A Study of Atezolizumab in Combination With Carboplatin + Paclitaxel or Carboplatin + Nab-Paclitaxel Compared With Carboplatin + Nab-Paclitaxel in Participants With Stage IV Squamous Non-Small Cell Lung Cancer (NSCLC) [IMpower131]
- Conditions
- Squamous Non-Small Cell Lung Cancer
- Interventions
- Registration Number
- NCT02367794
- Lead Sponsor
- Hoffmann-La Roche
- Brief Summary
This randomized, open-label study will evaluate the safety and efficacy of atezolizumab (MPDL3280A) in combination with carboplatin + paclitaxel or carboplatin + nab-paclitaxel compared with treatment with carboplatin + nab-paclitaxel in chemotherapy-naive participants with Stage IV squamous NSCLC.
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 1021
- Eastern Cooperative Oncology Group (ECOG) performance status 0 or 1
- Histologically or cytologically confirmed, treatment-naïve Stage IV squamous NSCLC
- Previously obtained archival tumor tissue or tissue obtained from biopsy at screening
- Measurable disease as defined by RECIST v1.1
- Adequate hematologic and end organ function
- Active or untreated central nervous system (CNS) metastasis
- Malignancies other than NSCLC within 5 years prior to randomization, with the exception of those with a negligible risk of metastasis or death treated with expected curative outcome
- Pregnant or lactating women
- History of autoimmune disease
- History of idiopathic pulmonary fibrosis, organizing pneumonia, drug-induced pneumonitis, idiopathic pneumonitis, or evidence of active pneumonitis on screening chest Computed Tomography (CT) scan, History of radiation pneumonitis in the radiation field (fibrosis) is permitted
- Positive test for Human Immunodeficiency Virus (HIV)
- Active hepatitis B or hepatitis C
- Prior treatment with cluster of differentiation 137 (CD137) agonists or immune checkpoint blockade therapies, anti-programmed death-1 (anti-PD-1), and anti-PD-L1 therapeutic antibody
- Severe infection within 4 weeks prior to randomization
- Significant history of cardiovascular disease
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Arm A: Atezolizumab + Paclitaxel + Carboplatin Atezolizumab (MPDL3280A), an engineered anti-programmed death-ligand 1 (anti-PD-L1) antibody The induction phase of the study will consist of four or six cycles; atezolizumab, paclitaxel, and carboplatin will be administered on Day 1 of each 21-day cycle. The Day 1 order of drug administration is as follows: atezolizumab, then paclitaxel, then carboplatin. Participants who experience no further clinical benefit at any time during the induction phase will discontinue all study treatments. In the absence of the above criteria, after the 4- or 6-cycle induction phase, participants will begin maintenance therapy with atezolizumab. Atezolizumab will be continued as long as there is a clinical benefit to the participant. Arm B: Atezolizumab + Nab-Paclitaxel + Carboplatin Nab-Paclitaxel The induction phase of the study will consist of four or six cycles; atezolizumab and carboplatin will be administered on Day 1 of each 21-day cycle. Nab-Paclitaxel will be administered on Days 1, 8, and 15 of each 21-day cycle. The Day 1 order of drug administration is as follows: atezolizumab, then nab-paclitaxel, then carboplatin. Participants who experience no further clinical benefit at any time during the induction phase will discontinue all study treatments. In the absence of the above criteria, after the 4- or 6-cycle induction phase, participants will begin maintenance therapy with atezolizumab. Atezolizumab will be continued as long as there is a clinical benefit to the participant. Arm B: Atezolizumab + Nab-Paclitaxel + Carboplatin Atezolizumab (MPDL3280A), an engineered anti-programmed death-ligand 1 (anti-PD-L1) antibody The induction phase of the study will consist of four or six cycles; atezolizumab and carboplatin will be administered on Day 1 of each 21-day cycle. Nab-Paclitaxel will be administered on Days 1, 8, and 15 of each 21-day cycle. The Day 1 order of drug administration is as follows: atezolizumab, then nab-paclitaxel, then carboplatin. Participants who experience no further clinical benefit at any time during the induction phase will discontinue all study treatments. In the absence of the above criteria, after the 4- or 6-cycle induction phase, participants will begin maintenance therapy with atezolizumab. Atezolizumab will be continued as long as there is a clinical benefit to the participant. Arm C: Nab-Paclitaxel + Carboplatin Nab-Paclitaxel The induction phase of the study will consist of four or six cycles; carboplatin will be administered on Day 1 of each 21-day cycle, nab-paclitaxel will be administered on Days 1, 8, and 15 of each 21-day cycle. The Day 1 order of drug administration is as follows: nab-paclitaxel, then carboplatin. Participants who experience disease progression at any time during the induction phase will discontinue all study treatment. In the maintenance phase, participants will receive best supportive care. Arm A: Atezolizumab + Paclitaxel + Carboplatin Carboplatin The induction phase of the study will consist of four or six cycles; atezolizumab, paclitaxel, and carboplatin will be administered on Day 1 of each 21-day cycle. The Day 1 order of drug administration is as follows: atezolizumab, then paclitaxel, then carboplatin. Participants who experience no further clinical benefit at any time during the induction phase will discontinue all study treatments. In the absence of the above criteria, after the 4- or 6-cycle induction phase, participants will begin maintenance therapy with atezolizumab. Atezolizumab will be continued as long as there is a clinical benefit to the participant. Arm A: Atezolizumab + Paclitaxel + Carboplatin Paclitaxel The induction phase of the study will consist of four or six cycles; atezolizumab, paclitaxel, and carboplatin will be administered on Day 1 of each 21-day cycle. The Day 1 order of drug administration is as follows: atezolizumab, then paclitaxel, then carboplatin. Participants who experience no further clinical benefit at any time during the induction phase will discontinue all study treatments. In the absence of the above criteria, after the 4- or 6-cycle induction phase, participants will begin maintenance therapy with atezolizumab. Atezolizumab will be continued as long as there is a clinical benefit to the participant. Arm B: Atezolizumab + Nab-Paclitaxel + Carboplatin Carboplatin The induction phase of the study will consist of four or six cycles; atezolizumab and carboplatin will be administered on Day 1 of each 21-day cycle. Nab-Paclitaxel will be administered on Days 1, 8, and 15 of each 21-day cycle. The Day 1 order of drug administration is as follows: atezolizumab, then nab-paclitaxel, then carboplatin. Participants who experience no further clinical benefit at any time during the induction phase will discontinue all study treatments. In the absence of the above criteria, after the 4- or 6-cycle induction phase, participants will begin maintenance therapy with atezolizumab. Atezolizumab will be continued as long as there is a clinical benefit to the participant. Arm C: Nab-Paclitaxel + Carboplatin Carboplatin The induction phase of the study will consist of four or six cycles; carboplatin will be administered on Day 1 of each 21-day cycle, nab-paclitaxel will be administered on Days 1, 8, and 15 of each 21-day cycle. The Day 1 order of drug administration is as follows: nab-paclitaxel, then carboplatin. Participants who experience disease progression at any time during the induction phase will discontinue all study treatment. In the maintenance phase, participants will receive best supportive care.
- Primary Outcome Measures
Name Time Method Overall Survival (OS) in the ITT Population Up to approximately 39 months after first participant enrolled OS is defined as the time between the date of randomization and date of death from any cause in the ITT population.
Progression Free Survival (PFS) as Determined by the Investigator Using Response Evaluation Criteria in Solid Tumors Version 1.1 (RECIST v1.1) in the Intent-to-Treat (ITT) Population Up to approximately 30 months after first participant enrolled PFS is defined as the time between the date of randomization and the date of first documented disease progression or death, whichever occurs first, in the ITT population.
- Secondary Outcome Measures
Name Time Method PFS as Determined by the Investigator Using RECIST v1.1 in the TC1/2/3 or IC1/2/3 Population Up to approximately 30 months after first participant enrolled PFS is defined as the time between the date of randomization and the date of first documented disease progression or death, whichever occurs first, in the TC1/2/3 or IC1/2/3 Population.
OS in the TC2/3 or IC2/3 Population Up to approximately 39 months after first participant enrolled OS is defined as the time between the date of randomization and date of death from any cause, in the TC2/3 or IC2/3 Population.
OS in the TC1/2/3 or IC1/2/3 Population Up to approximately 39 months after first participant enrolled OS is defined as the time between the date of randomization and date of death from any cause in the TC1/2/3 or IC1/2/3 Population.
Percentage of Participants With Objective Response as Determined by the Investigator Using RECIST v1.1 in the ITT Population Up to approximately 30 months after first participant enrolled Proportion of participants with an objective response (CR or PR) in the ITT population.
Percentage of Participants With Adverse Events Up to approximately 68 months after first participant enrolled Percentage of participants with at least one adverse event.
Percentage of Participants With Anti-therapeutic Antibody (ATA) Response to Atezolizumab Up to approximately 30 months after first participant enrolled Percentage of participants with Anti-therapeutic Antibody (ATA) response to atezolizumab.
Maximum Observed Serum Atezolizumab Concentration (Cmax) Cycle 1 Day 1 and Cycle 3 Day 1 (Cycle length = 21 days) Maximum observed serum atezolizumab concentration (Cmax). The predose samples will be collected on the same day of treatment administration. The infusion duration of atezolizumab will be of 30-60 minutes.
PFS as Determined by the Investigator Using RECIST v1.1 in the ITT Population (Arm A and Arm B) Up to approximately 30 months after first participant enrolled PFS is defined as the time between the date of randomization and the date of first documented disease progression or death, whichever occurs first, in the ITT Population Arm A and Arm B.
Plasma Concentrations for Paclitaxel Prior to infusion (within same day of treatment administration), 5-10 minutes before the end of infusion, and 1 hour after the end of infusion (infusion duration 180 minutes) on Day 1 of Cycles 1 and 3 (each cycle is 21 days) Plasma concentrations for paclitaxel.
Plasma Concentrations for Carboplatin Prior to infusion (within same day of treatment administration), 5-10 minutes before the end of infusion, and 1 hour after the end of infusion (infusion duration 15 to 30 minutes) on Day 1 of Cycles 1 and 3 (each cycle is 21 days) Plasma concentrations for carboplatin.
OS in the in the Teff Population Up to approximately 39 months after first participant enrolled OS is defined as the time between the date of randomization and date of death from any cause in the in the Teff Population.
PFS as Determined by the Investigator Using RECIST v1.1 in the Teff Population Up to approximately 30 months after first participant enrolled PFS is defined as the time between the date of randomization and the date of first documented disease progression or death, whichever occurs first, in the Teff Population.
PFS as Determined by the Investigator Using RECIST v1.1 in the Tumor Cell (TC) 2/3 or Tumor-Infiltrating Immune Cell (IC) 2/3 Population Up to approximately 30 months after first participant enrolled PFS is defined as the time between the date of randomization and the date of first documented disease progression or death, whichever occurs first, in the Tumor Cell (TC) 2/3 or Tumor-Infiltrating Immune Cell (IC) 2/3 Population.
Plasma Concentrations for Nab-Paclitaxel Prior to infusion (within same day of treatment administration), 5-10 minutes before the end of infusion, and 1 hour after the end of infusion (infusion duration 30 minutes) on Day 1 of Cycles 1 and 3 (each cycle is 21 days) Plasma concentrations for nab-paclitaxel.
Minimum Observed Serum Atezolizumab Concentration (Cmin) Predose on Day 1 of Cycles 1-4, 8, 16, every 8 cycle thereafter (up to 30 months), at treatment discontinuation (up to 30 months), and at 120 days after the last dose of atezolizumab (up to approximately 30 months, each cycle is 21 days) Minimum observed serum atezolizumab concentration (Cmin). The predose samples will be collected on the same day of treatment administration.
Duration of Response as Determined by the Investigator Using RECIST v1.1 in the ITT Population Up to approximately 30 months after first participant enrolled Duration of response is defined as the time from the first documented objective response to documented PD or death from any cause, whichever occurred first, in the ITT Population.
Event Free Rate at 1 and 2 Years in the ITT Population 1 and 2 years Event free rate at 1 and 2 years is defined as the proportion of participants alive at 1 and 2 years after randomization estimated using Kaplan-Meier (KM) methodology for the ITT population.
Time to Deterioration (TTD) in Patient-reported Lung Cancer Symptoms Using EORTC QLQ-C30 Symptom Subscales in the ITT Population Up to approximately 30 months after first participant enrolled TTD in Patient-reported Lung Cancer Symptoms Using EORTC QLQ-C30 Symptom Subscales in the ITT Population. The EORTC QLQ-C30 is a validated and reliable self-report measure that consists of 30 questions that assess five aspects of patient functioning (physical, emotional, role, cognitive, and social), three symptom scales (fatigue, nausea and vomiting, pain), global health/quality of life, and six single items (dyspnea, insomnia, appetite loss, constipation, diarrhea, and financial difficulties). EORTC scales and single-item measures will be linearly transformed so that each score has a range of 0-100. A high score for a functional scale represents a high or healthy level of functioning, and a high score for the global health status and HRQoL represents a high HRQoL; however, a high score for a symptom scale or item represents a high level of symptomatology or problems.
TTD in Patient-reported Lung Cancer Symptoms Using EORTC QLQ-LC13 Symptom Subscales in the ITT Population Up to approximately 30 months after the first participant enrolled TTD was documented for a 3-symptom composite endpoint using the following EORTC QLQ-LC13 symptom scores: cough, chest pain, and dyspnea multi--item scale. In this instance, symptom deterioration will be determined as a \>= 10-point increase above baseline in any of the listed symptom scores, whichever occurs first (cough, chest pain, and dyspnea multi-item scale). Confirmed clinically meaningful symptom deterioration will need to be held for the original symptom; a \>= 10-point increase above baseline in a symptom score must be held for at least two consecutive assessments or an initial\>=10-point increase above baseline followed by death within 3 weeks from the last assessment. A \>= 10-point change in the EORTC scale score is perceived by patients as clinically significant.
Change From Baseline in Patient-reported Lung Cancer Symptoms Score Using the SILC Scale Symptom Severity Score in the ITT Population Baseline up to approximately 30 months after first participant enrolled Change from baseline per SILC scale will be analyzed for each lung cancer symptoms scores. SILC questionnaire comprises 3 individual symptoms \& are scored at individual symptom level, thus have a dyspnea score, chest pain score, \& cough score. There are a total of 9 questions in SILC questionnaire, each question has a minimum value of 0 \& maximum value of 4. Each individual symptom score is calculated as average of responses for symptom items. 'Chest pain' score is mean of question 1 \& 2, 'Cough' score is mean of question 3 \& 4 and 'Dyspnea' score is mean of question 5 to 9 in SILC questionnaire. An increase in score is suggestive of a worsening in symptomology. A score change of ≥0.3 points for dyspnea \& cough symptom scores is considered to be clinically significant; whereas a score change of ≥0.5 points for chest pain score is considered to be clinically significant. (Note: PD=progression of disease)
OS in the ITT Population (Arm A and Arm B) Up to approximately 39 months after first participant enrolled OS is defined as the time between the date of randomization and date of death from any cause in the ITT Population, Arm A and Arm B.
Trial Locations
- Locations (242)
Southern CA Permanente Med Grp
🇺🇸Bellflower, California, United States
Kaiser Permanente Oakland Medical Center
🇺🇸Oakland, California, United States
Kaiser Permanente - Santa Clara
🇺🇸Santa Clara, California, United States
Kaiser Permanente; Oncology Clinical Trials
🇺🇸Vallejo, California, United States
Kaiser Permanente - Walnut Creek
🇺🇸Walnut Creek, California, United States
Holy Cross Hospital Inc
🇺🇸Fort Lauderdale, Florida, United States
SCRI Florida Cancer Specialists South
🇺🇸Fort Myers, Florida, United States
Hematology Oncology Associates of the Treasure Coast
🇺🇸Port Saint Lucie, Florida, United States
Florida Cancer Specialists
🇺🇸Palm Beach Gardens, Florida, United States
Florida Cancer Specialists (St. Petersburg - St. Anthony's Professional Building)
🇺🇸Saint Petersburg, 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
Central Georgia Cancer Care PC
🇺🇸Macon, Georgia, United States
Southeastern Regional Medical Center, Inc.
🇺🇸Newnan, Georgia, United States
University of Chicago
🇺🇸Chicago, Illinois, United States
Joliet Oncology-Hematology; Associates, Ltd.
🇺🇸Joliet, Illinois, United States
Quincy Medical Group
🇺🇸Quincy, Illinois, United States
Hematology-Oncology; Associates of the Quad Cities
🇺🇸Bettendorf, Iowa, United States
Siouxland Hematology/Oncology
🇺🇸Sioux City, Iowa, United States
Fort Wayne Med Oncology & Hematology Inc
🇺🇸Fort Wayne, Indiana, United States
Lahey Clinic Med Ctr
🇺🇸Lexington, Kentucky, United States
Southcoast Health System; Southcoast Centers For Cancer Care
🇺🇸Fairhaven, Massachusetts, United States
St. Luke's Regional Cancer Center
🇺🇸Duluth, Minnesota, United States
Regional Cancer Care Associates LLC
🇺🇸Sewell, New Jersey, United States
W.G. Bill Hefner VA Medical Center
🇺🇸Salisbury, North Carolina, United States
Clinical Research Alliance
🇺🇸Westbury, New York, United States
Mark H. Zangmeister Center
🇺🇸Columbus, Ohio, United States
Oncology Hematology Care, Inc.
🇺🇸Hamilton, Ohio, United States
Univ of Pittsburgh Medical Ctr
🇺🇸Pittsburgh, Pennsylvania, United States
St. Luke's Cancer Care Associates
🇺🇸Bethlehem, Pennsylvania, United States
Allegheny Cancer Center
🇺🇸Pittsburgh, Pennsylvania, United States
Maryland Oncology Hematology (Lanham) - USOR
🇺🇸Gettysburg, Pennsylvania, United States
SCRI The Center For Cancer and Blood Disorders
🇺🇸Denton, Texas, United States
Longview Cancer Center
🇺🇸Longview, Texas, United States
Virginia Oncology Associates
🇺🇸Norfolk, Virginia, United States
Virginia Cancer Specialists, PC
🇺🇸Fairfax, Virginia, United States
Centro Oncologico Riojano Integral (CORI)
🇦🇷La Rioja, Argentina
Blue Ridge Cancer Care
🇺🇸Roanoke, Virginia, United States
Medical Oncology Associates
🇺🇸Spokane, Washington, United States
Providence Regional Cancer Partnership
🇺🇸Everett, Washington, United States
Fundacion Koriza
🇦🇷Santa Rosa, Argentina
Chris O'Brien Lifehouse
🇦🇺Camperdown, New South Wales, Australia
Calvary Mater Newcastle; Medical Oncology
🇦🇺Waratah, New South Wales, Australia
Centro de Investigacion; Clinica - Clinica Viedma S.A.
🇦🇷Viedma, Argentina
Prince Charles Hospital
🇦🇺Chermside, Queensland, Australia
Townsville Hospital
🇦🇺Townsville, Queensland, Australia
Princess Alexandra Hospital
🇦🇺Woolloongabba, Queensland, Australia
Royal Adelaide Hospital
🇦🇺Adelaide, South Australia, Australia
Austin Health
🇦🇺Heidelberg, Victoria, Australia
CHU Sart-Tilman
🇧🇪Liège, Belgium
Werken Glorieux VZW
🇧🇪Ronse, Belgium
Cenantron - Centro Avancado de Tratamento Oncologico
🇧🇷Belo Horizonte, MG, Brazil
Instituto Do Cancer Delondrina_X; Unidade De Pesquisa Clinica
🇧🇷Londrina, PR, Brazil
IPCEM; Instituto de Pesquisa de Estudos Multicêntricos
🇧🇷Caxias do Sul, RS, Brazil
Hospital das Clinicas - UFRGS
🇧🇷Porto Alegre, RS, Brazil
Hospital Bruno Born
🇧🇷Lajeado, RS, Brazil
Hospital Mae de Deus
🇧🇷Porto Alegre, RS, Brazil
Hospital de Base de Sao Jose do Rio Preto
🇧🇷Sao Jose do Rio Preto, SP, Brazil
Hospital Do Cancer A C Camargo
🇧🇷Sao Paulo, SP, Brazil
Royal Victoria Regional Health Centre
🇨🇦Barrie, Ontario, Canada
Multiprofile Hospital for Active Treatment Serdika EOOD
🇧🇬Sofia, Bulgaria
Lakeridge Health Center
🇨🇦Oshawa, Ontario, Canada
William Osler Health Centre
🇨🇦Etobicoke, Ontario, Canada
St. Jerome Medical Research
🇨🇦St. Jerome, Quebec, Canada
Sociedad de Investigaciones Medicas Ltda (SIM)
🇨🇱Temuco, Chile
CHU de Grenoble
🇫🇷Grenoble, France
Ctr Jean Bernard Clin V. Hugo; Service d'Oncologie Méd
🇫🇷Le Mans, France
Health & Care SPA
🇨🇱Santiago, Chile
Centre Léon Bérard Centre Régional de Lutte Contre Le Cancer Rhône Alpes
🇫🇷Lyon, France
Clinique Clémentville
🇫🇷Montpellier, France
Hopital de La Source
🇫🇷Orleans, France
Centre Hospitalier Lyon Sud
🇫🇷Pierre Benite, France
Hopital de Pontchaillou; Service de Pneumologie
🇫🇷Rennes, France
Centre Hospitalier Regional Sud Reunion; Service de Pneumologie
🇫🇷Saint Pierre, France
Charite - Universitätsmedizin Berlin
🇩🇪Berlin, Germany
Hôpital d'Instruction des Armées de Sainte Anne; Service Pharmacie Essais Cliniques
🇫🇷Toulon Cedex 9, France
CH de Saint Quentin
🇫🇷Saint Quentin, France
Ev.Krankenhaus Bielefeld gGmbH; Klinik für Innere Medizin und Geriatrie
🇩🇪Bielefeld, Germany
Augusta Kranken-Anstalt gGmbH
🇩🇪Bochum, Germany
Universitätsklinikum "Carl Gustav Carus" der Technischen Universität Dresden
🇩🇪Dresden, Germany
St. Elisabethen Krankenhaus
🇩🇪Frankfurt am Main, Germany
Robert Bosch Krankenhaus; Pneumologie und pneumologische Onkologie
🇩🇪Gerlingen, Germany
LungenClinic Großhansdorf GmbH
🇩🇪Großhansdorf, Germany
Universitätsklinikum Hamburg-Eppendorf
🇩🇪Hamburg, Germany
Krankenhaus Martha-Maria; Halle-Dolau gGmbH
🇩🇪Halle, Germany
Asklepios Klinik Harburg
🇩🇪Hamburg, Germany
Lungenklinik Hemer
🇩🇪Hemer, Germany
Fachklinik für Lungenerkrankungen
🇩🇪Immenhausen, Germany
Kliniken der Stadt Koln gGmbH
🇩🇪Koln, Germany
Universität Des Saarlandes; Klinik für Innere Medizin V
🇩🇪Homburg, Germany
Johannes Wesling Klinikum Minden; Hämatologie, Onkologie, Hämostaseologie und Palliativmedizin
🇩🇪Minden, Germany
Klinikum Bogenhausen; Klinik für Pneumologie und Pneumologische Onkologie
🇩🇪München, Germany
Stiftung Mathias-Spital Rheine
🇩🇪Rheine, Germany
Krankenhaus Barmherzige Bruder Regensburg
🇩🇪Regensburg, Germany
Klinikum der Universität Regensburg
🇩🇪Regensburg, Germany
Schwarzwald-Baar Klinikum/VS GmbH; Onkologie/Hämatologie/Infektologie
🇩🇪Villingen-Schwenningen, Germany
Hadassah University Hospital - Ein Kerem
🇮🇱Jerusalem, Israel
Meir Medical Center; Oncology
🇮🇱Kfar-Saba, Israel
AORN A Cardarelli
🇮🇹Napoli, Campania, Italy
Azienda Ospedaliera di Rilievo Nazionale e di Alta Specialita San Giuseppe Moscati
🇮🇹Avellino, Campania, Italy
Azienda Ospedaliero Universitaria Seconda Università degli Studi di Napoli; Farmacia Centralizzata
🇮🇹Napoli, Campania, Italy
Azienda Ospedaliera San Camillo Forlanini
🇮🇹Roma, Lazio, Italy
Istituto Nazionale per lo Studio e la Cura dei Tumori Fondazione G. Pascale
🇮🇹Napoli, Campania, Italy
Fondazione IRCCS Policlinico San Matteo
🇮🇹Pavia, Lombardia, Italy
Ospedale Civile - Livorno
🇮🇹Livorno, Toscana, Italy
IRCCS Giovanni Paolo II Istituto Oncologico
🇮🇹Bari, Puglia, Italy
Azienda Ospedaliero Universitaria Pisana
🇮🇹Pisa, Toscana, Italy
Ospedale Silvestrini
🇮🇹Perugia, Umbria, Italy
National Hospital Organization Shikoku Cancer Center; Internal Medicine
🇯🇵Ehime, Japan
Kyushu University Hospital; Respiratory
🇯🇵Fukuoka, Japan
Kobe City Medical Center General Hospital; Respiratory Medicine
🇯🇵Hyogo, Japan
Hyogo Cancer Center; Thoracic Oncology
🇯🇵Hyogo, Japan
Kyoto University Hospital, Respiratory Medicine
🇯🇵Kyoto, Japan
Niigata University Medical & Dental Hospital; Respiratory Medicine and Infectious Disease
🇯🇵Niigata, Japan
Okayama University Hospital; Respiratory and Allergy Medicine
🇯🇵Okayama, Japan
Osaka International Cancer Institute; Thoracic Oncology
🇯🇵Osaka, Japan
Kansai Medical university Hospital; Thoracic Oncology
🇯🇵Osaka, Japan
Osaka City Uni Hospital; Respiratory Medicine
🇯🇵Osaka, Japan
Osaka Habikino Medical Center
🇯🇵Osaka, Japan
Saitama Cancer Center; Thoracic Oncology
🇯🇵Satima, Japan
National Hospital Organization Kinki-Chuo Chest Medical Center
🇯🇵Sakai-shi, Japan
Shizuoka Cancer Center; Thoracic Oncology
🇯🇵Shizuoka, Japan
National Cancer Center Hospital; Thoracic Medical Oncology
🇯🇵Tokyo, Japan
Tokyo Medical University Hospital; Dept of Surgery
🇯🇵Tokyo, Japan
VU Medisch Centrum; VU University Medical Center
🇳🇱Amsterdam, Netherlands
Het Nederlands Kanker Instituut Antoni Van Leeuwenhoek Ziekenhuis
🇳🇱Amsterdam, Netherlands
Catharina Hospital; Afdeling Longgeneeskunde en Tuberculose
🇳🇱Eindhoven, Netherlands
Ziekenhuis Gelderse Vallei
🇳🇱EDE, Netherlands
St. Antonius Ziekenhuis; R&D Long
🇳🇱Nieuwegein, Netherlands
Centro Medico Monte Carmelo
🇵🇪Arequipa, Peru
Hospital Nacional Guillermo Almenara Irigoyen ESSALUD
🇵🇪Lima, Peru
Instituto Regional de Enfermedades Neoplásicas Del Norte
🇵🇪Trujillo, Peru
IPO de Lisboa; Servico de Pneumologia
🇵🇹Lisboa, Portugal
Hospital Pulido Valente; Servico de Pneumologia
🇵🇹Lisboa, Portugal
Centro Hospitalar do Porto - Hospital de Santo António
🇵🇹Porto, Portugal
Instituto Portugues de Oncologia Do Porto Francisco Gentil Epe
🇵🇹Porto, Portugal
Hospital de Sao Joao; Servico de Pneumologia
🇵🇹Porto, Portugal
Moscow City Oncology Hospital #62
🇷🇺Moscovskaya Oblast, Moskovskaja Oblast, Russian Federation
Clinical Oncology Dispensary
🇷🇺Omsk, Russian Federation
City Clinical Oncology Dispensary
🇷🇺Saint-Petersburg, Russian Federation
Volgograd Regional Clinical Oncology Dispensary
🇷🇺Volgograd, Russian Federation
National University Hospital
🇸🇬Singapore, Singapore
National Cancer Centre
🇸🇬Singapore, Singapore
POKO Poprad s.r.o.
🇸🇰Poprad, Slovakia
Hospital Universitario Marques de Valdecilla; Servicio de Oncologia
🇪🇸Santander, Cantabria, Spain
Complejo Hospitalario Universitario A Coruña
🇪🇸A Coruña, LA Coruña, Spain
Hospital General Universitario Gregorio Marañon; Servicio de Oncologia
🇪🇸Madrid, Spain
Hospital del Mar
🇪🇸Barcelona, Spain
Hospital Universitario de Canarias
🇪🇸S. Cristobal De La Laguna, Tenerife, Spain
Hospital Univ Vall d'Hebron; Servicio de Oncologia
🇪🇸Barcelona, Spain
Hospital Clinic de Barcelona
🇪🇸Barcelona, Spain
Hospital Lucus Augusti; Servicio de Oncologia
🇪🇸Lugo, Spain
Hospital de la Santa Creu i Sant Pau; Servicio de Oncologia
🇪🇸Barcelona, Spain
Hospital Universitario Reina Sofia
🇪🇸Cordoba, Spain
Hospital Ramon y Cajal; Servicio de Oncologia
🇪🇸Madrid, Spain
Fundación Jimenez Díaz
🇪🇸Madrid, Spain
Hospital Universitario La Paz
🇪🇸Madrid, Spain
Hospital Clinico San Carlos; Servicio de Oncologia
🇪🇸Madrid, Spain
Hospital Universitario 12 de Octubre
🇪🇸Madrid, Spain
HOSPITAL DE MADRID NORTE SANCHINARRO- CENTRO INTEGRAL ONCOLOGICO CLARA CAMPAL; Servicio de Oncologia
🇪🇸Madrid, Spain
Hospital Clinico Universitario de Valencia
🇪🇸Valencia, Spain
Hospital General Universitario de Valencia
🇪🇸Valencia, Spain
Hospital Universitario Miguel Servet
🇪🇸Zaragoza, Spain
Changhua Christian Hospital; Hematology-Oncology
🇨🇳Changhua, Taiwan
Mackay Memorial Hospital
🇨🇳Taipei, Taiwan
National Taiwan Uni Hospital
🇨🇳Taipei City, Taiwan
Regional Municipal Institution Sumy Regional Clinical Oncology Dispensary
🇺🇦Sumy, Ukraine
Sir Charles Gairdner Hospital
🇦🇺Nedlands, Western Australia, Australia
Kaiser Permanente - San Leandro Medical Center
🇺🇸San Leandro, California, United States
Karmanos Cancer Institute
🇺🇸Detroit, Michigan, United States
Oregon Health & Science Uni
🇺🇸Portland, Oregon, United States
Rocky Mountain Cancer Center
🇺🇸Denver, Colorado, United States
Policlinico Vittorio Emanuele
🇮🇹Catania, Sicilia, Italy
Liga Norte Riograndense Contra O Câncer
🇧🇷Natal, RN, Brazil
*X*Fundação Pio XII Hospital de Câncer de Barretos
🇧🇷Barretos, SP, Brazil
Fundación CENIT para la Investigación en Neurociencias
🇦🇷Buenos Aires, Argentina
University of Cincinnati
🇺🇸Cincinnati, Ohio, United States
Cabrini Hospital Malvern
🇦🇺Malvern, Victoria, Australia
Cite de La Sante de Laval; Hemato-Oncologie
🇨🇦Laval, Quebec, Canada
Clínica Pergamino
🇦🇷Pergamino, Argentina
Paracelsus Medizinische Privatuniversität
🇦🇹Salzburg, Austria
GasthuisZusters Antwerpen
🇧🇪Wilrijk, Belgium
Hôpital du Sacré-Coeur de Montreal
🇨🇦Montreal, Quebec, Canada
Sunshine Hospital
🇦🇺St Albans, Victoria, Australia
Cliniques Universitaires St-Luc
🇧🇪Bruxelles, Belgium
Tennessee Cancer Specialists
🇺🇸Knoxville, Tennessee, United States
Sanatorio Allende
🇦🇷Cordoba, Argentina
Multiprofile Hospital for Active Treatment Central Onco Hospital OOD
🇧🇬Plovdiv, Bulgaria
Nagoya University Hospital; Respiratory Medicine
🇯🇵Aichi, Japan
Chi Mei Medical Center Liou Ying Campus
🇨🇳Liuying Township, Taiwan
Poltava Regional Clinical Oncology Dispensary of Poltava Regional Council; Thoracic department
🇺🇦Poltava, Ukraine
Hematology and Oncology Associates at Bridgepoint
🇺🇸Tupelo, Mississippi, United States
Danbury Hospital
🇺🇸Danbury, Connecticut, United States
SCRI Tennessee Oncology Chattanooga
🇺🇸Chattanooga, Tennessee, United States
Ochsner Clinic Foundation
🇺🇸New Orleans, Louisiana, United States
Ironwood Cancer & Research Centers
🇺🇸Chandler, Arizona, United States
Highlands Oncology Group
🇺🇸Springdale, Arkansas, United States
Clinique Ste-Elisabeth
🇧🇪Namur, Belgium
Chaim Sheba Medical Center; Oncology Dept
🇮🇱Ramat Gan, Israel
Tel Aviv Sourasky Medical Ctr; Oncology
🇮🇱Tel Aviv, Israel
National Cancer Center Hospital East; Thoracic Oncology
🇯🇵Chiba, Japan
National Hospital Organization Kyushu Medical Center; Respiratory Internal Medicine
🇯🇵Fukuoka, Japan
Billings Clinic
🇺🇸Billings, Montana, United States
New England Cancer Specialists
🇺🇸Scarborough, Maine, United States
Cancerología
🇲🇽Queretaro, Mexico
National Hospital Organization Himeji Medical Center
🇯🇵Hyogo, Japan
Kanagawa Cancer Center;Thoracic Oncology
🇯🇵Kanagawa, Japan
Pauls Stradins Clinical University Hospital
🇱🇻Rīga, Latvia
National Cancer Institute
🇱🇹Vilnius, Lithuania
Corporacio Sanitaria Parc Tauli; Servicio de Oncologia
🇪🇸Sabadell, Barcelona, Spain
Soroka Medical Center
🇮🇱Beer Sheva, Israel
Rambam Health Corporation; Oncology Institute
🇮🇱Rambam, Israel
Ibaraki Prefectural Central Hospital; Division of respiratory
🇯🇵Ibaraki, Japan
Sendai Kousei Hospital; Pulmonary Medicine
🇯🇵Miyagi, Japan
Instituto Catalan de Oncologia de Hospitalet (ICO); Servicio de Farmacia
🇪🇸L'Hospitalet de Llobregat, Barcelona, Spain
Hospital Nuestra Senora de Valme
🇪🇸Seville, Sevilla, Spain
Kaohsiung Medical University Hospital; Department of Urology
🇨🇳Kaohsiung City, Taiwan
Municipal Institution Chernivtsi Regional Clinical Oncology Dispensary; Surgery Department #1
🇺🇦Chernivtsi, Ukraine
Rabin Medical Center
🇮🇱Petach Tiqwa, Israel
Aichi Cancer Center Hospital; Respiratory Medicine
🇯🇵Aichi, Japan
Riga East Clinical University Hospital Latvian Oncology Centre
🇱🇻Riga, Latvia
Hospital Universitario Son Espases
🇪🇸Palma De Mallorca, Islas Baleares, Spain
Centro Universitario Contra El Cancer
🇲🇽Monterrey, Mexico
Univerzitna nemocnica Bratislava
🇸🇰Bratislava, Slovakia
Narodny onkologicky ustav
🇸🇰Bratislava, Slovakia
MNPE Zaporizhzhia Regional Antitumor Center ZRC
🇺🇦Zaporizhzhia, Katerynoslav Governorate, Ukraine
Russian Oncology Research Center n.a. N.N. Blokhin
🇷🇺Moscow, Russian Federation
Complejo Hospitalario Universitario Insular-Materno Infantil
🇪🇸Las Palmas de Gran Canaria, LAS Palmas, Spain
Chang Gung Memorial Hospital Chiayi
🇨🇳Putzu, Taiwan
China Medical University Hospital
🇨🇳Taichung, Taiwan
Municipal Institution City Clinical Hospital #4 of Dnipro City Council - PPDS; Dept of Chemotherapy
🇺🇦Dnipropetrovsk, Katerynoslav Governorate, Ukraine
SI Institute of Medical Radiology n.a. S.P. Hryhoriev of NAMS of Ukraine
🇺🇦Kharkiv, Ukraine
ME Kryviy Rih Oncology Dispensary of Dnipropetrovs'k Regional Council; Chemotherapy Department
🇺🇦Kryvyi Rih, Ukraine
Uzhgorod Central City Clinical Hospital
🇺🇦Uzhhorod, Katerynoslav Governorate, Ukraine
MI of the Lviv Regional Council Lviv Oncology Regional Treatment and Diagnostic Centre; Chemotherapy
🇺🇦Lviv, Volhynian Governorate, Ukraine
Communal Non profit Enterprise Regional Center of Oncology; Oncosurgical dept of thoracic organs
🇺🇦Kharkiv, Kharkiv Governorate, Ukraine
Communal Nonprofit Enterprise Podilsky Regional Center Of Oncology OfTheVinnytsia Regional Council
🇺🇦Vinnytsia, KIEV Governorate, Ukraine
Valley Hospital; Oncology Research
🇺🇸Paramus, New Jersey, United States
ASL 3 Genovese; DSM
🇮🇹Genova, Liguria, Italy
Kaiser Permanente - Sacramento Medical Center and Medical Offices
🇺🇸Sacramento, California, United States
Norton Cancer Institute
🇺🇸Louisville, Kentucky, United States
St. Joseph Mercy Health System
🇺🇸Ann Arbor, Michigan, United States