Study of Sacituzumab Govitecan-hziy (IMMU-132) Versus Treatment of Physician's Choice in Participants With Metastatic or Locally Advanced Unresectable Urothelial Cancer

Phase 3

Active, not recruiting

• Conditions: Locally Advanced or Metastatic Unresectable Urothelial Cancer
• Interventions: Drug: Sacituzumab Govitecan-hziy; Drug: Paclitaxel; Drug: Docetaxel; Drug: Vinflunine

• Registration Number: NCT04527991
• Lead Sponsor: Gilead Sciences

Brief Summary

The primary objective of this study is to assess overall survival (OS) with sacituzumab govitecan-hziy in comparison with treatment of physician's choice (TPC) in participants with metastatic or locally advanced unresectable urothelial cancer (UC).

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: 2020-08-19
• Study First Submitted QC: 2020-08-22
• Study First Posted: 2020-08-27
• Study Start: 2021-01-13
• Status Verified: 2024-05
• Last Update Submitted: 2024-05-03
• Last Update Posted: 2024-05-06
• Primary Completion: 2024-10
• Study Completion: 2024-10

Recruitment & Eligibility

• Status: ACTIVE_NOT_RECRUITING
• Sex: All
• Target Recruitment: 696

Inclusion Criteria

1. Individuals with histologically documented metastatic or locally advanced unresectable UC defined as

   • Tumor (T) 4b, any node (N) or
   • Any T, N 2-3 Tumors of upper and lower urinary tract are permitted. Mixed histologic types are allowed if urothelial is the predominant histology.

2. Eastern Cooperative Oncology Group (ECOG) performance status (PS) score of 0 or 1.

3. Individuals with progression or recurrence following receipt of platinum-containing regimen and anti programmed cell death protein 1/programmed death-ligand 1 (PD-1/PD-L1) therapy for metastatic or locally advanced unresectable disease will be enrolled.

   • a. Individuals with recurrence or progression ≤12 months following completion of cisplatin-containing chemotherapy given in the neo-adjuvant/adjuvant setting may utilize that line of therapy to be eligible for the study. The 12-month period is counted from completion of surgical intervention or platinum therapy, respectively. These individuals must receive anti PD-1/PD-L1 therapy in the metastatic or locally advanced unresectable setting to be eligible.

   • b. Individuals who received either carboplatin or anti PD-1/PD-L1 therapy in the neo- adjuvant/adjuvant setting will not be able to count that line of therapy towards eligibility for the study.

   • c. Cisplatin ineligible individuals who meet one of the below criteria and who were treated with carboplatin in the metastatic or locally advanced unresectable settings may count that line of therapy towards eligibility. They must then have received anti PD-1/PD-L1 therapy in metastatic or locally advanced unresectable setting to be eligible for the study.

     • Cisplatin ineligibility is defined as meeting one of the following criteria:

       • 1. Creatinine Clearance < 60 mL/min
       • 2. Grade ≥ 2 Audiometric Hearing Loss
       • 3. Grade ≥ 2 Peripheral Neuropathy
       • 4. New York Heart Association (NYHA) Class III heart failure
       • 5. ECOG PS ≥ 2

   • d. Anti PD-1/PD-L1 therapy administered as part of maintenance therapy may be counted towards eligibility for the study

   • e. Individuals who have progressed after receiving enfortumab vedotin in prior lines of therapy, and individuals who are either ineligible or unable to tolerate enfortumab vedotin therapy, are eligible to enroll in the study

   • f. Individuals who received only concurrent chemoradiation for bladder preservation without further systemic therapy are not eligible to enroll in the study. The substitution of carboplatin for cisplatin does not constitute a new regimen provided no new chemotherapeutic agents were added to the regimen and no progression was noted prior to the change in platinum.

4. Individuals with previously treated brain metastases may participate in the study provided they have stable CNS disease for at least 4 weeks prior to the first dose of study drug and stabilization of all neurologic symptoms, have no evidence of new or enlarging brain metastases, and are not using steroids >20 mg of prednisone (or equivalent) daily for brain metastases for at least 7 days prior to first dose of the study drug.

5. Adequate hematologic counts without transfusion or growth factor support within 2 weeks of study drug initiation (hemoglobin ≥ 9 g/dL, absolute neutrophil count (ANC) ≥1,500/mm^3, and platelets ≥100,000/µL).

6. Adequate hepatic function (bilirubin ≤1.5x institutional upper limit of normal (IULN), aspartate aminotransferase (AST) and alanine aminotransferase (ALT) ≤ 2.5 x IULN or ≤ 5 x IULN if known liver metastases and serum albumin >3 g/dL).

   Docetaxel will only be option in TPC arm for Individuals with a total bilirubin ≤1 x IULN, and an AST and/or ALT ≤1.5x IULN if alkaline phosphatase is also >2.5 x IULN.

7. Creatinine clearance ≥30 mL/min as assessed by the Cockcroft-Gault equation or other validated instruments (e.g. Modification of Diet in Renal Disease (MDRD) equation).

8. Females of childbearing potential must have a negative urine or serum pregnancy test within 72 hours prior to receiving the first dose of study drug. If the urine test is positive or cannot be confirmed as negative, a serum pregnancy test will be required.

9. Females of childbearing potential must be willing to use 2 methods of birth control or be surgically sterile or abstain from heterosexual activity for the course of the study through 6 months after the last dose of study drug. Individuals of childbearing potential are those who have not been surgically sterilized or have not been free from menses for >2 years.

10. Males must agree to use an adequate method of contraception starting with the first dose of study therapy through 6 months after the last dose of study therapy.

Key

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Exclusion Criteria

1. Females who are pregnant or lactating.

2. Have had a prior anti-cancer monoclonal antibody (mAb)/ antibody-drug conjugate (ADC) within 4 weeks prior to Cycle 1 Day 1 (C1D1) or have had prior chemotherapy, targeted small molecule therapy, or radiation therapy within 2 weeks prior to C1D1. Individuals participating in observational studies are eligible.

3. Have received prior chemotherapy for UC with any available SOC therapies in the control arm (i.e., both prior paclitaxel and docetaxel in regions where vinflunine is not an approved therapy, or prior paclitaxel, docetaxel and vinflunine in regions where vinflunine is approved and is commercially available).

4. Have not recovered (i.e., ≤ Grade 1) from AEs due to previously administered chemotherapeutic agent.

   • Note: Individuals with ≤ Grade 2 neuropathy or any grade of alopecia are an exception to this criterion and will qualify for the study.
   • Note: If Individuals received major surgery, they must have recovered adequately from the toxicity and/or complications from the intervention prior to starting study therapy.

5. Have previously received topoisomerase 1 inhibitors.

6. Have an active second malignancy.

   • Note: Individuals with a history of malignancy that have been completely treated and with no evidence of active cancer for 3 years prior to enrollment, or individuals with surgically cured tumors with low risk of recurrence are allowed to enroll in the study after discussion with the medical monitor.

7. Have active cardiac disease, defined as:

   • Myocardial infarction or unstable angina pectoris within 6 months of C1D1.
   • History of serious ventricular arrhythmia (i.e., ventricular tachycardia or ventricular fibrillation), high-grade atrioventricular block, or other cardiac arrhythmias requiring anti-arrhythmic medications (except for atrial fibrillation that is well controlled with antiarrhythmic medication); history of QT interval prolongation.
   • NYHA Class III or greater congestive heart failure or left ventricular ejection fraction of <40%.

8. Have active chronic inflammatory bowel disease (ulcerative colitis, Crohn's disease) or gastrointestinal (GI) perforation within 6 months of enrollment.

9. Have an active serious infection requiring anti-infective therapy (Contact medical monitor for clarification).

10. Have known history of Human Immunodeficiency Virus (HIV)-1/2 with undetectable viral load and on medications that may interfere with SN-38 metabolism.

11. Have active Hepatitis B Virus (HBV) or Hepatitis C Virus (HCV). In individuals with a history of HBV or HCV, individuals with a detectable viral load will be excluded.

12. Have other concurrent medical or psychiatric conditions that, in the investigator's opinion, may be likely to confound study interpretation or prevent completion of study procedures and follow-up examinations.

13. Have inability to tolerate or are allergic to any potential TPC agent or sacituzumab govitecan-hziy or unable or unwilling to receive the doses specified in the protocol.

14. Have inability to complete all specified study procedures for any reason.

Note: Other protocol defined Inclusion/Exclusion criteria may apply.

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Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Sacituzumab Govitecan-hziy	Sacituzumab Govitecan-hziy	Participants will receive 10 mg/kg of sacituzumab govitecan-hziy intravenously on Day 1 and Day 8 of 21-day cycles.
Treatment of Physician's Choice	Paclitaxel	Participants will have the choice of receiving paclitaxel, docetaxel, or vinflunine at standard of care (SOC) doses of 175, 75, and 320 mg/m\^2 respectively, every 3 weeks on Day 1 of 21-day cycles.
Treatment of Physician's Choice	Docetaxel	Participants will have the choice of receiving paclitaxel, docetaxel, or vinflunine at standard of care (SOC) doses of 175, 75, and 320 mg/m\^2 respectively, every 3 weeks on Day 1 of 21-day cycles.
Treatment of Physician's Choice	Vinflunine	Participants will have the choice of receiving paclitaxel, docetaxel, or vinflunine at standard of care (SOC) doses of 175, 75, and 320 mg/m\^2 respectively, every 3 weeks on Day 1 of 21-day cycles.

Primary Outcome Measures

Name	Time	Method
Overall Survival (OS)	Up to 3.5 years	OS is defined as time from the date of randomization to the date of death, regardless of cause.

Secondary Outcome Measures

Name	Time	Method
Progression-Free Survival (PFS) by Investigator Assessment	Up to 3.5 years	PFS is defined as the time from the date of randomization to the date of the first objectively documented disease progression, per response evaluation criteria in solid tumors version 1.1 (RECIST v1.1) criteria, as determined by investigator assessment, or death regardless of cause, whichever occurs first.
European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC-QLQ-C30) Score	Up to 3.5 years	The EORTC QLQ-C30 is a questionnaire to assess quality of life of cancer patients, it is composed of 30 questions (items) resulting in 5 functional scales, 1 global health status scale, 3 symptom scales, and 6 single items. Scoring of the QLQ-C30 is performed according to QLQ-C30 Scoring manual. All of the scales and single-item measures range in score from ...
Duration of Objective Tumor Response (DOR) by BICR	Up to 3.5 years	DOR is defined as the time from the date when the criteria is first met for a complete response or partial response to the first date that disease progression is documented per RECIST 1.1 as determined by BICR, or date of death, whichever occurs first.
Percentage of Participants Experiencing any Clinically Significant Laboratory Abnormalities	Up to 3.5 years
Progression-Free Survival (PFS) by Blinded Independent Central Review (BICR)	Up to 3.5 years	PFS is defined as the time from the date of randomization to the date of the first objectively documented disease progression, per RECIST v1.1 criteria as determined by BICR, or death regardless of cause, whichever occurs first.
Objective Response Rate (ORR) by Investigator Assessment	Up to 3.5 years	ORR is defined as the proportion of participants who achieved a complete response or partial response as best overall response (BOR). BOR is determined per RECIST 1.1 as determined by investigator assessment.
European Quality of Life 5-Dimensions 5 Levels Instrument (EuroQOL EQ-5D-5L) Score	Up to 3.5 years	The EQ-5D-5L is a standard measure of health-related quality of life. The tool consists of the EQ-5D-5L descriptive part and the EQ visual analogue scale (VAS). The descriptive part comprises 5 dimensions (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression). Each of these 5 dimensions has 5 levels (no problem, slight problems, mod...
Clinical Benefit Rate (CBR) by BICR	Up to 3.5 years	CBR is defined as the percentage of participants with advanced or metastatic cancer who have achieved complete response, partial response and stable disease for greater than or equal to 6 months to therapeutic intervention in a clinical study. CBR will be determined per RECIST v1.1 by BICR.
Percentage of Participants Experiencing any Serious Treatment Emergent Adverse Events	Up to 3.5 years
Objective Response Rate (ORR) by BICR	Up to 3.5 years	ORR is defined as the proportion of participants who achieved a complete response or partial response as best overall response (BOR). BOR is determined per RECIST 1.1 as determined by BICR.
Clinical Benefit Rate (CBR) by Investigator Assessment	Up to 3.5 years	CBR is defined as the percentage of patients with advanced or metastatic cancer who have achieved complete response, partial response and stable disease for greater than or equal to 6 months to therapeutic intervention in a clinical study. CBR will be determined per RECIST v1.1 by investigator assessment.
Duration of Objective Tumor Response (DOR) by Investigator Assessment	Up to 3.5 years	DOR is defined as the time from the date when the criteria is first met for a complete response or partial response to the first date that disease progression is documented per RECIST 1.1 as determined by investigator assessment, or date of death, whichever occurs first.
Percentage of Participants Experiencing any Treatment Emergent Adverse Events	Up to 3.5 years

Trial Locations

Locations (234)

Mayo Clinic - Arizona; 🇺🇸 Phoenix, Arizona, United States

University of California Irvine (UCIMC); 🇺🇸 Orange, California, United States

MedStar Washington Hospital Center; 🇺🇸 Washington, District of Columbia, United States

Baptist MD Anderson Cancer Center; 🇺🇸 Jacksonville, Florida, United States

Boca Raton Clinical Research Global USA - Plantation; 🇺🇸 Plantation, Florida, United States

University of Iowa Hospitals and Clinics; 🇺🇸 Iowa City, Iowa, United States

Roswell Park Cancer Institute; 🇺🇸 Buffalo, New York, United States

Penn State Hershey Cancer Institute; 🇺🇸 Hershey, Pennsylvania, United States

Thompson Oncology Group - Knoxville Downtown; 🇺🇸 Knoxville, Tennessee, United States

Seattle Cancer Care Alliance (SCCA); 🇺🇸 Seattle, Washington, United States

Chris O'Brien Lifehouse; 🇦🇺 North Ryde, New South Wales, Australia

Ashford Cancer Centre Research - ICON Cancer Centre Adelaide; 🇦🇺 Kurralta Park, South Australia, Australia

Monash Health; 🇦🇺 Clayton, Victoria, Australia

Peter MacCallum Cancer Centre; 🇦🇺 Melbourne, Victoria, Australia

Krankenhaus Der Barmherzigen Bruder Wien; 🇦🇹 Wien, Austria

Grand Hôpital De Charleroi - Notre Dame; 🇧🇪 Charleroi, Belgium

Universitair Ziekenhuis Gent; 🇧🇪 Gent, Belgium

Centre Hospitalier Universitaire de Liège; 🇧🇪 Liège, Belgium

Tallaght University Hospital; 🇮🇪 Dublin, Ireland

Azienda Ospedaliera Universitaria Integrata Verona; 🇮🇹 Verona, Italy

The Catholic University of Korea Seoul Saint Mary's Hospital; 🇰🇷 Seoul, Korea, Republic of

Centro Hospitalar de Tras-os-Montes e Alto Douro; 🇵🇹 Vila Real, Portugal

UCLA Hematology/ Oncology; 🇺🇸 Los Angeles, California, United States

University of Maryland School of Medicine; 🇺🇸 Baltimore, Maryland, United States

Cleveland Clinic; 🇺🇸 Cleveland, Ohio, United States

Harold C. Simmons Comprehensive Cancer Center; 🇺🇸 Dallas, Texas, United States

Beth Israel Deaconess Medical Center; 🇺🇸 Boston, Massachusetts, United States

Liverpool Hospital; 🇦🇺 Nedlands, Western Australia, Australia

Sir Charles Gairdner Hospital; 🇦🇺 Nedlands, Western Australia, Australia

Multiprofile Hospital for Active Treatment Heart and Brain EAD; 🇧🇬 Pleven, Bulgaria

Specialized Hospital for Active Treatment of Oncological Diseases - Sofia District; 🇧🇬 Sofia, Bulgaria

Centro Hospitalar de Lisboa Norte - Hospital de Santa Maria; 🇵🇹 Lisbon, Portugal

Weill Cornell Medical College; 🇺🇸 New York, New York, United States

Austin Health; 🇦🇺 Heidelberg, Victoria, Australia

Instituto Portugues de Oncologia do Porto Francisco Gentil, E.P.E; 🇵🇹 Porto, Portugal

Kaohsiung Chang Gung Memorial Hospital; 🇨🇳 Kaohsiung, Taiwan

Universitair Ziekenhuis Leuven; 🇧🇪 Leuven, Belgium

Rambam Health Care Campus; 🇮🇱 Haifa, Israel

Tan Tock Seng Hospital; 🇸🇬 Singapore, Singapore

China Medical University Hospital; 🇨🇳 Taichung City, Taiwan

ICON Cancer Centre Hobart; 🇦🇺 Hobart, Tasmania, Australia

University Hospital of Larissa; 🇬🇷 Larisa, Greece

Taichung Veterans General Hospital; 🇨🇳 Taichung, Taiwan

Sunshine Hospital; 🇦🇺 Saint Albans, Victoria, Australia

National University Hospital; 🇸🇬 Singapore, Singapore

Icon Cancer Centre Farrer Park; 🇸🇬 Singapore, Singapore

Kaohsiung Veterans General Hospital; 🇨🇳 Kaohsiung, Taiwan

Institut Claudius Regaud; 🇫🇷 Toulouse Cedex 9, France

Barts Health NHS Trust; 🇬🇧 London, United Kingdom

Cross Cancer Institute; 🇨🇦 Edmonton, Canada

MD Anderson Cancer Center; 🇪🇸 Madrid, Spain

Center for Cancer and Blood Disorders; 🇺🇸 Fort Worth, Texas, United States

Oklahoma Cancer Specialists and Research Institute (OCSRI); 🇺🇸 Tulsa, Oklahoma, United States

University Cancer Specialists - Knoxville; 🇺🇸 Knoxville, Tennessee, United States

Summit Cancer Centers; 🇺🇸 Spokane, Washington, United States

Westmead Hospital; 🇦🇺 Westmead, New South Wales, Australia

Icon Cancer Centre Wesley; 🇦🇺 Auchenflower, Queensland, Australia

Calvary Mater Newcastle; 🇦🇺 Waratah, New South Wales, Australia

Universitätsklinik für Innere Medizin Graz; 🇦🇹 Graz, Austria

Ordensklinikum Linz GmbH Barmherzige Schwestern; 🇦🇹 Linz, Austria

Az Maria Middelares Ghent; 🇧🇪 Gent, Belgium

Jewish General Hospital; 🇨🇦 Montréal, Canada

McGill University Health Centre; 🇨🇦 Montréal, Canada

qeii health sciences centre - VG site; 🇨🇦 Halifax, Canada

London Health Sciences Centre; 🇨🇦 London, Canada

R.S. McLaughlin Durham Regional Cancer Centre; 🇨🇦 Oshawa, Canada

West China Hospital Sichuan University; 🇨🇳 Chengdu, China

Chinese People's Liberation Army General Hospital - 301 Hospital; 🇨🇳 Beijing, China

British Columbia Cancer Agency-Vancouver Centre; 🇨🇦 Vancouver, Canada

Peking University First Hospital; 🇨🇳 Beijing, China

Hunan Cancer Hospital - Xiangya Hospital - Central South University; 🇨🇳 Changsha, China

Chongqing University Cancer Hospital; 🇨🇳 Chongqing, China

1st Hospital Jilin University; 🇨🇳 Changchun, China

Beijing Cancer Hospital; 🇨🇳 Beijing, China

Chinese Academy of Medical Sciences Cancer Hospital; 🇨🇳 Beijing, China

Union Hospital of Fujian Medical University; 🇨🇳 Fuzhou, China

Sun Yat-Sen University Cancer Center; 🇨🇳 Guangzhou, China

Zhejiang Provincial People's Hospital - Zhaohui; 🇨🇳 Hangzhou, China

Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital; 🇨🇳 Chengdu, China

The First Affiliated Hospital of Fujian Medical University; 🇨🇳 Fujian, China

The First Affiliated Hospital of Nanchang University; 🇨🇳 Nanchang, China

Cancer Hospital of the University of Chinese Academy of Sciences Zhejiang Cancer Hospital; 🇨🇳 Hangzhou, China

Qilu Hospital of Shandong University; 🇨🇳 Jinan, China

Anhui Provincial Cancer Hospital; 🇨🇳 Hefei, China

Nanjing Drum Tower Hospital; 🇨🇳 Nanjing, China

Liaoning Cancer Hospital and Institute; 🇨🇳 Shenyang, China

Tianjin Medical University Cancer Institute & Hospital; 🇨🇳 Tianjin, China

Affiliated Tumor Hospital of Xinjiang Medical University; 🇨🇳 Urumqi, China

The First Affiliated Hospital of Wenzhou Medical University; 🇨🇳 Wenzhou, China

Union Hospital Tongji Medical College Huazhong University of Science and Technology; 🇨🇳 Wuhan, China

Clinical Hospital Centre Split; 🇭🇷 Split, Croatia

Clinical Hospital Centre "Sestre Milosrdnice"; 🇭🇷 Zagreb, Croatia

Fakultni nemocnice Olomouc; 🇨🇿 Olomouc, Czechia

University Hospital Centre Zagreb; 🇭🇷 Zagreb, Croatia

Urocentrum Praha; 🇨🇿 Praha 2, Czechia

Ramsay Health Clinic Belharra; 🇫🇷 Bayonne, France

Centre Hospiltalier Universitaire Brest - Hôpital Morvan; 🇫🇷 Brest, France

CHU Saint Andre; 🇫🇷 Bordeaux, France

Centre Jean Perrin; 🇫🇷 Clermont-Ferrand, France

Centre Francois Baclesse; 🇫🇷 Caen Cedex 5, France

Centre Leon Berard; 🇫🇷 Lyon, France

Centre Hospitalier Departemental Vendee; 🇫🇷 La Roche-Sur-Yon Cedex, France

Centre Georges- Francois Leclerc; 🇫🇷 Dijon, France

Centre Hospitalier Universitaire de Nimes; 🇫🇷 Nimes, France

Centre Oscar Lambret; 🇫🇷 Lille, France

Hôpital Foch; 🇫🇷 Suresnes, France

Centre Antoine Lacassagne; 🇫🇷 Nice Cedex 2, France

Centre Eugene Marquis; 🇫🇷 Rennes Cedex, France

Institut Régional du Cancer de Montpellier ICM Val d' Aurelle; 🇫🇷 Montpellier, France

Hôpital Européen Georges-Pompidou; 🇫🇷 Paris, France

Institut Gustave Roussy; 🇫🇷 Villejuif Cedex, France

High Technology Hospital MedCenter; 🇬🇪 Batumi, Georgia

Centre Hospitalier Privé Saint-Grégoire; 🇫🇷 Saint-Grégoire, France

Les Hôpitaux Universitaires de Strasbourg; 🇫🇷 Strasbourg cedex, France

New Hospitals; 🇬🇪 Tbilisi, Georgia

L. Managadze National Center of Urology; 🇬🇪 Tbilisi, Georgia

Evex Medical corporation; 🇬🇪 Tbilisi, Georgia

Jerarsi Clinic; 🇬🇪 Tbilisi, Georgia

Malteser Waldkrankenhaus Erlangen; 🇩🇪 Erlangen, Germany

Universitätsklinikum Essen; 🇩🇪 Essen, Germany

Universitatsklinik Dresden; 🇩🇪 Dresden, Germany

Centrum fur Hamatologie und Onkologie Bethanien; 🇩🇪 Frankfurt/Main, Germany

Asklepios Klinik Altona; 🇩🇪 Hamburg, Germany

Studienpraxis Urologie; 🇩🇪 Nürtingen, Germany

Institut Für Versorgungsforschung in Der Onkologie; 🇩🇪 Koblenz, Germany

Universitatsklinikum Munster; 🇩🇪 Münster, Germany

401 General Military Hospital of Athens; 🇬🇷 Athens, Greece

Charité Universitätsmedizin Berlin - Campus Benjamin Franklin; 🇩🇪 Wien, Germany

Universitätsklinikum Tübingen; 🇩🇪 Tübingen, Germany

University Hospital of Patras; 🇬🇷 Patra, Greece

Attikon Hospital; 🇬🇷 Chaidari, Greece

Regional University General Hospital of Herakleio, Crete; 🇬🇷 Herakleio, Greece

Henry Dunant Hospital; 🇬🇷 Athens, Greece

Alexandra General Hospital; 🇬🇷 Athens, Greece

University Hospital Of Ioannina; 🇬🇷 Ioannina, Greece

Athens Medical Center; 🇬🇷 Maroussi, Greece

Bioclinic - Thessaloniki; 🇬🇷 Thessaloniki, Greece

Theagenio Anticancer Hospital of Thessaloniki; 🇬🇷 Thessaloniki, Greece

Anassa General Clinic; 🇬🇷 Thessaloniki, Greece

Prince of Wales Hospital; 🇭🇰 Hong Kong, Hong Kong

University Hospital Waterford; 🇮🇪 Waterford, Ireland

Interbalkan Medical Center of Thessaloniki; 🇬🇷 Thessaloniki, Greece

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

Chaim Sheba Medical Center; 🇮🇱 Tel Hashomer, Israel

Centro di Riferimento Oncologico di Aviano; 🇮🇹 Aviano, Italy

Istituto di Candiolo - Fondazione del Piemonte per l'Oncologia; 🇮🇹 Candiolo (TO), Italy

Hadassah University Hospital Ein Kerem; 🇮🇱 Jerusalem, Israel

Meir Medical Center; 🇮🇱 Kfar-Sava, Israel

Ospedale Policlinico San Martino; 🇮🇹 Genova, Italy

Rabin Medical Center; 🇮🇱 Petach Tikva, Israel

Tel Aviv Medical Center (Ichilov Hospital); 🇮🇱 Tel Aviv, Israel

Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori; 🇮🇹 Meldola, Italy

Ospedale San Donato; 🇮🇹 Arezzo, Italy

Istituto Tumori Bari Giovanni Paolo II - IRCCS; 🇮🇹 Bari, Italy

Azienda Ospedaliero Universitaria Pisana; 🇮🇹 Pisa, Italy

Ospedale Civile Di Sondrio; 🇮🇹 Sondrio, Italy

Ospedale San Raffaele; 🇮🇹 Milan, Italy

Istituto Regina Elena; 🇮🇹 Roma, Italy

Azienda Ospedaliero Universitaria Maggiore Della Carita; 🇮🇹 Novara, Italy

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

Ospedale di Trento - Presidio Ospedaliero Santa Chiara; 🇮🇹 Trento, Italy

Azienda Ospedaliera Santa Maria di Terni; 🇮🇹 Terni, Italy

Azienda Ospedaliero-Universitaria San Luigi Gonzaga; 🇮🇹 Torino, Italy

Pusan National University Hospital; 🇰🇷 Busan-si, Korea, Republic of

Chungnam National University Hospital; 🇰🇷 Daejeon, Korea, Republic of

Chungbuk National University Hospital; 🇰🇷 Cheongju, Korea, Republic of

National Cancer Center; 🇰🇷 Goyang-si, Korea, Republic of

Gachon University Gil Medical Center; 🇰🇷 Incheon, Korea, Republic of

Seoul National University Bundang Hospital; 🇰🇷 Seongnam-si, Korea, Republic of

Pusan National University Yangsan Hospital; 🇰🇷 Gyeongsangnam-do, Korea, Republic of

Hospital de Braga; 🇵🇹 Braga, Portugal

Asan Medical Center; 🇰🇷 Seoul, Korea, Republic of

The Catholic University of Korea Saint Vincent's Hospital; 🇰🇷 Suwon, Korea, Republic of

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

Severance Hospital, Yonsei University Health System; 🇰🇷 Seoul, Korea, Republic of

Samsung Medical Center; 🇰🇷 Seoul, Korea, Republic of

Unidade Local de Saúde da Guarda - Hospital Sousa Martins; 🇵🇹 Guarda, Portugal

Centro Hospitalar de Leiria - Hospital de Santo André; 🇵🇹 Leiria, Portugal

BRCR Medical Center, Inc; 🇵🇷 San Juan, Puerto Rico

Hospital Universitari Vall D'Hebron; 🇪🇸 Barcelona, Spain

Hospital del Mar - Parc de Salut; 🇪🇸 Barcelona, Spain

Hospital Clinic de Barcelona; 🇪🇸 Barcelona, Spain

Hospital Reina Sofia; 🇪🇸 Córdoba, Spain

Hospital Universitario Ramon y Cajal; 🇪🇸 Madrid, Spain

Karolinska Universitetssjukhuset - Solna; 🇸🇪 Stockholm, Sweden

Universitetssjukhuset i Linköping; 🇸🇪 Linköping, Sweden

Complexo Hospitalario de Ourense (CHOU); 🇪🇸 Ourense, Spain

Hospital Universitario Virgen del Rocio; 🇪🇸 Sevilla, Spain

Álvaro Cunqueiro Hospital; 🇪🇸 Vigo, Spain

Hospital Universitario Marqués de Valdecilla; 🇪🇸 Santander, Spain

Hospital Sant Joan de Déu de Manresa; 🇪🇸 Manresa, Spain

Länssjukhuset Ryhov; 🇸🇪 Jönköping, Sweden

University Hospital Basel; 🇨🇭 Basel, Switzerland

Istituto Oncologico Della Svizzera Italiana (IOSI); 🇨🇭 Bellinzona, Switzerland

Hôpitaux Universitaires de Genève; 🇨🇭 Geneva, Switzerland

Universitaetsspital Zurich - Klinik fur Medizinische Onkologie und Hematologie; 🇨🇭 Zurich, Switzerland

University of Bern; 🇨🇭 Bern, Switzerland

Taipei Tzu Chi General Hospital; 🇨🇳 New Taipei City, Taiwan

National Taiwan University Hospital; 🇨🇳 Taipei City, Taiwan

National Cheng Kung University Hospital; 🇨🇳 Tainan, Taiwan

Hacettepe Universitesi Tip Fakultesi- Kanser Enstitusu; 🇹🇷 Ankara, Turkey

Chiayi Chang Gung Memorial Hospital; 🇨🇳 Puzi, Taiwan

Taipei Veterans General Hospital; 🇨🇳 Taipei City, Taiwan

Istanbul Acibadem University Maslak Hospital; 🇹🇷 Istanbul, Turkey

T.C. Saglik Bakanligi Goztepe Prof. Dr. Suleyman Yalcin Sehir Hastanesi; 🇹🇷 Istanbul, Turkey

Medical Park Izmır Hastanesi; 🇹🇷 İzmir, Turkey

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

Bagcilar Medipol Mega Universite Hastanesi; 🇹🇷 Istanbul, Turkey

Trakya Universitesi Saglik Arastirma ve Uygulama Merkezi; 🇹🇷 Edirne, Turkey

Cebeci Hastanesi; 🇹🇷 Mamak, Turkey

VKV Amerikan Hastanesi Department of Oncology; 🇹🇷 Şişli, Turkey

Dorset County Hospital NHS Foundation Trust; 🇬🇧 Dorchester, United Kingdom

University Hospitals Birmingham NHS Foundation Trust; 🇬🇧 Birmingham, United Kingdom

NHS Greater Glasgow and Clyde; 🇬🇧 Glasgow, United Kingdom

Guys and Saint Thomas NHS Foundation Trust, Guy's Hospital; 🇬🇧 London, United Kingdom

Royal Preston Hospital; 🇬🇧 Preston, United Kingdom

The Christie NHS Foundation Trust; 🇬🇧 Manchester, United Kingdom

Sarah Cannon Research Institute London; 🇬🇧 London, United Kingdom

East and North Hertfordshire NHS Trust; 🇬🇧 Middlesex, United Kingdom

The Royal Marsden NHS Foundation Trust; 🇬🇧 Surrey, United Kingdom

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

Swansea Bay University Health Board; 🇬🇧 Port Talbot, United Kingdom

The Royal Wolverhampton NHS Trust; 🇬🇧 Wolverhampton, United Kingdom

Juravinski Hospital and Cancer Centre; 🇨🇦 Hamilton, Canada

Southern Adelaide Local Health Network Incorporated; 🇦🇺 Bedford Park, South Australia, Australia

Princess Margaret Cancer Centre; 🇨🇦 Toronto, Canada

Clinica Universidad de Navarra; 🇪🇸 Pamplona, Spain

Hospital Universitario Puerta de Hierro de Majadahonda; 🇪🇸 Majadahonda, Spain

Hospital Universitario 12 de Octubre; 🇪🇸 Madrid, Spain

Hospital General Universitario Gregorio Maranon; 🇪🇸 Madrid, Spain

Clínica Universidad de Navarra - Madrid; 🇪🇸 Madrid, Spain

Montefiore Medical Center; 🇺🇸 Bronx, New York, United States

Queen Mary Hospital; 🇭🇰 Hong Kong, Hong Kong

Hong Kong United Oncology Centre; 🇭🇰 Kowloon, Hong Kong