MedPath

A Study of PF-06873600 in People With Cancer

Phase 2
Active, not recruiting
Conditions
HR+ HER2- Metastatic Breast Cancer, Ovarian Cancer, Fallopian Tube Cancer, Primary Peritoneal Cancer, Triple Negative Breast Cancer, Male Breast Cancer
Interventions
Drug: PF-06873600
Drug: Endocrine Therapy 1
Drug: Endocrine Therapy 2
Registration Number
NCT03519178
Lead Sponsor
Pfizer
Brief Summary

The purpose of this clinical trial is to learn about the safety and effects of study medicine (PF-06873600) when taken alone or with hormone therapy by people with cancer.

People may be able to participate in this study if they have the following types of cancer: Hormone Receptor positive (HR+) breast cancer; Human Epidermal Growth Factor Receptor 2 (HER2)-negative breast cancer that is advanced or metastatic (spread to other parts of the body); triple negative breast cancer; epithelial ovarian cancer; fallopian tube cancer; or primary peritoneal cancer.

All participants in this study will receive the study medicine by mouth, 1 to 2 times a day at home. The dose of the study medicine may be changed during the study.

Some participants will also receive hormone therapy. The hormone therapy will be either letrozole by mouth once a day at home, or fulvestrant as a shot into the muscle. Fulvestrant will be given every two weeks at the study clinic for the first month, and then once a month after that.

Participants will take part in this study for at least 7 to 8 months, depending on how they respond to the therapy. During this time participants will visit the study clinic once a week.

Detailed Description

This is a Phase 1/2a, open-label, multi-center, non-randomized, multiple dose, safety, tolerability, pharmacokinetic, and pharmacodynamic study of PF-06873600 administered as a single agent in sequential dose levels and then in combination with endocrine therapy. In Part 1A and Part 1C, successive cohorts of patients will receive escalating doses of PF-06873600 and then in dose finding (Part 1B) with PF-06873600 in combination with endocrine therapy (ET). This study contains 2 parts, dose escalation with single agent (Part 1A and 1C) and then dose finding with PF-06873600 in combination with endocrine therapy (Part 1B) followed by dose expansion arms of PF-06873600 in combination with endocrine therapy (Part 2).

Recruitment & Eligibility

Status
ACTIVE_NOT_RECRUITING
Sex
All
Target Recruitment
155
Inclusion Criteria
  • Have a diagnosis of Hormone Receptor Positive (HR+), Human Epidermal Growth Factor Receptor 2 Negative (HER2-) breast cancer

    • Prior combined CDK 4/6 inhibitor and endocrine therapy and 1 or 2 prior lines of chemotherapy

  • Have a diagnosis of metastatic triple negative breast cancer (TNBC)

    • Up to 1-2 prior lines of chemotherapy

  • Have a diagnosis of advanced platinum resistant epithelial ovarian cancer (EOC)/fallopian tube cancer/primary peritoneal cancer (PPC)

    • Up to 2-3 prior lines of therapy

  • Eastern Cooperative Oncology Group (ECOG) Performance Status (PS) 0 or 1

  • Measurable disease or non-measurable disease and refractory to or intolerant of existing therapies (Part 1)

  • Measurable disease as defined by RECIST 1.1 is required (Part 1B and Part 2 only)

Read More
Exclusion Criteria
  • Known active uncontrolled or symptomatic Central Nervous System (CNS) metastases
  • Other active malignancy within 3 years prior to randomization, except for adequately treated basal cell or squamous cell skin cancer, or carcinoma in situ
  • Major surgery or radiation within 4 weeks prior to study entry
  • Last anti-cancer treatment within 2 weeks prior to study entry
  • Participation in other studies involving investigational drug(s) within 4 weeks prior to study entry
  • Pregnant or breastfeeding female patients
  • Active inflammatory gastrointestinal (GI) disease, known diverticular disease or previous gastric resection or lap band surgery including impairment of gastro intestinal function or GI disease
Read More

Study & Design

Study Type
INTERVENTIONAL
Study Design
SEQUENTIAL
Arm && Interventions
GroupInterventionDescription
Dose Expansion Arm CEndocrine Therapy 1PF-06873600 in Combination with Endocrine Therapy 1
Dose Expansion Arm DPF-06873600PF-06873600 in Combination with Endocrine Therapy 1
Dose Expansion Arm DEndocrine Therapy 1PF-06873600 in Combination with Endocrine Therapy 1
Dose Expansion Arm EPF-06873600PF-06873600 in Combination with Endocrine Therapy 2
Dose Expansion Arm APF-06873600PF-06873600 as a Single Agent
Dose Expansion Arm BPF-06873600PF-06873600 as a Single Agent in Various Tumor Types
Dose Expansion Arm CPF-06873600PF-06873600 in Combination with Endocrine Therapy 1
Dose EscalationPF-06873600Single Agent Dose Escalation
Dose Finding Endocrine Therapy 1 CombinationPF-06873600Part 1B PF-06873600 plus Endocrine Therapy 1
Dose Finding Endocrine Therapy 1 CombinationEndocrine Therapy 1Part 1B PF-06873600 plus Endocrine Therapy 1
Dose Finding Endocrine Therapy 2 CombinationPF-06873600Part 1B PF-06873600 plus Endocrine Therapy 2
Dose Finding Endocrine Therapy 2 CombinationEndocrine Therapy 2Part 1B PF-06873600 plus Endocrine Therapy 2
Dose Expansion Arm EEndocrine Therapy 2PF-06873600 in Combination with Endocrine Therapy 2
Primary Outcome Measures
NameTimeMethod
Number of Participants With Worst Post-Baseline Hematology Results Based on Common Terminology Criteria for Adverse Events (CTCAE) Grade: Part 1 + Part 2Day 1 up to 28 days after the last dose of study intervention, up to approximately 24 months

Severity was graded as NCI CTCAE version 4.03:Grade 1: asymptomatic or mild symptoms, clinical or diagnostic observations only, intervention not indicated; Grade 2: moderate, minimal, local or noninvasive intervention indicated, limiting age-appropriate instrumental activities of daily life (ADL); Grade 3: severe or medically significant but not immediately life-threatening, hospitalization or prolongation of existing hospitalization indicated, disabling, limiting self-care ADL; Grade 4: life-threatening consequence, urgent intervention indicated; Grade 5: death related to AE.

Number of Participants With Post-Baseline Vital Sign Abnormalities Meeting Pre-Defined Categorization - Part 1 + Part 2Day 1 up to 28 days after the last dose of study intervention, up to approximately 24 months

Pre-defined criteria included: 1) systolic blood pressure (SBP) (mm Hg) minimum (min) value \<90; 2) SBP change from baseline (CFB) (mm Hg) maximum (max) decrease \>=30 or max increase \>=30; 3) diastolic blood pressure (DBP) (mm Hg) min \<50; 4) DBP CFB (mm Hg) max decrease \>=20 or max increase \>=20; 5) supine heart rate (HR) beats per minute (bpm) min \<40 or max \>120.

Number of Participants With Post-Baseline Electrocardiogram (ECG) Changes Meeting Pre-Defined Categorization - Part 1 + Part 2Day 1 up to 28 days after the last dose of study intervention, up to approximately 24 months

ECG pre-defined categories for QTc interval adjusted according to Fridericia formula (QTcF) (msec) included: 450 \<= max. \<=480, 481 \<= max. \<=500, max \>=501; QTcF CFB: 30 \< max \<=60, max \>60; for PR and QRS: PR (msec): max \>=300; PR increase from baseline: Baseline \>200 and max. \>=25% increase, Baseline \<=200 and max. \>=50% increase; QRS (msec): max \>=200; QRS (msec) increase from baseline: Baseline \>100 and max. \>=25% increase, Baseline \<=100 and max. \>=50% increase. Categories, with at least 1 participant having ECG abnormality in any of the reporting arms, were reported in this outcome measure.

Overall Response Rate (ORR): Part 2From the start of the treatment until disease/clinical progression or death or early study discontinuation, whichever happened earlier (approximately up to 24 months)

ORR: percentage of participants with confirmed complete response (CR) or partial response (PR). Response evaluation criteria in solid tumors (RECIST) v1.1: a) CR = disappearance of all non-nodal target lesions. In addition, any pathological lymph nodes assigned as target lesions that had a reduction in short axis to less than (\<) 10 millimeter (mm). Disappearance of all non-target lesions. In addition, all lymph nodes assigned a non-target lesion must be non-pathological in size (\<10 mm short axis) and b) PR = at least a 30 percent (%) decrease in the sum of diameter of all target lesions, taking as reference the baseline sum of diameters. Any radiological assessments taken more than 30 days after the last dose of study therapy or after antineoplastic agents other than study treatments taken by the participants was excluded from the best overall response derivation. Confirmation of CR or PR was to be at least 4 weeks apart from the previous radiological assessment.

Number of Participants With Dose Limiting Toxicities (DLTs) - Part 1Cycle 1 (within 28 days after the first dose of study intervention)

DLT was defined as any of the following adverse events (AEs) occurring in the first cycle of treatment (28 days) which were attributable to one, the other, or both agents in the combination: Hematologic - grade(G) 4 neutropenia lasting \>7 days; Febrile neutropenia defined as an absolute neutrophil count (ANC) \<1.0 \* 10\^9/L with a single temperature of \>38.3°C, or a sustained temperature of ≥38°C, for more than 1 hour; G≥3 neutropenia with associated infection; G3 thrombocytopenia with clinically significant bleeding as indicated by ≥ G2 bleeding; G4 thrombocytopenia. Nonhematologic: Confirmed case of Drug Induced Liver Injury (DILI) (Hy's Law); G≥3 AEs that were clinically significant.

Number of Participants With Adverse Events (AEs) and Serious AEs (SAEs) - Part 1 + Part 2Day 1 up to 28 days after the last dose of study intervention, up to approximately 24 months

An AE was defined as the appearance of (or worsening of any pre-existing) undesirable sign(s), symptom(s), or medical condition(s) that occurred after participants' signed informed consent has been obtained. An SAE was an AE resulting in any of the following outcomes: was fatal or life-threatening; resulted in persistent or significant disability/incapacity; constituted a congenital anomaly/birth defect; was medically significant; required inpatient hospitalization or prolongation of existing hospitalization. Treatment Related AEs were treatment emergent AEs with cause categorized by the investigator as related to study treatment.

Number of Participants With Worst Post-Baseline Chemistry Results Based on Common Terminology Criteria for Adverse Events (CTCAE) Grade: Part 1 + Part 2Day 1 up to 28 days after the last dose of study intervention, up to approximately 24 months

Severity was graded as NCI CTCAE version 4.03:Grade 1: asymptomatic or mild symptoms, clinical or diagnostic observations only, intervention not indicated; Grade 2: moderate, minimal, local or noninvasive intervention indicated, limiting age-appropriate instrumental activities of daily life (ADL); Grade 3: severe or medically significant but not immediately life-threatening, hospitalization or prolongation of existing hospitalization indicated, disabling, limiting self-care ADL; Grade 4: life-threatening consequence, urgent intervention indicated; Grade 5: death related to AE.

Secondary Outcome Measures
NameTimeMethod
Accumulation Ratio Based on AUC (Rac) of PF-06873600 Following Multiple Doses of Study Intervention on Cycle 1 Day 15 - Part 1Pre-dose, 0.25, 0.5, 1, 2, 3, 4, 6, 12 hours post-dose on C1D15

Rac of PF-06873600 after multiple doses of study intervention when given as a single agent (Part 1A and Part 1C), in combination with letrozole, and in combination with fulvestrant (Part 1B) was reported. Multiple-dose PK parameters were not calculated for the modified release selection cohort in Part 1C (ie, the group "Part 1C PF-06873600 MR 20 IR 25 mg BID").

Accumulation Ratio Based on Cmax (Observed) (Rac,Cmax) of PF-06873600 Following Multiple Doses of Study Intervention on Cycle 1 Day 15 - Part 2Pre-dose, 1, 2, 4, 6 hours post-dose on C1D15

Rac,cmax of PF-06873600 after multiple doses of study intervention when given as in combination with fulvestrant (Part 2) was reported.

Pharmacodynamic (PD) Biomarker Phospho-retinoblastoma Protein (pRb) in Tumor Tissue in Participants - Part 1 + Part 2Screening and Cycle 2 Day 1

Level of the PD marker, pRb, was analyzed at 2 time points, at screening and at Cycle 2 Day 1. Percentage changes of pRb at Cycle 2 Day 1 from screening (baseline) were calculated.

PD Biomarker Ki67 in Tumor Tissue in Participants - Part 1 + Part 2Screening and Cycle 2 Day 1

Level of the PD marker, Ki67, was analyzed at 2 time points, at screening and at Cycle 2 Day 1. Percent changes of pRb at Cycle 2 Day 1 from screening (baseline) were calculated.

Maximum Observed Plasma Concentration (Cmax) of PF-06873600 Following a Single Oral Dose of Study Intervention on Cycle 1 Day 1 - Part 1 + Part 2Part 1: pre-dose, 0.25, 0.5, 1, 2, 3, 4, 6, 12 hours post-dose on Cycle 1 Day 1 (C1D1); Part 2: pre-dose, 1, 2, 4, 6 hours post-dose on C1D1

The maximum observed concentration of PF-06873600 after single dose of study intervention when given as a single agent (Part 1A and Part 1C), in combination with letrozole, and in combination with fulvestrant (Part 1B and Part 2) was reported. The Cmax value was observed directly from data.

Time to Reach Cmax at Steady State (Tmax) of PF-06873600 Following a Single Oral Dose of Study Intervention on Cycle 1 Day 1 - Part 1 + Part 2Part 1: pre-dose, 0.25, 0.5, 1, 2, 3, 4, 6, 12 hours post-dose on C1D1; Part 2: pre-dose, 1, 2, 4, 6 hours post-dose on C1D1

Tmax of PF-06873600 after single dose of study intervention when given as a single agent (Part 1A and Part 1C), in combination with letrozole, and in combination with fulvestrant (Part 1B and Part 2) was reported.

Apparent Clearance (CL/F) of PF-06873600 Following a Single Oral Dose of Study Intervention on Cycle 1 Day 1 - Part 1Pre-dose, 0.25, 0.5, 1, 2, 3, 4, 6, 12 hours post-dose on C1D1

CL/F of PF-06873600 after single dose of study intervention when given as a single agent (Part 1A and Part 1C), in combination with letrozole, and in combination with fulvestrant (Part 1B) was reported.

Apparent Volume of Distribution (Vz/F) of PF-06873600 Following a Single Oral Dose of Study Intervention on Cycle 1 Day 1 - Part 1Pre-dose, 0.25, 0.5, 1, 2, 3, 4, 6, 12 hours post-dose on C1D1

Vz/F of PF-06873600 after single dose of study intervention when given as a single agent (Part 1A and Part 1C), in combination with letrozole, and in combination with fulvestrant (Part 1B) was reported.

Terminal Half-life (t1/2) of PF-06873600 Following a Single Oral Dose of Study Intervention on Cycle 1 Day 1 - Part 1Pre-dose, 0.25, 0.5, 1, 2, 3, 4, 6, 12 hours post-dose on C1D1

t1/2 of PF-06873600 after single dose of study intervention when given as a single agent (Part 1A and Part 1C), in combination with letrozole, and in combination with fulvestrant (Part 1B) was reported.

Steady State Maximum Concentration (Css,Max) of PF-06873600 Following Multiple Doses of Study Intervention on Cycle 1 Day 15 - Part 1 + Part 2Part 1: pre-dose, 0.25, 0.5, 1, 2, 3, 4, 6, 12 hours post-dose on C1D15; Part 2: pre-dose, 1, 2, 4, 6 hours post-dose on C1D15

Css,max of PF-06873600 after multiple doses of study intervention when given as a single agent (Part 1A and Part 1C), in combination with letrozole, and in combination with fulvestrant (Part 1B and Part 2) was reported. Multiple-dose PK parameters were not calculated for the modified release selection cohort in Part 1C (ie, the group "Part 1C PF-06873600 MR 20 IR 25 mg BID").

Area Under the Concentration-Time Profile From Time 0 to the Time of the Last Quantifiable Concentration (AUClast) of PF-06873600 Following a Single Oral Dose of Study Intervention on Cycle 1 Day 1 - Part 1Pre-dose, 0.25, 0.5, 1, 2, 3, 4, 6, 12 hours post-dose on C1D1

AUClast of PF-06873600 after single dose of study intervention when given as a single agent (Part 1A and Part 1C), in combination with letrozole, and in combination with fulvestrant (Part 1B) was reported.

Area Under the Concentration-Time Profile From Time 0 Extrapolated to Infinite Time (AUCinf) of PF-06873600 Following a Single Oral Dose of Study Intervention on Cycle 1 Day 1 - Part 1Pre-dose, 0.25, 0.5, 1, 2, 3, 4, 6, 12 hours post-dose on C1D1

AUCinf of PF-06873600 after single dose of study intervention when given as a single agent (Part 1A and Part 1C), in combination with letrozole, and in combination with fulvestrant (Part 1B) was reported.

Time to Maximum Plasma Concentration at Steady State (Tss,Max) of PF-06873600 Following Multiple Doses of Study Intervention on Cycle 1 Day 15 - Part 1 + Part 2Part 1: pre-dose, 0.25, 0.5, 1, 2, 3, 4, 6, 12 hours post-dose on C1D15; Part 2: pre-dose, 1, 2, 4, 6 hours post-dose on C1D15

Tss,max of PF-06873600 after multiple doses of study intervention when given as a single agent (Part 1A and Part 1C), in combination with letrozole, and in combination with fulvestrant (Part 1B and Part 2) was reported. Multiple-dose PK parameters were not calculated for the modified release selection cohort in Part 1C (ie, the group "Part 1C PF-06873600 MR 20 IR 25 mg BID").

Steady State Minimum Plasma Concentration (Css,Min) of PF-06873600 Following Multiple Doses of Study Intervention on Cycle 1 Day 15 - Part 1 + Part 2Part 1: pre-dose, 0.25, 0.5, 1, 2, 3, 4, 6, 12 hours post-dose on C1D15; Part 2: pre-dose, 1, 2, 4, 6 hours post-dose on C1D15

Css,min of PF-06873600 after multiple doses of study intervention when given as a single agent (Part 1A and Part 1C), in combination with letrozole, and in combination with fulvestrant (Part 1B and Part 2) was reported. Multiple-dose PK parameters were not calculated for the modified release selection cohort in Part 1C (ie, the group "Part 1C PF-06873600 MR 20 IR 25 mg BID").

Steady-State Area Under the Plasma Concentration Versus Time Curve Within One Dose Interval (AUCss,Tau) of PF-06873600 Following Multiple Doses of Study Intervention on Cycle 1 Day 15 - Part 1Pre-dose, 0.25, 0.5, 1, 2, 3, 4, 6, 12 hours post-dose on C1D15

AUCss,tau of PF-06873600 after multiple doses of study intervention when given as a single agent (Part 1A and Part 1C), in combination with letrozole, and in combination with fulvestrant (Part 1B) was reported. Multiple-dose PK parameters were not calculated for the modified release selection cohort in Part 1C (ie, the group "Part 1C PF-06873600 MR 20 IR 25 mg BID").

Steady-State Apparent Oral Plasma Clearance (CLss/F) of PF-06873600 Following Multiple Doses of Study Intervention on Cycle 1 Day 15 - Part 1Pre-dose, 0.25, 0.5, 1, 2, 3, 4, 6, 12 hours post-dose on C1D15

CLss/F of PF-06873600 after multiple doses of study intervention when given as a single agent (Part 1A and Part 1C), in combination with letrozole, and in combination with fulvestrant (Part 1B) was reported. Multiple-dose PK parameters were not calculated for the modified release selection cohort in Part 1C (ie, the group "Part 1C PF-06873600 MR 20 IR 25 mg BID").

Apparent Volume of Distribution at Steady State (Vss/F) of PF-06873600 Following Multiple Doses of Study Intervention on Cycle 1 Day 15 - Part 1Pre-dose, 0.25, 0.5, 1, 2, 3, 4, 6, 12 hours post-dose on C1D15

Vss/F of PF-06873600 after multiple doses of study intervention when given as a single agent (Part 1A and Part 1C), in combination with letrozole, and in combination with fulvestrant (Part 1B) was reported. Multiple-dose PK parameters were not calculated for the modified release selection cohort in Part 1C (ie, the group "Part 1C PF-06873600 MR 20 IR 25 mg BID").

Trial Locations

Locations (47)

Dana-Farber Cancer Institute

🇺🇸

Boston, Massachusetts, United States

UCLA Hematology/Oncology - Parkside

🇺🇸

Santa Monica, California, United States

UCLA Hematology/Oncology - Santa Monica

🇺🇸

Santa Monica, California, United States

Massachusetts General Hospital

🇺🇸

Boston, Massachusetts, United States

HonorHealth Research Institute

🇺🇸

Scottsdale, Arizona, United States

UCHealth Lone Tree Medical Center

🇺🇸

Lone Tree, Colorado, United States

Northwest Medical Specialties, PLLC

🇺🇸

Tacoma, Washington, United States

Private Medical Institution "Euromedservice"

🇷🇺

Pushkin, Saint-petersburg, Russian Federation

Rainier Hematology-Oncology, PC

🇺🇸

Puyallup, Washington, United States

Brigham & Women's Hospital

🇺🇸

Boston, Massachusetts, United States

Municipal Non-profit Enterprise "City Clinical Hospital #4" of Dnipro City Council, "Dnipro State Me

🇺🇦

Dnipro, Dnipropetrovska Oblast, Ukraine

Virginia G. Piper Cancer Center Pharmacy

🇺🇸

Scottsdale, Arizona, United States

Highlands Oncology Group

🇺🇸

Springdale, Arkansas, United States

Holy Cross Hospital

🇺🇸

Fort Lauderdale, Florida, United States

Rainier Hematology-Oncology PC

🇺🇸

Puyallup, Washington, United States

Seattle Cancer Care Alliance

🇺🇸

Seattle, Washington, United States

HonorHealth

🇺🇸

Scottsdale, Arizona, United States

The Oncology Institute of Hope and Innovation

🇺🇸

Whittier, California, United States

Memorial Sloan Kettering Cancer Center

🇺🇸

New York, New York, United States

Dana Farber Cancer Institute

🇺🇸

Boston, Massachusetts, United States

Communal nonprofit enterprise "Kyiv City Clinical Oncology Center" of Executive Body of Kyiv City

🇺🇦

Kyiv, Ukraine

Specialized Hospital for Active Treatment of Oncology - Haskovo EOOD

🇧🇬

Haskovo, Bulgaria

BIH of Omsk Region "Clinical Oncological Dispensary"

🇷🇺

Omsk, Russian Federation

Communal noncommercial enterprise of Lviv regional council "Lviv oncological regional therapeutical

🇺🇦

Lviv, Ukraine

Multiprofile Hospital of Active Treatment - Dobrich AD

🇧🇬

Dobrich, Bulgaria

Kanagawa cancer center

🇯🇵

Yokohama, Kanagawa, Japan

LLC "Medicina Severnoy Stolitsy"

🇷🇺

Saint-Petersburg, Russian Federation

The University of Texas MD Anderson Cancer Center

🇺🇸

Houston, Texas, United States

South Texas Accelerated Research Therapeutics, LLC

🇺🇸

San Antonio, Texas, United States

University of Alabama at Birmingham

🇺🇸

Birmingham, Alabama, United States

UCSF Investigational Drugs Pharmacy

🇺🇸

San Francisco, California, United States

University Of Alabama at Birmingham

🇺🇸

Birmingham, Alabama, United States

UCSF Helen Diller Family Comprehensive Cancer Center

🇺🇸

San Francisco, California, United States

Tennessee Oncology, PLLC

🇺🇸

Nashville, Tennessee, United States

The Sarah Cannon Research Institute-Pharmacy

🇺🇸

Nashville, Tennessee, United States

The Sarah Cannon Research Institute

🇺🇸

Nashville, Tennessee, United States

University of Washington Medical Center

🇺🇸

Seattle, Washington, United States

University of Colorado Hospital - Anschutz Cancer Pavilion (ACP)

🇺🇸

Aurora, Colorado, United States

University of Colorado Hospital - Anschutz Inpatient Pavilion (AIP)

🇺🇸

Aurora, Colorado, United States

University of Colorado Hospital - Anschutz Outpatient Pavilion (AOP)

🇺🇸

Aurora, Colorado, United States

McGill University Health Centre

🇨🇦

Montreal, Quebec, Canada

LLC "Severo-Zapadny Medical Center"

🇷🇺

Saint-Petersburg, Russian Federation

Complex Oncology Center -Plovdiv

🇧🇬

Plovdiv, Bulgaria

National Cancer Center Hospital East

🇯🇵

Kashiwa, Chiba, Japan

Highlands Oncology

🇺🇸

Springdale, Arkansas, United States

Kharkiv Regional Specialized Dispensary of Radiation Protection of the Population

🇺🇦

Kharkiv, Kharkivska Oblast, Ukraine

Fred Hutchinson Cancer Center

🇺🇸

Seattle, Washington, United States

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