A Study Comparing Alectinib With Crizotinib in Treatment-Naive Anaplastic Lymphoma Kinase-Positive Advanced Non-Small Cell Lung Cancer Participants
- Registration Number
- NCT02075840
- Lead Sponsor
- Hoffmann-La Roche
- Brief Summary
This randomized, active controlled, multicenter phase III open-label study is designed to evaluate the efficacy and safety of alectinib compared with crizotinib treatment in participants with treatment-naive anaplastic lymphoma kinase-positive (ALK-positive) advanced non-small cell lung cancer (NSCLC). Participants will be randomized in a 1:1 ratio to receive either alectinib, 600 milligrams (mg) orally twice daily (BID), or crizotinib, 250 mg orally BID. Participants will receive treatment until disease progression, unacceptable toxicity, withdrawal of consent, or death. The study is expected to last approximately 144 months.
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 303
- Histologically or cytologically confirmed diagnosis of advanced or recurrent (Stage IIIB not amenable for multimodality treatment) or metastatic (Stage IV) NSCLC that is ALK-positive as assessed by the Ventana immunohistochemistry (IHC) test
- Life expectancy of at least 12 weeks
- Eastern cooperative oncology group performance status (ECOG PS) of 0-2
- Participants with no prior systemic treatment for advanced or recurrent (Stage IIIB not amenable for multimodality treatment) or metastatic (Stage IV) NSCLC
- Adequate renal, and hematologic function
- Participants must have recovered from effects of any major surgery or significant traumatic injury at least 28 days before the first dose of study treatment
- Measurable disease by response evaluation criteria in solid tumors (RECIST) version 1.1 (v1.1) prior to the administration of study treatment
- Prior brain or leptomeningeal metastases allowed if asymptomatic (e.g., diagnosed incidentally at study baseline)
- Negative pregnancy test for all females of child bearing potential
- Use of highly effective contraception as defined by the study protocol
- Participants with a previous malignancy within the past 3 years
- Any gastrointestinal (GI) disorder or liver disease
- National cancer institute common terminology criteria for adverse events (NCI CTCAE) (version 4.0) Grade 3 or higher toxicities due to any prior therapy (e.g., radiotherapy) (excluding alopecia)
- History of organ transplant
- Co-administration of anti-cancer therapies other than those administered in this study
- Participants with baseline QTc greater than (>) 470 milliseconds or symptomatic bradycardia
- Recipient of strong/potent cytochrome P4503A inhibitors or inducers within 14 days prior to the first dose until the end of study treatment
- Recipient of any drug with potential QT interval prolonging effects within 14 days prior to the first dose for all participants and while on treatment through the end of the study for crizotinib-treated participants only
- History of hypersensitivity to any of the additives in the alectinib and crizotinib drug formulation
- Pregnancy or lactation
- Any clinically significant disease or condition (or history of) that could interfere with, or for which the treatment might interfere with, the conduct of the study or the absorption of oral medications or that would, in the opinion of the principal investigator, pose an unacceptable risk to the participant in this study
- Any psychological, familial, sociological, or geographical condition potentially hampering compliance with the study protocol requirements and/or follow-up procedures; those conditions should be discussed with the participant before trial entry
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Alectinib Alectinib Participants will receive alectinib from Visit 0 (baseline) until disease progression, unacceptable toxicity, withdrawal of consent or death. Crizotinib Crizotinib Participants will receive crizotinib from Visit 0 (baseline) until disease progression, unacceptable toxicity, withdrawal of consent or death.
- Primary Outcome Measures
Name Time Method Progression-Free Survival (PFS) by Investigator Assessment Randomization to first documented disease progression or death, whichever occurs first (assessed every 8 weeks up to 33 months) PFS was assessed as time to disease progression or death whichever occurred first by investigator assessment using Response Evaluation Criteria in Solid Tumors (RECIST) Version 1.1 (v1.1) Criteria. As per RECIST v1.1, disease progression is a 20% increase in the sum of the diameters of target lesions, an increase in size of measurable lesions by at least 5 millimeter (mm) and the appearance of new lesions.
Percentage of Participants With PFS Event by Investigator Assessment Randomization to first documented disease progression or death, whichever occurs first (assessed every 8 weeks up to 33 months) PFS was assessed percentage of participants with disease progression or death whichever occurred first by investigator assessment using Response Evaluation Criteria in Solid Tumors (RECIST) Version 1.1 (v1.1) Criteria. As per RECIST v1.1, disease progression is a 20% increase in the sum of the diameters of target lesions, an increase in size of measurable lesions by at least 5 millimeter (mm) and the appearance of new lesions.
- Secondary Outcome Measures
Name Time Method PFS Independent Review Committee (IRC)-Assessed Randomization to first documented disease progression or death, whichever occurs first (assessed every 8 weeks up to 33 months) PFS was assessed as time to disease progression or death whichever occurred first by IRC assessment using Response Evaluation Criteria in Solid Tumors (RECIST) Version 1.1 (v1.1) Criteria. As per RECIST v1.1, disease progression is a 20% increase in the sum of the diameters of target lesions, an increase in size of measurable lesions by at least 5 mm and the appearance of new lesions.
Percentage of Participants With PFS Event by IRC Randomization to first documented disease progression or death, whichever occurs first (assessed every 8 weeks up to 33 months) PFS was assessed as percentage of participants with disease progression or death whichever occurred first by IRC assessment using Response Evaluation Criteria in Solid Tumors (RECIST) Version 1.1 (v1.1) Criteria. As per RECIST v1.1, disease progression is a 20% increase in the sum of the diameters of target lesions, an increase in size of measurable lesions by at least 5 mm and the appearance of new lesions.
Duration of Response (DOR) According to RECIST V1.1 Criteria as Assessed by the Investigators First occurrence of objective response to first documented disease progression or death, whichever occurs first (assessed every 8 weeks up to 33 months) DOR was defined as the time from when response (CR or PR) was first documented to first documented disease progression or death, whichever occurred first. DOR was evaluated for participants who had a best overall response (BOR) of CR or PR.
Overall Survival (OS) From randomization until death (up to 43 months) Overall survival (OS) was defined as the time from randomization to death from any cause.
Percentage of Participants With CNS ORR of CR or PR IRC-assessed According to RECIST v1.1 Criteria Randomization to first documented disease progression or death, whichever occurs first (assessed every 8 weeks up to 33 months) CNS ORR was defined as the percentage of participants who attained CR or PR and had measurable/non-measurable CNS lesions at baseline. As per RECIST v1.1, CR: Disappearance of all target lesions and any pathological lymph nodes (whether target or non-target) must have reduction in short axis to \< 10 mm, PR: At least a 30% decrease in the sum of the diameters of target lesions, taking as reference the baseline sum of diameters.
Percentage of Participants With Adverse Events Baseline up to 28 months in the crizotinib arm and up to 30 months in the alectinib arm An adverse event (AE) is any untoward medical occurrence in a participant, temporally associated with the use of a medicinal product, whether or not considered related to the medicinal product.
Area Under The Concentration-Time Curve (AUC) of Alectinib Pre-dose (within 2 hours before alectinib) (baseline), 1, 2, 4, 6, and 8 hours post-dose at Visit 0 (first dosing day) and Week 4; Pre-dose (within 2 hours) at Week 8, then every 8 weeks until disease progression or death/withdrawal (up to 33 months) Percentage of Participants With Central Nervous System (CNS) Progression as Determined by IRC Using RECIST V1.1 Criteria Randomization to CNS PD as first occurrence of disease progression (assessed every 8 weeks up to 33 months) CNS progression was assessed as percentage of participants with an event defined as time from randomization until first radiographic evidence of CNS progression by IRC. The risk for a CNS progression without a prior non-CNS progression with alectinib compared with crizotinib.
Percentage of Participants With Central Nervous System (CNS) Progression as Determined by IRC Using Revised Assessment in Neuro Oncology (RANO) Criteria Randomization to the first occurrence of disease progression in the CNS (assessed every 8 weeks up to 33 months) CNS progression was assessed as percentage of participants with event defined as time from randomization until first radiographic evidence of CNS progression by IRC. The risk for a CNS progression without a prior non-CNS progression with alectinib compared with crizotinib.
Percentage of Participants With Objective Response Rate (ORR) of Complete Response (CR) or Partial Response (PR) as Determined by The Investigators According to RECIST V1.1 Criteria Randomization to first documented disease progression or death, whichever occurs first (assessed every 8 weeks up to 33 months) ORR was defined as the percentage of participants who attained CR or PR. As per RECIST v1.1, CR: Disappearance of all target lesions and any pathological lymph nodes (whether target or non-target) must have reduction in short axis to \< 10 mm, PR: At least a 30% decrease in the sum of the diameters of target lesions, taking as reference the baseline sum of diameters.
Percentage of Participants With OS Event From randomization until death (up to 43 months) Overall survival (OS) was defined as the time from randomization to death from any cause.
CNS DOR IRC-assessed According to RECIST v1.1 Criteria First occurrence of CNS objective response to first documented disease progression or death, whichever occurs first (assessed every 8 weeks up to 33 months) CNS DOR was defined as the time from when response (CR or PR) was first documented to first documented disease progression or death, whichever occurred first. DOR was evaluated for participants who had a best overall response (BOR) of CR or PR.
Time to Reach Cmax (Tmax) of Alectinib Pre-dose (within 2 hours before alectinib), 1, 2, 4, 6, and 8 hours post-dose at baseline and Week 4; Pre-dose (within 2 hours before alectinib) at Week 8, then every 8 weeks until disease progression or death/withdrawal from study (up to 33 months) AUC of Alectinib Metabolite Pre-dose (within 2 hours before alectinib) (baseline), 1, 2, 4, 6, and 8 hours post-dose at Visit 0 (first dosing day) and Week 4; Pre-dose (within 2 hours) at Week 8, then every 8 weeks until disease progression or death/withdrawal (up to 33 months) Cmax of Alectinib Metabolite Pre-dose (within 2 hours before alectinib), 1, 2, 4, 6, and 8 hours post-dose at baseline and Week 4; Pre-dose (within 2 hours before alectinib) at Week 8, then every 8 weeks until disease progression or death/withdrawal from study (up to 33 months) Tmax of Alectinib Metabolite Pre-dose (within 2 hours before alectinib), 1, 2, 4, 6, and 8 hours post-dose at baseline and Week 4; Pre-dose (within 2 hours before alectinib) at Week 8, then every 8 weeks until disease progression or death/withdrawal from study (up to 33 months) Time to Deterioration by European Organization for The Research And Treatment of Cancer (EORTC) Quality Of Life Questionnaire Core 30 (C30) Baseline, every 4 weeks until disease progression (up to 33 months) The EORTC QLQ-30 module generated one multiple-item scale score assessing dyspnea and a series of single item scores assessing chest pain, arm/shoulder pain, pain in other parts, coughing, sore mouth, dysphagia, peripheral neuropathy, alopecia, and hemoptysis. All the scales and single-item scores were linearly transformed so that each score ranged from 0 to 100. A higher score on the global health and functioning subscales is indicative of better functioning. Confirmed clinically meaningful deterioration in global health status or function is defined as a \>or=10-point decrease from baseline in a symptom score that must be held for at least two consecutive assessments or an initial \>or=10-point decrease from baseline followed by death within 5 weeks from the last assessment.
Percentage of Participants With Deterioration by EORTC Quality Of Life Questionnaire Core 30 (C30) Baseline, every 4 weeks until disease progression (up to 33 months) The EORTC QLQ-30 module generated one multiple-item scale score assessing dyspnea and a series of single item scores assessing chest pain, arm/shoulder pain, pain in other parts, coughing, sore mouth, dysphagia, peripheral neuropathy, alopecia, and hemoptysis. All the scales and single-item scores were linearly transformed so that each score ranged from 0 to 100. A higher score on the global health and functioning subscales is indicative of better functioning. Confirmed clinically meaningful deterioration in global health status or function is defined as a \>or=10-point decrease from baseline in a symptom score that must be held for at least two consecutive assessments or an initial \>or=10-point decrease from baseline followed by death within 5 weeks from the last assessment.
Time to Deterioration by EORTC Quality of Life Questionnaire Lung Cancer Module 13 (LC13) Baseline, every 4 weeks until disease progression (up to 33 months) The EORTC QLQ-LC13 module generated one multiple-item scale score assessing dyspnea and a series of single item scores assessing chest pain, arm/shoulder pain, pain in other parts, coughing, sore mouth, dysphagia, peripheral neuropathy, alopecia, and hemoptysis. All the scales and single-item scores were linearly transformed so that each score ranged from 0 to 100. A higher score on the global health and functioning subscales is indicative of better functioning. Confirmed clinically meaningful deterioration in lung cancer symptoms is defined as a \>or=10-point increase from baseline in a symptom score that must be held for at least two consecutive assessments or an initial \>or=10-point increase above baseline followed by death within 5 weeks from the last assessment.
Percentage of Participants With Deterioration by EORTC Quality of Life Questionnaire Lung Cancer Module 13 (LC13) Baseline, every 4 weeks until disease progression (up to 33 months) The EORTC QLQ-LC13 module generated one multiple-item scale score assessing dyspnea and a series of single item scores assessing chest pain, arm/shoulder pain, pain in other parts, coughing, sore mouth, dysphagia, peripheral neuropathy, alopecia, and hemoptysis. All the scales and single-item scores were linearly transformed so that each score ranged from 0 to 100. A higher score on the global health and functioning subscales is indicative of better functioning. Confirmed clinically meaningful deterioration in lung cancer symptoms is defined as a \>or=10-point increase from baseline in a symptom score that must be held for at least two consecutive assessments or an initial \>or=10-point increase above baseline followed by death within 5 weeks from the last assessment.
Maximum Concentration (Cmax) of Alectinib Pre-dose (within 2 hours before alectinib), 1, 2, 4, 6, and 8 hours post-dose at baseline and Week 4; Pre-dose (within 2 hours before alectinib) at Week 8, then every 8 weeks until disease progression or death/withdrawal from study (up to 33 months) Health-Related Quality of Life (HRQoL) by EORTC Quality of Life Questionnaire C30 Score Baseline, every 4 weeks until disease progression (up to 33 months) The EORTC QLQ-C30 questionnaire consisted of 30 questions generating five functional scores (physical, role, cognitive, emotional, and social); a global health status/global quality of life scale score; three symptom scale scores (fatigue, pain, and nausea and vomiting); and six stand alone one-item scores that capture additional symptoms (dyspnea, appetite loss, sleep disturbance, constipation, and diarrhea) and perceived financial burden. All the scales and single-item scores were linearly transformed so that each score ranged from 0 to 100. A higher score on the global health and functioning subscales is indicative of better functioning.
HRQoL by EORTC Quality of Life Questionnaire LC13 Score Coughing Baseline, every 4 weeks until disease progression (up to 33 months) The EORTC QLQ-LC13 module generated one multiple-item scale score assessing dyspnea and a series of single item scores assessing chest pain, arm/shoulder pain, pain in other parts, coughing, sore mouth, dysphagia, peripheral neuropathy, alopecia, and hemoptysis. All the scales and single-item scores were linearly transformed so that each score ranged from 0 to 100. A higher score on the global health and functioning subscales is indicative of better functioning.
HRQoL by EORTC Quality of Life Questionnaire LC13 Score Dyspnoea Baseline, every 4 weeks until disease progression (up to 33 months) The EORTC QLQ-LC13 module generated one multiple-item scale score assessing dyspnea and a series of single item scores assessing chest pain, arm/shoulder pain, pain in other parts, coughing, sore mouth, dysphagia, peripheral neuropathy, alopecia, and hemoptysis. All the scales and single-item scores were linearly transformed so that each score ranged from 0 to 100. A higher score on the global health and functioning subscales is indicative of better functioning.
HRQoL by EORTC Quality of Life Questionnaire LC13 Score Pain in Arm and Shoulder Baseline, every 4 weeks until disease progression (up to 33 months) The EORTC QLQ-LC13 module generated one multiple-item scale score assessing dyspnea and a series of single item scores assessing chest pain, arm/shoulder pain, pain in other parts, coughing, sore mouth, dysphagia, peripheral neuropathy, alopecia, and hemoptysis. All the scales and single-item scores were linearly transformed so that each score ranged from 0 to 100. A higher score on the global health and functioning subscales is indicative of better functioning.
HRQoL by EORTC Quality of Life Questionnaire LC13 Score Pain in Chest Baseline, every 4 weeks until disease progression (up to 33 months) The EORTC QLQ-LC13 module generated one multiple-item scale score assessing dyspnea and a series of single item scores assessing chest pain, arm/shoulder pain, pain in other parts, coughing, sore mouth, dysphagia, peripheral neuropathy, alopecia, and hemoptysis. All the scales and single-item scores were linearly transformed so that each score ranged from 0 to 100. A higher score on the global health and functioning subscales is indicative of better functioning.
Trial Locations
- Locations (98)
Kyiv Regional Oncological Dispensary
🇺🇦Kyiv, Ukraine
Sun Yet-sen University Cancer Center
🇨🇳Guangzhou, China
Chu Grenoble - Hopital Albert Michallon
🇫🇷Grenoble, France
CHRU de Lille
🇫🇷Lille, France
Uni of Auckland
🇳🇿Auckland, New Zealand
Uniwersyteckie Centrum Kliniczne
🇵🇱Gda?sk, Poland
Khonkaen Hospital
🇹🇭Khonkaen, Thailand
North Valley Hem Onc Med Grp
🇺🇸Northridge, California, United States
TMPN/ Cancer Care Associates
🇺🇸Redondo Beach, California, United States
University of Colorado Cancer Center
🇺🇸Aurora, Colorado, United States
University of Miami-Deerfield Beach
🇺🇸Deerfield Beach, Florida, United States
Massachusetts General Hospital Cancer Center
🇺🇸Boston, Massachusetts, United States
Beth Israel Deaconess Med Ctr
🇺🇸Boston, Massachusetts, United States
Dana Farber Can Ins
🇺🇸Boston, Massachusetts, United States
Karmanos Cancer Institute
🇺🇸Detroit, Michigan, United States
Washington Uni School of Medicine
🇺🇸Saint Louis, Missouri, United States
SCRI Oncology Partners
🇺🇸Nashville, Tennessee, United States
University of Texas M.D. Anderson Cancer Center
🇺🇸Houston, Texas, United States
Kinghorn Cancer Centre
🇦🇺Darlinghurst, New South Wales, Australia
Royal North Shore Hospital
🇦🇺St Leonards, New South Wales, Australia
Calvary Mater Newcastle
🇦🇺Waratah, New South Wales, Australia
Queen Elizabeth Hospital
🇦🇺Adelaide, South Australia, Australia
Monash Health Translational Precinct
🇦🇺Victoria, Australia
University Clinical Center Sarajevo
🇧🇦Sarajevo, Bosnia and Herzegovina
Instituto do Cancer do Estado de Sao Paulo - ICESP
🇧🇷Sao Paulo, São Paulo, Brazil
Cross Cancer Institute
🇨🇦Edmonton, Alberta, Canada
Sunnybrook Odette Cancer Centre
🇨🇦Toronto, Ontario, Canada
Mount Sinai Hospital
🇨🇦Toronto, Ontario, Canada
Saskatoon Cancer Centre
🇨🇦Saskatoon, Saskatchewan, Canada
Centro Internacional de Estudios Clínicos (CIEC)
🇨🇱Santiago, Chile
Shanghai Pulmonary Hospital
🇨🇳Shanghai, China
Clinica CIMCA
🇨🇷San Jose, Costa Rica
Kasr Eieny Uni Hospital
🇪🇬Cairo, Egypt
Centre Leon Berard
🇫🇷Lyon, France
Hopital Haut Leveque
🇫🇷Pessac, France
Grupo Angeles
🇬🇹Guatemala City, Guatemala
Tuen Mun Hospital
🇭🇰Hong Kong, Hong Kong
Pamela Youde Nethersole Eastern Hospital
🇭🇰Hong Kong, Hong Kong
Prince of Wales Hosp
🇭🇰Hong Kong, Hong Kong
Princess Margaret Hospital
🇭🇰Hong Kong, Hong Kong
Queen Mary Hospital
🇭🇰Hong Kong, Hong Kong
Rambam Medical Center
🇮🇱Haifa, Israel
Meir Medical Center
🇮🇱Kfar Saba, Israel
A.O. Universitaria Di Parma
🇮🇹Parma, Emilia-Romagna, Italy
Ospedale Provinciale Santa Maria Delle Croci
🇮🇹Ravenna, Emilia-Romagna, Italy
Policlinico Umberto i di Roma
🇮🇹Roma, Lazio, Italy
Irccs Istituto Nazionale Dei Tumori (Int)
🇮🇹Milano, Lombardia, Italy
Irccs Istituto Europeo Di Oncologia (IEO)
🇮🇹Milano, Lombardia, Italy
Irccs Ist. Tumori Giovanni Paolo Ii
🇮🇹Bari, Puglia, Italy
Az Ospedaliera Nuovo Garibaldi Quartiere Nesima
🇮🇹Catania, Sicilia, Italy
Azienda Ospedaliera Di Perugia Ospedale s. Maria Della Misericordia
🇮🇹Perugia, Umbria, Italy
National Cancer Center
🇰🇷Gyeonggi-do, Korea, Republic of
Seoul National University Bundang Hospital
🇰🇷Gyeonggi-do, Korea, Republic of
Seoul National University Hospital
🇰🇷Seoul, Korea, Republic of
Severance Hospital, Yonsei University Health System
🇰🇷Seoul, Korea, Republic of
Asan Medical Center
🇰🇷Seoul, Korea, Republic of
Samsung Medical Center
🇰🇷Seoul, Korea, Republic of
Instituto Nacional De Enfermedades Respiratorias
🇲🇽Ciudad de México, Mexico CITY (federal District), Mexico
Ms Clinsearch Specjalistyczny Niepubliczny Zaklad Opieki Zdrowotnej
🇵🇱Lublin, Poland
Warminsko-Mazurskie Centrum Chorób P?uc w Olsztynie
🇵🇱Olsztyn, Poland
Mazowieckie Centrum Leczenia Chorob Pluc I Gruzlicy
🇵🇱Otwock, Poland
Centrum Onkologii - Inst.Im. Marii Sklodowskiej-Curie
🇵🇱Warszawa, Poland
CHUC - Unidade de Pneumologia Oncológica
🇵🇹Coimbra, Portugal
IPO de Lisboa
🇵🇹Lisboa, Portugal
IPO do Porto
🇵🇹Porto, Portugal
Moscow City Oncology Hospital #62
🇷🇺Moscovskaya Oblast, Moskovskaja Oblast, Russian Federation
SPb City Clin Onc Dsp
🇷🇺Sankt-peterburg, Sankt Petersburg, Russian Federation
Scientific Research Oncology Institute named after N.N. Petrov
🇷🇺St. Petersburg, Sankt Petersburg, Russian Federation
N.N.Burdenko Main Military Clinical Hospital
🇷🇺Moscow, Russian Federation
Clinical Center of Serbia
🇷🇸Belgrade, Serbia
Institute for pulmonary diseases of Vojvodina
🇷🇸Sremska Kamenica, Serbia
National University Hospital
🇸🇬Singapore, Singapore
National Cancer Centre
🇸🇬Singapore, Singapore
Hospital General Univ. de Alicante
🇪🇸Alicante, Spain
Vall d'Hebron Institute of Oncology (VHIO), Barcelona
🇪🇸Barcelona, Spain
Hospital Universitari Germans Trias i Pujol
🇪🇸Barcelona, Spain
Hospital Universitario Puerta de Hierro
🇪🇸Madrid, Spain
Hospital Universitario Virgen del Rocio
🇪🇸Sevilla, Spain
Universitaetsspital Basel
🇨🇭Basel, Switzerland
Inselspital Bern
🇨🇭Bern, Switzerland
CHUV
🇨🇭Lausanne, Switzerland
UniversitätsSpital Zürich
🇨🇭Zürich, Switzerland
Taichung Veterans General Hospital
🇨🇳Taichung, Taiwan
National Cheng Kung Univ Hosp
🇨🇳Tainan, Taiwan
National Taiwan University Hospital
🇨🇳Taipei, Taiwan
Taipei Veterans General Hospital
🇨🇳Taipei, Taiwan
National Cancer Inst.
🇹🇭Bangkok, Thailand
Chiang Rai Prachanukroh Hospital
🇹🇭Chiang Rai, Thailand
King Chulalongkorn Memorial Hospital
🇹🇭Patumwan, Thailand
Songklanagarind Hospital
🇹🇭Songkla, Thailand
Baskent University Adana Dr. Turgut Noyan Practice and Research Hospital
🇹🇷Adana, Turkey
Ankara University Medical Faculty
🇹🇷Ankara, Turkey
Trakya University Medical Faculty Research And Practice Hospital Medical Oncology Department
🇹🇷Edirne, Turkey
Inonu University Medical Faculty Turgut Ozal Medical Center Medical Oncology Department
🇹🇷Malatya, Turkey
Lviv State Oncology Regional Treatment and Diagnostic Centre
🇺🇦Lviv, Ukraine
Birmingham Heartlands Hospital
🇬🇧Birmingham, United Kingdom
University College London Hospital
🇬🇧London, United Kingdom
Guys & St Thomas Hospital
🇬🇧London, United Kingdom