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Study of Nivolumab in Combination With Ipilimumab Versus Nivolumab in Combination With Ipilimumab Placebo in Patients With Recurrent or Metastatic Squamous Cell Carcinoma of the Head and Neck

Phase 2
Completed
Conditions
Head and Neck Cancer
Interventions
Biological: Nivolumab
Biological: Ipilimumab
Other: Placebo
Registration Number
NCT02823574
Lead Sponsor
Bristol-Myers Squibb
Brief Summary

A study in patients with metastatic or recurrent squamous cell cancer of the head and neck to evaluate the effectiveness of Nivolumab plus Ipilumumab vs. Nivolumab alone (CheckMate 714)

Detailed Description

Not available

Recruitment & Eligibility

Status
COMPLETED
Sex
All
Target Recruitment
425
Inclusion Criteria
  • Confirmed squamous cell head and neck cancer
  • Widespread (metastatic) disease, or returned after previous treatment (recurrent)
  • Tumor sample must be available for analysis of PDL1 (Programmed death-ligand 1) and HPV [Human Papilloma Virus (oropharynx only)]
  • Performance status ECOG 0-1 (Eastern Cooperative Oncology Group)
Read More
Exclusion Criteria
  • Previous treatment for metastatic or recurrent disease
  • Cancer arising from one of the following primary sites: paranasal sinus, nasopharynx, salivary gland, skin
  • Any non-squamous subtype
  • Active autoimmune disease
  • Positive test for hepatitis B, C or HIV (Human Immunodeficiency Virus) virus
  • Previous treatment with checkpoint inhibitor drugs
  • Active CNS metastases or carcinomatous meningitis

Other protocol-defined inclusion/exclusion criteria apply

Read More

Study & Design

Study Type
INTERVENTIONAL
Study Design
PARALLEL
Arm && Interventions
GroupInterventionDescription
Nivolumab and IpilimumabNivolumabSpecified dose on specified days
Nivolumab and Ipilimumab-placeboNivolumabSpecified dose on specified days
Nivolumab and IpilimumabIpilimumabSpecified dose on specified days
Nivolumab and Ipilimumab-placeboPlaceboSpecified dose on specified days
Primary Outcome Measures
NameTimeMethod
Objective Response Rate (ORR) as Determined by Blinded Independent Central Review (BIRC) - Platinum Refractory SubgroupApproximately up to 30 months (from FPFV to Data base lock)

ORR is defined as best overall response (BOR) of a complete response (CR) or partial response (PR) divided by the number of randomized participants for each treatment group.

Complete Response (CR): Disappearance of all target lesions. Any pathological lymph nodes(whether target or non-target) must have reduction in short axis to \< 10 mm.

Partial Response (PR): At least a 30% decrease in the sum of diameters of target lesions, taking as reference the baseline sum diameters.

Duration of Response (DOR) as Determined by Blinded Independent Central Review (BIRC) - Platinum Refractory SubgroupApproximately up to 30 months (from FPFV to Data base lock)

The time between the date of first confirmed response to the date of the first documented tumor progression, or death due to any cause, whichever occurs first.

Time to Response (TTR) as Determined by Blinded Independent Central Review (BIRC) - Platinum Refractory SubgroupApproximately up to 30 months (from FPFV to Data base lock)

Time to Response (TTR) for participants demonstrating a response (either CR or PR) was defined as the time from the date of randomization to the date of the first confirmed response.

Complete Response (CR): Disappearance of all target lesions. Any pathological lymph nodes(whether target or non-target) must have reduction in short axis to \< 10 mm.

Partial Response (PR): At least a 30% decrease in the sum of diameters of target lesions, taking as reference the baseline sum diameters.

Secondary Outcome Measures
NameTimeMethod
Progression Free Survival (PFS) as Determined by Blinded Independent Central Review (BIRC) - Platinum Eligible SubgroupFrom randomization to disease progression or death. Approximately 63 Months

the time from randomization to the date of first documented disease progression, or death due to any cause, whichever occurs first.

Progressive Disease (PD): At least a 20% increase in the sum of diameters of target lesions, taking as reference the smallest sum on study (this includes the baseline sum if that is the smallest on study). In addition to the relative increase of 20%, the sum must also demonstrate an absolute increase of at least 5 mm. (Note: the appearance of one or more new lesions is also considered progression).

Overall Survival (OS) - Platinum Refractory SubgroupFrom randomization to death. Approximately 63 Months

Overall survival was defined as the time from randomization to the date of death from any cause. Participants were censored at the date they were last known to be alive and at the date of randomization if they were randomized but had no follow-up.

Overall Survival (OS)From randomization to death. Approximately 63 Months

Overall survival was defined as the time from randomization to the date of death from any cause. Participants were censored at the date they were last known to be alive and at the date of randomization if they were randomized but had no follow-up.

Progression Free Survival (PFS) as Determined by Blinded Independent Central Review (BIRC) - Platinum Refractory SubgroupFrom randomization to disease progression or death. Approximately 63 Months

The time from randomization to the date of first documented disease progression, or death due to any cause, whichever occurs first.

Progressive Disease (PD): At least a 20% increase in the sum of diameters of target lesions, taking as reference the smallest sum on study (this includes the baseline sum if that is the smallest on study). In addition to the relative increase of 20%, the sum must also demonstrate an absolute increase of at least 5 mm. (Note: the appearance of one or more new lesions is also considered progression).

ORR - Platinum Eligible Subgroup Based on HPV p-16 StatusFrom randomization to end of study. Approximately 63 Months

ORR is defined as the best overall response (BOR) of a complete response (CR) or partial response (PR) divided by the number of randomized participants for each treatment group.

Complete Response (CR): Disappearance of all target lesions. Any pathological lymph nodes(whether target or non-target) must have reduction in short axis to \< 10 mm.

Partial Response (PR): At least a 30% decrease in the sum of diameters of target lesions, taking as reference the baseline sum diameters.

ORR - Platinum Eligible Subgroup Based on Tumor Mutation Burden (TMB) BiomarkerFrom randomization to end of study. Approximately 63 Months

ORR is defined as the best overall response (BOR) of a complete response (CR) or partial response (PR) divided by the number of randomized participants for each treatment group.

Tumor Mutational Burden (TMB) refers to the number of nonsynonymous somatic mutations that exist within a tumor's genome as measured by the Foundation One CDx panel at Foundation Medicine. The analysis was done on subjects with baseline tumor mutation burden by a cutoff of 7 mutations/megabase (mut/Mb) and 10 mut/Mb

Complete Response (CR): Disappearance of all target lesions. Any pathological lymph nodes(whether target or non-target) must have reduction in short axis to \< 10 mm.

Partial Response (PR): At least a 30% decrease in the sum of diameters of target lesions, taking as reference the baseline sum diameters.

Objective Response Rate (ORR) as Determined by Blinded Independent Central Review (BIRC) - Platinum Eligible SubgroupFrom randomization to end of study. Approximately 63 Months

ORR is defined as percentage of participants with a complete response (CR) or partial response (PR).

Complete Response (CR): Disappearance of all target lesions. Any pathological lymph nodes(whether target or non-target) must have reduction in short axis to \< 10 mm.

Partial Response (PR): At least a 30% decrease in the sum of diameters of target lesions, taking as reference the baseline sum diameters.

Duration of Response (DOR) as Determined by Blinded Independent Central Review (BIRC) - Platinum Eligible SubgroupFrom randomization to disease progression or death. Approximately 63 Months

The time between the date of first confirmed response to the date of the first documented tumor progression, or death due to any cause, whichever occurs first.

ORR - Platinum Refractory Subgroup Based on HPV p-16 StatusFrom randomization to end of study. Approximately 63 Months

ORR is defined as the best overall response (BOR) of a complete response (CR) or partial response (PR) divided by the number of randomized participants for each treatment group.

Complete Response (CR): Disappearance of all target lesions. Any pathological lymph nodes(whether target or non-target) must have reduction in short axis to \< 10 mm.

Partial Response (PR): At least a 30% decrease in the sum of diameters of target lesions, taking as reference the baseline sum diameters.

ORR - Platinum Refractory Subgroup Based on Tumor Mutation Burden (TMB) BiomarkerFrom randomization to end of study. Approximately 63 Months

ORR is defined as the best overall response (BOR) of a complete response (CR) or partial response (PR) divided by the number of randomized participants for each treatment group.

Tumor Mutational Burden (TMB) refers to the number of nonsynonymous somatic mutations that exist within a tumor's genome as measured by the Foundation One CDx panel at Foundation Medicine. The analysis was done on subjects with baseline tumor mutation burden by a cutoff of 7 mutations/megabase (mut/Mb) and 10 mut/Mb

Complete Response (CR): Disappearance of all target lesions. Any pathological lymph nodes(whether target or non-target) must have reduction in short axis to \< 10 mm.

Partial Response (PR): At least a 30% decrease in the sum of diameters of target lesions, taking as reference the baseline sum diameters.

Duration of Response (DOR) - Platinum Refractory Subgroup Based on HPV p-16 StatusFrom randomization to disease progression or death. Approximately 63 Months

The time between the date of first confirmed response to the date of the first documented tumor progression, or death due to any cause, whichever occurs first.

Overall Survival (OS) - Platinum Eligible SubgroupFrom randomization to death. Approximately 63 Months

Overall survival was defined as the time from randomization to the date of death from any cause. Participants were censored at the date they were last known to be alive and at the date of randomization if they were randomized but had no follow-up.

Duration of Response (DOR) - Platinum Refractory Subgroup Based on Tumor Mutation Burden (TMB) StatusFrom randomization to disease progression or death. Approximately 63 Months

The time between the date of first confirmed response to the date of the first documented tumor progression, or death due to any cause, whichever occurs first.

Tumor Mutational Burden (TMB) refers to the number of nonsynonymous somatic mutations that exist within a tumor's genome as measured by the Foundation One CDx panel at Foundation Medicine. The analysis was done on subjects with baseline tumor mutation burden by a cutoff of 7 mutations/megabase (mut/Mb) and 10 mut/Mb

Progression Free Survival (PFS) - Platinum Refractory Subgroup Based on HPV p-16 StatusFrom randomization to disease progression or death. Approximately 63 Months

the time from randomization to the date of first documented disease progression, or death due to any cause, whichever occurs first.

Progressive Disease (PD): At least a 20% increase in the sum of diameters of target lesions, taking as reference the smallest sum on study (this includes the baseline sum if that is the smallest on study). In addition to the relative increase of 20%, the sum must also demonstrate an absolute increase of at least 5 mm. (Note: the appearance of one or more new lesions is also considered progression).

Progression Free Survival (PFS) - Platinum Refractory Subgroup Based on Tumor Mutation Burden (TMB) StatusFrom randomization to disease progression or death. Approximately 63 Months

the time from randomization to the date of first documented disease progression, or death due to any cause, whichever occurs first.

Tumor Mutational Burden (TMB) refers to the number of nonsynonymous somatic mutations that exist within a tumor's genome as measured by the Foundation One CDx panel at Foundation Medicine. The analysis was done on subjects with baseline tumor mutation burden by a cutoff of 7 mutations/megabase (mut/Mb) and 10 mut/Mb

Progressive Disease (PD): At least a 20% increase in the sum of diameters of target lesions, taking as reference the smallest sum on study (this includes the baseline sum if that is the smallest on study). In addition to the relative increase of 20%, the sum must also demonstrate an absolute increase of at least 5 mm. (Note: the appearance of one or more new lesions is also considered progression).

Overall Survival (OS) - Platinum Refractory Subgroup Based on HPV p-16 StatusFrom randomization to death. Approximately 63 Months

Overall survival was defined as the time from randomization to the date of death from any cause. Participants were censored at the date they were last known to be alive and at the date of randomization if they were randomized but had no follow-up.

Overall Survival (OS) - Platinum Refractory Subgroup Based on Tumor Mutation Burden (TMB) StatusFrom randomization to death. Approximately 63 Months

Overall survival was defined as the time from randomization to the date of death from any cause. Participants were censored at the date they were last known to be alive and at the date of randomization if they were randomized but had no follow-up.

Tumor Mutational Burden (TMB) refers to the number of nonsynonymous somatic mutations that exist within a tumor's genome as measured by the Foundation One CDx panel at Foundation Medicine. The analysis was done on subjects with baseline tumor mutation burden by a cutoff of 7 mutations/megabase (mut/Mb) and 10 mut/Mb

Overall Survival (OS) - Platinum Eligible Subgroup Based on HPV p-16 StatusFrom randomization to death. Approximately 63 Months

Overall survival was defined as the time from randomization to the date of death from any cause. Participants were censored at the date they were last known to be alive and at the date of randomization if they were randomized but had no follow-up.

Progression Free Survival (PFS) - Platinum Eligible Subgroup Based on HPV p-16 StatusFrom randomization to disease progression or death. Approximately 63 Months

the time from randomization to the date of first documented disease progression, or death due to any cause, whichever occurs first.

Progressive Disease (PD): At least a 20% increase in the sum of diameters of target lesions, taking as reference the smallest sum on study (this includes the baseline sum if that is the smallest on study). In addition to the relative increase of 20%, the sum must also demonstrate an absolute increase of at least 5 mm. (Note: the appearance of one or more new lesions is also considered progression).

Progression Free Survival (PFS) - Platinum Refractory Subgroup Based on PD-L1 StatusFrom randomization to disease progression or death. Approximately 63 Months

The time from randomization to the date of first documented disease progression, or death due to any cause, whichever occurs first.

Tumor PD-L1 expression was defined as the percent of tumor cell membrane staining in a minimum of 100 evaluable tumor cells per validated Dako PD-L1 IHC assay.

Progressive Disease (PD): At least a 20% increase in the sum of diameters of target lesions, taking as reference the smallest sum on study (this includes the baseline sum if that is the smallest on study). In addition to the relative increase of 20%, the sum must also demonstrate an absolute increase of at least 5 mm. (Note: the appearance of one or more new lesions is also considered progression).

Progression Free Survival (PFS) - Platinum Eligible Subgroup Based on PD-L1 StatusFrom randomization to disease progression or death. Approximately 63 Months

The time from randomization to the date of first documented disease progression, or death due to any cause, whichever occurs first.

Tumor PD-L1 expression was defined as the percent of tumor cell membrane staining in a minimum of 100 evaluable tumor cells per validated Dako PD-L1 IHC assay

Progressive Disease (PD): At least a 20% increase in the sum of diameters of target lesions, taking as reference the smallest sum on study (this includes the baseline sum if that is the smallest on study). In addition to the relative increase of 20%, the sum must also demonstrate an absolute increase of at least 5 mm. (Note: the appearance of one or more new lesions is also considered progression).

Overall Survival (OS) - Platinum Eligible Subgroup Based on Tumor Mutation Burden (TMB) StatusFrom randomization to death. Approximately 63 Months

Overall survival was defined as the time from randomization to the date of death from any cause. Participants were censored at the date they were last known to be alive and at the date of randomization if they were randomized but had no follow-up.

Tumor Mutational Burden (TMB) refers to the number of nonsynonymous somatic mutations that exist within a tumor's genome as measured by the Foundation One CDx panel at Foundation Medicine. The analysis was done on subjects with baseline tumor mutation burden by a cutoff of 7 mutations/megabase (mut/Mb) and 10 mut/Mb

Overall Survival (OS) - Platinum Refractory Subgroup Based on PD-L1 StatusFrom randomization to death. Approximately 63 Months

Overall survival was defined as the time from randomization to the date of death from any cause. Participants were censored at the date they were last known to be alive and at the date of randomization if they were randomized but had no follow-up.

Tumor PD-L1 expression was defined as the percent of tumor cell membrane staining in a minimum of 100 evaluable tumor cells per validated Dako PD-L1 IHC assay

Progression Free Survival (PFS) - Platinum Eligible Subgroup Based on Tumor Mutation Burden (TMB) StatusFrom randomization to disease progression or death. Approximately 63 Months

the time from randomization to the date of first documented disease progression, or death due to any cause, whichever occurs first.

Tumor Mutational Burden (TMB) refers to the number of nonsynonymous somatic mutations that exist within a tumor's genome as measured by the Foundation One CDx panel at Foundation Medicine. The analysis was done on subjects with baseline tumor mutation burden by a cutoff of 7 mutations/megabase (mut/Mb) and 10 mut/Mb

Progressive Disease (PD): At least a 20% increase in the sum of diameters of target lesions, taking as reference the smallest sum on study (this includes the baseline sum if that is the smallest on study). In addition to the relative increase of 20%, the sum must also demonstrate an absolute increase of at least 5 mm. (Note: the appearance of one or more new lesions is also considered progression).

Duration of Response (DOR) - Platinum Eligible Subgroup Based on HPV p-16 StatusFrom randomization to disease progression or death. Approximately 63 Months

The time between the date of first confirmed response to the date of the first documented tumor progression, or death due to any cause, whichever occurs first.

Progressive Disease (PD): At least a 20% increase in the sum of diameters of target lesions, taking as reference the smallest sum on study (this includes the baseline sum if that is the smallest on study). In addition to the relative increase of 20%, the sum must also demonstrate an absolute increase of at least 5 mm. (Note: the appearance of one or more new lesions is also considered progression).

Duration of Response (DOR) - Platinum Eligible Subgroup Based on Tumor Mutation Burden (TMB) StatusFrom randomization to disease progression or death. Approximately 63 Months

The time between the date of first confirmed response to the date of the first documented tumor progression, or death due to any cause, whichever occurs first.

Tumor Mutational Burden (TMB) refers to the number of nonsynonymous somatic mutations that exist within a tumor's genome as measured by the Foundation One CDx panel at Foundation Medicine. The analysis was done on subjects with baseline tumor mutation burden by a cutoff of 7 mutations/megabase (mut/Mb) and 10 mut/Mb.

Progressive Disease (PD): At least a 20% increase in the sum of diameters of target lesions, taking as reference the smallest sum on study (this includes the baseline sum if that is the smallest on study). In addition to the relative increase of 20%, the sum must also demonstrate an absolute increase of at least 5 mm. (Note: the appearance of one or more new lesions is also considered progression).

Duration of Response (DOR) - Platinum Eligible Subgroup Based on PD-L1 StatusFrom randomization to disease progression or death. Approximately 63 Months

The time between the date of first confirmed response to the date of the first documented tumor progression, or death due to any cause, whichever occurs first.

Tumor PD-L1 expression was defined as the percent of tumor cell membrane staining in a minimum of 100 evaluable tumor cells per validated Dako PD-L1 IHC assay

Progressive Disease (PD): At least a 20% increase in the sum of diameters of target lesions, taking as reference the smallest sum on study (this includes the baseline sum if that is the smallest on study). In addition to the relative increase of 20%, the sum must also demonstrate an absolute increase of at least 5 mm. (Note: the appearance of one or more new lesions is also considered progression).

Duration of Response (DOR) - Platinum Refractory Subgroup Based on PD-L1 StatusFrom randomization to disease progression or death. Approximately 63 Months

The time between the date of first confirmed response to the date of the first documented tumor progression, or death due to any cause, whichever occurs first.

Tumor PD-L1 expression was defined as the percent of tumor cell membrane staining in a minimum of 100 evaluable tumor cells per validated Dako PD-L1 IHC assay.

Progressive Disease (PD): At least a 20% increase in the sum of diameters of target lesions, taking as reference the smallest sum on study (this includes the baseline sum if that is the smallest on study). In addition to the relative increase of 20%, the sum must also demonstrate an absolute increase of at least 5 mm. (Note: the appearance of one or more new lesions is also considered progression).

ORR - Platinum Refractory Subgroup Based on PD-L1 ExpressionFrom randomization to end of study. Approximately 63 Months

ORR is defined as the best overall response (BOR) of a complete response (CR) or partial response (PR) divided by the number of randomized participants for each treatment group.

Tumor PD-L1 expression was defined as the percent of tumor cell membrane staining in a minimum of 100 evaluable tumor cells per validated Dako PD-L1 IHC assay

Complete Response (CR): Disappearance of all target lesions. Any pathological lymph nodes(whether target or non-target) must have reduction in short axis to \< 10 mm.

Partial Response (PR): At least a 30% decrease in the sum of diameters of target lesions, taking as reference the baseline sum diameters.

Overall Survival (OS) - Platinum Eligible Subgroup Based on PD-L1 StatusFrom randomization to death. Approximately 63 Months

Overall survival was defined as the time from randomization to the date of death from any cause. Participants were censored at the date they were last known to be alive and at the date of randomization if they were randomized but had no follow-up.

Tumor PD-L1 expression was defined as the percent of tumor cell membrane staining in a minimum of 100 evaluable tumor cells per validated Dako PD-L1 IHC assay

ORR - Platinum Eligible Subgroup Based on PD-L1 ExpressionFrom randomization to end of study. Approximately 63 Months

ORR is defined as the best overall response (BOR) of a complete response (CR) or partial response (PR) divided by the number of randomized participants for each treatment group.

Tumor PD-L1 expression was defined as the percent of tumor cell membrane staining in a minimum of 100 evaluable tumor cells per validated Dako PD-L1 IHC assay Complete Response (CR): Disappearance of all target lesions. Any pathological lymph nodes(whether target or non-target) must have reduction in short axis to \< 10 mm.

Partial Response (PR): At least a 30% decrease in the sum of diameters of target lesions, taking as reference the baseline sum diameters.

Trial Locations

Locations (101)

Local Institution - 0087

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Chicago, Illinois, United States

Local Institution - 0014

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Quebec, Canada

Local Institution - 0023

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Gent, Belgium

Local Institution - 0012

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Toronto, Ontario, Canada

Local Institution - 0001

🇺🇸

Boston, Massachusetts, United States

Local Institution - 0071

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Boston, Massachusetts, United States

Local Institution - 0070

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Cleveland, Ohio, United States

Mission Hospital, Inc

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Asheville, North Carolina, United States

Local Institution - 0103

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Cincinnati, Ohio, United States

Local Institution - 0038

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Seattle, Washington, United States

University of Arizona Cancer Center

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Tucson, Arizona, United States

Local Institution - 0034

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Duarte, California, United States

Los Angeles Cancer Network

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Los Angeles, California, United States

Ucla Department Of Medicine

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Los Angeles, California, United States

Local Institution - 0098

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Redondo Beach, California, United States

Central Coast Med Oncology

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Santa Maria, California, United States

Local Institution - 0097

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San Luis Obispo, California, United States

Local Institution - 0010

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Atlanta, Georgia, United States

Local Institution - 0015

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Decatur, Georgia, United States

Ft. Wayne Med Onco-Hema Inc

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Fort Wayne, Indiana, United States

Oncology Associated Of Western Kentucky

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Paducah, Kentucky, United States

Local Institution - 0006

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Pittsburgh, Pennsylvania, United States

Donald Guthrie Foundation

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Sayre, Pennsylvania, United States

Local Institution - 0102

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Dallas, Texas, United States

Local Institution - 0121

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Pergamino, Buenos Aires, Argentina

Local Institution - 0111

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Buenos Aires, Argentina

Local Institution - 0074

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Sint-Niklaas, Belgium

Local Institution - 0053

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Yvoir, Belgium

Local Institution - 0125

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Caxias do Sul, RIO Grande DO SUL, Brazil

Local Institution - 0047

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Curitiba, Parana, Brazil

Local Institution - 0045

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Barretos, Sao Paulo, Brazil

Local Institution - 0123

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Santo Andre, Sao Paulo, Brazil

Local Institution - 0013

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Edmonton, Alberta, Canada

Local Institution - 0048

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Sao Jose do Rio Preto, SAO Paulo, Brazil

Local Institution

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Cape Town, Western CAPE, South Africa

Local Institution - 0049

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Sao Paulo, Brazil

Local Institution - 0050

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Sao Paulo, Brazil

Local Institution - 0056

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Ottawa, Ontario, Canada

Local Institution - 0016

🇨🇦

Montreal, Quebec, Canada

Local Institution - 0115

🇨🇱

Santiago, Metropolitana, Chile

Local Institution - 0022

🇨🇿

Brno, Czechia

Local Institution - 0020

🇨🇿

Hradec Kralove, Czechia

Local Institution - 0021

🇨🇿

Olomouc, Czechia

Local Institution - 0069

🇫🇮

Helsinki, Finland

Local Institution - 0032

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Amiens Cedex 1, France

Local Institution - 0120

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Bordeaux, France

Local Institution - 0073

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Clermont Ferrand cedex 01, France

Local Institution - 0029

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Lyon Cedex 08, France

Local Institution - 0075

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Marseille Cedex 5, France

Local Institution - 0030

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Rennes Cedex, France

Local Institution - 0079

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Nice, France

Local Institution - 0088

🇫🇷

Villejuif, France

Local Institution - 0119

🇮🇹

Napoli, Italy

Local Institution - 0090

🇲🇽

Merida, Yucatan, Mexico

Local Institution - 0107

🇲🇽

Merida, Yucatan, Mexico

Local Institution - 0108

🇲🇽

Oaxaca, Mexico

Local Institution - 0068

🇳🇱

Amsterdam, Netherlands

Local Institution - 0028

🇳🇱

Amsterdam, Netherlands

Local Institution - 0065

🇳🇴

Bergen, Norway

Local Institution - 0027

🇳🇱

Groningen, Netherlands

Local Institution - 0064

🇳🇴

Oslo, Norway

Local Institution - 0054

🇷🇴

Cluj-Napoca, Romania

Local Institution - 0055

🇷🇴

Bucharest, Romania

Local Institution - 0060

🇷🇴

Iasi, Romania

Local Institution - 0033

🇷🇴

Craiova, Romania

Local Institution - 0031

🇷🇺

Moscow, Russian Federation

Local Institution - 0059

🇷🇴

Suceava, Romania

Local Institution - 0017

🇿🇦

Sandton, Gauteng, South Africa

Local Institution - 0092

🇷🇺

Ryazan, Russian Federation

Local Institution - 0116

🇪🇸

Barcelona, Spain

Local Institution - 0040

🇪🇸

A Coruna, Spain

Local Institution - 0077

🇪🇸

Madrid, Spain

Local Institution - 0039

🇪🇸

Barcelona, Spain

Local Institution - 0076

🇪🇸

Marbella, Spain

Local Institution - 0041

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San Sabastian Gipuzkoa, Spain

Local Institution - 0067

🇸🇪

Goteborg, Sweden

Local Institution - 0037

🇸🇪

Lund, Sweden

Local Institution - 0035

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Stockholm, Sweden

Local Institution - 0062

🇹🇷

Izmir, Turkey

Local Institution - 0063

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Adana, Turkey

Local Institution - 0066

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Antalya, Turkey

Local Institution - 0086

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London, Greater London, United Kingdom

Local Institution - 0083

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Wirral, Merseyside, United Kingdom

Local Institution - 0114

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Cardiff, United Kingdom

Local Institution - 0082

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Newcastle Upon Tyne, United Kingdom

Local Institution - 0084

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Glasgow, United Kingdom

Local Institution - 0026

🇮🇪

Dublin 8, Dublin, Ireland

Local Institution - 0124

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Ipatinga, Minas Gerais, Brazil

Local Institution - 0051

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Ijui, RIO Grande DO SUL, Brazil

Local Institution - 0046

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Belo Horizonte, Minas Gerais, Brazil

Local Institution - 0052

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Porto Alegre, RIO Grande DO SUL, Brazil

Local Institution - 0110

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Aberdeen, Aberdeenshire, United Kingdom

Local Institution - 0081

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Sutton, Surrey, United Kingdom

Local Institution - 0089

🇫🇷

Clichy, France

Local Institution - 0072

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San Francisco, California, United States

Local Institution - 0042

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Rochester, Minnesota, United States

Local Institution - 0008

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Portland, Oregon, United States

Local Institution - 0007

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Tampa, Florida, United States

Local Institution - 0004

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Sacramento, California, United States

Local Institution - 0005

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Louisville, Kentucky, United States

Local Institution - 0101

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New Haven, Connecticut, United States

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