A Study to Compare Subcutaneous (SC) Versus Intravenous (IV) Administration of Herceptin (Trastuzumab) in Women With Human Epidermal Growth Factor Receptor (HER) 2-Positive Early Breast Cancer
- Conditions
- Breast Cancer
- Interventions
- Registration Number
- NCT00950300
- Lead Sponsor
- Hoffmann-La Roche
- Brief Summary
In this open-label multicenter trial, participants with operable or locally advanced breast cancer will be randomized to pre-operative treatment with 8 cycles of chemotherapy (4 cycles of docetaxel followed by 4 cycles of 5-fluorouracil, epirubicin, and cyclophosphamide) concurrent with either SC Herceptin or IV Herceptin. After surgery, participants will receive a further 10 cycles of SC or IV Herceptin as per randomization to complete 1 year of treatment. All cycles will be 21 days in length. After the end of study treatment, participants will be followed for safety and efficacy for up to 5 years or until disease recurrence, whichever is earlier.
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- Female
- Target Recruitment
- 596
- Adult women greater than or equal to (≥) 18 years of age
- Non-metastatic primary invasive adenocarcinoma of the breast clinical stage I to IIIC, including inflammatory and multicentric/multifocal breast cancer, with tumor size ≥1 centimeter (cm) by ultrasound or ≥2 cm by palpation, centrally confirmed HER2-positive (immunohistochemical score [IHC] 3+ or in situ hybridization [ISH]-positive)
- At least 1 measurable lesion in breast or lymph nodes (≥1 cm by ultrasound or ≥2 cm by palpation), except for inflammatory carcinoma (T4d)
- Baseline left ventricular ejection fraction (LVEF) ≥55%
- Eastern Cooperative Oncology Group (ECOG) status of 0 or 1
- Adequate organ function at Baseline
- History of any prior (ipsilateral and/or contralateral) invasive breast carcinoma
- Past or current history of malignant neoplasms, except for curatively treated basal and squamous cell carcinoma of the skin and in situ carcinoma of the cervix
- Metastatic disease
- Any prior therapy with anthracyclines
- Prior anti-HER2 therapy or biologic or immunotherapy
- Serious cardiac illness
- Pregnant or lactating women
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Herceptin SC + Chemotherapy Herceptin SC [trastuzumab] Participants will receive Herceptin via SC injection for 8 cycles prior to surgery and an additional 10 cycles after surgery. Docetaxel will be co-administered during Cycles 1 to 4; chemotherapy during Cycles 5 to 8 will include 5-fluorouracil, cyclophosphamide, and epirubicin. Herceptin SC will be given on Day 1 of each 21-day cycle, as a 600-milligram (mg) fixed dose. Herceptin IV + Chemotherapy Herceptin IV [trastuzumab] Participants will receive Herceptin via IV infusion for 8 cycles prior to surgery and an additional 10 cycles after surgery. Docetaxel will be co-administered during Cycles 1 to 4; chemotherapy during Cycles 5 to 8 will include 5-fluorouracil, cyclophosphamide, and epirubicin. Herceptin IV will be given on Day 1 of each 21-day cycle, as 8 milligrams per kilogram (mg/kg) for a loading dose during Cycle 1 and as 6 mg/kg during subsequent cycles. Herceptin IV + Chemotherapy 5-Fluorouracil Participants will receive Herceptin via IV infusion for 8 cycles prior to surgery and an additional 10 cycles after surgery. Docetaxel will be co-administered during Cycles 1 to 4; chemotherapy during Cycles 5 to 8 will include 5-fluorouracil, cyclophosphamide, and epirubicin. Herceptin IV will be given on Day 1 of each 21-day cycle, as 8 milligrams per kilogram (mg/kg) for a loading dose during Cycle 1 and as 6 mg/kg during subsequent cycles. Herceptin IV + Chemotherapy Cyclophosphamide Participants will receive Herceptin via IV infusion for 8 cycles prior to surgery and an additional 10 cycles after surgery. Docetaxel will be co-administered during Cycles 1 to 4; chemotherapy during Cycles 5 to 8 will include 5-fluorouracil, cyclophosphamide, and epirubicin. Herceptin IV will be given on Day 1 of each 21-day cycle, as 8 milligrams per kilogram (mg/kg) for a loading dose during Cycle 1 and as 6 mg/kg during subsequent cycles. Herceptin IV + Chemotherapy Docetaxel Participants will receive Herceptin via IV infusion for 8 cycles prior to surgery and an additional 10 cycles after surgery. Docetaxel will be co-administered during Cycles 1 to 4; chemotherapy during Cycles 5 to 8 will include 5-fluorouracil, cyclophosphamide, and epirubicin. Herceptin IV will be given on Day 1 of each 21-day cycle, as 8 milligrams per kilogram (mg/kg) for a loading dose during Cycle 1 and as 6 mg/kg during subsequent cycles. Herceptin IV + Chemotherapy Epirubicin Participants will receive Herceptin via IV infusion for 8 cycles prior to surgery and an additional 10 cycles after surgery. Docetaxel will be co-administered during Cycles 1 to 4; chemotherapy during Cycles 5 to 8 will include 5-fluorouracil, cyclophosphamide, and epirubicin. Herceptin IV will be given on Day 1 of each 21-day cycle, as 8 milligrams per kilogram (mg/kg) for a loading dose during Cycle 1 and as 6 mg/kg during subsequent cycles. Herceptin SC + Chemotherapy 5-Fluorouracil Participants will receive Herceptin via SC injection for 8 cycles prior to surgery and an additional 10 cycles after surgery. Docetaxel will be co-administered during Cycles 1 to 4; chemotherapy during Cycles 5 to 8 will include 5-fluorouracil, cyclophosphamide, and epirubicin. Herceptin SC will be given on Day 1 of each 21-day cycle, as a 600-milligram (mg) fixed dose. Herceptin SC + Chemotherapy Cyclophosphamide Participants will receive Herceptin via SC injection for 8 cycles prior to surgery and an additional 10 cycles after surgery. Docetaxel will be co-administered during Cycles 1 to 4; chemotherapy during Cycles 5 to 8 will include 5-fluorouracil, cyclophosphamide, and epirubicin. Herceptin SC will be given on Day 1 of each 21-day cycle, as a 600-milligram (mg) fixed dose. Herceptin SC + Chemotherapy Docetaxel Participants will receive Herceptin via SC injection for 8 cycles prior to surgery and an additional 10 cycles after surgery. Docetaxel will be co-administered during Cycles 1 to 4; chemotherapy during Cycles 5 to 8 will include 5-fluorouracil, cyclophosphamide, and epirubicin. Herceptin SC will be given on Day 1 of each 21-day cycle, as a 600-milligram (mg) fixed dose. Herceptin SC + Chemotherapy Epirubicin Participants will receive Herceptin via SC injection for 8 cycles prior to surgery and an additional 10 cycles after surgery. Docetaxel will be co-administered during Cycles 1 to 4; chemotherapy during Cycles 5 to 8 will include 5-fluorouracil, cyclophosphamide, and epirubicin. Herceptin SC will be given on Day 1 of each 21-day cycle, as a 600-milligram (mg) fixed dose.
- Primary Outcome Measures
Name Time Method Observed Serum Trough Concentration (Ctrough) of Trastuzumab Prior to Surgery Pre-dose (0 hours) on Day 1 of Cycle 8 (cycle length of 21 days) Pre-dose samples were obtained prior to surgery (Cycle 8). The observed Ctrough was recorded, averaged among all participants, and expressed in micrograms per milliliter (μg/mL).
Percentage of Participants With Pathological Complete Response (pCR) After surgery following eight cycles of Herceptin + chemotherapy (approximately 6 months from Baseline) Participants were evaluated following eight cycles of treatment and after surgery to assess for pCR, defined as absence of neoplastic invasive cells in the breast according to pathologist examination. The percentage of participants with pCR was reported, and the 95% CI for one-sample binomial was constructed using the Pearson-Clopper method.
- Secondary Outcome Measures
Name Time Method Number of Participants With Ctrough of Trastuzumab >20 μg/mL Prior to Surgery Pre-dose (0 hours) on Day 1 of Cycle 8 (cycle length of 21 days) Pre-dose samples were obtained prior to surgery (Cycle 8). The number of participants who had an observed Ctrough \>20 μg/mL was reported.
Number of Participants With Ctrough of Trastuzumab >20 μg/mL After Surgery Pre-dose (0 hours) on Day 1 of Cycle 13 (cycle length of 21 days) Pre-dose samples were obtained after surgery (Cycle 13). The number of participants who had an observed Ctrough \>20 μg/mL was reported.
Maximum Serum Concentration (Cmax) of Trastuzumab Prior to Surgery Pre-dose (0 hours) and at end of 30-minute infusion (Herceptin IV only) on Day 1 of Cycle 7; on Days 2, 4, 8, 15 of Cycle 7; pre-dose (0 hours) on Day 1 of Cycle 8 (cycle length of 21 days) PK samples were obtained prior to surgery (Cycle 7). The Cmax during Cycle 7 was recorded, averaged among all participants, and expressed in μg/mL.
Time of Maximum Serum Concentration (Tmax) of Trastuzumab Prior to Surgery Pre-dose (0 hours) and at end of 30-minute infusion (Herceptin IV only) on Day 1 of Cycle 7; on Days 2, 4, 8, 15 of Cycle 7; pre-dose (0 hours) on Day 1 of Cycle 8 (cycle length of 21 days) PK samples were obtained prior to surgery (Cycle 7). The Tmax during Cycle 7 was recorded, averaged among all participants, and expressed in days.
Observed Ctrough of Trastuzumab After Surgery Pre-dose (0 hours) on Day 1 of Cycle 13 (cycle length of 21 days) Pre-dose samples were obtained after surgery (Cycle 13). The observed Ctrough was recorded, averaged among all participants, and expressed in μg/mL.
Predicted Ctrough of Trastuzumab Prior to Surgery Pre-dose (0 hours) on Day 1 of Cycle 8 (cycle length of 21 days) Predicted Ctrough at pre-dose prior to surgery (Cycle 8) was determined on the basis of a population PK model from Study BP22023 (NCT00800436). The mean predicted Ctrough was expressed in μg/mL.
Predicted Ctrough of Trastuzumab After Surgery Pre-dose (0 hours) on Day 1 of Cycle 13 (cycle length of 21 days) Predicted Ctrough at pre-dose after surgery (Cycle 13) was determined on the basis of a population PK model from Study BP22023 (NCT00800436). The mean predicted Ctrough was expressed in μg/mL.
Percentage of Participants With Complete Response (CR) or Partial Response (PR) According to Response Evaluation Criteria in Solid Tumors (RECIST) Version 1.0, Among Those With Measurable Disease at Baseline Tumor assessments at Baseline; on Day 1 of Cycles 3, 5, 7 (cycle length of 21 days); and at time of surgery following eight cycles of Herceptin + chemotherapy (approximately 6 months overall) Tumor response was assessed using RECIST version 1.0. CR was defined as disappearance of all target lesions and short-axis reduction of any pathological lymph nodes to less than (\<) 10 millimeters (mm) with no prior assessment of progressive disease (PD). PR was defined as greater than or equal to (≥) 30% decrease from Baseline in sum diameter (SD) of target lesions with no prior assessment of PD. PD was defined as ≥20% relative increase and ≥5 mm of absolute increase in the SD of target lesions, taking as reference the smallest SD recorded since treatment started; or appearance of 1 or more new lesions. The percentage of participants with overall response of CR or PR at the end of neoadjuvant treatment was reported, and the 95% CI for one-sample binomial was constructed using the Pearson-Clopper method.
Area Under the Concentration-Time Curve From 0 to 21 Days (AUC21d) of Trastuzumab Prior to Surgery Pre-dose (0 hours) and at end of 30-minute infusion (Herceptin IV only) on Day 1 of Cycle 7; on Days 2, 4, 8, 15 of Cycle 7; pre-dose (0 hours) on Day 1 of Cycle 8 (cycle length of 21 days) PK samples were obtained prior to surgery (Cycle 7). Values were extrapolated beyond Day 15 to produce the area over the full 21-day cycle. The AUC21d value at Cycle 7 was calculated from trastuzumab concentration-time profiles using standard non-compartmental PK methods, averaged among all participants, and expressed in days multiplied by micrograms per milliliters (d\*μg/mL).
Cmax of Trastuzumab After Surgery Pre-dose (0 hours) and at end of 30-minute infusion (Herceptin IV only) on Day 1 of Cycle 12; on Days 2, 4, 8, 15 of Cycle 12; pre-dose (0 hours) on Day 1 of Cycle 13 (cycle length of 21 days) PK samples were obtained after surgery (Cycle 12). The Cmax during Cycle 12 was recorded, averaged among all participants, and expressed in μg/mL.
Tmax of Trastuzumab After Surgery Pre-dose (0 hours) and at end of 30-minute infusion (Herceptin IV only) on Day 1 of Cycle 12; on Days 2, 4, 8, 15 of Cycle 12; pre-dose (0 hours) on Day 1 of Cycle 13 (cycle length of 21 days) PK samples were obtained after surgery (Cycle 12). The Tmax during Cycle 12 was recorded, averaged among all participants, and expressed in days.
AUC21d of Trastuzumab After Surgery Pre-dose (0 hours) and at end of 30-minute infusion (Herceptin IV only) on Day 1 of Cycle 12; on Days 2, 4, 8, 15 of Cycle 12; pre-dose (0 hours) on Day 1 of Cycle 13 (cycle length of 21 days) PK samples were obtained after surgery (Cycle 12). Values were extrapolated beyond Day 15 to produce the area over the full 21-day cycle. The AUC21d value at Cycle 12 was calculated from trastuzumab concentration-time profiles using standard non-compartmental PK methods, averaged among all participants, and expressed in d\*μg/mL.
Percentage of Participants With Total Pathological Complete Response (tpCR) After surgery following eight cycles of Herceptin + chemotherapy (approximately 6 months from Baseline) Participants were evaluated following eight cycles of treatment and after surgery to assess for tpCR, defined as absence of neoplastic invasive cells in the breast and axillary lymph nodes according to pathologist examination. The percentage of participants with tpCR was reported, and the 95% CI for one-sample binomial was constructed using the Pearson-Clopper method.
Time to Response According to RECIST Version 1.0, Among Those With Measurable Disease at Baseline Tumor assessments at Baseline; on Day 1 Cycles 3, 5, 7 (cycle length of 21 days); and at time of surgery following eight cycles of chemotherapy (approximately 6 months overall) Tumor response was assessed using RECIST version 1.0. CR was defined as disappearance of all target lesions and short-axis reduction of any pathological lymph nodes to \<10 mm with no prior assessment of PD. PR was defined as ≥30% decrease from Baseline in SD of target lesions with no prior assessment of PD. PD was defined as ≥20% relative increase and ≥5 mm of absolute increase in the SD of target lesions, taking as reference the smallest SD recorded since treatment started; or appearance of 1 or more new lesions. Time to response was defined as the time from first dose of study medication to the first assessment of CR or PR, which was the date the response was first documented by objective evidence, among participants with an overall response of CR or PR.
Percentage of Participants Who Experienced a Protocol-Defined Event Screening; Day 1 of Cycle 18 (cycle length of 21 days); and Months 6, 12, 24, 36, 48, 60 from last dose of Cycle 18; then every 6 months until withdrawal for any reason (up to approximately 87 months overall) Protocol-defined events included disease recurrence/progression (local, regional, distant, contralateral) or death from any cause. Imaging was performed at specified visits for up to 5 years after last dose. Thereafter, participants were followed for survival only. The percentage of participants who experienced a protocol-defined event at any time during the study was reported.
Event-Free Survival (EFS) Screening; Day 1 of Cycle 18 (cycle length of 21 days); and Months 6, 12, 24, 36, 48, 60 from last dose of Cycle 18; then every 6 months until withdrawal for any reason (up to approximately 87 months overall) Protocol-defined events included disease recurrence or progression (local, regional, distant, contralateral) or death from any cause. Imaging was performed at specified visits for up to 5 years after last dose. Thereafter, participants were followed for survival only. EFS was estimated by Kaplan-Meier analysis and defined as the time from randomization to the first protocol-defined event.
Percentage of Participants Who Died Continuously during treatment (up to 12 months); at Months 1, 3, 6 from last dose of Cycle 18 (cycle length of 21 days); then every 6 months until withdrawal for any reason (up to approximately 87 months overall) The percentage of participants who died at any time during the study was reported.
Overall Survival (OS) Continuously during treatment (up to 12 months); at Months 1, 3, 6 from last dose of Cycle 18 (cycle length of 21 days); then every 6 months until withdrawal for any reason (up to approximately 87 months overall) OS was estimated by Kaplan-Meier analysis and defined as the time from randomization to death from any cause.
Number of Participants With Anti-Drug Antibodies (ADAs) Against Trastuzumab Baseline; pre-dose (0 hours) on Day 1 of Cycles 2, 5, 13, 18 (cycle length of 21 days); and Months 3, 6, 12, 18, 24, 30, 36, 42, 48, 54, 60 from last dose of Cycle 18 Participants provided PK samples for evaluation of anti-trastuzumab antibodies. The number of participants with "Treatment-induced ADAs" and "Treatment-enhanced ADA" against trastuzumab at any time during or after treatment was reported. Treatment-induced ADA = a participant with negative or missing Baseline ADA result(s) and at least one positive post-Baseline ADA result. Treatment-enhanced ADA = a participant with positive ADA result at Baseline who has one or more post Baseline titer results that are at least 0.60 titer unit greater than the Baseline titer result (four-fold increase of titer).
Number of Participants With ADAs Against Recombinant Human Hyaluronidase (rHuPH20) Baseline; pre-dose (0 hours) on Day 1 of Cycles 2, 5, 13, 18 (cycle length of 21 days); and Months 3, 6, 12, 18, 24, 30, 36, 42, 48, 54, 60 from last dose of Cycle 18 Participants in the Herceptin SC arm provided PK samples for evaluation of anti-rHuPH20 antibodies. The number of participants with "Treatment-induced ADAs" and "Treatment-enhanced ADA" against rHuPH20 (an excipient unique to the SC formulation) at any time during or after treatment was reported. Treatment-induced ADA = a participant with negative or missing Baseline ADA result(s) and at least one positive post-Baseline ADA result. Treatment-enhanced ADA = a participant with positive ADA result at Baseline who has one or more post Baseline titer results that are at least 0.60 titer unit greater than the Baseline titer result (four-fold increase of titer).
Trial Locations
- Locations (106)
Centro Medico San Roque; Oncology Dept
🇦🇷Tucuman, Argentina
Szegedi Tudomanyegyetem, AOK, Szent-Gyorgyi Albert Klinikai Kozpont, Onkoterapias Klinika
🇭🇺Szeged, Hungary
Hospital Privado San Jose; Oncologia
🇲🇽Obregon, Mexico
Chang Gung Medical Foundation-Taipei
🇨🇳Taoyuan, Taiwan
Chulalongkorn Hospital; Medical Oncology
🇹🇭Bangkok, Thailand
National Cancer Inst.
🇹🇭Bangkok, Thailand
Phramongkutklao Hospital;Dept Surgery/Surgical Oncology Unit
🇹🇭Bangkok, Thailand
Blokhin Cancer Research Center; Combined Treatment
🇷🇺Moscow, Russian Federation
Moscow city oncology hospital #62 of Moscow Healthcare Department
🇷🇺Moscow, Russian Federation
SBI of Healthcare Samara Regional Clinical Oncology Dispensary
🇷🇺Samara, Russian Federation
Caipo; Oncology
🇦🇷Tucuman, Argentina
Liga Norte Riograndense Contra O Câncer
🇧🇷Natal, RN, Brazil
Hospital Sao Rafael - HSR
🇧🇷Salvador, BA, Brazil
Hospital das Clinicas - UFPR; Quimioterapia
🇧🇷Curitiba, PR, Brazil
Clinica de Neoplasias Litoral
🇧🇷Itajai, SC, Brazil
Instituto do Cancer do Estado de Sao Paulo - ICESP
🇧🇷Sao Paulo, SP, Brazil
Hospital Amaral Carvalho
🇧🇷Jau, SP, Brazil
Hopital Albert Michallon; Oncologie
🇫🇷La Tronche, France
Institut Daniel Hollard; Chimiotherapie Ambulatoire
🇫🇷Grenoble, France
Praxis Dr. Schoenegg
🇩🇪Berlin, Germany
Centre Jean Bernard
🇫🇷Le Mans, France
Olsztyński Ośrodek Onkologiczny Kopernik sp. z o.o.
🇵🇱Olsztyn, Poland
FSBI"National Medical Research Center of Oncology named after N.N.Petrov" MHRF
🇷🇺St Petersburg, Leningrad, Russian Federation
Centrum Onkologii - Instytut im. Marii Skłodowskiej-Curie Klinika Nowotworów Piersi i Chirurgii
🇵🇱Warszawa, Poland
Ivanovo Regional Oncology Dispensary
🇷🇺Ivanovo, Russian Federation
SBI for HPE "Ryazan State Medical University n.a. I.P. Pavlov" of MoH of RF
🇷🇺Ryazan, Russian Federation
Cancercare
🇿🇦Cape Town, South Africa
Groote Schuur Hospital ( Uni of Capetown ); Oncology Dept
🇿🇦Cape Town, South Africa
Wits Donald Gordon Clinical Trial Centre; Medical Oncology
🇿🇦Parktown, Johannesburg, South Africa
Pretoria-East Hospital; 1 Sanwood Park
🇿🇦Pretoria, South Africa
Rondebosch Oncology Centre
🇿🇦Rondebosch, South Africa
Hospital General Universitario Gregorio Marañon; Servicio de Oncologia
🇪🇸Madrid, Spain
Prince of Songkla Uni ; Unit of Medical Oncology
🇹🇭Songkhla, Thailand
Istituto Nazionale Tumori Irccs Fondazione g. Pascale;s.c. Ematologia Oncologica
🇮🇹Napoli, Campania, Italy
Fondazione Salvatore Maugeri; Servizio Di Prevenzione Oncologica
🇮🇹Pavia, Lombardia, Italy
Fondazione Salvatore Maugeri
🇮🇹Pavia, Lombardia, Italy
Fakultni nemocnice Olomouc; Onkologicka klinika
🇨🇿Olomouc, Czechia
Lekarske Fakulty Univerzity Karlovy Fakultni Nemocnice Na Bulovce; Ustav Radiacni Onkologie
🇨🇿Praha, Czechia
St. Johannes Hospital
🇩🇪Dortmund, Germany
Hopital Maisonneuve- Rosemont; Oncology
🇨🇦Montreal, Quebec, Canada
Grupo Salud Coop
🇨🇴Bogota, Colombia
Oncólogos de Occidente
🇨🇴Pereira, Colombia
HOPITAL JEAN MINJOZ; Oncologie
🇫🇷Besancon, France
Hospital Perola Byington
🇧🇷Sao Paulo, SP, Brazil
Instituto de Oncologia de Sorocaba - CEPOS
🇧🇷Sorocaba, SP, Brazil
Hospital Universitario San Ignacio
🇨🇴Bogota, Colombia
CHU de Québec - Hôpital du Saint-Sacrement / ONCOLOGY
🇨🇦Quebec, Canada
Krajska Nemocnice Pardubice Neurologicka Klinika
🇨🇿Pardubice, Czechia
Fakultni Thomayerova Nemocnice; Onkologicke Oddeleni
🇨🇿Praha, Czechia
Tartu University Hospital; Clinic of Hematology and Oncology
🇪🇪Tartu, Estonia
Institut Jean Godinot; Hopital De Jour
🇫🇷Reims, France
CAMPUS CHARITÉ MITTE; Tagesklinik für Onkologie u.Hämatologie
🇩🇪Berlin, Germany
Johanniter GmbH; Johanniter-Krankenhaus; Internistische Onkologie
🇩🇪Bonn, Germany
North Estonia Medical Centre Foundation; Oncology Centre
🇪🇪Tallinn, Estonia
Centre Rene Huguenin; Medecine B
🇫🇷St Cloud, France
Hopital Saint Louis ; Service d Oncologie Medicale Fougere 6 (Pr Misset)
🇫🇷Paris, France
Centro Oncologico S.A.
🇬🇹Guatemala, Guatemala
Queen Mary Hospital; Surgery
🇭🇰Hong Kong, Hong Kong
Hospital of Aladar Petz; Dept of Oncoradiology
🇭🇺Gyor, Hungary
Rabin Medical Center; Oncology Dept
🇮🇱Petach Tikva, Israel
Universitätsklinik Tübingen; Frauenklinik
🇩🇪Tübingen, Germany
Semmelweis Egyetem Onkologiai Központ
🇭🇺Budapest, Hungary
Sana Klinikum Offenbach GmbH; Klinik für Gynäkologie & Geburtshilfe
🇩🇪Offenbach, Germany
Sankt Elisabeth Krankenhaus; Gynaekology
🇩🇪Leipzig, Germany
Gynaekologisch-Onkologische Schwerpunktpraxis Prof. Dr. med. Lueck, Dr. Schrader und Dr. Noeding
🇩🇪Hannover, Germany
Klinik Lippe Lemgo; Frauenklinik
🇩🇪Lemgo, Germany
Klinik Obergöltzsch; Abt. Gynäkologie
🇩🇪Rodewisch, Germany
Hadassah Ein Karem Hospital; Oncology Dept
🇮🇱Jerusalem, Israel
ASST DI CREMONA; Dip. Medicina - S.C. Oncologia
🇮🇹Cremona, Lombardia, Italy
Korea University Anam Hospital; Oncology Haemotology
🇰🇷Seoul, Korea, Republic of
Asan Medical Center, Uni Ulsan Collegemedicine; Dept.Internal Medicine / Divisionhematology/Oncology
🇰🇷Seoul, Korea, Republic of
Hospital Nacional Carlos Alberto Seguin Escobedo-Essalud; Oncology & Haemathology
🇵🇪Arequipa, Peru
Hospital Nacional Edgardo Rebagliati Martins; Oncologia
🇵🇪Lima, Peru
Samsung Medical Centre; Division of Hematology/Oncology
🇰🇷Seoul, Korea, Republic of
Gachon Medical School Gil Medical Center; Medical Oncology
🇰🇷Incheon, Korea, Republic of
Oncosalud Sac; Oncología
🇵🇪Lima, Peru
Wojewodzki Szpital Zespolony; Oddział Onkologii
🇵🇱Elblag, Poland
Centro Oncológico Estatal; ISSSEMYM Oncología
🇲🇽Toluca, Mexico
Centro Oncologico America
🇵🇦Panama, Panama
Unidad de Investigacion Oncologia Clinica - Piura; Unidad de Oncología Clínica
🇵🇪Piura, Peru
Clinica Ricardo Palma
🇵🇪San Isidro, Peru
COZL Oddzial Onkologii Klinicznej z pododdzialem Chemioterapii Dziennej
🇵🇱Lublin, Poland
State Budget Institution of Healthcare of Stavropol region Pyatigorsk Oncology Dispensary
🇷🇺Pyatigorsk, Russian Federation
Saratov Regional Clinical Hospital & Pathology Centre
🇷🇺Saratov, Russian Federation
Tula Regional Oncology Dispensary
🇷🇺Tula, Russian Federation
Saint-Petersburg City Clinical Oncology Dispensary
🇷🇺St Petersburg, Russian Federation
SBI of Healthcare of Stavropol region Stavropol Regional Clinical Oncology Dispensary
🇷🇺Stavropol, Russian Federation
GUZ Vladimir Regional Clinical Oncological Dispensary
🇷🇺Vladimir, Russian Federation
Vychodoslovensky onkologicky ustav
🇸🇰Kosice, Slovakia
Nzz - Oncology Outpatient Clinic
🇸🇰Poprad, Slovakia
Hospital Clinico Universitario de Valencia; Servicio de Onco-hematologia
🇪🇸Valencia, Spain
National Hospital; Oncotherapy Dept
🇿🇦Bloemfontein, South Africa
Hospital Universitari Sant Joan de Reus; Servicio de Oncologia
🇪🇸Reus, Tarragona, Spain
Sandton Oncology Centre
🇿🇦Sandton, South Africa
Complejo Hospitalario Universitario de Santiago (CHUS) ; Servicio de Oncologia
🇪🇸Santiago de Compostela, LA Coruña, Spain
Skånes University Hospital, Skånes Department of Onclology
🇸🇪Lund, Sweden
Hospital Universitario Miguel Servet; Servicio Oncologia
🇪🇸Zaragoza, Spain
Changhua Christian Hospital; Dept of Surgery
🇨🇳Changhua, Taiwan
Akademiska sjukhuset, Onkologkliniken
🇸🇪Uppsala, Sweden
Taipei Veterans General Hospital
🇨🇳Taipei City, Taiwan
Koo Foundation Sun Yat-Sen Cancer Center; Hemato-Oncology
🇨🇳Taipei, Taiwan
Faculty of Med. Siriraj Hosp.; Med.-Div. of Med. Oncology
🇹🇭Bangkok, Thailand
Dokuz Eylul Uni Medical Faculty; Oncology Dept
🇹🇷Izmir, Turkey
Akdeniz University Medical Faculty; Medical Oncology Department
🇹🇷Antalya, Turkey
Istanbul Uni of Medicine Faculty; Oncology Dept
🇹🇷Istanbul, Turkey
Hacettepe Uni Medical Faculty Hospital; Oncology Dept
🇹🇷Sıhhiye, Ankara, Turkey