A Study of Bevacizumab (Avastin®) in Combination With Temozolomide and Radiotherapy in Participants With Newly Diagnosed Glioblastoma
- Conditions
- Glioblastoma
- Interventions
- Registration Number
- NCT00943826
- Lead Sponsor
- Hoffmann-La Roche
- Brief Summary
This 2 arm study investigated the efficacy and safety of the addition of bevacizumab to the current standard of care (multimodality therapy of concurrent radiotherapy plus temozolomide followed by adjuvant temozolomide) as compared to the current standard of care alone. Participants were randomly assigned to either the bevacizumab (10 milligrams per kilogram (mg/kg) intravenously \[IV\] once every 2 week \[q2w\]) or the placebo arm, in combination with radiation therapy (total dose 60 Gray \[Gy\], administered as 2 Gy fractions, 5 days/week) plus temozolomide (75 milligrams per meter squared \[mg/m\^2\] oral administration \[po\] daily) for 6 weeks. After a 4 week treatment break, participants continued to receive bevacizumab (10 mg/kg IV q2w) or placebo, plus temozolomide (150-200 mg/m\^2 po daily on days 1-5 of each 4 week cycle) for 6 cycles of maintenance treatment or until disease progression or unacceptable toxicity, whichever occured first. Following the maintenance phase, bevacizumab (15 mg/kg iv every 3 weeks \[q3w\]) or placebo monotherapy continued. The time on study treatment was until disease progression.
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 921
- newly diagnosed glioblastoma
- World Health Organization (WHO) performance status less than or equal to (<=2)
- stable or decreasing corticosteroid dose within 5 days prior to randomization
Key
- evidence of recent hemorrhage on postoperative magnetic resonance imaging (MRI) of brain
- any prior chemotherapy or immunotherapy for glioblastomas and low grade astrocytomas
- any prior radiotherapy to brain
- clinically significant cardiovascular disease
- history of greater than or equal to (>=) grade 2 hemoptysis within 1 month prior to randomization
- previous centralized screening for Methylguanine-DNA methyltransferase (MGMT) status for enrollment into a clinical trial
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Bevacizumab + RT + Temozolomide Radiation therapy In the Concurrent Phase participants will receive radiotherapy (RT) in daily fractions of 2 Gy to be given 5 days per week for 6 weeks and temozolomide 75 mg/m\^2 daily from the first day to the last day of radiotherapy (it may continue for a maximum of 49 days in case of delay to the end of radiation therapy) and bevacizumab 10 mg/kg IV every 2 weeks for 6 weeks. There will be a 4 week treatment break. Participants will then enter the Maintenance Phase where they receive six 28-day cycle of bevacizumab 10 mg/kg IV q2w and temozolomide 150 to 200 mg/m\^2 daily in the first 5 days of each cycle. The participants will then enter the Monotherapy Phase where they will receive bevacizumab 15 mg/kg IV q3w until disease progression/unacceptable toxicity. Placebo + RT + Temozolomide Radiation therapy In the Concurrent Phase participants will receive radiotherapy in daily fractions of 2 Gy to be given 5 days per week for 6 weeks and temozolomide 75 mg/m\^2 daily from the first day to the last day of radiotherapy (it may continue for a maximum of 49 days in case of delay to the end of radiation therapy) and placebo IV every 2 weeks for 6 weeks. There will be a 4 week treatment break. Participants will then enter the Maintenance Phase where they will receive six 28-day cycle of placebo IV q2w and temozolomide 150 to 200 mg/m\^2 daily in the first 5 days of each cycle. The participants will then enter the Monotherapy Phase where they will receive placebo IV q3w until disease progression/unacceptable toxicity. Placebo + RT + Temozolomide Placebo In the Concurrent Phase participants will receive radiotherapy in daily fractions of 2 Gy to be given 5 days per week for 6 weeks and temozolomide 75 mg/m\^2 daily from the first day to the last day of radiotherapy (it may continue for a maximum of 49 days in case of delay to the end of radiation therapy) and placebo IV every 2 weeks for 6 weeks. There will be a 4 week treatment break. Participants will then enter the Maintenance Phase where they will receive six 28-day cycle of placebo IV q2w and temozolomide 150 to 200 mg/m\^2 daily in the first 5 days of each cycle. The participants will then enter the Monotherapy Phase where they will receive placebo IV q3w until disease progression/unacceptable toxicity. Bevacizumab + RT + Temozolomide Temozolomide In the Concurrent Phase participants will receive radiotherapy (RT) in daily fractions of 2 Gy to be given 5 days per week for 6 weeks and temozolomide 75 mg/m\^2 daily from the first day to the last day of radiotherapy (it may continue for a maximum of 49 days in case of delay to the end of radiation therapy) and bevacizumab 10 mg/kg IV every 2 weeks for 6 weeks. There will be a 4 week treatment break. Participants will then enter the Maintenance Phase where they receive six 28-day cycle of bevacizumab 10 mg/kg IV q2w and temozolomide 150 to 200 mg/m\^2 daily in the first 5 days of each cycle. The participants will then enter the Monotherapy Phase where they will receive bevacizumab 15 mg/kg IV q3w until disease progression/unacceptable toxicity. Bevacizumab + RT + Temozolomide Bevacizumab In the Concurrent Phase participants will receive radiotherapy (RT) in daily fractions of 2 Gy to be given 5 days per week for 6 weeks and temozolomide 75 mg/m\^2 daily from the first day to the last day of radiotherapy (it may continue for a maximum of 49 days in case of delay to the end of radiation therapy) and bevacizumab 10 mg/kg IV every 2 weeks for 6 weeks. There will be a 4 week treatment break. Participants will then enter the Maintenance Phase where they receive six 28-day cycle of bevacizumab 10 mg/kg IV q2w and temozolomide 150 to 200 mg/m\^2 daily in the first 5 days of each cycle. The participants will then enter the Monotherapy Phase where they will receive bevacizumab 15 mg/kg IV q3w until disease progression/unacceptable toxicity. Placebo + RT + Temozolomide Temozolomide In the Concurrent Phase participants will receive radiotherapy in daily fractions of 2 Gy to be given 5 days per week for 6 weeks and temozolomide 75 mg/m\^2 daily from the first day to the last day of radiotherapy (it may continue for a maximum of 49 days in case of delay to the end of radiation therapy) and placebo IV every 2 weeks for 6 weeks. There will be a 4 week treatment break. Participants will then enter the Maintenance Phase where they will receive six 28-day cycle of placebo IV q2w and temozolomide 150 to 200 mg/m\^2 daily in the first 5 days of each cycle. The participants will then enter the Monotherapy Phase where they will receive placebo IV q3w until disease progression/unacceptable toxicity.
- Primary Outcome Measures
Name Time Method Co-Primary: Progression-free Survival (PFS) as Assessed by Investigator Randomization until PFS Event [Until data cutoff= 31 March 2012 (up to 31.4 months) PFS is defined as time from randomization to disease progression (PD) or death. PD was assessed using adapted Macdonald response criteria (modified World Health Organization \[WHO\] criteria) based on 3 components: radiological tumor assessments using Magnetic Resonance Imaging \[MRI\] scans,neurological assessment and changes in corticosteroid use. PD is assessed as greater than or equal to(\>=) 25% increase in sum of products of the longest diameters of all index lesions (enhancing,measurable) compared with the smallest recorded sum (nadir); or unequivocal PD of existing non-index lesions (non-enhancing and enhancing,non-measurable); or unequivocal appearance of new lesions); or neurological worsening (if corticosteroid dose is stable or increased) compared to neurological evaluation at previous disease assessment with no need for a confirmatory scan. Participants without a PFS event were censored at last disease assessment.
Co-Primary: Overall Survival (OS) Randomization until OS Event (Until data cutoff= 28 February 2013 [up to 42.2 months]) Overall Survival was defined as the time from randomization to death due to any cause.
- Secondary Outcome Measures
Name Time Method PFS as Assessed by an Independent Review Facility Randomization until PFS Event (Until data cutoff= 31 March 2012 [up to 29.5 months]) An Independent Review Facility reviewed the MRI scans used by investigator to evaluate radiological tumor response. PFS is defined as time from randomization to PD or death. PD was assessed using adapted Macdonald response (modified WHO) criteria based on 3 components: radiological tumor assessments using MRI scans, neurological assessment and changes in corticosteroid use. PD is assessed as \>=25% increase in sum of products of the longest diameters of all index lesions (enhancing, measurable) compared with the smallest recorded sum (nadir); or unequivocal PD of existing non-index lesions (non-enhancing and enhancing, non-measurable); or unequivocal appearance of new lesions); or neurological worsening (if corticosteroid dose is stable or increased) compared to neurological evaluation at previous disease assessment with no need for a confirmatory scan. Participants without a PFS event were censored at last disease assessment.
Kaplan-Meier (KM) Estimate of One Year Overall Survival Randomization until Overall Survival Event (Until data cutoff= 28 February 2013 [up to 42.2 months]) KM estimate of one year overall survival (probability to survive for at least 1 year) was reported. Corresponding 95% confidence interval (CI) was calculated using Greenwood's formula.
Kaplan-Meier (KM) Estimate of Two Year Overall Survival Randomization until Overall Survival Event (Until data cutoff= 28 February 2013 [up to 42.2 months]) KM estimate of two year overall survival was reported (probability to survive for at least 2 years). Corresponding 95% CI was calculated using Greenwood's formula.
PFS in Participants With Stable/Improved Health Related Quality of Life (HRQoL) Based on European Organization for Research & Treatment of Cancer (EORTC) Quality of Life Questionnaire (QLQ) Core 30 (C30)(EORTC QLQ-C30) & EORTC QLQ Brain Neoplasm 20 (BN20) Randomization until PFS Event [Until data cutoff= 31 March 2012 (up to 31.4 months) EORTC QLQ-C30: 30 items; 5 functional scales; 9 symptom scales; \& global health status. Most questions used 4-point scale (1:Not at all, 4:Very much), 2 questions used 7-point scale (1:very poor, 7:Excellent). EORTC QLQ-BN20: 20 items rated on a 4 point scale (1:not at all, 4:very much). EORTC QLQ-C30 and BN20 scores were transformed to a 0-100 scale, higher score=better functioning/global health (C30) or more severe symptoms (BN20). Stable HRQoL: change from baseline (BL) within 10 points. Improved HRQoL: an increase from BL \>/=10 points for functioning/global health status, \& decrease of \>/=10 points for symptoms. PFS is reported for participants with Stable/Improved global health; physical, social functioning (C30); motor dysfunction \& communication deficit (BN20). PFS: randomization to PD or death. PD: \>=25% increase in sum of products of longest diameters of index lesions; or progression of existing non-index lesions; or appearance of new lesions; or neurological worsening.
Number of Participants With Non-Serious Adverse Events, Serious Adverse Events and Death Randomization until study completion (Until data cutoff= 09 Sep 2015 [up to 64 months]) An adverse event (AE) was considered any unfavorable and unintended sign, symptom, or disease associated with the use of the study drug, whether or not considered related to the study drug. Preexisting conditions that worsened during the study were reported as AE.A serious adverse event (SAE) is any experience that suggests a significant hazard,contraindication, side effect or precaution that: results in death, is life-threatening, required in-patient hospitalization or prolongation of existing hospitalization, results in persistent or significant disability/incapacity, is a congenital anomaly/birth defect or is medically significant. Non-serious adverse events (Non-SAEs) included all AEs except SAEs (non-SAEs = all AEs - SAEs). Nine participants randomized to the Placebo+RT+Temozolomide arm incorrectly received at least 1 dose of bevacizumab and were added to the Bevacizumab+RT+Temozolomide arm for Safety.
Trial Locations
- Locations (133)
CHU Sart-Tilman
🇧🇪Liège, Belgium
University of Virgina
🇺🇸Charlottesville, Virginia, United States
Centre Georges François Leclerc
🇫🇷Dijon, France
Clin Univ de Bxl Hôpital Erasme
🇧🇪Bruxelles, Belgium
Tom Baker Cancer Centre-Calgary
🇨🇦Calgary, Alberta, Canada
UZ Antwerpen
🇧🇪Edegem, Belgium
Ärztehaus Velen
🇩🇪Ibbenbühren, Germany
Centre Jean Perrin; Hopital De Jour
🇫🇷Clermont Ferrand, France
Hopital Beaujon; Oncologie
🇫🇷Clichy, France
Klinikum der Johannes Gutenberg Uni Mainz; Studienz. Neurologie, Klinik und Poliklinik Neurologie
🇩🇪Mainz, Germany
Rambam Medical Center; Oncology
🇮🇱Haifa, Israel
Utrecht University Medical Centre; Dept of Medical Oncology and UPC
🇳🇱Utrecht, Netherlands
Ospedale Bufalini
🇮🇹Forli, Emilia-Romagna, Italy
Princess AleXandra Hospital; Department of Medical Oncology
🇦🇺Woolloongabba, Queensland, Australia
Komagome Hospital; Neurosurgery
🇯🇵Tokyo, Japan
Hôpital Central; Departement de Neuro-Oncologie
🇫🇷Nancy, France
BC Cancer Agency, Vancouver Clinic; Dept. of Medical Oncology
🇨🇦Vancouver, British Columbia, Canada
Universitatsklinikum Hamburg-Eppendorf; Klinik und Poliklinik fur Neurochirurgie
🇩🇪Hamburg, Germany
Fondazione IRCCS Istituto Neurologico C. Besta; Neuro-oncologia Sperimentale e Terapia Genica
🇮🇹Milano, Lombardia, Italy
Saskatoon Cancer Centre; Uni of Saskatoon Campus
🇨🇦Saskatoon, Saskatchewan, Canada
Hopital Pitié Salpétrière - CHU; Service de neurologie 2 - Mazarin
🇫🇷Paris, France
Institut Bergonie; Gastro Enterologie Oncologie
🇫🇷Bordeaux, France
Pécsi Tudományegyetem Áok; Onkoterapias Intezet
🇭🇺Pecs, Hungary
Cliniques Universitaires St-Luc
🇧🇪Bruxelles, Belgium
AZ Sint Lucas (Sint Lucas)
🇧🇪Gent, Belgium
AZ Delta (Campus Wilgenstraat)
🇧🇪Roeselare, Belgium
Rabin MC; Davidof Center - Oncology Institute
🇮🇱Petach Tikva, Israel
Hopital neurologique Pierre Wertheimer - CHU Lyon; Neurologie
🇫🇷Bron, France
Universitätsklinikum "Carl Gustav Carus"; Klinik und Poliklinik für Neurochirurgie
🇩🇪Dresden, Germany
Hospital de Santa Maria; Servico de Oncologia Medica
🇵🇹Lisboa, Portugal
Institut Oncologic Ion Chiricuta; Departament Radioterapie
🇷🇴Cluj-napoca, Romania
Univ General Hosp Heraklion; Medical Oncology
🇬🇷Heraklion, Greece
Skånes University Hospital, Skånes Department of Onclology
🇸🇪Lund, Sweden
N.N.Burdenko Main Military Clinical Hospital; Oncology Dept
🇷🇺Moscow, Russian Federation
Hospital Clínic i Provincial; Servicio de Hematología y Oncología
🇪🇸Barcelona, Spain
Centre Val Aurelle Paul Lamarque; Medecine B3
🇫🇷Montpellier, France
Samodzielny Publiczny Szpital Kliniczny nr 4 w Lublinie; Klinika Neurochirurgii i Neurochirurgii Dzi
🇵🇱Lublin, Poland
Institut Oncologic Prof. Dr. Alexandru Trestioreanu; Departament Radioterapie
🇷🇴Bucharest, Romania
Waikato Hospital; Regional Cancer Center
🇳🇿Hamilton, New Zealand
Hospital Ramon y Cajal; Servicio de Oncologia
🇪🇸Madrid, Spain
Russian Research Oncology Center n.a. N.N. Blokhin of the RAMS; Department of Neurosurgery
🇷🇺Moscow, Russian Federation
Hospital Clinico Universitario de Valencia; Servicio de Onco-hematologia
🇪🇸Valencia, Spain
Scientific Research Neurosurgery Institute; Dept. of Neurooncology
🇷🇺Moscow, Russian Federation
Institution of Higher Professional Learning Military; Neurooncology
🇷🇺St. Petersburg, Russian Federation
Queen Elizabeth Medical Centre; Neurosurgery
🇬🇧Birmingham, United Kingdom
Spital Clinic Judetean Mures; Oncologie
🇷🇴Targu Mures, Romania
HUG; Oncologie
🇨🇭Geneve, Switzerland
The Clatterbridge Cancer Ctr For Oncolgy
🇬🇧Wirral, United Kingdom
Hospital Universitario La Paz; Servicio de Oncologia
🇪🇸Madrid, Spain
Institut Catala d Oncologia Hospital Duran i Reynals
🇪🇸Barcelona, Spain
Northern Centre for Cancer Care;Oncology
🇬🇧Newcastle Upon Tyne, United Kingdom
Hospital Universitari Germans Trias i Pujol; Servicio de Oncologia
🇪🇸Barcelona, Spain
Hospital de Sao Joao; Servico de Oncologia
🇵🇹Porto, Portugal
University Hospital of Larissa; Oncology
🇬🇷Larissa, Greece
Papageorgiou General Hospital; Medical Oncology
🇬🇷Thessaloniki, Greece
Az. Osp. S. Maria; Dept. Di Oncologia Medica
🇮🇹Terni, Umbria, Italy
Odense Universitetshospital, Onkologisk Afdeling R
🇩🇰Odense, Denmark
Azienda Ospedaliera Le Molintte di Torino; Dipartimento Di Neurologia - Oncologia
🇮🇹Torino, Piemonte, Italy
CancerCare Manitoba; Neuro-Oncology
🇨🇦Winnipeg, Manitoba, Canada
Hamilton Health Sciences - Juravinski Cancer Centre
🇨🇦Hamilton, Ontario, Canada
Hopital Notre-Dame
🇨🇦Montreal, Quebec, Canada
McGill University; Montreal Neurological Institute; Oncology
🇨🇦Montreal, Quebec, Canada
Chuq - Hopital Hotel Dieu de Quebec
🇨🇦Quebec City, Quebec, Canada
Hospital Regional Universitario Carlos Haya; Servicio de Oncologia
🇪🇸Malaga, Spain
Oncology-Evanston Nthwest Healthcare Kellogg Cancer Care Ctr
🇺🇸Evanston, Illinois, United States
North Shore Private Hospital; Northern Specialist Centre
🇦🇺St Leonards, New South Wales, Australia
Royal North Shore Hospital; Department of Medical Oncology
🇦🇺St Leonards, New South Wales, Australia
Aalborg Universitetshospital, Klinik Kirurgi-Kræft, Onkologisk afd.
🇩🇰Aalborg, Denmark
Righospitalet, Hæmatologisk Klinik
🇩🇰København Ø, Denmark
Hopital Avicenne; Rhumatologie
🇫🇷Bobigny, France
Chaim Sheba MC; Pediatric Hematology Oncology
🇮🇱Tel Hashomer, Israel
Hiroshima University Hospital; Neurosurgery
🇯🇵Hiroshima, Japan
Kumamoto University Hospital; Neurosurgery
🇯🇵Kumamoto, Japan
National Cancer Center Hospital; Neurosurgery
🇯🇵Tokyo, Japan
Kitano Hospital; Neurosurgery
🇯🇵Osaka, Japan
Saitama Medical University International Medical Center; Clinical and Medical Oncology
🇯🇵Saitama, Japan
Kyorin University Hospital; Neurosurgery
🇯🇵Tokyo, Japan
Chonnam National University Hwasun Hospital
🇰🇷Jeollanam-do, Korea, Republic of
Kyungpook National University Hosital; Neuro Sugery
🇰🇷Daegu, Korea, Republic of
VU MEDISCH CENTRUM; Dept. of Medical Oncology
🇳🇱Amsterdam, Netherlands
Asan Medical Center; Medical Oncology
🇰🇷Seoul, Korea, Republic of
Catharina Ziekenhuis; Dept of Internal Medicin
🇳🇱Eindhoven, Netherlands
Auckland city hospital; Auckland Regional Cancer Centre and Blood Service
🇳🇿Auckland, New Zealand
Christchurch Hospital; Dept of Oncology
🇳🇿Christchurch, New Zealand
Bialostockie Centrum Onkologii; Oddzial Onkologii Klinicznej
🇵🇱Bialystok, Poland
IPO de Lisboa; Servico de Neurologia
🇵🇹Lisboa, Portugal
IPO de Coimbra; Servico de Oncologia Medica
🇵🇹Coimbra, Portugal
Norrlands Universitetssjukhus; Cancer Centrum
🇸🇪Umea, Sweden
Sahlgrenska Universitetssjukhuset; Jubileumskliniken
🇸🇪Göteborg, Sweden
Akademiska sjukhuset, Onkologkliniken
🇸🇪Uppsala, Sweden
Bristol Haematology and Oncology Centre
🇬🇧Bristol, United Kingdom
Royal Marsden Hospital; Dept of Medical Oncology
🇬🇧Sutton, United Kingdom
Nottingham City Hospital; Dept of Haematology
🇬🇧Nottingham, United Kingdom
The Royal Marsden NHS Foundation Trust; Oncology
🇬🇧London, United Kingdom
Weston Park Hospital; Cancer Clinical Trials Centre
🇬🇧Sheffield, United Kingdom
Sir Charles Gairdner Hospital
🇦🇺Nedlands, Western Australia, Australia
Universitatsklinikum Heidelberg; Abteilung Neuroonkologie
🇩🇪Heidelberg, Germany
London Health Sciences Centre
🇨🇦London, Ontario, Canada
Prince of Wales Hospital; Department of Medical Oncology
🇦🇺Randwick, New South Wales, Australia
Justus-Liebig-Universität Giessen; Neurochirurgische Klinik
🇩🇪Gießen, Germany
Royal Melbourne Hospital; Hematology and Medical Oncology
🇦🇺Parkville, Victoria, Australia
Calvary North Adelaide; North Adeliade Oncology Centre
🇦🇺North Adelaide, South Australia, Australia
Cross Cancer Institute ; Dept of Medical Oncology
🇨🇦Edmonton, Alberta, Canada
Hopital Saint Andre; Département de Radiothérapie Et D'Oncologie Médicale
🇫🇷Bordeaux, France
Hopital de La Timone - CHU de Marseille; Service de neuro-oncologie - Hôpital Adultes - 12ème étage
🇫🇷Marseille, France
Magyar Honvedseg Egeszsegugyi Kozpont
🇭🇺Budapest, Hungary
Uni Klinikum München - Großhardern; Med. Klinik U. Poliklinik III - Abt. Onkologie u. Hämatologie
🇩🇪München, Germany
Borsod-Abaúj-Zemplén Megyei Kórház és Egyetemi Oktató Kórház; Neurosurgery
🇭🇺Miskolc, Hungary
Hadassah Hebrew University Hospital; Leslie and Michael Gaffin Center for Neuro-Oncology
🇮🇱Jerusalem, Israel
Samsung Medical Center; Neurosurgery Department
🇰🇷Seoul, Korea, Republic of
Ausl Di Bologna-Ospedale Bellaria;U.O. Oncologia Medica
🇮🇹Bologna, Emilia-Romagna, Italy
Ospedale di Treviso, Universita di Padova; Neurosurgery Dept
🇮🇹Treviso, Veneto, Italy
Tsukuba University Hospital; Neurology
🇯🇵Ibaraki, Japan
Pusan National University Hospital; Neuro Sugery
🇰🇷Busan, Korea, Republic of
National Cancer Centre; Neurosurgery Dept
🇰🇷Goyang-si, Korea, Republic of
Seoul National Uni Hospital; Dept. of Internal Medicine/Hematology/Oncology
🇰🇷Seoul, Korea, Republic of
Queen's Hospital; Oncology
🇬🇧Romford, United Kingdom
Yonsei University Severance Hospital; Medical Oncology
🇰🇷Seoul, Korea, Republic of
Centrum Onkologii;Im. Franciszka Lukaszczyka;Onkologii
🇵🇱Bydgoszcz, Poland
UCLA
🇺🇸Los Angeles, California, United States
University of Colorado
🇺🇸Aurora, Colorado, United States
University of Alabama At Birmingham; Neuro-Oncology
🇺🇸Birmingham, Alabama, United States
Moffitt Cancer Center
🇺🇸Tampa, Florida, United States
Henry Ford Health System
🇺🇸Detroit, Michigan, United States
Hatton Research Institutes
🇺🇸Cincinnati, Ohio, United States
Sarah Cannon Cancer Center and Research Institute
🇺🇸Nashville, Tennessee, United States
Cancer Centre of Southeastern Ontario; Kingston General Hospital
🇨🇦Kingston, Ontario, Canada
Sunnybrook Odette Cancer Centre
🇨🇦Toronto, Ontario, Canada
Princess Margaret Hospital; Pencer Brain Tumour Centre, 18-727
🇨🇦Toronto, Ontario, Canada
Ottawa Hospital Regional Cancer Centre; Neuro-Oncology
🇨🇦Ottawa, Ontario, Canada
Dr Stephen Yau; Clinical oncology
🇭🇰Hong Kong, Hong Kong
Hong Kong Sanatorium & Hospital; Comprehensive Oncology Centre
🇭🇰Hong Kong, Hong Kong
Queen Mary Hospital; Microbiology Dept.
🇭🇰Hong Kong, Hong Kong