A Study Comparing Imetelstat Versus Best Available Therapy for the Treatment of Intermediate-2 or High-risk Myelofibrosis (MF) Who Have Not Responded to Janus Kinase (JAK)-Inhibitor Treatment

Phase 3

Recruiting

• Conditions: Myelofibrosis
• Interventions: Drug: Imetelstat; Drug: Best Available Therapy (BAT)

• Registration Number: NCT04576156
• Lead Sponsor: Geron Corporation

Brief Summary

The purpose of the study is to evaluate the overall survival of participants treated with imetelstat compared to best available therapy with intermediate-2 or high-risk Myelofibrosis (MF) who are relapsed/refractory (R/R) to Janus Kinase (JAK)-Inhibitor treatment.

Detailed Description

This is a multicenter study with 2 arms, and will include 3 phases: a) screening phase of up to 28 days before randomization during which participants will complete a 14-day washout period from all prior therapies including JAK-inhibitor treatment, and the participant's eligibility will be reviewed; b) treatment phase, from randomization until study treatment (imetelstat or BAT) discontinuation; and c) post treatment follow-up phase, that begins when the participant discontinues treatment, and will continue until death, lost to follow-up, withdrawal of consent, or study end, whichever occurs first. Participants will be randomized (2:1) into 2 Arms (Arm A will receive imetelstat and Arm B will receive BAT).

Participants who meet progressive disease criteria and discontinue BAT, may crossover to receive imetelstat treatment after sponsor's approval.

Study Timeline

• Study First Submitted: 2020-09-18
• Study First Submitted QC: 2020-10-02
• Study First Posted: 2020-10-06
• Study Start: 2021-04-12
• Status Verified: 2024-12
• Last Update Submitted: 2024-12-12
• Last Update Posted: 2024-12-17
• Primary Completion: 2026-11-25
• Study Completion: 2026-11-25

Recruitment & Eligibility

• Status: RECRUITING
• Sex: All
• Target Recruitment: 320

Inclusion Criteria

• Diagnosis of primary myelofibrosis according to the revised World Health Organization criteria or post-essential thrombocythemia-MF or post-polycythemia vera-MF according to the IWG-MRT criteria

• Dynamic International Prognostic Scoring System intermediate-2 or high-risk MF

• Relapsed/refractory to JAK-inhibitor treatment as defined in either inclusion (i), (ii) or (iii) and not eligible for allogeneic stem cell transplantation (ASCT) at screening:

  • (i) Treatment with JAK-inhibitor for >= 6 months duration, including at least 2 months at an optimal dose as assessed by the investigator for that participant and at least one of the following:

    1. no decrease in spleen volume (< 10% by MRI or CT) from the start of treatment with JAK-inhibitor
    2. no decrease in spleen size (< 30% by palpation or length by imaging) from the start of treatment with JAK-inhibitor
    3. no decrease in symptoms (< 20% by Myelofibrosis Symptom Assessment Form [MFSAF] or myeloproliferative neoplasm SAF) from the start of treatment with JAK-inhibitor
    4. a score of at least 15 on TSS assessed using the MFSAF v4.0 during screening.

  • (ii) Treatment with JAK-inhibitor treatment for>= 3 months duration with maximal doses (e.g., 20-25 mg twice daily ruxolitinib) for that participant and no decrease in spleen volume/size or symptoms as defined in inclusion criterion (i [a, b, or c]).

  • (iii) Following maximum tolerated doses of JAK inhibitor therapy for ≥3 months duration, having documented relapsed disease defined as either

    1. Increase in spleen volume from time of best response by 25% measured by MRI or CT, or

    2. Increase in spleen size by palpation, CT, or ultrasound

       • (b.i) For splenomegaly of 5-10 cm at the start of JAK inhibitor treatment, at least 100% increase in palpable spleen size from time of best response;
       • (b.ii) For splenomegaly of > 10 cm at the start of JAK inhibitor treatment, at least 50% increase in palpable spleen size from time of best response;

AND not a candidate for further JAK inhibitor at screening per investigator.

• Measurable splenomegaly demonstrated by a palpable spleen measuring >= 5 cm below the left costal margin or a spleen volume >= 450 cm^3 by MRI or CT
• Active symptoms of MF on the MFSAF v4.0 demonstrated by a symptom score of at least 5 points (on a 0 to 10 scale)
• Hematology laboratory test values within the protocol defined limits
• Biochemical laboratory test values must be within protocol defined limits
• Eastern Cooperative Oncology Group Performance Status score of 0, 1, or 2
• Participants should follow protocol defined contraceptives procedures
• A woman of childbearing potential must have a negative serum or urine pregnancy test at screening

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Exclusion Criteria

• Peripheral blood blast count of >= 10% or bone marrow blast count of >=10%

• Known allergies, hypersensitivity, or intolerance to imetelstat or its excipients

• Prior treatment with imetelstat

• Any chemotherapy or MF directed therapy, including investigational drug regardless of class or mechanism of action, immunomodulatory or immunosuppressive therapy, corticosteroids greater than 30 mg/day prednisone or equivalent, and JAK-inhibitor treatment less than equal to 14 days prior to randomization

• Diagnosis or treatment for malignancy other than MF except:

  • Malignancy treated with curative intent and with no known active disease present for >= 3 years before randomization
  • Adequately treated non-melanoma skin cancer or lentigo maligna without evidence of disease
  • Adequately treated cervical carcinoma in situ without evidence of disease

• Known history of human immunodeficiency virus or any uncontrolled active systemic infection requiring IV antibiotics

• Active systemic hepatitis infection requiring treatment (carriers of hepatitis virus are permitted to enter the study), or any known acute or chronic liver disease requiring treatment unless related to underlying hepatosplenomegaly due to MF

• Major surgery within 28 days prior to randomization

• Any life-threatening illness (e.g., coronavirus disease-2019), medical condition, or organ system dysfunction which, in the investigator's opinion, could compromise the participant's safety, interfere with the imetelstat metabolism, or put the study outcomes at undue risk

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Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Imetelstat	Imetelstat	Participants will receive imetelstat sodium at 9.4 mg/kg intravenous (IV) every 21 days (±3 days), until disease progression or unacceptable toxicity, treatment discontinuation or study end.
Best Available Therapy (BAT)	Best Available Therapy (BAT)	Participants will receive BAT (investigator-selected non-JAK-inhibitor treatment), until disease progression or unacceptable toxicity, treatment discontinuation or study end. Participants on BAT who meet protocol-defined criteria for progressive disease may crossover to receive imetelstat treatment after sponsor's approval.

Primary Outcome Measures

Name	Time	Method
Overall survival (OS)	Baseline (Day 1) until End of Study (EOS) (approximately 3 years )]	Overall survival is defined as the time interval from randomization date to date of death from any cause.

Secondary Outcome Measures

Name	Time	Method
Assessment of Cmax	Day 1 of all cycles (each cycle is 21 days)	Maximum Observed Plasma Concentration (Cmax).
Assessment of t1/2	Day 1 of all cycles (each cycle is 21 days)	Elimination half-life.
Symptom response rate	Baseline (Day 1), and at Week 24	The proportion of participants achieving a ≥50% reduction in Total Symptom Score (TSS) measured at Week 24 compared to baseline
Progression-free survival	Baseline (Day 1) until End of Study (EOS) (approximately 3 years)	Progression-free survival is defined as the time interval from randomization date to the first date of disease progression (worsening splenomegaly or leukemic transformation per 2013 International Working Group - Myeloproliferative Neoplasms Research and Treatment (IWG-MRT) criteria) or death from any cause, whichever occurs first.
Spleen response rate	Baseline (Day 1), and at Week 24	The proportion of participants who achieve a reduction in spleen volume of ≥ 35% from baseline at Week 24.
Reduction in the degree of bone marrow fibrosis	Baseline (Day 1) until End of Treatment (approximately 3 years)	Reduction in the degree of bone marrow fibrosis will be assessed.
Number of Participants with Adverse Events	Screening (Day -28 to -1) until End of Study (approximately 3 years)	Safety will be assessed based on the incidence and severity (according to the Common Terminology Criteria for Adverse Events) of treatment emergent adverse events from the time of randomization until 30 days after completion of treatment
Assessment of Tmax	Day 1 of all cycles (each cycle is 21 days)	Time to reach the maximum observed plasma concentration
Assessment of AUC	Day 1 of all cycles (each cycle is 21 days)	Area under the drug concentration-plasma time curve (AUC) from time zero to last measurable concentration
Complete remission (CR), partial remission (PR), clinical improvement (CI), spleen response, symptoms response, and anemia response per modified 2013 IWG-MRT criteria	Baseline (Day 1) until End of Treatment (approximately 3 years)	The proportion of participants achieving CR or PR, CI, spleen response, symptom response, and anemia response per modified 2013 IWG-MRT criteria.
European Organization for Research and Treatment of Cancer Quality-of-Life-Questionnaire-Core-30 (EORTC QLQ-C30) scores	Baseline to End of Study (approximately 3 years)	Patient-reported outcomes including health-related quality of life, pain, and overall change in participant's health will be assessed using the EORTC QLQ-C30. The EORTC QLQ-C30 includes 30 items resulting in 5 functional scales (physical functioning, role functioning, emotional functioning, cognitive functioning, and social functioning), 1 Global Health Status scale, 3 symptom scales (fatigue, nausea and vomiting, and pain), and 6 single items (dyspnea, insomnia, appetite loss, constipation, diarrhea, and financial difficulties). Scores are transformed to a 0 to 100 scale. Higher scores indicated worse outcome.
EuroQol-EQ-5D (EQ-5D-5L) questionnaire scores	Baseline to End of Study (approximately 3 years)	EQ-5D-5L is a 5 item questionnaire that assesses 5 domains including mobility, self-care, usual activities, pain/discomfort and anxiety/depression plus a visual analog scale rating "health today" with anchors ranging from 0 (worst imaginable health state) to 100 (best imaginable health state).

Trial Locations

Locations (211)

Memorial Care; 🇺🇸 Long Beach, California, United States

UCLA David Geffen School of Medicine; 🇺🇸 Los Angeles, California, United States

University of California-San Diego/Moores UCSD Cancer Center; 🇺🇸 La Jolla, California, United States

The University of Texas MD; 🇺🇸 Houston, Texas, United States

Smilow Cancer Center at YNHH; 🇺🇸 New Haven, Connecticut, United States

BRCR Medical Center Inc; 🇺🇸 Plantation, Florida, United States

University of South Florida; 🇺🇸 Tampa, Florida, United States

Fort Wayne Medical Oncology and Hematology; 🇺🇸 Fort Wayne, Indiana, United States

Goshen Center for Cancer Care; 🇺🇸 Goshen, Indiana, United States

Norton Cancer Institute; 🇺🇸 Louisville, Kentucky, United States

Our Lady of the Lake Cancer Institute; 🇺🇸 Baton Rouge, Louisiana, United States

Maryland Oncology Hematology; 🇺🇸 Rockville, Maryland, United States

Oncology Hematology Associates; 🇺🇸 Springfield, Missouri, United States

Nebraska Cancer Specialists; 🇺🇸 Omaha, Nebraska, United States

Hematology-Oncology Associates of Central New York (HOACNY); 🇺🇸 East Syracuse, New York, United States

Icahn School of Medicine at Mount Sinai; 🇺🇸 New York, New York, United States

Duke University Medical Center; 🇺🇸 Durham, North Carolina, United States

Gabrail Cancer Center; 🇺🇸 Canton, Ohio, United States

Ohio Health; 🇺🇸 Columbus, Ohio, United States

Taylor Cancer Research Center; 🇺🇸 Maumee, Ohio, United States

Cancer Care Associates of York; 🇺🇸 York, Pennsylvania, United States

Sanford Health; 🇺🇸 Sioux Falls, South Dakota, United States

Avera Cancer Institute; 🇺🇸 Sioux Falls, South Dakota, United States

Prairie Lakes Health Care System, Inc.; 🇺🇸 Watertown, South Dakota, United States

Oncology Consultants; 🇺🇸 Houston, Texas, United States

Klinikum Wels-Grieskirchen GmbH; 🇦🇹 Wels, Oberösterreich, Austria

Community Cancer Trials of Utah; 🇺🇸 Ogden, Utah, United States

Utah Cancer Specialists; 🇺🇸 Salt Lake City, Utah, United States

Northwest Medical Specialties PLLC; 🇺🇸 Tacoma, Washington, United States

Northwest Specialits; 🇺🇸 Tacoma, Washington, United States

Hospital Aleman; 🇦🇷 Ciudad de Buenos Aires, Buenos Aires, Argentina

Sanatorio de la Mujer; 🇦🇷 Rosario, Santa Fe, Argentina

Sanatorio Allende; 🇦🇷 Córdoba, Argentina

Royal North Shore Hospital; 🇦🇺 St Leonards, New South Wales, Australia

Royal Brisbane and Women's Hospital; 🇦🇺 Herston, Queensland, Australia

Royal Hobart Hospital; 🇦🇺 Hobart, Tasmania, Australia

Epworth Healthcare; 🇦🇺 Richmond, Victoria, Australia

Krankenhaus Hietzing mit Neurologischem Zentrum Rosenhügel; 🇦🇹 Wein, Burgenland, Austria

Krankenhaus der Elisabethinen; 🇦🇹 Linz, Oberösterreich, Austria

Kepler Universitätsklinikum Gm; 🇦🇹 Linz, Oberösterreich, Austria

UZ Antwerpen; 🇧🇪 Edegem, Antwerpen, Belgium

Centre Hospitalier de Jolimont; 🇧🇪 Haine-Saint-Paul, Hainaut, Belgium

Odense University Hospital - Hematology; 🇩🇰 Odense, Denmark

CHU De Liège; 🇧🇪 Liege, Liège, Belgium

Universitair Ziekenhuis Gent; 🇧🇪 Gent, Oost-Vlaanderen, Belgium

Zna - Campus Middelheim; 🇧🇪 Antwerpen, Belgium

ZNA Stuyvenberg Antwerpen; 🇧🇪 Antwerpen, Belgium

AZ Klina; 🇧🇪 Antwerpen, Belgium

Universitair Ziekenhuis Brussel - Myeloom Centrum Brussel (MCB); 🇧🇪 Jette, Belgium

Centro de oncologia Leonardo da Vinci; 🇧🇷 Fortaleza, Ceará, Brazil

Hospital das Clínicas UFG; 🇧🇷 Goiânia, Goiás, Brazil

Hospital Erasto Gaertner; 🇧🇷 Curitiba, Paraná, Brazil

Hospital de Clinicas de Porto Alegre - UFRGS; 🇧🇷 Porto Alegre, Rio Grande do Sul, Brazil

Centro Gaucho Integrado de Oncologia, Hematologia, Ensino e Pesquisa LTDA; 🇧🇷 Porto Alegre, Rio Grande do Sul, Brazil

CEPON Centro de Pesquisas Oncologicas SC; 🇧🇷 Florianópolis, Brazil

Instituto de Educação, Pesquisa e Gestão em Saúde; 🇧🇷 São Paulo, Brazil

Hospital Israelita Albert Einstein; 🇧🇷 São Paulo, Brazil

Fundacao Doutor Amaral Carvalho / Hospital Amaral Carvalho; 🇧🇷 São Paulo, Brazil

Hospital A.C.Camargo Cancer Center - Clinical Oncology; 🇧🇷 São Paulo, Brazil

UMHAT "Dr. Georgi Stranski"; 🇧🇬 Pleven, Bulgaria

UMBAL Sveti Georgi; 🇧🇬 Plovdiv, Bulgaria

Specialized Hospital for Active Therapy of Hematological dis; 🇧🇬 Sofia, Bulgaria

Oncologos del Occidente S.A; 🇨🇴 Pereira, Risaralda, Colombia

Hospital Pablo Tobon Uribe; 🇨🇴 Antioquia, Colombia

Centro Medico Imbanaco de Cali S.A.; 🇨🇴 Cali, Colombia

FOSCAL; 🇨🇴 Floridablanca, Colombia

Institut de cancérologie du Gard - Hematologie clinique; 🇫🇷 Nimes Cedex 09, Gard, France

CHU Bretonneau; 🇫🇷 Tours, Indre-et-Loire, France

Centre Hospitalier Lyon; 🇫🇷 Pierre-benite, Rhône-Alpes, France

CHU de Saint Etienne; 🇫🇷 Loire, Saint Priest en Jarez, France

Hopital Bicetre; 🇫🇷 Paris, Le Kremlin-Bicêtre, France

CHU de Limoges Dupuytren; 🇫🇷 Haute-Vienne, Limoges, France

CHU De Nantes - Hématologie C; 🇫🇷 Nantes, Loire-Atlantique, France

CHU de Nice - Hopital de l'Archet II - Pharmacie; 🇫🇷 Nice, Nice cedex 3, France

Hospital CENTRE HOSPITALIER AVIGNON; 🇫🇷 Avignon cedex, Provence-Alpes-Côte-d'Azur, France

Centre Hospitalier Du Mans - Cancérologie Médicale; 🇫🇷 Le Mans, Sarthe, France

Hopital Avicenne - Hématologie Clinique; 🇫🇷 Bobigny, Seine-Saint-Denis, France

Universitätsklinikum Schleswig; 🇩🇪 Kiel, Schleswig-Holstein, Germany

CHRU Brest - Hôpital Morvan; 🇫🇷 Brest cedex, France

CHU - Hôpital Saint Louis - Centre D'Investigations Cliniq; 🇫🇷 Paris, France

Hopital Cochin - Aphp Hôpitaux Universitaires Paris Centre; 🇫🇷 Paris, Île-de-France, France

LTD Israeli-Georgian Medical R; 🇬🇪 Tbilisi, Georgia

M.Zodelava Hematology Center L; 🇬🇪 Tbilisi, Georgia

J.S.C."K.Eristavi National Cen; 🇬🇪 Tbilisi, Georgia

Multi Profile Clinic Consilium; 🇬🇪 Tbilisi, Georgia

Ltd "Medinvest - Institute of Hematology and Trans; 🇬🇪 Tbilisi, Georgia

Universitätsklinikum Mannheim - University of Heidelberg; 🇩🇪 Mannheim, Baden-Württemberg, Germany

Universitätsklinikum Tübingen; 🇩🇪 Tübingen, Baden-Württemberg, Germany

Universitätsklinikum Carl Gust; 🇩🇪 Dresden, Hamburg, Germany

Klinikum Kempten-Oberallgaeu GmbH; 🇩🇪 Kempten, Rheinland-Pfalz, Germany

Martin-Luther-Universität Halle-Wittenberg; 🇩🇪 Halle (Saale), Sachsen-Anhalt, Germany

Universitätsklinikum Leipzig AöR; 🇩🇪 Leipzig, Sachsen, Germany

Semmelweis Egyetem - III. sz.; 🇭🇺 Budapest, Hungary

Dél-pesti Centrumkórház Ország; 🇭🇺 Budapest, Hungary

Western Galilee Hospital - Nahariya; 🇮🇱 Nahariya, HaZafon, Israel

Szabolcs-Szatmár-Bereg Megyei Önkormányzat Jósa András; 🇭🇺 Nyíregyháza, Hungary

Fejer Megyei Szent Gyorgy Egyetemi Oktato Korhaz -; 🇭🇺 Székesfehérvár, Hungary

All India Institute of Medical Sciences, Dept. of Hematology, New Delhi (All India Institute Of Medical Sciences); 🇮🇳 New Delhi, Delhi, India

Sir Ganga Ram Hospital; 🇮🇳 New Delhi, Delhi, India

Nirmal Hospital - Hematology; 🇮🇳 Surat, Gujarat, India

St. John's Medical College Hospital; 🇮🇳 Bangalore, Karnataka, India

Fortis Hospital 154/9; 🇮🇳 Bengaluru, Karnataka, India

Fortis Memorial Research Institute; 🇮🇳 Gurgaon, New Delhi, India

All India Institute of Medical Sciences; 🇮🇳 Bhubaneswar, Orissa, India

Nilratan Sircar Medical College; 🇮🇳 Kolkata, West Bengal, India

Narayana Hrudayalaya Hospital; 🇮🇳 Hyderabad, India

Deenanath Mangeshkar Hospital & Research Center; 🇮🇳 Pune, India

Sahyadri Specialty Hospital; 🇮🇳 Pune, India

Assuta Ashdod University Hospi; 🇮🇱 Ashdod, HaDarom, Israel

Barzilai Medical Center; 🇮🇱 Ashkelon, HaDarom, Israel

Kaplan Medical Center; 🇮🇱 Rehovot, HaMerkaz, Israel

Shamir Medical Center (Assaf Harofeh); 🇮🇱 Zerifin, HaMerkaz, Israel

Tel Aviv Sourasky Medical Cent; 🇮🇱 Tel Aviv, Tel-Aviv, Israel

Hadassah Medical Organization; 🇮🇱 Jerusalem, Yerushalayim, Israel

Bnai Zion Medical Center; 🇮🇱 Haifa, Israel

Carmel MC; 🇮🇱 Haifa, Israel

Soroka Medical Center - Hematology Institute; 🇮🇱 Beersheba, Israel

Arcispedale S.Anna - Ematologi; 🇮🇹 Cona, Ferrara, Italy

Istituto Clinico Humanitas Roz; 🇮🇹 Rozzano, Milano, Italy

AOU San Luigi Gonzaga; 🇮🇹 Orbassano, Torino, Italy

PO Civile SS.Antonio e Biagio; 🇮🇹 Alessandria, Italy

A.O.di Bologna Policl.S.Orsola; 🇮🇹 Bologna, Italy

Presidio Ospedaliero Garibaldi; 🇮🇹 Catania, Italy

AOU Careggi; 🇮🇹 Firenze, Italy

IRCCS Ospedale Policlinico San Martino; 🇮🇹 Genova, Italy

Clinica Ematologica, Univ. Deg; 🇮🇹 Genova, Italy

Irccs Irst; 🇮🇹 Meldola, Italy

Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico; 🇮🇹 Milano, Italy

Ospedale San Raffaele; 🇮🇹 Milano, Italy

ASST Grande Ospedale Metropoli; 🇮🇹 Milano, Italy

Azienda Ospedaliera San Gerard; 🇮🇹 Monza, Italy

AOU Federico II; 🇮🇹 Napoli, Italy

Ospedale Civile S.Maria delle Croci, AUSL Ravenna; 🇮🇹 Ravenna, Italy

Arcispedale S Maria Nuova, AO di Reggio Emilia; 🇮🇹 Reggio Calabria, Italy

Azienda Ospedaliera Bianchi-Me; 🇮🇹 Reggio Calabria, Italy

AUSL di Rimini Ospedale Infermi di Rimini; 🇮🇹 Rimini, Italy

ASL Roma 2 - PO "S. Eugenio"; 🇮🇹 Roma, Italy

Policlinico Universitario Agostino Gemelli; 🇮🇹 Roma, Italy

AOU Città della Salute e della Scienza di Torino; 🇮🇹 Torino, Italy

Ospedale di Circolo, PO Varese; 🇮🇹 Varese, Italy

Ospedale S.Bortolo, AULSS n.6; 🇮🇹 Vicenza, Italy

Inje University Busan Paik Hos; 🇰🇷 Busan, Busan Gwang'yeogsi [Pusan-Kwangyokshi], Korea, Republic of

Inje University Haeundae Paik Hospital; 🇰🇷 Busan, Busan Gwang'yeogsi [Pusan-Kwangyokshi], Korea, Republic of

Kyungpook National University Hospital - Hematolog; 🇰🇷 Daegu, Daegu Gwang'yeogsi [Taegu-Kwan], Korea, Republic of

National Cancer Institute Center for Cancer Research; 🇰🇷 Goyang-Si, Gyeonggido, Korea, Republic of

Korea University Anam Hospital; 🇰🇷 Seoul, Seoul Teugbyeolsi [Seoul-T'ukpyolshi], Korea, Republic of

Gachon University Gil Medical Center; 🇰🇷 Incheon, Incheon Gwang'yeogsi [Inch'n-Kwangyokshi], Korea, Republic of

Gangnam Severance Hospital, Yonsei University Health System; 🇰🇷 Seoul, Seoul Teugbyeolsi [Seoul-T'ukpyolshi], Korea, Republic of

Korea University Guro Hospital; 🇰🇷 Seoul, Seoul Teugbyeolsi [Seoul-T'ukpyolshi], Korea, Republic of

Samsung Medical Center; 🇰🇷 Seoul, Seoul Teugbyeolsi [Seoul-T'ukpyolshi], Korea, Republic of

Seoul National University Hospital - Department of Internal; 🇰🇷 Seoul, Seoul Teugbyeolsi [Seoul-T'ukp, Korea, Republic of

Pusan National University Hospital - Hematology and Oncology; 🇰🇷 Busan, Korea, Republic of

The Catholic University of Korea; 🇰🇷 Seongdong, Korea, Republic of

Severance Hospital, Yonsei Uni; 🇰🇷 Seoul, Korea, Republic of

Hospital Pulau Pinang; 🇲🇾 Pulau Pinang, Georgetown, Malaysia

Hospital Sultanah Aminah Johor Bahru; 🇲🇾 Johor Bahru, Johor, Malaysia

Hospital Raja Perempuan Zainab II; 🇲🇾 Kota Bharu, Kelantan, Malaysia

Sarawak General Hospital; 🇲🇾 Kuching, Sarawak, Malaysia

Hospital Ampang; 🇲🇾 Ampang, Selangor, Malaysia

Wojewodzki Szpital Specjalistyczny im. Janusza Korczaka w Sl; 🇵🇱 Slupsk, Pomorskie, Poland

Ars Medical Sp. z o.o.; 🇵🇱 Piła, Wielkopolskie, Poland

Centrum Medyczne Pratia Poznan; 🇵🇱 Skorzewo, Wielkopolskie, Poland

Wojewodzki Szpital Specjalistyczny; 🇵🇱 Biała Podlaska, Poland

Pratia Onkologia Katowice; 🇵🇱 Katowice, Śląskie, Poland

CCA-Braga. Centro Clínico Académico - Hospital Braga; 🇵🇹 Braga, Portugal

CHUC - Centro Hospitalar e Universitário de Coimbr; 🇵🇹 Coimbra, Portugal

Instituto Português de Oncologia de Lisboa; 🇵🇹 Lisboa, Portugal

Centro Clinico Fundacao Champalimaud; 🇵🇹 Lisboa, Portugal

H. São Francisco Xavier-Centro; 🇵🇹 Lisboa, Portugal

H. Santa Maria. Centro Hospita; 🇵🇹 Lisboa, Portugal

MONIKI - Oncology; 🇷🇺 Moscow, Moskovskaya oblast', Russian Federation

MUZ City Clinical Hospital # 2; 🇷🇺 Novosibirsk, Novosibirskaya oblast', Russian Federation

Tula Regional Clinical Hospital; 🇷🇺 Tula, Tul'skaya oblast', Russian Federation

Budgetary Healthcare Institution of Omsk Region; 🇷🇺 Omsk, Russian Federation

V.A. Almazov National Medical Research Center; 🇷🇺 Saint Petersburg, Russian Federation

First Saint-Petersburg State Medical University n.; 🇷🇺 Saint-Petersburg, Russian Federation

GOU VPO Saratov State Medical University n.a. V.I.; 🇷🇺 Saratov, Russian Federation

National University Cancer Institute (NCIS); 🇸🇬 Singapore, Central Singapore, Singapore

Singapore General Hospital; 🇸🇬 Singapore, Central Singapore, Singapore

Institut Català d'Oncologia-Ho; 🇪🇸 Badalona, Barcelona, Spain

C.S. Parc Tauli; 🇪🇸 Sabadell, Barcelona, Spain

Hospital Universitario de Gran; 🇪🇸 Las Palmas de Gran Canaria, Canarias, Spain

H. Comarcal Costa del Sol; 🇪🇸 Málaga, Marbella, Spain

H.U. Ribera de Alzira; 🇪🇸 Alzira, Valencia, Spain

H.G.U. Alicante; 🇪🇸 Alicante, Spain

H. San Pedro de Alcántara; 🇪🇸 Cáceres, Spain

ICO-Hospital Universitari de G; 🇪🇸 Girona, Spain

Hospital Universitario Virgen; 🇪🇸 Granada, Spain

Hospital Universitario Fundaci; 🇪🇸 Madrid, Spain

Hospital U. 12 Octubre; 🇪🇸 Madrid, Spain

H.U. La Paz; 🇪🇸 Madrid, Spain

H.U.V. de la Victoria; 🇪🇸 Málaga, Spain

Hospital Universitario de Salamanco; 🇪🇸 Salamanca, Spain

Hospital Universitario Doctor; 🇪🇸 Valencia, Spain

H. Quirón Zaragoza; 🇪🇸 Zaragoza, Spain

Chang Gung Medical Foundation; 🇨🇳 Chiayi City, Chiayi, Taiwan

China Medical University Hospital - Hematology/Onc; 🇨🇳 Taichung City, Taiwan

Tri-Service General Hospital; 🇨🇳 Taipei, Taiwan

Medical Park Mersin Hastanesi; 🇹🇷 Mersin, Içel, Turkey

Sakarya Research and Training Hospital - Medical Oncology; 🇹🇷 Adapazarı, Turkey

Gazi University Medical Faculty; 🇹🇷 Ankara, Turkey

Ankara University Medical Facu; 🇹🇷 Ankara, Turkey

Istanbul üniversitesi cerrahpaşa; 🇹🇷 Istanbul, Turkey

Medipol Bagcilar Mega Hospital; 🇹🇷 Istanbul, Turkey

Marmara university pendik training and research hospital; 🇹🇷 Istanbul, Turkey

Ege Universitesi Tip Fakultesi; 🇹🇷 Izmir, Turkey

Mersin University Medical Faculty; 🇹🇷 Yenisehir/Mersin, Turkey

Maidstone Hospital; 🇬🇧 Maidstone, Kent, United Kingdom

St Bartholomew's Hospital; 🇬🇧 London, United Kingdom

Guys and St Thomas' Hospital; 🇬🇧 London, United Kingdom

Oxford University Hospitals; 🇬🇧 Oxford, United Kingdom