MedPath

A Study Comparing Bevacizumab Therapy With or Without Erlotinib for First-Line Treatment of Non-Small Cell Lung Cancer (ATLAS)

Phase 3
Completed
Conditions
Non-Small Cell Lung Cancer
Interventions
Registration Number
NCT00257608
Lead Sponsor
Genentech, Inc.
Brief Summary

This is a Phase IIIb, multicenter, randomized, placebo-controlled trial to evaluate the safety and efficacy of chemotherapy+bevacizumab followed by bevacizumab+erlotinib versus bevacizumab+erlotinib placebo in subjects with locally advanced or metastatic NSCLC.

Detailed Description

Not available

Recruitment & Eligibility

Status
COMPLETED
Sex
All
Target Recruitment
1145
Inclusion Criteria
  • Signed Informed Consent Form
  • Histologically or cytologically confirmed NSCLC
  • Advanced NSCLC or recurrent disease
  • INR no greater than 1.3 and aPTT no greater than upper limits of normal (ULN) within 28 days prior to enrollment for subjects not on low molecular weight heparin or fondaparinux. Subjects on low molecular weight heparin or fondaparinux are not required to meet INR or aPTT limits. Chronic full-dose anticoagulation with warfarin is not permitted.
  • 18 years of age or older
  • For women of childbearing potential and sexually active men, use of an accepted and effective method of contraception (hormonal or barrier methods, abstinence) prior to enrollment and for the duration of the study
Read More
Exclusion Criteria
  • Prior systemic chemotherapy in the metastatic setting
  • Treatment with an investigational or marketed agent that acts by either EGFR inhibition or anti-angiogenesis mechanisms
  • Pregnancy or lactation
  • Any other medical condition, including mental illness or substance abuse, deemed by the clinician to be likely to interfere with a subject's ability to provide informed consent, cooperate, and participate in the study, or to interfere with the interpretation of the results
  • Active infection or a fever within 3 days of enrollment
  • Active malignancy other than lung cancer
  • Radiation therapy to sites other than whole brain within 14 days prior to enrollment
  • History of gross hemoptysis within 3 months prior to enrollment
  • Known hypersensitivity to any of the components of cytotoxic chemotherapy combinations, bevacizumab, or tyrosine kinase inhibitors
  • Inadequately controlled hypertension
  • Unstable angina or New York Heart Association Grade II or greater CHF
  • Abdominal fistula, gastrointestinal perforation, or intra-abdominal abscess within 6 months prior to enrollment
  • History of myocardial infarction within 6 months prior to enrollment
  • History of stroke within 6 months prior to enrollment
  • Symptomatic peripheral vascular disease within 6 months prior to enrollment
  • Evidence of bleeding diathesis or coagulopathy
  • Serious, non-healing wound, ulcer, or bone fracture
  • Major surgical procedure, open biopsy, or significant traumatic injury within 28 days prior to enrollment; anticipation of need for major surgical procedure during the course of the study
  • Current, recent, or planned participation in an experimental drug study other than this Genentech-sponsored bevacizumab/erlotinib study
  • Progressive neurologic symptoms in subjects with a history of brain metastases
  • History of significant vascular disease (e.g., aortic aneurysm)
Read More

Study & Design

Study Type
INTERVENTIONAL
Study Design
PARALLEL
Arm && Interventions
GroupInterventionDescription
1erlotinib HCl-
2placebo-
1bevacizumab-
2bevacizumab-
Primary Outcome Measures
NameTimeMethod
Progression-free Survival (PFS)Approximately 3 years

PFS was defined as the length of time from randomization until documented disease progression or death from any cause, whichever occurred earlier. Progression is defined using Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.0), as a 20% increase in the sum of the longest diameter of target lesions, or a measurable increase in a non-target lesion, or the appearance of new lesions. Data presented until cut-off date 18 July 2008.

Secondary Outcome Measures
NameTimeMethod
Number of Participants With Prospectively Identified Treatment Emergent Adverse Events (TEAE) During Chemotherapy PhaseApproximately 3 years

Treatment-emergent adverse events were events between administration of study drug and up to 30 days after last dose of study drug that were absent before treatment or that worsened relative to pre-treatment state.. Number of participants who had Grade \>=3TEAEs of pulmonary hemorrhage, gastrointestinal (GI) perforation, arterial thromboembolic (ATE) events, proteinuria, congestive heart failure (CHF), and hypertension were presented. Data presented up to data cutoff 18 July 2008.

Number of Participants With Prospectively Identified Treatment Emergent Adverse Events (TEAE) During Post-Chemotherapy PhaseApproximately 3 years

Treatment-related adverse events are defined as new events that occur following subject entry into the study or events that worsen following study entry state and are judged by the investigator to be possibly, probably or definitely related to study medication. Pulmonary hemorrhage, GI perforation, ATE events, proteinuria, CHF, and hypertension were prospectively identified TEAEs of grade \>=3. Data presented until cut-off date 28 January 2009.

Number of Participants With Any Adverse Events During Post-Chemotherapy PhaseApproximately 3.5 years

An AE is defined as any unfavorable and unintended sign (including an abnormal laboratory finding), symptom, or disease temporally associated with the use of a medicinal product, whether or not considered related to the medicinal product. An SAE is defined as any untoward medical occurrence that, at any dose, results in death, is life threatening, requires hospitalization or prolongation of existing hospitalization, results in persistent or significant disability/incapacity, is a congenital anomaly/birth defect, or is a significant medical event. Data presented up to data cutoff 19 June 2009.

Incidence of Study Treatment Discontinuation for Reasons Other Than Disease Progression in Chemotherapy PhaseApproximately 3 years

Participants who experienced disease progression were discontinued from the study. Data presented up to data cutoff (18 July 2008).

Incidence of Study Treatment DiscontinuationApproximately 3 years

Participants in post-chemotherapy phase were discontinued from the study for the reasons other than disease progression. Data presented Up to data cutoff 18 July 2008.

Overall SurvivalApproximately 3.5 years

Overall survival was defined as the length of time from randomization to death.

Trial Locations

Locations (241)

Siouxland Hem-Onc Assoc LLP

🇺🇸

Sioux City, Iowa, United States

Montana Cancer Specialists

🇺🇸

Missoula, Montana, United States

Coastal Bend Cancer Center

🇺🇸

Corpus Christi, Texas, United States

Ellis Fischel Cancer Center

🇺🇸

Columbia, Missouri, United States

BRANY

🇺🇸

Great Neck, New York, United States

Gabrail Cancer Center

🇺🇸

Canton, Ohio, United States

Billings Clinic

🇺🇸

Billings, Montana, United States

Sheba Medical Center

🇮🇱

Tel-Hashomer, Israel

Pramongkutklao Hospital

🇹🇭

Bangkok, Thailand

Torre Medica Cristobal Colon

🇲🇽

Acapulco, Mexico

Hospital de Especialidades

🇲🇽

Torreon, Coahuila, Mexico

Siriraj Hospital

🇹🇭

Bangkok, Thailand

Maharaj Nakorn Chiang Mai Hosp

🇹🇭

Chiangmai, Thailand

Inst Nacional de Cancerologia

🇲🇽

Distrito Federal, Mexico

ISSSTE Merida

🇲🇽

Merida, Mexico

Philippine General Hospital

🇵🇭

Manila, Luzon, Philippines

The Medical City

🇵🇭

Pasig City, Luzon, Philippines

Veterans Memorial Medical Ctr

🇵🇭

Quezon City, Luzon, Philippines

Univ of Santo Tomas Hospital

🇵🇭

Manila, Philippines

Spitalul Clinic Judetean Sibiu

🇷🇴

Sibiu, Romania

Spitalul Judetean de Urgente

🇷🇴

Suceava, Romania

Centrul de Onc Medical Lasi

🇷🇴

Iasi, Romania

National Cancer Center

🇸🇬

Singapore, Singapore

China Medical Univ Hosp

🇨🇳

Taichung, Taiwan

Dana Farber Cancer Institute

🇺🇸

Boston, Massachusetts, United States

Caritas St. Elizabeth Med Ctr

🇺🇸

Boston, Massachusetts, United States

MetroHealth Medical Center

🇺🇸

Cleveland, Ohio, United States

Riverside Methodist Hospital

🇺🇸

Columbus, Ohio, United States

Comp Blood & Cancer Center

🇺🇸

Bakersfield, California, United States

Kenmar Research Institute LLC

🇺🇸

Los Angeles, California, United States

Glendale Adventist Medical Ctr

🇺🇸

Glendale, California, United States

Scipps Clinic

🇺🇸

La Jolla, California, United States

UCLA Medical Ctr

🇺🇸

Los Angeles, California, United States

Pacific Shores Medical Group

🇺🇸

Long Beach, California, United States

Medical Oncology Care Assoc

🇺🇸

Orange, California, United States

Kalamazoo Hem & Onc

🇺🇸

Kalamazoo, Michigan, United States

Hunterdon Medical Center

🇺🇸

Flemington, New Jersey, United States

William Beaumont Hospital

🇺🇸

Royal Oak, Michigan, United States

Ronald H. Yanagihara

🇺🇸

Gilroy, California, United States

Loma Linda Univ Medical Center

🇺🇸

Loma Linda, California, United States

St. Joseph Mercy Oakland

🇺🇸

Pontiac, Michigan, United States

Lahey Clinic Med Ctr

🇺🇸

Burlington, Massachusetts, United States

South Bay Oncology

🇺🇸

Campbell, California, United States

Sutter Gould Med Foundation

🇺🇸

Modesto, California, United States

Frederick Memorial Hospital

🇺🇸

Frederick, Maryland, United States

Forte, Attas & Schleider

🇺🇸

Englewood, New Jersey, United States

Summa Health System

🇺🇸

Akron, Ohio, United States

Morristown Memorial Hospital

🇺🇸

Morristown, New Jersey, United States

Baystate Medical Center

🇺🇸

Springfield, Massachusetts, United States

Mountainside Hospital

🇺🇸

Montclair, New Jersey, United States

Zale P Bernstein MD - PP

🇺🇸

Buffalo, New York, United States

Missouri Cancer Center, PC

🇺🇸

St Charles, Missouri, United States

Metrowest Cancer Center

🇺🇸

Framingham, Massachusetts, United States

Texas Cancer Associates

🇺🇸

Dallas, Texas, United States

Clopton Clinic

🇺🇸

Memphis, Tennessee, United States

Providence Medical Group

🇺🇸

Terre Haute, Indiana, United States

Marquette General Health Sys

🇺🇸

Marquette, Michigan, United States

Arch Medical Services

🇺🇸

Washington, Missouri, United States

Ctr for Cancer & Hem Disease

🇺🇸

Cherry Hill, New Jersey, United States

Freeman Cancer Institute

🇺🇸

Joplin, Missouri, United States

Big Sky Oncology

🇺🇸

Great Falls, Montana, United States

Central State Medical Center

🇺🇸

Freehold, New Jersey, United States

The Valley Hospital

🇺🇸

Paramus, New Jersey, United States

San Juan Onco Assoc

🇺🇸

Farmington, New Mexico, United States

NE Hematology Oncology, PC

🇺🇸

Lincoln, Nebraska, United States

St. Barnabas Health Care Sys

🇺🇸

Livingston, New Jersey, United States

Moses Cone Reg Cncr Ctr

🇺🇸

Greensboro, North Carolina, United States

Armstrong County Memorial Hosp

🇺🇸

Kittanning, Pennsylvania, United States

Overlook Hospital

🇺🇸

Summit, New Jersey, United States

Mid Ohio Onc Hematology Inc

🇺🇸

Columbus, Ohio, United States

Mem Sloan Kettering Cancer Ctr

🇺🇸

New York, New York, United States

Hospital del Mar

🇪🇸

Barcelona, Spain

Kinston Medical Specialists

🇺🇸

Kinston, North Carolina, United States

Aultman Hospital

🇺🇸

Canton, Ohio, United States

Univ of Texas Medical Branch

🇺🇸

Galveston, Texas, United States

Emerywood Hematology Oncology

🇺🇸

High Point, North Carolina, United States

Hem Onc Assoc Phys Lancaster

🇺🇸

Lancaster, Pennsylvania, United States

Jersey Shore Medical Center

🇺🇸

Neptune, New Jersey, United States

NYU Medical Center

🇺🇸

New York, New York, United States

Erlanger Health Systems

🇺🇸

Chattanooga, Tennessee, United States

Ephrata Cancer Center

🇺🇸

Ephrata, Pennsylvania, United States

Assoc in Hematology Oncology

🇺🇸

Upland, Pennsylvania, United States

The Jones Clinic

🇺🇸

Germantown, Tennessee, United States

SW Virginia Hem Onc

🇺🇸

Roanoke, Virginia, United States

All Saints Cancer Center

🇺🇸

Racine, Wisconsin, United States

JPS Center for Cancer Care

🇺🇸

Fort Worth, Texas, United States

Centro Oncologico de Cordoba

🇦🇷

Cordoba, Argentina

MHAT "St Marina"

🇧🇬

Varna, Bulgaria

Instituto Nacional do Cancer

🇧🇷

Rio de Janeiro, Brazil

UMHAT "Queen Joanna"

🇧🇬

Sofia, Bulgaria

Divisione Onc Med dell'Azienda

🇮🇹

Udine, Italy

Sir Charles Gairdner Hospital

🇦🇺

Nedlands, WA, Australia

Palmetto Hematology Oncology

🇺🇸

Spartanburg, South Carolina, United States

West Virginia University

🇺🇸

Morgantown, West Virginia, United States

Queen Mary Hospital

🇭🇰

Hong Kong, Hong Kong

Hospital Britanico

🇦🇷

Buenos Aires, Argentina

Jackson-Madsion County Hosp

🇺🇸

Jackson, Tennessee, United States

Instituto Medico Privado

🇦🇷

Resistencia, Argentina

Bristol Heamatology & Onc Ctr

🇬🇧

Bristol, United Kingdom

Vermont Ctr Cancer Medicine

🇺🇸

Colchester, Vermont, United States

Azienda Ospedaliera

🇮🇹

Parma, Italy

Azienda Osper di Perugia

🇮🇹

Perugia, Italy

Dean Clinic

🇺🇸

Madison, Wisconsin, United States

Peninsula Cancer Institute

🇺🇸

Newport News, Virginia, United States

Hospital Toru

🇦🇷

Buenos Aires, Argentina

Burnside War Memorial Hospital

🇦🇺

Toorak Gardens, SA, Australia

CEMIC

🇦🇷

Buenos Aires, Argentina

COIR

🇦🇷

Mendoza, Argentina

National Specialized Hospital

🇧🇬

Sofia, Bulgaria

Univ degli Studi di Napoli

🇮🇹

Napoli, Italy

Hadassah Medical Center

🇮🇱

Jerusalem, Israel

Ist Nazion per Ricerca Cancro

🇮🇹

Genova, Italy

ISIS Clinica Especializada

🇦🇷

Sante Fe, Argentina

Sunshine Coast Cancer Centre

🇦🇺

Nambour, QLD, Australia

Bumrungrad International Hosp

🇹🇭

Bangkok, Thailand

Taichung Veterans Gen Hosp

🇨🇳

Taiwan, Taiwan

National Taiwan University

🇨🇳

Taipei, Taiwan

National Cancer Institute

🇹🇭

Bangkok, Thailand

Hospital Clinico Universitario

🇪🇸

Valencia, Spain

Comp Cancer Centers of Nevada

🇺🇸

Las Vegas, Nevada, United States

Onc/Hem Care Clin Trials LLC

🇺🇸

Cincinnati, Ohio, United States

Virginia Piper Cancer Inst

🇺🇸

Minneapolis, Minnesota, United States

Pacific Hematology Oncology

🇺🇸

San Francisco, California, United States

Sarah Cannon Cancer Center

🇺🇸

Nashville, Tennessee, United States

Vanderbilt University Medical

🇺🇸

Nashville, Tennessee, United States

Community Cancer Center

🇺🇸

Rutland, Vermont, United States

Hospital Das Clinicas

🇧🇷

Sao Paulo, Brazil

Queens Cancer Center

🇺🇸

Jamaica, New York, United States

Nebraska Methodist Hospital

🇺🇸

Omaha, Nebraska, United States

Medical Consultants LTD

🇺🇸

Milwaukee, Wisconsin, United States

Bay Area Cancer Research Grp

🇺🇸

Concord, California, United States

Cancer Care Associates

🇺🇸

Torrance, California, United States

Santa Barbara Hem Onc Med Grp

🇺🇸

Santa Barbara, California, United States

Redwood Regional Med Grp

🇺🇸

Santa Rosa, California, United States

Holy Name Hospital

🇺🇸

Teaneck, New Jersey, United States

Cancer Institute of New Jersey

🇺🇸

New Brunswick, New Jersey, United States

Beaufort County Hospital

🇺🇸

Washington, North Carolina, United States

Providence Portland Med Center

🇺🇸

Portland, Oregon, United States

Hem Onc Med Grp Orange Cty

🇺🇸

Orange, California, United States

Ohio Cancer Specialists

🇺🇸

Mansfield, Ohio, United States

Mayo Clinic

🇺🇸

Scottsdale, Arizona, United States

St. Edward Mercy Medical Ctr

🇺🇸

Ft Smith, Arizona, United States

St. Jude Heritage Med Group

🇺🇸

Fullerton, California, United States

North Valley Hem Onc Med Grp

🇺🇸

Northridge, California, United States

Wilshire Oncology Medical Grp

🇺🇸

Pomona, California, United States

Kaiser Permanente

🇺🇸

San Diego, California, United States

Sansum Medical Clinic, Inc.

🇺🇸

Santa Barbara, California, United States

Central Coast Medical Oncology

🇺🇸

Santa Maria, California, United States

The Angeles Clinic

🇺🇸

Santa Monica, California, United States

Front Range Cancer Specialists

🇺🇸

Fort Collins, Colorado, United States

Mile High Oncology

🇺🇸

Denver, Colorado, United States

Washington Onc Hem Center PC

🇺🇸

Washington, District of Columbia, United States

Center for Hematology-Oncology

🇺🇸

Boca Raton, Florida, United States

Halifax Medical Center

🇺🇸

Daytona Beach, Florida, United States

Jackson Memorial Hospital

🇺🇸

Miami, Florida, United States

Baptist Cancer Institute

🇺🇸

Jacksonville, Florida, United States

Florida Wellcare Alliance

🇺🇸

Inverness, Florida, United States

Hematology Onc Treasure Coast

🇺🇸

Port Saint Lucie, Florida, United States

Integrated Comm Onc Network

🇺🇸

Orange Park, Florida, United States

Phoebe Putney Cancer Center

🇺🇸

Albany, Georgia, United States

Northeast Georgia Cancer Care

🇺🇸

Athens, Georgia, United States

Suburban Hem-Onc Associates

🇺🇸

Lawrenceville, Georgia, United States

Northwest Georgia Onc Centers

🇺🇸

Marietta, Georgia, United States

LaGrange Oncology Associates

🇺🇸

Geneva, Illinois, United States

Associates in Medical Oncology

🇺🇸

Oak Lawn, Illinois, United States

Onc Hem Assoc of Central IL

🇺🇸

Peoria, Illinois, United States

West Suburban Cancer Center

🇺🇸

River Forest, Illinois, United States

Community Hospital

🇺🇸

Munster, Indiana, United States

Gajera & Patel, PLLC

🇺🇸

Hopkinsville, Kentucky, United States

H&J Weinberg Cancer Institute

🇺🇸

Baltimore, Maryland, United States

Willis-Knighton Cancer Center

🇺🇸

Shreveport, Louisiana, United States

Owensboro Medical Health Sys

🇺🇸

Owensboro, Kentucky, United States

Oncology Hematology Associates

🇺🇸

Clinton, Maryland, United States

Maryland Oncology/Hema PA

🇺🇸

Columbia, Maryland, United States

Adriondack Cancer Care

🇺🇸

Glen Falls, New York, United States

Bassett Cancer Center

🇺🇸

Cooperstown, New York, United States

Presbyterian Hospital

🇺🇸

Charlotte, North Carolina, United States

SUNY Upstate

🇺🇸

Syracuse, New York, United States

Carolina BioOncology Institute

🇺🇸

Huntersville, North Carolina, United States

Dayton Clinical Oncology Prog

🇺🇸

Dayton, Ohio, United States

Signal Point Hem/Oncology Inc

🇺🇸

Middletown, Ohio, United States

Toledo Community Hospital

🇺🇸

Toledo, Ohio, United States

Forum Health Cancer Care Ctr

🇺🇸

Youngstown, Ohio, United States

Scranton Hematology Oncology

🇺🇸

Scranton, Pennsylvania, United States

Lankenau Medical Office Bldg

🇺🇸

Wynnewood, Pennsylvania, United States

Texas Hematology Oncology

🇺🇸

Dallas, Texas, United States

Northwest Medical Specialists

🇺🇸

Tacoma, Washington, United States

Wilford Hall Medical Center

🇺🇸

Lackland AFB, Texas, United States

SW Vermont Healthcare Onc Asoc

🇺🇸

Bennington, Vermont, United States

Cascade Cancer Center

🇺🇸

Kirkland, Washington, United States

Univ Physicians Internal Med

🇺🇸

Huntington, West Virginia, United States

Oncology Alliance

🇺🇸

Glendale, Wisconsin, United States

Hospital Pirovano

🇦🇷

Buenos Aires, Argentina

Clinica Oncologica de Rosario

🇦🇷

Rosario, Argentina

Holy Spirit Hospital Northside

🇦🇺

Chermside, QLD, Australia

CHR Citadelle Liege

🇧🇪

Liege, Belgium

Cliniques Univ St Luc

🇧🇪

Brussels, Belgium

Regional Oncodispensary

🇧🇬

Veliko Tarnovo, Bulgaria

Instituto de cancer Arnaldo

🇧🇷

Sao Paulo, Brazil

Tuen Mun Hospital

🇭🇰

Hong Kong, Hong Kong

Azienda Ospedaliera Univ

🇮🇹

Genova, Italy

Sourasky Medical Center

🇮🇱

Tel-Aviv, Israel

Perpetual Succour Hospital

🇵🇭

Cebu City, Visayas, Philippines

St Luke's Medical Center

🇵🇭

Quezon City, Philippines

Hospital Clinic i Provincial

🇪🇸

Barcelona, Spain

Hospital de Cruces

🇪🇸

Barakaldo, Spain

Corporacio Sanitaria Parc

🇪🇸

Sabadell, Barcelona, Spain

Hospital Universitario

🇪🇸

La Laguna, Spain

Instituto Valenciano Oncologia

🇪🇸

Valencia, Spain

Sacred Heart Medical Onc Group

🇺🇸

Mobile, Alabama, United States

OSF St. Anthony Med Ctr

🇺🇸

Rockford, Illinois, United States

Arizona Cancer Center

🇺🇸

Tucson, Arizona, United States

Central Hem/Onc Medical Group

🇺🇸

Alhambra, California, United States

Chicagoland Hematology Onc

🇺🇸

Arlington Heights, Illinois, United States

Kaiser Permanente Santa Teresa

🇺🇸

San Jose, California, United States

Pacific Coast Hem/Onc

🇺🇸

Fountain Valley, California, United States

Pacific Onc & Hem Assoc

🇺🇸

Encinitas, California, United States

Hematology Oncology Associates

🇺🇸

Bettendorf, Iowa, United States

Ventura Co Hem-Onc Specialists

🇺🇸

Oxnard, California, United States

Los Palos Oncology & Hem

🇺🇸

Salinas, California, United States

Naval Medical Center

🇺🇸

San Diego, California, United States

Mid-Florida Hem Oncology Ctr

🇺🇸

Orange City, Florida, United States

La Grange Oncology Associates

🇺🇸

Lagrange, Illinois, United States

Akron General Medical Center

🇺🇸

Akron, Ohio, United States

Weiss-Strauss Oncology Center

🇺🇸

Chicago, Illinois, United States

Covenant Clinic

🇺🇸

Waterloo, Iowa, United States

Spectrum Health

🇺🇸

Grand Rapids, Michigan, United States

St. Louis Univ Care Center

🇺🇸

Saint Louis, Missouri, United States

University of Pennsylvania

🇺🇸

Philadelphia, Pennsylvania, United States

Charleston Cancer Center

🇺🇸

Charleston, South Carolina, United States

Lone Star Oncology Consultants

🇺🇸

Austin, Texas, United States

Sutter Cancer Center

🇺🇸

Sacramento, California, United States

Mercy General Hospital

🇺🇸

Sacramento, California, United States

Consultants in Blood Disorders

🇺🇸

Louisville, Kentucky, United States

Kentuckiana Cancer Center

🇺🇸

Louisville, Kentucky, United States

University of Louisville

🇺🇸

Louisville, Kentucky, United States

Hematology Oncology Assoc SJ

🇺🇸

Mount Holly, New Jersey, United States

Crystal Run Health Care

🇺🇸

Middletown, New York, United States

NorthEast Medical Center

🇺🇸

Concord, North Carolina, United States

Princess Margaret Hospital

🇭🇰

Hong Kong, Hong Kong

Queen Elizabeth Hospital

🇭🇰

Hong Kong, Hong Kong

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