Study to Assess Safety and Efficacy of Atezolizumab (MPDL3280A) Compared to Best Supportive Care Following Chemotherapy in Patients With Lung Cancer [IMpower010]
- Conditions
- Non-Small Cell Lung Cancer
- Interventions
- Registration Number
- NCT02486718
- Lead Sponsor
- Hoffmann-La Roche
- Brief Summary
This is a Phase III, global, multicenter, open-label, randomized study to compare the efficacy and safety of 16 cycles (1 cycle duration=21 days) of atezolizumab (MPDL3280A) treatment compared with best supportive care (BSC) in participants with Stage IB-Stage IIIA non-small cell lung cancer (NSCLC) following resection and adjuvant chemotherapy, as measured by disease-free survival (DFS) as assessed by the investigator and overall survival (OS). Participants, after completing up to 4 cycles of adjuvant cisplatin-based chemotherapy, will be randomized in a 1:1 ratio to receive atezolizumab for 16 cycles or BSC.
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- ACTIVE_NOT_RECRUITING
- Sex
- All
- Target Recruitment
- 1280
Inclusion Criteria for Enrollment Phase
- Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1
- Histological or cytological diagnosis of Stage IB (tumors greater than or equal to [>/=] 4 centimeters [cm])-IIIA (T2-3 N0, T1-3 N1, T1-3 N2, T4 N0-1) NSCLC (per the Union Internationale Contre le Cancer staging system (UICC)/American Joint Committee on Cancer staging system (AJCC) staging system, 7th edition; Detterbeck et al. 2009)
- Participants must have had complete resection of NSCLC 4-12 weeks (>/=28 days and less than or equal to [</=] 84 days) prior to enrollment and must be adequately recovered from surgery
- If mediastinoscopy was not performed preoperatively, it is required that, at a minimum, mediastinal lymph node systematic sampling will have occurred. Systematic sampling is defined as removal of at least one representative lymph node at specified levels. MLND entails resection of all lymph nodes at those same levels. For a right thoracotomy, sampling or MLND is required at levels 4 and 7 and for a left thoracotomy, levels 5 and/or 6 and 7. Exceptions will be granted if there is clear documentation in the operative report or in a separately submitted addendum by the surgeon of exploration of the required lymph node areas, the participant will be considered eligible if no lymph nodes are found in those areas; if participants have documented N2 disease in one level (per the UICC/AJCC staging system, 7th edition; Detterbeck et al. 2009), not all levels need to be sampled; if the preoperative staging imaging results (contrast computed tomography [CT] and positron emission tomography [PET] scans) do not suggest evidence of disease in the mediastinum, the participant will be considered eligible if N2 nodal sampling is not performed per surgeon's decision
- Eligible to receive a cisplatin-based chemotherapy regimen
- Adequate hematologic and end-organ function
- Women who are not postmenopausal (>/=12 months of non-therapy-induced amenorrhea) or surgically sterile must have a negative serum pregnancy test result within 14 days prior to initiation of cisplatin-based chemotherapy
Inclusion Criteria for Randomized Phase - Women who are not postmenopausal (>/=12 months of non-therapy-induced amenorrhea) or surgically sterile must have a negative serum pregnancy test result within 14 days prior to initiation of atezolizumab or BSC
Exclusion Criteria for Enrollment Phase
- Illness or condition that may interfere with a participant's capacity to understand, follow, and/or comply with study procedures
- Pregnant and lactating women
- Treatment with prior systemic chemotherapy: Chemotherapy for early stage of malignancy with curative intent, provided that the last dose received was more than 5 years prior to enrollment and low-dose chemotherapy for non-malignant conditions may be allowed upon approval by the Medical Monitor
- Hormonal cancer therapy or radiation therapy as prior cancer treatment within 5 years before enrollment
- Treatment with any other investigational agent with therapeutic intent within 28 days prior to enrollment
- Participants with hearing impairment
- Known sensitivity to any component of the chemotherapy regimen the participant will be assigned to, or to mannitol
- Prior treatment with cluster of differentiation (CD) 137 (CD137) agonists or immune checkpoint blockade therapies, anti-programmed death-1 (PD-1), and anti programmed death ligand 1 (PD-L1) therapeutic antibodies
- Malignancies other than NSCLC within 5 years prior to randomization, with the exception of those with a negligible risk of metastasis or death (e.g., expected 5-year OS greater than [>] 90 percent [%]) treated with expected curative outcome (such as adequately treated carcinoma in situ of the cervix, basal or squamous cell skin cancer, localized prostate cancer treated surgically with curative intent, ductal carcinoma in situ treated surgically with curative intent)
- History of severe allergic, anaphylactic, or other hypersensitivity reactions to chimeric or humanized antibodies or fusion proteins
- Known hypersensitivity to biopharmaceuticals produced in Chinese hamster ovary cells or any component of the atezolizumab formulation
- History of autoimmune disease, including but not limited to myasthenia gravis, myositis, autoimmune hepatitis, systemic lupus erythematosus, rheumatoid arthritis, inflammatory bowel disease, vascular thrombosis associated with antiphospholipid syndrome, Wegener's granulomatosis, Sjögren's syndrome, Guillain-Barré syndrome, multiple sclerosis, vasculitis, or glomerulonephritis
- Positive test for human immunodeficiency virus (HIV)
- Participants with active hepatitis B (chronic or acute; defined as having a positive hepatitis B surface antigen [HBsAg] test at screening) or hepatitis C
- Active tuberculosis
- Significant cardiovascular disease, such as New York Heart Association cardiac disease (Class II or greater), myocardial infarction, or cerebrovascular accident within the previous 3 months, unstable arrhythmias, or unstable angina
- History of idiopathic pulmonary fibrosis, organizing pneumonia (e.g., bronchiolitis obliterans), drug-induced pneumonitis, idiopathic pneumonitis, or evidence of active pneumonitis on screening chest CT scan
- Prior allogeneic bone marrow transplantation or solid organ transplant
- Any other diseases, metabolic dysfunction, physical examination finding, or clinical laboratory finding giving reasonable suspicion of a disease or condition that contraindicates the use of an investigational drug or that may affect the interpretation of the results or render the participant at high risk from treatment complications
- Known tumor PD-L1 expression status as determined by an immunohistochemistry (IHC) assay from other clinical studies (e.g., participants whose PD-L1 expression status was determined during screening for entry into a study with anti-PD-1 or anti-PD-L1 antibodies but were not eligible are excluded)
Specific Exclusions for Pemetrexed Treatment
- Participants with squamous cell histology
Exclusion Criteria for Randomized Phase
- Signs or symptoms of infection within 14 days prior to randomization (severe infection within 28 days prior to randomization), including but not limited to hospitalization for complications of infection, bacteremia, or severe pneumonia
- Received therapeutic oral or intravenous (IV) antibiotics within 14 days prior to randomization
- Major surgical procedure within 28 days prior to randomization or anticipation of need for a major surgical procedure during the course of the study
- Administration of a live, attenuated vaccine within 4 weeks prior to initiation of study treatment or anticipation that such a live attenuated vaccine will be required during the study
- Treatment with systemic immunostimulatory agents (including but not limited to interferons or interleukin-2) within 4 weeks or 5 half-lives of the drug, whichever is longer, prior to randomization: Prior treatment with cancer vaccines is allowed
- Treatment with systemic corticosteroids or other immunosuppressive medications (including but not limited to prednisone, dexamethasone, cyclophosphamide, azathioprine, methotrexate, thalidomide, and anti-tumor necrosis factor [anti-TNF] agents) within 14 days prior to randomization
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Atezolizumab Atezolizumab Enrollment Phase: Participants will receive four 21-day cycles of cisplatin-based chemotherapy (cisplatin plus either vinorelbine or docetaxel or gemcitabine or pemetrexed \[non-squamous cell NSCLC only\]), unless unacceptable toxicity, disease relapse, or participant's decision to discontinue occur. Randomization Phase: Participants will receive atezolizumab 1200 milligrams (mg) intravenously (IV) every 3 weeks (Q3W) for sixteen 21-day cycles and will undergo periodic chest X-ray and CT scan. Atezolizumab Cisplatin Enrollment Phase: Participants will receive four 21-day cycles of cisplatin-based chemotherapy (cisplatin plus either vinorelbine or docetaxel or gemcitabine or pemetrexed \[non-squamous cell NSCLC only\]), unless unacceptable toxicity, disease relapse, or participant's decision to discontinue occur. Randomization Phase: Participants will receive atezolizumab 1200 milligrams (mg) intravenously (IV) every 3 weeks (Q3W) for sixteen 21-day cycles and will undergo periodic chest X-ray and CT scan. Atezolizumab Docetaxel Enrollment Phase: Participants will receive four 21-day cycles of cisplatin-based chemotherapy (cisplatin plus either vinorelbine or docetaxel or gemcitabine or pemetrexed \[non-squamous cell NSCLC only\]), unless unacceptable toxicity, disease relapse, or participant's decision to discontinue occur. Randomization Phase: Participants will receive atezolizumab 1200 milligrams (mg) intravenously (IV) every 3 weeks (Q3W) for sixteen 21-day cycles and will undergo periodic chest X-ray and CT scan. Atezolizumab Pemetrexed Enrollment Phase: Participants will receive four 21-day cycles of cisplatin-based chemotherapy (cisplatin plus either vinorelbine or docetaxel or gemcitabine or pemetrexed \[non-squamous cell NSCLC only\]), unless unacceptable toxicity, disease relapse, or participant's decision to discontinue occur. Randomization Phase: Participants will receive atezolizumab 1200 milligrams (mg) intravenously (IV) every 3 weeks (Q3W) for sixteen 21-day cycles and will undergo periodic chest X-ray and CT scan. Atezolizumab Gemcitabine Enrollment Phase: Participants will receive four 21-day cycles of cisplatin-based chemotherapy (cisplatin plus either vinorelbine or docetaxel or gemcitabine or pemetrexed \[non-squamous cell NSCLC only\]), unless unacceptable toxicity, disease relapse, or participant's decision to discontinue occur. Randomization Phase: Participants will receive atezolizumab 1200 milligrams (mg) intravenously (IV) every 3 weeks (Q3W) for sixteen 21-day cycles and will undergo periodic chest X-ray and CT scan. Best Supportive Care Vinorelbine Enrollment Phase: Participants will receive four 21-day cycles of cisplatin-based chemotherapy (cisplatin plus either vinorelbine or docetaxel or gemcitabine or pemetrexed \[non-squamous cell NSCLC only\]), unless unacceptable toxicity, disease relapse, or participant's decision to discontinue occur. Randomization Phase: After enrollment phase participants will receive only the best supportive care and will undergo periodic chest X-ray and CT scan. Best Supportive Care Docetaxel Enrollment Phase: Participants will receive four 21-day cycles of cisplatin-based chemotherapy (cisplatin plus either vinorelbine or docetaxel or gemcitabine or pemetrexed \[non-squamous cell NSCLC only\]), unless unacceptable toxicity, disease relapse, or participant's decision to discontinue occur. Randomization Phase: After enrollment phase participants will receive only the best supportive care and will undergo periodic chest X-ray and CT scan. Best Supportive Care Pemetrexed Enrollment Phase: Participants will receive four 21-day cycles of cisplatin-based chemotherapy (cisplatin plus either vinorelbine or docetaxel or gemcitabine or pemetrexed \[non-squamous cell NSCLC only\]), unless unacceptable toxicity, disease relapse, or participant's decision to discontinue occur. Randomization Phase: After enrollment phase participants will receive only the best supportive care and will undergo periodic chest X-ray and CT scan. Atezolizumab Vinorelbine Enrollment Phase: Participants will receive four 21-day cycles of cisplatin-based chemotherapy (cisplatin plus either vinorelbine or docetaxel or gemcitabine or pemetrexed \[non-squamous cell NSCLC only\]), unless unacceptable toxicity, disease relapse, or participant's decision to discontinue occur. Randomization Phase: Participants will receive atezolizumab 1200 milligrams (mg) intravenously (IV) every 3 weeks (Q3W) for sixteen 21-day cycles and will undergo periodic chest X-ray and CT scan. Best Supportive Care Cisplatin Enrollment Phase: Participants will receive four 21-day cycles of cisplatin-based chemotherapy (cisplatin plus either vinorelbine or docetaxel or gemcitabine or pemetrexed \[non-squamous cell NSCLC only\]), unless unacceptable toxicity, disease relapse, or participant's decision to discontinue occur. Randomization Phase: After enrollment phase participants will receive only the best supportive care and will undergo periodic chest X-ray and CT scan. Best Supportive Care Gemcitabine Enrollment Phase: Participants will receive four 21-day cycles of cisplatin-based chemotherapy (cisplatin plus either vinorelbine or docetaxel or gemcitabine or pemetrexed \[non-squamous cell NSCLC only\]), unless unacceptable toxicity, disease relapse, or participant's decision to discontinue occur. Randomization Phase: After enrollment phase participants will receive only the best supportive care and will undergo periodic chest X-ray and CT scan.
- Primary Outcome Measures
Name Time Method Disease-Free Survival (DFS) in Intent-to-treat (ITT) Population Up to 95 months DFS was defined as the time from randomization to the first recurrence of NSCLC or occurrence of new primary NSCLC as determined by the investigator or death, whichever occurs first. Kaplan-Meier methodology was used to estimate the median DFS for each treatment arm.
DFS in All Randomized Stage II-IIIA Population Up to 95 months DFS was defined as the time from randomization to the first recurrence of NSCLC or occurrence of new primary NSCLC as determined by the investigator or death, whichever occurs first. DFS was analyzed in participants with disease stage II-IIIA. Kaplan-Meier methodology was used to estimate the median DFS for each treatment arm.
DFS in the Programmed Death-ligand 1 (PD-L1) SP263 ≥ 1% Tumor Cell (TC) Subpopulation Within the Stage II-IIIA Population Up to 95 months DFS was defined as the time from randomization to the first recurrence of NSCLC or occurrence of new primary NSCLC as determined by the investigator or death, whichever occurs first. DFS was analyzed in PD-L1 ≥1% subpopulation within the Stage II-IIIA population. Kaplan-Meier methodology was used to estimate the median DFS for each treatment arm.
- Secondary Outcome Measures
Name Time Method Overall Survival (OS) in the ITT Population Up to 20 years OS was defined as the time from randomization to death from any cause.
Disease-free Rate at Year 3 in ITT Population Year 3 DFS rate was defined as percentage of participants who were disease-free at Year 3. The DFS rate was estimated by the Kaplan-Meier methodology for each treatment arm. Percentages have been rounded off to the nearest decimal.
Disease-free Rate at Year 3 in All Randomized Stage II-IIIA Population Year 3 DFS rate was defined as percentage of participants who were disease-free at Year 3. DFS rate was analyzed in participants with disease stage II-IIIA. The DFS rate was estimated by the Kaplan-Meier methodology for each treatment arm. Percentages have been rounded off to the nearest decimal.
Disease-free Rate at Year 3 in PD-L1 (SP263 ≥ 1% TC) Subpopulation Within the Stage II-IIIA Population Year 3 DFS rate was defined as percentage of participants who were disease-free at Year 3. DFS rate was analyzed in PD-L1 subpopulation within the Stage II-IIIA population. The DFS rate was estimated by the Kaplan-Meier methodology for each treatment arm. Percentages have been rounded off to the nearest decimal.
Disease-free Rate at Year 5 in ITT Population Year 5 DFS rate was defined as percentage of participants who were disease-free at Year 5. The DFS rate was estimated by the Kaplan-Meier methodology for each treatment arm. Percentages have been rounded off to the nearest decimal.
Disease-free Rate at Year 5 in All Randomized Stage II-IIIA Population Year 5 DFS rate was defined as percentage of participants who were disease-free at Year 5. DFS rate was analyzed in participants with disease stage II-IIIA. The DFS rate was estimated by the Kaplan-Meier methodology for each treatment arm. Percentages have been rounded off to the nearest decimal.
Disease-free Rate at Year 5 in PD-L1 (SP263 ≥ 1% TC) Subpopulation Within the Stage II-IIIA Population Year 5 DFS rate was defined as percentage of participants who were disease-free at Year 5. DFS rate was analyzed in PD-L1 subpopulation within the Stage II-IIIA population. The DFS rate was estimated by the Kaplan-Meier methodology for each treatment arm. Percentages have been rounded off to the nearest decimal.
DFS in the PD-L1 (SP263 ≥ 50% TC) Subpopulation Within the Stage II-IIIA Population Up to 95 months DFS was defined as the time from randomization to the first recurrence of NSCLC or occurrence of new primary NSCLC as determined by the investigator or death, whichever occurs first. DFS was analyzed in PD-L1 subpopulation within the Stage II-IIIA population. Kaplan-Meier methodology was used to estimate the median DFS for each treatment arm.
Percentage of Participants With Adverse Events (AEs) Up to 20 years An AE is any untoward medical occurrence in a participant when administered a pharmaceutical product regardless of the causal relationship with this treatment. An AE can therefore be any unfavorable and unintended sign (including an abnormal laboratory finding), symptom/disease temporally associated with the use of an investigational product, whether or not considered related to the investigational product.
Percentage of Participants With Anti-Therapeutic Antibodies (ATAs) to Atezolizumab Predose (Hour 0) on Day 1 of Cycles 2, 3, 4, 8, 16 (Cycle length = 21 days), at treatment discontinuation (TD) (up to 12 months), 120 days after last atezolizumab administration (up to 16 months) The percentage of ATA (Also called anti-drug antibodies (ADA))-positive participants after drug administration were determined for participants exposed to atezolizumab. For determining post-baseline incidence, participants were considered to be ADA-positive if they were ADA-negative or had missing data at baseline but developed an ADA response following study drug exposure, or if they were ADA-positive at baseline and the titer of 1 or more post-baseline samples was at least 0.60 titer units (t.u.) greater than the baseline titer result.
Maximum Plasma Concentration (Cmax) of Atezolizumab 30 min post-infusion on Day 1 of Cycle 1 (Cycle length = 21 days) Minimum Serum Concentration (Cmin) at Steady-State Within a Dosing Interval of Atezolizumab Prior to infusion on Day 1 of Cycles 1, 2, 3, 4, 8, 16 (Cycle length = 21 days), at study discontinuation visit (up to 12 months), Day 120 post last dose of atezolizumab (up to 16 months)
Trial Locations
- Locations (228)
Hospital NisA 9 de Octubre
🇪🇸Valencia, Spain
Zhejiang Cancer Hospital
🇨🇳Zhejiang, China
Hôpital Universitaire Dupuytren
🇫🇷Limoges, France
Centre Léon Bérard Centre Régional de Lutte Contre Le Cancer Rhône Alpes
🇫🇷Lyon, France
Hôpital Saint Joseph; Oncologie Medicale
🇫🇷Marseille, France
Centre Hospitalier de Mont de Marsan - Hopital Layne
🇫🇷Mont De Marsan, France
Clinique Clémentville
🇫🇷Montpellier, France
Centre Regional de Lutte contre le Cancer Val d Aurelle - Paul Lamarque; Service d oncologie
🇫🇷Montpellier, France
Reformatus Pulmonologiai Centrum
🇭🇺Törökbálint, Hungary
Rambam Medical Center; Oncology
🇮🇱Haifa, Israel
Jasz-Nagykun-Szolnok Megyei Hetenyi Geza Korhaz-Rend.Int.
🇭🇺Szolnok, Hungary
Edith Wolfson Medical Center
🇮🇱Holon, Israel
Meir Medical Center; Oncology
🇮🇱Kfar-Saba, Israel
Rabin Medical Center
🇮🇱Petach Tikva, Israel
Chaim Sheba Medical Center; Oncology Dept
🇮🇱Ramat Gan, Israel
Tel Aviv Sourasky Medical Ctr; Oncology
🇮🇱Tel Aviv, Israel
Niigata Cancer Center Hospital
🇯🇵Niigata, Japan
Okayama University Hospital
🇯🇵Okayama, Japan
Saitama Cancer Center
🇯🇵Saitama, Japan
Shizuoka Cancer Center
🇯🇵Shizuoka, Japan
National Cancer Center Hospital
🇯🇵Tokyo, Japan
Chang Gung Medical Foundation Linkou Branch
🇨🇳Taoyuan City, Taiwan
Taichung Veterans General Hospital
🇨🇳Xitun Dist., Taiwan
MI Dnipropetrovsk City Multifield Clinical Hospital 4 of Dnipropetrovsk Regional Council
🇺🇦Dnipropetrovsk, Katerynoslav Governorate, Ukraine
First Hospital of China Medical University
🇨🇳Shenyang, China
First Affiliated Hospital of Soochow University
🇨🇳Suzhou, China
Highlands Oncology Group
🇺🇸Springdale, Arkansas, United States
Southern California Permanente Medical Group Bellflower
🇺🇸Bellflower, California, United States
Compassionate Cancer Care Medical Group, Inc
🇺🇸Corona, California, United States
Stanford University
🇺🇸Palo Alto, California, United States
California Cancer Associates for Research & Excellence, Inc.
🇺🇸San Marcos, California, United States
University of California Los Angeles
🇺🇸Santa Monica, California, United States
Kaiser Permanente; Oncology Clinical Trials
🇺🇸Vallejo, California, United States
Kaiser Permanente - Walnut Creek
🇺🇸Walnut Creek, California, United States
Praxair Cancer Center at Danbury Hospital
🇺🇸Danbury, Connecticut, United States
Eastern Connecticut Hematology and Oncology Associates; (ECHO)
🇺🇸Norwich, Connecticut, United States
Lynn Cancer Institute - West
🇺🇸Boca Raton, Florida, United States
University of Miami School of Medicine - Sylvester at Deerfield
🇺🇸Deerfield Beach, Florida, United States
Holy Cross Hospital Inc
🇺🇸Fort Lauderdale, Florida, United States
Florida Cancer Specialists-Broadway, Fort Myers
🇺🇸Fort Myers, Florida, United States
SCRI Florida Cancer Specialists North; Research Office North Region.
🇺🇸Saint Petersburg, Florida, United States
SCRI Florida Cancer Specialists East
🇺🇸West Palm Beach, Florida, United States
University Cancer & Blood Center, LLC; Research
🇺🇸Athens, Georgia, United States
Northwest Georgia Oncology Centers, a Service of Wellstar Cobb Hospital
🇺🇸Carrollton, Georgia, United States
Lewis Hall Singletary Oncology Center
🇺🇸Thomasville, Georgia, United States
Rush University Medical Center
🇺🇸Chicago, Illinois, United States
University of Illinois at Chicago
🇺🇸Chicago, Illinois, United States
Ingalls Memorial Hospital
🇺🇸Harvey, Illinois, United States
Illinois Cancer Care
🇺🇸Peoria, Illinois, United States
Quincy Medical Group; Canc Ctr at Blessing Hosp
🇺🇸Quincy, Illinois, United States
Southern Illinois University, Simmons Cancer Institute
🇺🇸Springfield, Illinois, United States
Norton Cancer Institute
🇺🇸Louisville, Kentucky, United States
New England Cancer Specialists
🇺🇸Scarborough, Maine, United States
Karmanos Cancer Institute
🇺🇸Detroit, Michigan, United States
Cancer and Hematology Centers of Western Michigan
🇺🇸Grand Rapids, Michigan, United States
Hematology and Oncology Associates at Bridgepoint
🇺🇸Tupelo, Mississippi, United States
St. Luke's Cancer Institute
🇺🇸Kansas City, Missouri, United States
Comprehensive Cancer Centers of Nevada
🇺🇸Henderson, Nevada, United States
Hematology Oncology Associates of Northern New Jersey
🇺🇸Florham Park, New Jersey, United States
Saint Barnabas Medical Center
🇺🇸Livingston, New Jersey, United States
Valley Hospital; Oncology Research
🇺🇸Paramus, New Jersey, United States
Overlook Medical Center; Medical Diagnostic Associates
🇺🇸Summit, New Jersey, United States
Weill Cornell Medical College
🇺🇸New York, New York, United States
Clinical Research Alliance
🇺🇸Westbury, New York, United States
Presbyterian Hospital
🇺🇸Charlotte, North Carolina, United States
University of Cincinnati
🇺🇸Cincinnati, Ohio, United States
Oncology Hematology Care - SCRI
🇺🇸Cincinnati, Ohio, United States
SCRI Mark H. Zangmeister Center
🇺🇸Columbus, Ohio, United States
Oregon Health and Science University
🇺🇸Portland, Oregon, United States
St. Luke's Cancer Care Associates
🇺🇸Bethlehem, Pennsylvania, United States
Pinnacle Health
🇺🇸Harrisburg, Pennsylvania, United States
Allegheny General Hospital
🇺🇸Pittsburgh, Pennsylvania, United States
Rhode Island Hospital
🇺🇸Providence, Rhode Island, United States
Greenville Health System
🇺🇸Greenville, South Carolina, United States
University Oncology Associates
🇺🇸Chattanooga, Tennessee, United States
Sarah Cannon Research Institute / Tennessee Oncology
🇺🇸Nashville, Tennessee, United States
Houston Methodist Cancer Center
🇺🇸Houston, Texas, United States
Wellmont Medical Associates
🇺🇸Bristol, Virginia, United States
Hematology Oncology Associates of Fredericksburg, Inc.
🇺🇸Fredericksburg, Virginia, United States
MultiCare Regional Cancer Center - Auburn
🇺🇸Auburn, Washington, United States
Providence Everett Med Ctr
🇺🇸Everett, Washington, United States
Swedish Medical Center
🇺🇸Seattle, Washington, United States
Townsville Hospital
🇦🇺Townsville, Queensland, Australia
Cabrini Hospital Malvern
🇦🇺Malvern, Victoria, Australia
Cliniques Universitaires St-Luc
🇧🇪Bruxelles, Belgium
CHU Sart-Tilman
🇧🇪Liège, Belgium
William Osler Health Centre
🇨🇦Etobicoke, Ontario, Canada
Cite de La Sante de Laval; Hemato-Oncologie
🇨🇦Laval, Quebec, Canada
Cancer Institute and Hospital Chinese Academy of Medical Sciences
🇨🇳Beijing, China
Beijing Cancer Hospital
🇨🇳Beijing, China
Chinese People's Liberation Army (PLA) General Hospital (301 Hospital)
🇨🇳Beijing, China
Affiliated Hospital of Guangdong Medical University
🇨🇳Guangdong, China
The First Affiliated Hospital of Guangzhou Medical University
🇨🇳Guangzhou, China
Anhui Province Cancer Hospital
🇨🇳Hefei City, China
Shanghai Chest Hospital
🇨🇳Shanghai, China
Shanghai Pulmonary Hospital
🇨🇳Shanghai, China
Liaoning Provincial Cancer Hospital
🇨🇳Shengyang, China
Centre René Gauducheau Centre de Lutte Contre Le Cancer Nantes Atlantique
🇫🇷Nantes, France
Centre Hospitalier Regional Sud Reunion; Service de Pneumologie
🇫🇷Saint Pierre, France
Hopital d'Instruction des Armees de Begin
🇫🇷Saint-Mande, France
Centre Hospitalier de Saint-Quentin; Pharmacie-URCC
🇫🇷Saint-Quentin, France
Centre Hospitalier Intercommunal Toulon - La Seyne sur Mer
🇫🇷Toulon, France
Hopital d Instruction des Armees de Sainte Anne
🇫🇷Toulon, France
Evang. Lungenklinik Berlin Klinik für Pneumologie
🇩🇪Berlin, Germany
Ev.Krankenhaus Bielefeld gGmbH; Klinik für Innere Medizin und Geriatrie
🇩🇪Bielefeld, Germany
Stadtisches Klinikum Braunschweig
🇩🇪Braunschweig, Germany
Klinikum Chemnitz gGmbH
🇩🇪Chemnitz, Germany
Krankenhaus Nordwest
🇩🇪Frankfurt am Main, Germany
LungenClinic Grosshansdorf GmbH; Zentrum fur Pneumologie und Thoraxchirurgie
🇩🇪Großhansdorf, Germany
Krankenhaus Martha-Maria; Halle-Dolau gGmbH
🇩🇪Halle, Germany
Universitätsklinikum Hamburg-Eppendorf
🇩🇪Hamburg, Germany
Asklepios Klinik Harburg
🇩🇪Hamburg, Germany
Thoraxklinik Heidelberg gGmbH
🇩🇪Heidelberg, Germany
Lungenklinik Hemer
🇩🇪Hemer, Germany
Universität Des Saarlandes
🇩🇪Homburg, Germany
Fachklinik für Lungenerkrankungen
🇩🇪Immenhausen, Germany
Vincentius-Diakonissen-Kliniken gAG
🇩🇪Karlsruhe, Germany
Katholisches Klinikum Marienhof
🇩🇪Koblenz Am Rhein, Germany
Kliniken der Stadt Koln gGmbH; Lungenklinik Onkologische Ambulanz
🇩🇪Koln, Germany
SLK Kliniken Heilbronn GmbH, Standort Fachklinik Löwenstein; Onk & Pal
🇩🇪Löwenstein, Germany
Klinikum Bogenhausen
🇩🇪München, Germany
Gemeinschaftspraxis für Hämatologie und Onkologie
🇩🇪Münster, Germany
Pius-Hospital Oldenburg
🇩🇪Oldenburg, Germany
Krankenhaus Barmherzige Bruder Regensburg
🇩🇪Regensburg, Germany
Praxis fur Hamatologie und internistische Onkologie
🇩🇪Velbert, Germany
Semmelweis Egyetem; Belgyogyaszati es Hematologiai Klinika
🇭🇺Budapest, Hungary
University of Pecs, I st Dept of Internal Medicine
🇭🇺Pecs, Hungary
Ospedale Clinicizzato SS Annunziata
🇮🇹Chieti, Abruzzo, Italy
Azienda per l'Assistenza Sanitaria N° 5 - Friuli Occidentale; S.C. Oncologia Pordenone
🇮🇹Pordenone, Friuli-Venezia Giulia, Italy
Policlinico Universitario Campus Biomedico Di Roma; U.O.Oncologia Medica
🇮🇹Roma, Lazio, Italy
Asst Papa Giovanni XXIII; Oncologia Medica
🇮🇹Bergamo, Lombardia, Italy
ASST Spedali Civili di Brescia
🇮🇹Brescia, Lombardia, Italy
Ospedale San Raffaele
🇮🇹Milano, Lombardia, Italy
Azienda Sanitaria Ospedaliera s. Croce e Carle; Oncologia Medica
🇮🇹Cuneo, Piemonte, Italy
A.O.U. Maggiore della Carità
🇮🇹Novara, Piemonte, Italy
Azienda Sanitaria Ospedaliera S Luigi Gonzaga
🇮🇹Orbassano, Piemonte, Italy
Azienda Ospedaliera Città della Salute e della Scienza di Torino
🇮🇹Torino, Piemonte, Italy
Azienda Ospedaliera Di Rilievo Nazionale E Di Alta Specializzazione Garibaldi
🇮🇹Palermo, Sicilia, Italy
Azienda Ospedaliero Universitaria Pisana
🇮🇹Pisa, Toscana, Italy
Ospedale Santa Chiara; Oncologia Medica
🇮🇹Trento, Trentino-Alto Adige, Italy
Ospedale Silvestrini
🇮🇹Perugia, Umbria, Italy
Azienda Ospedaliera Universitaria Integrata Verona; UOC Oncologia
🇮🇹Verona, Veneto, Italy
Aichi Cancer Center Hospital
🇯🇵Aichi, Japan
Nagoya University Hospital
🇯🇵Aichi, Japan
National Cancer Center East
🇯🇵Chiba, Japan
Shikoku Cancer Center
🇯🇵Ehime, Japan
Kyushu University Hospital
🇯🇵Fukuoka, Japan
Hiroshima University Hospital
🇯🇵Hiroshima, Japan
National Hospital Organization Hokkaido Cancer Center
🇯🇵Hokkaido, Japan
Hyogo Cancer Center
🇯🇵Hyogo, Japan
Kanagawa Cancer Center
🇯🇵Kanagawa, Japan
Hospital of the University of Occupational and Environmental Health,Japan
🇯🇵Kitakyushu-shi, Japan
Kumamoto University Hospital
🇯🇵Kumamoto, Japan
Kyoto University Hospital
🇯🇵Kyoto, Japan
Sendai Kousei Hospital
🇯🇵Miyagi, Japan
Toranomon Hospital
🇯🇵Tokyo, Japan
Juntendo University Hospital
🇯🇵Tokyo, Japan
Tokyo Metropolitan Cancer and Infectious diseases Center Komagome Hospital
🇯🇵Tokyo, Japan
Tokyo Medical University Hospital
🇯🇵Tokyo, Japan
Kyorin University Hospital
🇯🇵Tokyo, Japan
Wakayama Medical University Hospital
🇯🇵Wakayama, Japan
Chonnam National University Hwasun Hospital
🇰🇷Jeollanam-do, Korea, Republic of
The Catholic University of Korea St. Vincent's Hospital
🇰🇷Suwon, Korea, Republic of
Jeroen Bosch Ziekenhuis
🇳🇱'S Hertogenbosch, Netherlands
Martini Ziekenhuis
🇳🇱Groningen, Netherlands
St. Antonius Ziekenhuis Nieuwegein
🇳🇱Nieuwegein, Netherlands
Mazowieckie Centrum Leczenia Chorob Pluc i Gruzlicy
🇵🇱Otwock, Poland
Wielkopolskie Centrum Pulmonologii i Torakochirurgii w Poznaniu
🇵🇱Poznan, Poland
Centro Hospitalar E Universitário de Coimbra EPE
🇵🇹Coimbra, Portugal
Centro Hospitalar de Lisboa Norte E.P.E ? Hospital Pulido Valente
🇵🇹Lisboa, Portugal
Instituto Portugues de Oncologia Do Porto Francisco Gentil Epe
🇵🇹Porto, Portugal
Hospital de Sao Joao; Servico de Pneumologia
🇵🇹Porto, Portugal
Oncology Center Sf. Nectarie
🇷🇴Craiova, Romania
Mordovia State University
🇷🇺Saransk, Mordovija, Russian Federation
Moscow City Oncology Hospital #62
🇷🇺Moscovskaya Oblast, Moskovskaja Oblast, Russian Federation
Principal Military Clinical Hospital n.a. N.N. Burdenko
🇷🇺Moscow, Moskovskaja Oblast, Russian Federation
Russian Oncology Research Center n a N N Blokhin
🇷🇺Moscow, Moskovskaja Oblast, Russian Federation
Evromedservis LCC
🇷🇺Pushkin, Sankt Petersburg, Russian Federation
GBUZ Saint Petersburg Clinical Research Center of Specialized Types of Care (Oncology)
🇷🇺Saint Petersburg, Sankt Petersburg, Russian Federation
City Clinical Oncology Dispensary
🇷🇺Saint-Petersburg, Sankt Petersburg, Russian Federation
Leningrad Regional Clinical Hospital
🇷🇺St Petersburg, Sankt Petersburg, Russian Federation
St. Petersburg Med Univ; n.a. I.P. Pavlov; Pulmonology Research
🇷🇺St Petersburg, Sankt Petersburg, Russian Federation
Scientific Research Institute of Oncology n.a. N.N. Petrov; Department of Oncogynecology
🇷🇺St. Petersburg, Sankt Petersburg, Russian Federation
Republican Clinical Oncology Dispensary of Ministry of Healthcare of Tatarstan Republic
🇷🇺Kazan, Tatarstan, Russian Federation
City Clinical Hospital #1; Dpt of Oncology
🇷🇺Novosibirsk, Russian Federation
Volgograd Regional Clinical Oncology Dispensary
🇷🇺Volgograd, Russian Federation
Regional Clinical Oncology Hospital
🇷🇺Yaroslavl, Russian Federation
Hospital Universitari Germans Trias i Pujol; Servicio de Oncologia
🇪🇸Badalona, Barcelona, Spain
Hospital Univ Vall d'Hebron; Servicio de Oncologia
🇪🇸Sant Andreu de La Barca, Barcelona, Spain
Hospital Universitario Marques de Valdecilla; Servicio de Oncologia
🇪🇸Santander, Cantabria, Spain
Consorcio Hospitalario Provincial de Castellon
🇪🇸Castellon DE LA Plana/castello DE LA Plana, Castellon, Spain
Hospital Universitario Son Espases
🇪🇸Palma De Mallorca, Islas Baleares, Spain
Centro Oncologico de Galicia COG; Medical Oncology
🇪🇸A Coruna, LA Coruña, Spain
Hospital Universitario Virgen de La Arrixaca; Servicio De Oncologia
🇪🇸El Palmar, Murcia, Spain
Hospital Universitario de Canarias
🇪🇸S. Cristobal De La Laguna, Tenerife, Spain
Hospital del Mar
🇪🇸Barcelona, Spain
Hospital Santa Creu i Sant Pau
🇪🇸Barcelona, Spain
C.H. Regional Reina Sofia
🇪🇸Cordoba, Spain
Complejo Hospitalario de Jaen
🇪🇸Jaen, Spain
Hospital Lucus Augusti; Servicio de Oncologia
🇪🇸Lugo, Spain
Hospital Ramon y Cajal; Servicio de Oncologia
🇪🇸Madrid, Spain
Hosp. Clinico San Carlos
🇪🇸Madrid, Spain
Hospital Universitario La Paz
🇪🇸Madrid, Spain
Hospital Universitario HM Sanchinarro-CIOCC; Oncología Médica
🇪🇸Madrid, Spain
Hospital Clinico Universitario de Valencia
🇪🇸Valencia, Spain
Hospital Universitari i Politecnic La Fe de Valencia
🇪🇸Valencia, Spain
Hosp Clinico Univ Lozano Blesa
🇪🇸Zaragoza, Spain
Changhua Christian Hospital
🇨🇳Chang Hua, Taiwan
Kaohsiung Medical University Hospital; Department of Urology
🇨🇳Kaohsiung City, Taiwan
Chi Mei Medical Center Liou Ying Campus
🇨🇳Liuying Township, Taiwan
Chang Gung Memorial Hospital Chiayi
🇨🇳Putzu, Taiwan
National Taiwan Uni Hospital
🇨🇳Taipei City, Taiwan
Taipei Veterans General Hospital
🇨🇳Taipei City, Taiwan
Mackay Memorial Hospital
🇨🇳Taipei, Taiwan
Communal Non profit Enterprise Regional Center of Oncology; Oncosurgical dept of thoracic organs
🇺🇦Kharkiv, Kharkiv Governorate, Ukraine
Kyiv Railway Clinical Hospital #3 of Branch Health Center of the PJSC Ukrainian Railway
🇺🇦Kyiv, KIEV Governorate, Ukraine
Municipal Institution Odesa Regional Oncology Dispensary
🇺🇦Odesa, KIEV Governorate, Ukraine
Communal Nonprofit Enterprise Podilsky Regional Center Of Oncology OfTheVinnytsia Regional Council
🇺🇦Vinnytsia, KIEV Governorate, Ukraine
Municipal Institution SubCarpathian ClinicalOncological Centre; Chemotherapy department
🇺🇦Ivano-Frankivsk, Poltava Governorate, Ukraine
Private Enterprise Private Manufacturing Company Acinus
🇺🇦Kirovograd, Ukraine
ME Kryviy Rih Oncology Dispensary of Dnipropetrovs?k Regional Council; Chemotherapy Department
🇺🇦Kryvyi Rih, Ukraine
Kyiv City Clinical Oncological Center
🇺🇦Kyiv, Ukraine
Regional Municipal Institution Sumy Regional Clinical Oncology Dispensary
🇺🇦Sumy, Ukraine
MI Zaporizhzhia Regional Clinical Oncological Dispensary Zaporizhzhia SMU Ch of Oncology
🇺🇦Zaporizhzhya, Ukraine
Birmingham Heartlands Hospital
🇬🇧Birmingham, United Kingdom
Colchester General Hospital
🇬🇧Colchester, Essex, United Kingdom
St Bartholomew's Hospital
🇬🇧London, United Kingdom
Prince of Wales Hosp; Dept. Of Clinical Onc
🇭🇰Shatin, Hong Kong