Study of Romiplostim for Chemotherapy-induced Thrombocytopenia in Adult Subjects With Non-small Cell Lung Cancer (NSCLC), Ovarian Cancer, or Breast Cancer
- Conditions
- Chemotherapy-induced Thrombocytopenia
- Interventions
- Drug: Placebo
- Registration Number
- NCT03937154
- Lead Sponsor
- Amgen
- Brief Summary
To evaluate the efficacy of romiplostim for the treatment of CIT in patients receiving chemotherapy for the treatment of NSCLC, ovarian cancer, or breast cancer measured by the ability to administer on-time, full-dose chemotherapy
- Detailed Description
This is a phase 3, randomized, placebo-controlled, multicenter, international study for the treatment of CIT in adult subjects receiving chemotherapy for the treatment of NSCLC, ovarian cancer, or breast cancer. Subjects must have a platelet count ≤ 85 x 10\^9/L on day 1 of the study. The study will consist of a screening period of up to 4 weeks, a treatment period long enough to allow for assessment of 3 planned cycles of chemotherapy, a follow-up visit, and long-term follow-up (LTFU). Given that subjects are required to have 3 remaining planned cycles of chemotherapy, the chemotherapy cycles may be 3 or 4 weeks in duration, and the investigational product dose adjustment guidelines allow for up to 12 weeks of dosing before a subject is declared a non-responder, the majority of study subjects will receive investigational product for a range of 10-24 weeks.
Recruitment & Eligibility
- Status
- RECRUITING
- Sex
- All
- Target Recruitment
- 162
- Subject has provided informed consent prior to initiation of any study-specific activities/procedures or subject's legally acceptable representative has provided informed consent prior to any study-specific activities/procedures being initiated when the subject has any kind of condition that, in the opinion of the investigator, may compromise the ability of the subject to give written informed consent.
- Males or females greater than or equal to 18 years of age at signing of the informed consent.
- Documented active stage I, II, III or IV locally advanced or metastatic of the following tumor types: NSCLC, breast cancer, or ovarian cancer (includes fallopian tube epithelial carcinomas and peritoneal epithelial carcinoma of unknown primary), or any stage recurrent disease. Patients with documented locally advanced (stage III) NSCLC should not be amenable to definitive treatment with chemoradiation and/or surgery.
- Subjects must be receiving cancer treatment with 21- or 28-day cycles, using one of the following carboplatinum-based combination chemotherapy regimens: carboplatin/gemcitabine based, carboplatin/pemetrexed based, carboplatin/liposomal doxorubicin based or carboplatin/taxane based (which includes either paclitaxel, nab-paclitaxel, or docetaxel) or single agent chemotherapy regimen with any of the above mentioned drugs. Use of combination regimens with one of the above carboplatinum-based regimens is permitted with (1) anti-angiogenic agents (such as bevacizumab); (2) targeted therapy (such as anti-epidermal growth factor agents or anti- human epidermal growth factor receptor 2) or (3) immune checkpoint inhibitors. Cycle duration is based on intervals between day 1 of chemotherapy cycles (overlapping with carboplatin intervals) every 21 or 28 day cycles for single agent regimens. OR, Subjects must have CIT from a non-protocol chemotherapy regimen, planning to start treatment with one of the above protocol chemotherapy regimens which has been delayed ≥ 1 week due to CIT.
- Subjects must have a local platelet count ≤ 85 x 109/L on day 1 of the study.
- Subjects must be at least 21 or 28 days removed from the start of the chemotherapy cycle immediately prior to study day 1 if receiving a 21-day or 28-day cycle chemotherapy regimen, respectively.
- Subjects must have at least 3 remaining planned cycles of chemotherapy at study enrollment.
- Eastern Cooperative Oncology Group (ECOG) performance status of 0, 1, or 2.
- Acute lymphoblastic leukemia.
- Acute myeloid leukemia.
- Any myeloid malignancy.
- Myelodysplastic syndrome. Baseline bone marrow biopsy is not required to rule out MDS. However, if a bone marrow biopsy and cytogenetics were performed as part of diagnostic or staging work-up, these results will be collected to confirm.
- Myeloproliferative disease.
- Multiple myeloma.
- Within 4 months prior to enrollment, any history of active congestive heart failure (New York Heart Association [NYHA] Class III to IV), symptomatic ischemia, uncontrolled arrhythmias, clinically significant electrocardiogram (ECG) abnormalities, screening ECG with corrected QT (QTc) interval of greater than 470 msec, pericardial disease, or myocardial infarction.
- Major surgery less than or equal to 28 days or minor surgery less than or equal to 3 days prior to enrollment.
- New or uncontrolled venous thromboembolism or thrombotic events within 3 months prior to screening. To be eligible, subjects must have received at least 14 days of anticoagulation for a new thrombotic event and considered to be stable and suitable for continued therapeutic anticoagulation during trial participation.
- History of arterial thrombotic events (eg, myocardial ischemia, transient ischemic attack, or stroke) within 6 months prior to screening.
- Evidence of active infection within 2 weeks prior to the first dose of study treatment.
- Known human immunodeficiency virus infection with any detectable viral load at screening. Subjects without a documented diagnosis in their medical history will require a local laboratory assessment at screening. If local laboratory results are not available use central laboratory results.
- Known active of chronic hepatitis C or hepatitis B infection. Subjects without a documented diagnosis in their medical history will require a local laboratory assessment at screening. If local laboratory results are not available use central laboratory results. Hepatitis B and C infection is based on the following results:
- Positive for hepatitis B surface antigen (HBsAg) (indicative of chronic hepatitis B or recent acute hepatitis B).
- Negative HBsAg and positive for hepatitis B core antibody: hepatitis B virus DNA by polymerase chain reaction (PCR) is necessary. Detectable hepatitis B virus DNA suggests occult hepatitis B.
- Positive hepatitis C virus antibody: hepatitis C virus RNA by PCR is necessary. Detectable hepatitis C virus RNA suggests chronic hepatitis C.
- In addition to the conditions listed in exclusion criteria 201 through 206, secondary malignancy within the past 5 years except:
- Adequately treated non-melanoma skin cancer or lentigo maligna without evidence of disease.
- Adequately treated cervical carcinoma in situ without evidence of disease.
- Adequately treated breast ductal carcinoma in situ without evidence of disease.
- Prostatic intraepithelial neoplasia without evidence of prostate cancer.
- Adequately treated urothelial papillary noninvasive carcinoma or carcinoma in situ.
- Malignancy treated with curative intent and with no known active disease present for greater than or equal to 3 years before enrollment and felt to be at low risk for recurrence by the treating physician (excluding malignancies listed in exclusion criteria 201 - 206).
- Thrombocytopenia due to another etiology other than CIT (eg, chronic liver disease, prior history of immune thrombocytopenia purpura).
- Any combined modality regimen containing radiation therapy or surgery occurring concomitantly with neo-adjuvant chemotherapy or where radiation therapy is planned during the cycle preceding 3 planned on-study cycles of chemotherapy.
Prior/Concomitant Therapy:
- Previous use of romiplostim, pegylated recombinant human megakaryocyte growth and development factor, eltrombopag, recombinant human TPO, any other TPO receptor agonist, or any investigational platelet producing agent.
Prior/Concurrent Clinical Study Experience - Currently receiving (or plan to receive) treatment in another investigational device or drug study, or less than 28 days since ending treatment on another investigational device or drug study(ies). Other investigational procedures while participating in this study are excluded.
Diagnostic Assessments
- Anemia (hemoglobin < 80 g/L [8 g/dL]) on the day of initiation of investigational product as assessed by local labs. Use of red cell transfusions and erythropoietic stimulating agents is permitted throughout the study as per institutional guidelines.
- Neutropenia (absolute neutrophil count less than 1 x 10 9/L) on the day of initiation of investigational product as assessed by local labs. Use of granulocyte-colony stimulating factor is permitted throughout the study as per institutional guidelines.
- Abnormal renal function with creatinine clearance less than 30 mL/min using the Cockcroft-Gault estimated creatinine clearance as assessed by local laboratory. If local laboratory results are not available use central laboratory results.
during screening.
- Abnormal liver function (total bilirubin greater than 3X ULN; alanine aminotransferase [ALT] or aspartate aminotransferase [AST] greater than 3X ULN for subjects without liver metastases or greater than or equal to 5X ULN for subjects with liver metastases) as assessed by local laboratory during screening. If local laboratory results are not available use central laboratory results.
Other Exclusions
- Females who are pregnant or breastfeeding or planning to become pregnant or breastfeed during treatment and for an additional 7 months after treatment (and chemotherapy) discontinuation (females of childbearing potential should only be included after a confirmed menstrual period and a negative highly sensitive urine or serum pregnancy test.)
- Females of childbearing potential unwilling to use a highly effective method of contraception during treatment and for an additional 7 months after treatment (and chemotherapy) discontinuation. Refer to Appendix 5 for additional contraceptive information.
- Males unwilling to use contraception* (male condom or sexual abstinence) or their female partner(s) of childbearing potential who are unwilling to use a highly effective method of contraception during treatment (and chemotherapy) and for an additional 7 months after treatment (and chemotherapy) discontinuation. *If the male's sole partner is of non-childbearing potential, he is not required to use additional forms of contraception during the study.
- Subject has known sensitivity to any of the products to be administered during dosing.
- Subject likely to not be available to complete all protocol-required study visits or procedures, and/or to comply with all required study procedures (eg, COAs) to the best of the subject and investigator's knowledge.
- History or evidence of any other clinically significant disorder, condition or disease (with the exception of those outlined above) that, in the opinion of the investigator or Amgen physician, if consulted, would pose a risk to subject safety or interfere with the study evaluation, procedures or completion.
- Male subjects with a pregnant partner who are unwilling to practice abstinence or use a condom during treatment (and chemotherapy) and for an additional 7 months after treatment (and chemotherapy) discontinuation.
- Male subjects unwilling to abstain from donating sperm during treatment (and chemotherapy) and for an additional 7 months after treatment (and chemotherapy) discontinuation.
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Placebo Placebo The study in a 2:1 randomization ratio (54 subjects to placebo) Amgen investigational product (romiplostim or placebo) will be administered in the clinic by a qualified healthcare provider as a subcutaneous injection. Romiplostim Romiplostim The study in a 2:1 randomization ratio(108 subjects to romiplostim). Amgen investigational product (romiplostim or placebo) will be administered in the clinic by a qualified healthcare provider as a subcutaneous injection.
- Primary Outcome Measures
Name Time Method Incidence of either a chemotherapy dose delay or reduction 48 days No thrombocytopenia-induced modification of any myelosuppressive agent in the second and third cycles of the planned on-study chemotherapy regimen. Thrombocytopenia-induced modifications include chemotherapy dose reduction, delay, omission, or chemotherapy treatment discontinuation due to platelet counts below 100 x 109/L
- Secondary Outcome Measures
Name Time Method the duration-adjusted event rate of ≥ grade 2 bleeding events 48 days the duration-adjusted event rate of ≥ grade 2 bleeding events, as assessed by Common Terminology Criteria for Adverse Events (CTCAE) version 5.0 grading scale
Overall survival 1 Year 1-year overall survival
Proportion of subjects with at leat 1 incidence of platelet transfusion 48 days platelet transfusion(s) during the treatment period
Depth of Platelet Count 48 days the depth of the platelet count nadir from the start of the first on-study chemotherapy cycle through the end of the treatment period
Time to First platelet response 7 days The time to first platelet response, defined by platelet count ≥ 100 x 109/L in the absence of platelet transfusions during the preceding 7 days
proportion of patients achieving platelet count >= 100 x 10 9/L 7 days 7 days after 3rd dose of IP with no transfusions in preceding 7 days
The subject incidence of adverse events 36 months Through end of study, up to 36 months. It will be counted in as an adverse event: any treatment - emergent adverse events, fatal adverse events, serious adverse events, or clinically significant changes in laboratory values.
Number of subjects who develop anti-romiplostim antibodies 36 Months Through end of study up to 36 months
Number of subjects who develop anti-TPO antibodies 36 months Through end of study, up to 36 months
Number of subjects who experience myelodysplastic syndromes 36 months Through end of study, up to 36 months
Number of subjects who experience secondary malignancies 36 months Through end of study, up to 36 months
Trial Locations
- Locations (135)
Saint Bernards Medical Center
🇺🇸Jonesboro, Arkansas, United States
Los Angeles Cancer Network
🇺🇸Anaheim, California, United States
University of California Irvine
🇺🇸Orange, California, United States
University of Miami School of Medicine
🇺🇸Miami, Florida, United States
Colorado West Healthcare System dba Grand Valley Oncology
🇺🇸Grand Junction, Colorado, United States
Great Falls Clinic
🇺🇸Great Falls, Montana, United States
Ocala Oncology Center
🇺🇸Ocala, Florida, United States
Mid Florida Hematology and Oncology Centers PA
🇺🇸Orange City, Florida, United States
Saint Alphonsus Regional Medical Center
🇺🇸Boise, Idaho, United States
University of Chicago
🇺🇸Chicago, Illinois, United States
Orchard Healthcare Research Inc
🇺🇸Skokie, Illinois, United States
Christus Saint Frances Cabrini Hospital
🇺🇸Alexandria, Louisiana, United States
University Medical Center New Orleans
🇺🇸New Orleans, Louisiana, United States
Christus Highland Cancer Treatment Center
🇺🇸Shreveport, Louisiana, United States
Mercy Medical Center
🇺🇸Baltimore, Maryland, United States
American Oncology Partners, PA
🇺🇸Bethesda, Maryland, United States
Massachusetts General Hospital
🇺🇸Boston, Massachusetts, United States
Hattiesburg Clinic Hematology/Oncology
🇺🇸Hattiesburg, Mississippi, United States
Oncology Hematology Associates
🇺🇸Springfield, Missouri, United States
Spitalul Municipal Ploiesti
🇷🇴Ploiesti, Romania
Nebraska Cancer Specialists
🇺🇸Omaha, Nebraska, United States
Regional Cancer Care Associates
🇺🇸Sparta, New Jersey, United States
Broome Oncology LLC
🇺🇸Binghamton, New York, United States
Saint Lukes University Health Network
🇺🇸Bethlehem, Pennsylvania, United States
The Center for Cancer and Blood Disorders
🇺🇸Fort Worth, Texas, United States
Community Cancer Trials of Utah
🇺🇸Ogden, Utah, United States
Medical Oncology Associates PS
🇺🇸Spokane, Washington, United States
Yakima Valley Memorial Hospital
🇺🇸Yakima, Washington, United States
Instituto Oncologico Cordoba
🇦🇷Ciudad de Cordoba, Córdoba, Argentina
Centro Medico Austral
🇦🇷Ciudad Autónoma de Buenos Aires, Distrito Federal, Argentina
Centro de Investigaciones Clínicas Clínica Viedma
🇦🇷Viedma, Río Negro, Argentina
Centro de Diagnostico Investigacion y Tratamiento
🇦🇷Salta, Argentina
Medizinische Universitaet Innsbruck
🇦🇹Innsbruck, Austria
Instituto de Oncologia do Parana
🇧🇷Curitba, Paraná, Brazil
Vencer e Oncoclinica
🇧🇷Teresina, Piauí, Brazil
Liga Norte-Riograndense Contra O Cancer
🇧🇷Natal, Rio Grande Do Norte, Brazil
Centro de Pesquisa da Serra Gaucha - Cepesg
🇧🇷Caxias do Sul, Rio Grande Do Sul, Brazil
Associação Hospitalar Moinhos de Vento
🇧🇷Porto Alegre, Rio Grande Do Sul, Brazil
Clinica de Neoplasias Litoral
🇧🇷Itajai, Santa Catarina, Brazil
Hospital de Amor
🇧🇷Barretos, São Paulo, Brazil
Loema Instituto de Pesquisa Clinica e Consultores Ltda - Clinica Loema
🇧🇷Campinas, São Paulo, Brazil
Casa de Saude Santa Marcelina
🇧🇷Sao Paulo, São Paulo, Brazil
Hospital de Base de Sao Jose do Rio Preto
🇧🇷São José do Rio Preto, São Paulo, Brazil
Pérola Clínica de Pesquisa e Centro de Estudos em Oncologia Ginecológica e Mamaria Ltda
🇧🇷São Paulo, Brazil
Complex Oncology Center - Ruse EOOD
🇧🇬Ruse, Bulgaria
Multiprofile Hospital for Active Treatment Serdika EOOD
🇧🇬Sofia, Bulgaria
Specialized Hospital for Active Treatment of Oncology EAD
🇧🇬Sofia, Bulgaria
James Lind Centro de Investigacion del Cancer
🇨🇱Temuco, Cautín, Chile
Orlandi Oncologia
🇨🇱Santiago, Chile
Oncomedica Imat
🇨🇴Monteria, Córdoba, Colombia
Centro Medico Imbanaco
🇨🇴Cali, Valle Del Cauca, Colombia
Agios Savvas Anticancer Hospital
🇬🇷Athens, Greece
Henry Dunant Hospital Center
🇬🇷Athens, Greece
Sotiria General Hospital
🇬🇷Athens, Greece
Alexandra Hospital
🇬🇷Athens, Greece
Attikon University Hospital
🇬🇷Athens, Greece
University Hospital of Heraklion
🇬🇷Heraklion - Crete, Greece
Agios Loukas Clinic
🇬🇷Thessaloniki, Greece
Iatriko Diavalkaniko Thessalonikis
🇬🇷Thessaloniki, Greece
Semmelweis Egyetem
🇭🇺Budapest, Hungary
Farkasgyepui Tudogyogyintezet
🇭🇺Farkasgyepu, Hungary
Gyor-Moson-Sopron Varmegyei Petz Aladar Egyetemi Oktatokorhaz
🇭🇺Gyor, Hungary
Fejer Varmegyei Szent Gyorgy Egyetemi Oktato Korhaz
🇭🇺Szekesfehervar, Hungary
Jasz-Nagykun-Szolnok Varmegyei Hetenyi Geza Korhaz-Rendelointezet
🇭🇺Szolnok, Hungary
Reformatus Pulmonologiai Centrum
🇭🇺Torokbalint, Hungary
Oncotech
🇲🇽La Paz, Baja California Sur, Mexico
Centro de Atencion e Investigacion Cardiovascular del Potosi Sc
🇲🇽San Luis Potosi, San Luis Potosí, Mexico
Phylasis Clinical Research
🇲🇽Mexico City, Mexico
Centro Medico Nacional Siglo XXI
🇲🇽Mexico, Mexico
Oaxaca Site Management Organization SC
🇲🇽Oaxaca, Mexico
Phylasis Clinicas Research Toluca
🇲🇽Toluca, Mexico
Hospital Goyeneche
🇵🇪Arequipa, Peru
Oncosalud
🇵🇪Lima, Peru
Powiatowe Centrum Zdrowia w Brzezinach Sp Z o o
🇵🇱Brzeziny, Poland
Centrum Onkologii im prof Franciszka Lukaszczyka w Bydgoszczy
🇵🇱Bydgoszcz, Poland
Szpital Wojewodzki imienia Mikolaja Kopernika w Koszalinie
🇵🇱Koszalin, Poland
Centrum Onkologii Ziemi Lubelskiej im sw Jana z Dukli
🇵🇱Lublin, Poland
Uniwersytecki Szpital Kliniczny w Poznaniu
🇵🇱Poznan, Poland
Wojewodzki Szpital im Sw Ojca Pio w Przemyslu
🇵🇱Przemysl, Poland
Uniwersytecki Szpital Kliniczny nr 2 Pum w Szczecinie
🇵🇱Szczecin, Poland
Specjalistyczny Szpital im dra Alfreda Sokolowskiego
🇵🇱Walbrzych, Poland
Dolnoslaskie Centrum Onkologii, Pulmonologii i Hematologii
🇵🇱Wroclaw, Poland
Unidade Local de Saude de Santo Antonio, EPE - Hospital de Santo Antonio
🇵🇹Porto, Portugal
SC Oncomed SRL
🇷🇴Timisoara, Romania
Unidade Local de Saude de Santa Maria, EPE - Hospital Pulido Valente
🇵🇹Lisboa, Portugal
Memorial Healthcare International SRL
🇷🇴Bucuresti, Romania
Unidade Local de Saude de Matosinhos, EPE - Hospital Pedro Hispano
🇵🇹Matosinhos, Portugal
Spitalul Universitar de Urgenta Elias
🇷🇴Bucharest, Romania
Spitalul Clinic Coltea
🇷🇴Bucharest, Romania
Unidade Local de Saude de Sao Joao, EPE - Hospital de Sao Joao
🇵🇹Porto, Portugal
Institutul Oncologic, Prof Dr Alexandru Trestioreanu
🇷🇴Bucharest, Romania
Institutul Oncologic Prof Dr Ion Chiricuta Cluj-Napoca
🇷🇴Cluj Napoca, Romania
Oncolab
🇷🇴Craiova, Romania
SC Medisprof SRL
🇷🇴Cluj-Napoca, Romania
Institutul Regional de Oncologie Iasi
🇷🇴Iasi, Romania
SBHI of Arkhangelsk region Arkhangelsk clinical oncology dispensary
🇷🇺Arkhangelsk, Russian Federation
Autonomic SHI Republican clinical oncology dispensary of MoH of the Republic of Tatarstan
🇷🇺Kazan, Russian Federation
Medsi Group
🇷🇺Moscow Region, Russian Federation
State Healthcare Institution Goroda Moskvi City Clinical Hospital 1
🇷🇺Moscow, Russian Federation
Clinical hospital 2, Group of companies medsi
🇷🇺Moscow, Russian Federation
LLC Tonus
🇷🇺Nizhniy Novgorod, Russian Federation
Omsk Regional Clinical Oncology Dispensary
🇷🇺Omsk, Russian Federation
State budget institution of public health Pyatigorsk oncology dispensary
🇷🇺Pyatigorsk, Russian Federation
State Institution of Public Health
🇷🇺Ryazan, Russian Federation
State Institution of Public Health Oncology Dispensary 2 of Public Health Krasnodar Region
🇷🇺Sochi, Russian Federation
State Institution of Public Health Tambov Regional Oncology Dispensary
🇷🇺Tambov, Russian Federation
Respublican clinical oncology dispensary Minzdrava of Republic of Bashkortostan
🇷🇺Ufa, Russian Federation
Hospital Clinico Universitario San Cecilio
🇪🇸Granada, Andalucía, Spain
Hospital Universitario Nuestra Señora de Valme
🇪🇸Sevilla, Andalucía, Spain
Hospital Universitario Virgen del Rocio
🇪🇸Sevilla, Andalucía, Spain
Hospital Clinico Universitario de Salamanca
🇪🇸Salamanca, Castilla León, Spain
Instituto Oncologico IOB
🇪🇸Barcelona, Cataluña, Spain
Consorcio Hospitalario Provincial de Castellon
🇪🇸Castellon, Comunidad Valenciana, Spain
Hospital Santa Maria Nai
🇪🇸Ourense, Galicia, Spain
Hospital Universitario de Fuenlabrada
🇪🇸Fuenlabrada, Madrid, Spain
Hospital Universitario Madrid Sanchinarro
🇪🇸Madrid, Spain
Saglik Bilimleri Universitesi Gulhane Egitim ve Arastirma Hastanesi
🇹🇷Ankara, Turkey
Doktor Abdurrahman Yurtaslan Ankara Onkoloji Egitim ve Arastirma Hastanesi
🇹🇷Ankara, Turkey
Saglik Bilimleri University Ankara Ataturk Chest Diseases and Chest Surgery Training and Research Ho
🇹🇷Ankara, Turkey
Memorial Ankara Hastanesi
🇹🇷Ankara, Turkey
Ankara Bilkent Sehir Hastanesi
🇹🇷Ankara, Turkey
Pamukkale Universitesi Tip Fakultesi Hastanesi
🇹🇷Denizli, Turkey
Trakya Universitesi Saglik Arastirma ve Uygulama Merkezi
🇹🇷Edirne, Turkey
Istanbul Universitesi Cerrahpasa Tip Fakultesi
🇹🇷Istanbul, Turkey
Marmara Universitesi Tip Fakultesi Hastanesi
🇹🇷Istanbul, Turkey
Izmir Katip Celebi Universitesi Ataturk Egitim ve Arastirma Hastanesi
🇹🇷Izmir, Turkey
Izmir Ekonomi Universitesi Medical Point Hastanesi
🇹🇷Izmir, Turkey
Kocaeli Universitesi Tip Fakultesi Hastanesi
🇹🇷Kocaeli, Turkey
Necmettin Erbakan Universitesi Tip Fakultesi Hastanesi
🇹🇷Konya, Turkey
Inonu Universitesi Turgut Ozal Tip Merkezi
🇹🇷Malatya, Turkey
Sakarya Egitim ve Arastirma Hastanesi
🇹🇷Sakarya, Turkey
Namik Kemal Universitesi Hastanesi
🇹🇷Tekirdag, Turkey
Communal Institution Chernivtsi Regional Clinical Oncological Dispensary
🇺🇦Chernivtsi, Ukraine
Transcarpathian Regional Clinical Oncological Dispensary
🇺🇦Uzhgorod, Ukraine
Vinnytsya Regional Clinical Oncological Dispensary
🇺🇦Vinnytsya, Ukraine