A Study of Atezolizumab in Combination With Carboplatin or Cisplatin + Pemetrexed Compared With Carboplatin or Cisplatin + Pemetrexed in Participants Who Are Chemotherapy-Naive and Have Stage IV Non-Squamous Non-Small Cell Lung Cancer (NSCLC) (IMpower 132)
- Conditions
- Non-Small Cell Lung Cancer
- Interventions
- Registration Number
- NCT02657434
- Lead Sponsor
- Hoffmann-La Roche
- Brief Summary
This is a randomized, Phase III, multicenter, open-label study designed to evaluate the safety and efficacy of atezolizumab in combination with cisplatin or carboplatin + pemetrexed compared with treatment with cisplatin or carboplatin + pemetrexed in participants who are chemotherapy-naive and have Stage IV non-squamous NSCLC. Eligible participants will be randomized by a 1:1 ratio into 2 groups: Arm A (Atezolizumab + Carboplatin or Cisplatin + Pemetrexed) and Arm B (Carboplatin or Cisplatin + Pemetrexed). The study will be conducted in two phases: Induction Phase and Maintenance Phase.
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 578
- Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1
- Histologically or cytologically confirmed, Stage IV non-squamous NSCLC. Participants with tumors of mixed non-small cell histology (i.e., squamous and non-squamous) are eligible if the major histological component appears to be non-squamous
- No prior treatment for Stage IV non-squamous NSCLC. Participants with a sensitizing mutation in the epidermal growth factor receptor (EGFR) gene or with an anaplastic lymphoma kinase (ALK) fusion oncogene are excluded. Participants with unknown EGFR and ALK status require test results at screening from a local or central laboratory
- Participants who have received prior neo-adjuvant, radiotherapy, adjuvant chemotherapy, or chemoradiotherapy with curative intent for non-metastatic disease must have experienced a treatment-free interval of at least 6 months from randomization since the last dose of chemotherapy and/or radiotherapy
- Participants should submit a pre-treatment tumor tissue sample if available before or within 4 weeks after enrollment. If tumor tissue is not available, participants are still eligible
- For participants enrolled in the extended China enrollment phase: current resident of mainland China, Hong Kong, or Taiwan and of Chinese ancestry
- Measurable disease, as defined by RECIST v1.1
- Adequate hematologic and end organ function
- For women of childbearing potential: agreement to remain abstinent or use contraceptive methods that result in a failure rate of less than (<) 1 percent (%) per year during the treatment period and for at least 5 months after the last dose of atezolizumab or 6 months after the last dose of cisplatin
- For men: agreement to remain abstinent or use contraceptive measures and agreement to refrain from donating sperm
Cancer-Specific Exclusions
- Participants with a sensitizing mutation in the EGFR gene or an ALK fusion oncogene
- Active or untreated central nervous system (CNS) metastases as determined by computed tomography (CT) or magnetic resonance imaging (MRI) evaluation during screening and prior radiographic assessments
- Spinal cord compression not definitively treated with surgery and/or radiation or previously diagnosed and treated spinal cord compression without evidence that disease has been clinically stable for greater than or equal to (>= 2) weeks prior to randomization
- Leptomeningeal disease
- Uncontrolled tumor-related pain
- Uncontrolled or symptomatic hypercalcemia (greater than [>] 1.5 millimole/Liter ionized calcium or calcium >12 milligrams/deciliter or corrected serum calcium >upper limit of normal)
- Malignancies other than NSCLC within 5 years prior to randomization
- Known tumor programmed death-ligand 1 (PD-L1) expression status from other clinical studies (e.g., participants whose PD-L1 expression status was determined during screening for entry into a study with anti-PD-1 or anti-PD L1 antibodies but were not eligible are excluded)
General Medical Exclusions:
- History of severe allergic, anaphylactic, or other hypersensitivity reactions to chimeric or humanized antibodies or fusion proteins
- History of certain autoimmune disease
- History of idiopathic pulmonary fibrosis, organizing pneumonia, drug-induced pneumonitis, idiopathic pneumonitis, or evidence of active pneumonitis
- All participants will be tested for human immunodeficiency virus (HIV) prior to the inclusion into the study and HIV-positive participants will be excluded from the clinical study
- Severe infections within 4 weeks prior to randomization
- Significant cardiovascular disease, such as New York Heart Association cardiac disease (Class II or greater), myocardial infarction or cerebrovascular accident within 3 months prior to randomization, unstable arrhythmias, or unstable angina
- Illness or condition that may interfere with a participant's capacity to understand, follow, and/or comply with study procedures
Exclusion Criteria Related to Medications and Chemotherapy:
- Prior treatment with EGFR inhibitors or ALK inhibitors
- Any approved anti-cancer therapy, including hormonal therapy within 21 days prior to initiation of study treatment
- Prior treatment with cluster of differentiation 137 (CD137) agonists or immune checkpoint blockade therapies, anti-PD-1, and anti-PD-L1 therapeutic antibodies
- Treatment with systemic immunostimulatory agents within 4 weeks prior to randomization
- Treatment with systemic immunosuppressive medications
Exclusion Criteria Related to Chemotherapy:
- History of allergic reactions to cisplatin, carboplatin, or other platinum-containing compounds
- Participants with hearing impairment (cisplatin)
- Grade >=2 peripheral neuropathy as defined by National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE) version 4.0 criteria (cisplatin)
- Creatinine clearance (CRCL) <60 milliliters/minute (mL/min) for cisplatin or <45 mL/min for carboplatin
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Arm A (Atezolizumab + Carboplatin or Cisplatin + Pemetrexed Carboplatin Participants received intravenous (IV) infusion of 1200 milligrams (mg) of atezolizumab on Day 1 every 3 weeks (q3w), IV infusion of 500 milligrams per meter square (mg/m\^2) pemetrexed on Day 1 q3w, and as per investigator's choice either IV infusion of carboplatin on Day 1 q3w with a dose calculated using 'Calvert formula' to obtain area under concentration versus time (AUC) = 6 milligrams per milliliter per minute (mg/mL/min) or IV infusion of 75 mg/m\^2 cisplatin q3w on Day 1 q3w, during induction dosing period of 4 or 6 cycles (Cycle length=21 days). Participants who experienced clinical benefit during the induction phase began maintenance therapy. Participants will receive IV infusion of 1200 mg of atezolizumab and 500 mg/m\^2 of pemetrexed on Day 1 q3w until disease progression in the maintenance period. Arm B (Carboplatin or Cisplatin + Pemetrexed) Carboplatin Participants received IV infusion of 500 mg/m\^2 pemetrexed on Day 1 q3w, and as per investigator's choice of either IV infusion of carboplatin on Day 1 q3w with a dose calculated using 'Calvert formula' to obtain AUC =6 mg/mL/min or IV infusion of 75 mg/m\^2 cisplatin q3w on Day 1 q3w, during induction dosing period for 4 or 6 cycles (Cycle length=21 days). Participants who did not experience disease progression during the induction phase began maintenance therapy. Participants will receive IV infusion of 500 mg/m\^2 of pemetrexed on Day 1 q3w until disease progression in the maintenance period. Arm A (Atezolizumab + Carboplatin or Cisplatin + Pemetrexed Atezolizumab Participants received intravenous (IV) infusion of 1200 milligrams (mg) of atezolizumab on Day 1 every 3 weeks (q3w), IV infusion of 500 milligrams per meter square (mg/m\^2) pemetrexed on Day 1 q3w, and as per investigator's choice either IV infusion of carboplatin on Day 1 q3w with a dose calculated using 'Calvert formula' to obtain area under concentration versus time (AUC) = 6 milligrams per milliliter per minute (mg/mL/min) or IV infusion of 75 mg/m\^2 cisplatin q3w on Day 1 q3w, during induction dosing period of 4 or 6 cycles (Cycle length=21 days). Participants who experienced clinical benefit during the induction phase began maintenance therapy. Participants will receive IV infusion of 1200 mg of atezolizumab and 500 mg/m\^2 of pemetrexed on Day 1 q3w until disease progression in the maintenance period. Arm A (Atezolizumab + Carboplatin or Cisplatin + Pemetrexed Cisplatin Participants received intravenous (IV) infusion of 1200 milligrams (mg) of atezolizumab on Day 1 every 3 weeks (q3w), IV infusion of 500 milligrams per meter square (mg/m\^2) pemetrexed on Day 1 q3w, and as per investigator's choice either IV infusion of carboplatin on Day 1 q3w with a dose calculated using 'Calvert formula' to obtain area under concentration versus time (AUC) = 6 milligrams per milliliter per minute (mg/mL/min) or IV infusion of 75 mg/m\^2 cisplatin q3w on Day 1 q3w, during induction dosing period of 4 or 6 cycles (Cycle length=21 days). Participants who experienced clinical benefit during the induction phase began maintenance therapy. Participants will receive IV infusion of 1200 mg of atezolizumab and 500 mg/m\^2 of pemetrexed on Day 1 q3w until disease progression in the maintenance period. Arm A (Atezolizumab + Carboplatin or Cisplatin + Pemetrexed Pemetrexed Participants received intravenous (IV) infusion of 1200 milligrams (mg) of atezolizumab on Day 1 every 3 weeks (q3w), IV infusion of 500 milligrams per meter square (mg/m\^2) pemetrexed on Day 1 q3w, and as per investigator's choice either IV infusion of carboplatin on Day 1 q3w with a dose calculated using 'Calvert formula' to obtain area under concentration versus time (AUC) = 6 milligrams per milliliter per minute (mg/mL/min) or IV infusion of 75 mg/m\^2 cisplatin q3w on Day 1 q3w, during induction dosing period of 4 or 6 cycles (Cycle length=21 days). Participants who experienced clinical benefit during the induction phase began maintenance therapy. Participants will receive IV infusion of 1200 mg of atezolizumab and 500 mg/m\^2 of pemetrexed on Day 1 q3w until disease progression in the maintenance period. Arm B (Carboplatin or Cisplatin + Pemetrexed) Cisplatin Participants received IV infusion of 500 mg/m\^2 pemetrexed on Day 1 q3w, and as per investigator's choice of either IV infusion of carboplatin on Day 1 q3w with a dose calculated using 'Calvert formula' to obtain AUC =6 mg/mL/min or IV infusion of 75 mg/m\^2 cisplatin q3w on Day 1 q3w, during induction dosing period for 4 or 6 cycles (Cycle length=21 days). Participants who did not experience disease progression during the induction phase began maintenance therapy. Participants will receive IV infusion of 500 mg/m\^2 of pemetrexed on Day 1 q3w until disease progression in the maintenance period. Arm B (Carboplatin or Cisplatin + Pemetrexed) Pemetrexed Participants received IV infusion of 500 mg/m\^2 pemetrexed on Day 1 q3w, and as per investigator's choice of either IV infusion of carboplatin on Day 1 q3w with a dose calculated using 'Calvert formula' to obtain AUC =6 mg/mL/min or IV infusion of 75 mg/m\^2 cisplatin q3w on Day 1 q3w, during induction dosing period for 4 or 6 cycles (Cycle length=21 days). Participants who did not experience disease progression during the induction phase began maintenance therapy. Participants will receive IV infusion of 500 mg/m\^2 of pemetrexed on Day 1 q3w until disease progression in the maintenance period.
- Primary Outcome Measures
Name Time Method Overall Survival (OS) Randomization up to approximately 39 months OS is defined as time from randomization to death from any cause.
Progression Free Survival (PFS) as Assessed by the Investigator Using Response Evaluation Criteria in Solid Tumors Version 1.1 (RECIST v1.1) Randomization up to approximately 39 months PFS is defined as the time from randomization to the first occurrence of disease progression as determined by the investigator using RECIST v1.1 or death from any cause, whichever occurred first.
- Secondary Outcome Measures
Name Time Method Overall Survival Rate at Year 1 Year 1 The Overall Survival Rate at the 1-year landmark time point is defined as the probabilities that participants are alive 1-year after randomization.
Overall Survival Rate Year 2 Year 2 The Overall Survival Rate at the 2-year landmark time point is defined as the probabilities that participants are alive 2-years after randomization.
Percentage of Participants With an Objective Response (Complete Response [CR] or Partial Response [PR]) Assessed by the Investigator Using RECIST V1.1 Randomization up to approximately 25 months An objective response is defined as either an unconfirmed CR or a PR, as determined by the investigator using RECIST v1.1. Objective Response Rate is defined as the proportion of patients who had an objective response.
Duration of Response (DOR) as Determined by the Investigator Using RECIST v1.1 Randomization up to approximately 25 months DOR is defined as the time interval from the date of the first occurrence of a CR or PR (whichever status is recorded first) until the first date that progressive disease or death is documented, whichever occurs first.
Change From Baseline in Patient-Reported Lung Cancer Symptoms as Assessed by EORTC Quality-of-Life Lung Cancer Module (QLQ-LC13) Symptom Score Baseline up to 3 and 6 months after disease progression or loss of clinical benefit (up to approximately 25 months) The EORTC QLQ-LC13 module incorporates one multiple item scale to assess dyspnea and a series of single items assessing pain, coughing, sore mouth, dysphagia, peripheral neuropathy, alopecia, and hemoptysis. The EORTC QLQ-LC13 is scored according to the EORTC scoring manual (Fayers et al. 2001). All EORTC scales and single-item measures are linearly transformed so that each score has a range of 0-100. A high score for a functional/global health status scale represents a high or healthy level of functioning/HRQoL (Health-Related Quality of Life); however, a high score for a symptom scale or item represents a high level of symptomatology or problems. A≥10-point change in the symptoms subscale score is perceived by patients as clinically significant (Osoba et al. 1998).
Change From Baseline in Patient-Reported Lung Cancer Symptoms as Assessed by European Organization for the Research and Treatment of Cancer (EORTC) Quality-of-Life Questionnaire-Core 30 (QLQ-C30) Symptom Score Baseline up to 3 and 6 months after disease progression or loss of clinical benefit (up to approximately 25 months) 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 QLQ-C30 is scored according to the EORTC scoring manual (Fayers et al. 2001). All EORTC scales and single-item measures are linearly transformed so that each score has a range of 0-100. A high score for a functional/global health status scale represents a high or healthy level of functioning/HRQoL (Health-Related Quality of Life); however a high score for a symptom scale or item represents a high level of symptomatology or problems. A ≥10-point change in the symptoms subscale score is perceived by patients as clinically significant (Osoba et al. 1998).
Change From Baseline in Patient-Reported Lung Cancer Symptoms as Reported Using the Symptoms in Lung Cancer (SILC) Scale Score Baseline up to 3 and 6 months after disease progression or loss of clinical benefit (up to approximately 25 months) 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.
Minimum Observed Serum Atezolizumab Concentration (Cmin) Predose (Prd; 0 hour [h]) on D1 of Cy 2,3,4,8,16 (Cy length=21 days) and thereafter on D1 of every 8th cycle (up to approximately 25 months) Minimum observed serum atezolizumab concentration (Cmin) prior to infusion at selected cycles (Arm A)
Maximum Observed Serum Atezolizumab Concentration (Cmax) Day 1 of Cycle 1 (Cycle length=21 days) Maximum observed serum atezolizumab concentration (Cmax) after infusion (Arm A)
Plasma Concentrations for Carboplatin in Arm A(Atezolizumab + Carboplatin or Cisplatin + Pemetrexed) Prd (0 h), 5-10 minutes (mins) before end of carboplatin infusion (infusion duration=1-2 h), 1 h post-infusion on D1 of Cy1,3 (Cy length=21 days) Plasma Concentrations for Cisplatin in Arm A (Atezolizumab + Carboplatin or Cisplatin + Pemetrexed) Prd (0 h), 5-10 mins before end of cisplatin infusion (infusion duration=30-60 mins), 1 h post-infusion on D1 of Cy1,3 (Cy length=21 days) Plasma Concentrations for Pemetrexed in Arm A (Atezolizumab + Carboplatin or Cisplatin + Pemetrexed) Prd (0 h), 5-10 mins before end of pemetrexed infusion (infusion duration=10 mins), 1 h post-infusion on D1 of Cy1,3 (Cy length=21 days) Percentage of Participants With Anti-Therapeutic Antibodies (ATAs) of Atezolizumab Prd (0 h) on D1 of Cy1,2,3,4,8,16 (Cy length=21 days) and thereafter on D1 of every 8th cycle, at treatment discontinuation & then every 30 days (up to 120 days) after last dose of atezolizumab (up to app 25 months) Baseline prevalence and post-baseline incidence of anti-drug antibodies (ADA) to Atezolizumab in the Arm A (Atezolizumab + Carboplatin or Cisplatin + Pemetrexed)
Trial Locations
- Locations (183)
Los Angeles Hematology Oncology Medical Group
🇺🇸Los Angeles, California, United States
Fort Wayne Med Oncology & Hematology Inc
🇺🇸Fort Wayne, Indiana, United States
Oncology Consultants PA
🇺🇸Houston, Texas, United States
Illinois Cancer Care
🇺🇸Peoria, Illinois, United States
Gettysburg Cancer Center
🇺🇸Gettysburg, Pennsylvania, United States
St. Joseph Heritage Healthcare
🇺🇸Sebastopol, California, United States
Virginia Cancer Specialists (Fairfax) - USOR
🇺🇸Fairfax, Virginia, United States
HealthCare Research Network II, LLC - PPDS
🇺🇸Tinley Park, Illinois, United States
Tohoku University Hospital
🇯🇵Miyagi, Japan
Ingalls Memorial Hospital
🇺🇸Harvey, Illinois, United States
Stamford Hospital; BCC, MOHR
🇺🇸Stamford, Connecticut, United States
Tallahassee Memorial Hospital
🇺🇸Tallahassee, Florida, United States
Allegheny Cancer Center
🇺🇸Pittsburgh, Pennsylvania, United States
Sociedad de Investigaciones Medicas Ltda (SIM)
🇨🇱Temuco, Chile
Riga East Clinical University Hospital Latvian Oncology Centre
🇱🇻Riga, Latvia
University of Kentucky; Markey Cancer Center
🇺🇸Lexington, Kentucky, United States
Zuyderland Medisch Centrum - Sittard Geleen
🇳🇱Sittard-Geleen, Netherlands
Barzilai Medical Center
🇮🇱Ashkelon, Israel
National Cancer Center Hospital East
🇯🇵Chiba, Japan
University of Washington
🇺🇸Seattle, Washington, United States
Goshen Health System
🇺🇸Goshen, Indiana, United States
Clinica Viedma S.A.
🇦🇷Viedma, Argentina
Fejer Megyei Szent Gyorgy Egyetemi Oktato Korhaz
🇭🇺Székesfehérvár, Hungary
Veszprem Megyei Tudogyogyintezet
🇭🇺Farkasgyepu, Hungary
Petz Aladar Megyei Oktato Korhaz
🇭🇺Gyor, Hungary
Mater Misecordiae University Hospital
🇮🇪Dublin, Ireland
Institut Sainte Catherine
🇫🇷Avignon, France
Edith Wolfson Medical Center
🇮🇱Holon, Israel
Hopital Nord AP-HM
🇫🇷Marseille, France
Centre Hospitalier de Mulhouse - Hopital Emile Muller
🇫🇷Mulhouse, France
Azienda Policlinico Umberto I
🇮🇹Roma, Lazio, Italy
Azienda Ospedaliero Universitaria di Parma
🇮🇹Parma, Emilia-Romagna, Italy
AZ Maria Middelares
🇧🇪Gent, Belgium
Ospedale Santa Maria Delle Croci
🇮🇹Ravenna, Emilia-Romagna, Italy
Hopital d Instruction des Armees de Sainte Anne
🇫🇷Toulon, France
National Hospital Organization Nagoya Medical Center
🇯🇵Aichi, Japan
National Hospital Organization Himeji Medical Center
🇯🇵Hyogo, Japan
Hopital Louis Pradel; Pneumologie
🇫🇷Bron, France
Rabin Medical Center
🇮🇱Petach Tiqwa, Israel
Markusovszky Hospital
🇭🇺Szombathely, Hungary
Tudogyogyintezet Torokbalint
🇭🇺Torokbalint, Hungary
Istituto Nazionale Tumori Regina Elena
🇮🇹Roma, Lazio, Italy
Centre Jean Perrin Centre Regional de Lutte Contre Le Cancer D auvergne
🇫🇷Clermont-ferrand, France
Hospital Nacional Cayetano Heredia
🇵🇪Lima, Peru
Azienda Sanitaria Ospedaliera S Luigi Gonzaga; S.C.D.U. di Oncologia Toracica
🇮🇹Orbassano (TO), Piemonte, Italy
Presidio Ospedaliero Vito Fazzi; Unita Operativa Di Oncologia Medica
🇮🇹Lecce, Puglia, Italy
Ospedale San Vincenzo Taormina :Divisione di Oncologia Medica
🇮🇹Taormina, Sicilia, Italy
Centre Hospitalier Intercommunal; Service de Pneumologie
🇫🇷Creteil, France
Polyclinique de Limoges - Site Chenieux; Oncologie Medicale
🇫🇷Limoges, France
Centre Regional de Lutte contre le Cancer Val d Aurelle - Paul Lamarque; Service d oncologie
🇫🇷Montpellier, France
Osaka University Hospital
🇯🇵Osaka, Japan
ETZ TweeSteden
🇳🇱Tilburg, Netherlands
Hospital CUF Porto; Servico de Imunoalergologia
🇵🇹Senhora Da Hora - Porto, Portugal
Medisprof SRL
🇷🇴Cluj-Napoca, Romania
Samsung Medical Center
🇰🇷Seoul, Korea, Republic of
Niigata University Medical & Dental Hospital
🇯🇵Niigata, Japan
Kanagawa Cancer Center
🇯🇵Kanagawa, Japan
Ospedale San Luca - USL2 Lucca
🇮🇹Lucca, Toscana, Italy
Amphia Ziekenhuis
🇳🇱Breda, Netherlands
Panevezys Hospital
🇱🇹Panevezys, Lithuania
Hospital Universitario Virgen de La Arrixaca; Servicio De Oncologia
🇪🇸El Palmar, Murcia, Spain
MI Dnipropetrovsk City Multifield Clinical Hospital 4 of Dnipropetrovsk Regional Council
🇺🇦Dnipropetrovsk, Katerynoslav Governorate, Ukraine
Clinica Universitaria de Navarra; Servicio de Oncologia
🇪🇸Pamplona, Navarra, Spain
Tokyo Metropolitan Cancer and Infectious diseases Center Komagome Hospital
🇯🇵Tokyo, Japan
HM Sanchinarro ? CIOCC
🇪🇸Madrid, Spain
Seoul National University Hospital
🇰🇷Seoul, Korea, Republic of
Ziekenhuis St. Jansdal
🇳🇱Harderwijk, Netherlands
Hospital Kuala Lumpur
🇲🇾Kuala Lumpur, FED. Territory OF Kuala Lumpur, Malaysia
Advanced Medical and Dental Institute; Kompleks Klinikal
🇲🇾Kepala Batas, Penang, Malaysia
Corporacio Sanitaria Parc Tauli; Servicio de Oncologia
🇪🇸Sabadell, Barcelona, Spain
Chelyabinsk Regional Clinical Oncology Dispensary
🇷🇺Chelyabinsk, Moskovskaja Oblast, Russian Federation
Churchill Hospital
🇬🇧Oxford, United Kingdom
Velindre Hospital
🇬🇧Cardiff, United Kingdom
Hospital de la Santa Creu i Sant Pau
🇪🇸Barcelona, Spain
National Taiwan Uni Hospital; Internal Medicine
🇨🇳Taipei, Taiwan
ICO L'Hospitalet; Servicio de oncologia medica
🇪🇸L'Hospitalet de Llobregat, Barcelona, Spain
Onkologikoa; Ensayos Clinicos
🇪🇸Donostia, Guipuzcoa, Spain
Raigmore Hospital
🇬🇧Inverness, United Kingdom
E-DA Hospital; Chest
🇨🇳Kaohsiung, Taiwan
Hospital Lucus Augusti; Servicio de Oncologia
🇪🇸Lugo, Spain
Derriford Hospital; Plymouth Oncology Centre
🇬🇧Plymouth, United Kingdom
Chi Mei Medical Center Liou Ying Campus
🇨🇳Liuying Township, Taiwan
Regional Municipal Institution Sumy Regional Clinical Oncology Dispensary; Oncothoracic department
🇺🇦Sumy, Ukraine
Hospital Universitari de Girona Dr Josep Trueta; Departamento de Oncologia Medica
🇪🇸Girona, Spain
Hospital General Univ. de Alicante
🇪🇸Alicante, Spain
Royal Cornwall Hospital
🇬🇧Truro, United Kingdom
Complejo Hospitalario Nuestra Senora de Valme
🇪🇸Seville, Sevilla, Spain
St George?s Hospital
🇬🇧London, United Kingdom
Private Enterprise Private Manufacturing Company Acinus
🇺🇦Kirovograd, Ukraine
Queen's Hospital
🇬🇧Romford, United Kingdom
Gartnavel General Hospital; Beatson West of Scotland Cancer Centre
🇬🇧Glasgow, United Kingdom
Beijing Friendship Hospital Affiliated of Capital University of Medical Science
🇨🇳Beijing Shi, China
Changzhou First People's Hospital
🇨🇳Changzhou, China
Qilu Hospital
🇨🇳Jinan City, China
Beijing Cancer Hospital
🇨🇳Beijing, China
Tianjin Medical University General Hospital
🇨🇳Tianjin, China
Hopital d'Instruction des Armees de Begin
🇫🇷Saint-Mande, France
National Hospital Organization Asahikawa Medical Center
🇯🇵Hokkaido, Japan
Nippon Medical School Hospital
🇯🇵Tokyo, Japan
NTT Medical Center Tokyo
🇯🇵Tokyo, Japan
National Hospital Organization Yamaguchi - Ube Medical Center
🇯🇵Yamaguchi, Japan
Hiroshima University Hospital
🇯🇵Hiroshima, Japan
Kanazawa University Hospital
🇯🇵Ishikawa, Japan
Kagoshima University Hospital
🇯🇵Kagoshima, Japan
Osaka Medical and Pharmaceutical University Hospital
🇯🇵Osaka, Japan
Hospital Universitari Dexeus - Grupo Quironsalud; Servicio de Oncologia Medica
🇪🇸Barcelona, Spain
Hospital Regional Universitario de Malaga ? Hospital General; Servicio de Neurologia
🇪🇸Malaga, Spain
Instituto Valenciano Oncologia; Oncologia Medica
🇪🇸Valencia, Spain
C.A.U de Burgos- Hospital Universitario de Burgos; Servicio de Oncologia
🇪🇸Burgos, Spain
Northside Hospital
🇺🇸Atlanta, Georgia, United States
CHI Health St. Francis
🇺🇸Grand Island, Nebraska, United States
Haga Ziekenhuis
🇳🇱Den Haag, Netherlands
Peninsula Cancer Institute
🇺🇸Newport News, Virginia, United States
Blue Ridge Cancer Care
🇺🇸Roanoke, Virginia, United States
St. Vincent Hospital
🇺🇸Green Bay, Wisconsin, United States
Hunan Cancer Hospital
🇨🇳Changsha CITY, China
Ziekenhuis Gelderse Vallei
🇳🇱EDE, Netherlands
St Vincent's Hospital Sydney
🇦🇺Darlinghurst, New South Wales, Australia
Fundacion Clinica Colombo
🇦🇷Cordoba, Argentina
Redcliffe Hospital
🇦🇺Redcliffe, Queensland, Australia
Sydney Adventist Hospital; Clinical Trial Unit
🇦🇺Sydney, New South Wales, Australia
Mater Adult Hospital
🇦🇺South Brisbane, Queensland, Australia
Ballarat Health Services
🇦🇺Ballarat, Victoria, Australia
Klinikum Wels-Grieskirchen GmbH
🇦🇹Wels, Austria
Peninsula and South Eastern Haematology and Oncology Group
🇦🇺Frankston, Victoria, Australia
Clinique André Renard; Pneumologie
🇧🇪Herstal, Belgium
Health & Care SPA
🇨🇱Santiago, Chile
AZ Delta (Campus Rumbeke), Apotheek
🇧🇪Roeselare, Belgium
Hospital Clinico Vina del Mar?
🇨🇱Viña del Mar, Chile
The First Affiliated Hospital of Guangzhou Medical University
🇨🇳Guangzhou, China
The First Affiliated Hospital of Medical School of Zhejiang University
🇨🇳Hangzhou City, China
Anhui Provincial Hospital; 2F,Tumor chemotherapy Department
🇨🇳Hefei, China
Sir Run Run Shaw Hospital Zhejiang University
🇨🇳Hangzhou City, China
Anhui Provincial Hospital; Respiratory Department
🇨🇳Hefei, China
Jiangsu Province Hospital (the First Affiliated Hospital With Nanjing Medical University)
🇨🇳Nanjing City, China
Zhongshan Hospital Fudan University
🇨🇳Shanghai, China
First Hospital of China Medical University
🇨🇳Shenyang, China
Tianjin Medical University Cancer Institute & Hospital
🇨🇳Tianjin, China
Shanghai Chest Hospital
🇨🇳Shanghai, China
Tongji Hospital Tongji Medical College Huazhong University of Science and Technology
🇨🇳Wuhan City, China
Tumor Center,Union Hospital, Tongji Medical College, Huazhong University of Science and Technology
🇨🇳Wuhan, China
Zhejiang Cancer Hospital
🇨🇳Zhejiang, China
St James's Hospital
🇮🇪Dublin, Ireland
Ospedale Casa Sollievo Della Sofferenza IRCCS
🇮🇹San Giovanni Rotondo, Puglia, Italy
Tokushima University Hospital
🇯🇵Tokushima, Japan
Juntendo University Hospital
🇯🇵Tokyo, Japan
The Cancer Institute Hospital of JFCR
🇯🇵Tokyo, Japan
Asan Medical Center
🇰🇷Seoul, Korea, Republic of
Hospital Beatriz Angelo
🇵🇹Loures, Portugal
Spitalul Clinic Judetean de Urgenta Sf. Apostol Andrei Constanta
🇷🇴Constanta, Romania
Regional Clinical Oncology Hospital
🇷🇺Yaroslavl, Russian Federation
Hospital Universitario Germans Trias i Pujol
🇪🇸Badalona, Barcelona, Spain
Moscow City Oncology Hospital #62
🇷🇺Moscovskaya Oblast, Moskovskaja Oblast, Russian Federation
Hospital de Mataro
🇪🇸Mataro, Cantabria, Spain
Hospital Univ Vall d'Hebron; Servicio de Oncologia
🇪🇸Sant Andreu de La Barca, Barcelona, Spain
Centro Oncologico de Galicia COG; Medical Oncology
🇪🇸A Coruna, LA Coruña, Spain
Complejo Hospitalario de Navarra; Servicio de Oncologia
🇪🇸Pamplona, Navarra, Spain
Hospital Universitari i Politecnic La Fe de Valencia
🇪🇸Valencia, Spain
Hospital Universitario Ramon y Cajal
🇪🇸Madrid, Spain
Buddhist Dalin Tzuchi General Hospital
🇨🇳Dalin, Chiayi, Taiwan
Kyiv Railway Clinical Hospital #3 of Branch Health Center of PJSC Ukrainian Railway; Surgery Dept
🇺🇦Kyiv, Kharkiv Governorate, Ukraine
MICR Oncology Dispensary of Cherkasy Regional Council; Regional Center of Clinical Oncology
🇺🇦Cherkasy, Ukraine
MI Zaporizhzhia Regional Clinical Oncological Dispensary Zaporizhzhia SMU Ch of Oncology
🇺🇦Zaporizhzhya, Ukraine
Bristol Haematology and Oncology centre
🇬🇧Bristol, United Kingdom
Swedish Cancer Institute
🇺🇸Cary, North Carolina, United States
Barwon Health
🇦🇺Geelong, Victoria, Australia
Saga University Hospital
🇯🇵Saga, Japan
Hospital Militar Central Cirujano Mayor Dr. Cosme Argerich
🇦🇷Buenos Aires, Argentina
Multiprofile Hospital for Active Treatment Serdika EOOD
🇧🇬Sofia, Bulgaria
St George Hospital; Medical Oncology
🇦🇺Sydney, New South Wales, Australia
University of Michigan
🇺🇸Ann Arbor, Michigan, United States
Providence Portland Medical Center
🇺🇸Portland, Oregon, United States
Orlando Health Inc.
🇺🇸Orlando, Florida, United States
Nebraska Methodist Hospital
🇺🇸Omaha, Nebraska, United States
Euroclinic Center of Oncology SRL
🇷🇴Iasi, Romania
Royal Hobart Hospital
🇦🇺Hobart, Tasmania, Australia
MD Anderson Cancer Center
🇪🇸Madrid, Spain
Tri-Service General Hospital
🇨🇳Taipei, Taiwan
Unidade Local de Saude de Matosinhos SA
🇵🇹Matosinhos, Portugal
Hospital General Universitario de Elche; Servicio de Oncologia
🇪🇸Elche, Alicante, Spain
Taipei Veterans General Hospital
🇨🇳Taipei City, Taiwan
Montefiore Medical Center
🇺🇸Bronx, New York, United States
Charing Cross Hospital
🇬🇧London, United Kingdom