A Study of Atezolizumab Versus Observation as Adjuvant Therapy in Participants With High-Risk Muscle-Invasive Urothelial Carcinoma (UC) After Surgical Resection
- Registration Number
- NCT02450331
- Lead Sponsor
- Hoffmann-La Roche
- Brief Summary
This Phase III, open-label, randomized, multicenter study is to evaluate the efficacy and safety of adjuvant treatment with atezolizumab compared with observation in participants with muscle-invasive UC who are at high risk for recurrence following resection. Eligible participants were randomized by a 1:1 ratio into atezolizumab group or control group.
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- TERMINATED
- Sex
- All
- Target Recruitment
- 809
- Histologically confirmed muscle-invasive UC (also termed transitional cell carcinoma) of the bladder or upper urinary tract (i.e., renal pelvis or ureters)
- For participants treated with prior neoadjuvant chemotherapy: tumor stage of ypT2-4a or ypN+ (ypT2-4 or ypN+ for participants with upper urinary tract UC) and M0
- For participants who have not received prior neoadjuvant chemotherapy: tumor stage of pT3-4a or pN+ (pT3-4 or pN+ for participants with upper urinary tract UC) and M0
- Representative formalin-fixed paraffin-embedded tumor specimens from surgical resection (i.e., radical cystectomy, nephroureterectomy, or lymph node dissection) in paraffin blocks (blocks preferred) or at least 15 unstained slides, with an associated pathology report, for central testing and determined to be evaluable for tumor programmed death-ligand 1 (PD-L1) expression prior to study enrollment
- Absence of residual disease and absence of metastasis, as confirmed by a negative baseline computed tomography (CT) or magnetic resonance imaging scan of the pelvis, abdomen, and chest no more than 4 weeks prior to randomization
- Full recovery from cystectomy or nephroureterectomy within 14 weeks following surgery
- Eastern Cooperative Oncology Group performance status of less than or equal to (</=) 2
- Life expectancy greater than or equal to (>/=) 12 weeks
- Adequate hematologic and end-organ function
- For women who are not postmenopausal or surgically sterile: agreement to remain abstinent or use contraceptive methods that result in a failure rate of less than (<) 1 percent (%) per year during the treatment period and for at least 5 months after the last dose of atezolizumab
- Any approved anti-cancer therapy within 3 weeks prior to initiation of study treatment
- Adjuvant chemotherapy or radiation therapy for UC following surgical resection
- Treatment with any other investigational agent or participation in another clinical trial with therapeutic intent within 28 days or five half-lives of the drug prior to enrollment
- Malignancies other than UC within 5 years prior to Cycle 1, Day 1
- Pregnancy or breastfeeding
- Significant cardiovascular disease
- Severe infections within 4 weeks prior to Cycle 1, Day 1
- Major surgical procedure other than for diagnosis within 28 days prior to Cycle 1, Day 1
- History of severe allergic, anaphylactic, or other hypersensitivity reactions to chimeric or humanized antibodies or fusion proteins
- Known hypersensitivity to biopharmaceuticals produced in Chinese hamster ovary cells or any component of the atezolizumab formulation
- History of autoimmune disease
- Prior allogeneic stem cell or solid organ transplant
- History of idiopathic pulmonary fibrosis, organizing pneumonia, drug-induced pneumonitis, idiopathic pneumonitis, or evidence of active pneumonitis on screening chest CT scan
- Positive test for human immunodeficiency virus and/or active hepatitis B or hepatitis C or tuberculosis
- Administration of a live, attenuated vaccine within 4 weeks before Cycle 1 Day 1
- Prior treatment with cluster of differentiation 137 (CD137) agonists or immune checkpoint blockade therapies, including anti-CD40, anti-cytotoxic T-lymphocyte-associated protein 4 (anti-CTLA-4), anti-programmed death-1 (anti-PD-1), and anti-PD-L1 therapeutic antibodies
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Atezolizumab Atezolizumab Participants will receive intravenous (IV) atezolizumab on Day 1 of each 21-day cycle for 16 cycles (up to 1 year).
- Primary Outcome Measures
Name Time Method Disease-Free Survival (DFS), as Assessed by Investigator Randomization up to first occurrence of DFS event (up to approximately 50 months) DFS is defined as the time from randomization to the time of first occurrence of a DFS event. DFS events include: local (pelvic) recurrence of UC (including soft tissue and regional lymph nodes); urinary tract recurrence of UC (including all pathological stages and grades); distant metastasis of UC; or death from any cause. Tumor assessment will be performed using radiographic evaluations.
- Secondary Outcome Measures
Name Time Method Overall Survival (OS) Randomization until death due to any cause (up to approximately 80 months) Overall survival is defined as the time from randomization to the date of death from any cause, regardless of whether the death occurs during study treatment or following treatment discontinuation.
Disease-Specific Survival (DSS), as Assessed by Investigator Randomization until death due to UC (up to approximately 50 months) DSS is defined as the time from randomization until the date of death from UC.
Distant Metastasis-Free Survival (DMFS) Randomization up to diagnosis of distant metastases or death from any cause (up to approximately 50 months) DMFS is defined as the time from randomization to the date of diagnosis of distant (that is, non-locoregional) metastases or death from any cause. Tumor assessment will be performed using radiographic evaluations.
Non-Urinary Tract Recurrence-Free Survival (NURFS) Randomization up to time of first occurrence of a NURFS event (up to approximately 50 months) NURFS is defined as the time from randomization to the time of first occurrence of a NURFS event. NURFS events include: local (pelvic) recurrence of UC (including soft tissue and regional lymph nodes); distant metastasis of UC; or death from any cause. Tumor assessment will be performed using radiographic evaluations.
Percentage of Participants With Adverse Events (AEs) Screening up to approximately 80 months Percentage of participants with at least one Adverse Event.
Percentage of Participants With Anti-Therapeutic Antibodies (ATAs) to Atezolizumab Baseline up to approximately 50 months Percentage of participants with anti-therapeutic antibodies to atezolizumab.
EuroQol 5-Dimension 5-Level (EQ-5D-5L) Visual Analogue Scale Score Day 1 of Cycle 1 up to approximately 50 months (Cycle length = 21 days) The EQ-5D-5L is a generic preference-based HRQoL questionnaire that provides a single index value for health status and is used to inform pharmacoeconomic evaluations and to measure general health status. Visual analog scale (VAS) allows the patient to indicate, on a scale of 0-100, how his or her health is on the day of assessment, with 100 being the "best imaginable health state" and 0 being the "worst imaginable health state."
Minimum Observed Serum Atezolizumab Concentration (Cmin) Pre-dose (Hour 0) on Day 1 of Cycles 1, 2, 3, 4, every 8 cycles from Cycle 8, at treatment discontinuation, 120 days after treatment discontinuation (up to approximately 50 months))(Cycle length = 21 days) Minimum observed serum atezolizumab concentration (Cmin) prior to infusion on Day 1 of Cycles 1, 2, 3, and 4; every 8 cycles starting on Cycle 8; at treatment discontinuation; and at 120 days after the last dose of atezolizumab.
Maximum Observed Serum Atezolizumab Concentration (Cmax) Day 1 of Cycle 1 (Cycle length = 21 days) Maximum observed serum atezolizumab concentration (Cmax) after infusion on Day 1 of Cycle 1.
Trial Locations
- Locations (186)
Chesapeake Urology Research Associates
🇺🇸Towson, Maryland, United States
Beth Israel Deaconess Medical Center
🇺🇸Boston, Massachusetts, United States
Fairview Hospital; Cleveland Clinic Cancer Center
🇺🇸Cleveland, Ohio, United States
Baylor College of Medicine; Gastroenterology
🇺🇸Houston, Texas, United States
Seattle Cancer Care Alliance
🇺🇸Seattle, Washington, United States
Duke Cancer Center
🇺🇸Durham, North Carolina, United States
Fudan University Shanghai Cancer Center
🇨🇳Shanghai City, China
Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine
🇨🇳Shanghai, China
Azienda Ospedaliera S. Maria - Terni; Oncologia
🇮🇹Terni, Umbria, Italy
Szpital Kliniczny Dzieci?tka Jezus; Oddzia? Urologii
🇵🇱Warszawa, Poland
Taichung Veterans General Hospital; Division of Urology
🇨🇳Taichung, Taiwan
Memorial Sloan-Kettering Cancer Center
🇺🇸Commack, New York, United States
Clinic for Urology; Clinical Hospital Center "Dragisa Misovic-Dedinje"
🇷🇸Belgrade, Serbia
National Taiwan University Hospital, Department of Urology
🇨🇳Taipei, Taiwan
Szpital Kliniczny im. Heliodora ?wi?cickiego UM w Poznaniu; Oddzia? Chemioterapii
🇵🇱Pozna?, Poland
Tampere University Hospital; Dept Of Urology
🇫🇮Tampere, Finland
ICO - Site René Gauducheau
🇫🇷Saint Herblain, France
Campus Charitè Mitte Charité Centrum 10. Klinik f.Urologie
🇩🇪Berlin, Germany
SpecjalistycznySzpital Miejski w Toruniu; Oddzia? Urologii Ogólnej i Onkologicznej
🇵🇱Toru?, Poland
National Cancer Center Hospital; Urology
🇯🇵Tokyo, Japan
Uniwersytecki Szpital Kliniczny im. Jana Mikulicza-Radeckiego; Oddzial Urologii i Onkologii
🇵🇱Wroclaw, Poland
The Urology Center of Colorado
🇺🇸Denver, Colorado, United States
Karmanos Cancer Institute
🇺🇸Detroit, Michigan, United States
Henry Ford Health System
🇺🇸Detroit, Michigan, United States
McGill University; Glen Site; Oncology
🇨🇦Montreal, Quebec, Canada
University Hospitals Birmingham NHS Foundation Trust
🇬🇧Birmingham, United Kingdom
Southampton General Hospital
🇬🇧Southampton, United Kingdom
Centre Leon Berard; Departement Oncologie Medicale
🇫🇷Lyon, France
Institut Mutualiste Montsouris; Oncologie
🇫🇷Paris, France
Hospital Clinic de Barcelona. Unidad de Nuevas Terapias;Oncology Department
🇪🇸Barcelona, Spain
National Cancer Center
🇰🇷Goyang-si, Korea, Republic of
UCLA
🇺🇸Los Angeles, California, United States
HonorHealth Research Institute - Pima - Virginia G. Piper Cancer Care Network
🇺🇸Scottsdale, Arizona, United States
USC Norris Cancer Center
🇺🇸Los Angeles, California, United States
Stanford University Medical Center
🇺🇸Palo Alto, California, United States
University Of Colorado
🇺🇸Aurora, Colorado, United States
University of Iowa Hospital & Clinic; Division of Hematology/Oncology
🇺🇸Iowa City, Iowa, United States
University of Chicago; Hematology/Oncology
🇺🇸Chicago, Illinois, United States
Albert B. Chandler Medical Center; University of Kentucky
🇺🇸Lexington, Kentucky, United States
Johns Hopkins Sidney Kimmel Comprehensive Cancer Center
🇺🇸Baltimore, Maryland, United States
Massachusetts General Hospital.
🇺🇸Boston, Massachusetts, United States
Dana Farber Cancer Inst.
🇺🇸Boston, Massachusetts, United States
MSK @Basking Ridge
🇺🇸Basking Ridge, New Jersey, United States
Saint Barnabas Medical Center Cancer Center
🇺🇸Livingston, New Jersey, United States
Columbia University Medical Center
🇺🇸New York, New York, United States
Laura and ISAAC Perlmutter Cancer Center at NYU Langone.
🇺🇸New York, New York, United States
Levine Cancer Institute
🇺🇸Charlotte, North Carolina, United States
Cleveland Clinic
🇺🇸Cleveland, Ohio, United States
The Ohio State University Wexner Medical Center
🇺🇸Columbus, Ohio, United States
Cleveland CL N Coast Cancer Cr
🇺🇸Sandusky, Ohio, United States
Abramson Cancer Center; Univ of Pennsylvania
🇺🇸Philadelphia, Pennsylvania, United States
Miriam Hospital
🇺🇸Providence, Rhode Island, United States
Kimmel Cancer Center Thomas Jefferson University
🇺🇸Philadelphia, Pennsylvania, United States
Fox Chase-Temple Cancer Center
🇺🇸Philadelphia, Pennsylvania, United States
University of Texas Southwestern
🇺🇸Dallas, Texas, United States
University of Texas Health Science Center at San Antonio
🇺🇸San Antonio, Texas, United States
University of Virginia
🇺🇸Charlottesville, Virginia, United States
Monash Medical Centre; Oncology
🇦🇺Clayton, Victoria, Australia
Royal Brisbane & Women's Hosp; Cancer Care Serv
🇦🇺Herston, Queensland, Australia
Austin and Repatriation Medical Centre; Cancer Services
🇦🇺Melbourne, Victoria, Australia
Cliniques Universitaires St-Luc
🇧🇪Bruxelles, Belgium
UZ Gent
🇧🇪Gent, Belgium
UZ Leuven Gasthuisberg
🇧🇪Leuven, Belgium
Cross Cancer Institute ; Dept of Medical Oncology
🇨🇦Edmonton, Alberta, Canada
Lakeridge Health Oshawa; Oncology
🇨🇦Oshawa, Ontario, Canada
BCCA-Vancouver Cancer Centre
🇨🇦Vancouver, British Columbia, Canada
London Regional Cancer Centre
🇨🇦London, Ontario, Canada
Royal Victoria Hospital
🇨🇦Barrie, Ontario, Canada
The Ottawa Hospital Cancer Centre; Oncology
🇨🇦Ottawa, Ontario, Canada
North York General Hospital
🇨🇦Toronto, Ontario, Canada
Sunnybrook Odette Cancer Centre
🇨🇦Toronto, Ontario, Canada
Beijing Cancer Hospital
🇨🇳Beijing, China
CHU de Quebec Hotel-Dieu de Quebec
🇨🇦Quebec City, Quebec, Canada
Peking University First Hospital
🇨🇳Beijing City, China
Friendship Hospital, Capital Medical University
🇨🇳Beijing, China
The Second Affiliated Hospital, Sun Yat-sen University
🇨🇳Guangzhou City, China
Jiangsu Cancer Hospital
🇨🇳Nanjing City, China
Huashan Hospital Affiliated to Fudan University
🇨🇳Shanghai City, China
Fakultni nemocnice Olomouc; Onkologicka klinika
🇨🇿Olomouc, Czechia
Zhongshan Hospital Fudan University
🇨🇳Shanghai, China
Masarykuv onkologicky ustav
🇨🇿Brno, Czechia
Multiscan s.r.o.
🇨🇿Pardubice, Czechia
University Hospital Motol; Department of Urology
🇨🇿Praha 5, Czechia
Helsinki University Central Hospital; Urology Clinics
🇫🇮Helsinki, Finland
Turku University Central Hospital; Urology clinic
🇫🇮Turku, Finland
ICO Paul Papin; Oncologie Medicale.
🇫🇷Angers, France
Institut Sainte Catherine;Recherche Clinique
🇫🇷Avignon, France
Hopital Saint Andre
🇫🇷Bordeaux, France
Centre Francois Baclesse; Recherche Clinique
🇫🇷Caen, France
Centre Jean Perrin
🇫🇷Clermont Ferrand, France
Centre D'Oncologie de Gentilly; Oncology
🇫🇷Nancy, France
Hopital Cochin; Unite Fonctionnelle D Oncologie
🇫🇷Paris, France
Hopital Saint Louis; Oncologie Medicale
🇫🇷Paris, France
Centre Antoine Lacassagne
🇫🇷Nice, France
Hopital Europeen Georges Pompidou; Service D'Oncologie Medicale
🇫🇷Paris, France
Institut Claudius Regaud; Departement Oncologie Medicale
🇫🇷Toulouse, France
Augusta-Kranken-Anstalt gGmbH; Klinik für Hämatologie, Onkologie & Palliativmedizin
🇩🇪Bochum, Germany
Universitätsklinikum "Carl Gustav Carus"; Klinik und Poliklinik für Urologie
🇩🇪Dresden, Germany
Universitätsklinikum der Ruhr-Universität Bochum, Marien-Hospital Herne, Urologische Klinik
🇩🇪Herne, Germany
Klinikum rechts der Isar der TU München; Urologische Klinik und Poliklinik
🇩🇪München, Germany
Universitätsmedizin Rostock, Urologische Klinik und Poliklinik
🇩🇪Rostock, Germany
Alexandras General Hospital of Athens; Oncology Department
🇬🇷Athens, Greece
Universitätsklinikum Ulm; Klinik für Urologie
🇩🇪Ulm, Germany
Diakonie-Klinikum Stuttgart; Urologische Klinik
🇩🇪Stuttgart, Germany
Hadassah Ein Karem Hospital; Oncology Dept
🇮🇱Jerusalem, Israel
Universitätsklinikum Tübingen; Klinik für Urologie
🇩🇪Tübingen, Germany
University Hospital of Patras Medical Oncology
🇬🇷Patras, Greece
Rambam Health Care Campus; Oncology - Hafia
🇮🇱Hafia, Israel
Meir Medical Center; Oncology
🇮🇱Kfar-Saba, Israel
Rabin Medical Center; Oncology Dept
🇮🇱Petah Tikva, Israel
Tel-Aviv Sourasky Medical Center
🇮🇱Tel Aviv, Israel
Chaim Sheba Medical Center; Oncology Dept
🇮🇱Ramat Gan, Israel
Az. Osp. Cardarelli; Divisione Di Oncologia
🇮🇹Napoli, Campania, Italy
Assaf Harofeh; Oncology
🇮🇱Zerifin, Israel
ISTITUTO NAZIONALE TUMORI IRCCS FONDAZIONE G. PASCALE; Dipartimento Uro-Ginecologico
🇮🇹Napoli, Campania, Italy
Azienda Ospedaliero-Universitaria S.Orsola-Malpighi; Unità Operativa Oncologia Medica
🇮🇹Bologna, Emilia-Romagna, Italy
Azienda Ospedaliera San Camillo Forlanini; Oncologia Medica
🇮🇹Roma, Lazio, Italy
IRST Istituto Scientifico Romagnolo Per Lo Studio E Cura Dei Tumori, Sede Meldola; Oncologia Medica
🇮🇹Meldola, Emilia-Romagna, Italy
Irccs Ospedale San Raffaele;Oncologia Medica
🇮🇹Milano, Lombardia, Italy
Irccs Istituto Europeo Di Oncologia (IEO); Cure Mediche
🇮🇹Milano, Lombardia, Italy
Azienda USL8 Arezzo-Presidio Ospedaliero 1 San Donato;U.O.C. Oncologia
🇮🇹Arezzo, Toscana, Italy
A.O. UNIVERSITARIA S. LUIGI GONZAGA; Oncologia Medica
🇮🇹Orbassano, Piemonte, Italy
Nagoya University Hospital; Urology
🇯🇵Aichi, Japan
Shikoku Cancer Center
🇯🇵Ehime, Japan
Hirosaki University School of Medicine & Hospital; Urology
🇯🇵Aomori, Japan
National Hospital Organization Hokkaido Cancer Center
🇯🇵Hokkaido, Japan
Hiroshima City Hiroshima Citizens Hospital; Urology
🇯🇵Hiroshima, Japan
University of Tsukuba Hospital
🇯🇵Ibaraki, Japan
Iwate Medical University Hospital; Urology
🇯🇵Iwate, Japan
Kyoto University Hospital
🇯🇵Kyoto, Japan
Osaka University Hospital; Urology
🇯🇵Osaka, Japan
Kindai University Hospital; Urology
🇯🇵Osaka, Japan
Shizuoka Cancer Center; Urology
🇯🇵Shizuoka, Japan
Saitama Medical University International Medical Center
🇯🇵Saitama, Japan
The University of Tokyo Hospital
🇯🇵Tokyo, Japan
VU MEDISCH CENTRUM; Dept. of Medical Oncology
🇳🇱Amsterdam, Netherlands
The Cancer Institute Hospital, JFCR; Urology
🇯🇵Tokyo, Japan
Kyorin University Hospital
🇯🇵Tokyo, Japan
Academ Ziekenhuis Groningen; Medical Oncology
🇳🇱Groningen, Netherlands
NKI/AvL
🇳🇱Amsterdam, Netherlands
KO-MED Centra Kliniczne Lublin II
🇵🇱Lublin, Poland
Erasmus Mc - Daniel Den Hoed Kliniek; Interne Oncologie
🇳🇱Rotterdam, Netherlands
St. Antonius locatie Leidsche Rijn
🇳🇱Utrecht, Netherlands
P.A. Herzen Oncological Inst. ; Oncology
🇷🇺Moscow, Moskovskaja Oblast, Russian Federation
Privolzhsk Regional Medical Center
🇷🇺Nizhny Novgorod, Niznij Novgorod, Russian Federation
Sverdlovsk Regional Oncology Dispensary; Chemotherapy
🇷🇺Ekaterinburg, Sverdlovsk, Russian Federation
Ivanovo Regional Oncology Dispensary
🇷🇺Ivanovo, Russian Federation
Clinical Center of Serbia; Clinic of Urology
🇷🇸Belgrade, Serbia
Hospital de Donostia; Servicio de Oncologia Medica
🇪🇸San Sebastian, Guipuzcoa, Spain
Hospital de la Santa Creu i Sant Pau; Servicio de Oncologia
🇪🇸Barcelona, Spain
Hospital Clinico San Carlos; Servicio de Oncologia
🇪🇸Madrid, Spain
Hospital Ramon y Cajal; Servicio de Oncologia
🇪🇸Madrid, Spain
Hospital General Universitario Gregorio Marañon; Servicio de Oncologia
🇪🇸Madrid, Spain
Hospital Universitario 12 de Octubre; Servicio de Oncologia
🇪🇸Madrid, Spain
Instituto Valenciano Oncologia; Oncologia Medica
🇪🇸Valencia, Spain
Hospital Universitario La Paz; Servicio de Oncologia
🇪🇸Madrid, Spain
UniversitätsSpital Zürich; Zentrum für Hämatologie und Onkologie, Klinik für Onkologie
🇨🇭Zürich, Switzerland
Baskent University Adana Dr. Turgut Noyan Practice and Research Hospital; Medical Oncology
🇹🇷Adana, Turkey
Trakya University Medical Faculty Research And Practice Hospital Medical Oncology Department
🇹🇷Edirne, Turkey
Istanbul Uni Cerrahpasa Medical Faculty Hospital; Medical Oncology
🇹🇷Istanbul, Turkey
Medikal Park Izmir Hospital
🇹🇷Kar??yaka, Turkey
Regional Clinical Center of Urology and Nephrology n.a. V.I. Shapoval Department of Urology #4
🇺🇦Kharkiv, Kharkiv Governorate, Ukraine
CI Dnipropetrovsk CMCH #4 MA of MOHU Ch of Oncology and MR
🇺🇦Dnipropetrovsk, Ukraine
GU "Institution of urology of Academy Medical science of Ukraine"
🇺🇦Kiev, Ukraine
University Hospitals Bristol NHS Foundation Trust
🇬🇧Bristol, United Kingdom
Beatson West of Scotland Cancer Centre
🇬🇧Glasgow, United Kingdom
Sarah Cannon Research Institute
🇬🇧London, United Kingdom
Royal Preston Hosptial
🇬🇧Preston, United Kingdom
Barts Health NHS Trust - St Bartholomew's Hospital
🇬🇧London, United Kingdom
James Cook Uni Hospital
🇬🇧Middlesborough, United Kingdom
Northwestern University Feinberg School Of Medicine
🇺🇸Chicago, Illinois, United States
Macquarie University Hospital
🇦🇺Macquarie Park, New South Wales, Australia
Universitätsklinikum Düsseldorf; Urologische Klinik
🇩🇪Düsseldorf, Germany
Medizinische Fakultät Mannheim, Universitätsklinikum Mannheim, Klinik für Urologie
🇩🇪Mannheim, Germany
Okayama University Hospital
🇯🇵Okayama, Japan
Asan Medical Center
🇰🇷Seoul, Korea, Republic of
Samsung Medical Center
🇰🇷Seoul, Korea, Republic of
SBEI of HPE ?Bashkir State Medical University? of MoH RF
🇷🇺UFA, Baskortostan, Russian Federation
Corporacio Sanitaria Parc Tauli; Servicio de Oncologia
🇪🇸Sabadell, Barcelona, Spain
Hospital Univ Vall d'Hebron; Servicio de Oncologia
🇪🇸Sant Andreu de La Barca, Barcelona, Spain
Institut Jules Bordet
🇧🇪Anderlecht, Belgium
Yale Cancer Center; Medical Oncology
🇺🇸New Haven, Connecticut, United States
University Of Michigan
🇺🇸Ann Arbor, Michigan, United States
Norton Cancer Institute
🇺🇸Louisville, Kentucky, United States
Wake Forest University Baptist Medical Center
🇺🇸Winston-Salem, North Carolina, United States
Jiangsu Province Hospital
🇨🇳Nanjing, China
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