Study of Romiplostim for Chemotherapy-induced Thrombocytopenia in Adult Subjects With Non-small Cell Lung Cancer (NSCLC), Ovarian Cancer, or Breast Cancer

Sponsor

Amgen (Industry)

Overall Status

Recruiting

CT.gov ID

NCT03937154

Collaborator

(none)

162

Enrollment

104

Locations

Arms

Anticipated Duration (Months)

1.6

Patients Per Site

Patients Per Site Per Month

Study Details

Study Description

Brief Summary

To evaluate the efficacy of romiplostim for the treatment of CIT in patients receiving chemotherapy for the treatment of NSCLC, ovarian cancer, or breast cancer measured by the ability to administer on-time, full-dose chemotherapy

Condition or Disease	Intervention/Treatment	Phase
Chemotherapy-induced Thrombocytopenia	Drug: Romiplostim Drug: Placebo	Phase 3

Detailed Description

This is a phase 3, randomized, placebo-controlled, multicenter, international study for the treatment of CIT in adult subjects receiving chemotherapy for the treatment of NSCLC, ovarian cancer, or breast cancer. Subjects must have a platelet count ≤ 85 x 10^9/L on day 1 of the study. The study will consist of a screening period of up to 4 weeks, a treatment period long enough to allow for assessment of 3 planned cycles of chemotherapy, a follow-up visit, and long-term follow-up (LTFU). Given that subjects are required to have 3 remaining planned cycles of chemotherapy, the chemotherapy cycles may be 3 or 4 weeks in duration, and the investigational product dose adjustment guidelines allow for up to 12 weeks of dosing before a subject is declared a non-responder, the majority of study subjects will receive investigational product for a range of 10-24 weeks.

Study Design

Study Type:

Interventional

Anticipated Enrollment :

162 participants

Allocation:

Randomized

Intervention Model:

Parallel Assignment

Intervention Model Description:

The study will consist of a screening period of up to 4 weeks, a treatment period long enough to allow for assessment of 3 planned cycles of chemotherapy, a follow-up visit, and LTFU. Given that subjects are required to have 3 remaining planned cycles of chemotherapy, the chemotherapy cycles may be 3 or 4 weeks in duration, and the investigational product dose adjustment guidelines allow for up to 12 weeks of dosing before a subject is declared a non-responder, the majority of study subjects will receive investigational product for a range of 10-24 weeks.The study will consist of a screening period of up to 4 weeks, a treatment period long enough to allow for assessment of 3 planned cycles of chemotherapy, a follow-up visit, and LTFU. Given that subjects are required to have 3 remaining planned cycles of chemotherapy, the chemotherapy cycles may be 3 or 4 weeks in duration, and the investigational product dose adjustment guidelines allow for up to 12 weeks of dosing before a subject is declared a non-responder, the majority of study subjects will receive investigational product for a range of 10-24 weeks.

Masking:

Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)

Primary Purpose:

Treatment

Official Title:

A Phase 3 Randomized Placebo-controlled Double-blind Study of Romiplostim for the Treatment of Chemotherapy-induced Thrombocytopenia in Patients Receiving Chemotherapy for Treatment of Non-small Cell Lung Cancer (NSCLC), Ovarian Cancer, or Breast Cancer

Actual Study Start Date :

Feb 26, 2020

Anticipated Primary Completion Date :

Apr 28, 2024

Anticipated Study Completion Date :

Mar 29, 2025

Arms and Interventions

Arm	Intervention/Treatment
Experimental: Romiplostim The study in a 2:1 randomization ratio(108 subjects to romiplostim). Amgen investigational product (romiplostim or placebo) will be administered in the clinic by a qualified healthcare provider as a subcutaneous injection.	Drug: Romiplostim This study is designed to study Romiplostim for the treatment of chemotherapy-induced thrombocytopenia (CIT) in patients receiving chemotherapy for the treatment of non-small cell lung cancer (NSCLC), ovarian cancer, or breast cancer Other Names: Nplate
Placebo Comparator: Placebo The study in a 2:1 randomization ratio (54 subjects to placebo) Amgen investigational product (romiplostim or placebo) will be administered in the clinic by a qualified healthcare provider as a subcutaneous injection.	Drug: Placebo Placebo comparator

Arm

Intervention/Treatment

Experimental: Romiplostim

The study in a 2:1 randomization ratio(108 subjects to romiplostim). Amgen investigational product (romiplostim or placebo) will be administered in the clinic by a qualified healthcare provider as a subcutaneous injection.

Drug: Romiplostim

This study is designed to study Romiplostim for the treatment of chemotherapy-induced thrombocytopenia (CIT) in patients receiving chemotherapy for the treatment of non-small cell lung cancer (NSCLC), ovarian cancer, or breast cancer

Other Names:

Nplate

Placebo Comparator: Placebo

The study in a 2:1 randomization ratio (54 subjects to placebo) Amgen investigational product (romiplostim or placebo) will be administered in the clinic by a qualified healthcare provider as a subcutaneous injection.

Drug: Placebo

Placebo comparator

Outcome Measures

Primary Outcome Measures

Incidence of either a chemotherapy dose delay or reduction [48 days]
No thrombocytopenia-induced modification of any myelosuppressive agent in the second and third cycles of the planned on-study chemotherapy regimen. Thrombocytopenia-induced modifications include chemotherapy dose reduction, delay, omission, or chemotherapy treatment discontinuation due to platelet counts below 100 x 109/L

Secondary Outcome Measures

Depth of Platelet Count [48 days]
the depth of the platelet count nadir from the start of the first on-study chemotherapy cycle through the end of the treatment period
Time to First platelet response [7 days]
The time to first platelet response, defined by platelet count ≥ 100 x 109/L in the absence of platelet transfusions during the preceding 7 days
the duration-adjusted event rate of ≥ grade 2 bleeding events [48 days]
the duration-adjusted event rate of ≥ grade 2 bleeding events, as assessed by Common Terminology Criteria for Adverse Events (CTCAE) version 5.0 grading scale
Overall survival [1 Year]
1-year overall survival
Proportion of subjects with at leat 1 incidence of platelet transfusion [48 days]
platelet transfusion(s) during the treatment period
proportion of patients achieving platelet count >= 100 x 10 9/L [7 days]
7 days after 3rd dose of IP with no transfusions in preceding 7 days
The subject incidence of adverse events [36 months]
Through end of study, up to 36 months. It will be counted in as an adverse event: any treatment - emergent adverse events, fatal adverse events, serious adverse events, or clinically significant changes in laboratory values.
Number of subjects who develop anti-romiplostim antibodies [36 Months]
Through end of study up to 36 months
Number of subjects who develop anti-TPO antibodies [36 months]
Through end of study, up to 36 months
Number of subjects who experience myelodysplastic syndromes [36 months]
Through end of study, up to 36 months
Number of subjects who experience secondary malignancies [36 months]
Through end of study, up to 36 months

Eligibility Criteria

Criteria

Ages Eligible for Study:

18 Years to 100 Years

Sexes Eligible for Study:

All

Accepts Healthy Volunteers:

Inclusion Criteria:

Subject has provided informed consent prior to initiation of any study-specific activities/procedures or subject's legally acceptable representative has provided informed consent prior to any study-specific activities/procedures being initiated when the subject has any kind of condition that, in the opinion of the investigator, may compromise the ability of the subject to give written informed consent.
Males or females greater than or equal to 18 years of age at signing of the informed consent.
Documented active stage I, II, III or IV locally advanced or metastatic of the following tumor types: NSCLC, breast cancer, or ovarian cancer (includes fallopian tube epithelial carcinomas and peritoneal epithelial carcinoma of unknown primary), or any stage recurrent disease. Patients with documented locally advanced (stage III) NSCLC should not be amenable to definitive treatment with chemoradiation and/or surgery.
Subjects must be receiving cancer treatment with 21- or 28-day cycles, using one of the following carboplatinum-based combination chemotherapy regimens: carboplatin/gemcitabine based, carboplatin/pemetrexed based, carboplatin/liposomal doxorubicin based or carboplatin/taxane based (which includes either paclitaxel, nab-paclitaxel, or docetaxel). Use of combination regimens with one of the above carboplatinum-based regimens is permitted with (1) anti-angiogenic agents (such as bevacizumab); (2) targeted therapy (such as anti-epidermal growth factor agents or anti- human epidermal growth factor receptor 2) or (3) immune checkpoint inhibitors. Cycle duration is based on intervals between day 1 of chemotherapy cycles (overlapping with carboplatin intervals) every 21 or 28 days. OR, Subjects must have CIT from a non-protocol chemotherapy regimen, planning to start treatment with one of the above protocol chemotherapy regimens which has been delayed ≥ 1 week due to CIT.
Subjects must have a local platelet count ≤ 85 x 109/L on day 1 of the study.
Subjects must be at least 21 or 28 days removed from the start of the chemotherapy cycle immediately prior to study day 1 if receiving a 21-day or 28-day cycle chemotherapy regimen, respectively.
Subjects must have at least 3 remaining planned cycles of chemotherapy at study enrollment.
Eastern Cooperative Oncology Group (ECOG) performance status of 0, 1, or 2.

Exclusion Criteria:

Acute lymphoblastic leukemia.
Acute myeloid leukemia.
Any myeloid malignancy.
Myelodysplastic syndrome. Baseline bone marrow biopsy is not required to rule out MDS. However, if a bone marrow biopsy and cytogenetics were performed as part of diagnostic or staging work-up, these results will be collected to confirm.
Myeloproliferative disease.
Multiple myeloma.
Within 4 months prior to enrollment, any history of active congestive heart failure (New York Heart Association [NYHA] Class III to IV), symptomatic ischemia, uncontrolled arrhythmias, clinically significant electrocardiogram (ECG) abnormalities, screening ECG with corrected QT (QTc) interval of greater than 470 msec, pericardial disease, or myocardial infarction.
Major surgery less than or equal to 28 days or minor surgery less than or equal to 3 days prior to enrollment.
New or uncontrolled venous thromboembolism or thrombotic events within 3 months prior to screening. To be eligible, subjects must have received at least 14 days of anticoagulation for a new thrombotic event and considered to be stable and suitable for continued therapeutic anticoagulation during trial participation.
History of arterial thrombotic events (eg, myocardial ischemia, transient ischemic attack, or stroke) within 6 months prior to screening.
Evidence of active infection within 2 weeks prior to the first dose of study treatment.
Known human immunodeficiency virus infection. Subjects without a documented diagnosis in their medical history will require a local laboratory assessment at screening. If local laboratory results are not available use central laboratory results.
Known active of chronic hepatitis C or hepatitis B infection. Subjects without a documented diagnosis in their medical history will require a local laboratory assessment at screening. If local laboratory results are not available use central laboratory results. Hepatitis B and C infection is based on the following results:
Positive for hepatitis B surface antigen (HBsAg) (indicative of chronic hepatitis B or recent acute hepatitis B).
Negative HBsAg and positive for hepatitis B core antibody: hepatitis B virus DNA by polymerase chain reaction (PCR) is necessary. Detectable hepatitis B virus DNA suggests occult hepatitis B.
Positive hepatitis C virus antibody: hepatitis C virus RNA by PCR is necessary. Detectable hepatitis C virus RNA suggests chronic hepatitis C.
In addition to the conditions listed in exclusion criteria 201 through 206, secondary malignancy within the past 5 years except:
Adequately treated non-melanoma skin cancer or lentigo maligna without evidence of disease.
Adequately treated cervical carcinoma in situ without evidence of disease.
Adequately treated breast ductal carcinoma in situ without evidence of disease.
Prostatic intraepithelial neoplasia without evidence of prostate cancer.
Adequately treated urothelial papillary noninvasive carcinoma or carcinoma in situ.
Malignancy treated with curative intent and with no known active disease present for greater than or equal to 3 years before enrollment and felt to be at low risk for recurrence by the treating physician (excluding malignancies listed in exclusion criteria 201 - 206).
Thrombocytopenia due to another etiology other than CIT (eg, chronic liver disease, prior history of immune thrombocytopenia purpura).
Any combined modality regimen containing radiation therapy or surgery occurring concomitantly with neo-adjuvant chemotherapy or where radiation therapy is planned before the 3 planned on-study cycles of chemotherapy.

Prior/Concomitant Therapy:

Previous use of romiplostim, pegylated recombinant human megakaryocyte growth and development factor, eltrombopag, recombinant human TPO, any other TPO receptor agonist, or any investigational platelet producing agent.

Prior/Concurrent Clinical Study Experience - Currently receiving (or plan to receive) treatment in another investigational device or drug study, or less than 28 days since ending treatment on another investigational device or drug study(ies). Other investigational procedures while participating in this study are excluded.

Diagnostic Assessments

Anemia (hemoglobin < 80 g/L [8 g/dL]) on the day of initiation of investigational product as assessed by local labs. Use of red cell transfusions and erythropoietic stimulating agents is permitted throughout the study as per institutional guidelines.
Neutropenia (absolute neutrophil count less than 1 x 10 9/L) on the day of initiation of investigational product as assessed by local labs. Use of granulocyte-colony stimulating factor is permitted throughout the study as per institutional guidelines.
Abnormal renal function with creatinine clearance less than 30 mL/min using the Cockcroft-Gault estimated creatinine clearance as assessed by local laboratory. If local laboratory results are not available use central laboratory results.

during screening.

Abnormal liver function (total bilirubin greater than 3X ULN; alanine aminotransferase [ALT] or aspartate aminotransferase [AST] greater than 3X ULN for subjects without liver metastases or greater than or equal to 5X ULN for subjects with liver metastases) as assessed by local laboratory during screening. If local laboratory results are not available use central laboratory results.

Other Exclusions

Females who are pregnant or breastfeeding or planning to become pregnant or breastfeed during treatment and for an additional 7 months after treatment (and chemotherapy) discontinuation (females of childbearing potential should only be included after a confirmed menstrual period and a negative highly sensitive urine or serum pregnancy test.)
Females of childbearing potential unwilling to use a highly effective method of contraception during treatment and for an additional 7 months after treatment (and chemotherapy) discontinuation. Refer to Appendix 5 for additional contraceptive information.
Males unwilling to use contraception* (male condom or sexual abstinence) or their female partner(s) of childbearing potential who are unwilling to use a highly effective method of contraception during treatment (and chemotherapy) and for an additional 7 months after treatment (and chemotherapy) discontinuation. *If the male's sole partner is of non-childbearing potential, he is not required to use additional forms of contraception during the study.
Subject has known sensitivity to any of the products to be administered during dosing.
Subject likely to not be available to complete all protocol-required study visits or procedures, and/or to comply with all required study procedures (eg, COAs) to the best of the subject and investigator's knowledge.
History or evidence of any other clinically significant disorder, condition or disease (with the exception of those outlined above) that, in the opinion of the investigator or Amgen physician, if consulted, would pose a risk to subject safety or interfere with the study evaluation, procedures or completion.
Male subjects with a pregnant partner who are unwilling to practice abstinence or use a condom during treatment (and chemotherapy) and for an additional 7 months after treatment (and chemotherapy) discontinuation.
Male subjects unwilling to abstain from donating sperm during treatment (and chemotherapy) and for an additional 7 months after treatment (and chemotherapy) discontinuation.

Contacts and Locations

Locations

	Site	City	State	Country	Postal Code
1	Saint Bernards Medical Center	Jonesboro	Arkansas	United States	72401
2	Pacific Cancer Medical Center Inc	Anaheim	California	United States	92801
3	University of California at Irvine Medical Center	Orange	California	United States	92868
4	Colorado West Healthcare System dba Grand Valley Oncology	Grand Junction	Colorado	United States	81505
5	Ocala Oncology Center	Ocala	Florida	United States	34474
6	Mid Florida Hematology and Oncology Centers PA	Orange City	Florida	United States	32763
7	Saint Alphonsus Regional Medical Center	Boise	Idaho	United States	83706
8	Orchard Healthcare Research Inc	Skokie	Illinois	United States	60076
9	Christus Saint Frances Cabrini Hospital	Alexandria	Louisiana	United States	71301
10	University Medical Center New Orleans	New Orleans	Louisiana	United States	70112
11	CHRISTUS Highland Cancer Treatment Center	Shreveport	Louisiana	United States	71105
12	Mercy Medical Center	Baltimore	Maryland	United States	21202
13	American Oncology Partners of Maryland, PA	Bethesda	Maryland	United States	20817
14	Massachusetts General Hospital Cancer Center	Boston	Massachusetts	United States	02114
15	Hattiesburg Clinic Hematology/Oncology	Hattiesburg	Mississippi	United States	39401
16	Oncology Hematology Associates	Springfield	Missouri	United States	65807
17	Regional Cancer Care Associates	Sparta	New Jersey	United States	07871
18	Broome Oncology LLC	Binghamton	New York	United States	13905
19	Saint Lukes University Health Network	Bethlehem	Pennsylvania	United States	18015
20	The Center for Cancer and Blood Disorders	Fort Worth	Texas	United States	76104
21	Medical Oncology Associates PS	Spokane	Washington	United States	99208
22	Yakima Valley Memorial Hospital	Yakima	Washington	United States	98902
23	Instituto Oncologico Cordoba	Ciudad de Cordoba	Córdoba	Argentina	X5002HWE
24	Centro Medico Austral	Ciudad Autónoma de Buenos Aires	Distrito Federal	Argentina	C1019ABS
25	Centro de Investigaciones Clínicas Clínica Viedma	Viedma	Río Negro	Argentina	8500
26	Medizinische Universitaet Innsbruck	Innsbruck		Austria	6020
27	Instituto de Oncologia do Parana	Curitba	Paraná	Brazil	81520-060
28	Vencer e Oncoclinica	Teresina	Piauí	Brazil	64049-200
29	Centro de Pesquisa da Serra Gaucha - Cepesg	Caxias do Sul	Rio Grande Do Sul	Brazil	95020-450
30	Catarina Pesquisa Clinica	Itajaí	Santa Catarina	Brazil	88301-220
31	Loema Instituto de Pesquisa Clinica & Consultores Ltda	Campinas	São Paulo	Brazil	13010-001
32	Casa de Saude Santa Marcelina	Sao Paulo	São Paulo	Brazil	08270-120
33	Complex Oncology Center - Ruse EOOD	Ruse		Bulgaria	7002
34	Multiprofile Hospital for Active Treatment Serdika EOOD	Sofia		Bulgaria	1632
35	Specialized Hospital for Active Treatment of Oncology EAD	Sofia		Bulgaria	1756
36	James Lind Centro de Investigacion del Cancer	Temuco	Cautín	Chile	4800827
37	Orlandi Oncologia	Santiago		Chile	7500713
38	Oncomedica Imat	Monteria	Córdoba	Colombia	230002
39	Centro Medico Imbanaco	Cali	Valle Del Cauca	Colombia	760042
40	Agios Savvas Anticancer Hospital	Athens		Greece	115 22
41	Henry Dunant Hospital Center	Athens		Greece	11526
42	Sotiria General Hospital	Athens		Greece	11527
43	Attikon University Hospital	Athens		Greece	12462
44	University Hospital of Heraklion	Heraklion - Crete		Greece	71110
45	Agios Loukas Clinic	Thessaloniki		Greece	55236
46	Iatriko Diavalkaniko Thessalonikis	Thessaloniki		Greece	57001
47	Semmelweis Egyetem	Budapest		Hungary	1083
48	Veszprem Megyei Tudogyogyintezet	Farkasgyepu		Hungary	8582
49	Petz Aladar Egyetemi Oktato Korhaz	Gyor		Hungary	9024
50	Fejer Megyei Szent Gyorgy Egyetemi Oktato Korhaz	Szekesfehervar		Hungary	8000
51	Jasz-Nagykun-Szolnok Megyei Hetenyi Geza Korhaz Rendelointezet	Szolnok		Hungary	5004
52	Tudogyogyintezet Torokbalint	Torokbalint		Hungary	2045
53	Oncotech	La Paz	Baja California Sur	Mexico	23040
54	Centro de Atencion e Investigacion Cardiovascular del Potosi Sc	San Luis Potosi	San Luis Potosí	Mexico	78200
55	Centro Medico Nacional Siglo XXI	Mexico		Mexico	06720
56	Oaxaca Site Management Organization SC	Oaxaca		Mexico	68000
57	Hospital Goyeneche	Arequipa		Peru	04001
58	Oncosalud	Lima		Peru	15036
59	Powiatowe Centrum Zdrowia w Brzezinach Sp Z o o	Brzeziny		Poland	95-060
60	Szpital Kliniczny im Heliodora Swiecickiego UM im Karola Marcinkowskiego w Poznaniu	Poznan		Poland	60-569
61	Centro Hospitalar Universitario de Lisboa Norte EPE - Hospital Pulido Valente	Lisboa		Portugal	1769-001
62	Unidade Local de Saude de Matosinhos, EPE - Hospital Pedro Hispano	Matosinhos		Portugal	4464-513
63	Centro Hospitalar Universitario do Porto EPE - Hospital de Santo Antonio	Porto		Portugal	4099-001
64	Hospital de Sao Joao, EPE	Porto		Portugal	4200-319
65	Institutul Oncologic, Prof Dr Alexandru Trestioreanu	Bucharest		Romania	022328
66	Institutul Oncologic, Prof Dr Alexandru Trestioreanu	Bucharest		Romania	022338
67	Spitalul Clinic Coltea	Bucharest		Romania	030171
68	Institutul Oncologic Prof Dr Ion Chiricuta Cluj-Napoca	Cluj Napoca		Romania	400015
69	Institutul Regional de Oncologie Iasi	Iasi		Romania	700483
70	Spitalul Municipal Ploiesti	Ploiesti		Romania	100337
71	SC Oncomed SRL	Timisoara		Romania	300239
72	SBHI of Arkhangelsk region Arkhangelsk clinical oncology dispensary	Arkhangelsk		Russian Federation	163045
73	Autonomic SHI Republican clinical oncology dispensary of MoH of the Republic of Tatarstan	Kazan		Russian Federation	420029
74	Medsi Group	Moscow Region		Russian Federation	143442
75	State Healthcare Institution Goroda Moskvi City Clinical Hospital 1	Moscow		Russian Federation	119049
76	Clinical hospital 2, Group of companies medsi	Moscow		Russian Federation	125284
77	LLC Tonus	Nizhniy Novgorod		Russian Federation	603089
78	Omsk Regional Clinical Oncology Dispensary	Omsk		Russian Federation	644013
79	State budget institution of public health Pyatigorsk oncology dispensary	Pyatigorsk		Russian Federation	357502
80	State Institution of Public Health	Ryazan		Russian Federation	390011
81	State Institution of Public Health Oncology Dispensary 2 of Public Health Krasnodar Region	Sochi		Russian Federation	354057
82	State Institution of Public Health Tambov Regional Oncology Dispensary	Tambov		Russian Federation	390013
83	Respublican clinical oncology dispensary Minzdrava of Republic of Bashkortostan	Ufa		Russian Federation	450054
84	Hospital Clinico Universitario San Cecilio	Granada	Andalucía	Spain	18016
85	Hospital Universitario Nuestra Señora de Valme	Sevilla	Andalucía	Spain	41013
86	Hospital Clinico Universitario de Salamanca	Salamanca	Castilla León	Spain	37007
87	Instituto Oncologico IOB	Barcelona	Cataluña	Spain	08023
88	Consorcio Hospitalario Provincial de Castellon	Castellon	Comunidad Valenciana	Spain	12002
89	Hospital Santa Maria Nai	Ourense	Galicia	Spain	32005
90	Hospital Universitario Madrid Sanchinarro	Madrid		Spain	28050
91	Doktor Abdurrahman Yurtaslan Ankara Onkoloji Egitim ve Arastirma Hastanesi	Ankara		Turkey	06200
92	Saglik Bilimleri University Ankara Ataturk Chest Diseases and Chest Surgery Training and Research Ho	Ankara		Turkey	06280
93	Pamukkale Universitesi Tip Fakultesi Hastanesi	Denizli		Turkey	20070
94	Trakya Universitesi Saglik Arastirma ve Uygulama Merkezi	Edirne		Turkey	22030
95	Istanbul Universitesi Cerrahpasa Tip Fakultesi	Istanbul		Turkey	34098
96	Pendik Egitim Arastirma Hastanesi	Istanbul		Turkey	34890
97	Izmir Katip Celebi Universitesi Ataturk Egitim ve Arastirma Hastanesi	Izmir		Turkey	35150
98	Medical Park Izmir Hastanesi	Izmir		Turkey	35575
99	Kocaeli Universitesi Arastirma ve Uygulama Hastanesi	Kocaeli		Turkey	41380
100	Inonu Universitesi Turgut Ozal Tip Merkezi	Malatya		Turkey	44280
101	Namik Kemal Universitesi Hastanesi	Tekirdag		Turkey	59100
102	Communal Institution Chernivtsi Regional Clinical Oncological Dispensary	Chernivtsi		Ukraine	58013
103	Transcarpathian Regional Clinical Oncological Dispensary	Uzhgorod		Ukraine	88011
104	Vinnytsya Regional Clinical Oncological Dispensary	Vinnytsia		Ukraine	21029