧🇪Kortrijk, Belgium
Universitair Ziekenhuis Gasthuisberg
🇧🇪Leuven, Belgium
Fundacao Universidade de Caxias do Sul
🇧🇷Caxias do Sul, Brazil
Liga Paranaense de Combate ao Cancer
🇧🇷Curitiba, Brazil
Instituto Joinvilense de Hematologia e Oncologia Ltda Centro de Hematologia e Oncologia
🇧🇷Joinville, Brazil
Liga Norte Riograndense Contra O Cancer
🇧🇷Natal, Brazil
Complexo Hospitalar de Niteroi
🇧🇷Niteroi, Brazil
Instituto de Educacao, Pesquisa e Gestao em Saude Instituto Americas (COI)
🇧🇷Rio de Janeiro, Brazil
Hospital Sao Rafael
🇧🇷Salvador, Brazil
Fundacao Faculdade Regional de Medicina de Sao Jose do Rio Preto Hospital de Base
🇧🇷Sao Jose do Rio Preto, Brazil
Sociedade Beneficente de Senhoras Hospital Sirio Libanes
🇧🇷Sao Paulo, Brazil
Instituto D Or de Pesquisa e Ensino IDOR
🇧🇷Sao Paulo, Brazil
Fundacao Antonio Prudente A C Camargo Cancer Center
🇧🇷Sao Paulo, Brazil
Real e Benemérita Associação Portuguesa de Beneficência
🇧🇷São Paulo, Brazil
Hospital Alemao Oswaldo Cruz
🇧🇷São Paulo, Brazil
Sociedade Beneficente Israelita Brasileira Hospital Albert Einstein
🇧🇷São Paulo, Brazil
Arthur J E Child Comprehensive Cancer Centre
🇨🇦Calgary, Alberta, Canada
Saint John Regional Hospital
🇨🇦Saint John, New Brunswick, Canada
Brampton Civic Hospital
🇨🇦Brampton, Ontario, Canada
Lakeridge Health Oshawa
🇨🇦Oshawa, Ontario, Canada
CIUSSS de l Est de l Ile de Montreal Installation Hopital Maisonneuve Rosemont
🇨🇦Montreal, Quebec, Canada
Beijing Chaoyang Hospital
🇨🇳Beijing, China
BeiJing JiShuiTan Hospital
🇨🇳Beijing, China
The First Bethune Hospital of Jilin University
🇨🇳Changchun, China
The Third Xiangya Hospital, Central South University
🇨🇳Changsha, China
Sichuan Provincial Peoples Hospital
🇨🇳Chengdu, China
Chongqing University Cancer Hospital
🇨🇳Chongqing, China
Fujian Meidical University Union Hospital
🇨🇳Fu Zhou, China
Sun Yat -Sen University Cancer Center
🇨🇳Guangzhou, China
First affiliated Hospital of Zhejiang University
🇨🇳Hangzhou, China
Harbin medical university cancer hospital
🇨🇳Harbin, China
The First Affiliated Hospital of NanChang University
🇨🇳Nanchang, China
ASUI Santa Maria della Misericordia di Udine
🇮🇹Udine, Italy
Nanjing Drum Tower Hospital
🇨🇳Nanjing, China
First Affiliated Hospital of Guangxi Medical University
🇨🇳Nanning, China
Shanghai Fourth People s Hospital
🇨🇳Shanghai, China
Shengjing Hospital Of China Medical University
🇨🇳Shenyang, China
Shenzhen 2nd People's Hospital
🇨🇳Shenzhen, China
Institute of Hematology and Blood Diseases Hospital
🇨🇳Tian Jin, China
Tianjin Medical University Cancer Institute and Hospital
🇨🇳Tianjin, China
Campus Bio Medico di Roma
🇮🇹Roma, Italy
The First Affiliated Hospital of Wenzhou Medical University
🇨🇳Wenzhou, China
The Second Affiliated Hospital of Xi'an Jiaotong University
🇨🇳Xi'an, China
Henan Cancer Hospital
🇨🇳Zhengzhou, China
Fakultni nemocnice Brno
🇨🇿Brno, Czechia
Fakultni nemocnice Olomouc
🇨🇿Olomouc, Czechia
Fakultni Nemocnice Ostrava
🇨🇿Ostrava - Poruba, Czechia
Vseobecna fakultni nemocnice v Praze
🇨🇿Praha 2, Czechia
Aalborg University Hospital
🇩🇰Aalborg, Denmark
Aarhus University Hospital
🇩🇰Aarhus, Denmark
Rigshospitalet
🇩🇰Copenhagen, Denmark
Regionshospitalet Godstrup
🇩🇰Herning, Denmark
Odense Universitetshospital
🇩🇰Odense C, Denmark
Vejle Sygehus
🇩🇰Vejle, Denmark
CHU Amiens - Hopital Sud
🇫🇷AMIENS cedex 1, France
Hôpital Côte de Nacre
🇫🇷Caen cedex 9, France
CHU Grenoble
🇫🇷Grenoble, France
CHU de Nancy - Hopital de Brabois
🇫🇷Vandœuvre-lès-Nancy, France
Medizinische Universitat Lausitz Carl Thiem
🇩🇪Cottbus, Germany
Universitatsklinikum Carl Gustav Carus Dresden
🇩🇪Dresden, Germany
Universitätsmedizin Greifswald
🇩🇪Greifswald, Germany
Asklepios Klinik Altona
🇩🇪Hamburg, Germany
Universitaetsklinikum Heidelberg
🇩🇪Heidelberg, Germany
Universitaetsklinikum Giessen und Marburg GmbH
🇩🇪Marburg, Germany
Universitatsklinikum Tubingen
🇩🇪Tübingen, Germany
Universitatsklinikum Ulm
🇩🇪Ulm, Germany
Heinrich-Braun-Klinikum gGmbH
🇩🇪Zwickau, Germany
Alexandra General Hospital of Athens
🇬🇷Athens Attica, Greece
Agios Andreas General Hospital of Patra
🇬🇷Patra, Greece
G Papanikolaou Hospital of Thessaloniki
🇬🇷Thessaloniki, Greece
Fortis Memorial Research Institute
🇮🇳Gurgaon, India
Bhagwan Mahaveer Cancer Hospital & Research Centre
🇮🇳Jaipur, India
Deenanath Mangeshkar Hospital and Research Centre
🇮🇳Pune, India
Hillel Yaffe Medical Center
🇮🇱Hadera, Israel
Bnai Zion Medical Center
🇮🇱Haifa, Israel
Carmel Medical Center
🇮🇱Haifa, Israel
Rabin Medical Center
🇮🇱Petah Tikva, Israel
Sheba Medical Center
🇮🇱Ramat Gan, Israel
Tel Aviv Sourasky Medical Center
🇮🇱Tel-Aviv, Israel
A O U Sant Orsola Malpighi
🇮🇹Bologna, Italy
Fondazione IRCCS Istituto Nazionale dei Tumori
🇮🇹Milano, Italy
Azienda Ospedaliero Universitaria Policlinico Paolo Giaccone
🇮🇹Palermo, Italy
Ospedale Santa Chiara AO Universitaria Pisana
🇮🇹Pisa, Italy
Arcispedale Santa Maria Nuova - IRCCS
🇮🇹Reggio Emilia, Italy
A O Universitaria Senese Ospedale Santa Maria alle Scotte
🇮🇹Siena, Italy
A.O.U. Citta della Salute e della Scienza di Torino - Presidio Molinette
🇮🇹Turin, Italy
Ospedale di Circolo e Fondazione Macchi
🇮🇹Varese, Italy
Institute of Science Tokyo Hospital
🇯🇵Bunkyo ku, Japan
Chiba Cancer Center
🇯🇵Chiba, Japan
Ogaki Municipal Hospital
🇯🇵Gifu, Japan
National Hospital Organization Shibukawa Medical Center
🇯🇵Gunma, Japan
Kansai Medical University Hospital
🇯🇵Hirakata, Japan
Hitachi General Hospital
🇯🇵Hitachi, Japan
Saitama Medical University Hospital
🇯🇵Iruma-gun, Japan
Kameda Medical Center
🇯🇵Kamogawa City, Japan
National Cancer Center Hospital East
🇯🇵Kashiwa, Japan
Kurashiki Central Hospital
🇯🇵Kurashiki, Japan
Matsuyama Red Cross Hospital
🇯🇵Matsuyama, Japan
Aichi Medical University Hospital
🇯🇵Nagakute, Japan
JRC Nagasaki Genbaku Hospital
🇯🇵Nagasaki-Shi, Japan
Niigata University Medical And Dental Hospital
🇯🇵Niigata, Japan
National Hospital Organization Okayama Medical Center
🇯🇵Okayama, Japan
Osaka Metropolitan University Hospital
🇯🇵Osaka, Japan
Hokkaido University Hospital
🇯🇵Sapporo, Japan
Juntendo University Hospital
🇯🇵Tokyo, Japan
The Cancer Institute Hospital of JFCR
🇯🇵Tokyo, Japan
Yamagata University Hospital
🇯🇵Yamagata, Japan
Yamanashi Prefectural Central Hospital
🇯🇵Yamanashi, Japan
Hospital Pulau Pinang
🇲🇾Georgetown, Malaysia
Universitair Medisch Centrum Groningen
🇳🇱Groningen, Netherlands
UMC Utrecht
🇳🇱Utrecht, Netherlands
Uniwersyteckie Centrum Kliniczne
🇵🇱Gdansk, Poland
Pratia Onkologia Katowice
🇵🇱Katowice, Poland
Swietokrzyskie Centrum Onkologii SPZOZ w Kielcach
🇵🇱Kielce, Poland
Uniwersytecki Szpital Kliniczny Nr 1 w Lublinie
🇵🇱Lublin, Poland
Uls Almada Seixal - Hosp. Garcia de Orta
🇵🇹Almada, Portugal
Hospital Universitario Central de Asturias
🇪🇸Oviedo, Spain
Hosp. Son Llatzer
🇪🇸Palma de Mallorca, Spain
Hosp. Montecelo
🇪🇸Pontevedra, Spain
Hosp. Quiron Madrid Pozuelo
🇪🇸Pozuelo de Alarcon, Spain
Hospital Universitari i Politecnic La Fe
🇪🇸València, Spain
Falu Lasarett Medicinkliniken Falun
🇸🇪Falun, Sweden
Helsingborgs lasarett
🇸🇪Helsingborg, Sweden
Akademiska Sjukhuset
🇸🇪Uppsala, Sweden
Ankara Gulhane Training and Research Hospital
🇹🇷Ankara, Turkey
Dr Abdurrahman Yurtaslan Oncology Training and Research Hospital
🇹🇷Ankara, Turkey
Ankara University Medical Faculty
🇹🇷Ankara, Turkey
Liv Hospital Ankara
🇹🇷Ankara, Turkey
Antalya Training And Research Hospital
🇹🇷Antalya, Turkey
Ondokuz Mayis University
🇹🇷Atakum, Turkey
Pamukkale University Medical Faculty
🇹🇷Denizli, Turkey
Medipol University Hospital
🇹🇷Istanbul, Turkey
Aberdeen Royal Infirmary
🇬🇧Aberdeen, United Kingdom
University Hospitals Birmingham NHS Foundation Trust
🇬🇧Birmingham, United Kingdom
Colchester Hospital University NHS
🇬🇧Colchester, United Kingdom
The Clatterbridge Cancer Centre
🇬🇧Liverpool, United Kingdom
Chelsea And Westminster Hospital
🇬🇧London, United Kingdom
St George's Hospital
🇬🇧London, United Kingdom
James Cook University Hospital
🇬🇧Middlesborough, United Kingdom
Norfolk and Norwich University Hospital
🇬🇧Norwich, United Kingdom
Royal Stoke University Hospital
🇬🇧Staffordshire, United Kingdom