Study of Selinexor in Combination With Ruxolitinib in Myelofibrosis

Phase 3

Recruiting

• Conditions: Myelofibrosis
• Interventions: Drug: Selinexor; Other: Placebo; Drug: Ruxolitinib

• Registration Number: NCT04562389
• Lead Sponsor: Karyopharm Therapeutics Inc

Brief Summary

This is a global, multicenter Phase 1/3 study to evaluate the efficacy and safety of selinexor plus ruxolitinib in JAK inhibitor (JAKi) treatment-naïve myelofibrosis (MF) participants. The study will be conducted in two phases: Phase 1 (open-label) and Phase 3 (double-blind). Phase 1 (enrollment completed) was an open-label evaluation of the safety and recom...

Detailed Description

Not available

Basic Information
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Recruitment & Eligibility
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Study & Design
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Trial Locations
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Related News

Study Timeline

• Study First Submitted: 2020-09-14
• Study First Submitted QC: 2020-09-18
• Study First Posted: 2020-09-24
• Study Start: 2021-03-11
• Status Verified: 2024-07
• Last Update Submitted: 2024-07-23
• Last Update Posted: 2024-07-24
• Primary Completion: 2025-09
• Study Completion: 2028-03

Recruitment & Eligibility

• Status: RECRUITING
• Sex: All
• Target Recruitment: 330

Inclusion Criteria

• A diagnosis of primary MF or post-essential thrombocythemia (ET) or postpolycythemia- vera (PV) MF according to the 2016 World Health Organization (WHO) classification of MPN, confirmed by the most recent local pathology report.
• Measurable splenomegaly during the screening period as demonstrated by spleen volume of greater than or equal to (>=) 450 cubic centimeter (cm^3) by MRI or CT scan (results from MRI or CT imaging performed within 28 days prior to screening are acceptable).
• Participants with international prognostic scoring system (DIPSS) risk category of intermediate-1, or intermediate-2, or high-risk.
• Participants >=18 years of age.
• Eastern Cooperative Oncology Group (ECOG) Performance Status less than or equal to (<=) 2.
• Platelet count >= 100*10^9/liter (L) without platelet transfusion.
• Absolute neutrophil count (ANC) >=1.0 *10^9/L without need for growth factors within 7 days prior to C1D1.
• Adequate liver function as defined by the following: aspartate transaminase (AST) and alanine aminotransferase (ALT) <= 2.5*upper limit normal (ULN) and serum total bilirubin <= 2 × ULN.
• Calculated creatinine clearance (CrCl) greater than (>) 15 milliliters per minute (mL/min) based on the Cockcroft and Gault formula.
• Participants with active hepatitis B virus (HBV) are eligible if antiviral therapy for hepatitis B has been given for > 8 weeks and the viral load is less than (<) 100 international units/milliliter (IU/mL).
• Participants with history of hepatitis C virus (HCV) are eligible if they have received adequate curative anti-HCV treatment and HCV viral load is below the limit of quantification.
• Participants with history of human immunodeficiency virus (HIV) are eligible if they have CD4+ T-cell counts >= 350 cells/microliter (cells/mcL), negative viral load, and no history of acquired immunodeficiency syndrome (AIDS)-defining opportunistic infections in the last year and should be on established antiretroviral therapy (ART) for at least 4 weeks.
• Female participants of childbearing potential must have a negative serum pregnancy test at screening and within 3 days prior to first dose on C1D1 and agree to use highly effective methods of contraception throughout the selinexor treatment period and for 90 days following the last dose of selinexor treatment. A woman is considered of childbearing potential, i.e., fertile, following menarche and until becoming post-menopausal unless permanently sterile. Permanent sterilization methods include hysterectomy, bilateral salpingectomy and bilateral oophorectomy. A postmenopausal state is defined as no menses for 12 months without an alternative medical cause.
• Male participants who are sexually active must use highly effective methods of contraception throughout the study treatment period and for 90 days following the last dose of selinexor treatment. Male participants must agree not to donate sperm during the study treatment period and for at least 90 days after the last dose of selinexor treatment.
• Participants must sign written informed consent in accordance with federal, local, and institutional guidelines.
• Active symptoms of MF as determined by presence of at least 2 symptoms with a score >=3 or total score of >= 10 at screening using the Myelofibrosis Symptom Assessment Form (MFSAF) V4.0.
• Participant currently not eligible for stem cell transplantation.
• Participants must provide bone marrow biopsy samples (samples obtained up to 3 months prior to C1D1 are permitted) at screening and during the study.
• Life expectancy of greater than 6 months in the opinion of the investigator.
• Participants with no other concomitant malignancies or history of another malignancy within 2 years prior to C1D1 except for adequately treated early-stage basal cell or squamous cell carcinoma of skin, adequately treated carcinoma in situ of breast or cervix or organ confined prostate cancer, or PV or ET.

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Exclusion Criteria

• More than 10% blasts in peripheral blood or bone marrow (accelerated or blast phase).
• Previous treatment with JAK inhibitors for MF.
• Previous treatment with selinexor or other XPO1 inhibitors.
• Impairment of gastrointestinal (GI) function or GI disease that could significantly alter the absorption of selinexor (e.g., vomiting or diarrhea > CTCAE v 5.0 Grade 1).
• Received strong cytochrome P450 3A (CYP3A) inhibitors <= 7 days prior to selinexor dosing OR strong CYP3A inducers <= 14 days prior to selinexor dosing (Phase 1 participants only)
• Major surgery < 28 days prior to C1D1.
• Uncontrolled (i.e., clinically unstable) infection requiring parenteral antibiotics, antivirals, or antifungals within 7 days prior to C1D1; however, prophylactic use of these agents is acceptable (including parenteral).
• Any life-threatening illness, medical condition, or organ system dysfunction which, in the Investigator's opinion, could compromise the participants safety, prevent the participant from giving informed consent, or being compliant with the study procedures, or confound the ability to interpret study results.
• Female participants who are pregnant or lactating.
• Prior splenectomy, or splenic radiation within 6 months prior to C1D1.
• Unable or unwilling to undergo CT scan or MRI per protocol.
• Participants with contraindications or known hypersensitivity to selinexor or ruxolitinib or excipients.
• History of pulmonary hypertension.
• History of myocardial infarction, unstable angina, percutaneous transluminal coronary angioplasty (PTCA) or coronary artery bypass graft (CABG), cerebrovascular accident (stroke or transient ischemic attack [TIA]), ventricular arrhythmias, congestive heart failure New York Heart Association (NYHA) class > 2 within 6 months of C1D1.
• Participants unable to tolerate two forms of antiemetics prior to each dose for at least 2 cycles.

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Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Phase 1a: Cohort 2: Selinexor 60 mg + Ruxolitinib BID	Selinexor	Participants with MF will receive a dose of 60 mg selinexor oral tablets QW on Days 1, 8, 15, and 22 of each 28-day cycle in combination with 15 or 20 mg ruxolitinib BID based on the participants baseline platelet count.
Phase 3: Placebo + Ruxolitinib BID	Placebo	Participants with MF will receive a matching placebo of selinexor oral tablets QW on Days 1, 8, 15, and 22 of each 28-day cycle in combination with a starting dose of 15 or 20 mg ruxolitinib BID based on the participants baseline platelet count.
Phase 1a: Cohort 1: Selinexor 40 mg + Ruxolitinib BID	Selinexor	Participants with MF will receive a dose of 40 milligrams (mg) selinexor oral tablets once weekly (QW) on Days 1, 8, 15, and 22 of each 28-day cycle in combination with 15 or 20 mg ruxolitinib twice a day (BID) based on the participants baseline platelet count.
Phase 1a: Cohort 2: Selinexor 60 mg + Ruxolitinib BID	Ruxolitinib	Participants with MF will receive a dose of 60 mg selinexor oral tablets QW on Days 1, 8, 15, and 22 of each 28-day cycle in combination with 15 or 20 mg ruxolitinib BID based on the participants baseline platelet count.
Phase 1a: Cohort 1: Selinexor 40 mg + Ruxolitinib BID	Ruxolitinib	Participants with MF will receive a dose of 40 milligrams (mg) selinexor oral tablets once weekly (QW) on Days 1, 8, 15, and 22 of each 28-day cycle in combination with 15 or 20 mg ruxolitinib twice a day (BID) based on the participants baseline platelet count.
Phase 1b: Selinexor and Ruxolitinib BID	Selinexor	Participants with MF will receive a dose of 40 or 60 mg selinexor oral tablets QW on Days 1, 8, 15, and 22 of each 28-day cycle in combination with 15 or 20 mg ruxolitinib BID based on the participants baseline platelet count.
Phase 1b: Selinexor and Ruxolitinib BID	Ruxolitinib	Participants with MF will receive a dose of 40 or 60 mg selinexor oral tablets QW on Days 1, 8, 15, and 22 of each 28-day cycle in combination with 15 or 20 mg ruxolitinib BID based on the participants baseline platelet count.
Phase 3: Selinexor 60 mg + Ruxolitinib BID	Selinexor	Participants with MF will receive a fixed starting dose of 60 mg selinexor (RD) oral tablets QW on Days 1, 8, 15, and 22 of each 28-day cycle in combination with a starting dose of 15 or 20 mg ruxolitinib BID based on the participants baseline platelet count.
Phase 3: Selinexor 60 mg + Ruxolitinib BID	Ruxolitinib	Participants with MF will receive a fixed starting dose of 60 mg selinexor (RD) oral tablets QW on Days 1, 8, 15, and 22 of each 28-day cycle in combination with a starting dose of 15 or 20 mg ruxolitinib BID based on the participants baseline platelet count.
Phase 3: Placebo + Ruxolitinib BID	Ruxolitinib	Participants with MF will receive a matching placebo of selinexor oral tablets QW on Days 1, 8, 15, and 22 of each 28-day cycle in combination with a starting dose of 15 or 20 mg ruxolitinib BID based on the participants baseline platelet count.

Primary Outcome Measures

Name	Time	Method
Phase 3: Proportion of Participants with Spleen Volume Reduction (SVR) of Greater than or Equal to (>=) 35 Percent (%) (SVR35) at Week 24 Measured by the Magnetic Resonance Imaging (MRI) or Computed Tomography (CT) Scan	At Week 24
Phase 3: Proportion of Participants with Total Symptom Score (TSS) Reduction of >= 50% (TSS50) at Week 24 Measured by the Myelofibrosis Symptom Assessment Form (MFSAF) V4.0	At Week 24
Phase 1: Maximum Tolerated Dose (MTD)	Approximately within the first cycle (28 days) of therapy
Phase 1: Recommended Phase 2 Dose (RP2D)	Approximately within the first cycle (28 days) of therapy
Phase 1: Number of Participants With Adverse Events (AEs) by Occurrence, Nature, and Severity	From start of drug administration up to 30 days after last dose of study treatment (approximately 48 months)

Secondary Outcome Measures

Name	Time	Method
Phase 3: Proportion of Participants with Anemia Response at Week 24, as per the International Working Group Myeloproliferative Neoplasms Research and Treatment and European Leukemia Network (IWG-MRT and ELN) criteria	At Week 24
Phase 3: Overall Survival	From date of randomization to the date of death due to any cause or EoS (assessed at approximately 48 months)
Phase 3: Overall Response Rate as per IWG-MRT and ELN criteria	From Cycle 1 Day 1 (28-day cycle) up to EoS (approximately 48 months)
Phase 3: Proportion of Participants with SVR35 at any Time Point	From Baseline up to EoS (approximately 48 months)
Phase 3: Proportion of Participants with TSS50 at any Time as measured by the MFSAF V4.0	From Baseline up to EoS (approximately 48 months)
Phase 3: SVR35 Response in Participants	From Baseline up to EoS (approximately 48 months)
Phase 3: TSS50 Response in Participants	From Baseline up to EoS (approximately 48 months)
Phase 3: Anemia Response in Participants	From Baseline up to EoS (approximately 48 months)
Phase 3: Number of Participants With Treatment-emergent Adverse Events (TEAEs), Treatment Related Adverse Events (TRAEs), and Serious Adverse Events (SAEs)	From start of drug administration up to 30 days after last dose of study treatment (approximately 48 months)
Phase 3: Number of Participants With Severity of TEAEs	From start of drug administration up to 30 days after last dose of study treatment (approximately 48 months)
Phase 3: Area Under the Concentration-time Curve (AUC) of Selinexor	Predose, 0.5, 1, 2, 4, 6, and 24 hours post-dose on Cycle 1 Day 15 and 2.5 hours post-dose on Cycle 2 Day 15 (28-day cycle)
Phase 3: Maximum Plasma Concentration (Cmax) of Selinexor	Predose, 0.5, 1, 2, 4, 6, and 24 hours post-dose on Cycle 1 Day 15 and 2.5 hours post-dose on Cycle 2 Day 15 (28-day cycle)
Phase 3: Time at Which Cmax is Achieved (Tmax) of Selinexor	Predose, 0.5, 1, 2, 4, 6, and 24 hours post-dose on Cycle 1 Day 15 and 2.5 hours post-dose on Cycle 2 Day 15 (28-day cycle)
Phase 3: Proportion of Participants with at least Grade 1 Decrease in Bone Marrow Fibrosis	From Baseline up to EoS (approximately 48 months)
Phase 3: Progression-free survival (PFS)	Time from randomization until disease progression or death, whichever occurs first (approximately 48 months)
Phase 1: Percentage of Participants with TSS Reduction of >= 50% (TSS50) in the MFSAF V4.0 Based on Local Assessment	From Baseline up to 28 days after last dose (approximately 48 months)
Phase 1: Percentage of Participants with Spleen Volume Reduction of >= 25% (SVR25) Based on Local Assessment	From Baseline up to Week 48
Phase 1: Percentage of Participants with Spleen Volume Reduction of >= 35% (SVR35) Based on Local Assessment	From Baseline up to Week 48
Phase 1: Overall Survival	From Baseline up to 12 months after last dose
Phase 1: Anaemia Response in Participants as per International Working Group -Myeloproliferative Neoplasms Research and Treatment (IWG-MRT) Criteria	From Baseline up to 28 days after last dose (approximately 48 months)
Phase 1: Duration of SVR35 Based on Local Assessment	From Baseline up to 28 days after last dose (approximately 48 months)
Phase 1: Duration of SVR25 Based on Local Assessment	From Baseline up to 28 days after last dose (approximately 48 months)
Phase 1: Duration of TSS50 Based on Local Assessment	From Baseline up to 28 days after last dose (approximately 48 months)
Phase 1: Overall Response Rate Based on Local Assessment	Cycle 1 Day 1 (28-day cycle) up to 28 days after last dose (approximately 48 months)
Phase 1: Number of Participants with Adverse Events (AEs) by Occurrence, Nature, and Severity	From start of drug administration up to 30 days after last dose of study treatment (approximately 48 months)
Phase 1: Maximum Plasma Concentration (Cmax) of Selinexor and Ruxolitinib	Predose, 0.5, 1, 2, 4, 6, and 24 hours post-dose on Cycle 1 Day 15 and Cycle 1 Day 16 (28-day cycle)
Phase 1: Area Under the Concentration-time Curve (AUC) of Selinexor and Ruxolitinib	Predose, 0.5, 1, 2, 4, 6, and 24 hours post-dose on Cycle 1 Day 15 and Cycle 1 Day 16 (28-day cycle)

Trial Locations

Locations (133)

UAB Division of Hematology/Oncology; 🇺🇸 Birmingham, Alabama, United States

UCLA - Satellite Site; 🇺🇸 Encino, California, United States

City of Hope; 🇺🇸 Duarte, California, United States

City of Hope - Irvine Lennar - Satellite; 🇺🇸 Irvine, California, United States

UCLA; 🇺🇸 Los Angles, California, United States

The Oncology Institute of Hope & Innovation; 🇺🇸 Pasadena, California, United States

Smilow Cancer Hospital - New Haven; 🇺🇸 New Haven, Connecticut, United States

Norton Cancer Institute - Saint Matthews; 🇺🇸 Louisville, Kentucky, United States

Maryland Oncology Hematology-Satellite; 🇺🇸 Silver Spring, Maryland, United States

The Sidney Kimmel Comprehensive Cancer Center; 🇺🇸 Baltimore, Maryland, United States

Maryland Oncology Hematology; 🇺🇸 Columbia, Maryland, United States

The Cancer & Hematology Centers -Satellite Site; 🇺🇸 Grand Rapids, Michigan, United States

The Cancer & Hematology Centers of Muskegon; 🇺🇸 Norton Shores, Michigan, United States

John Theurer Cancer Center at Hackensack University Medical Center; 🇺🇸 Hackensack, New Jersey, United States

Mount Sinai Health System; 🇺🇸 New York, New York, United States

Memorial Sloan Kettering Cancer Center; 🇺🇸 New York, New York, United States

Duke Cancer Institue; 🇺🇸 Durham, North Carolina, United States

OhioHealth; 🇺🇸 Columbus, Ohio, United States

Vanderbilt Ingram Cancer Center; 🇺🇸 Nashville, Tennessee, United States

Texas Oncology; 🇺🇸 Dallas, Texas, United States

University of Texas MD Anderson Cancer Center; 🇺🇸 Houston, Texas, United States

Huntsman Cancer Institute; 🇺🇸 Salt Lake City, Utah, United States

VCU Massey Cancer Center; 🇺🇸 Richmond, Virginia, United States

Fred Hutchinson Cancer Center - SCAA South Lake Union; 🇺🇸 Seattle, Washington, United States

West Virginia University Cancer Institute, Wheeling Hospital; 🇺🇸 Wheeling, West Virginia, United States

University of Wisconsin - Madison; 🇺🇸 Madison, Wisconsin, United States

Universitair Ziekenhuis Leuven - Campus Gasthuisberg; 🇧🇪 Leuven, Flemish Brabant, Belgium

Universitair Ziekenhuis Gent; 🇧🇪 Gent, Oost-Vlaanderen, Belgium

Algemeen Ziekenhuis Sint-Jan Brugge-Oostende - Campus Sint-Jan; 🇧🇪 Brugge, West-Vlaanderen, Belgium

ZNA Stuivenberg - Satelite; 🇧🇪 Antwerpen, Belgium

ZNA Stuivenberg; 🇧🇪 Antwerpen, Belgium

University Multiprofile Hospital for Active Treatment Sveti George - Base 1; 🇧🇬 Plovdiv, Bulgaria

University Multiprofile Hospital for Active Treatment Aleksandrovska; 🇧🇬 Sofia, Bulgaria

University Multiprofile Hospital for Active Treatment St. Ivan Rilski; 🇧🇬 Sofia, Bulgaria

Specialized Hospital for Active Treatment of Hematological Diseases - EAD Sofia; 🇧🇬 Sofia, Bulgaria

University Multiprofile Hospital for Active Treatment - Prof. Dr. Stoyan Kirkovich; 🇧🇬 Stara Zagora, Bulgaria

Research Institute of the McGill University Health Centre; 🇨🇦 Montreal, Quebec, Canada

Vseobecna Fakultni Nemocnice v Praze; 🇨🇿 Praha 2, Prague, Czech Republic

Fakultní Nemocnice Hradec Králové; 🇨🇿 Hradec Králové, Czechia

Fakultní Nemocnice Olomouc; 🇨🇿 Olomouc, Czechia

Aarhus Universitetshospital; 🇩🇰 Aarhus N, Midtjylland, Denmark

Tang Severinsen, Marianne; 🇩🇰 Aalborg, Nordjylland, Denmark

Institut Bergonié; 🇫🇷 Bordeaux, Aquitaine, France

Centre Hospitalier Universitaire Estaing; 🇫🇷 Clermont-Ferrand, Aubergne, France

Hôpital Morvan; 🇫🇷 Brest, Bretagne, France

Chu De Nîmes - Institut De Cancérologie Du Gard; 🇫🇷 Nimes, Gard, France

Hôpital Huriez; 🇫🇷 Lille, Hauts-de-France, France

Hôpital Emile Muller; 🇫🇷 Mulhouse, Grand Est, France

Hôpital Bretonneau; 🇫🇷 Tours Cedex, Indre-et-Loire, France

Centre Hospitalier Universitaire de Saint-Étienne; 🇫🇷 Saint-Priest-en-Jarez, Loire, France

Centre Hospitalier Universitaire d'Angers; 🇫🇷 Angers, Pays de la Loire, France

Hôpital l'Archet - CHU Nice; 🇫🇷 Nice Cedex 3, Provence-Alpes-Côte d'Azur, France

Centre Hospitalier Lyon-Sud; 🇫🇷 Pierre-Bénite, Rhone-Alpes, France

Hôpital Saint-Louis; 🇫🇷 Paris, France

Kliniken Ostalb - Stauferklinikum Schwäbisch Gmünd; 🇩🇪 Mutlangen, Baden-Württemberg, Germany

Marien Hospital Düsseldorf; 🇩🇪 Düsseldorf, Nordrhein-Westfalen, Germany

Universitätsklinikum Halle; 🇩🇪 Halle, Sachsen-Anhalt, Germany

Städtisches Krankenhaus Kiel; 🇩🇪 Kiel, Schleswig-Holstein, Germany

Universitätsklinikum Jena; 🇩🇪 Jena, Thuringen, Germany

Laiko General Hospital of Athens; 🇬🇷 Athens, Attica, Greece

University General Hospital Attikon; 🇬🇷 Athens, Attica, Greece

General Hospital of Thessaloniki George Papanikolaou; 🇬🇷 Thessaloniki, Central Macedonia, Greece

University General Hospital of Larissa, Hematology Department; 🇬🇷 Larissa, Thessaly, Greece

Győr-Moson-Sopron Vármegyei Petz Aladár Egyetemi Oktató Kórház; 🇭🇺 Győr, Gyor-Moson-Sopron, Hungary

Semmelweis Egyetem; 🇭🇺 Budapest, Hungary

Shamir Medical Center (Assaf Harofeh); 🇮🇱 Be'er Ya'akov, Central District, Israel

The Chaim Sheba Medical Center; 🇮🇱 Ramat Gan, Central District, Israel

Rambam Health Care Campus; 🇮🇱 Haifa, Haifa District, Israel

Carmel Medical Center; 🇮🇱 Haifa, Haifa District, Israel

Hadassah University Hospital - Mount Scopus - Satellite Site; 🇮🇱 Jerusalem, Jerusalem District, Israel

Hadassah University Hospital Ein Kerem; 🇮🇱 Jerusalem, Jerusalem District, Israel

Emek Medical Center; 🇮🇱 Afula, Northern District, Israel

Western Galilee Hospital-Nahariya; 🇮🇱 Nahariya, Northern District, Israel

Tel Aviv Sourasky Medical Center; 🇮🇱 Tel Aviv, Israel

Istituto Romagnolo per lo Studio dei Tumori "Dino Amadori" - IRST; 🇮🇹 Meldola, Forli-Cesena, Italy

IRCCS Ospedale Policlinico San Martino; 🇮🇹 Genova, Genoa, Italy

Fondazione IRCCS Cà Granda - Ospedale Maggiore Policlinico; 🇮🇹 Milano, Milan, Italy

Istituto Europeo di Oncologia; 🇮🇹 Milano, Milan, Italy

Fondazione IRCCS San Gerardo dei Tintori; 🇮🇹 Monza, Monza and Brianza, Italy

IRCCS Centro di Riferimento Oncologico di Basilicata; 🇮🇹 Rionero In Vulture, Potenza, Italy

Azienda Ospedaliero-Universitaria Citta della Salute e della Scienza di Torino; 🇮🇹 Torino, Turin, Italy

Università Campus Bio-Medico di Roma; 🇮🇹 Rome, Viterbo, Italy

Azienda Ospedaliero-Universitaria di Bologna - Policlinico Sant Orsola-Malpighi; 🇮🇹 Bologna, Italy

Azienda Ospedaliero-Universitaria Maggiore della Carità di Novara; 🇮🇹 Novara, Italy

Fondazione IRCCS Policlinico San Matteo; 🇮🇹 Pavia, Italy

Fondazione Policlinico Universitario Agostino Gemelli IRCCS; 🇮🇹 Roma, Italy

Azienda Ospedaliera Ordine Mauriziano di Torino; 🇮🇹 Torino, Italy

Centro Ricerche Cliniche di Verona; 🇮🇹 Verona, Italy

Pusan National University Hospital; 🇰🇷 Busan Gwang'yeogsi [Pusan-Kwangyokshi], Korea, Republic of

Kyungpook National University Hospital; 🇰🇷 Daegu, Korea, Republic of

Chonnam National University Hwasun Hospital; 🇰🇷 Hwasun-gun, Korea, Republic of

Seoul National University Bundang Hospital; 🇰🇷 Seongnam-si Gyeonggido [Kyonggi-do], Korea, Republic of

Samsung Medical Center; 🇰🇷 Seoul Teugbyeolsi [Seoul-T'ukpyolshi], Korea, Republic of

Seoul National University Hospital; 🇰🇷 Seoul, Korea, Republic of

Severance Hospital; 🇰🇷 Seoul, Korea, Republic of

The Catholic University of Korea - Seoul St. Mary's Hospital; 🇰🇷 Seoul, Korea, Republic of

Universitair Medisch Centrum Groningen; 🇳🇱 Groningen, Netherlands

Medicover Integrated Clinical Services (MICS) - Centrum Medyczne Toruń; 🇵🇱 Toruń, Kujawsko-Pomorskie, Poland

Uniwersytecki Szpital Kliniczny Nr 4 w Lublinie; 🇵🇱 Lublin, Lubelskie, Poland

Szpital Specjalistyczny w Brzozowie - Podkarpacki Ośrodek Onkologiczny im. Ks. B. Markiewicza; 🇵🇱 Brzozów, Podkarpackie, Poland

Uniwersyteckie Centrum Kliniczne w Gdańsku; 🇵🇱 Gdańsk, Pomorskie, Poland

Pratia Onkologia Katowice; 🇵🇱 Katowice, Slaskie, Poland

Specjalistyczny Szpital im. dra Alfreda Sokołowskiego w Wałbrzychu; 🇵🇱 Wałbrzych, Slaskie, Poland

AIDPORT; 🇵🇱 Skórzewo, Wielkopolskie, Poland

Institutul Oncologic Prof. Dr. Ion Chiricuta; 🇷🇴 Cluj-Napoca, Cluj, Romania

Spitalul Filantropia - Craiova; 🇷🇴 Craiova, Dolj, Romania

Institutul Regional De Oncologie Iasi; 🇷🇴 Moldova, Iasi, Romania

Spitalul Clinic Judetean De Urgenta Târgu Mureș; 🇷🇴 Târgu Mureş, Mureș, Romania

Coltea - Spital Clinic; 🇷🇴 Bucuresti, Romania

Spitalul Clinic Colentina; 🇷🇴 Bucuresti, Romania

Hospital Universitario Central de Asturias; 🇪🇸 Oviedo, Asturias, Spain

Hospital Universitari Vall d'Hebrón; 🇪🇸 Barcelona, Spain

Hospital Clinic de Barcelona; 🇪🇸 Barcelona, Spain

Institut Català d&#39;Oncologia Girona (ICO Girona); 🇪🇸 Girona, Spain

Hospital Universitario de Gran Canaria Doctor Negrin; 🇪🇸 Las Palmas de Gran Canaria, Spain

Hospital Universitario Lucus Augusti; 🇪🇸 Lugo, Spain

Hospital General Universitario Gregorio Marañón; 🇪🇸 Madrid, Spain

Hospital Universitario Ramón y Cajal; 🇪🇸 Madrid, Spain

Hospital Universitario 12 de Octubre; 🇪🇸 Madrid, Spain

Hospital Clínico Universitario Virgen de la Arrixaca; 🇪🇸 Murcia, Spain

Hospital Universitario Virgen de la Victoria; 🇪🇸 Málaga, Spain

Complejo Asistencial Universitario de Salamanca - Hospital Clínico; 🇪🇸 Salamanca, Spain

Hospital Clínico Universitario de Valencia; 🇪🇸 Valencia, Spain

China Medical University Hospital; 🇨🇳 Taichung City, Taichung, Taiwan

Kaohsiung Medical University Chung-Ho Memorial Hospital; 🇨🇳 Kaohsiung, Taiwan

National Taiwan University Hospital; 🇨🇳 Taipei City, Taiwan

Chang Gung Memorial Hospital - Linkou Branch; 🇨🇳 Taoyuan, Taiwan

Oxford University Hospitals NHS Foundation Trust; 🇬🇧 Oxford, England, United Kingdom

United Lincolnshire Hospitals NHS Trust-Satellite Site; 🇬🇧 Boston, United Kingdom

United Lincolnshire Hospitals NHS Trust; 🇬🇧 Boston, United Kingdom

The Clatterbridge Cancer Centre NHS Foundation Trust; 🇬🇧 Liverpool, United Kingdom

Imperial College Healthcare NHS Trust; 🇬🇧 London, United Kingdom

The Newcastle Upon Tyne Hospitals NHS Foundation Trust; 🇬🇧 Newcastle Upon Tyne, United Kingdom