DS-8201a in Pre-treated HER2 Breast Cancer That Cannot be Surgically Removed or Has Spread [DESTINY-Breast02]

Sponsor

Daiichi Sankyo, Inc. (Industry)

Overall Status

Active, not recruiting

CT.gov ID

NCT03523585

Collaborator

Daiichi Sankyo Co., Ltd. (Industry), AstraZeneca (Industry)

600

Enrollment

227

Locations

Arms

Anticipated Duration (Months)

2.6

Patients Per Site

Patients Per Site Per Month

Study Details

Study Description

Brief Summary

This study will compare DS 8201a to standard treatment.

Participants must have HER2 breast cancer that has been treated before.

Their cancer:

cannot be removed by an operation
has spread to other parts of the body

Condition or Disease	Intervention/Treatment	Phase
Breast Cancer	Drug: Trastuzumab deruxtecan Drug: Capecitabine Drug: Lapatinib Drug: Trastuzumab	Phase 3

Detailed Description

The study is designed to compare DS 8201a versus standard of care (investigator's choice) in subjects with unresectable and/or metastatic breast cancer previously treated with T-DM1.

Study Design

Study Type:

Interventional

Anticipated Enrollment :

600 participants

Allocation:

Randomized

Intervention Model:

Parallel Assignment

Masking:

None (Open Label)

Primary Purpose:

Treatment

Official Title:

A Phase 3, Multicenter, Randomized, Open-label, Active-controlled Study of Trastuzumab Deruxtecan (DS-8201a), an Anti-HER2-antibody Drug Conjugate, Versus Treatment of Investigator's Choice for HER2-positive, Unresectable and/or Metastatic Breast Cancer Subjects Previously Treated With T-DM1

Actual Study Start Date :

Aug 1, 2018

Actual Primary Completion Date :

Jun 30, 2022

Anticipated Study Completion Date :

Sep 1, 2024

Arms and Interventions

Arm	Intervention/Treatment
Experimental: Trastuzumab deruxtecan (DS-8201a) HER2 positive, unresectable and/or metastatic breast cancer participants previously treated with standard of care HER2 therapies, including ado-trastuzumab emtansine (T-DM1), randomized to treatment with DS-8201a	Drug: Trastuzumab deruxtecan DS-8201a is sterile lyophilized powder reconstituted into a sterile aqueous solution (100 mg/5 mL) to be administered as intravenous (IV) dose Other Names: DS-8201a
Active Comparator: Trastuzumab+capecitabine HER2 positive, unresectable and/or metastatic breast cancer participants previously treated with standard of care HER2 therapies, including ado-trastuzumab emtansine (T-DM1), randomized to investigator's choice treatment with Trastuzumab/capecitabine	Drug: Capecitabine Investigator's choice Standard of Care when combined with trastuzumab or lapatinib Other Names: Investigator's Choice Comparative Therapy Drug: Trastuzumab Investigator's choice Standard of Care when combined with capecitabine Other Names: Investigator's Choice Comparative Therapy
Active Comparator: Lapatinib+capecitabine HER2 positive, unresectable and/or metastatic breast cancer participants previously treated with standard of care HER2 therapies, including ado-trastuzumab emtansine (T-DM1), randomized to investigator's choice treatment with Lapatinib/capecitabine	Drug: Capecitabine Investigator's choice Standard of Care when combined with trastuzumab or lapatinib Other Names: Investigator's Choice Comparative Therapy Drug: Lapatinib Investigator's choice Standard of Care when combined with capecitabine Other Names: Investigator's Choice Comparative Therapy

Arm

Intervention/Treatment

Experimental: Trastuzumab deruxtecan (DS-8201a)

HER2 positive, unresectable and/or metastatic breast cancer participants previously treated with standard of care HER2 therapies, including ado-trastuzumab emtansine (T-DM1), randomized to treatment with DS-8201a

Drug: Trastuzumab deruxtecan

DS-8201a is sterile lyophilized powder reconstituted into a sterile aqueous solution (100 mg/5 mL) to be administered as intravenous (IV) dose

Other Names:

DS-8201a

Active Comparator: Trastuzumab+capecitabine

Drug: Capecitabine

Investigator's choice Standard of Care when combined with trastuzumab or lapatinib

Other Names:

Investigator's Choice Comparative Therapy

Drug: Trastuzumab

Investigator's choice Standard of Care when combined with capecitabine

Other Names:

Investigator's Choice Comparative Therapy

Active Comparator: Lapatinib+capecitabine

Drug: Capecitabine

Investigator's choice Standard of Care when combined with trastuzumab or lapatinib

Other Names:

Investigator's Choice Comparative Therapy

Drug: Lapatinib

Investigator's choice Standard of Care when combined with capecitabine

Other Names:

Investigator's Choice Comparative Therapy

Outcome Measures

Primary Outcome Measures

Progression-free survival (PFS) based on blinded independent central review (BICR) [Baseline up to 42 months postdose]
Time from the date of randomization to the first objective documentation of radiographic disease progression via BICR according to modified Response Evaluation Criteria in Solid Tumors (mRECIST) version 1.1, or death due to any cause.

Secondary Outcome Measures

Overall survival (OS) [Baseline up to 78 months postdose]
Time from the date of randomization to the date of death for any cause. If there is no death reported for a subject before the data cutoff for OS analysis, OS will be censored at the last contact date at which the subject is known to be alive.
Objective response rate (ORR) based on BICR and investigator assessment [Baseline up to 78 months postdose]
Percentage of participants who achieved a best overall response of complete response (CR) or partial response (PR), based on BICR and investigator assessment
Duration of response (DoR) based on BICR and investigator's assessment [Baseline up to 78 months postdose]
Length of time response continued, based on BICR and investigator's assessment
Progression-free survival (PFS) based on investigator's assessment [Baseline up to 42 months postdose]
Time from the date of randomization to the first objective documentation of radiographic disease progression via investigator assessment, according to mRECIST version 1.1, or death due to any cause.

Eligibility Criteria

Criteria

Ages Eligible for Study:

18 Years and Older

Sexes Eligible for Study:

All

Accepts Healthy Volunteers:

Inclusion Criteria:

Is the age of majority in their country
Has pathologically documented breast cancer that:

is unresectable or metastatic
has confirmed HER2-positive expression as determined according to American Society of Clinical Oncology - College of American Pathologists guidelines evaluated at a central laboratory
was previously treated with ado-trastuzumab emtansine (T-DM1)

Has documented radiologic progression (during or after most recent treatment or within 6 months after completing adjuvant therapy)
Is HER2 positive as confirmed by central laboratory assessment of most recent tumor tissue sample available. If archived tissue is not available, agrees to provide a fresh biopsy.
Male and female participants of reproductive/childbearing potential must agree to use a highly effective form of contraception or avoid intercourse during and upon completion of the study and for at least:

7 months after the last dose of DS-8201a (females); 4.5 months after last dose of DS-8201a (males)
6 months after the last dose of lapatinib/capecitabine for female participants (3 months for male participants)
7 months after the last dose of trastuzumab/capecitabine

Has adequate hematopoietic, renal and hepatic functions

Exclusion Criteria:

Has previously participated in an antibody drug conjugate study sponsored by Daiichi Sankyo. Prior treatment in the adjuvant/neo-adjuvant setting would be allowed if progression of disease did not occur within 12 months of end of adjuvant therapy
Has had prior treatment with capecitabine
Has uncontrolled or significant cardiovascular disease
Has a history of (noninfectious) interstitial lung disease (ILD)/pneumonitis that required steroids, has current ILD/pneumonitis, or suspected ILD/pneumonitis that cannot be ruled out by imaging at screening
Has active central nervous system (CNS) metastases

Contacts and Locations

Locations

	Site	City	State	Country	Postal Code
1	Ironwood Cancer Research Centers	Chandler	Arizona	United States	85224-5665
2	UCLA Hematology Oncology - Main Site	Los Angeles	California	United States	90095
3	Pacific Cancer Care	Monterey	California	United States	93940
4	Sharp Memorial Hospital	San Diego	California	United States	92123
5	Innovative Clinical Research Institute	Whittier	California	United States	90603
6	Smilow Cancer Hospital at Yale New Haven	New Haven	Connecticut	United States	06510
7	Washington Cancer Institute	Washington	District of Columbia	United States	20010
8	Florida Cancer Specialists-Broadway	Fort Myers	Florida	United States	33901
9	Piedmont Cancer Institute, PC	Atlanta	Georgia	United States	30318
10	Kapiolani Medical Center for Women and Children/Univ of HI	Honolulu	Hawaii	United States	96826
11	Loyola University Health System	Maywood	Illinois	United States	60153
12	Community Hospital	Munster	Indiana	United States	46321
13	Norton Cancer Institute	Louisville	Kentucky	United States	40207
14	Maine Center for Cancer Medicine	Scarborough	Maine	United States	04074
15	University of Maryland	Baltimore	Maryland	United States	21201
16	Beth Israel Deaconess Medical Center	Boston	Massachusetts	United States	02215
17	Dana Farber Cancer Institute	Boston	Massachusetts	United States	02215
18	Henry Ford Hospital	Detroit	Michigan	United States	48202
19	Cornell-Beshore Cancer Institute	Joplin	Missouri	United States	64804
20	Saint Luke's Cancer Institute	Kansas City	Missouri	United States	64111
21	Health Midwest Ventures Group, Inc d/b/a HCA MidAmerica Division, LLC	Kansas City	Missouri	United States	64132
22	Washington University	Saint Louis	Missouri	United States	63110
23	North Shore Hematology Oncology Associates, PC	East Setauket	New York	United States	11733
24	Memorial Sloan-Kettering Cancer Center (MSKCC) - New York	New York	New York	United States	10065
25	University of Cincinnati Medical Center	Cincinnati	Ohio	United States	45267-0502
26	Cleveland Clinic Main Campus	Cleveland	Ohio	United States	44195
27	The Ohio State University	Columbus	Ohio	United States	43235
28	Dayton Physicians, LLC	Kettering	Ohio	United States	45409
29	Abramson Cancer Center	Philadelphia	Pennsylvania	United States	19104
30	Allegheny General Hospital	Pittsburgh	Pennsylvania	United States	15212
31	UPMC Cancer Center	Pittsburgh	Pennsylvania	United States	15213
32	Tennessee Oncology, PLLC Chattanooga	Chattanooga	Tennessee	United States	37404
33	The West Clinic	Germantown	Tennessee	United States	38138
34	SCRI - Tennessee Oncology	Nashville	Tennessee	United States	37203
35	UT Southwestern Medical Center	Dallas	Texas	United States	75390-8857
36	MD Anderson Cancer Center	Houston	Texas	United States	77030
37	The Methodist Hospital Research Institute	Houston	Texas	United States	77030
38	The University of Texas Health Science Center at Tyler	Tyler	Texas	United States	75708
39	Community Cancer Trials of Utah	Ogden	Utah	United States	84405
40	Virginia Cancer Specialists, PC	Fairfax	Virginia	United States	22031
41	MultiCare Health System Institute for Research and Innovation	Tacoma	Washington	United States	98405
42	St Vincent's Hospital Sydney	Darlinghurst	New South Wales	Australia	2010
43	Liverpool Hospital	Liverpool	New South Wales	Australia	2170
44	Macquarie University Hospital	Sydney	New South Wales	Australia	2109
45	The Tweed Hospital	Tweed Heads	New South Wales	Australia	2485
46	Princess Alexandra Hospital	Woolloongabba	Queensland	Australia	4102
47	Ashford Cancer Centre Research	Kurralta Park	South Australia	Australia	5037
48	Box Hill Hospital	Box Hill	Victoria	Australia	3128
49	Frankston Hospital	Frankston	Victoria	Australia	3199
50	Peninsula and South Eastern Haematology & Oncology Group	Frankston	Victoria	Australia	3199
51	Austin Health	Heidelberg	Victoria	Australia	3084
52	Peter MacCallum Cancer Centre	Melbourne	Victoria	Australia	3000
53	Sunshine Hospital	Saint Albans	Victoria	Australia	3021
54	South West Oncology	Warrnambool	Victoria	Australia	3280
55	Ballarat Oncology & Haematology Service	Wendouree	Victoria	Australia	3355
56	St John of God Subiaco Hospital	Subiaco	Western Australia	Australia	6008
57	Calvary North Adelaide Hospital	Bruce		Australia	2614
58	Universitair Ziekenhuis Brussel	Bruxelles		Belgium	1090
59	Cliniques Universitaires Saint-Luc	Bruxelles		Belgium	1200
60	AZ Maria Middelares	Gent		Belgium	9000
61	Az Groeninge	Kortrijk		Belgium	8500
62	UZ Leuven	Leuven		Belgium	3000
63	CHU UCL Namur site de Sainte Elisabeth	Namur		Belgium	5000
64	NOB - Núcleo de Oncologia da Bahia	Salvador	Bahia	Brazil	40170-110
65	AMO - Assistência Multidisciplinar em Oncologia	Salvador	Bahia	Brazil	41950-640
66	Pronutrir	Fortaleza	Ceará	Brazil	60810-180
67	Oncobio Servicos de Saude	Nova Lima	Minas Gerais	Brazil	34000
68	HGB - Hospital Giovanni Battista - Mãe de Deus Center	Porto Alegre	Rio Grande Do Sul	Brazil	90110-270
69	CliniOnco - Tratamento Integrado do Câncer	Porto Alegre	Rio Grande Do Sul	Brazil	90430-090
70	Escosteguy Barrios, Carlos Henrique	Porto Alegre	Rio Grande Do Sul	Brazil	90610-000
71	Hospital Nossa Senhora da Conceição	Porto Alegre	Rio Grande Do Sul	Brazil	91350-200
72	Clínica de Neoplasias Litoral Ltda.	Itajaí	Santa Catarina	Brazil	88301-220
73	CEPHO - Centro de Estudos e Pesquisas de Hematologia e Oncologia	Santo André	Sao Paulo	Brazil	09060-650
74	IBCC - Instituto Brasileiro de Controle do Câncer	São Paulo	Sao Paulo	Brazil	03102-002
75	COI - Clínicas Oncológicas Integradas	Rio De Janeiro		Brazil	22793-080
76	Sociedade Beneficiente de Senhoras Hospital Sírio Libanês	São Paulo		Brazil	01308
77	A. C. Camargo Cancer Center	São Paulo		Brazil	01509-900
78	Fakultni nemocnice Brno	Brno		Czechia	625 00
79	Fakultni nemocnice Olomouc	Olomouc		Czechia	775 20
80	Fakultni nemocnice v Motole	Prague 5		Czechia	150 06
81	Nemocnice Na Bulovce	Praha		Czechia	180 81
82	Hôpital Nord - CHU Marseille	Marseille cedex 20	Bouches-du-Rhône	France	13915
83	Centre François Baclesse	Caen Cedex 05	Calvados	France	14076
84	CARIO - Centre Armoricain de Radiothérapie, Imagerie médicale et Oncologie	Plérin	Cotes d'Armor	France	22190
85	Centre Georges François Leclerc	Dijon cedex	Côte-d'Or	France	21079
86	CHU Besançon - Hôpital Jean Minjoz	Besançon	Doubs	France	25030
87	CHU Brest - Hôpital Morvan	Brest Cedex	Finistere	France	29609
88	Hôpital Privé d'Antony	Antony	Hauts De Seine	France	92160
89	Centre René Huguenin	Saint-Cloud	Hauts De Seine	France	92110
90	Clinique Clementville	Montpellier	Herault	France	34070
91	Institut Régional du Cancer de Montpellier	Montpellier	Herault	France	34298
92	CRLCC Eugene Marquis	Rennes cedex	Ille Et Vilaine	France	35042
93	Centre Oscar Lambret	Lille cedex	Nord	France	59020
94	Centre de cancerologie les Dentellieres	Valenciennes	Nord	France	59300
95	Institut Curie - site de Paris	Paris Cedex 05	Paris	France	75005
96	Centre Hospitalier de la côte Basque	Bayonne Cedex	Pyrenees Atlantiques	France	64109
97	Centre Hospitalier Lyon Sud	Pierre Benite cedex	Rhone	France	69495
98	Clinique Victor Hugo - Centre Jean Bernard	Le Mans Cedex 02	Sarthe	France	72015
99	Centre Henri Becquerel	Rouen	Seine Maritime	France	76038
100	Institut Sainte Catherine	Avignon Cedex 9	Vaculuse	France	84918
101	Institut Gustave Roussy	Villejuif cedex	Val De Marne	France	94805
102	Institut Régional du Cancer de Montpellier	Montpellier		France	34298
103	Institut Curie - site de Paris	Paris		France	75005
104	Hopital Tenon	Paris		France	75020
105	Klinikum rechts der Isar der TU Muenchen	Muenchen	Bayern	Germany	81675
106	Marienhospital Bottrop gGmbH	Bottrop	Rheinland Pfalz	Germany	46236
107	Universitaetsklinikum Schleswig-Holstein - Campus Luebeck	Luebeck	Schleswig Holstein	Germany	23538
108	Helios-Kliniken Berlin-Buch	Berlin		Germany	13125
109	Universitaetsklinikum Duesseldorf AoeR	Düsseldorf		Germany	40225
110	Universitaetsklinikum Erlangen	Erlangen		Germany	91054
111	Kliniken Koeln	Koeln		Germany	51067
112	Universitaetsklinikum Leipzig AoeR	Leipzig		Germany	04103
113	Klinikum der Universitaet Muenchen - Campus Grosshardern	Munich		Germany	81377
114	Universitaetsklinikum Muenster	Müenster		Germany	48149
115	Haematologisch-Onkologische Schwerpunktpraxis	Troisdorf		Germany	53840
116	251 General Air Force Hospital	Athens		Greece	11525
117	General Hospital of Athens "Alexandra"	Athens		Greece	11528
118	General Oncology Hospital of Kifissia " Agioi Anargyroi"	Athens		Greece	14564
119	University General Hospital of Heraklion	Heraklion		Greece	71110
120	Euromedica General Clinic Thessaloniki	Thessaloníki		Greece	54645
121	Rambam Health Care Center	Haifa		Israel	3109601
122	Shaare Zedek Medical Center	Jerusalem		Israel	9103102
123	Hadassah University Hospital - Ein Kerem	Jerusalem		Israel	9112001
124	Sapir Medical Center, Meir Hospital	Kfar Saba		Israel	4428164
125	Rabin Medical Center-Beilinson Campus	Petah tikva		Israel	49100
126	Chaim Sheba Medical Center	Ramat Gan		Israel	52363
127	Tel Aviv Sourasky Medical Center	Tel Aviv		Israel	6423906
128	Azienda Socio Sanitaria Territoriale di Monza (Presidio San Gerardo)	Monza	Milano	Italy	20900
129	IRCCS Centro di Riferimento Oncologico	Aviano	Pordenone	Italy	33081
130	Ospedale Sacro Cuore Don Calabria	Negrar	Verona	Italy	37024
131	Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII (Presidio Papa Giovanni XXIII)	Bergamo		Italy	24127
132	Azienda Ospedaliera Universitaria Policlinico Sant'Orsola Malpighi	Bologna		Italy	40138
133	Azienda Ospedaliera Universitaria Arcispedale Sant'Anna	Cona		Italy	44124
134	Istituto Nazionale per la Ricerca sul Cancro di Genova	Genova		Italy	16132
135	Azienda Ospealiera della Provincia di Lecco	Lecco		Italy	23900
136	Azienda Ospedaliera Ospedali Riuniti Papardo-Piemonte	Messina		Italy	98158
137	Ospedale San Raffaele	Milano		Italy	20132
138	Fondazione IRCCS Istituto Nazionale dei Tumori	Milano		Italy	20133
139	IEO Istituto Europeo di Oncologia	Milano		Italy	20141
140	A.O.U. Policlinico di Modena	Modena		Italy	41124
141	Istituto Nazionale Tumori Fondazione G. Pascale	Napoli		Italy	80131
142	IOV - Istituto Oncologico Veneto IRCCS	Padova		Italy	35128
143	Azienda Ospedaliero Universitaria di Parma	Parma		Italy	43100
144	Fondazione IRCCS Policlinico San Matteo	Pavia		Italy	27100
145	Azienda Ospedaliero Universitaria Pisana	Pisa		Italy	56126
146	Azienda Ospedaliera Città della Salute e della Scienza di Torino	Torino		Italy	10126
147	Fukushima Medical University Hospital	Fukushima-shi	Fukushima-Ken	Japan	960-1295
148	Kindai University Hospital	Osakasayama-shi	Osaka-Fu	Japan	589-8511
149	Kindai University Hospital	Ōsakasayama-shi	Osaka-Fu	Japan	589-8511
150	National Cancer Center Hospital	Chuo Ku	Tokyo-To	Japan	104-0045
151	NHO Shikoku Cancer Center	Ehime		Japan	791-0280
152	NHO Kyushu Cancer Center	Fukuoka		Japan	811-1395
153	Hiroshima City Hiroshima Citizens Hospital	Hiroshima		Japan	730-8518
154	NHO Hokkaido Cancer Center	Hokkaido		Japan	003-0804
155	Hyōgo College of Medicine Hospital	Hyōgo		Japan	663-8501
156	St. Marianna University School of Medicine Hospital	Kanagawa		Japan	216-8511
157	Kanagawa Cancer Center	Kanagawa		Japan	241-8515
158	Kyoto University Hospital	Kyoto		Japan	606-8507
159	Tohoku University Hospital	Miyagi		Japan	980-8574
160	Aichi Cancer Center Hospital	Nagoya		Japan	464-8681
161	Niigata Cancer Center Hospital	Niigata		Japan	951-8566
162	Okayama University Hospital	Okayama		Japan	700-8558
163	NHO Osaka National Hospital	Osaka		Japan	540-0006
164	Osaka International Cancer Institute	Osaka		Japan	541-8567
165	Saitama Cancer Center	Saitama		Japan	362-0806
166	Shizuoka Cancer Center	Shizuoka		Japan	411-8777
167	Toranomon Hospital	Tokyo		Japan	105-8470
168	The Cancer Institute Hospital of JFCR	Tokyo		Japan	135-8550
169	Tokyo Medical University Hospital	Tokyo		Japan	160-0023
170	Chungbuk National University Hospital	Cheongju-si	Chungcheongbuk-do	Korea, Republic of	28644
171	Inha University Hospital	Incheon	Gyeonggi-do	Korea, Republic of	22332
172	Seoul National University Bundang Hospital	Seongnam-si	Gyeonggi-do	Korea, Republic of	13620
173	The Catholic University of Korea, St. Vincent's Hospital	Suwon-si	Gyeonggi-do	Korea, Republic of	16247
174	Ajou University Hospital	Suwon	Gyeonggi-do	Korea, Republic of	16499
175	Kyungpook National University Chilgok Hospital	Daegu		Korea, Republic of	41404
176	National Cancer Center	Goyang-si		Korea, Republic of	10408
177	Korea University Anam Hospital	Seoul		Korea, Republic of	02841
178	Seoul National University Hospital	Seoul		Korea, Republic of	03080
179	Severance Hospital, Yonsei University	Seoul		Korea, Republic of	03772
180	Asan Medical Center	Seoul		Korea, Republic of	05505
181	Samsung Medical Center	Seoul		Korea, Republic of	06351
182	The Catholic University of Korea, Seoul St. Mary's Hospital	Seoul		Korea, Republic of	06591
183	ICO Badalona - Hospital Universitari Germans Trias i Pujol	Badalona	Barcelona	Spain	08916
184	ICO l'Hospitalet - Hospital Duran i Reynals	L'Hospitalet De Llobregat	Barcelona	Spain	08908
185	Hospital de Especialidades de Jerez de la Frontera	Jerez De La Frontera	Cádiz	Spain	11407
186	Complejo Hospitalario Universitario A Coruña	A Coruña	La Coruña	Spain	15006
187	Hospital Universitario de Canarias	San Cristobal de la Laguna	Tenerife	Spain	38320
188	Hospital Infanta Cristina	Badajoz		Spain	06007
189	Hospital Quironsalud Barcelona	Barcelona		Spain	08023
190	Hospital Universitari Vall d'Hebron	Barcelona		Spain	08035
191	Hospital Clinic de Barcelona	Barcelona		Spain	08036
192	Hospital del Mar	Barcelona		Spain	8003
193	Hospital Universitari Arnau de Vilanova	Lleida		Spain	25198
194	Hospital General Universitario Gregorio Marañon	Madrid		Spain	28007
195	MD Anderson Cancer Centre	Madrid		Spain	28033
196	Hospital Universitario Clinico San Carlos	Madrid		Spain	28040
197	Hospital Clinico Universitario Virgen de la Victoria	Málaga		Spain	29010
198	Hospital Universitario de Salamanca	Salamanca		Spain	37370
199	Hospital Universitario Virgen Macarena	Sevilla		Spain	41009
200	Hospital Universitario Virgen del Rocio	Sevilla		Spain	41013
201	Instituto Valenciano de Oncologia IVO	Valencia		Spain	46009
202	Hospital Universitario Miguel Servet	Zaragoza		Spain	50009
203	Acibadem Adana Hospital	Adana		Turkey	01130
204	Adana Numune Training and Research Hospital	Adana		Turkey	01370
205	Ankara Yildirim Beyazit Uni. Med. Fac.Ankara City Hospital	Ankara		Turkey	6800
206	Akdeniz University Medical Faculty	Antalya		Turkey	07058
207	Uludag University Medical Faculty	Bursa		Turkey	16059
208	Istanbul University Cerrahpasa - Cerrahpasa Medical Faculty	Istanbul		Turkey	34098
209	Bakirkoy Dr. Sadi Konuk Teaching and Research Hospital	Istanbul		Turkey	34147
210	Medipol University Medical Faculty	Istanbul		Turkey	34214
211	Medical Park Goztepe Hospital	Istanbul		Turkey	34732
212	Istanbul Medeniyet Uni Goztepe Training & Research Hospital	Istanbul		Turkey	34854
213	Kartal Lutfi Kirdar Research and Training Hospital	Istanbul		Turkey	34890
214	Izmir Medicalpark Hospital	İzmir		Turkey	35530
215	Konya Necmettin Erbakan University Meram Faculty of Medicine	Konya		Turkey	42080
216	Sakarya Traning and Research Hospital	Sakarya		Turkey	54187
217	Medical Park Samsun Hastanesi	Samsun		Turkey	55200
218	Namik Kemal University	Tekirdağ		Turkey	59100
219	Royal Cornwall Hospital	Truro	Cornwall	United Kingdom	TR1 3LJ
220	Royal Devon and Exeter Hospital (Wonford)	Exeter	Devon	United Kingdom	EX2 5DW
221	Derriford Hospital	Plymouth	Devon	United Kingdom	PL6 8BQ
222	Aberdeen Royal Infirmary	Aberdeen	Grampian Region	United Kingdom	AB25 2ZB
223	Queen Mary University of London	London	Greater London	United Kingdom	EC1M 6BQ
224	University College London Hospitals	London	Greater London	United Kingdom	NW1 2PG
225	Sarah Cannon Research Institute UK	London	Greater London	United Kingdom	W1G 6AD
226	Western General Hospital	Edinburgh	Lothian Region	United Kingdom	EH4 2XU
227	Nottingham University Hospitals City Campus	Nottingham	Nottinghamshire	United Kingdom	NG5 1PB