Avelumab in First-Line Maintenance Gastric Cancer (JAVELIN Gastric 100)

Phase 3

Completed

Conditions: Unresectable, Locally Advanced or Metastatic, Adenocarcinoma of the Stomach, or of the Gastro Esophageal Junction

Interventions: Drug: Oxaliplatin
Drug: Avelumab
Drug: 5-Fluorouracil
Drug: Leucovorin
Drug: Capecitabine
Other: Best supportive care

Registration Number: NCT02625610

Lead Sponsor: EMD Serono Research & Development Institute, Inc.

Brief Summary: The purpose of this study was to demonstrate superiority of treatment with avelumab versus continuation of first-line chemotherapy.

Detailed Description: Not available

Recruitment & Eligibility

Status: COMPLETED

Sex: All

Target Recruitment: 499

Inclusion Criteria

Male or female participants greater than or equal to (>=) 18 years
Disease must be measurable by Response Evaluation Criteria in Solid Tumors version 1.1 (RECIST 1.1)
Participants with histologically confirmed unresectable locally advanced or metastatic adenocarcinoma of the stomach or gastro-esophageal junction (GEJ)
Eastern Cooperative Oncology Group Performance Status (ECOG PS) of 0 to 1 at trial entry
Estimated life expectancy of more than 12 weeks
Adequate haematological, hepatic and renal functions defined by the protocol
Negative blood pregnancy test at Screening for women of childbearing potential
Highly effective contraception for both male and female participants if the risk of conception exists
Other protocol defined inclusion criteria could apply

Exclusion Criteria

Prior therapy with any antibody or drug targeting T-cell coregulatory proteins
Concurrent anticancer treatment or immunosuppressive agents
Prior chemotherapy for unresectable locally advanced or metastatic adenocarcinoma of the stomach or gastro-esophageal junction (GEJ)
Tumor shown to be human epidermal growth factor 2 plus (HER2+)
Major surgery for any reason, except diagnostic biopsy, within 4 weeks of enrolment and/or if the participant has not fully recovered from the surgery within 4 weeks of enrolment
Participants receiving immunosuppressive agents (such as steroids) for any reason should be tapered off these drugs before initiation of the study treatment (with the exception of participants with adrenal insufficiency, who may continue corticosteroids at physiologic replacement dose, equivalent to <= 10 mg prednisone daily)
All participants with brain metastases, except those meeting the following criteria: a. Brain metastases have been treated locally, have not been progressing at least 2 months after completion of therapy, and no steroid maintenance therapy is required, and b. No ongoing neurological symptoms that are related to the brain localization of the disease (sequelae that are a consequence of the treatment of the brain metastases are acceptable)
Previous malignant disease (other than gastric cancer) within the last 5 years with the exception of basal or squamous cell carcinoma of the skin or carcinoma in situ (bladder, cervical, colorectal, breast)
Prior organ transplantation, including allogeneic stem-cell transplantation
Significant acute or chronic infections
Active autoimmune disease that might deteriorate when receiving an immunostimulatory agent
Known severe hypersensitivity reactions to monoclonal antibodies, any history of anaphylaxis, or uncontrolled asthma (that is, 3 or more features of partially controlled asthma)
Persisting toxicity related to prior therapy except alopecia
Neuropathy Grade > 3
Pregnancy or lactation
Known alcohol or drug abuse
History of uncontrolled intercurrent illness including hypertension, active infection, diabetes
Clinically significant (i.e., active) cardiovascular disease
All other significant diseases might impair the participant's tolerance of study treatment
Any psychiatric condition that would prohibit the understanding or rendering of informed consent and that would limit compliance with study requirements
Vaccination with live or live/attenuated viruses within 55 days of the first dose of avelumab and while on trial is prohibited except for administration of inactivated vaccines
Legal incapacity or limited legal capacity
Participants will be excluded from the Induction Phase and the Maintenance Phase if administration of their chemotherapy would be inconsistent with the current local labelling (SmPC) (e.g., in regard to contraindications, warnings/precautions or special provisions) for that chemotherapy. Investigators should check updated labelling via relevant websites at the time of entry into the Induction Phase and the Maintenance Phase
Other protocol defined exclusion criteria could apply

Study & Design

Study Type: INTERVENTIONAL

Study Design: SEQUENTIAL

Arm && Interventions

Group	Intervention	Description
Chemotherapy + Best Supportive Care (BSC)	Best supportive care	In Maintenance Phase, participants continued the same regimen of oxaliplatin-fluoropyrimidine doublet chemotherapy (oxaliplatin + 5FU/LV or oxaliplatin + capecitabine) as they received during the Induction Phase until disease progression, significant clinical deterioration, unacceptable toxicity, or discontinuation. Participants who were not deemed eligible to receive chemotherapy at the dose and schedule specified above received BSC alone once every 3 weeks. BSC was defined as treatment administered with the intent to maximize quality of life without a specific antineoplastic regimen and was based on Investigator's discretion.
Chemotherapy + Best Supportive Care (BSC)	Oxaliplatin	In Maintenance Phase, participants continued the same regimen of oxaliplatin-fluoropyrimidine doublet chemotherapy (oxaliplatin + 5FU/LV or oxaliplatin + capecitabine) as they received during the Induction Phase until disease progression, significant clinical deterioration, unacceptable toxicity, or discontinuation. Participants who were not deemed eligible to receive chemotherapy at the dose and schedule specified above received BSC alone once every 3 weeks. BSC was defined as treatment administered with the intent to maximize quality of life without a specific antineoplastic regimen and was based on Investigator's discretion.
Chemotherapy + Best Supportive Care (BSC)	5-Fluorouracil	In Maintenance Phase, participants continued the same regimen of oxaliplatin-fluoropyrimidine doublet chemotherapy (oxaliplatin + 5FU/LV or oxaliplatin + capecitabine) as they received during the Induction Phase until disease progression, significant clinical deterioration, unacceptable toxicity, or discontinuation. Participants who were not deemed eligible to receive chemotherapy at the dose and schedule specified above received BSC alone once every 3 weeks. BSC was defined as treatment administered with the intent to maximize quality of life without a specific antineoplastic regimen and was based on Investigator's discretion.
Chemotherapy + Best Supportive Care (BSC)	Leucovorin	In Maintenance Phase, participants continued the same regimen of oxaliplatin-fluoropyrimidine doublet chemotherapy (oxaliplatin + 5FU/LV or oxaliplatin + capecitabine) as they received during the Induction Phase until disease progression, significant clinical deterioration, unacceptable toxicity, or discontinuation. Participants who were not deemed eligible to receive chemotherapy at the dose and schedule specified above received BSC alone once every 3 weeks. BSC was defined as treatment administered with the intent to maximize quality of life without a specific antineoplastic regimen and was based on Investigator's discretion.
Chemotherapy + Best Supportive Care (BSC)	Capecitabine	In Maintenance Phase, participants continued the same regimen of oxaliplatin-fluoropyrimidine doublet chemotherapy (oxaliplatin + 5FU/LV or oxaliplatin + capecitabine) as they received during the Induction Phase until disease progression, significant clinical deterioration, unacceptable toxicity, or discontinuation. Participants who were not deemed eligible to receive chemotherapy at the dose and schedule specified above received BSC alone once every 3 weeks. BSC was defined as treatment administered with the intent to maximize quality of life without a specific antineoplastic regimen and was based on Investigator's discretion.
Avelumab	Avelumab	In Maintenance phase, participants received avelumab as a 1-hour intravenous (IV) infusion at 10 milligrams per kilogram (mg/kg) once every 2-week treatment cycle until progressive disease or unacceptable toxicity or discontinuation.

Primary Outcome Measures

Name	Time	Method
Overall Survival (OS)	From randomization into maintenance phase up to 1276 days	Overall Survival was defined as the time from randomization to the date of death due to any cause. For participants who were still alive at the time of data analysis or who were lost to follow-up, OS time was censored at the date of last contact. OS was measured using Kaplan-Meier (KM) estimates.

Secondary Outcome Measures

Name	Time	Method
Progression Free Survival (PFS) by Independent Review Committee (IRC)	From randomization into maintenance phase up to 1276 days	The PFS time was defined as the time from date of randomization until date of the first documentation of progressive disease (PD) or death due to any cause (whichever occurs first). PFS was assessed as per Response Evaluation Criteria in Solid Tumors version 1.1 (RECIST v1.1) as per IRC. PD was defined as at least a 20 percent (%) increase in the sum of longest diameter (SLD), taking as reference the smallest SLD recorded from baseline or the appearance of 1 or more new lesions. PFS was measured using Kaplan-Meier (KM) estimates.
Best Overall Response (BOR) by Investigator Assessment	From randomization into maintenance phase up to 1276 days	BOR was determined by RECIST v1.1 per Investigator assessment and defined as best-confirmed response of any of following: complete response (CR), partial response (PR), stable disease (SD) and PD recorded from date of randomization until disease progression or recurrence. CR: Disappearance of all evidence of target and non-target lesions. PR: At least 30% reduction from baseline in SLD of all lesions. SD: Neither sufficient increase to qualify for PD nor sufficient shrinkage to qualify for PR. PD is defined as at least a 20% increase in the SLD, taking as reference the smallest SLD recorded from baseline or appearance of 1 or more new lesions. PR or CR confirmed at a subsequent tumor assessment, not sooner than 5 weeks after initial documentation or at an assessment later than the next assessment after the initial documentation of PR or CR. SD confirmed at least 6 weeks after randomization. Confirmed PD equal to progression \<=2 weeks after date of randomization.
Objective Response Rate (ORR) by Investigator Assessment	From randomization into maintenance phase up to 1276 days	The ORR defined as the percentage of all randomized participants with a confirmed best overall response (BOR) of partial response (PR),or complete response (CR) according to RECIST v1.1 and as per Investigator assessment. CR: Disappearance of all evidence of target and non-target lesions. PR: At least 30 percent (%) reduction from baseline in sum of longest diameter (SLD) of all lesions.
Change From Baseline in European Quality of Life 5-dimensions (EQ-5D-5L) Health Outcome Questionnaire Through Composite Index Score up to Safety Follow-up (Up to 152.3 Weeks)	Baseline, Week 3/4, Week 7, Week 13, Week 19, Week 25, Week 31, Week 37, Week 43, Week 49, Week 55, Week 61, Week 67, End of Treatment ( EOT up to 148 weeks) and Safety Follow-up (Up to 152.3 Weeks)	EQ-5D-5L is comprised of the following 5 participant-reported dimensions: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. Each dimension has 5 levels: no problems, slight problems, moderate problems, severe problems, and extreme problems. The responses are used to derive overall composite health state index score, with scores ranging from -0.594 to 1. A higher score indicates better health state.
Change From Baseline in European Quality of Life 5-dimensions Health Outcome Questionnaire Through Visual Analogue Scale up to Safety Follow-up (Up to 152.3 Weeks)	Baseline, Week 3/4, Week 7, Week 13, Week 19, Week 25, Week 31, Week 37, Week 43, Week 49, Week 55, Week 61, Week 67, End of Treatment ( EOT up to 148 weeks) and Safety Follow-up (Up to 152.3 Weeks)	EQ-5D-5L is comprised of the following 5 participant-reported dimensions: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. Each dimension has 5 levels: no problems, slight problems, moderate problems, severe problems, and extreme problems. The responses are used to derive overall score using a visual analog scale (VAS) that ranged from 0 to 100 millimeter (mm), where 0 is the worst health you can imagine and 100 is the best health you can imagine.
Change From Baseline in European Organization for the Research and Treatment of Cancer Quality of Life (EORTC QLQ-C30) Global Health Status Scale Score up to Safety Follow-up (Up to 152.3 Weeks)	Baseline, Week 3/4, Week 7, Week 13, Week 19, Week 25, Week 31, Week 37, Week 43, Week 49, Week 55, Week 61, Week 67, End of Treatment ( EOT up to 148 weeks) and Safety Follow-up (Up to 152.3 Weeks)	European Organization for the Research and Treatment of Cancer Quality of Life (EORTC QLQ-C30) is a 30-question tool used to assess the overall quality of life (QoL) in cancer participants. It consisted of 15 domains: 1 global health status (GHS) scale, 5 functional scales (Physical, role, cognitive, emotional, social), and 9 symptom scales/items (Fatigue, nausea and vomiting, pain, dyspnoea, sleep disturbance, appetite loss, constipation, diarrhea, financial impact. The EORTC QLQ-C30 GHS/QoL score ranges from 0 to 100; High score indicates better GHS/QoL. Score 0 represents: very poor physical condition and QoL. Score 100 represents: excellent overall physical condition and QoL.
Change From Baseline in European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire-Stomach Cancer Specific (EORTC QLQ-STO22 ) Questionnaire Scores up to Safety Follow-up (Up to 152.3 Weeks)	Baseline, Week 3/4, Week 7, Week 13, Week 19, Week 25, Week 31, Week 37, Week 43, Week 49, Week 55, Week 61, Week 67, End of Treatment ( EOT up to 148 weeks) and Safety Follow-up (Up to 152.3 Weeks)	European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire-Stomach Cancer Specific (EORTC QLQ-STO22 ) supplements the EORTC QLQ-C30 to assess symptoms and treatment-related side effects commonly reported in participants. There are 22 questions which comprise 5 scales (dysphagia, pain, reflux symptom, dietary restrictions, and anxiety) and 4 single items (dry mouth, hair loss, taste, body image). Most questions use 4-point scale (1 'Not at all' to 4 'Very much'; 1 question was a yes or no answer). A linear transformation was used to standardize all scores and single-items to a scale of 0 to 100; higher score=better level of functioning or greater degree of symptoms.
Maintenance Phase: Number of Participants With Treatment-Emergent Adverse Events (TEAEs) and Serious TEAEs According to National Cancer Institute-Common Terminology Criteria for Adverse Events Version 4.03 (NCI-CTCAE v4.03)	From randomization into maintenance phase up to 1276 days	Adverse event (AE) was defined as any untoward medical occurrence in a participant, which does not necessarily have causal relationship with treatment. A serious AE was defined as an AE that resulted in any of the following outcomes: death; life threatening; persistent/significant disability/incapacity; initial or prolonged in participant hospitalization; congenital anomaly/birth defect or was otherwise considered medically important. The term TEAE is defined as AEs starting or worsening after the first intake of the study drug. TEAEs included both serious TEAEs and non-serious TEAEs. Number of participants with TEAEs and serious TEAEs were reported.
Maintenance Phase: Number of Participants With Grade Change From Baseline to Worst On-Treatment Grade 4 Hematology Values	From baseline up to 1276 days	Blood samples were collected for the analysis of following hematology parameters: lymphocyte count, neutrophil count, white blood cells, platelet count, lipase, serum amylase, creatinine phosphokinase and creatinine. The hematology parameters were graded according to National Cancer Institute - Common Terminology Criteria for Adverse Events (NCI-CTCAE) version 4.03. Grade 1: mild; Grade 2: moderate; Grade 3: severe or medically significant; Grade 4: life-threatening consequences. An increase is defined as an increase in CTCAE grade relative to Baseline grade. Data for worst-case (Grade 4) post Baseline is presented. Only those participants with increase to grade 4 have been presented.
Maintenance Phase: Number of Participants With Potentially Clinically Significant Abnormalities in Vital Signs	From randomization into maintenance phase up to 1276 days	Vital signs assessment included Systolic blood pressure (SBP), Diastolic blood pressure (DBP) and Pulse Rate (PR). Number of Participants with any potentially clinically significant abnormalities in vital signs were reported. Clinical significance was determined by the investigator.
Maintenance Phase: Number of Participants With Potentially Clinically Significant Electrocardiogram (ECG) Abnormalities	From randomization into maintenance phase up to 1276 days	ECG parameters included heart rate, pulse rate intervals, QRS interval, QT interval corrected based on Fridericia's formula (QTcF) intervals and QTcB intervals. Clinical significance was determined by the investigator. Number of participants with potentially clinically significant ECG abnormalities were reported.
Maintenance Phase: Number of Participants With Shift in Eastern Cooperative Oncology Group (ECOG) Performance Status Score to 1 or Higher Than 1	From randomization into maintenance phase up to 1276 days	ECOG PS score is widely used by doctors and researchers to assess how a participants' disease is progressing, and is used to assess how the disease affects the daily living abilities of the participant, and determine appropriate treatment and prognosis. The score ranges from Grade 0 to Grade 5, where Grade 0 = Fully active, able to carry on all pre-disease performance without restriction, Grade 1 = Restricted in physically strenuous activity but ambulatory and able to carry out work of a light or sedentary nature (like light house work, office work), Grade 2 = Ambulatory and capable of all self-care but unable to carry out any work activities, Grade 3 = Capable of only limited self-care, confined to bed or chair more than 50% of waking hours and Grade 4 = Completely disabled. Cannot carry on any self-care. Totally confined to bed or chair, Grade 5 = Death. Number of participants with shift in ECOG PS Score to 1 or Higher Than 1 were reported.

Trial Locations

Locations (199): University of Rochester
🇺🇸
Rochester, New York, United States
Fiona Stanley Hospital
🇦🇺
Murdoch, Western Australia, Australia
Centre Georges François Leclerc
🇫🇷
Dijon cedex, Côte-d'Or, France
NOB - Núcleo de Oncologia da Bahia
🇧🇷
Salvador, Bahia, Brazil
King Chulalongkorn Memorial Hospital
🇹🇭
Patumwan, Bangkok, Thailand
Institutul Oncologic "Prof. Dr. Ion Chiricuta" Cluj Napoca
🇷🇴
Cluj Napoca, Cluj, Romania
Royal Hobart Hospital
🇦🇺
Hobart, Tasmania, Australia
Magyar Honvedseg Egeszsegugyi
🇭🇺
Budapest, Hungary
Pecsi Tudomanyegyetem
🇭🇺
Pecs, Baranya, Hungary
Petz Aladar Megyei Oktato Korhaz
🇭🇺
Gyor, Győr-Moson-Sopron, Hungary
Zala Megyei Szent Rafael Korhaz
🇭🇺
Zalaegerszeg, Hungary
S.C Oncomed S.R.L
🇷🇴
Timisoara, Timis, Romania
S.C Oncopremium Team S.R.L
🇷🇴
Baia Mare, Romania
CHU Bordeaux
🇫🇷
Bordeaux Cedex, Gironde, France
Debreceni Egyetem Klinikai Kozpont
🇭🇺
Debrecen, Hajdú-Bihar, Hungary
CHU Besancon - Hopital Jean Minjoz
🇫🇷
Besancon, Doubs, France
Tolna Megyei Balassa Janos Korhaz
🇭🇺
Szekszard, Hungary
Jasz-Nagykun-Szolnok Megyei Hetenyi Geza Korhaz-Rendelointezet
🇭🇺
Szolnok, Hungary
Hifu Terramed Conformal SRL
🇷🇴
Bucuresti, Romania
Clinique Victor Hugo - Centre Jean Bernard
🇫🇷
Le Mans Cedex 02, Sarthe, France
SzSzB Megyei Korhazak es Egyetemi Oktatokorhaz
🇭🇺
Nyiregyhaza, Hungary
S.C Radiotherapy Center Cluj S.R.L
🇷🇴
Comuna Floresti, Cluj, Romania
S.C Centrul de Oncologie Sf. Nectarie S.R.L
🇷🇴
Craiova, Dolj, Romania
S.C Oncocenter Oncologie Clinica S.R.L
🇷🇴
Timisoara, Timis, Romania
Institutul Clinic Fundeni
🇷🇴
Bucuresti, Romania
Kaohsiung Chang Gung Memorial Hospital
🇨🇳
Kaohsiung, Taiwan
Derriford Hospital
🇬🇧
Torquay, Devon, United Kingdom
Mackay Memorial Hospital
🇨🇳
Taipei, Taiwan
Spitalul Clinic Coltea
🇷🇴
Bucuresti, Romania
China Medical University Hospital
🇨🇳
Taichung, Taiwan
National Cheng Kung University Hospital
🇨🇳
Tainan, Taiwan
Maharaj Nakorn Chiang Mai Hospital
🇹🇭
Muang, Chiang Mai, Thailand
Siriraj Hospital
🇹🇭
Bangkok, Thailand
Taichung Veterans General Hospital
🇨🇳
Taichung, Taiwan
Chang Gung Memorial Hospital, Linkou
🇨🇳
Taoyuan, Taiwan
Comprehensive Blood & Cancer Center
🇺🇸
Bakersfield, California, United States
St George Hospital
🇦🇺
Kogarah, New South Wales, Australia
Hospital São Lucas da PUCRS
🇧🇷
Porto Alegre, Rio Grande Do Sul, Brazil
Sansum Clinic
🇺🇸
Santa Barbara, California, United States
Norwalk Hospital
🇺🇸
Norwalk, Connecticut, United States
University of South Florida - Parent
🇺🇸
Tampa, Florida, United States
University of Washington - Seattle Cancer Care Alliance
🇺🇸
East Seattle, Washington, United States
St. Luke's Hospital
🇺🇸
Bethlehem, Pennsylvania, United States
University of Texas Health Science Center at San Antonio
🇺🇸
San Antonio, Texas, United States
UC Health Clinical Trials Office
🇺🇸
Cincinnati, Ohio, United States
Wenatchee Valley Hospital & Clinics
🇺🇸
Wenatchee, Washington, United States
Lyell McEwin Hospital
🇦🇺
Elizabeth Vale, South Australia, Australia
Hospital Bruno Born
🇧🇷
Lajeado, Rio Grande Do Sul, Brazil
CEPHO - Centro de Estudos e Pesquisas em Hematologia e Oncologia
🇧🇷
Santo Andre, Sao Paulo, Brazil
Oncosinos - Clínica de Oncologia - Hospital Regina
🇧🇷
Novo Hamburgo, Rio Grande Do Sul, Brazil
Centre Antoine Lacassagne
🇫🇷
Nice cedex 02, Alpes Maritimes, France
McGill University - Dept. Oncology Clinical Research Program
🇨🇦
Montréal, Quebec, Canada
Hôpital de la Timone
🇫🇷
Marseille cedex 5, Bouches Du Rhone, France
Hôpital Européen Georges Pompidou
🇫🇷
Paris Cedex 15, Paris, France
Presidio Ospedaliero Garibaldi Nesima
🇮🇹
Catania, Italy
Ospedale San Raffaele
🇮🇹
Milano, Italy
Cité de la Santé de Laval
🇨🇦
Laval, Quebec, Canada
Hacettepe University Medical Faculty
🇹🇷
Ankara, Turkey
IOV - Istituto Oncologico Veneto IRCCS
🇮🇹
Padova, Italy
Azienda Ospedaliero-Universitaria Santa Maria della Misericordia
🇮🇹
Udine, Italy
Kyungpook National University Medical Center
🇰🇷
Daegu, Korea, Republic of
Keimyung University Dongsan Hospital
🇰🇷
Daegu, Jung-gu, Korea, Republic of
Adana Numune Training and Research Hospital
🇹🇷
Adana, Turkey
Akdeniz University Medical Faculty
🇹🇷
Antalya, Turkey
Istanbul University Cerrahpasa Medical Faculty
🇹🇷
Istanbul, Turkey
Marmara University Pendik Research and Training Hospital
🇹🇷
Istanbul, Turkey
Acibadem Adana Hospital
🇹🇷
Adana, Turkey
Hospital Universitario Virgen del Rocio
🇪🇸
Sevilla, Spain
Dicle University, Medical faculty
🇹🇷
Diyarbakir, Turkey
Inonu Uni. Med. Fac.
🇹🇷
Malatya, Turkey
Mersin University Medical Faculty
🇹🇷
Mersin, Turkey
Barts Hospital
🇬🇧
London, Greater London, United Kingdom
Mount Vernon Hospital
🇬🇧
Northwood, Middlesex, United Kingdom
Konya Necmettin Erbakan University Meram Medical Faculty
🇹🇷
Konya, Turkey
The Clatterbridge Cancer Centre
🇬🇧
Wirral, Merseyside, United Kingdom
Chiba Cancer Center
🇯🇵
Chiba-shi, Chiba-Ken, Japan
The Christie
🇬🇧
Manchester, Greater Manchester, United Kingdom
St James's University Hospital
🇬🇧
Leeds, West Yorkshire, United Kingdom
Oita University Hospital
🇯🇵
Yufu-shi, Oita-ken, Japan
Niigata Cancer Center Hospital
🇯🇵
Niigata-shi, Niigata-Ken, Japan
Kindai University Hospital
🇯🇵
Osakasayama, Osaka-Fu, Japan
Saitama Cancer Center
🇯🇵
Kitaadachi-gun, Saitama-Ken, Japan
Toranomon Hospital
🇯🇵
Minato-ku, Tokyo-To, Japan
Hospital de Câncer de Barretos-Fundação Pio XII
🇧🇷
Barretos, Sao Paulo, Brazil
Fundação Faculdade Regional de Medicina de São José do Rio Preto
🇧🇷
São José do Rio Preto, Sao Paulo, Brazil
ICESP - Instituto do Câncer do Estado de São Paulo Octavio Frias de Oliveira
🇧🇷
São Paulo, Sao Paulo, Brazil
Hospital Infanta Cristina
🇧🇷
Badajoz, Brazil
SBIH " Clinical Oncological Dispensary # 1"
🇷🇺
Krasnodar, Russian Federation
Leopoldina Krankenhaus Schweinfurt
🇩🇪
Schweinfurt, Bayern, Germany
Inje University Haeundae Paik Hospital
🇰🇷
Busan, Korea, Republic of
National Cancer Center
🇰🇷
Goyang-si, Gyeonggi-do, Korea, Republic of
Asan Medical Center
🇰🇷
Seoul, Korea, Republic of
Royal North Shore Hospital
🇦🇺
St Leonards, New South Wales, Australia
Memorial West Cancer Institute
🇺🇸
Pembroke Pines, Florida, United States
Virginia Crosson Cancer Center
🇺🇸
Fullerton, California, United States
UCLA Medical Center
🇺🇸
Los Angeles, California, United States
Desert Hematology Oncology Medical Group, Inc.
🇺🇸
Rancho Mirage, California, United States
UF Health Cancer Center Orlando
🇺🇸
Orlando, Florida, United States
Oncology Specialists, S.C.
🇺🇸
Park Ridge, Illinois, United States
Franciscan St. Francis Health Cancer Center
🇺🇸
Indianapolis, Indiana, United States
Mount Sinai - PRIME
🇺🇸
Jamaica, New York, United States
Nevada Cancer Research Foundation
🇺🇸
Las Vegas, Nevada, United States
University of Kansas Medical Center Research Institute, Inc.
🇺🇸
Westwood, Kansas, United States
Virginia Piper Cancer Institute
🇺🇸
Minneapolis, Minnesota, United States
Clinical Research Alliance, Inc
🇺🇸
New York, New York, United States
Mid Ohio Oncology Hematology, DBA The Mark H. Zangmeister Center
🇺🇸
Columbus, Ohio, United States
TriHealth Hatton Institute
🇺🇸
Cincinnati, Ohio, United States
Oncology Consultants, P.A.
🇺🇸
Houston, Texas, United States
Greenslopes Private Hospital
🇦🇺
Greenslopes, Queensland, Australia
Ballarat Base Hospital
🇦🇺
Ballarat, Victoria, Australia
Flinders Medical Centre
🇦🇺
Bedford Park, South Australia, Australia
Box Hill Hospital
🇦🇺
Box Hill, Victoria, Australia
Royal Brisbane and Women's Hospital
🇦🇺
Herston, Queensland, Australia
Bendigo Hospital
🇦🇺
Bendigo, Victoria, Australia
Monash Medical Centre Clayton
🇦🇺
Bentleigh, Victoria, Australia
Border Medical Oncology
🇦🇺
Wodonga, Victoria, Australia
Hospital de Clínicas de Porto Alegre
🇧🇷
Porto Alegre, Rio Grande Do Sul, Brazil
IMV - Instituto De Medicina Vascular Hospital Mae de Deus
🇧🇷
Porto Alegre, Sao Paulo, Brazil
The Royal Victoria Hospital
🇨🇦
Barrie, Ontario, Canada
Humber River Hospital
🇨🇦
Toronto, Ontario, Canada
Mount Sinai Hospital
🇨🇦
Toronto, Ontario, Canada
Hôpital Morvan
🇫🇷
Brest, Brittany, France
CHU de Toulouse - Hôpital Rangueil
🇫🇷
Toulouse Cedex 9, Haute Garonne, France
CRLCC Eugene Marquis
🇫🇷
Rennes cedex, Ille Et Vilaine, France
CHU Tours - Hôpital Trousseau
🇫🇷
Chambray les Tours, Indre Et Loire, France
ICO - Site René Gauducheau
🇫🇷
Angers Cedex 9, Maine Et Loire, France
Hôpital Cochin
🇫🇷
Paris cedex 14, Paris, France
CHU Clermont Ferrand
🇫🇷
Clermont Ferrand cedex 1, Puy De Dome, France
Krankenhaus Nordwest GmbH
🇩🇪
Frankfurt, Hessen, Germany
Klinikum Bogenhausen
🇩🇪
Muenchen, Bayern, Germany
Klinikum Esslingen GmbH
🇩🇪
Esslingen A. N., Baden Wuerttemberg, Germany
SLK-Kliniken Heilbronn GmbH
🇩🇪
Heilbronn, Baden Wuerttemberg, Germany
Universitaetsmedizin der Johannes Gutenberg-Universitaet Mainz
🇩🇪
Mainz, Rheinland Pfalz, Germany
Onkologische Schwerpunktpraxis Eppendorf
🇩🇪
Hamburg, Germany
Marienkrankenhaus Hamburg
🇩🇪
Hamburg, Germany
Azienda Socio Sanitaria Territoriale di Cremona (Istituti Ospitalieri di Cremona)
🇮🇹
Cremona, Italy
Azienda Ospedaliera Universitaria Careggi
🇮🇹
Firenze, Italy
Istituto Nazionale Tumori Fondazione G. Pascale
🇮🇹
Napoli, Italy
Fondazione IRCCS Istituto Nazionale dei Tumori
🇮🇹
Milano, Italy
IEO Istituto Europeo di Oncologia
🇮🇹
Milano, Italy
Università Campus Bio-Medico di Roma
🇮🇹
Roma, Italy
Seconda Università degli Studi di Napoli
🇮🇹
Napoli, Italy
Ospedale degli Infermi
🇮🇹
Rimini, Italy
Azienda Ospedaliera S. Maria Di Terni
🇮🇹
Terni, Italy
Kumamoto University Hospital
🇯🇵
Kumamoto-shi, Kumamoto-Ken, Japan
Kagawa University Hospital
🇯🇵
Kita-gun, Kagawa-Ken, Japan
Kanagawa Cancer Center
🇯🇵
Yokohama-shi, Kanagawa-Ken, Japan
Tohoku University Hospital
🇯🇵
Sendai-shi, Miyagi-Ken, Japan
Izumi Municipal Hospital
🇯🇵
Izumi-shi, Osaka, Japan
Saitama Medical University International Medical Center
🇯🇵
Hidaka-shi, Saitama-Ken, Japan
Tochigi Cancer Center
🇯🇵
Utsunomiya-shi, Tochigi-Ken, Japan
Nat Cancer Ctr Hosp
🇯🇵
Chuo-ku, Tokyo-To, Japan
Kagoshima University Medical And Dental Hospital
🇯🇵
Kagoshima-shi, Japan
Chungbuk National University Hospital
🇰🇷
Cheongju-si, Chungcheongbuk-do, Korea, Republic of
Seoul National University Bundang Hospital
🇰🇷
Seongnam-si, Gyeonggi-do, Korea, Republic of
Korea University Anam Hospital
🇰🇷
Seoul, Korea, Republic of
Yonsei University Health System
🇰🇷
Seoul, Korea, Republic of
The Catholic University of Korea, Seoul St. Mary's Hospital
🇰🇷
Seoul, Korea, Republic of
Seoul National University Hospital
🇰🇷
Seoul, Korea, Republic of
Spital Lotus SRL
🇷🇴
Ploiesti, Prahova, Romania
Pavlov First Saint Petersburg State Medical University
🇷🇺
Saint-Petersburg, Leningrado, Russian Federation
Institutul Regional de Oncologie Iasi
🇷🇴
Iasi, Romania
FBI "Scientific Research Institute of Oncology n. a. N. N. Petrov"
🇷🇺
Saint-Petersburg, Leningrado, Russian Federation
LLC Evimed
🇷🇺
Chelyabinsk, Russian Federation
SBIH of Arkhangelsk region "Arkhangelsk Clinical Oncological Dispensary"
🇷🇺
Arkhangelsk, Russian Federation
RBIH "Ivanovo Regional Oncological Dispensary"
🇷🇺
Ivanovo, Russian Federation
BHI of Omsk region "Clinical Oncology Dispensary"
🇷🇺
Omsk, Russian Federation
SBIH of Stavropol territory "Pyatigorsk Oncological Dispensary"
🇷🇺
Pyatigorsk, Russian Federation
FSBSI "Russian Oncological Scientific Center n.a. N.N. Blokhin"
🇷🇺
Moscow, Russian Federation
Hospital General Universitario de Elche
🇪🇸
Elche, Alicante, Spain
SPb SBIH "City Clinical Oncological Dispensary"
🇷🇺
Saint-Petersburg, Russian Federation
ICO l´Hospitalet - Hospital Duran i Reynals
🇪🇸
L'Hospitalet de Llobregat, Barcelona, Spain
Hospital Clinic i Provincial de Barcelona
🇪🇸
Barcelona, Spain
Hospital Universitari Vall d'Hebron
🇪🇸
Barcelona, Spain
Hospital de la Santa Creu i Sant Pau
🇪🇸
Barcelona, Spain
Corporacio Sanitaria Parc Tauli
🇪🇸
Sabadell, Barcelona, Spain
Hospital General Universitario Gregorio Marañon
🇪🇸
Madrid, Spain
Hospital Universitario 12 de Octubre
🇪🇸
Madrid, Spain
Hospital Universitario La Paz
🇪🇸
Madrid, Spain
Hospital Universitario HM Madrid Sanchinarro
🇪🇸
Madrid, Spain
Kocaeli University Medical Faculty
🇹🇷
Kocaeli, Turkey
University College London Hospitals
🇬🇧
London, Greater London, United Kingdom
Royal Surrey County Hospital
🇬🇧
Guildford, Surrey, United Kingdom
Ninewells Hospital
🇬🇧
Dundee, Tayside Region, United Kingdom
Thomas Jefferson University Hospital
🇺🇸
Philadelphia, Pennsylvania, United States
University of Texas Southwestern Medical Center
🇺🇸
Dallas, Texas, United States
Chonnam National University Hwasun Hospital
🇰🇷
Hwasun-gun, Jeollanam-do, Korea, Republic of
Northwest Medical Specialties, PLLC
🇺🇸
Tacoma, Washington, United States
Taipei Veterans General Hospital
🇨🇳
Taipei, Taiwan
Trio - Central Coast Medical Oncology Corporation
🇺🇸
Santa Maria, California, United States
Oregon Health & Science University
🇺🇸
Portland, Oregon, United States
Greenville Hospital System University Medical Center (ITOR)
🇺🇸
Greenville, South Carolina, United States
Cedar Rapids Oncology Project
🇺🇸
Cedar Rapids, Iowa, United States
Cotton-O'Neil Clinical Research Center, Hematology and Oncology
🇺🇸
Topeka, Kansas, United States
Baylor Scott & White Health
🇺🇸
Temple, Texas, United States
Royal Melbourne Hospital
🇦🇺
Parkville, Victoria, Australia
National Taiwan University Hospital
🇨🇳
Taipei, Taiwan
Rhode Island Hospital
🇺🇸
Providence, Rhode Island, United States
Queen Elizabeth II Health Sciences Centre
🇨🇦
Halifax, Nova Scotia, Canada