A Study of Neoadjuvant Atezolizumab Plus Chemotherapy Versus Placebo Plus Chemotherapy in Patients With Resectable Stage II, IIIA, or Select IIIB Non-Small Cell Lung Cancer (IMpower030)

Sponsor

Hoffmann-La Roche (Industry)

Overall Status

Active, not recruiting

CT.gov ID

NCT03456063

Collaborator

(none)

453

Enrollment

129

Locations

Arms

78.9

Anticipated Duration (Months)

3.5

Patients Per Site

Patients Per Site Per Month

Study Details

Study Description

Brief Summary

This is a randomized, double-blinded study designed to evaluate the efficacy, safety, pharmacokinetics, and immunogenicity of neoadjuvant treatment with atezolizumab (MPDL3280A) or placebo in combination with platinum-based chemotherapy in participants with resectable Stage II, IIIA, or select IIIB non-small cell lung cancer (NSCLC) followed by open-label adjuvant/postoperative atezolizumab or best supportive care and monitoring.

Condition or Disease	Intervention/Treatment	Phase
Non-Small-Cell Lung	Drug: Atezolizumab (MPDL3280A), an engineered anti-PD-L1 antibody Drug: Placebo Comparator Drug: Nab-paclitaxel Drug: Pemetrexed Drug: Carboplatin Drug: Cisplatin Drug: Gemcitabine	Phase 3

Study Design

Study Type:

Interventional

Actual Enrollment :

453 participants

Allocation:

Randomized

Intervention Model:

Parallel Assignment

Masking:

Double (Participant, Care Provider)

Primary Purpose:

Treatment

Official Title:

A Phase III, Double-Blinded, Multicenter, Randomized Study Evaluating the Efficacy and Safety of Neoadjuvant Treatment With Atezolizumab or Placebo in Combination With Platinum-Based Chemotherapy in Patients With Resectable Stage II, IIIA, or Select IIIB Non-Small Cell Lung Cancer

Actual Study Start Date :

Apr 24, 2018

Anticipated Primary Completion Date :

Nov 20, 2024

Anticipated Study Completion Date :

Nov 20, 2024

Arms and Interventions

Arm	Intervention/Treatment
Experimental: Arm A: Atezolizumab + platinum-based chemotherapy Neoadjuvant treatment will consist of 4 cycles; atezolizumab + platinum-based chemotherapy Platinum-based chemotherapy may include: carboplatin + pemetrexed carboplatin + nab-paclitaxel cisplatin + pemetrexed cisplatin + gemcitabine Post-operative adjuvant treatment will consist of 16-cycles of atezolizumab	Drug: Atezolizumab (MPDL3280A), an engineered anti-PD-L1 antibody Atezolizumab will be administered as intravenous (IV) infusion at a dose of 1200 milligrams (mg) on Day 1 of each 21-day cycle (every 3 weeks) for 4 cycles during the neoadjuvant treatment phase Atezolizumab will be administered as IV infusion at a dose of 1200 milligrams (mg) every 3 weeks for 16 cycles during the post-operative adjuvant phase Other Names: Tecentriq Drug: Nab-paclitaxel Nab-paclitaxel 100 mg/m^2 will be administered intravenously on Days 1, 8, and 15 of each 21 day cycle for 4 cycles during the neoadjuvant treatment phase Other Names: Abraxane Drug: Pemetrexed Pemetrexed 500 mg/m^2 will be administered intravenously on Day 1 of each 21-day cycle for 4 cycles during the neoadjuvant treatment phase Other Names: Alimta Drug: Carboplatin Carboplatin initial target AUC of 6 mg/mL/min will be administered intravenously on Day 1 of each 21-day cycle for 4 cycles during the neoadjuvant treatment phase Drug: Cisplatin Cisplatin 75 mg/m^2 will be administered intravenously on Day 1 of each 21-day cycle for 4 cycles during the neoadjuvant treatment phase Drug: Gemcitabine Gemcitabine 1250 mg/m^2 will be administered intravenously on Day 1 and 8 of each 21-day cycle for 4 cycles during the neoadjuvant treatment phase Other Names: Gemzar
Placebo Comparator: Arm B: Placebo + platinum-based chemotherapy Neoadjuvant treatment will consist of 4 cycles; placebo + platinum-based chemotherapy Platinum-based chemotherapy may include: carboplatin + pemetrexed carboplatin + nab-paclitaxel cisplatin + pemetrexed cisplatin + gemcitabine Participants will receive best supportive care and monitoring after surgery	Drug: Placebo Comparator Placebo will be administered as IV infusion at a dose of 1200 milligrams (mg) on Day 1 of each 21-day cycle for 4 cycles during the neoadjuvant treatment phase Drug: Nab-paclitaxel Nab-paclitaxel 100 mg/m^2 will be administered intravenously on Days 1, 8, and 15 of each 21 day cycle for 4 cycles during the neoadjuvant treatment phase Other Names: Abraxane Drug: Pemetrexed Pemetrexed 500 mg/m^2 will be administered intravenously on Day 1 of each 21-day cycle for 4 cycles during the neoadjuvant treatment phase Other Names: Alimta Drug: Carboplatin Carboplatin initial target AUC of 6 mg/mL/min will be administered intravenously on Day 1 of each 21-day cycle for 4 cycles during the neoadjuvant treatment phase Drug: Cisplatin Cisplatin 75 mg/m^2 will be administered intravenously on Day 1 of each 21-day cycle for 4 cycles during the neoadjuvant treatment phase Drug: Gemcitabine Gemcitabine 1250 mg/m^2 will be administered intravenously on Day 1 and 8 of each 21-day cycle for 4 cycles during the neoadjuvant treatment phase Other Names: Gemzar

Arm

Intervention/Treatment

Experimental: Arm A: Atezolizumab + platinum-based chemotherapy

Neoadjuvant treatment will consist of 4 cycles; atezolizumab + platinum-based chemotherapy Platinum-based chemotherapy may include: carboplatin + pemetrexed carboplatin + nab-paclitaxel cisplatin + pemetrexed cisplatin + gemcitabine Post-operative adjuvant treatment will consist of 16-cycles of atezolizumab

Drug: Atezolizumab (MPDL3280A), an engineered anti-PD-L1 antibody

Atezolizumab will be administered as intravenous (IV) infusion at a dose of 1200 milligrams (mg) on Day 1 of each 21-day cycle (every 3 weeks) for 4 cycles during the neoadjuvant treatment phase Atezolizumab will be administered as IV infusion at a dose of 1200 milligrams (mg) every 3 weeks for 16 cycles during the post-operative adjuvant phase

Other Names:

Tecentriq

Drug: Nab-paclitaxel

Nab-paclitaxel 100 mg/m^2 will be administered intravenously on Days 1, 8, and 15 of each 21 day cycle for 4 cycles during the neoadjuvant treatment phase

Other Names:

Abraxane

Drug: Pemetrexed

Pemetrexed 500 mg/m^2 will be administered intravenously on Day 1 of each 21-day cycle for 4 cycles during the neoadjuvant treatment phase

Other Names:

Alimta

Drug: Carboplatin

Carboplatin initial target AUC of 6 mg/mL/min will be administered intravenously on Day 1 of each 21-day cycle for 4 cycles during the neoadjuvant treatment phase

Drug: Cisplatin

Cisplatin 75 mg/m^2 will be administered intravenously on Day 1 of each 21-day cycle for 4 cycles during the neoadjuvant treatment phase

Drug: Gemcitabine

Gemcitabine 1250 mg/m^2 will be administered intravenously on Day 1 and 8 of each 21-day cycle for 4 cycles during the neoadjuvant treatment phase

Other Names:

Gemzar

Placebo Comparator: Arm B: Placebo + platinum-based chemotherapy

Neoadjuvant treatment will consist of 4 cycles; placebo + platinum-based chemotherapy Platinum-based chemotherapy may include: carboplatin + pemetrexed carboplatin + nab-paclitaxel cisplatin + pemetrexed cisplatin + gemcitabine Participants will receive best supportive care and monitoring after surgery

Drug: Placebo Comparator

Placebo will be administered as IV infusion at a dose of 1200 milligrams (mg) on Day 1 of each 21-day cycle for 4 cycles during the neoadjuvant treatment phase

Drug: Nab-paclitaxel

Nab-paclitaxel 100 mg/m^2 will be administered intravenously on Days 1, 8, and 15 of each 21 day cycle for 4 cycles during the neoadjuvant treatment phase

Other Names:

Abraxane

Drug: Pemetrexed

Pemetrexed 500 mg/m^2 will be administered intravenously on Day 1 of each 21-day cycle for 4 cycles during the neoadjuvant treatment phase

Other Names:

Alimta

Drug: Carboplatin

Carboplatin initial target AUC of 6 mg/mL/min will be administered intravenously on Day 1 of each 21-day cycle for 4 cycles during the neoadjuvant treatment phase

Drug: Cisplatin

Cisplatin 75 mg/m^2 will be administered intravenously on Day 1 of each 21-day cycle for 4 cycles during the neoadjuvant treatment phase

Drug: Gemcitabine

Gemcitabine 1250 mg/m^2 will be administered intravenously on Day 1 and 8 of each 21-day cycle for 4 cycles during the neoadjuvant treatment phase

Other Names:

Gemzar

Outcome Measures

Primary Outcome Measures

Independent Review Facility (IRF)-Assessed Event Free Survival (EFS) [Up to approximately 96 months]
IRF-assessed EFS is defined as the time from randomization to the first documented disease progression per RECIST v1.1 that precludes surgery, local or distant disease recurrence, or death from any cause, whichever occurs first.

Secondary Outcome Measures

Pathological Complete Response (pCR) [At time of surgery]
pCR is defined as the absence of any viable primary tumor cells at the time of surgical resection in the primary tumor and all sampled lymph nodes as assessed by central and local pathology laboratory.
Major Pathological Response (MPR) [At time of surgery]
MPR is defined as ≤ 10% residual viable tumor cells at the time of surgical resection in the primary tumor, as assessed by central and local pathology laboratory.
Objective Response (OR) [Prior to surgery, up to approximately 84 days]
Objective response is defined as a complete response or partial response, as determined by the investigator according to RECIST v1.1
Overall Survival (OS) [Up to approximately 96 months]
OS is defined as the time from randomization to death from any cause during the course of the study.
Investigator-Assessed EFS [Up to approximately 96 months]
EFS is defined as the time from randomization to the first documented disease progression per RECIST v1.1 that precludes surgery, local or distant disease recurrence, as assessed by the investigator; or death from any cause, whichever occurs first.
Disease-Free Survival (DFS) [Up to approximately 96 months]
DFS is defined as the time from the first date of no disease to local or distant recurrence (including occurrence of new primary NSCLC) or death due to any cause, whichever occurs first, as determined by the investigator during the adjuvant treatment and observation follow-up
2-Year and 3-Year OS [Up to approximately 96 months]
The 2-year and 3-year OS rate is defined as the probability that a participant will be alive 2 years and 3 years after randomization, respectively.
2-Year and 3-Year Independent Review Facility-Assessed EFS [Up to approximately 96 months]
EFS is defined as the probability that a participant will be event-free 2 years and 3 years after randomization, respectively, as assessed by the Independent Review Facility.
2-Year and 3-Year Investigator-Assessed EFS [Up to approximately 96 months]
EFS is defined as the probability that a participant will be event-free 2 years and 3 years after randomization, respectively, as assessed by the Investigator.
Change from baseline in HRQoL scores [Up to approximately 96 months]
Change from baseline in HRQoL scores as assessed through use of the two-item GHS/HRQoL subscale (Questions 29 and 30) of the EORTC QLQ-C30 at each assessment time point during the study through the completion of adjuvant treatment and observation follow-up assessments
Percentage of Participants With Adverse Events (AEs) [Up to approximately 96 months]
Number and Severity of Surgical Related Adverse Events [Up to approximately 96 months]
Number of Surgical Delays [Up to approximately 96 months]
Number of surgical delays.
Length of Surgical Delays [Up to approximately 96 months]
Length of surgical delays.
Number of Operative and Post-Operative Complications [Up to approximately 96 months]
Number of operative and post-operative complications.
Reasons for Surgical Cancellations [Up to approximately 96 months]
Reasons for surgical cancellations.
Minimum Observed Serum Atezolizumab Concentration (Cmin) [Pre-dose on Day 1 of Cycles 1 and 3 (each cylce is 21 days) for Neoadjuvant Treatment; pre-dose on Day 1 of Cycles 5, 7, 9, 11 and 19 (each cycle is 21 days) for Arm A; at treatment or observation follow-up discontinuation (up to approximately 96 months)]
Cmin is the minimum (or trough) concentration that a study drug achieves in the body.
Maximum Observed Serum Atezolizumab Concentration (Cmax) [Pre-dose on Day 1 of Cycles 1 and 3 for Neoadjuvant Treatment; Pre-dose on Day 1 of Cycles 5, 7, 9, 11 and 19 for Arm A. Each cycle is 21 days; at treatment or observation follow-up discontinuation (up to approximately 96 months)]
Cmax is the maximum (or peak) concentration that a study drug achieves in the body.
Percentage of Participants With Anti-Drug Antibody (ADA) to Atezolizumab [Pre-dose on Day 1 of Cycles 1 and 3 for Neoadjuvant Treatment; Pre-dose on Day 1 of Cycles 5, 7, 9, 11 and 19 for Arm A. Each cycle is 21 days; at treatment or observation follow-up discontinuation (up to approximately 96 months)]

Eligibility Criteria

Criteria

Ages Eligible for Study:

18 Years and Older

Sexes Eligible for Study:

All

Accepts Healthy Volunteers:

Inclusion criteria:

Eastern Cooperative Oncology Group (ECOG) performance status 0 or 1
Histologically or cytologically confirmed, resectable Stage II, IIIA, or Select IIIB (T3N2 only) NSCLC of squamous or non-squamous histology. Staging should be based on the 8th edition of the AJCC/UICC staging system
Evaluation by an attending thoracic surgeon to confirm eligibility for an R0 resection with curative intent
Adequate pulmonary and cardiac function to undergo surgical resection
Measurable disease as defined by RECIST v1.1
Adequate hematologic and end organ function
Negative HIV test at screening
Negative for active HBV and HCV at screening
Adequate tissue for PD-L1 IHC assessment

Exclusion criteria:

NSCLC with histology of large cell neuroendocrine carcinoma or sarcomatoid carcinoma
Mixed NSCLC and small cell lung cancer histology
Any prior therapy for lung cancer
Malignancies other than NSCLC within 5 years prior to randomization, with the exception of those with a negligible risk of metastasis or death treated expected curative outcome
Non-squamous NSCLC histology with activating ALK and EGFR mutation
Pregnant or lactating women
History of autoimmune disease
History of idiopathic pulmonary fibrosis, organizing pneumonia, drug-induced pneumonitis, or evidence of active of active pneumonitis on screening chest Computed Tomography (CT) scan
Prior treatment with cluster of differentiation 137 (CD137) agonist or immune checkpoint blockade therapies, anti-programmed-death-1 (anti-PD-1), and anti-PD-L1 therapeutic antibody
Severe infection within 4 weeks prior to randomization
Significant history of cardiovascular disease

Contacts and Locations

Locations

	Site	City	State	Country	Postal Code
1	Arizona Oncology	Tucson	Arizona	United States	85711
2	USC Norris Cancer Center	Los Angeles	California	United States	90033
3	USC Norris Cancer Center; USC Oncology Hematology Newport Beach	Newport Beach	California	United States	92663
4	The Center for Cancer Prevention and Treatment at St.Joseph Hospital of Orange	Orange	California	United States	92868
5	UC Davis Cancer Center; Oncology	Sacramento	California	United States	95817
6	Scripps Clinic	San Diego	California	United States	92037
7	University Of Colorado	Aurora	Colorado	United States	80045
8	National Jewish Health	Denver	Colorado	United States	80206
9	Rocky Mountain Cancer Center	Denver	Colorado	United States	80218
10	Georgetown University	Washington	District of Columbia	United States	20007
11	Washington Cancer Institute; Washington Hospital Center	Washington	District of Columbia	United States	20010
12	Illinois Cancer Care	Peoria	Illinois	United States	61615
13	Uni of Maryland Cancer Center	Baltimore	Maryland	United States	21201
14	University of Michigan	Ann Arbor	Michigan	United States	48109-0934
15	Brighton Center for Specialty Care	Brighton	Michigan	United States	48116
16	Barbara Ann Karmanos Cancer Institute	Detroit	Michigan	United States	48201
17	Minnesota Oncology Minneapolis	Minneapolis	Minnesota	United States	55404
18	Mayo Clinic - Rochester	Rochester	Minnesota	United States	55905
19	Mercy Clinic Cancer & Hematology	Springfield	Missouri	United States	65804
20	Nebraska Methodist Estabrook Cancer Center	Omaha	Nebraska	United States	68114
21	Northwell Health; Monter Cancer Center	Lake Success	New York	United States	11042
22	NYU Winthrop Hospital	Mineola	New York	United States	11501
23	NYU Langone Medical Center; Laura and Isaac Perlmutter Cancer Center	New York	New York	United States	10016
24	Columbia University Medical Center	New York	New York	United States	10032
25	Levine Cancer Institute	Charlotte	North Carolina	United States	28204
26	Lehigh Valley Health Network	Allentown	Pennsylvania	United States	18103
27	SCRI-Tennessee Oncology	Nashville	Tennessee	United States	37203
28	Texas Oncology - South Austin	Austin	Texas	United States	78745
29	UT Health East Texas HOPE Cancer Center	Tyler	Texas	United States	75701
30	Virginia Cancer Specialists, PC	Fairfax	Virginia	United States	22031
31	Northwest Cancer Specialists - Vancouver	Vancouver	Washington	United States	98684
32	St George Hospital; Cancer Care Centre	Kogarah	New South Wales	Australia	2217
33	Box Hill Hospital; Oncology	Box Hill	Victoria	Australia	3128
34	Peter MacCallum Cancer Center	North Melbourne	Victoria	Australia	3051
35	Kepler Universitätskliniken GmbH - Med Campus III; Abt. für Lungenkrankheiten	Linz		Austria	4020
36	Ordensklinikum Linz Elisabethinen	Linz		Austria	4020
37	SMZ - Baumgartner Hohe, Otto-Wagner-Spital; 2.Interne Lungenabteilung	Wien		Austria	1140
38	Krankenhaus Nord - Klinik Floridsdorf; Abteilung Pulmologie	Wien		Austria	1210
39	Cenantron - Centro Avancado de Tratamento Oncologico	Belo Horizonte	MG	Brazil	30130-090
40	Hospital Nossa Senhora da Conceicao	Porto Alegre	RS	Brazil	91350-200
41	Instituto do Cancer do Estado de Sao Paulo - ICESP	Sao Paulo	SP	Brazil	01246-000
42	Shanghai Chest Hospital	Shanghai		China	200000
43	The Second Affiliated Hospital of The Fourth Military Medical University (Tangdu Hospital)	Xi'an		China	710038
44	CHU Angers	Angers		France	49933
45	Centre Léon Bérard	Lyon		France	69008
46	Centre Hospitalier Saint Quentin	Saint Quentin		France	02321
47	Hopital d'Instruction des Armees de Begin	Saint-Mande		France	94160
48	CHU Strasbourg - Nouvel Hopital Civil	Strasbourg		France	67091
49	Hôpital d'Instruction des Armées de Sainte Anne; Service de Pneumologie	Toulon		France	83000
50	Universitätsklinikum Freiburg; Klinik für Innere Medizin I; Hämatologie/Onkologie	Freiburg		Germany	79106
51	Asklepios-Fachkliniken Muenchen-Gauting; Onkologie	Gauting		Germany	82131
52	Robert Bosch Krankenhaus; Pneumologie und pneumologische Onkologie	Gerlingen		Germany	70839
53	LungenClinic Großhansdorf GmbH	Großhansdorf		Germany	22927
54	Krankenhaus Martha-Maria Halle-Doelau gGmbH; Klinik fuer Innere Medizin II	Halle		Germany	06120
55	Pius-Hospital Oldenburg	Oldenburg		Germany	26121
56	Klinikum der Univer Regenburg; Klinik und Poliklinik fuer Inn	Regensburg		Germany	93053
57	Missionsärztliche Klinik, Gemeinnützige Gesellschaft mbH	Würzburg		Germany	97074
58	Semmelweis Egyetem X; Pulmonologiai Klinika	Budapest		Hungary	1083
59	Soroka Medical Center	Beer Sheva		Israel	8410101
60	Rambam Health Care Campus; Oncology	Haifa		Israel	3109601
61	Shaare Zedek Medical Center; Oncology Dept	Jerusalem		Israel	9103102
62	Meir Medical Center; Oncology	Kfar-Saba		Israel	4428164
63	Sourasky / Ichilov Hospital; Dept. of Oncology	Tel Aviv		Israel	6423906
64	Policlinico Universitario Campus Biomedico; Uoc Oncologia Medica	Roma	Lazio	Italy	00128
65	Irccs Istituto Nazionale Dei Tumori (Int);S.C. Medicina Oncologica 1	Milano	Lombardia	Italy	20133
66	Irccs Istituto Europeo Di Oncologia (IEO); Oncologia Medica	Milano	Lombardia	Italy	20141
67	A.O. Universitaria Pisana-Ospedale Cisanello; Dipartimento Cardio Toracico-Pneumologia Ii	Pisa	Toscana	Italy	56124
68	IOV - Istituto Oncologico Veneto - IRCCS; Oncologia Medica II	Padova	Veneto	Italy	35128
69	Aichi Cancer Center Hospital	Aichi		Japan	464-8681
70	National Hospital Organization Kyushu Cancer Center	Fukuoka		Japan	811-1395
71	Fukushima Medical University Hospital	Fukushima		Japan	960-1295
72	Hiroshima City Hiroshima Citizens Hospital	Hiroshima		Japan	730-8518
73	Hiroshima University Hospital	Hiroshima		Japan	734-8551
74	Kobe University Hospital	Hyogo		Japan	650-0017
75	Hyogo Medical University Hospital	Hyogo		Japan	663-8501
76	Kyoto University Hospital	Kyoto		Japan	606-8507
77	Sendai Kousei Hospital	Miyagi		Japan	980-0873
78	Okayama University Hospital	Okayama		Japan	700-8558
79	Kurashiki Central Hospital	Okayama		Japan	710-8602
80	Osaka City General Hospital	Osaka		Japan	534-0021
81	Osaka International Cancer Institute	Osaka		Japan	541-8567
82	Juntendo University Hospital	Tokyo		Japan	113-8431
83	Tokyo Metropolitan Cancer and Infectious diseases Center Komagome Hospital	Tokyo		Japan	113-8677
84	The Cancer Institute Hospital of JFCR	Tokyo		Japan	135-8550
85	Tokyo Medical University Hospital	Tokyo		Japan	160-0023
86	Kosin University Gospel Hospital	Busan		Korea, Republic of	49267
87	St. Vincent's Hospital	Gyeonggi-do		Korea, Republic of	16247
88	Seoul National University Hospital	Seoul		Korea, Republic of	03080
89	Asan Medical Center	Seoul		Korea, Republic of	05505
90	Gangnam Severance Hospital	Seoul		Korea, Republic of	06273
91	Korea University Guro Hospital	Seoul		Korea, Republic of	08308
92	Uniwersyteckie Centrum Kliniczne; Klinika Onkologii i Radioterapii	Gdańsk		Poland	80-214
93	Krakowski Szpital Specjalistyczny im. Jana Pawła II; Oddz. Klin. Chir. Klatki Piersiowej i Onkol.	Kraków		Poland	31-202
94	Narod.Inst.Onkol. im. M.Sklodowskiej - Curie-Panst.Inst.Bad; Klinika Nowot.Pluca i Klatki Piers	Warszawa		Poland	02-781
95	Main Military Clinical Hospital named after N.N. Burdenko	Moscow	Moskovskaja Oblast	Russian Federation	105229
96	FSBI Russian Oncology Research Center n.a. Blokhin of MOH RF	Moscow		Russian Federation	115478
97	S-Pb clinical scientific practical center of specialized kinds of medical care (oncological)	Saint-Petersburg		Russian Federation	197758
98	Scientific Research Oncology Institute named after N.N. Petrov; Oncology	St. Petersburg		Russian Federation	197758
99	University Hospital Medical Center Bezanijska kosa	Belgrade		Serbia	11080
100	University Clinic Golnik	Golnik		Slovenia	4204
101	Medical Oncology Centre of Rosebank; Oncology	Johannesburg		South Africa	2196
102	Eugene Marais Hospital; Oncology	Pretoria		South Africa
103	Corporacio Sanitaria Parc Tauli; Servicio de Oncologia	Sabadell	Barcelona	Spain	8208
104	Hospital Son Llatzer; Servicio de Oncologia	Palma de Mallorca	Islas Baleares	Spain	07198
105	Clinica Universitaria de Navarra; Servicio de Oncologia	Pamplona	Navarra	Spain	31008
106	Hospital de Basurto; Servicio de Oncologia	Bilbao	Vizcaya	Spain	48013
107	Hospital Universitari Vall d'Hebron; Oncology	Barcelona		Spain	08035
108	Clinica Universidad de Navarra Madrid; Servicio de Oncología	Madrid		Spain	28027
109	Hospital Clinico San Carlos; Servicio de Oncologia	Madrid		Spain	28040
110	Hospital Regional Universitario Carlos Haya; Servicio de Oncologia	Malaga		Spain	29011
111	Hospital Universitario Virgen Macarena; Servicio de Oncologia	Sevilla		Spain	41009
112	Hospital Clinico Universitario de Valencia; Servicio de Onco-hematologia	Valencia		Spain	46010
113	Hospital Universitario la Fe; Servicio de Oncologia	Valencia		Spain	46026
114	Lungmedicinska kliniken, Centrum för kirurgi, ortopedi och cancervård, Universitetssjukhuset	Linköping		Sweden	58185
115	Uni Hospital in Lund; Respiratory Medicine & Allergology	Lund		Sweden	22185
116	Karolinska Universitetssjukhuset, Solna; Kliniska prövningsenheten Z:4:01	Stockholm		Sweden	171 76
117	Uppsala University Hospital; Department of Oncology	Uppsala		Sweden	751 85
118	CHUV; Departement d'Oncologie	Lausanne		Switzerland	1011
119	UniversitätsSpital Zürich; Zentrum für Hämatologie und Onkologie, Klinik für Onkologie	Zürich		Switzerland	8091
120	Kaohsiung Chang Gung Memorial Hospital; Dept of Internal Medicine	Kaohsiung		Taiwan	83301
121	Taipei Veterans General Hospital; Chest Dept , Section of Thoracic Oncology	Taipei		Taiwan	112
122	Taichung Veterans General Hospital	Xitun Dist.		Taiwan	40705
123	Chulalongkorn Hospital; Medical Oncology	Bangkok		Thailand	10330
124	Maharaj Nakorn Chiang Mai Hospital; Department of Medicine	ChiangMai		Thailand	50200
125	Chemotherapy SI Dnipropetrovsk MA of MOHU	Dnipropetrovsk		Ukraine	49102
126	Queen Elizabeth Hospital	Birmingham		United Kingdom	B15 2TH
127	Leeds Teaching Hosp NHS Trust;St James's Institute of Onc	Leeds		United Kingdom	LS9 7TF
128	The Clatterbridge Cancer Centre NHS Foundation Trust	Liverpool		United Kingdom	L7 8YA
129	Barts and the London NHS Trust.	London		United Kingdom	EC1A 7BE