A Study of Atezolizumab in Combination With Cabozantinib Compared to Cabozantinib Alone in Participants With Advanced Renal Cell Carcinoma After Immune Checkpoint Inhibitor Treatment

Phase 3

Active, not recruiting

• Conditions: Carcinoma, Renal Cell
• Interventions: Drug: Atezolizumab; Drug: Cabozantinib

• Registration Number: NCT04338269
• Lead Sponsor: Hoffmann-La Roche

Brief Summary

This is a Phase III, multicenter, randomized, open-label study designed to evaluate the efficacy and safety of atezolizumab given in combination with cabozantinib versus cabozantinib alone in participants with inoperable, locally advanced, or metastatic renal cell carcinoma (RCC) who experienced radiographic tumor progression during or after Immune Checkpoint Inhibitor (ICI) treatment in the metastatic setting.

Detailed Description

Not available

Study Timeline

• Study First Submitted: 2020-04-06
• Study First Submitted QC: 2020-04-06
• Study First Posted: 2020-04-08
• Study Start: 2020-07-28
• Primary Completion: 2023-01-03
• Results First Submitted: 2023-12-20
• Results First Submitted QC: 2024-02-05
• Results First Posted: 2024-02-28
• Status Verified: 2024-10
• Last Update Submitted: 2024-10-07
• Last Update Posted: 2024-10-09
• Study Completion: 2024-11-30

Recruitment & Eligibility

• Status: ACTIVE_NOT_RECRUITING
• Sex: All
• Target Recruitment: 522

Inclusion Criteria

• Histologically confirmed locally advanced or metastatic clear cell or non-clear cell (papillary, chromophobe, and unclassified only) RCC. RCC with sarcomatoid features is allowed. Patients with the chromophobe subtype of non-clear cell RCC must have sarcomatoid differentiation.
• Radiographic disease progression to prior ICI therapy for RCC. Patients who experienced radiographic tumor progression during or within 6 months after the last dose of adjuvant ICI are also eligible. ICI is defined by anti-PD-L1 or anti-PD1 antibody including atezolizumab, avelumab, pembrolizumab, durvalumab, or nivolumab. Only patients for whom the immediate preceding line of therapy was an ICI are allowed.
• Measurable disease per RECIST v1.1
• Evaluable IMDC risk score
• Archival tumor specimen, and pretreatment tumor tissue from fresh biopsy at screening, if clinically feasible. Both archival and fresh samples are preferred.
• KPS score of >=70
• Recovery to baseline or Grade </= 1 NCI CTCAE v5.0 from toxicities related to any prior treatments, unless adverse events are clinically nonsignificant and/or stable in the opinion of the investigator. Grade 2 alopecia is allowed for study participation
• Adequate hematologic and end-organ function
• Negative HIV test at screening
• Negative hepatitis B testing at screening
• Negative hepatitis C virus (HCV) antibody test at screening, or positive HCV antibody test followed by a negative HCV RNA test at screening
• For women of childbearing potential: agreement to remain abstinent (refrain from heterosexual intercourse) or use contraception and agreement to refrain from donating eggs
• For men: agreement to remain abstinent (refrain from heterosexual intercourse) or use a condom, and agreement to refrain from donating sperm

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Exclusion Criteria

• Treatment with anti-cancer therapy within 14 days prior to initiation of study treatment
• Patients received cabozantinib at any time prior to screening
• Patients who received more than one ICI treatment in the locally advanced or metastatic setting
• Patients who received more than two prior lines of therapy in the locally advanced or metastatic setting
• Patients who have received a mammalian target of rapamycin (mTOR) inhibitor in any setting
• Symptomatic, untreated, or actively progressing CNS metastases
• History of leptomeningeal disease
• Uncontrolled pleural effusion, pericardial effusion, or ascites requiring recurrent drainage procedures
• Uncontrolled or symptomatic hypercalcemia or symptomatic hypercalcemia requiring continued use of bisphosphonate therapy or denosumab
• History of malignancy other than renal carcinoma within 5 years prior to screening, with the exception of malignancies with a negligible risk of metastasis or death
• Radiotherapy for RCC within 14 days prior to Day 1 of Cycle 1
• Active tuberculosis
• Major surgical procedure, other than for diagnosis, within 4 weeks prior to initiation of study treatment, or anticipation of need for a major surgical procedure during the study
• Pregnancy or breastfeeding, or intention of becoming pregnant during study treatment or within 5 months after final dose of atezolizumab and 4 months after final dose of cabozantinib
• Severe infection within 4 weeks prior to initiation of study treatment, including, but not limited to, hospitalization for complications of infection, bacteremia, or severe pneumonia, or any active infection that, in the opinion of the investigator, could impact patient safety
• Pharmacologically uncompensated, symptomatic hypothyroidism
• Uncontrolled hypertension defined as sustained blood pressure >150 mm Hg systolic or > 90 mm Hg diastolic despite optimal antihypertensive treatment (all countries except France); sustained BP > 140 mmHg systolic or > 90 mmHg diastolic despite optimal antihypertensive treatment (France only)
• Significant cardiovascular disease (such as New York Heart Association Class II or greater cardiac disease, unstable arrhythmia, or unstable angina) within 3 months prior to initiation of study treatment
• Significant vascular disease (e.g., aortic aneurysm or arterial dissection requiring surgical repair or recent peripheral arterial thrombosis) within 6 months prior to Day 1 of Cycle 1
• History of congenital QT syndrome
• History or presence of an abnormal ECG that is clinically significant in the investigator's opinion
• Concomitant anticoagulation with coumarin agents (e.g., warfarin), direct thrombin inhibitor dabigatran, direct factor Xa inhibitor betrixaban, or platelet inhibitors (e.g. clopidogrel)

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Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Atezo+Cabo	Cabozantinib	Participants will receive atezolizumab every 3 weeks on Day 1 of each 21-day cycle (1 cycle=21 days) plus oral tablets of cabozantinib every day.
Atezo+Cabo	Atezolizumab	Participants will receive atezolizumab every 3 weeks on Day 1 of each 21-day cycle (1 cycle=21 days) plus oral tablets of cabozantinib every day.
Cabozantinib	Cabozantinib	Participants will receive cabozantinib every day.

Primary Outcome Measures

Name	Time	Method
Progression Free Survival (PFS) as Assessed by an Independent Review Facility (IRF) (IRF-PFS) According to RECIST v1.1	From randomization to the first occurrence of disease progression according to RECIST v1.1 (up to 2 years 5 months).	Progression Free Survival (PFS) is defined as the time from randomization to disease progression, as determined by the Independent Review Facility (IRF) per RECIST v1.1, or death from any cause, whichever occurs first. Data for patients who have not experienced disease progression or death were censored at the last tumor assessment date. Data for patients with no postbaseline tumor assessments were censored at the randomization date.
Overall Survival (OS)	From randomization to death due to any cause (up to 2 years 5 months).	From randomization to death due to any cause. Data for patients who are not reported as having died at the date of analysis were censored at the date when they were last known to be alive. Patients who do not have post-baseline information were censored at the date of randomization.

Secondary Outcome Measures

Name	Time	Method
Independent Review Facility (IRF)-Assessed Overall Response Rate (ORR) (IRF-ORR) According to RECIST v1.1	From randomization to the first occurrence of disease progression according to RECIST v1.1 or death from any cause (whichever occurs first) (up to 2 years 5 months).	Overall Response Rate (ORR) is defined as the proportion of participants who had an objective response (complete response \[CR\] or partial response \[PR\]) on two consecutive occasions at least 4 weeks apart according to RECIST v1.1. in the ORR evaluable population, defined as patients with measurable disease at baseline.
Investigator-assessed Overall Response Rate (ORR) (INV-ORR) According to RECIST v1.1	From randomization to the first occurrence of disease progression according to RECIST v1.1 or death from any cause (whichever occurs first) (up to 2 years 5 months).	Overall Response Rate (ORR) is defined as the proportion of participants who had an objective response (complete response \[CR\] or partial response \[PR\]) on two consecutive occasions at least 4 weeks apart according to RECIST v1.1. in the ORR evaluable population, defined as patients with measurable disease at baseline.
Progression Free Survival (PFS) as Assessed by Investigators (INV-PFS), According to RECIST v1.1	From randomization to the first occurrence of disease progression according to RECIST v1.1 or death from any cause (whichever occurs first) (up to 2 years 5 months).	Progression Free Survival (PFS) is defined as the time from randomization to disease progression, as determined by the Investigators per RECIST v1.1, or death from any cause, whichever occurs first. Data for patients who have not experienced disease progression or death were censored at the last tumor assessment date. Data for patients with no postbaseline tumor assessments were censored at the randomization date.
Investigator-assessed Duration of Response (DOR) (INV-DOR) According to RECIST v1.1	From the date of first occurrence of a documented objective response to disease progression or death from any cause, whichever occurs first (up to 2 years 5 months)	Duration of Response (DOR) is defined as the time from the first occurrence of a confirmed objective response (complete response \[CR\] or partial response \[PR\]) to disease progression, or death, whichever occurs first. Data for participants who have not experienced disease progression or death will be censored at the last tumor assessment date. If no tumor assessments were performed after the date of the first occurrence of CR or PR, data for DOR will be censored at the date of the first occurrence of CR or PR.
Independent Review Facility (IRF)-Assessed Duration of Response (DOR) (IRF-DOR) According to RECIST v1.1	From the date of first occurrence of a documented objective response to disease progression or death from any cause, whichever occurs first (up to 2 years 5 months)	Duration of Response (DOR) is defined as the time from the first occurrence of a confirmed objective response (complete response \[CR\] or partial response \[PR\]) to disease progression, or death, whichever occurs first. Data for participants who have not experienced disease progression or death will be censored at the last tumor assessment date. If no tumor assessments were performed after the date of the first occurrence of CR or PR, data for DOR will be censored at the date of the first occurrence of CR or PR.

Trial Locations

Locations (143)

Texas Oncology - Central South; 🇺🇸 Austin, Texas, United States

University of Arizona; 🇺🇸 Tucson, Arizona, United States

City of Hope Comprehensive Cancer Center; 🇺🇸 Duarte, California, United States

UC San Diego Health System; 🇺🇸 La Jolla, California, United States

UCLA; 🇺🇸 Los Angeles, California, United States

University of Colorado; 🇺🇸 Aurora, Colorado, United States

Rocky Mountain Cancer Center - Denver; 🇺🇸 Littleton, Colorado, United States

Woodlands Medical Specialists, P.A.; 🇺🇸 Pensacola, Florida, United States

Moffitt Cancer Center; 🇺🇸 Tampa, Florida, United States

Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; Skip Viragh Outpatient Cancer Building; 🇺🇸 Baltimore, Maryland, United States

MGH; 🇺🇸 Boston, Massachusetts, United States

Beth Israel Deaconess Med Ctr; 🇺🇸 Boston, Massachusetts, United States

Dana-Farber Cancer Institute; 🇺🇸 Boston, Massachusetts, United States

Minnesota Oncology Hematology; 🇺🇸 Saint Paul, Minnesota, United States

Comprehensive Cancer Centers of Nevada (CCCN) - Central Valley; 🇺🇸 Las Vegas, Nevada, United States

Memorial Sloan Kettering - Monmouth; 🇺🇸 Middletown, New Jersey, United States

Memorial Sloan Kettering Bergen; 🇺🇸 Montvale, New Jersey, United States

New York Oncology Hematology,P.C.-Albany; 🇺🇸 Albany, New York, United States

Montefiore Medical Center; 🇺🇸 Bronx, New York, United States

Memorial Sloan Kettering Cancer Center - Commack; 🇺🇸 Commack, New York, United States

MSKCC @ West Harrison; 🇺🇸 Harrison, New York, United States

Mount Sinai Medical Center; 🇺🇸 New York, New York, United States

Memorial Sloan Kettering Cancer Center; 🇺🇸 New York, New York, United States

SUNY Upstate Medical University; 🇺🇸 Syracuse, New York, United States

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

Cleveland Clinic; 🇺🇸 Cleveland, Ohio, United States

Fox Chase Cancer Center; 🇺🇸 Philadelphia, Pennsylvania, United States

University Of Utah; 🇺🇸 Salt Lake City, Utah, United States

Virginia Cancer Specialists - Gainsville; 🇺🇸 Gainesville, Virginia, United States

Fundación CENIT para la Investigación en Neurociencias; 🇦🇷 Buenos Aires, Argentina

Inst. Alexander Fleming; Oncologia; 🇦🇷 Buenos Aires, Argentina

Hospital Britanico; 🇦🇷 Ciudad Autonoma Bs As, Argentina

Centro Medico Austral OMI; 🇦🇷 Ciudad Autonoma Buenos Aires, Argentina

Macquarie University Hospital; 🇦🇺 Macquarie Park, New South Wales, Australia

Orange Hospital; 🇦🇺 Orange, New South Wales, Australia

Icon Cancer Foundation; 🇦🇺 South Brisbane, Queensland, Australia

Bendigo Cancer Centre; 🇦🇺 Bendigo, Victoria, Australia

St. Joseph's Healthcare Hamilton; 🇨🇦 Hamilton, Ontario, Canada

Princess Margaret Cancer Center; 🇨🇦 Toronto, Ontario, Canada

Herlev Hospital; Afdeling for Kræftbehandling; 🇩🇰 Herlev, Denmark

CHU Besançon - Hôpital Jean Minjoz; 🇫🇷 Besançon Cedex, France

CHU de Bordeaux - Groupe Hospitalier Saint-André - Hopital Saint-Andre; 🇫🇷 Bordeaux, France

Centre Francois Baclesse; Oncologie; 🇫🇷 Caen, France

Centre Jean Perrin; Oncologie; 🇫🇷 Clermont Ferrand, France

Centre Oscar Lambret; Chir Cancerologie General; 🇫🇷 Lille, France

Centre Leon Berard; Departement Oncologie Medicale; 🇫🇷 Lyon, France

Centre Antoine Lacassagne; 🇫🇷 Nice, France

Institut de cancerologie du Gard; 🇫🇷 Nimes, France

Hopital Europeen Georges Pompidou; Service D'Oncologie Medicale; 🇫🇷 Paris, France

ICANS; 🇫🇷 Strasbourg, France

Institut Gustave Roussy; Oncologie Medicale; 🇫🇷 Villejuif, France

Zeisigwaldkliniken Bethanien; 🇩🇪 Chemnitz, Germany

Klinikum der Johann Wolfgang Goethe-Universitaet; Urologie und Kinderurologie; 🇩🇪 Frankfurt, Germany

Universitaetsklinikum Freiburg; Urology; 🇩🇪 Freiburg, Germany

Krankenhaus Martha-Maria Halle-Dölau, Klinik für Urologie; 🇩🇪 Halle (Saale), Germany

Uniklinik-Eppendorf; Klinik U Poliklinik F Urologie; 🇩🇪 Hamburg, Germany

Med. Hochschule Hannover, Hämatologie, Hämostaseologie, Onkologie u. Stammzelltransplantation; 🇩🇪 Hannover, Germany

Universitaetsklinikum Muenster; Urology; 🇩🇪 Muenster, Germany

Klinikum rechts der Isar der TU München; Urologische Klinik und Poliklinik; 🇩🇪 München, Germany

Universitätsklinikum Tübingen; Klinik für Urologie; 🇩🇪 Tübingen, Germany

Universitätsklinikum Ulm; Klinik für Urologie; 🇩🇪 Ulm, Germany

Alexandras General Hospital of Athens; Oncology Department; 🇬🇷 Athens, Greece

Athens Medical Center; Dept. of Oncology; 🇬🇷 Athens, Greece

Attikon University General Hospital; 🇬🇷 Chaidari, Greece

University Hospital of Larissa;Department of Medical Oncology; 🇬🇷 Larissa, Greece

Diavalkaniko Hospital; 🇬🇷 Thessaloniki, Greece

Istituto Tumori Napoli;Unità Operativa Oncologia Medica Uro-Ginecologica; 🇮🇹 Napoli, Campania, Italy

Azienda Ospedaliero-Universitaria S.Orsola-Malpighi; Unità Operativa Oncologia Medica; 🇮🇹 Bologna, Emilia-Romagna, Italy

IRST Istituto Scientifico Romagnolo Per Lo Studio E Cura Dei Tumori, Sede Meldola; Oncologia Medica; 🇮🇹 Meldola, Emilia-Romagna, Italy

Policlinico Universitario "Agostino Gemelli"; U.O.C. Oncologia Medica; 🇮🇹 Roma, Lazio, Italy

ASST DEGLI SPEDALI CIVILI DI BRESCIA; Oncologia Medica; 🇮🇹 Brescia, Lombardia, Italy

Irccs Istituto Nazionale Dei Tumori (Int);S.C. Medicina Oncologica 2; 🇮🇹 Milano, Lombardia, Italy

Fondazione Salvatore Maugeri; Divisione Di Oncologia Medica; 🇮🇹 Pavia, Lombardia, Italy

Istituto Clinico Humanitas;U.O. Oncologia Medica Ed Ematologia; 🇮🇹 Rozzano, Lombardia, Italy

Ospedale Di Macerata; Oncologia; 🇮🇹 Macerata, Marche, Italy

Fondazione del Piemonte per l?Oncologia (IRCCS); Day Hospital Oncologico Multidisciplinare; 🇮🇹 Candiolo (TO), Piemonte, Italy

A.O. Universitaria Ospedale Consorziale Policlinico Di Bari; U.O. Oncologia Medica Universitaria; 🇮🇹 Bari, Puglia, Italy

Azienda Ospedaliera S. Maria - Terni; Oncologia; 🇮🇹 Terni, Umbria, Italy

A.O.U di Verona Policlinico G.B. Rossi; Centro Ricerche Cliniche; 🇮🇹 Verona, Veneto, Italy

Hokkaido University Hospital; 🇯🇵 Hokkaido, Japan

University of Tsukuba Hospital; 🇯🇵 Ibaraki, Japan

Yokohama City University Hospital; 🇯🇵 Kanagawa, Japan

Okayama University Hospital; 🇯🇵 Okayama, Japan

Osaka Metropolitan University Hospital; 🇯🇵 Osaka, Japan

Tokushima University Hospital; 🇯🇵 Tokushima, Japan

Keio University Hospital; 🇯🇵 Tokyo, Japan

Tokyo Women's Medical University Hospital; 🇯🇵 Tokyo, Japan

Chungnam National University Hospital; 🇰🇷 Daejeon, Korea, Republic of

CHA Bundang Medical Center; 🇰🇷 Gyeonggi-do, Korea, Republic of

Pusan National University Yangsan Hospital; 🇰🇷 Gyeongsangnam-do, Korea, Republic of

Chonnam National University Hwasun Hospital; 🇰🇷 Jeollanam-do, Korea, Republic of

Seoul National University Bundang Hospital; 🇰🇷 Seongnam-si, Korea, Republic of

Seoul National University Hospital; 🇰🇷 Seoul, Korea, Republic of

Kangbuk Samsung Medical Center; 🇰🇷 Seoul, Korea, Republic of

Severance Hospital; 🇰🇷 Seoul, Korea, Republic of

Asan Medical Center; 🇰🇷 Seoul, Korea, Republic of

Samsung Medical Center; 🇰🇷 Seoul, Korea, Republic of

Centrum Terapii Wspolczesnej J.M.Jasnorzewska Spolka Komandytowo-Akcyjna; 🇵🇱 ?ód?, Poland

Szpital Specjalistyczny Podkarpacki O?rodek Onkologiczny; 🇵🇱 Brzozów, Poland

Centrum Onkologii im. Prof. Franciszka ?ukaszczyka; Ambulatorium Chemioterapii; 🇵🇱 Bydgoszcz, Poland

SP ZOZ Wojewódzki Szpital Specjalistyczny nr 4; Oddzial Onkologii Klinicznej; 🇵🇱 Bytom, Poland

Europejskie Centrum Zdrowia Otwock Szpital im. Fryderyka Chopina, Klinika Onkologii; 🇵🇱 Otwock, Poland

Szpital Kliniczny im. Heliodora ?wi?cickiego UM w Poznaniu; Oddzia? Chemioterapii; 🇵🇱 Pozna?, Poland

Szpital Grochowski im. dr med. Rafa?a Masztaka Sp. z o.o.; 🇵🇱 Warszawa, Poland

Wojskowy Instytut Medyczny; Klinika Onkologii; 🇵🇱 Warszawa, Poland

Dolno?l?skie Centrum Onkologii, Pulmonologii i Hematologii; 🇵🇱 Wroc?aw, Poland

Regional Clinical Oncology Hospital; 🇷🇺 Yaroslavl, Jaroslavl, Russian Federation

St-Petersburg Regional Oncology Dispensary; Oncology; 🇷🇺 Kuzmolovo, Leningrad, Russian Federation

Branch of the company "Hadassah Medical LTD"; 🇷🇺 Innovatsionnogo Tsentra Skolkovo, Moskovskaja Oblast, Russian Federation

FSBSI "Russian Oncological Scientific Center n.a. N.N. Blokhin"; 🇷🇺 Moscow, Moskovskaja Oblast, Russian Federation

Royal Blackburn Hospital; 🇬🇧 Blackburn, United Kingdom

Leicester Royal Infirmary; Dept. of Medical Oncology; 🇬🇧 Leicester, United Kingdom

Barts & London School of Med; Medical Oncology; 🇬🇧 London, United Kingdom

Royal Marsden Hospital; Dept of Med-Onc; 🇬🇧 London, United Kingdom

Christie Hospital Nhs Trust; Medical Oncology; 🇬🇧 Manchester, United Kingdom

Royal Marsden Hospital (Sutton); 🇬🇧 Sutton, United Kingdom

MEDSI Clinical Hospital on Pyatnitsky Highway; Department of antitumor drug therapy; 🇷🇺 Moscow, Moskovskaja Oblast, Russian Federation

SBIH "Moscow Clinical Scientific and Practical Center named after A.S. Loginov of DHM"; 🇷🇺 Moskva, Moskovskaja Oblast, Russian Federation

National Medical Research Center for Surgery named after A.V. Vishnevsky; 🇷🇺 Moskva, Moskovskaja Oblast, Russian Federation

AV Medical Ltd.; 🇷🇺 Sait-Petersburg Sankt Petersburg, Sankt Petersburg, Russian Federation

Private Healthcare Institution Clinical Hospital RZhD Medicine; 🇷🇺 St. Petersburg, Sankt Petersburg, Russian Federation

Medical Center Avicenna; Urology; 🇷🇺 Novosibirsk, Russian Federation

Hospital Univ. Central de Asturias; Servicio de Oncologia; 🇪🇸 Oviedo, Asturias, Spain

Corporacio Sanitaria Parc Tauli; Servicio de Oncologia; 🇪🇸 Sabadell, Barcelona, Spain

Hospital Universitario Marques de Valdecilla; Servicio de Oncologia; 🇪🇸 Santander, Cantabria, Spain

Hospital Universitario Reina Sofia; Servicio de Oncologia; 🇪🇸 Córdoba, Cordoba, Spain

Hospital Universitario Son Espases; Servicio de Oncologia; 🇪🇸 Palma De Mallorca, Islas Baleares, Spain

Hospital Alvaro Cunqueiro; Servicio de Oncologia; 🇪🇸 Vigo, Pontevedra, Spain

Vall d?Hebron Institute of Oncology (VHIO), Barcelona; 🇪🇸 Barcelona, Spain

Hospital de la Santa Creu i Sant Pau; Servicio de Oncologia; 🇪🇸 Barcelona, Spain

Hospital Universitario de Burgos; Oncología; 🇪🇸 Burgos, Spain

Hospital San Pedro De Alcantara; Servicio de Oncologia; 🇪🇸 Caceres, Spain

Hospital Lucus Augusti; Servicio de Oncologia; 🇪🇸 Lugo, Spain

Hospital General Universitario Gregorio Marañon; Servicio de Oncologia; 🇪🇸 Madrid, Spain

Hospital Ramon y Cajal; Servicio de Oncologia; 🇪🇸 Madrid, Spain

Hospital Clinico San Carlos; Servicio de Oncologia; 🇪🇸 Madrid, Spain

Hospital Universitario 12 de Octubre; Servicio de Oncologia; 🇪🇸 Madrid, Spain

Hospital Universitario La Paz; Servicio de Oncologia; 🇪🇸 Madrid, Spain

Hospital Clinico Universitario Virgen de la Victoria; Servicio de Oncologia; 🇪🇸 Malaga, Spain

Hospital Universitario Virgen de Arrixaca; Servicio de Oncologia; 🇪🇸 Murcia, Spain

Hospital de Navarra; Servicio de Oncologia; 🇪🇸 Navarra, Spain

Hospital Universitario Virgen del Rocio; Servicio de Oncologia; 🇪🇸 Sevilla, Spain

Hospital Universitario la Fe; Servicio de Oncologia; 🇪🇸 Valencia, Spain