NAPOLI 3: A Study to Assess the Effectiveness and Safety of Irinotecan Liposome Injection, 5-fluorouracil/Leucovorin Plus Oxaliplatin in Patients Not Previously Treated for Metastatic Pancreatic Cancer, Compared to Nab-paclitaxel+Gemcitabine Treatment

Sponsor

Ipsen (Industry)

Overall Status

Active, not recruiting

CT.gov ID

NCT04083235

Collaborator

(none)

770

Enrollment

205

Locations

Arms

46.4

Anticipated Duration (Months)

3.8

Patients Per Site

0.1

Patients Per Site Per Month

Study Details

Study Description

Brief Summary

The purpose of this study is to look at the efficacy and safety of Irinotecan liposome injection in combination with other approved drugs used for cancer therapy, namely 5 fluorouracil/leucovorin (5FU/LV) plus oxaliplatin compared to nab-paclitaxel + gemcitabine treatment in improving the overall survival of patients not previously treated for metastatic pancreatic cancer.

Condition or Disease	Intervention/Treatment	Phase
Metastatic Adenocarcinoma of the Pancreas	Drug: Irinotecan Liposomal Injection Drug: Oxaliplatin Drug: 5Fluorouracil Drug: Leucovorin Drug: Nab-paclitaxel Drug: Gemcitabine	Phase 3

Study Design

Study Type:

Interventional

Actual Enrollment :

770 participants

Allocation:

Randomized

Intervention Model:

Parallel Assignment

Masking:

None (Open Label)

Primary Purpose:

Treatment

Official Title:

An Open-label, Randomised, Multicentre, Phase III Study of Irinotecan Liposome Injection, Oxaliplatin, 5-fluorouracil/Leucovorin Versus Nab-paclitaxel Plus Gemcitabine in Subjects Who Have Not Previously Received Chemotherapy for Metastatic Adenocarcinoma of the Pancreas

Actual Study Start Date :

Feb 19, 2020

Anticipated Primary Completion Date :

Dec 31, 2022

Anticipated Study Completion Date :

Dec 31, 2023

Arms and Interventions

Arm	Intervention/Treatment
Experimental: Irinotecan liposome injection + Oxaliplatin + 5-FU/LV Irinotecan liposome injection, oxaliplatin, 5 FU/LV, will be administered on Days 1 and 15 of each 28-day cycle (until progression or unacceptable toxicity).	Drug: Irinotecan Liposomal Injection Irinotecan liposome injection is irinotecan in the form of the sucrosofate salt, encapsulated in liposomes for i.v. infusion. It is supplied in sterile, single-use vials containing 10 mL of irinotecan liposome injection at a concentration of 4.3 mg/mL free base equivalent (FBE). Other Names: Onivyde® Nal-IRI Drug: Oxaliplatin Oxaliplatin injection, USP is supplied in single-dose vials containing 50 mg, 100 mg or 200 mg of oxaliplatin as a sterile, preservative-free, aqueous solution at a concentration of 5 mg/mL. Other Names: Eloxatin® Drug: 5Fluorouracil Fluorouracil injection, USP is a colorless to faint yellow, aqueous, sterile, nonpyrogenic injectable solution available in 50 mL and 100 mL pharmacy bulk package. Each mL contains 50 mg fluorouracil in water for injection, USP. Other Names: Adrucil® flurouracil 5-FU Drug: Leucovorin Leucovorin Calcium for Injection is supplied in vials ranging from 50-500 mg and available as an injectable solution or lyophilized powder for reconstitution. Other Names: Folinic Acid
Active Comparator: Nab-paclitaxel + Gemcitabine Nab-paclitaxel and gemcitabine will be administered on Days 1, 8 and 15 of each 28-day cycle (until progression or unacceptable toxicity).	Drug: Nab-paclitaxel Nab-paclitaxel is a lyophilised powder containing 100 or 250 mg of paclitaxel formulated as albumin-bound particles in single-use vials for re-constitution. Each mL of the reconstituted formulation will contain 5 mg/mL paclitaxel. Other Names: Abraxane® Drug: Gemcitabine Gemcitabine for injection is a lyophilised powder for solution for infusion, with each single use vial containing 200 mg, 1 g or 2 g of gemcitabine. Other Names: Gemzar®

Arm

Intervention/Treatment

Experimental: Irinotecan liposome injection + Oxaliplatin + 5-FU/LV

Irinotecan liposome injection, oxaliplatin, 5 FU/LV, will be administered on Days 1 and 15 of each 28-day cycle (until progression or unacceptable toxicity).

Drug: Irinotecan Liposomal Injection

Irinotecan liposome injection is irinotecan in the form of the sucrosofate salt, encapsulated in liposomes for i.v. infusion. It is supplied in sterile, single-use vials containing 10 mL of irinotecan liposome injection at a concentration of 4.3 mg/mL free base equivalent (FBE).

Other Names:

Onivyde®

Nal-IRI

Drug: Oxaliplatin

Oxaliplatin injection, USP is supplied in single-dose vials containing 50 mg, 100 mg or 200 mg of oxaliplatin as a sterile, preservative-free, aqueous solution at a concentration of 5 mg/mL.

Other Names:

Eloxatin®

Drug: 5Fluorouracil

Fluorouracil injection, USP is a colorless to faint yellow, aqueous, sterile, nonpyrogenic injectable solution available in 50 mL and 100 mL pharmacy bulk package. Each mL contains 50 mg fluorouracil in water for injection, USP.

Other Names:

Adrucil®

flurouracil

5-FU

Drug: Leucovorin

Leucovorin Calcium for Injection is supplied in vials ranging from 50-500 mg and available as an injectable solution or lyophilized powder for reconstitution.

Other Names:

Folinic Acid

Active Comparator: Nab-paclitaxel + Gemcitabine

Nab-paclitaxel and gemcitabine will be administered on Days 1, 8 and 15 of each 28-day cycle (until progression or unacceptable toxicity).

Drug: Nab-paclitaxel

Nab-paclitaxel is a lyophilised powder containing 100 or 250 mg of paclitaxel formulated as albumin-bound particles in single-use vials for re-constitution. Each mL of the reconstituted formulation will contain 5 mg/mL paclitaxel.

Other Names:

Abraxane®

Drug: Gemcitabine

Gemcitabine for injection is a lyophilised powder for solution for infusion, with each single use vial containing 200 mg, 1 g or 2 g of gemcitabine.

Other Names:

Gemzar®

Outcome Measures

Primary Outcome Measures

Overall survival (OS) [From study start until 543 OS events have occurred (approximately 15 months after last patient enrollment)]

Secondary Outcome Measures

Progression free survival (PFS) [From study start until 543 OS events have occurred (approximately 15 months after last patient enrollment)]
Overall Response Rate (ORR) [From study start until 543 OS events have occurred (approximately 15 months after last patient enrollment)]

Eligibility Criteria

Criteria

Ages Eligible for Study:

18 Years and Older

Sexes Eligible for Study:

All

Accepts Healthy Volunteers:

Inclusion Criteria:

Histological or cytologically confirmed adenocarcinoma of the pancreas that has not been previously treated in the metastatic setting.
Initial diagnosis of metastatic disease must have occurred ≤6 weeks prior to screening.
Subject has one or more metastatic lesions measurable by computed tomography (CT) scan (or magnetic resonance imaging (MRI), if the subject is allergic to CT contrast media) according to RECIST Version 1.1 criteria.
Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1.
Subject has adequate biological parameters as demonstrated by the following blood counts:(a) Absolute neutrophil count (ANC) ≥2000/mm3 without the use of hemopoietic growth factors within the last 7 days prior to randomisation (b) Platelet count ≥100,000/mm3 (c) Haemoglobin (Hgb) ≥9 g/dL obtained ≤14 days prior to randomisation.
Adequate hepatic function as evidenced by: (a) Serum total bilirubin ≤1.5x ULN (biliary drainage is allowed for biliary obstruction), and (b) Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) ≤2.5x upper limit of normal (ULN) (≤5x ULN is acceptable if liver metastases are present).
Adequate renal function as evidenced by creatinine clearance ≥30 mL/min.
Adequate coagulation studies (obtained ≤14 days prior to randomisation) as demonstrated by prothrombin time and partial thromboplastin time within normal limits (≤1.5xULN ).

Exclusion Criteria:

Prior treatment of pancreatic cancer in the metastatic setting with surgery, radiotherapy, chemotherapy or investigational therapy
Prior treatment of pancreatic adenocarcinoma with chemotherapy in the adjuvant setting, except those where at least 12 months have elapsed since completion of the last dose and no persistent treatment-related toxicities are present.
Subject has only localised advanced disease.
Documented serum albumin <3 g/dL
Known history of central nervous system (CNS) metastases.
Clinically significant gastrointestinal disorder
History of any second malignancy in the last 2 years
Concurrent illnesses that would be a relative contraindication to trial participation
Use of strong inhibitors or inducers of CYP3A, CYP2C8 and UGT1A1
Neuroendocrine (carcinoid, islet cell) or acinar pancreatic carcinoma
Known low or absent dihydropyrimidine dehydrogenase (DPD) activity

Contacts and Locations

Locations

	Site	City	State	Country	Postal Code
1	University of Alabama at Birmingham	Birmingham	Alabama	United States	35294
2	Banner Health- MD Anderson Cancer Center	Gilbert	Arizona	United States	85234
3	Mayo Clinic - Scottsdale	Phoenix	Arizona	United States	85054
4	Comprehensive Blood And Cancer Center	Bakersfield	California	United States	93309
5	University of California- Irvine Health Cancer Cente	Costa Mesa	California	United States	92627
6	City of Hope National Medical Center	Duarte	California	United States	91010
7	University of California, Los Angeles (UCLA)	Los Angeles	California	United States	90095
8	St. Jude Hospital Yorba Linda dba St. Joseph Heritage Healthcare	Orange	California	United States	92835
9	University of California - Irvine Medical Center	Orange	California	United States	92868
10	Torrance Memorial Physician Network Cancer Care	Redondo Beach	California	United States	90277
11	Sutter Health Sacramento	Sacramento	California	United States	95816
12	Presbyterian Intercommunity Hospital (PIH)	Whittier	California	United States	90602
13	UC Health Memorial Hospital	Colorado Springs	Colorado	United States	80909
14	Rocky Mountain Cancer Center	Denver	Colorado	United States	80218
15	Mount Sinai Medical Center of Florida, Inc.	Miami Beach	Florida	United States	33140
16	Miami Cancer Institute	Miami	Florida	United States	33176
17	Florida Cancer Specialists - Fort Myers	Sarasota	Florida	United States	34236
18	Florida Cancer Specialists - Panhandle	Tallahassee	Florida	United States	32308
19	Florida Cancer Specialists - St. Petersburg	Tampa	Florida	United States	33607
20	Florida Cancer Specialists - East	West Palm Beach	Florida	United States	33401
21	Rush University Medical Center	Chicago	Illinois	United States	60612
22	Edward Hospital - Elmhurst	Elmhurst	Illinois	United States	60540
23	Edward Hospital	Naperville	Illinois	United States	60540
24	Illinois CancerCare - Peoria	Peoria	Illinois	United States	61443
25	Carle Cancer Center	Urbana	Illinois	United States	61801
26	Fort Wayne Medical Oncology and Hematology	Fort Wayne	Indiana	United States	46804
27	Siouxland Hematology - Oncology Associates, LLP	Sioux City	Iowa	United States	51101
28	University of Kentucky Markey Cancer Center	Lexington	Kentucky	United States	40536
29	Pikeville Medical Center	Pikeville	Kentucky	United States	41501
30	Hematology Oncology Clinic	Baton Rouge	Louisiana	United States	70809
31	Ochsner Clinic Foundation	New Orleans	Louisiana	United States	70121
32	Willis-Knighton Cancer Center	Shreveport	Louisiana	United States	71103
33	Maine Center for Cancer Medicine	Scarborough	Maine	United States	04074
34	Maryland Oncology Hematology	Silver Spring	Maryland	United States	20904
35	Beth Israel Deaconess	Boston	Massachusetts	United States	02215
36	Henry Ford Health System	Detroit	Michigan	United States	48202
37	Cancer and Hematology Centers of Western Michigan	Grand Rapids	Michigan	United States	49546
38	Health Partners Institute	Minneapolis	Minnesota	United States	55425
39	Mayo Clinic - Rochester	Rochester	Minnesota	United States	55902
40	Research Medical Center	Kansas City	Missouri	United States	64132
41	Washington University School of Medicine in St. Louis	Saint Louis	Missouri	United States	63110
42	Frontier Cancer Center	Billings	Montana	United States	59102
43	Oncology Hematology West P.C. dba Nebraska Cancer Specialists	Omaha	Nebraska	United States	68130
44	Comprehensive Cancer Centers of Nevada	Las Vegas	Nevada	United States	89169
45	Clinical Research Alliance, Inc	Lake Success	New York	United States	10021
46	David H. Koch Center for Cancer Care at Memorial Sloan Kettering Cancer Center	New York	New York	United States	10065
47	University of Rochester	Rochester	New York	United States	14642
48	Stony Brook University Medical Center	Stony Brook	New York	United States	11794
49	Messino Cancer Center	Asheville	North Carolina	United States	28806
50	The Ohio State University Comprehensive Cancer Center - Arthur G. James Cancer Hospital and Richard J. Solovev Research Institute (OSUCCC - James)	Columbus	Ohio	United States	43210
51	Toledo Clinic Cancer Center	Toledo	Ohio	United States	43623
52	Mercy Health - St. Elizabeth Youngstown Hospital	Youngstown	Ohio	United States	44501
53	University of Oklahoma - Health Sciences Center	Oklahoma City	Oklahoma	United States	73104
54	Oncology Associates of Oregon	Eugene	Oregon	United States	97401
55	Compass Oncology - Rose Quarter Cancer Center	Portland	Oregon	United States	97227
56	Kaiser Permanente - Northwest	Portland	Oregon	United States	97227
57	Oregon Health & Science University (OHSU)	Portland	Oregon	United States	97239
58	University of Pittsburgh Medical Center (UPMC) - Hillman Cancer Center	Pittsburgh	Pennsylvania	United States	15232
59	Greenville Hospital System	Greenville	South Carolina	United States	29605
60	Chattanooga Oncology Hematology Care - Tennessee Oncology	Chattanooga	Tennessee	United States	37404
61	The West Cancer Center	Memphis	Tennessee	United States	38138
62	Sarah Cannon and HCA Research Institute	Nashville	Tennessee	United States	37203
63	Texas Oncology - Austin	Austin	Texas	United States	78731
64	Texas Oncology - Baylor Charles A. Sammons Cancer Center	Dallas	Texas	United States	75246
65	The Center for Cancer and Blood Disorders	Fort Worth	Texas	United States	76104
66	Baylor College of Medicine	Houston	Texas	United States	77030
67	Houston Methodist Research Institute	Houston	Texas	United States	77030
68	MD Anderson Cancer Center	Houston	Texas	United States	77030
69	Oncology Consultants	Houston	Texas	United States	77030
70	Texas Oncology - Tyler	Tyler	Texas	United States	75702
71	Texas Oncology - Wichita Falls	Wichita Falls	Texas	United States	76310
72	Utah Cancer Specialists	Salt Lake City	Utah	United States	84106
73	Virginia Cancer Specialists	Fairfax	Virginia	United States	22031
74	Blue Ridge Cancer Care	Wytheville	Virginia	United States	24014
75	Froedtert Hospital and the Medical College of Wisconsin	Milwaukee	Wisconsin	United States	53226
76	ProHealth Care Medical Associates	Waukesha	Wisconsin	United States	53188
77	Bankstown-Lidcombe Hospital	Bankstown		Australia	2200
78	Monash Medical Centre	Clayton		Australia	3168
79	Fiona Stanley Hospital	Murdoch		Australia	6150
80	Sir Charles Gairdner Hospital	Nedlands		Australia	6009
81	St John of God Subiaco Hospital	Subiaco		Australia	6008
82	Queen Elizabeth Hospital	Woodville South		Australia	5011
83	Medizinische Universitaet Graz	Graz		Austria	8036
84	Ordensklinikum Linz GmbH Barmherzige Schwestern	Linz		Austria	4010
85	SCRI-CCCIT Gemeinnutzige Gmbh- Gemeinnutzige Salzburger Landeskliniken Betriebsgesmbh	Salzburg		Austria	A-5020
86	Medical University of Vienna	Vienna		Austria	1090
87	Onze-Lieve-Vrouwziekenhuis	Aalst		Belgium	9300
88	ASBL Grand Hôpital de Charleroi (GHdC), Site Notre Dame	Charleroi		Belgium	6000
89	Universitair Ziekenhuis Antwerpen (UZA)	Edegem		Belgium	2650
90	University Hospital Gent	Gent		Belgium	9000
91	Hospital centre Jolimont	Haine-Saint-Paul		Belgium	7100
92	University Hospital (UZ) Leuven	Leuven		Belgium	3000
93	University Hospital Mont-Godinne	Yvoir		Belgium	5530
94	Fundação Pio XII - Hospital de Câncer de Barretos	Barretos		Brazil	14784-400
95	Centro Regional Integrado de Oncologia (CRIO)	Ceara		Brazil	60336-550
96	Instituto de Oncologia do Parana - IOP	Curitiba		Brazil	80530-010
97	Centro de Pesquisas Oncológicas - CEPON	Florianópolis		Brazil	88034-000
98	Hospital de Caridade de Ijui	Ijuí		Brazil	98700
99	Clinica Neoplasias Litoral	Itajaí		Brazil	88301-220
100	Hospital Bruno Born	Lajeado		Brazil	95900
101	Centro de Pesquisas Clinicas de Natal - CPCLIN	Natal		Brazil	59025-050
102	Irmandade da Santa Casa de Misericordia de Porto Alegre	Porto Alegre		Brazil
103	Instituto Nacional Do Cancer (INCA)	Rio de Janeiro		Brazil	20230-130
104	Instituto COI	Rio De Janeiro		Brazil	22793-080
105	Instituto Brasileiro de Controle do Cancer - IBCC (Sao Paulo)	San Paolo		Brazil	03102-006
106	CIP Centro Integrado de Pesquisas do Hospital de Base	São José Do Rio Preto		Brazil	5416
107	Hospital Alemão Oswaldo Cruz	São Paulo		Brazil	01323-001
108	Instituto do Cancer do Estado de São Paulo (ICESP)	São Paulo		Brazil
109	Alberta Health Services Cross Cancer Institute	Edmonton		Canada	T6G 1Z2
110	Queen Elizabeth II Health Sciences Centre	Halifax		Canada	B3H 3A7
111	McGill University Faculty of Medicine - Royal Victoria Hospital	Montréal		Canada	H3G 1Y6
112	Centre Hospitalier Universitaire de Sherbrooke	Sherbrooke		Canada	J1H 5N4
113	Masarykuv onkologicky ustav	Brno		Czechia	65653
114	Fakultni nemocnice Hradec Kralove	Hradec Králové		Czechia	50005
115	University Hospital Olomouc, Department of Oncology	Olomouc		Czechia	77020
116	Thomayerova Nemocnice	Praha		Czechia	14059
117	CHRU de Tours - Hôpital Trousseau	Chambray-lès-Tours		France	37170
118	Centre Oscar Lambret	Lille		France	59020
119	Hôpital Edouard Herriot	Lyon		France	69003
120	Centre Leon Berard	Lyon		France	69008
121	Hopital Prive Jean Mermoz	Lyon		France	69008
122	Centre Antoine-Lacassagne	Nice		France	06189
123	Hopital Saint Louis	Paris		France	75010
124	CHU Bordeaux - Hopital Haut-Leveque	Pessac		France	33604
125	Centre Hospitalier Universitaire de Poitiers - Poitiers University Hospital	Poitiers Cedex		France	86021
126	Strasbourg Oncologie Liberale	Strasbourg		France	67000
127	Charité - Universitaetsmedizin Berlin	Berlin		Germany	10117
128	St. Josef-Hospital	Bochum		Germany	44791
129	Klinikum Esslingen GmbH	Esslingen		Germany	73730
130	Krankenhaus Nordwest	Frankfurt		Germany	60488
131	Studiengesellschaft BSF	Halle		Germany	06108
132	Martin Luther Universitat Halle-Wittenberg	Halle		Germany	06120
133	Facharztzentrum Eppendorf	Hamburg		Germany	20249
134	Marienkrankenhaus Hamburg	Hamburg		Germany	22087
135	Asklepios Klinik Altona	Hamburg		Germany	22763
136	Medizinische Hochschule Hannover	Hannover		Germany	30625
137	Slk-Kliniken	Heilbronn		Germany	74078
138	Klinikum Mannheim	Mannheim		Germany	68167
139	Krankenhaus St. Franziskus - Kliniken Maria Hilf GmbH	Mönchengladbach		Germany	41063
140	Universitaetsklinikum Tuebingen	Tuebingen		Germany	72076
141	Universitaetsklinikum Ulm	Ulm		Germany	89081
142	Agios Savvas Anticancer Hospital	Athens		Greece	11522
143	General Hospital of Athens - Laiko	Athens		Greece	11528
144	National and Kapodistrian University of Athens	Athens		Greece	11528
145	University General Hospital of Ioannina	Ioánnina		Greece	45500
146	Theagenion Hospital	Thessaloníki		Greece	54007
147	Dél-pesti Centrumkórház - Szent László Kórház telephely	Budapest		Hungary	1097
148	Országos Onkológiai Intézet	Budapest		Hungary	1122
149	Semmelweis Egyetem Belgyógyászati és Hematológiai Klinika	Budapest		Hungary	H-1089
150	Debreceni Egyetem Klinikai Kozpont	Debrecen		Hungary	H-4032
151	Petz Aladar Megyei Oktato Korhaz	Győr		Hungary	9023
152	Somogy Megyei Kaposi Mor Oktato Korhaz	Kaposvár		Hungary	7400
153	Jász-Nagykun-Szolnok Megyei Hetényi Géza Kórház-Rendelointézet	Szolnok		Hungary	H-5000
154	Soroka Medical Center	Beer Sheva		Israel	Beer Sheva
155	Rambam Health Care Campus	Haifa		Israel	3109601
156	Policlinico S. Orsola-Malpighi	Bologna		Italy	40138
157	Istituto Romagnolo per lo Studio dei Tumori Dino Amadori	Meldola		Italy	47014
158	Istituto Europeo di Oncologia	Milano		Italy	20141
159	Azienda Ospedaliero-Universitaria di Modena	Modena		Italy	41124
160	AUSL di Piacenza-Ospedale Guglielmo Da Saliceto	Piacenza		Italy	29121
161	Azienda Ospedaliero Universitaria Pisana	Pisa		Italy	56126
162	AOU Ospedali Riuniti di Ancona	Torrette		Italy	60126
163	Azienda Ospedaliera - Universitaria Integrata di Verona - Ospedale Borgo Roma	Verona		Italy	37134
164	Inje University Haeundae Paik Hospital	Busan		Korea, Republic of	48108
165	National Cancer Center	Goyang-si		Korea, Republic of	10408
166	CHA Bundang Medical Center	Gyeonggi-do		Korea, Republic of	13520
167	Asan Medical Center	Seoul		Korea, Republic of	05505
168	Seoul St. Mary's Hospital, The Catholic University of Korea	Seoul		Korea, Republic of	06591
169	Korea University Guro Hospital	Seoul		Korea, Republic of	08308
170	Hospital de Braga	Braga		Portugal	4710-243
171	Centro Hospitalar Universitario de Lisboa Norte - Hospital de Santa Maria	Lisboa		Portugal	1649-035
172	Champalimaud Cancer Center	Lisbon		Portugal	1400-038
173	Unidade Local de Saude Matosinhos E.P.E. Hospital Pedro Hispano	Senhora da Hora		Portugal	4464-513
174	Centro Hospitalar de Vila Nova de Gaia/Espinho EPE	Vila Nova de Gaia		Portugal	4434-502
175	Evimed LLC	Chelyabinsk		Russian Federation	454048
176	Limited Liability Company- Clinica Druzhkovyh	Kazan		Russian Federation	420126
177	Kursk Regional Clinical Oncology Dispensary	Kursk		Russian Federation	305524
178	Main Military Clinical Hospital named after N.N. Burdenko	Moscow		Russian Federation	105229
179	Volga District Medical Centre	Novgorod		Russian Federation	603074
180	Federal State Budgetary Institution - Russian Scientific Center of Radiology and Surgical Technologies n.a. academician A.M.Granov	Saint-Petersburg		Russian Federation
181	Hospital General Universitario de Elche	Alicante		Spain	03203
182	Hospital Universitario de Badajoz	Badajoz		Spain	06080
183	Hospital Germans Trias i Pujol	Badalona		Spain	08916
184	Hospital Quironsalud Barcelona	Barcelona		Spain	08023
185	Hospital de la Santa Creu i Sant Pau Barcelona	Barcelona		Spain	08026
186	Hospital Vall D Hebron	Barcelona		Spain	08035
187	Hospital Clinic Barcelona	Barcelona		Spain	08036
188	Corporacio Sanitaria Parc Tauli - Hospital de Sabadell	Barcelona		Spain	08208
189	Institut Catala d'Oncologia - L'Hospitalet	Barcelona		Spain	08908
190	Complejo Hospitalario Universitario de Granada - Hospital Universitario Virgen de las Nieves	Granada		Spain	18014
191	Hospital General Universitario Gregorio Marañon	Madrid		Spain	28007
192	Fundacion Jimenez Diaz	Madrid		Spain	28040
193	Hospital Universitario 12 de Octubre	Madrid		Spain	28041
194	Hospital Universitario La Paz	Madrid		Spain	28046
195	Centro Integral Oncologico Clara Campal	Madrid		Spain	28050
196	Hospital Regional Universitario de Malaga	Málaga		Spain	29009
197	Complejo Hospitalario de Navarra	Pamplona		Spain	31008
198	Hospital Universitario Marques de Valdecilla	Santander		Spain	39008
199	Hospital Universitario Miguel Servet	Zaragoza		Spain	50009
200	Guy's and St. Thomas' NHS Foundation Trust	London		United Kingdom	SE1 9RT
201	Royal Marsden Foundation Trust	London		United Kingdom	SM2 5PT
202	Royal Marsden Foundation Trust	London		United Kingdom	SW3 6JJ
203	Imperial College Healthcare NHS Trust	London		United Kingdom	W12 0HS
204	Cancer Research UK - Christie Hospital Foundation NHS Trust - Dept of Medical Oncology	Manchester		United Kingdom	M20 4BX
205	Nottingham City Hospital	Nottingham		United Kingdom	NG5 1PB