Clinical Study of Fianlimab in Combination With Cemiplimab Versus Pembrolizumab in Adolescent and Adult Patients With Previously Untreated Unresectable Locally Advanced or Metastatic Melanoma
- Conditions
- Melanoma
- Interventions
- Registration Number
- NCT05352672
- Lead Sponsor
- Regeneron Pharmaceuticals
- Brief Summary
This study is researching an experimental drug called REGN3767, also known as fianlimab (R3767), when combined with another medication called REGN2810, also known as cemiplimab (each individually called a "study drug" or called "study drugs" when combined).
The study is focused on patients with a type of skin cancer known as melanoma. The aims of the study are to see how effective the combination of fianlimab and cemiplimab are in treating the melanoma skin cancer, in comparison with a medication, pembrolizumab, approved for the treatment of melanoma skin cancer in adults, and to observe any similarities, or differences, in how the study drugs work in adolescent participants compared with adult participants.
The study is looking at several other research questions, including:
* What side effects may happen from receiving the study drugs
* How much study drug is in the blood at different times
* Whether the body makes antibodies against the study drugs (which could make the drugs less effective or could lead to side effects). Antibodies are proteins that are naturally found in the blood stream that fight infections.
* How administering the study drugs might improve quality of life
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- RECRUITING
- Sex
- All
- Target Recruitment
- 1535
-
Age ≥12 years on the date of providing informed consent
-
Patients with histologically confirmed unresectable Stage III and Stage IV (metastatic) melanoma (AJCC, 8th revised edition) who have not received prior systemic therapy for advanced unresectable disease
- Patients who received adjuvant and/or neoadjuvant systemic therapies are eligible if they did not have evidence of progression or recurrence of disease and/or discontinued due to occurrence of unmanageable imAEs ≥ grade 3 (with the exclusion of endocrinopathies which are fully controlled by hormone replacement) while on such therapies. Also, patients must have had a treatment-free and disease-free interval of >6 months. Accrual of these patients is limited to approximately 10% of the total population enrolled.
- Patients with acral and mucosal melanomas are eligible. Accrual will be limited to 10% of the total population.
-
Measurable disease per RECIST v1.1
- Previously irradiated lesions can only be counted as target lesions if they have been demonstrated to progress and no other target lesion is available
- Cutaneous lesions should be evaluated as non-target lesions
-
Performance status:
- For adult patients: Eastern Cooperative Oncology Group (ECOG) performance status (PS) 0 or 1
- For pediatric patients: Karnofsky performance status ≥70 (patients ≥16 years) or Lansky performance status ≥70 (patients ≤16 years)
-
Anticipated life expectancy of at least 3 months
Key
-
Uveal melanoma
-
Ongoing or recent (within 2 years) evidence of an autoimmune disease that required systemic treatment with immunosuppressive agents. The following are non-exclusionary: vitiligo, childhood asthma that has resolved, residual hypothyroidism that requires only hormone replacement, psoriasis not requiring systemic treatment.
-
Uncontrolled infection with human immunodeficiency virus (HIV), hepatitis B (HBV) or hepatitis C virus (HCV) infection; or diagnosis of immunodeficiency that is related to, or results in chronic infection
-
Unknown BRAF V600 mutation status as described in the protocol
-
Systemic immune suppression:
- Use of immunosuppressive doses of corticosteroids (>10mg of prednisone per day or equivalent) within 14 days of the first dose of study medication. Physiologic replacement doses are allowed up to and including 10mg of prednisone/day or equivalent. Inhaled or topical steroids are permitted, if they are not for treatment of an autoimmune disorder.
- Other clinically relevant forms of systemic immune suppression
-
Treatment with other anti-cancer therapy including immuno- therapy, chemotherapy, major surgery or biological therapy within 21 days prior to the first dose of trial treatment. Adjuvant hormonotherapy used for breast cancer or other hormone-sensitive cancers in long term remission is allowed.
-
History or current evidence of significant (CTCAE Grade ≥2) local or systemic infection (e. g., cellulitis, pneumonia, septicemia) requiring systemic antibiotic treatment within 14 days prior to the first dose of trial medication.
-
Active or untreated brain metastases or spinal cord compression. Patients with leptomeningeal disease are excluded. Patients with known brain metastases are eligible if they:
- Received radiotherapy or another appropriate standard therapy for the brain metastases,
- Have neurologically returned to baseline (except for residual signs and symptoms related to the CNS treatment) for at least 14 days prior to enrollment
- Did not require immunosuppressive doses of corticosteroids therapy (>10mg of prednisone per day or equivalent) in the 14 days prior to enrollment
- Are asymptomatic with a single untreated brain metastasis <10 mm in size
-
Participants with a history of myocarditis.
Note: Other protocol-defined Inclusion/ Exclusion criteria apply
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description A: fianlimab+cemiplimab dose 1 Fianlimab As defined in Protocol Amendment 5 A: fianlimab+cemiplimab dose 1 Cemiplimab As defined in Protocol Amendment 5 A1: fianlimab+cemiplimab dose 2 Fianlimab As defined in Protocol Amendment 5 A1: fianlimab+cemiplimab dose 2 Cemiplimab As defined in Protocol Amendment 5 B: pembrolizumab+placebo Pembrolizumab As defined in Protocol Amendment 5 B: pembrolizumab+placebo Placebo As defined in Protocol Amendment 5 C: cemiplimab+placebo Cemiplimab As defined in Protocol Amendment 5 C: cemiplimab+placebo Placebo As defined in Protocol Amendment 5
- Primary Outcome Measures
Name Time Method Progression-free survival (PFS) Approximately 27 months Per Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 based on Blinded Independent Central Review (BICR)
- Secondary Outcome Measures
Name Time Method Overall survival (OS) Up to 96 months Objective response rate (ORR) Up to 27 months Per Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 based on Blinded Independent Central Review (BICR) or based on investigator assessment according to RECIST 1.1
Disease control rate (DCR) Up to 27 months Per RECIST 1.1 based on BICR or based on investigator assessment according to RECIST 1.1
Duration of response (DoR) Up to 27 months Per RECIST 1.1 via BICR or based on investigator assessment according to RECIST 1.1
PFS Up to 27 months Based on investigator assessment according to RECIST 1.1
Incidence of Adverse Events (AEs) Up to 90 days post last dose, approximately 6 years Including treatment emergent adverse events (TEAEs), serious adverse events (SAEs), adverse events of special interest (AESIs), and/ or immune-mediated adverse events (imAEs)
Occurrence of interruption and discontinuation of study drug(s) due to AEs Up to 90 days post last dose, approximately 6 years Including TEAEs, AESIs, and/ or imAEs
TEAEs leading to death Up to 6 years Incidence of laboratory abnormalities Up to 90 days post last dose, approximately 6 years Will be graded using the current version of the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI-CTCAE) grading system (version 5.0)
Concentrations of cemiplimab in serum Up to 90 days post last dose, approximately 6 years Concentrations of fianlimab in serum Up to 90 days post last dose, approximately 6 years Incidence of anti-drug antibodies (ADA) to fianlimab over time Up to 30 days post last dose, approximately 6 years Titer of anti-drug antibodies (ADA) to fianlimab over time Up to 30 days post last dose, approximately 6 years Incidence of ADA to cemiplimab over time Up to 30 days post last dose, approximately 6 years Titer of ADA to cemiplimab over time Up to 30 days post last dose, approximately 6 years Incidence of neutralizing antibodies (NAb) to fianlimab over time Up to 30 days post last dose, approximately 6 years Incidence of NAb to cemiplimab over time Up to 30 days post last dose, approximately 6 years Patient-reported outcomes (PROs) as measured by European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30 (EORTC QLQ-C30) Up to 90 days post last dose, approximately 6 years EORTC-QLQ-C30 is a 30-item participant self-report questionnaire composed of both multi-item and single scales, including a global health status/quality of life (GHS/QoL) scale. Participants rate items on a four-point scale, with 1 as "not at all" and 4 as "very much." A change of 5 - 10 points is considered a small change. A change of 10 - 20 points is considered a moderate change.
PROs as measured by EQ-5D-5L Up to 90 days post last dose, approximately 6 years The EQ-5D-5L consists of EQ-5D descriptive system comprises five dimensions: mobility, self-care, usual activities, pain/discomfort and anxiety/depression. Each dimension has 5 levels: no problems, slight problems, moderate problems, severe problems and extreme problems. Overall scores range from 0 to 1, with low scores representing a higher level of dysfunction.
PROs as measured by Functional Assessment of Cancer Therapy melanoma (FACTM) (melanoma subscale only) Up to 90 days post last dose, approximately 6 years The FACTM is a melanoma-specific quality of life questionnaire that is composed of items from the Functional Assessment of Cancer Therapy-General (FACT-G). The FACTM is scored on a 5 point Likert-scale: "Not at all", "A little bit", "Somewhat", "Quite a bit", and "Very much.". A Higher score represents higher Health Related Quality of Life (HRQoL).
PROs as measured by Patient Global Impression of Severity (PGIS) Up to 21 days post last dose, approximately 6 years The PGIS is a single 1-item questionnaire designed to assess participant's overall impression of disease severity at a given point in time by using a 4-point Likert scale that ranges from (1) = "none (no symptoms)" to (4) = "severe".
PROs as measured by Patient Global Impression of Change (PGIC) Up to 21 days post last dose, approximately 6 years The PGIC is a single-item questionnaire designed to assess the participant's overall sense of whether there has been a change since starting treatment as rated on a 5-point Likert scale anchored by (1) "much better" to (5) "much worse", with (4) = "no change"
Change in physical functioning per EORTC QLQ-C30 Baseline to end of study, approximately 6 years EORTC-QLQ-C30 is a 30-item subject self-report questionnaire composed of both multi-item and single scales, including a global health status/quality of life (GHS/QoL) scale. Participants rate items on a four-point scale, with 1 as "not at all" and 4 as "very much." A change of 5 - 10 points is considered a small change. A change of 10 - 20 points is considered a moderate change.
Change in role functioning per EORTC QLQ-C30 Baseline to end of study, approximately 6 years EORTC-QLQ-C30 is a 30-item subject self-report questionnaire composed of both multi-item and single scales, including a global health status/quality of life (GHS/QoL) scale. Participants rate items on a four-point scale, with 1 as "not at all" and 4 as "very much." A change of 5 - 10 points is considered a small change. A change of 10 - 20 points is considered a moderate change.
Change in global health status/quality of life (GHS/QoL) per EORTC QLQ-C30 Baseline to Week 25 Global Health Status/Quality of Life (GHS/Qol) Score (Items 29 and 30) using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30). Participants rate items on a four-point scale, with 1 as "not at all" and 4 as "very much." A change of 5 - 10 points is considered a small change. A change of 10 - 20 points is considered a moderate change.
Change in GHS/QoL per EORTC QLQ-C30 Baseline to end of study, approximately 6 years EORTC-QLQ-C30 is a 30-item subject self-report questionnaire composed of both multi-item and single scales, including a global health status/quality of life (GHS/QoL) scale. Participants rate items on a four-point scale, with 1 as "not at all" and 4 as "very much." A change of 5 - 10 points is considered a small change. A change of 10 - 20 points is considered a moderate change.
Trial Locations
- Locations (219)
Atlantic Health System - Morristown Medical Center
🇺🇸Morristown, New Jersey, United States
Fundacion Cenit para la Investigacion en Neurociencias
🇦🇷Buenos Aires, Argentina
DIABAID - Instituto de Asistencia Integral en Diabetes
🇦🇷Buenos Aires, Argentina
Fundacion CENIT Centro Medico de Neurociencias
🇦🇷Ciudad Autonoma de Buenos Aires, Argentina
Instituto de Oncologia de Rosario
🇦🇷Rosario, Argentina
Cliniques Universitaires Saint-Luc
🇧🇪Brussels, Belgium
Fundacao Pio XII - Hospital de Amor de Barretos
🇧🇷Barretos, Brazil
Centro Avancado de Tratamento Oncologico (CENANTRON)
🇧🇷Belo Horizonte, Brazil
Liga Paranaense de Combate ao Cancer - Hospital Erasto Gaertner
🇧🇷Curitiba, Brazil
Oncosite Centro De Pesquisa Clinica Em Oncologia
🇧🇷Ijui, Brazil
Instituto Joinvilense De Hematologia E Oncologia
🇧🇷Joinville, Brazil
Hospital de Clinicas de Porto Alegre (HCPA)
🇧🇷Porto Alegre, Brazil
Hospices Civils de Lyon
🇫🇷Pierre Benite Cedex, France
Clinique Sainte Anne/Strasbourg Oncologie Liberale
🇫🇷Strasbourg, France
LTD Tbilisi State Medical University and Ingorokva High Medical Technology University Clinic
🇬🇪Tbilisi, Georgia
Medulla - Clinics And Medical Centers
🇬🇪Tbilisi, Georgia
Universitatsklinikum Augsburg Klinik fur Dermatologie und Allergologie Campus Sud
🇩🇪Augsburg, Germany
Universitaetsklinikum der Ruhr Universitaet Bochum (UKRUB) St Josef Hospital
🇩🇪Bochum, Germany
Universitaetsklinikum Carl Gustav Carus an der Technischen Universitaet
🇩🇪Dresden, Germany
Helios Klinikum Erfurt Klinik fur Hautkrankheiten und Allergologie
🇩🇪Erfurt, Germany
University of Kiel
🇩🇪Kiel, Germany
Universitaetsklinikum Schleswig-Holstein Campus Luebeck
🇩🇪Luebeck, Germany
Universitatsmedizin der Johanned Gutenberg-Universitat Mainz
🇩🇪Mainz, Germany
Hospital Universitario Virgen de las Nieves
🇪🇸Granada, Spain
Istituti Fisioterapici Ospitalieri (IFO)
🇮🇹Roma, Italy
Università della Campania Luigi Vanvitella
🇮🇹Napoli, Italy
IRCCS Istituto Nazionale dei Tumori di Napoli Fondazione G. Pascale
🇮🇹Napoli, Italy
SCDU di Oncologia AOU Maggiore Della Carita
🇮🇹Novara, Italy
U.O. Oncologia Medica Universitaria - Istituto Toscano Tumori Polo Oncologico
🇮🇹Pisa, Italy
Campus Bio-Medico di Roma
🇮🇹Rome, Italy
Istituto Dermopatico Dell'Immacolata Irccs
🇮🇹Rome, Italy
Fondazione IRCSS Casa Sollievo Della Sofferenza
🇮🇹San Giovanni Rotondo, Italy
AOU Citta della Salute e della Scienza di Torino
🇮🇹Turin, Italy
Azienda Sanitaria Universitaria Friuli Centrale (ASU FC) - Ospedale Udine
🇮🇹Udine, Italy
CHU Jean MINJOZ
🇫🇷Besancon Cedex, France
HOPITAL SAINT ANDRE Chu De Bordeaux
🇫🇷Bordeaux Cedex, France
University of Szeged
🇭🇺Szeged, Hungary
Cork University Hospital
🇮🇪Cork, Ireland
University of Pecs Medical School
🇭🇺Pecs, Hungary
University of Tennessee Medical Center
🇺🇸Knoxville, Tennessee, United States
Clinica Adventista Belgrano
🇦🇷Caba, Argentina
Centro Medico San Roque
🇦🇷San Miguel de Tucuman, Argentina
Icon Cancer Centre Hobart
🇦🇺Hobart, Australia
Calvary North Adelaide Hospital
🇦🇺Adelaide, Australia
The Alfred Hospital
🇦🇺Melbourne, Australia
Gold Coast University Hospital
🇦🇺Southport, Australia
Ballarat Oncology and Haematology Clinical Trials Unit
🇦🇺Wendouree, Australia
Medical University of Graz
🇦🇹Graz, Austria
Medical University Innsbruck
🇦🇹Innsbruck, Tyrol, Austria
University Hospital St. Poelten
🇦🇹St. Poelten, Austria
Medical University Of Vienna
🇦🇹Vienna, Austria
AZ Groeninge, Campus Kennedylaan
🇧🇪Kortrijk, Belgium
Clinique et Maternite Sainte-Elisabeth (CMSE)
🇧🇪Namur, Belgium
AZ Nikolaas
🇧🇪Sint Niklaas, Belgium
Clinica de Neoplasias Litoral/atarina Pesquisa Clínica
🇧🇷Itajai, Brazil
Animi Unidade de Tratamento Oncologico Ltda
🇧🇷Lages, Brazil
Hospital Bruno Born
🇧🇷Lajeado, Brazil
Hospital Moinhos de Vento
🇧🇷Porto Alegre, Brazil
CPO - Centro de Pesquisas em Oncologia
🇧🇷Porto Alegre, Brazil
Fundacao PIO XII - Hospital de Amor Amazonia
🇧🇷Porto Velho, Brazil
Instituto COI
🇧🇷Rio de Janeiro, Brazil
Hospital Sao Vicente de Paulo (HSVP) Instituto do Cancer
🇧🇷Passo Fundo, Brazil
INCA - Brazilian National Cancer Institute
🇧🇷Santo Cristo, Brazil
Hospital Sao Rafael
🇧🇷Salvador, Brazil
Hemomed
🇧🇷Sao paulo, Brazil
Hospital Sirio Libanes (HSL)
🇧🇷Sao Paulo, Brazil
Fundacao Faculdade Regional de Medicina de Sao Jose do Rio Preto
🇧🇷Sao Jose do Rio Preto, Brazil
Sao Camilo Oncologia
🇧🇷Sao Paulo, Brazil
Cross Cancer Institute (CCI)
🇨🇦Edmonton, Canada
Saskatoon Cancer Centre (SCC)
🇨🇦Saskatoon, Canada
Royal Victoria Regional Health Centre
🇨🇦Barrie, Canada
Dr. Everett Chalmers Hospital
🇨🇦Fredericton, Canada
University Health Network, Princess Margaret Cancer Centre
🇨🇦Toronto, Canada
Centro Oncologico Antofagasta Bradford Hill Norte
🇨🇱Antofagasta, Chile
Oncocentro
🇨🇱Vina del Mar, Chile
Universidad Mayor - Centro Oncologia de Precision
🇨🇱Santiago, Chile
Fakultni Nemocnice Hradec Kralove
🇨🇿Hradec Kralove, Czechia
University Hospital Ostrava
🇨🇿Ostrava, Czechia
Fakultni nemocnice Kralovske Vinohrady, Dermatovenerologicka klinika
🇨🇿Prague 10, Czechia
Hopital Avicenne Service de Dermatologie du Pr Caux
🇫🇷Bobigny, France
Hopital Ambroise Pare
🇫🇷Boulogne Billancourt, France
CHU de DIJON - Service de Dermatologie
🇫🇷Dijon, France
Hopitaux Universitaires Henri-Mondor
🇫🇷Creteil, France
CHU Estaing, Service de Dermatologie
🇫🇷Clermont-Ferrand, France
Centre Hospitalier Universitaire De Grenoble Alpes Service Dermatologie
🇫🇷Grenoble, France
CH Le Mans - Plateforme de recherche clinique
🇫🇷Le Mans, France
Centre Leon Berard
🇫🇷Lyon cedex 08, France
Hopital Cochin APHP
🇫🇷Paris, France
Centre Hospitalier Universitaire de Nantes (CHU de Nantes) Hotel Dieu
🇫🇷Nantes, France
Chru De Lille
🇫🇷Lille Cedex, France
Hopital de la Miletrie Centre Hospitalier Universitaire de Poitiers
🇫🇷Poitiers Cedex, France
CHU Charles Nicolle Dermatologie
🇫🇷Rouen, France
CHU Saint-Etienne - Hopital Nord
🇫🇷Saint-Etienne, France
Institut Gustave Roussy Cancer Center DITEP
🇫🇷Villejuif Cedex, France
Israeli Georgian medical research clinic Helsicore
🇬🇪Tbilisi, Georgia
TIM -Tbilisi Institute of Medicine
🇬🇪Tbilisi, Georgia
LTD New Hospitals
🇬🇪Tbilisi, Georgia
JSC K. Eristavi National Center of Experimental and Clinical Surgery
🇬🇪Tbilisi, Georgia
LLC Todua Clinic
🇬🇪Tbilisi, Georgia
Staedtisches Klinikum Dessau
🇩🇪Dessau, Germany
Charite - Universitaetsmedizin Berlin
🇩🇪Berlin, Germany
Elbekliniken Buxtehude
🇩🇪Buxtehude, Germany
Universitatsklinik Frankfurt
🇩🇪Frankfurt, Germany
University Hospital Giessen
🇩🇪Giessen, Germany
Universitatsmedizin Gottingen Klinik fur Dermatologie
🇩🇪Göttingen, Germany
Universitaetsklinikum Leipzig
🇩🇪Leipzig, Germany
Fachklinik Hornheide
🇩🇪Muenster, Germany
University Medical Center Mannheim
🇩🇪Mannheim, Germany
Klinikum der Universitat Munchen - LMU Klinik und Poliklinik fur Dermatologie und Allergologie Hautt
🇩🇪Munchen, Germany
Universitätsklinik der Paracelsus Medizinischen Privatuniversität
🇩🇪Nuremberg, Germany
Universitaetsapotheke Tuebingen
🇩🇪Tuebingen, Germany
Harzklinikum, Klinik fur Dermatologie und Allergologie
🇩🇪Quedlinburg, Germany
University Clinic Regensburg
🇩🇪Regensburg, Germany
Helios Klinik Schwerin
🇩🇪Schwerin, Germany
University of Debrecen
🇭🇺Debrecen, Hungary
Szabolcs-Szatmar-Bereg Megyei Korhazak es Egyetemi Oktato Korhazak
🇭🇺Nyíregyhaza, Hungary
St. Vincents University Hospital
🇮🇪Dublin 4, Ireland
St. James Hospital
🇮🇪Dublin, Ireland
University College Hospital Galway
🇮🇪Galway, Ireland
Istituto dei Tumori
🇮🇹Bari, Italy
Azienda Sanitaria Ospedaliera Santa Croce E Carle - Cuneo
🇮🇹Cuneo, Italy
Ospedale Policlinico San Martino - IRCCS
🇮🇹Genova, Italy
ASST Spedali Civili Brescia
🇮🇹Brescia, Italy
Istituto di Candiolo, FPO IRCCS
🇮🇹Candiolo, Italy
Istituto Europeo di Oncologia
🇮🇹Milano, Italy
Fondazione IRCCS San Gerardo dei Tintori
🇮🇹Monza, Italy
IOV - Istituto Oncologico Veneto - IRCCS
🇮🇹Padova, Italy
IRCCS Istituto Clinico Humanitas
🇮🇹Rozzano, Italy
Azienda Ospedaliera S. Maria
🇮🇹Terni, Italy
Santa Chiara Regional Hospital
🇮🇹Trento, Italy
Centro Estatal de Cancerologia de Chihuahua
🇲🇽Chihuahua, Mexico
Neurociencias Estudios Clinicos SC
🇲🇽Culiacan, Mexico
Antiguo Hospital Civil de Guadalajara Fray Antonio Alcalde
🇲🇽Guadalajara, Mexico
Preparaciones Oncologicas SC
🇲🇽Leon, Mexico
Centro De Atencion E Investigacion Clinica En Oncologia Scp
🇲🇽Merida, Mexico
FAICIC S. de R.L. de C.V.
🇲🇽Veracruz, Mexico
Centro De Estudios Y Prevencion Del Cancer A. C.
🇲🇽Tuxtla Gutierrez, Mexico
iCan Oncology Center
🇲🇽Monterrey, Mexico
Investigacion Biomedica para el Desarrollo de Farmacos S.A. de C.V.
🇲🇽Zapopan, Mexico
University Medical Center Groningen
🇳🇱Groningen, Netherlands
The Netherlands Cancer Institute (NKI) - Antoni van Leeuwenhoek Hospital
🇳🇱Amsterdam, Netherlands
Centro Medico Monte Carmelo
🇵🇪Arequipa, Peru
Hospital Nacional Daniel Alcides Carrion
🇵🇪Bellavista, Peru
Hospital Goyeneche
🇵🇪Arequipa, Peru
Instituto Peruano de Oncologia and Radioterapia
🇵🇪Lima, Peru
Instituto Regional de Enfermedades Neoplasicas del Centro - IREN CENTRO
🇵🇪Concepcion, Peru
Clinica Internacional San Borja
🇵🇪San Borja, Peru
Clinica Peruano Americana
🇵🇪Trujillo, Peru
Uniwersyteckie Centrum Kliniczne (UCK)
🇵🇱Gdansk, Poland
Wojewodzki Szpital Specjalistyczny im. Janusza Korczaka
🇵🇱Slupsk, Poland
Narodowego Instytutu Onkologii im Maria Sklodowska Curie
🇵🇱Krakow, Poland
Mazowiecki Szpital Wojewodzki, Siedleckie Centrum Onkologii
🇵🇱Siedlce, Poland
Uniwersytecki Szpital Kliniczny w Poznaniu
🇵🇱Poznan, Poland
Institute of Oncology Bucharest
🇷🇴Bucharest, Romania
Klinika Nowotworow Tkanek Miekkich, Kosci i Czerniakow
🇵🇱Warszawa, Poland
Medisprof
🇷🇴Cluj Napoca, Romania
Centrul de Oncologie Sf. Nectarie S.R.L
🇷🇴Craiova, Romania
Cardiomed SRL
🇷🇴Cluj-Napoca, Romania
SC Radiotherapy Center Cluj SRL
🇷🇴Cluj, Romania
SC Centrul de Oncologie Euroclinic SRL
🇷🇴Iasi, Romania
Regional Institute of Oncology
🇷🇴Iasi, Romania
RTC Radiology Therapeutic Center SRL
🇷🇴Otopeni, Romania
Oncomed
🇷🇴Timisoara, Romania
Oncocenter Oncologie Clinica S.R.L
🇷🇴Timisoara, Romania
The Medical Oncology Centre of Rosebank
🇿🇦Johannesburg, South Africa
Cape Town Oncology Trials
🇿🇦Kraaifontein, South Africa
Groote Schuur Hospital
🇿🇦Cape Town, South Africa
Hospital Teresa Herrera-Chuac (CHUAC)
🇪🇸A Coruna, Spain
Hospital Universitari Germans Trias i Pujol (HUGTP)
🇪🇸Badalona, Spain
Instituto Oncologico Dr Rosel
🇪🇸Barcelona, Spain
Hospital de la Santa Creu i Sant Pau
🇪🇸Barcelona, Spain
Hospital Universitario Reina Sofia
🇪🇸Cordoba, Spain
Catalan Institute of Oncology (ICO) Hospitalet
🇪🇸Barcelona, Spain
Catalan Institute Of Oncology - Girona
🇪🇸Girona, Spain
Hospital Universitario Lucus Augusti
🇪🇸Lugo, Spain
Hospital General Universitario Gregorio Maranon
🇪🇸Madrid, Spain
Hospital Universitario Ramon y Cajal
🇪🇸Madrid, Spain
Hospital Fundacion Jimenez Diaz
🇪🇸Madrid, Spain
Hospital Universitario La Paz
🇪🇸Madrid, Spain
Hospital Regional Universitario de Malaga
🇪🇸Malaga, Spain
Hospital Universitario Virgen de la Arrixaca
🇪🇸Múrcia, Spain
Centro integral Oncologico HM Clara Campal
🇪🇸Madrid, Spain
Hospital Universitario Central de Asturias
🇪🇸Oviedo, Spain
Onkologikoa
🇪🇸San Sebastian, Spain
Hospital Universitario Virgen Macarena
🇪🇸Sevilla, Spain
Instituto Valenciano de Oncologia
🇪🇸Valencia, Spain
INCLIVA-Instituto de Investigacion Sanitaria
🇪🇸Valencia, Spain
Adana Baskent Hospital
🇹🇷Adana, Turkey
Gulhane Training and Research Hospital
🇹🇷Ankara, Turkey
Ozel Liv Hospital
🇹🇷Ankara, Turkey
Dicle University Medical Faculty
🇹🇷Diyarbakir, Turkey
Memorial Ankara Hospital
🇹🇷Ankara, Turkey
Ege University hospital
🇹🇷Izmir, Turkey
Cerrahpasa Medical Hospital
🇹🇷Istanbul, Turkey
Prof. Dr. Suleyman Yalcin Sehir Hospital
🇹🇷Istanbul, Turkey
Kocaeli Universitesi
🇹🇷Kocaeli, Turkey
Royal Surrey NHS Foundation Trust
🇬🇧Guildford, United Kingdom
Royal Devon and Exeter Hospital NHS Trust
🇬🇧Exeter, Devon, United Kingdom
Leeds Teaching Hospitals NHS Trust
🇬🇧Leeds, United Kingdom
Barwon Health Andrew Love Cancer Centre, University Hospital Geelong
🇦🇺Geelong, Australia
The Townsville Hospital and Health Service
🇦🇺Townsville, Australia
University of California San Diego
🇺🇸La Jolla, California, United States
Sunnybrook Research Institute
🇨🇦Toronto, Ontario, Canada
The Angeles Clinic and Research Institute
🇺🇸Los Angeles, California, United States
Miami Cancer Institute
🇺🇸Miami, Florida, United States
Orlando Health, Inc
🇺🇸Orlando, Florida, United States
University Hospitals Seidmand Cancer Center
🇺🇸Cleveland, Ohio, United States
Cleveland Clinic Foundation
🇺🇸Cleveland, Ohio, United States
LTD High Technology Hospital Medcenter
🇬🇪Batumi, Georgia
Centro De Investigacion Clinica Bradford Hill
🇨🇱Recoleta, Chi, Chile
Bezmialem University
🇹🇷Istanbul, Turkey
Hospital Clinico Universidad de Chile
🇨🇱Santiago, Chile
Trakya University
🇹🇷Edirne, Turkey
Instituto Nacional de Enfermedades Neoplasicas
🇵🇪Lima, Peru
Gaziantep University Medical Faculty
🇹🇷Gaziantep, Turkey
Oncovida
🇨🇱Santiago, Region Metropolitana De Santiago, Chile
Bakirkoy Sadi Konuk Training Hospital
🇹🇷Istanbul, Turkey
Guy's Hospital
🇬🇧London, United Kingdom
Hull University Teaching Hospitals NHS Trust
🇬🇧Hull, United Kingdom