Study of Nivolumab Versus Placebo in Combination With Neoadjuvant Chemotherapy and Adjuvant Endocrine Therapy in Participants With High-risk, Estrogen Receptor-Positive (ER+), Human Epidermal Growth Factor Receptor 2-Negative (HER2-) Primary Breast Cancer

Phase 3

Completed

• Conditions: Breast Cancer
• Interventions: Drug: paclitaxel (PTX); Biological: nivolumab; Other: nivolumab placebo; Drug: anthracycline; Drug: cyclophosphamide; Drug: Endocrine Therapy; Procedure: Surgery

• Registration Number: NCT04109066
• Lead Sponsor: Bristol-Myers Squibb

Brief Summary

A randomized multi-arm study evaluating the efficacy and safety of nivolumab versus placebo in combination with neoadjuvant (pre-surgery) chemotherapy and adjuvant (post-surgery) endocrine therapy in participants with high-risk, estrogen receptor-positive, human epidermal growth factor receptor 2-negative (ER+, HER2-) early stage breast cancer.

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: 2019-09-27
• Study First Submitted QC: 2019-09-27
• Study First Posted: 2019-09-30
• Study Start: 2019-11-20
• Primary Completion: 2023-01-16
• Study Completion: 2023-12-27
• Results First Submitted: 2024-01-12
• Status Verified: 2024-02
• Results First Submitted QC: 2024-02-13
• Last Update Submitted: 2024-02-13
• Results First Posted: 2024-03-12
• Last Update Posted: 2024-03-12

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 521

Inclusion Criteria

• Localized invasive breast ductal carcinoma, confirmed by the local pathologist, that includes the following combined primary tumor and clinical node (cN) categories: T1c (tumor size = 2 cm)-T2 (tumor size > 2 cm), cN1-N2 OR T3-T4, cN0-cN2. Note: Axillary lymph node status must be assessed by fine needle biopsy or core biopsy.
• Estrogen receptor-positive (ER+) breast cancer (BC) and with or without progesterone receptor (PgR) expression (determined on the most recently analyzed tissue sample, tested locally, and confirmed by the central laboratory), as defined in the relevant American Society of Clinical Oncology (ASCO)- College of American Pathologists (CAP) Guidelines.
• Human epidermal growth factor receptor 2 (HER2-) BC tested in the local laboratory, defined as a negative in situ hybridization test or an immunohistochemistry (IHC) status of 0, 1+, or 2+.
• Tumor Grade 3 of ductal histology, Or Tumor Grade 2 of ductal histology having an ER expression level percentage between 1-10%
• Must agree to provide primary breast tumor tissue at baseline and at surgery
• Must be deemed eligible for surgery
• Males and females must agree to follow specific methods of contraception, if applicable, while participating in the trial
• Must have an Eastern Cooperative Oncology Group (ECOG) scale performance status of 0 or 1

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Exclusion Criteria

• Breastfeeding, pregnant, or expecting to conceive or father children within the projected duration of the study, starting with the screening through 12 months for participants who receive cyclophosphamide, or 6 months for participants who do not receive cyclophosphamide, after the last dose of study treatment
• Prior treatment with chemotherapy, endocrine therapy (ET), targeted therapy, and/or radiation therapy for the currently diagnosed breast cancer prior to enrollment
• Prior treatment with an anti-PD-1, anti-PD-L1, anti-PD-L2, or anti-CTLA-4 antibody, or any other antibody or drug specifically targeting T-cell co-stimulation or checkpoint pathways
• Significant cardiovascular disease such as left ventricular ejection fraction (LVEF) < 50% at baseline as assessed by echocardiography (ECHO) or multigated acquisition (MUGA) scan performed at screening, or Class III or IV myocardial disease as described by the New York Heart Association
• History of ipsilateral invasive BC, regardless of treatment, ipsilateral ductal carcinoma in situ treated with radiation, or contralateral invasive BC, at any time
• Definitive clinical or radiologic evidence of metastatic disease
• Multicentric BC (the presence of > 1 tumor in different quadrants of the breast)
• Bilateral invasive BC

Other protocol-defined inclusion/exclusion criteria apply

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Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Arm B: Placebo combined with neoadjuvant CT and then adjuvant ET	paclitaxel (PTX)	Nivolumab placebo with paclitaxel followed by nivolumab placebo with anthracycline + cyclophosphamide as neoadjuvant (pre-surgery) treatment, then adjuvant (post-surgery) endocrine therapy of investigator's choice
Arm A: Nivolumab combined with neoadjuvant CT and adjuvant ET	paclitaxel (PTX)	Nivolumab with paclitaxel followed by nivolumab with anthracycline + cyclophosphamide as neoadjuvant (pre-surgery) treatment, then nivolumab with adjuvant (post-surgery) endocrine therapy of investigator's choice
Arm A: Nivolumab combined with neoadjuvant CT and adjuvant ET	nivolumab	Nivolumab with paclitaxel followed by nivolumab with anthracycline + cyclophosphamide as neoadjuvant (pre-surgery) treatment, then nivolumab with adjuvant (post-surgery) endocrine therapy of investigator's choice
Arm B: Placebo combined with neoadjuvant CT and then adjuvant ET	Surgery	Nivolumab placebo with paclitaxel followed by nivolumab placebo with anthracycline + cyclophosphamide as neoadjuvant (pre-surgery) treatment, then adjuvant (post-surgery) endocrine therapy of investigator's choice
Arm A: Nivolumab combined with neoadjuvant CT and adjuvant ET	Surgery	Nivolumab with paclitaxel followed by nivolumab with anthracycline + cyclophosphamide as neoadjuvant (pre-surgery) treatment, then nivolumab with adjuvant (post-surgery) endocrine therapy of investigator's choice
Arm B: Placebo combined with neoadjuvant CT and then adjuvant ET	nivolumab placebo	Nivolumab placebo with paclitaxel followed by nivolumab placebo with anthracycline + cyclophosphamide as neoadjuvant (pre-surgery) treatment, then adjuvant (post-surgery) endocrine therapy of investigator's choice
Arm B: Placebo combined with neoadjuvant CT and then adjuvant ET	anthracycline	Nivolumab placebo with paclitaxel followed by nivolumab placebo with anthracycline + cyclophosphamide as neoadjuvant (pre-surgery) treatment, then adjuvant (post-surgery) endocrine therapy of investigator's choice
Arm B: Placebo combined with neoadjuvant CT and then adjuvant ET	Endocrine Therapy	Nivolumab placebo with paclitaxel followed by nivolumab placebo with anthracycline + cyclophosphamide as neoadjuvant (pre-surgery) treatment, then adjuvant (post-surgery) endocrine therapy of investigator's choice
Arm A: Nivolumab combined with neoadjuvant CT and adjuvant ET	anthracycline	Nivolumab with paclitaxel followed by nivolumab with anthracycline + cyclophosphamide as neoadjuvant (pre-surgery) treatment, then nivolumab with adjuvant (post-surgery) endocrine therapy of investigator's choice
Arm A: Nivolumab combined with neoadjuvant CT and adjuvant ET	Endocrine Therapy	Nivolumab with paclitaxel followed by nivolumab with anthracycline + cyclophosphamide as neoadjuvant (pre-surgery) treatment, then nivolumab with adjuvant (post-surgery) endocrine therapy of investigator's choice
Arm A: Nivolumab combined with neoadjuvant CT and adjuvant ET	cyclophosphamide	Nivolumab with paclitaxel followed by nivolumab with anthracycline + cyclophosphamide as neoadjuvant (pre-surgery) treatment, then nivolumab with adjuvant (post-surgery) endocrine therapy of investigator's choice
Arm B: Placebo combined with neoadjuvant CT and then adjuvant ET	cyclophosphamide	Nivolumab placebo with paclitaxel followed by nivolumab placebo with anthracycline + cyclophosphamide as neoadjuvant (pre-surgery) treatment, then adjuvant (post-surgery) endocrine therapy of investigator's choice

Primary Outcome Measures

Name	Time	Method
Pathological Complete Response (pCR) Rate	Up to approximately 37 months	pCR rate is defined as the percentage of participants who achieved pCR. pCR is defined as no invasive residual disease in breast and lymph nodes performed by a local pathologist. Criteria for evaluation of pCR includes the following: pCR in breast, axillary lymph nodes and non-axillary sentinel node; no histologic evidence of invasive tumor cells; and pCR in the breast.

Secondary Outcome Measures

Name	Time	Method
Number of Participants With Residual Cancer Burden (RCB) PD-L1 >=1%	Up to approximately 37 months	RCB is estimated from routine pathologic sections of the primary breast tumor site and the regional lymph nodes after the completion of neoadjuvant therapy. RCB is categorized into the following 4 classes: RCB-0: no residual disease; RCB-1: minimal residual disease; RCB-II: moderate residual disease; RCB-III: and extensive residual disease.
Number of Participants With Serious Adverse Events (SAEs)	From first dose to 30 days post last dose of neoadjuvant or adjuvant study therapy (Up to approximately 25 months)	Number of participants with any grade serious adverse events (SAE). SAE is defined as any untoward medical occurrence that, at any dose: Results in death; is life threatening; requires inpatient hospitalization; results in persistent or significant disability; is a congenital anomaly/birth defect. Toxicities will be graded using the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) version 5.0.
Number of Participants Who Died	Up to approximately 37 months	Number of participants who died due to any cause.
Pathological Complete Response (pCR) Rate (PD-L1 >=1%)	Up to approximately 37 months	pCR rate is defined as the percentage of participants who achieved pCR. pCR is defined as no invasive residual disease in breast and lymph nodes performed by a local pathologist. Criteria for evaluation of pCR includes the following: pCR in breast, axillary lymph nodes and non-axillary sentinel node; no histologic evidence of invasive tumor cells; and pCR in the breast.
Number of Participants With Residual Cancer Burden (RCB)	Up to approximately 37 months	RCB is estimated from routine pathologic sections of the primary breast tumor site and the regional lymph nodes after the completion of neoadjuvant therapy. RCB is categorized into the following 4 classes: RCB-0: no residual disease; RCB-1: minimal residual disease; RCB-II: moderate residual disease; RCB-III: and extensive residual disease.
Number of Participants With Adverse Events (AEs)	From first dose to 30 days post last dose of neoadjuvant or adjuvant study therapy (Up to approximately 25 months)	Number of participants with any grade adverse events (AEs). An AE is defined as any new untoward medical occurrence or worsening of a pre-existing medical condition in a clinical investigation participant administered study treatment that does not necessarily have a causal relation with this treatment. Toxicities will be graded using the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) version 5.0.

Trial Locations

Locations (232)

Local Institution - 0031; 🇧🇪 Liege, Belgium

Local Institution - 0157; 🇩🇪 Velbert, Germany

Local Institution - 0177; 🇳🇱 Breda, Netherlands

Local Institution - 0107; 🇺🇸 Atlanta, Georgia, United States

Local Institution - 0120; 🇺🇸 Tallahassee, Florida, United States

Local Institution - 0227; 🇺🇸 Fort Wayne, Indiana, United States

Local Institution - 0068; 🇦🇺 North Ballarat, Victoria, Australia

Local Institution - 0071; 🇦🇺 North Sydney, New South Wales, Australia

Local Institution - 0014; 🇦🇷 Rosario Santa Fe, Santa FE, Argentina

Local Institution - 0303; 🇦🇷 Río Cuarto, Cordoba, Argentina

Local Institution - 0069; 🇦🇺 Port Macquarie, New South Wales, Australia

Local Institution - 0104; 🇧🇷 São Paulo, Brazil

Local Institution - 0287; 🇧🇷 Goiânia, Goias, Brazil

Local Institution - 0012; 🇦🇷 Ciudad Autonoma Beunos Aires, Buenos Aires, Argentina

Local Institution - 0072; 🇦🇺 Herston, Queensland, Australia

Local Institution - 0294; 🇦🇷 Córdoba, Cordoba, Argentina

Local Institution - 0067; 🇦🇺 Elizabeth Vale, South Australia, Australia

Local Institution - 0099; 🇨🇿 Praha 10, Czechia

Local Institution - 0132; 🇧🇷 Ijui, RIO Grande DO SUL, Brazil

Local Institution - 0016; 🇨🇱 Santiago de Chile, Metropolitana, Chile

Local Institution - 0024; 🇫🇷 Brest, France

Local Institution - 0162; 🇫🇷 Clermont-Ferrand, France

Local Institution - 0083; 🇩🇪 Berlin, Germany

Local Institution - 0111; 🇩🇪 Moenchengladbach, Germany

Local Institution - 0101; 🇨🇿 Olomouc, Czechia

Local Institution - 0084; 🇩🇪 München, Bayern, Germany

Local Institution - 0318; 🇨🇱 Santiago, Metropolitana, Chile

Local Institution - 0239; 🇨🇳 Hefei, Anhui, China

Local Institution - 0319; 🇨🇳 Chongqing, Chongqing, China

Local Institution - 0250; 🇨🇳 Wuhan, Hebei, China

Local Institution - 0100; 🇨🇿 Hradec Kralove, Czechia

Local Institution - 0103; 🇨🇿 Novy Jicin, Czechia

Local Institution - 0134; 🇧🇷 Barretos, SAO Paulo, Brazil

Local Institution - 0295; 🇰🇷 Seoul, Korea, Republic of

Local Institution - 0261; 🇨🇴 Barranquilla, Atlántico, Colombia

Local Institution - 0202; 🇨🇴 Rionegro, Colombia

Local Institution - 0128; 🇧🇷 Santo André, São Paulo, Brazil

Local Institution - 0235; 🇨🇳 Bengbu, Anhui, China

Local Institution - 0130; 🇧🇷 Fortaleza, Ceara, Brazil

Local Institution - 0194; 🇨🇦 Montreal, Quebec, Canada

Local Institution - 0095; 🇨🇦 Montréal, Quebec, Canada

Local Institution - 0207; 🇮🇹 Milano, Italy

Azienda Ospedaliero Universitaria Federico II di Napoli; 🇮🇹 Napoli, Italy

Local Institution - 0153; 🇫🇷 Lyon, France

Local Institution - 0129; 🇧🇷 Rio de Janeiro, Brazil

Local Institution - 0290; 🇰🇷 Seoul, Korea, Republic of

Local Institution - 0144; 🇧🇷 São Paulo, Brazil

Local Institution - 0112; 🇩🇪 Dresden, Germany

Local Institution - 0272; 🇧🇷 São Paulo, SAO Paulo, Brazil

Local Institution - 0156; 🇩🇪 Rostock, Germany

Local Institution - 0058; 🇨🇦 Sherbrooke, Quebec, Canada

Istituto Oncologico Veneto IOV; 🇮🇹 Padova, Italy

Fondazione Irccs - Policlinico San Matteo; 🇮🇹 Pavia, Italy

Local Institution - 0004; 🇫🇷 Besancon, France

Local Institution - 0152; 🇫🇷 Montpellier, France

Local Institution - 0325; 🇰🇷 Seongnam, Korea, Republic of

Local Institution - 0166; 🇩🇰 Naestved, Denmark

Local Institution - 0223; 🇩🇪 Hamburg, Germany

Local Institution - 0161; 🇫🇷 Paris, France

Local Institution - 0195; 🇫🇷 Plerin, France

Local Institution - 0320; 🇰🇷 Seoul, Korea, Republic of

Local Institution - 0158; 🇩🇪 Frankfurt, Germany

Local Institution - 0291; 🇰🇷 Seoul, Korea, Republic of

Policlinico Universitario Campus Biomedico Di Roma; 🇮🇹 Roma, Italy

Local Institution - 0002; 🇫🇷 Saint Herblain, France

Local Institution - 0081; 🇩🇪 Essen, Germany

Local Institution - 0089; 🇩🇪 Homburg, Germany

Local Institution - 0073; 🇹🇷 Adana, Turkey

Istituto Nazionale Tumori Fondazione Pascale; 🇮🇹 Napoli, Italy

Local Institution - 0173; 🇪🇸 Madrid, Spain

Local Institution - 0176; 🇪🇸 Madrid, Spain

Local Institution - 0204; 🇪🇸 Pamplona, Spain

Local Institution - 0074; 🇹🇷 Istanbul, Turkey

Local Institution - 0005; 🇬🇧 London, United Kingdom

Local Institution - 0171; 🇪🇸 Barcelona, Spain

Local Institution - 0172; 🇪🇸 Barcelona, Spain

Local Institution - 0280; 🇲🇽 Campeche, Mexico

Local Institution - 0175; 🇪🇸 Valencia, Spain

Local Institution - 0063; 🇵🇱 Lodz, Poland

Local Institution - 0062; 🇵🇱 Opole, Poland

Local Institution - 0026; 🇷🇴 Suceava, Romania

Local Institution - 0257; 🇹🇷 Ankara, Turkey

Local Institution - 0186; 🇨🇭 Lausanne, Switzerland

Local Institution - 0169; 🇪🇸 Malaga, Spain

Local Institution - 0174; 🇪🇸 Santiago de Compostela, Spain

Local Institution - 0075; 🇹🇷 Antalya, Turkey

Local Institution - 0136; 🇺🇸 Mobile, Alabama, United States

Local Institution - 0052; 🇺🇸 Greenbrae, California, United States

Local Institution - 0051; 🇺🇸 Whittier, California, United States

Local Institution - 0182; 🇺🇸 Stamford, Connecticut, United States

Local Institution - 0150; 🇺🇸 Jacksonville, Florida, United States

Local Institution - 0149; 🇺🇸 Pensacola, Florida, United States

Local Institution - 0054; 🇺🇸 Athens, Georgia, United States

Local Institution - 0056; 🇺🇸 Columbus, Georgia, United States

Local Institution - 0109; 🇺🇸 Florham Park, New Jersey, United States

Local Institution - 0050; 🇺🇸 Hackensack, New Jersey, United States

Local Institution - 0181; 🇺🇸 Albuquerque, New Mexico, United States

Local Institution - 0041; 🇺🇸 Bronx, New York, United States

Local Institution - 0283; 🇺🇸 Charlotte, North Carolina, United States

Local Institution - 0121; 🇺🇸 Fort Worth, Texas, United States

Local Institution - 0224; 🇺🇸 Fairfax, Virginia, United States

Local Institution - 0122; 🇺🇸 Fredericksburg, Virginia, United States

Virginia Cancer Institute; 🇺🇸 Richmond, Virginia, United States

Local Institution - 0030; 🇧🇪 Charleroi, Belgium

Local Institution - 0216; 🇫🇷 Le Mans, Sarthe, France

Local Institution - 0087; 🇩🇪 Heidelberg, Germany

Local Institution - 0080; 🇩🇪 Köln, Germany

Local Institution - 0196; 🇩🇪 Leipzig, Germany

Local Institution - 0036; 🇮🇪 Cork, Ireland

Local Institution - 0191; 🇮🇹 Catanzaro, Italy

Local Institution - 0185; 🇨🇭 Thun, Switzerland

Local Institution - 0097; 🇺🇸 Miami, Florida, United States

Local Institution - 0221; 🇺🇸 Chicago, Illinois, United States

Local Institution - 0053; 🇺🇸 Cleveland, Ohio, United States

Local Institution - 0274; 🇺🇸 Seattle, Washington, United States

Local Institution - 0267; 🇨🇳 Guangzhou, Guangdong, China

Local Institution - 0232; 🇨🇳 Chongqing, Chongqing, China

Local Institution - 0241; 🇨🇳 Guangzhou, Guangdong, China

Local Institution - 0215; 🇨🇳 Beijing, Beijing, China

Local Institution - 0312; 🇨🇳 Zunyi, Guizhou, China

Local Institution - 0240; 🇨🇳 Shjiazhuang, Hebei, China

Local Institution - 0248; 🇨🇳 Harbin, Heilongjiang, China

Local Institution - 0255; 🇨🇳 Changchun, Jilin, China

Local Institution - 0247; 🇨🇳 Changchun, Jilin, China

Local Institution - 0245; 🇨🇳 Jinan, Shandong, China

Local Institution - 0252; 🇨🇳 Shenyang, Liaoning, China

Local Institution - 0263; 🇨🇳 Xian, Shan3xi, China

Local Institution - 0127; 🇨🇳 Shanghai, Shanghai, China

Local Institution - 0256; 🇨🇳 Qingdao, Shandong, China

Local Institution - 0214; 🇨🇳 YanTai, Shandong, China

Local Institution - 0244; 🇨🇳 Chengdu, Sichuan, China

Local Institution - 0254; 🇨🇳 Tianjin, Tianjin, China

Local Institution - 0311; 🇨🇳 Urumqi, Xinjiang, China

Local Institution - 0238; 🇨🇳 Hangzhou, Zhejiang, China

Local Institution - 0237; 🇨🇳 Hangzhou, Zhejiang, China

Local Institution - 0231; 🇨🇳 Hangzhou, Zhejiang, China

Local Institution - 0034; 🇮🇪 Dublin 8, Dublin, Ireland

Local Institution - 0212; 🇲🇽 Merida, Yucatán, Mexico

Local Institution - 0225; 🇧🇷 Brasilia, Distrito Federal, Brazil

Local Institution - 0133; 🇧🇷 Belo Horizonte, Minas Gerais, Brazil

Local Institution - 0079; 🇩🇪 Saarbruecken, Saarland, Germany

Local Institution - 0006; 🇬🇧 Withington, Manchester, United Kingdom

Local Institution - 0288; 🇧🇷 Porto Alegre, RIO Grande DO SUL, Brazil

Local Institution - 0131; 🇧🇷 Porto Alegre, Rio Grande Do Sul, Brazil

Local Institution - 0135; 🇧🇷 Porto Alegre, RIO Grande DO SUL, Brazil

Local Institution - 0273; 🇧🇷 Santa Cruz do Sul, Rio Grande Do Sul, Brazil

Local Institution - 0167; 🇩🇰 Aarhus N, Denmark

Local Institution - 0165; 🇩🇰 Herlev, Denmark

Local Institution - 0164; 🇩🇰 Kobenhavn O, Denmark

Local Institution - 0046; 🇦🇹 Wien, Austria

Local Institution - 0037; 🇧🇪 Edegem, Belgium

Local Institution - 0160; 🇫🇮 Tampere, Finland

Local Institution - 0115; 🇭🇰 Hong Kong, Hong Kong

Local Institution - 0147; 🇳🇱 Utrecht, Netherlands

Local Institution - 0020; 🇦🇷 Buenos Aires, Ciudad Autónoma De Buenos Aires, Argentina

Local Institution - 0011; 🇦🇷 Caba, Distrito Federal, Argentina

Local Institution - 0222; 🇺🇸 Topsham, Maine, United States

Local Institution - 0015; 🇦🇷 La Plata, Buenos Aires, Argentina

Local Institution - 0008; 🇦🇷 Capital Federal, Distrito Federal, Argentina

Local Institution - 0013; 🇦🇷 Ciudad Autonoma de Buenos Aires, Distrito Federal, Argentina

Local Institution; 🇷🇺 Sochi, Russian Federation

Local Institution - 0042; 🇦🇹 Innsbruck, Austria

Local Institution - 0047; 🇦🇹 Wien, Austria

Local Institution - 0142; 🇦🇺 Clayton, Victoria, Australia

Local Institution - 0180; 🇺🇸 New Brunswick, New Jersey, United States

Local Institution - 0021; 🇦🇷 Cordoba, Argentina

Local Institution - 0045; 🇦🇹 Graz, Austria

Local Institution - 0048; 🇦🇹 Salzburg, Austria

Local Institution - 0326; 🇨🇱 Antofagasta, Chile

Local Institution - 0271; 🇨🇴 Pereira, Colombia

Local Institution - 0001; 🇫🇮 Helsinki, Finland

Local Institution - 0066; 🇦🇺 Clayton, Victoria, Australia

Local Institution - 0187; 🇧🇪 Brussels, Belgium

Local Institution - 0032; 🇧🇪 Gent, Belgium

Local Institution - 0018; 🇨🇱 Vina del Mar, Valparaiso, Chile

Local Institution - 0070; 🇦🇺 Melbourne, Victoria, Australia

Local Institution - 0197; 🇨🇱 La Serena, Coquimbo, Chile

Local Institution - 0019; 🇨🇱 Santiago Region Metropolitana, Metropolitana, Chile

Local Institution - 0203; 🇨🇴 Colombia, Bogota, Colombia

Local Institution - 0035; 🇮🇪 Beaumont, Ireland

Local Institution - 0154; 🇲🇽 Mexico City, Distrito Federal, Mexico

Local Institution - 0091; 🇲🇽 Chihuahua, Mexico

Local Institution - 0093; 🇨🇴 Cali, Colombia

Local Institution - 0168; 🇲🇽 Mexico City, Distrito Federal, Mexico

Local Institution - 0137; 🇲🇽 Monterrey, Nuevo LEON, Mexico

Local Institution - 0199; 🇳🇱 Deventer, Netherlands

Local Institution - 0059; 🇵🇱 Krakow, Poland

Local Institution - 0209; 🇵🇹 Porto, Portugal

Local Institution - 0025; 🇷🇴 Bucuresti, Romania

Local Institution - 0027; 🇷🇴 Floresti, Romania

Local Institution - 0285; 🇷🇺 Moskva, Russian Federation

Local Institution - 0301; 🇨🇳 Kaohsiung, Taiwan

Local Institution - 0098; 🇨🇴 Piedecuesta, Santander, Colombia

Local Institution - 0113; 🇨🇴 Montería, Córdoba, Colombia

Local Institution - 0094; 🇨🇴 Bogotá, Distrito Capital De Bogotá, Colombia

Local Institution - 0262; 🇲🇽 Tijuana, BAJA California, Mexico

Local Institution - 0145; 🇲🇽 Colima, Mexico

Local Institution - 0141; 🇲🇽 Oaxaca, Mexico

Local Institution - 0110; 🇵🇷 Ponce, Puerto Rico

Local Institution - 0205; 🇪🇸 Elche, Alicante, Spain

Local Institution - 0330; 🇲🇽 Zapopan, Jalisco, Mexico

Local Institution - 0033; 🇳🇱 Amsterdam, Netherlands

Local Institution - 0334; 🇵🇱 Gliwice, Śląskie, Poland

Local Institution - 0211; 🇵🇹 Lisboa, Portugal

Local Institution - 0270; 🇷🇴 Bucharest, Romania

Local Institution - 0284; 🇷🇺 Saint Petersburg, Russian Federation

Local Institution - 0298; 🇨🇳 Tainan, Taiwan

Local Institution - 0335; 🇵🇱 Bydgoszcz, Poland

Local Institution - 0061; 🇵🇱 Koszalin, Poland

Local Institution - 0029; 🇷🇴 Bucharest, Romania

Local Institution - 0078; 🇸🇬 Singapore, Singapore

Local Institution - 0076; 🇸🇬 Singapore, Singapore

Local Institution - 0119; 🇷🇺 Moscow, Russian Federation

Local Institution - 0060; 🇵🇱 Warszawa, Poland

Local Institution - 0210; 🇵🇹 Lisboa, Portugal

Local Institution - 0028; 🇷🇴 Craiova, Romania

Local Institution - 0306; 🇷🇺 Sankt-Peterburg, Russian Federation

Local Institution - 0077; 🇸🇬 Singapore, Singapore

Local Institution - 0300; 🇨🇳 Tainan City, Taiwan

Local Institution - 0184; 🇨🇭 Basel, Switzerland

Local Institution - 0305; 🇨🇳 Taipei, Taiwan

Local Institution - 0297; 🇨🇳 Taipei, Taiwan

Local Institution - 0125; 🇮🇹 Rozzano (MI), Italy

Local Institution - 0258; 🇫🇷 Strasbourg, France

Local Institution - 0228; 🇫🇷 Toulon Cedex, France

Local Institution - 0003; 🇫🇷 Villejuif, France

Local Institution - 0170; 🇪🇸 Sevilla, Spain

Local Institution - 0105; 🇩🇪 Würzburg, Germany

Local Institution - 0146; 🇺🇸 Bethesda, Maryland, United States

HCA Midwest Division; 🇺🇸 Kansas City, Missouri, United States

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

Local Institution - 0218; 🇺🇸 Nashville, Tennessee, United States