Safety and Efficacy of Pembrolizumab (MK-3475) Versus Placebo as Adjuvant Therapy in Participants With Hepatocellular Carcinoma (HCC) and Complete Radiological Response After Surgical Resection or Local Ablation (MK-3475-937 / KEYNOTE-937)
- Conditions
- Hepatocellular Carcinoma
- Interventions
- Biological: PembrolizumabDrug: Placebo
- Registration Number
- NCT03867084
- Lead Sponsor
- Merck Sharp & Dohme LLC
- Brief Summary
This study will evaluate the safety and efficacy of pembrolizumab (MK-3475) versus placebo as adjuvant therapy in participants with hepatocellular carcinoma (HCC) and complete radiological response after surgical resection or local ablation. The primary hypotheses of this study are that adjuvant pembrolizumab is superior to placebo with respect to: 1) recurrence-free survival (RFS) as assessed by blinded independent central review (BICR); and 2) overall survival (OS).
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- ACTIVE_NOT_RECRUITING
- Sex
- All
- Target Recruitment
- 950
- Has a diagnosis of HCC by radiological criteria and/or pathological confirmation.
- Has an eligibility scan (CT of the chest, triphasic CT scan or MRI of the abdomen, and CT or MRI of the pelvis) confirming complete radiological response โฅ4 weeks after complete surgical resection or local ablation. Randomization needs to occur within 12 weeks of the date of surgical resection or local ablation.
- Has no radiologic evidence of disease prior to enrollment.
- Has an Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1 within 7 days prior to Cycle 1, Day 1.
- Has a Child-Pugh class A liver score (5 to 6 points) within 7 days prior to Cycle 1, Day 1.
- Has alpha fetoprotein (AFP) concentration lower than 400 ng/mL within 28 days prior to Cycle 1, Day 1.
- Has controlled hepatitis B (Hep B).
- Has recovered adequately from toxicity and/or complications from the local intervention (surgical resection or local ablation) prior to starting study treatment.
- If female, is not pregnant or breastfeeding, and at least one of the following conditions applies: 1) Is not a woman of childbearing potential (WOCBP); or 2) Is a WOCBP and using a contraceptive method that is highly effective or be abstinent from heterosexual intercourse as their preferred and usual lifestyle (a WOCBP must have a negative pregnancy test within 72 hours before the first dose of study treatment).
- If undergoing surgical resection, has submitted a tumor tissue sample during Screening.
- Has adequate organ function.
- Has a known additional malignancy that is progressing or has required active antineoplastic treatment (including hormonal) or surgery within the past 3 years.
- Has had esophageal or gastric variceal bleeding within the last 6 months.
- Has clinically apparent ascites on physical examination.
- Has had clinically diagnosed hepatic encephalopathy in the last 6 months.
- Has received local therapy to liver ablation other than with radiofrequency or microwave ablation.
- Has a history of (noninfectious) pneumonitis/interstitial lung disease that required steroids or has current pneumonitis/interstitial lung disease.
- Has an active infection requiring systemic therapy.
- Has dual active Hepatitis B Virus (HBV) and Hepatitis C Virus (HCV) infection at study entry.
- Has a known history of human immunodeficiency virus (HIV) infection.
- Has known active tuberculosis (TB; Bacillus tuberculosis).
- Has received prior therapy with an anti-PD-1, anti-PD-L1, or anti PD-L2 agent or with an agent directed to another stimulatory or co-inhibitory T-cell receptor (eg, CTLA-4, OX-40, CD137).
- Has received prior systemic anti-cancer therapy for HCC including investigational agents.
- Is receiving any of the following prohibited concomitant therapies:1) Antineoplastic systemic chemotherapy or biological therapy; 2) Immunotherapy not specified in this protocol; 3) Investigational agents other than pembrolizumab; 4) Radiation therapy; 5) Oncological surgical therapy; or systemic glucocorticoids for any purpose other than to modulate symptoms from an AE that is suspected to have an immunologic etiology.
- Has received a live vaccine within 30 days prior to the first dose of study treatment.
- Is currently participating in or has participated in a study of an investigational agent or has used an investigational device within 4 weeks prior to Cycle 1, Day 1.
- Has a diagnosis of immunodeficiency or is receiving chronic systemic steroid therapy or any other form of immunosuppressive therapy within 7 days prior to Cycle 1, Day 1.
- Has severe hypersensitivity (โฅGrade 3) to pembrolizumab and/or any of its excipients.
- Has an active autoimmune disease that has required systemic treatment in past 2 years.
- Has a known psychiatric or substance abuse disorder that would interfere with the participant's ability to cooperate with the requirements of the study.
- Has had an allogenic tissue/solid organ transplant.
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Pembrolizumab Pembrolizumab Participants receive intravenous (IV) pembrolizumab at 200 mg on Day 1 of each 21-day cycle for up to 17 cycles. Placebo Placebo Participants receive IV placebo on Day 1 of each 21-day cycle for up to 17 cycles.
- Primary Outcome Measures
Name Time Method Recurrence-Free Survival (RFS) Up to ~6 years RFS is defined as the time from randomization to first documentation of disease recurrence (local, regional, or distant) as assessed by BICR or by pathology consistent with HCC if required per the site's standard of care, or death due to any cause (both cancer and non-cancer causes of death), whichever occurs first.
Overall Survival (OS) Up to ~8 years OS is defined as the time from randomization to death due to any cause.
- Secondary Outcome Measures
Name Time Method Percentage of Participants who Experience an Adverse Event (AE) Up to ~8 years An AE is defined as any unfavorable and unintended sign, symptom, or disease (new or worsening) temporally associated with the use of study therapy, regardless of whether or not a causal relationship with the study therapy can be determined.
Percentage of Participants who Discontinue Study Treatment Due to an AE Up to ~1 year An AE is defined as any unfavorable and unintended sign, symptom, or disease (new or worsening) temporally associated with the use of study therapy, regardless of whether or not a causal relationship with the study therapy can be determined.
Change from Baseline in European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire-Core 30 (QLQ-C30) Combined Global Health Status (GHS) / Quality of Life (QoL) Scale Score Baseline and time of last patient reported outcome (PRO) assessment (up to ~5 years) The EORTC-QLQ-C30 is a 30-item questionnaire developed to assess the quality of life of cancer patients, including a combined GHS/QoL (Items 29 and 30) scale. Per protocol, the change from baseline in the combined GHS/QoL score (range: 0-100) will be reported. Higher overall GHS/QoL scores indicate higher GHS/QoL.
Change from Baseline in EORTC QLQ-Hepatocellular Carcinoma Module (EORTC QLQ-HCC18) Scale Score Baseline and time of last PRO assessment (up to ~5 years) The EORTC QLQ-HCC18 is an HCC-specific questionnaire, administered in addition to the EORTC QLQ-C30, with scores ranging from 0-100. Higher scores indicate more severe symptoms/problems. Change from baseline in the EORTC QLQ-HCC18 scale score will be reported.
Change from Baseline in European Quality of Life (EuroQoL)-5 Dimensions, 5-level Questionnaire (EQ-5D-5L) Health Utility Score Baseline and time of last PRO assessment (up to ~5 years) The EQ-5D-5L measured health-related outcomes, assessing 5 health state dimensions (mobility, selfcare, usual activities, pain/discomfort, and anxiety/depression) on a 5-point scale from 1 (no problem) to 5 (extreme problems). The EQ-5D-5L also includes a graded (0 to 100) vertical visual analog scale on which the participant rates their general state of health.
Trial Locations
- Locations (249)
UZ Leuven ( Site 0377)
๐ง๐ชLeuven, Vlaams-Brabant, Belgium
City of Hope Medical Center ( Site 0027)
๐บ๐ธDuarte, California, United States
Fundaciรณn favaloro para la Docencia e Investigaciรณn Mรฉdica ( Site 0808)
๐ฆ๐ทBuenos Aires, Caba, Argentina
The University of Arizona Cancer Center - North Campus ( Site 0039)
๐บ๐ธTucson, Arizona, United States
University Medical Center New Orleans ( Site 0014)
๐บ๐ธNew Orleans, Louisiana, United States
Hospital Britanico de Buenos Aires ( Site 0792)
๐ฆ๐ทBuenos Aires, Argentina
University of Massachusetts Worcester ( Site 0017)
๐บ๐ธWorcester, Massachusetts, United States
Krankenhaus Nord-West GmbH ( Site 0472)
๐ฉ๐ชFrankfurt am Main, Hessen, Germany
Hospital Universitario Austral ( Site 0795)
๐ฆ๐ทPilar, Buenos Aires, Argentina
Instituto do Cancer do Estado de Sao Paulo - ICESP ( Site 0826)
๐ง๐ทSao Paulo, Brazil
Centre Hospitalier de l Universite de Montreal - CHUM ( Site 0211)
๐จ๐ฆMontreal, Quebec, Canada
Universitaetsklinikum Frankfurt ( Site 0467)
๐ฉ๐ชFrankfurt, Hessen, Germany
Baylor Scott & White Medical Center - Temple ( Site 0089)
๐บ๐ธTemple, Texas, United States
Universitatsklinikum Carl Gustav Carus ( Site 0459)
๐ฉ๐ชDresden, Sachsen, Germany
Hospital Paulistano ( Site 0829)
๐ง๐ทSรฃo Paulo, Sao Paulo, Brazil
Erasme Hospital ( Site 0376)
๐ง๐ชBruxelles, Bruxelles-Capitale, Region De, Belgium
University of New Mexico ( Site 0041)
๐บ๐ธAlbuquerque, New Mexico, United States
Alfred Health ( Site 0230)
๐ฆ๐บMelbourne, Victoria, Australia
Clinica de nefrologia urologia y enfermedades cardiovasculares ( Site 0802)
๐ฆ๐ทSanta Fe, Argentina
Instituto COI de Pesquisa Educacao e Gestao ( Site 0825)
๐ง๐ทRio de Janeiro, Brazil
University of Iowa ( Site 0067)
๐บ๐ธIowa City, Iowa, United States
Princess Alexandra Hospital ( Site 0228)
๐ฆ๐บWoollongabba, Queensland, Australia
Hospital Aleman ( Site 0806)
๐ฆ๐ทBuenos Aires, Argentina
Monash Health ( Site 0233)
๐ฆ๐บClayton, Victoria, Australia
Hospital Italiano ( Site 0793)
๐ฆ๐ทBuenos Aires, Argentina
Centro de Novos Tratamentos Itajai - Clinica de Neoplasias Litoral ( Site 0820)
๐ง๐ทItajai, Santa Catarina, Brazil
Beijing Cancer Hospital ( Site 0155)
๐จ๐ณBeijing, Beijing, China
UZ Gent ( Site 0375)
๐ง๐ชGent, Oost-Vlaanderen, Belgium
Hopital de la Timone ( Site 0442)
๐ซ๐ทMarseille, Bouches-du-Rhone, France
CIONC - Centro Integrado de Oncologia de Curitiba ( Site 0813)
๐ง๐ทCuritiba, Parana, Brazil
Real e Benemerita Associacao Portuguesa de Beneficencia ( Site 0828)
๐ง๐ทSao Paulo, Brazil
A.C. Camargo Cancer Center ( Site 0827)
๐ง๐ทSao Paulo, Brazil
Casa de Saude Santa Marcelina ( Site 0821)
๐ง๐ทSao Paulo, Brazil
Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico ( Site 0550)
๐ฎ๐นMilano, Italy
Istituto Tumori Giovanni Paolo II ( Site 0543)
๐ฎ๐นBari, Italy
Universitaetsklinikum Hamburg-Eppendorf ( Site 0469)
๐ฉ๐ชHamburg, Germany
Staedtisches Klinikum Dresden ( Site 0471)
๐ฉ๐ชDresden, Sachsen, Germany
Nova Scotia Health Authority QEII-HSC ( Site 0208)
๐จ๐ฆHalifax, Nova Scotia, Canada
SLK-Kliniken Heilbronn GmbH ( Site 0460)
๐ฉ๐ชHeilbronn, Baden-Wurttemberg, Germany
Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello ( Site 0547)
๐ฎ๐นPalermo, Sicilia, Italy
Semmelweis University ( Site 0480)
๐ญ๐บBudapest, Hungary
Toranomon Hospital Kajigaya ( Site 0109)
๐ฏ๐ตKawasaki, Kanagawa, Japan
Somogy Megyei Kaposi Mรณr Oktatรณ Kรณrhรกz-Oncology center ( Site 0484)
๐ญ๐บKaposvรกr, Somogy, Hungary
CHU Montpellier. ( Site 0443)
๐ซ๐ทMontpellier, Herault, France
Rambam Medical Center ( Site 0524)
๐ฎ๐ฑHaifa, Israel
Sourasky Medical Center ( Site 0522)
๐ฎ๐ฑTel Aviv, Israel
Hopital Paul Brousse ( Site 0447)
๐ซ๐ทVillejuif, Val-de-Marne, France
Ehime University Hospital ( Site 0123)
๐ฏ๐ตToon, Ehime, Japan
Medizinische Hochschule Hannover ( Site 0458)
๐ฉ๐ชHannover, Niedersachsen, Germany
Universitaetsklinikum Koeln ( Site 0463)
๐ฉ๐ชKoeln, Nordrhein-Westfalen, Germany
SZTE Szent-Gyorgyi Albert Klinikai Kozpont ( Site 0482)
๐ญ๐บSzeged, Csongrad, Hungary
Kurume University Hospital ( Site 0119)
๐ฏ๐ตKurume, Fukuoka, Japan
Kagawa Prefectural Central Hospital ( Site 0122)
๐ฏ๐ตTakamatsu, Kagawa, Japan
Fondazione IRCCS Istituto Nazionale dei Tumori di Milano ( Site 0540)
๐ฎ๐นMilano, Italy
Haddassah Medical Organization - Ein Kerem ( Site 0519)
๐ฎ๐ฑJerusalem, Israel
Hokkaido P.W.F.A.C Sapporo-Kosei General Hospital ( Site 0102)
๐ฏ๐ตSapporo, Hokkaido, Japan
Bacs-Kiskun Megyei Korhaz-Onkoradiologiai Kozpont ( Site 0483)
๐ญ๐บKecskemรฉt, Bacs-Kiskun, Hungary
Gulhane Egitim ve Arastirma Hastanesi ( Site 0741)
๐น๐ทAnkara, Turkey
Tallaght University Hospital ( Site 0499)
๐ฎ๐ชDublin, Ireland
Yokohama City University Medical Center ( Site 0110)
๐ฏ๐ตYokohama, Kanagawa, Japan
Kagawa University Hospital ( Site 0121)
๐ฏ๐ตKita-gun, Kagawa, Japan
Rabin Medical Center ( Site 0520)
๐ฎ๐ฑPetah Tikva, Israel
Kanazawa University Hospital ( Site 0111)
๐ฏ๐ตKanazawa, Ishikawa, Japan
University Hospital, Kyoto Prefectural University of Medicine ( Site 0112)
๐ฏ๐ตKyoto, Japan
Toranomon Hospital ( Site 0108)
๐ฏ๐ตTokyo, Japan
Seoul National University Bundang Hospital ( Site 0313)
๐ฐ๐ทSeongnam-si, Kyonggi-do, Korea, Republic of
ID Clinic ( Site 0619)
๐ต๐ฑMyslowice, Slaskie, Poland
University Hospital Coventry and Warwickshire NHS Trust ( Site 0754)
๐ฌ๐งCoventry, United Kingdom
Namik Kemal Universitesi Tip Fakultesi ( Site 0738)
๐น๐ทTekirdag, Tekirdas, Turkey
Universal Clinic Oberig-Oncology Center ( Site 0786)
๐บ๐ฆKyiv, Ukraine
Kings College Hospital NHS Foundation Trust ( Site 0758)
๐ฌ๐งLondon, London, City Of, United Kingdom
Leeds Teaching Hospitals NHS Trust ( Site 0751)
๐ฌ๐งLeeds, United Kingdom
Acฤฑbadem Maslak Hastanesi ( Site 0742)
๐น๐ทIstanbul, Turkey
Medical Center Dobrobut Clinic ( Site 0785)
๐บ๐ฆKyiv, Ukraine
Gรถztepe Prof. Dr. Sรผleyman Yalรงฤฑn ลehir Hastanesi-oncology ( Site 0730)
๐น๐ทIstanbul, Turkey
Dokuz Eylul Universitesi ( Site 0740)
๐น๐ทIzmir, Turkey
Nottingham University Hospitals NHS Trust ( Site 0756)
๐ฌ๐งNottingham, United Kingdom
The Beatson West of Scotland Cancer Centre ( Site 0750)
๐ฌ๐งGlasgow, Glasgow City, United Kingdom
Banner MD Anderson Cancer Center ( Site 0026)
๐บ๐ธGilbert, Arizona, United States
Regional Cancer Center ( Site 0054)
๐บ๐ธFort Myers, Florida, United States
Royal Prince Alfred Hospital AW ( Site 0225)
๐ฆ๐บCamperdown, New South Wales, Australia
Royal Adelaide Hospital ( Site 0234)
๐ฆ๐บAdelaide, South Australia, Australia
St Vincents Hospital Melbourne ( Site 0227)
๐ฆ๐บFitzroy, Victoria, Australia
Royal Perth Hospital ( Site 0229)
๐ฆ๐บPerth, Western Australia, Australia
Hospital de Clinicas de Porto Alegre ( Site 0824)
๐ง๐ทPorto Alegre, Rio Grande Do Sul, Brazil
University Hospital Basel ( Site 0709)
๐จ๐ญBasel, Basel-Stadt, Switzerland
Cancer Hospital Chinese Academy of Medical Sciences ( Site 0156)
๐จ๐ณBeijing, Beijing, China
Guangdong General Hospital ( Site 0166)
๐จ๐ณGuangzhou, Guangdong, China
Wuhan Union Hospital ( Site 0173)
๐จ๐ณWuhan, Hubei, China
Fujian Provincial Cancer Hospital ( Site 0165)
๐จ๐ณFuzhou, Fujian, China
900 Hospital of the Joint ( Site 0197)
๐จ๐ณFuzhou, Fujian, China
Hunan Cancer Hospital ( Site 0168)
๐จ๐ณChangsha, Hunan, China
Fudan University Shanghai Cancer Center ( Site 0161)
๐จ๐ณShanghai, Shanghai, China
Zhongshan Hospital Fudan University ( Site 0193)
๐จ๐ณShanghai, Shanghai, China
Renji Hospital Shanghai Jiaotong University School of Medicine ( Site 0174)
๐จ๐ณShanghai, Shanghai, China
Zhongshan Hospital affiliated to Fudan University ( Site 0153)
๐จ๐ณShanghai, Shanghai, China
West China Hospital of Sichuan University ( Site 0162)
๐จ๐ณChengdu, Sichuan, China
Affiliated Tumor Hospital of Xinjiang Medical University ( Site 0157)
๐จ๐ณUrumqi, Xinjiang, China
The First Affiliated Hospital of Xi an Jiaotong University ( Site 0164)
๐จ๐ณXI An, Shanxi, China
Zhejiang Cancer Hospital ( Site 0171)
๐จ๐ณHangzhou, Zhejiang, China
Herlev Hospital ( Site 0421)
๐ฉ๐ฐHerlev, Hovedstaden, Denmark
Aarhus Universitets hospital ( Site 0420)
๐ฉ๐ฐAarhus N, Midtjylland, Denmark
Odense Universitets Hospital ( Site 0422)
๐ฉ๐ฐOdense C, Syddanmark, Denmark
Indiana University Simon Cancer Center ( Site 0075)
๐บ๐ธIndianapolis, Indiana, United States
University of Cincinnati Medical Center ( Site 0084)
๐บ๐ธCincinnati, Ohio, United States
Stephenson Cancer Center ( Site 0045)
๐บ๐ธOklahoma City, Oklahoma, United States
Massachusetts General Hospital ( Site 0062)
๐บ๐ธBoston, Massachusetts, United States
Beth Israel Deaconess Medical Ctr. ( Site 0033)
๐บ๐ธBoston, Massachusetts, United States
Henry Ford Hospital-GI/Hepatology Research ( Site 0047)
๐บ๐ธDetroit, Michigan, United States
Vanderbilt Ingram Cancer Center ( Site 0006)
๐บ๐ธNashville, Tennessee, United States
Virginia Mason Medical Center ( Site 0028)
๐บ๐ธSeattle, Washington, United States
CHU Bordeaux Haut-Leveque ( Site 0437)
๐ซ๐ทPessac, Gironde, France
Hopital Beaujon ( Site 0439)
๐ซ๐ทClichy, Hauts-de-Seine, France
St Vincent's University Hospital ( Site 0498)
๐ฎ๐ชDublin, Ireland
A O U Policlinico di Modena ( Site 0548)
๐ฎ๐นModena, Abruzzo, Italy
HUS Hopital Hautepierre ( Site 0445)
๐ซ๐ทStrasbourg, Bas-Rhin, France
Hopital Claude Huriez CHRU LILLE ( Site 0440)
๐ซ๐ทLille, Nord, France
Hospital Provincial del Centenario ( Site 0794)
๐ฆ๐ทRosario, Santa Fe, Argentina
Belfast City Hospital ( Site 0752)
๐ฌ๐งBelfast, Northern Ireland, United Kingdom
Hospital de Cancer de Pernambuco ( Site 0815)
๐ง๐ทRecife, Pernambuco, Brazil
Clinica de Oncologia Reichow ( Site 0818)
๐ง๐ทBlumenau, Santa Catarina, Brazil
Kantonsspital Winterthur ( Site 0714)
๐จ๐ญWinterthur, Zurich, Switzerland
China Medical University Hospital ( Site 0333)
๐จ๐ณTaichung, Taiwan
Institut Kanser Negara - National Cancer Institute ( Site 0294)
๐ฒ๐พPutrajaya Wilayah Persekutuan, Wilayah Persekutuan Putrajaya, Malaysia
Regional Oncology Center of Kharkiv ( Site 0777)
๐บ๐ฆKharkiv, Kharkivska Oblast, Ukraine
Universitaetsspital Zurich ( Site 0713)
๐จ๐ญZurich, Switzerland
Weston Park Hospital ( Site 0753)
๐ฌ๐งSheffield, Derbyshire, United Kingdom
MI Odessa Regional Oncological Centre ( Site 0776)
๐บ๐ฆOdesa, Odeska Oblast, Ukraine
The Clatterbridge Cancer Centre NHS Foundation Trust ( Site 0757)
๐ฌ๐งBirkenhead, Wirral, United Kingdom
Cambridge University Hospitals NHS Trust ( Site 0755)
๐ฌ๐งCambridge, Cambridgeshire, United Kingdom
Shalimov s NI of Surgery and Transplantation ( Site 0781)
๐บ๐ฆKyiv, Kyivska Oblast, Ukraine
CI City Clinical Hospital # 3 ( Site 0783)
๐บ๐ฆZaporizhzhia, Zaporizka Oblast, Ukraine
AOU di Bologna Policliico S. Orsola-Malpighi ( Site 0541)
๐ฎ๐นBologna, Italy
Azienda Ospedaliero Universitaria Careggi ( Site 0549)
๐ฎ๐นFirenze, Italy
Ospedale del Mare ( Site 0545)
๐ฎ๐นNapoli, Italy
Ankara Sehir Hastanesi ( Site 0731)
๐น๐ทAnkara, Turkey
Kindai University Hospital ( Site 0116)
๐ฏ๐ตOsakasayama, Osaka, Japan
Saga-Ken Medical Centre Koseikan ( Site 0120)
๐ฏ๐ตSaga, Japan
The University of Tokyo Hospital ( Site 0105)
๐ฏ๐ตTokyo, Japan
Boston Medical Center ( Site 0025)
๐บ๐ธBoston, Massachusetts, United States
North Shore-Long Island Jewish Health System ( Site 0068)
๐บ๐ธLake Success, New York, United States
Miami Valley Hospital South ( Site 0093)
๐บ๐ธCenterville, Ohio, United States
Liverpool Hospital ( Site 0226)
๐ฆ๐บLiverpool, New South Wales, Australia
University Hospital Antwerp (UZA) ( Site 0374)
๐ง๐ชEdegem, Antwerpen, Belgium
Southern Medical University Nanfang Hospital ( Site 0172)
๐จ๐ณGuangzhou, Guangdong, China
Complex Cancer Center Plovdiv-First Medical Oncology Department ( Site 0982)
๐ง๐ฌPlovdiv, Bulgaria
Peking University People's Hospital ( Site 0191)
๐จ๐ณBeijing, Beijing, China
Anhui Provincil Hospital South District ( Site 0181)
๐จ๐ณHefei, Anhui, China
McGill University Health Centre ( Site 0207)
๐จ๐ฆMontreal, Quebec, Canada
The Third Xiangya Hospital of Central South University ( Site 0167)
๐จ๐ณChangsha, Hunan, China
Hunan Provincial People Hospital ( Site 0192)
๐จ๐ณChangsha, Hunan, China
Hubei Cancer Hospital ( Site 0189)
๐จ๐ณWuhan, Hubei, China
CHU Rangueil ( Site 0441)
๐ซ๐ทToulouse, Haute-Garonne, France
Universitaetsklinikum Wuerzburg ( Site 0468)
๐ฉ๐ชWuerzburg, Bayern, Germany
Klinikum rechts der Isar der Technischen Universitaet ( Site 0470)
๐ฉ๐ชMuenchen, Bayern, Germany
Universitaetsklinikum Duesseldorf ( Site 0461)
๐ฉ๐ชDuesseldorf, Nordrhein-Westfalen, Germany
Charite - Campus Virchow Klinikum ( Site 0457)
๐ฉ๐ชBerlin, Germany
Universitaetsklinikum Tuebingen ( Site 0466)
๐ฉ๐ชTuebingen, Baden-Wurttemberg, Germany
Debreceni Egyetem Klinikai Kozpont Onkologiai Tanszek ( Site 0481)
๐ญ๐บDebrecen, Hungary
Azienda Ospedaliera Ordine Mauriziano di Torino ( Site 0542)
๐ฎ๐นTorino, Piemonte, Italy
Chaim Sheba Medical Center ( Site 0523)
๐ฎ๐ฑRamat Gan, Israel
Azienda Ospedaliero Universitaria Pisana ( Site 0546)
๐ฎ๐นPisa, Italy
Musashino Red Cross Hospital ( Site 0107)
๐ฏ๐ตMusashino, Tokyo, Japan
Saitama Medical University Hospital ( Site 0104)
๐ฏ๐ตIruma-gun, Saitama, Japan
Kyorin University Hospital ( Site 0106)
๐ฏ๐ตMitaka, Tokyo, Japan
Chiba University Hospital ( Site 0103)
๐ฏ๐ตChiba, Japan
National Hospital Organization Kyushu Medical Center ( Site 0118)
๐ฏ๐ตFukuoka, Japan
Hiroshima University Hospital ( Site 0117)
๐ฏ๐ตHiroshima, Japan
Japanese Red Cross Osaka Hospital ( Site 0113)
๐ฏ๐ตOsaka, Japan
Osaka Metropolitan University Hospital. ( Site 0114)
๐ฏ๐ตOsaka, Japan
Severance Hospital Yonsei University Health System ( Site 0309)
๐ฐ๐ทSeoul, Korea, Republic of
Asan Medical Center ( Site 0310)
๐ฐ๐ทSeoul, Korea, Republic of
Wakayama Medical University Hospital ( Site 0115)
๐ฏ๐ตWakayama, Japan
Samsung Medical Center ( Site 0311)
๐ฐ๐ทSeoul, Korea, Republic of
National Cancer Center ( Site 0314)
๐ฐ๐ทGoyang-si, Kyonggi-do, Korea, Republic of
Seoul National University Hospital ( Site 0312)
๐ฐ๐ทSeoul, Korea, Republic of
The Catholic University of Korea. Seoul St. Mary s Hospital ( Site 0315)
๐ฐ๐ทSeoul, Korea, Republic of
Hospital Universiti Sains Malaysia ( Site 0295)
๐ฒ๐พKubang Kerian, Kelantan, Malaysia
Penang Adventist Hospital ( Site 0289)
๐ฒ๐พGeorge Town, Pulau Pinang, Malaysia
Gleneagles Penang ( Site 0290)
๐ฒ๐พPenang, Pulau Pinang, Malaysia
Sarawak General Hospital ( Site 0293)
๐ฒ๐พKuching, Sarawak, Malaysia
University Malaya Medical Centre ( Site 0288)
๐ฒ๐พKuala Lumpur, Malaysia
Auckland City Hospital ( Site 0246)
๐ณ๐ฟAuckland, New Zealand
Christchurch Hospital ( Site 0247)
๐ณ๐ฟChristchurch, Canterbury, New Zealand
MTZ Clinical Research Sp. z o. o. ( Site 0608)
๐ต๐ฑWarsaw, Mazowieckie, Poland
Oslo Universitetssykehus HF. Ulleval ( Site 0433)
๐ณ๐ดOslo, Norway
Copernicus PL Sp. z o.o. ( Site 0603)
๐ต๐ฑGdansk, Pomorskie, Poland
Izerskie Centrum Pulmonologii i Chemioterapii IZER-MED Spolka z o.o. ( Site 0607)
๐ต๐ฑSzklarska Poreba, Dolnoslaskie, Poland
Siberian Clinical Center of FMBA ( Site 0918)
๐ท๐บKrasnoyarsk, Krasnoyarskiy Kray, Russian Federation
Szpital Wojewodzki im. Mikolaja Kopernika ( Site 0604)
๐ต๐ฑKoszalin, Zachodniopomorskie, Poland
Altay Regional Oncology Dispensary ( Site 0919)
๐ท๐บBarnaul, Altayskiy Kray, Russian Federation
Krasnoyarsk Regional Clinical Oncological Dispensary ( Site 0648)
๐ท๐บKrasnoyarsk, Krasnoyarskiy Kray, Russian Federation
Blokhin National Medical Oncology ( Site 0645)
๐ท๐บMoscow, Moskva, Russian Federation
National Medical Research Radiological Centre ( Site 0660)
๐ท๐บMoscow, Moskva, Russian Federation
City Clinical Hospital 1 na. NI. Pirogov ( Site 0662)
๐ท๐บMoscow, Moskva, Russian Federation
Hadassah Medical-Clinical Research Department ( Site 0920)
๐ท๐บMoscow, Moskva, Russian Federation
First Moscow State Medical University n.a. I.M.Sechenov ( Site 0661)
๐ท๐บMoscow, Moskva, Russian Federation
Privolzhsky District Medical Center ( Site 0655)
๐ท๐บNizhniy Novgorod, Nizhegorodskaya Oblast, Russian Federation
Samara Regional Clinical Oncology Center ( Site 0656)
๐ท๐บSamara, Samarskaya Oblast, Russian Federation
Road Hospital JSC Russian railways ( Site 0649)
๐ท๐บSaint Petersburg, Sankt-Peterburg, Russian Federation
Russian Scientific Center of Radiology and Surgical Technologies ( Site 0665)
๐ท๐บSaint Petersburg, Sankt-Peterburg, Russian Federation
City Clinical Oncology Center ( Site 0646)
๐ท๐บSaint Petersburg, Sankt-Peterburg, Russian Federation
Hospital Universitario de Donostia ( Site 0671)
๐ช๐ธSan Sebastian, Gipuzkoa, Spain
Hospital Central de Asturias ( Site 0667)
๐ช๐ธOviedo, Asturias, Spain
Tomsk Scientific Research Institute of Oncology ( Site 0657)
๐ท๐บTomsk, Tomskaya Oblast, Russian Federation
Hospital Universitario Puerta de Hierro ( Site 0678)
๐ช๐ธMajadahonda, Madrid, Spain
Complejo Hospitalario Universitario de Santiago ( Site 0668)
๐ช๐ธSantiago de Compostela, La Coruna, Spain
Hospital Universitari Vall d Hebron ( Site 0674)
๐ช๐ธBarcelona, Spain
Hospital Ramon y Cajal ( Site 0673)
๐ช๐ธMadrid, Spain
Hospital General Universitario Gregorio Maranon ( Site 0676)
๐ช๐ธMadrid, Spain
Hospital Universitario La Paz ( Site 0677)
๐ช๐ธMadrid, Spain
Hospital Universitario Virgen del Rocio ( Site 0670)
๐ช๐ธSevilla, Spain
Hospital Universitario Miguel Servet-Gastroenterology ( Site 0682)
๐ช๐ธZaragoza, Spain
Skane University Hospital ( Site 0692)
๐ธ๐ชMalmo, Skane Lan, Sweden
Karolinska Universitetssjukhuset, Huddinge ( Site 0689)
๐ธ๐ชStockholm, Stockholms Lan, Sweden
Norrlands Universitetssjukhus ( Site 0687)
๐ธ๐ชUmea, Vasterbottens Lan, Sweden
Universitaetsspital Bern ( Site 0710)
๐จ๐ญBern, Aargau, Switzerland
CHUV (centre hospitalier universitaire vaudois) ( Site 0712)
๐จ๐ญLausanne, Vaud, Switzerland
Kantonsspital St. Gallen ( Site 0708)
๐จ๐ญSt. Gallen, Sankt Gallen, Switzerland
Sahlgrenska Universitetssjukhuset ( Site 0691)
๐ธ๐ชGoteborg, Vastra Gotalands Lan, Sweden
National Cheng Kung University Hospital ( Site 0334)
๐จ๐ณTainan, Taiwan
Hopitaux Universitaires de Geneve HUG ( Site 0711)
๐จ๐ญGeneve, Switzerland
National Taiwan University Hospital ( Site 0330)
๐จ๐ณTaipei, Taiwan
Chang Gung Medical Foundation. Kaohsiung Branch ( Site 0335)
๐จ๐ณKaohsiung, Taiwan
Taipei Veterans General Hospital ( Site 0331)
๐จ๐ณTaipei, Taiwan
Chang Gung Medical Foundation. Linkou ( Site 0332)
๐จ๐ณTaoyuan, Taiwan
Ramathibodi Hospital. ( Site 0352)
๐น๐ญBangkok, Krung Thep Maha Nakhon, Thailand
Siriraj Hospital ( Site 0351)
๐น๐ญBangkok, Krung Thep Maha Nakhon, Thailand
Maharaj Nakorn Chiangmai Hospital ( Site 0353)
๐น๐ญChiang Mai, Thailand
Srinagarind Hospital ( Site 0354)
๐น๐ญKhon Kaen, Thailand
Baskent Unv. Adana Uyg. ve Arast. Hastanesi ( Site 0733)
๐น๐ทAdana, Turkey
Adnan Menderes University Medical Faculty ( Site 0737)
๐น๐ทAydin, Turkey
Bezmialem Vakif University School of Medicine ( Site 0732)
๐น๐ทIstanbul, Turkey
Konya Necmettin Erbakan University Medical Faculty ( Site 0736)
๐น๐ทKonya, Turkey
Inonu University Faculty of Medicine ( Site 0729)
๐น๐ทMalatya, Turkey
VM Medical Park Hastanesi ( Site 0739)
๐น๐ทMersin, Turkey
Regional Clinical Onco Dispensary_ State Medical University ( Site 0782)
๐บ๐ฆChernivtsi, Chernivetska Oblast, Ukraine
National Cancer Institute of the MoH of Ukraine ( Site 0779)
๐บ๐ฆKyiv, Kyivska Oblast, Ukraine
ProMedica Flower Hospital ( Site 0090)
๐บ๐ธSylvania, Ohio, United States
Hospital Universitari Parc Tauli ( Site 0681)
๐ช๐ธSabadell, Barcelona, Spain
Samodzielny Publiczny Szpital Kliniczny nr 1 w Lublinie ( Site 0620)
๐ต๐ฑLublin, Lubelskie, Poland
SPZOZ MSWIA z Warminsko-Mazurskim Centrum Onkologii w Olsztynie ( Site 0606)
๐ต๐ฑOlsztyn, Warminsko-mazurskie, Poland
University of Louisville ( Site 0059)
๐บ๐ธLouisville, Kentucky, United States
Smilow Cancer Hospital at Yale New Haven ( Site 0042)
๐บ๐ธNew Haven, Connecticut, United States
James Graham Brown Cancer Center ( Site 0088)
๐บ๐ธLouisville, Kentucky, United States
Prince of Wales Hospital ( Site 0268)
๐ญ๐ฐHong Kong, Hong Kong
Pamela Youde Nethersole Eastern Hospital ( Site 0271)
๐ญ๐ฐHong Kong, Hong Kong
Tuen Mun Hospital ( Site 0272)
๐ญ๐ฐTuen Mun, Hong Kong
Queen Mary Hospital ( Site 0267)
๐ญ๐ฐHong Kong, Hong Kong