IMagyn050: A Study of Atezolizumab Versus Placebo in Combination With Paclitaxel, Carboplatin, and Bevacizumab in Participants With Newly-Diagnosed Stage III or Stage IV Ovarian, Fallopian Tube, or Primary Peritoneal Cancer

Sponsor

Hoffmann-La Roche (Industry)

Overall Status

Active, not recruiting

CT.gov ID

NCT03038100

Collaborator

GOG Foundation (Other), European Network of Gynaecological Oncological Trial Groups (ENGOT) (Other)

1,301

Enrollment

269

Locations

Arms

72.7

Anticipated Duration (Months)

4.8

Patients Per Site

0.1

Patients Per Site Per Month

Study Details

Study Description

Brief Summary

This is a Phase III, global, double-blind, 2-arm randomized study designed to compare the efficacy and safety of atezolizumab + paclitaxel + carboplatin + bevacizumab versus placebo + paclitaxel + carboplatin + bevacizumab. Study participants will have Stage 3 or 4 ovarian cancer (OC), fallopian tube cancer (FTC), or primary peritoneal cancer (PPC) with macroscopic residual disease postoperatively (i.e., after primary tumor reductive surgery) or who will undergo neoadjuvant therapy followed by interval surgery.

Condition or Disease	Intervention/Treatment	Phase
Ovarian Cancer Fallopian Tube Cancer Peritoneal Neoplasms	Drug: Paclitaxel Drug: Carboplatin Drug: Atezolizumab Drug: Bevacizumab Drug: Atezolizumab Placebo	Phase 3

Study Design

Study Type:

Interventional

Actual Enrollment :

1301 participants

Allocation:

Randomized

Intervention Model:

Parallel Assignment

Masking:

Double (Participant, Investigator)

Primary Purpose:

Treatment

Official Title:

A Phase III, Multicenter, Randomized, Study of Atezolizumab Versus Placebo Administered in Combination With Paclitaxel, Carboplatin, and Bevacizumab to Patients With Newly-Diagnosed Stage III or Stage IV Ovarian, Fallopian Tube, or Primary Peritoneal Cancer

Actual Study Start Date :

Mar 8, 2017

Anticipated Primary Completion Date :

Mar 31, 2023

Anticipated Study Completion Date :

Mar 31, 2023

Arms and Interventions

Arm	Intervention/Treatment
Experimental: Atezolizumab With Paclitaxel, Carboplatin and Bevacizumab Participants in the primary tumor-reductive surgery group will receive paclitaxel, carboplatin, atezolizumab intravenous (IV) infusion on Day 1 of each 21-day cycle for a total of 6 cycles, and bevacizumab IV infusion starting with Cycle 2 for a total of 5 cycles, followed by maintenance therapy bevacizumab with atezolizumab for a total of 22 cycles of atezolizumab and 21 cycles of bevacizumab. Participants in the neoadjuvant therapy group will receive paclitaxel, carboplatin and atezolizumab for 6 cycles and bevacizumab for 4 cycles. Interval surgery will occur between cycles 3 and 4. Each cycle is 21 days long. After 6 cycles, participants will start maintenance therapy of bevacizumab and atezolizumab for additional 16 cycles.	Drug: Paclitaxel Paclitaxel 175 milligrams per square meter (mg/m^2) IV infusion on Day 1 of each 21-day cycle Drug: Carboplatin Carboplatin at a dose to achieve a target area under the curve (AUC) of 6 milligrams per milliliterminute (mg/mLmin) on Day 1 of each 21-day cycle for a total of 6 cycles Drug: Atezolizumab Atezolizumab 1200 mg IV infusion on Day 1 of each 21-day cycle Drug: Bevacizumab Bevacizumab 15 milligrams per kilogram (mg/kg) IV infusion as per the schedule specified in respective arms
Placebo Comparator: Placebo With Paclitaxel, Carboplatin and Bevacizumab Participants in the primary tumor-reductive surgery group will receive paclitaxel, carboplatin, atezolizumab placebo IV infusion on Day 1 of each 21-day cycle for a total of 6 cycles, and bevacizumab IV infusion starting with Cycle 2 for a total of 5 cycles, followed by maintenance therapy bevacizumab with atezolizumab placebo for a total of 22 cycles of atezolizumab placebo and 21 cycles of bevacizumab. Participants in the neoadjuvant therapy group will receive paclitaxel, carboplatin and placebo for 6 cycles and bevacizumab for 4 cycles. Interval surgery will occur between cycles 3 and 4. Each cycle is 21 days long. After 6 cycles, participants will start maintenance therapy of bevacizumab and placebo for additional 16 cycles.	Drug: Paclitaxel Paclitaxel 175 milligrams per square meter (mg/m^2) IV infusion on Day 1 of each 21-day cycle Drug: Carboplatin Carboplatin at a dose to achieve a target area under the curve (AUC) of 6 milligrams per milliliterminute (mg/mLmin) on Day 1 of each 21-day cycle for a total of 6 cycles Drug: Bevacizumab Bevacizumab 15 milligrams per kilogram (mg/kg) IV infusion as per the schedule specified in respective arms Drug: Atezolizumab Placebo Placebo matching to atezolizumab on Day 1 of each 21-day cycle

Arm

Intervention/Treatment

Experimental: Atezolizumab With Paclitaxel, Carboplatin and Bevacizumab

Participants in the primary tumor-reductive surgery group will receive paclitaxel, carboplatin, atezolizumab intravenous (IV) infusion on Day 1 of each 21-day cycle for a total of 6 cycles, and bevacizumab IV infusion starting with Cycle 2 for a total of 5 cycles, followed by maintenance therapy bevacizumab with atezolizumab for a total of 22 cycles of atezolizumab and 21 cycles of bevacizumab. Participants in the neoadjuvant therapy group will receive paclitaxel, carboplatin and atezolizumab for 6 cycles and bevacizumab for 4 cycles. Interval surgery will occur between cycles 3 and 4. Each cycle is 21 days long. After 6 cycles, participants will start maintenance therapy of bevacizumab and atezolizumab for additional 16 cycles.

Drug: Paclitaxel

Paclitaxel 175 milligrams per square meter (mg/m^2) IV infusion on Day 1 of each 21-day cycle

Drug: Carboplatin

Carboplatin at a dose to achieve a target area under the curve (AUC) of 6 milligrams per milliliter*minute (mg/mL*min) on Day 1 of each 21-day cycle for a total of 6 cycles

Drug: Atezolizumab

Atezolizumab 1200 mg IV infusion on Day 1 of each 21-day cycle

Drug: Bevacizumab

Bevacizumab 15 milligrams per kilogram (mg/kg) IV infusion as per the schedule specified in respective arms

Placebo Comparator: Placebo With Paclitaxel, Carboplatin and Bevacizumab

Participants in the primary tumor-reductive surgery group will receive paclitaxel, carboplatin, atezolizumab placebo IV infusion on Day 1 of each 21-day cycle for a total of 6 cycles, and bevacizumab IV infusion starting with Cycle 2 for a total of 5 cycles, followed by maintenance therapy bevacizumab with atezolizumab placebo for a total of 22 cycles of atezolizumab placebo and 21 cycles of bevacizumab. Participants in the neoadjuvant therapy group will receive paclitaxel, carboplatin and placebo for 6 cycles and bevacizumab for 4 cycles. Interval surgery will occur between cycles 3 and 4. Each cycle is 21 days long. After 6 cycles, participants will start maintenance therapy of bevacizumab and placebo for additional 16 cycles.

Drug: Paclitaxel

Paclitaxel 175 milligrams per square meter (mg/m^2) IV infusion on Day 1 of each 21-day cycle

Drug: Carboplatin

Carboplatin at a dose to achieve a target area under the curve (AUC) of 6 milligrams per milliliter*minute (mg/mL*min) on Day 1 of each 21-day cycle for a total of 6 cycles

Drug: Bevacizumab

Bevacizumab 15 milligrams per kilogram (mg/kg) IV infusion as per the schedule specified in respective arms

Drug: Atezolizumab Placebo

Placebo matching to atezolizumab on Day 1 of each 21-day cycle

Outcome Measures

Primary Outcome Measures

Progression-Free Survival (PFS) Assessed by Investigator as Per Response Evaluation Criteria in Solid Tumors Version 1.1 (RECIST v1.1) - Intent-to-Treat (ITT) Population [From randomization until disease progression or death from any cause (up to approximately 55 months)]
PFS Assessed by Investigator as Per RECIST v1.1 - Programmed Death-Ligand 1 (PD-L1)-Positive Subpopulation [From randomization until disease progression or death from any cause (up to approximately 55 months)]
Overall Survival - ITT Population [From randomization up to death from any cause (up to approximately 60 months)]
Overall Survival - PD-L1-Positive Subpopulation [From randomization up to death from any cause (up to approximately 60 months)]

Secondary Outcome Measures

Percentage of Participants With Objective Response (OR) Assessed by Investigator as Per RECIST v1.1 - Primary Tumor-Reductive Surgery (Having Residual Measurable Disease) Group [From randomization until disease progression or death from any cause (up to approximately 55 months)]
Duration of Response Assessed by Investigator as Per RECIST v1.1 - Primary Tumor-Reductive Surgery (Having Residual Measurable Disease) Group [From the date of first occurrence of a confirmed complete or partial response until disease progression or death from any cause (up to approximately 55 months)]
Percentage of Participants who Achieve a Clinically-Meaningful Improvement in Patient-Reported Abdominal Pain or Bloating - Neoadjuvant Group [From randomization to the end of treatment/discontinuation (up to approximately 70 weeks), and during follow-up period (up to approximately 60 months)]
Clinically-meaningful improvement in patient-reported abdominal pain or bloating will be assessed using European Organisation for Research and Treatment of Cancer Quality-of-Life Questionnaires Ovarian Cancer Module 28 (EORTC QLQ-OV28) Abdominal/Gastrointestinal Symptom Scale (Items 31 and 31).
Percentage of Participants who Achieve a Clinically-Meaningful Improvement in Patient-Reported Function and Health Related Quality of Life (HRQoL) - Neoadjuvant Group [From randomization to the end of treatment/discontinuation (up to approximately 70 weeks), and during follow-up period (up to approximately 60 months)]
Clinically-meaningful improvement in patient-reported function and HRQoL will be assessed using European Organisation for Research and Treatment of Cancer Quality-of-Life Questionnaires Core 30 (EORTC QLQ-C30).
Percentage of Participants who Achieve a Clinically-Meaningful Improvement, Remain Stable or Deterioration in Patient-Reported Function and HRQoL - Primary Tumor-Reductive Surgery Group [From randomization to the end of treatment/discontinuation (up to approximately 66 weeks), and during follow-up period (up to approximately 60 months)]
Clinically-meaningful improvement in patient-reported function and HRQoL will be assessed using EORTC QLQ-C30.
Percentage of Participants With Adverse Events [From randomization up to 90 days after last dose of study treatment or until initiation of new anti-cancer therapy (up to approximately 82 weeks)]
Maximum Serum Concentration (Cmax) of Atezolizumab [Pre-infusion (0 hour [hr]), 30 minutes (min) after end of infusion (EOI) on Cycle 1 Day 1(Cycle length=21 days) up to approximately 82 weeks (detailed timeframe is provided in outcome measure description)]
Primary surgery group: Pre-infusion (0 hr), 30 min after EOI (infusion duration=60 min) on Day 1 of Cycles 1 and 3; pre-infusion (0 hr) on Day 1 of Cycles 2, 4, 8, 16 (each cycle=21 days); end of treatment/discontinuation visit (up to approximately 66 weeks); >/=90 days after last dose (up to approximately 78 weeks) Neoadjuvant therapy group: Pre-infusion (0 hr), 30 min after EOI (infusion duration=60 min) on Day 1 of Cycles 1 and 3; pre-infusion (0 hr) on Day 1 of Cycles 2, 4 (each cycle=21 days); end of treatment/discontinuation visit (up to approximately 70 weeks); >/= 90 days after last dose (up to approximately 82 weeks)
Minimum Serum Concentration (Cmin) of Atezolizumab [Pre-infusion (0 hr), 30 min after EOI on Cycle 1 Day 1(Cycle length=21 days) up to approximately 82 weeks (detailed timeframe is provided in outcome measure description)]
Primary surgery group: Pre-infusion (0 hr), 30 min after EOI (infusion duration=60 min) on Day 1 of Cycles 1 and 3; pre-infusion (0 hr) on Day 1 of Cycles 2, 4, 8, 16 (each cycle=21 days); end of treatment/discontinuation visit (up to approximately 66 weeks); >/= 90 days after last dose (up to approximately 78 weeks) Neoadjuvant therapy group: Pre-infusion (0 hr), 30 min after EOI (infusion duration=60 min) on Day 1 of Cycles 1 and 3; pre-infusion (0 hr) on Day 1 of Cycles 2, 4 (each cycle=21 days); end of treatment/discontinuation visit (up to approximately 70 weeks); >/= 90 days after last dose (up to approximately 82 weeks)
Percentage of Participants With Anti-Drug Antibodies (ADAs) to Atezolizumab [Pre-infusion (0 hr) on Cycle 1 Day 1(Cycle length=21 days) up to approximately 82 weeks (detailed timeframe is provided in outcome measure description)]
Primary surgery group: Pre-infusion (0 hr) on Day 1 of Cycles 1, 2, 3, 4, 8, 16 (each cycle=21 days); end of treatment/discontinuation visit (up to approximately 66 weeks); >/= 90 days after last dose (up to approximately 78 weeks) Neoadjuvant therapy group: Pre-infusion (0 hr) on Day 1 of Cycles 1, 2, 3, 4 (each cycle=21 days); end of treatment/discontinuation visit (up to approximately 70 weeks); >/= 90 days after last dose (up to approximately 82 weeks)

Eligibility Criteria

Criteria

Ages Eligible for Study:

18 Years and Older

Sexes Eligible for Study:

Female

Accepts Healthy Volunteers:

Inclusion Criteria:

Participants receiving a histologic diagnosis of epithelial ovarian cancer (EOC), peritoneal primary carcinoma, or fallopian tube cancer
Eastern Cooperative Oncology Group (ECOG) performance status of 0, 1, or 2
Life expectancy greater than (>) 12 weeks
For participants who receive therapeutic anticoagulation: stable anticoagulant regimen
Availability of a representative formalin-fixed, paraffin-embedded (FFPE) tumor specimen in paraffin blocks (preferred) or at least 20 unstained slides (for detailed tissue requirements at screening)

Exclusion Criteria:

Received a current diagnosis of borderline epithelial ovarian tumor (formerly tumors of low malignant potential)
Have recurrent invasive epithelial ovarian, fallopian tube, or primary peritoneal cancer that was treated only with surgery (example [e.g.], participants with Stage IA or Stage IB epithelial ovarian or fallopian tube cancers)
Have non-epithelial ovarian tumors (e.g., germ cell tumors, sex cord stromal tumors)
Received prior radiotherapy to any portion of the abdominal cavity or pelvis
Received prior chemotherapy for any abdominal or pelvic tumor that include neoadjuvant chemotherapy (NACT) for ovarian, primary peritoneal or fallopian tube cancer
Received any biological and/or targeted therapy (including but not limited to vaccines, antibodies, tyrosine kinase inhibitors) or hormonal therapy for management and/or treatment of epithelial ovarian or peritoneal primary cancer
Have synchronous primary endometrial cancer
Have a prior history of primary endometrial cancer, except: Stage IA cancer; superficial myometrial invasion, without lymphovascular invasion; grade less than (<) 3 or poorly differentiated subtypes, and this includes papillary serous, clear cell or other International Federation of Gynecological Oncologists (FIGO) Grade 3 lesions
With the exception of non-melanoma skin cancer and other specific malignancies as noted above, other invasive malignancies with any evidence of other cancers present within the last 5 years or previous cancer treatment that contraindicates this protocol therapy
Have a known hypersensitivity or allergy to biopharmaceutical agents produced in Chinese hamster ovary cells or any component of the atezolizumab and/or bevacizumab formulations
Undergo major surgical procedure within 28 days prior to first bevacizumab dose, or anticipation of the need for a major surgical procedure during the course of the study except participants who receive NACT and will need interval surgery. This may include but is not limited to laparotomy.
Have prior allogeneic bone marrow transplantation or solid organ transplant
Have any other diseases, metabolic dysfunction, physical examination finding, or clinical laboratory finding giving reasonable suspicion of a disease or condition that contraindicates the use of an investigational drug or that may affect the interpretation of the results
Have any approved or investigational anti-cancer therapy, including chemotherapy or hormonal therapy, with exceptions: Hormone-replacement therapy or oral contraceptives
Are administered treatment with any other investigational agent or participation in another clinical study with anti-cancer therapeutic intent
Have core biopsy or other minor surgical procedures within 7 days prior to the first dose of bevacizumab
Have known sensitivity to any component of bevacizumab
Have known sensitivity to any component of paclitaxel
Current treatment with anti-viral therapy for hepatitis B virus (HBV)
History of leptomeningeal disease

Contacts and Locations

Locations

	Site	City	State	Country	Postal Code
1	St. Joseph'S Hospital & Medical Center	Phoenix	Arizona	United States	85013
2	Arizona Oncology Associates, PC - HAL; Arizona Oncology Associates, PC - HAL	Scottsdale	Arizona	United States	85258
3	Arizona Oncology - HOPE Wilmot	Tucson	Arizona	United States	85710
4	Moores Cancer Center at UC San Diego Health	La Jolla	California	United States	92093
5	LAC + USC Medical Center	Los Angeles	California	United States	90033
6	UCLA - School of Medicine	Los Angeles	California	United States	90095
7	Kaiser Permanente - Oakland	Oakland	California	United States	94611
8	The Center for Cancer Prevention and Treatment at St.Joseph Hospital of Orange	Orange	California	United States	92868
9	UC Irvine Medical Center	Orange	California	United States	92868
10	Stanford University	Palo Alto	California	United States	94305
11	Kaiser Permanente - Sacramento	Roseville	California	United States	95661
12	Southern California Kaiser Permanente	San Diego	California	United States	92108
13	California Pacific Medical Center Research Institute	San Francisco	California	United States	94115
14	K. Permanente - San Fransisco	San Francisco	California	United States	94115
15	University of California San Francisco Cancer Center	San Francisco	California	United States	94158
16	Kaiser Permanente - Santa Clara	Santa Clara	California	United States	95051
17	Olive View/Ucla Medical Center	Sylmar	California	United States	91342
18	Kaiser Permanente - Vallejo	Vallejo	California	United States	94589
19	Kaiser Permanente - Walnut Creek	Walnut Creek	California	United States	94596
20	University of Colorado Hospital - Anschutz Cancer Pavilion	Aurora	Colorado	United States	80045
21	Danbury Hospital	Danbury	Connecticut	United States	06810
22	Eastern Connecticut Hematology and Oncology Associates; (ECHO)	Norwich	Connecticut	United States	06360
23	Sylvester Comprehensive Cent.	Miami	Florida	United States	33136
24	Miami Cancer Institute of Baptist Health, Inc.	Miami	Florida	United States	33176
25	Women's Cancer Associates	Saint Petersburg	Florida	United States	33701
26	Sarasota Memorial Health Care System; Cancer Research Program	Sarasota	Florida	United States	34239
27	Northside Hospital	Atlanta	Georgia	United States	30342
28	Northeast Georgia Medical Center; Oncology Research Dept-5C	Gainesville	Georgia	United States	30501
29	Women's Cancer Center	Honolulu	Hawaii	United States	96826
30	Rush University Medical Center	Chicago	Illinois	United States	60612
31	Univ of Chicago	Chicago	Illinois	United States	60637
32	Sudarshan K. Sharma, MD, Ltd.	Hinsdale	Illinois	United States	60521
33	Parkview Research Center	Fort Wayne	Indiana	United States	46845
34	St.Vincent Health System; Gynecologic Oncology	Indianapolis	Indiana	United States	46260
35	University of Iowa Hospital & Clinic; Division of Hematology/Oncology	Iowa City	Iowa	United States	52242
36	University of Kentucky; Gynecologic Oncology	Lexington	Kansas	United States	40536
37	St. Elizabeth Edgewood; Cancer Care Center" for Account St. Elizabeth Edgewood	Edgewood	Kentucky	United States	41017
38	Woman's Hospital	Baton Rouge	Louisiana	United States	70817
39	Maine Medical Partners Women's Health; Gyn-Oncology	Scarborough	Maine	United States	04074
40	Greater Baltimore Medical Center	Baltimore	Maryland	United States	21204
41	Sinai Hospital of Baltimore	Baltimore	Maryland	United States	21215
42	Weinberg CA Inst Franklin Sq	Baltimore	Maryland	United States	21237
43	Frederick Health Hospital	Frederick	Maryland	United States	21701
44	Massachusetts General Hospital	Boston	Massachusetts	United States	02114
45	Baystate Medical Center	Springfield	Massachusetts	United States	01199
46	St. Joseph Mercy Hospital	Ann Arbor	Michigan	United States	48106
47	Karmanos Cancer Institute	Detroit	Michigan	United States	48201
48	Munson Medical Center	Traverse City	Michigan	United States	49684
49	Sanford Health Bemidji	Bemidji	Minnesota	United States	56601
50	University of Minnesota	Minneapolis	Minnesota	United States	55455
51	Metro-Minnesota Community Oncology Research Consortium	Saint Louis Park	Minnesota	United States	55416
52	Minnesota Oncology Hematology Woodbury	Woodbury	Minnesota	United States	55125
53	St. Dominic-Jackson Memorial Hospital	Jackson	Mississippi	United States	39216
54	Washington University School of Medicine; Dept of Medicine/Div of Medical Oncology	Saint Louis	Missouri	United States	63108
55	Billings Clinic; Cancer Center	Billings	Montana	United States	59101
56	Community Cancer Care	Missoula	Montana	United States	59804
57	Nebraska Methodist Hospital	Omaha	Nebraska	United States	68114
58	University of Nebraska Medical Center	Omaha	Nebraska	United States	68198-0600
59	Women's Cancer Center	Las Vegas	Nevada	United States	89169
60	Center of Hope	Reno	Nevada	United States	89511
61	Dartmouth Hitchcock Medical Center	Lebanon	New Hampshire	United States	03756
62	MSK @Basking Ridge	Basking Ridge	New Jersey	United States	07920
63	Cooper Health System; MD Anderson Cancer Center	Camden	New Jersey	United States	08103
64	John Theurer Cancer Center at Hackensack University Medical Center	Hackensack	New Jersey	United States	07601
65	Memorial Sloan Kettering Cancer Center; MSK Monmouth	Middletown	New Jersey	United States	07748
66	Jersey Shore Med Ctr; OB/GYN	Neptune	New Jersey	United States	07753
67	Holy Name Hospital	Teaneck	New Jersey	United States	07666
68	Southwest Gynecologic Oncology Associates, Inc.	Albuquerque	New Mexico	United States	87106
69	University of New Mexico Cancer Center	Albuquerque	New Mexico	United States	87131
70	Womens Cancer Care Association	Albany	New York	United States	12208
71	New York Presbyterian Queens	Flushing	New York	United States	11355
72	Northwell Health; Monter Cancer Center	Lake Success	New York	United States	11042
73	New York Univ Medical Center; Obstetrics & Gynecolog	New York	New York	United States	10016
74	Mount Sinai Downtown Chelsea Centre	New York	New York	United States	10029-6574
75	Icahn School of Medicine at Mount Sinai	New York	New York	United States	10029
76	Memorial Sloan Kettering Cancer Center	New York	New York	United States	10065
77	Memorial Sloan-Kettering CC	Uniondale	New York	United States	11553
78	Levine Cancer Institute	Charlotte	North Carolina	United States	28204
79	Novant Health Presbyterain Medical Center	Charlotte	North Carolina	United States	28204
80	Duke Medical Center	Durham	North Carolina	United States	27710
81	Forsythe Memorial Hospital Inc., dba Novant Health Oncology Specialists	Winston-Salem	North Carolina	United States	27103
82	Wake Forest Baptist Medical Center	Winston-Salem	North Carolina	United States	27157
83	Sanford Health Bismarck	Bismarck	North Dakota	United States	58506
84	Sanford Roger Maris Cancer Center	Fargo	North Dakota	United States	58102
85	University of Cincinnati	Cincinnati	Ohio	United States	45203-0542
86	Cleveland Clinic	Cleveland	Ohio	United States	44106
87	Univ Hospitals of Cleveland	Cleveland	Ohio	United States	44106
88	Fairview Hospital; Cleveland Clinic Cancer Center	Cleveland	Ohio	United States	44111
89	Columbus NCORP	Columbus	Ohio	United States	43125
90	Ohio State University, Arthur James Cancer Hospital	Columbus	Ohio	United States	43210
91	Kettering Medical Center	Kettering	Ohio	United States	45429
92	University of Oklahoma; Stephenson Oklahoma Canc Ctr	Oklahoma City	Oklahoma	United States	73104
93	Oklahoma Cancer Specialists and Research Institute	Tulsa	Oklahoma	United States	74146
94	Oncology Associates of Oregon, P.C.; Willamette Valley Cancer Institute	Springfield	Oregon	United States	97477
95	Northwest Cancer Specialists, P.C.	Tigard	Oregon	United States	97223
96	University of Pennsylvania Health System; Cancer Center	Philadelphia	Pennsylvania	United States	19104
97	Thomas Jefferson University	Philadelphia	Pennsylvania	United States	19107
98	Temple University Hospital	Philadelphia	Pennsylvania	United States	19140
99	Magee-Woman's Hospital	Pittsburgh	Pennsylvania	United States	15213
100	Western Pennsylvania Hospital	Pittsburgh	Pennsylvania	United States	15224
101	Abington Mem Hosp-Abington; Rose. Can Ctr,Gyn Onc Ins	Willow Grove	Pennsylvania	United States	19090
102	WellSpan Gynecologic Oncology	York	Pennsylvania	United States	17403
103	Women & Infants Hospital	Providence	Rhode Island	United States	02905
104	Bon Secours - St. Francis Hospital	Greenville	South Carolina	United States	29607
105	Monument Health Rapid City Hospital, Inc.	Rapid City	South Dakota	United States	57701
106	Sanford Health System	Sioux Falls	South Dakota	United States	57105
107	Dell Seton Medical Center at UT-Seton Infusion Center; Research Department	Austin	Texas	United States	78701
108	Texas Oncology Cancer Center	Austin	Texas	United States	78731
109	Texas Oncology	Bedford	Texas	United States	76022
110	UT Southwestern Medical Center at Dallas; Department of Pathology	Dallas	Texas	United States	75390-9016
111	Texas Oncology, P.A. - Fort Worth	Fort Worth	Texas	United States	76104
112	The University of Texas MD Anderson Cancer Center	Houston	Texas	United States	77030-4009
113	Houston Methodist Hospital	Houston	Texas	United States	77030
114	Rocky Mountain Cancer Centers, LLP	Irving	Texas	United States	75063
115	Texas Oncology San Antonio Medical Center	San Antonio	Texas	United States	78240
116	Texas Oncology, P.A.	The Woodlands	Texas	United States	77060
117	Texas Oncology, P.A. - Tyler; Tyler Cancer Center	Tyler	Texas	United States	75702
118	Dixie Medical Center	Saint George	Utah	United States	84790
119	Huntsman Cancer Institute; Oncology	Salt Lake City	Utah	United States	84112
120	University of Virginia	Charlottesville	Virginia	United States	22906
121	Virginia Cancer Specialists, PC	Fairfax	Virginia	United States	22031
122	Virginia Oncology Associates	Norfolk	Virginia	United States	23502
123	Henrico Doctors' Hospital - Forest	Richmond	Virginia	United States	23229
124	Shenandoah Oncology Associates	Winchester	Virginia	United States	22601
125	University of Washington Seattle Cancer Care Alliance	Seattle	Washington	United States	98195
126	University of Wisconsin Hospital and Clinics	Madison	Wisconsin	United States	53792
127	DN Greenwald Center; DN Greenwald Center	Mukwonago	Wisconsin	United States	53149
128	Aspirus Regional Cancer Center	Wausau	Wisconsin	United States	54401
129	The Royal North Shore Hospital; Northern Sydney Cancer Centre	St Leonards	New South Wales	Australia	2065
130	Cabrini Hospital; Cabrini Foundation	Malvern	Victoria	Australia	3144
131	Peter MacCallum Cancer Center	North Melbourne	Victoria	Australia	3051
132	Krankenhaus Der Barmherzigen Brüder Graz; Gynäkologie	Graz		Austria	8020
133	Tiroler Landeskrankenanstalten Ges.M.B.H.; Abt. Für Gynäkologie	Innsbruck		Austria	6020
134	Landeskrankenhaus Salzburg; Gynäkologie Und Onkologie	Salzburg		Austria	5020
135	Medizinische Universität Wien; Univ.Klinik für Frauenheilkunde - Klinik für Gynäkologie	Wien		Austria	1090
136	AZ Maria Middelares	Gent		Belgium	9000
137	UZ Gent	Gent		Belgium	9000
138	UZ Leuven Gasthuisberg	Leuven		Belgium	3000
139	Sint Augustinus Wilrijk	Wilrijk		Belgium	2610
140	Instituto Nacional de Cancer - INCa; Oncologia	Rio de Janeiro	RJ	Brazil	20560-120
141	Clinica de Pesquisa e Centro de Estudos em Oncologia Ginecologica e Mamaria Ltda	Sao Paulo	SP	Brazil	01317-001
142	Peking Union Medical College Hospital	Beijing City		China	100032
143	Beijing Cancer Hospital	Beijing		China	100142
144	West China Second University Hospital	Chengdu City		China	610066
145	Chongqing Cancer Hospital	Chongqing		China	400030
146	Sun Yet-sen University Cancer Center	Guangzhou		China	510060
147	Women's hospital school of medicine Zhejiang University	Hangzhou		China	310006
148	Harbin Medical University Cancer Hospital	Harbin		China	150081
149	Jiangsu Province Hospital (the First Affiliated Hospital With Nanjing Medical University)	Nanjing City		China	210029
150	Zhongda Hospital Affiliated to Southeast University	Nanjing		China	210009
151	Guangxi Cancer Hospital of Guangxi Medical University	Nanning		China	530021
152	Fudan University Shanghai Cancer Center	Shanghai City		China	200120
153	Tianjin Central Hospital of Gynecology Obstetrics.	Tianjin City		China	300052
154	Zhejiang Cancer Hospital	Zhejiang		China	310022
155	Henan Cancer Hospital	Zhengzhou		China	450008
156	Fakultni nemocnice Olomouc; Onkologicka klinika	Olomouc		Czechia	779 00
157	University Hospital Ostrava; Fakultní nemocnice	Ostrava-Poruba		Czechia	70852
158	Gynekologicko-porodnicka klinika	Prague		Czechia	120 00
159	Onkologicka klinika UK 2.LF a FN v Motole	Praha 5		Czechia	15006
160	Rigshospitalet; Onkologisk Klinik	København Ø		Denmark	2100
161	Kuopio University Hospital	Kuopio		Finland	70211
162	Tampereen yliopistollinen sairaala	Tampere		Finland	33520
163	Turku Uni Central Hospital; Gynaecology Dept	Turku		Finland	20521
164	Clinique Sainte Catherine; Hopital De Semaine	Avignon		France	84918
165	Ctr Jean Bernard Clin V. Hugo; Service d'Oncologie Méd	Le Mans		France	72000
166	Centre Léon Bérard; Centre régional; le cancer Rhône-Alpes	Lyon		France	69373
167	l'Hôpital privé du Confluent SAS	Nantes		France	44202
168	Hopital Des Diaconesses; Oncologie	Paris		France	75571
169	Centre Hospitalier Lyon Sud	Pierre Benite		France	69495
170	Centre Rene Huguenin; CONSULT SPECIALISEES	St Cloud		France	92210
171	Institut Gustave Roussy	Villejuif		France	94805
172	Campus Virchow-Klinikum Charité; Centrum 17; Klinik für Gynäkologie	Berlin		Germany	13353
173	Universitätsklinikum Dresden; Klinik für Frauenheilkunde und Geburtshilfe	Dresden		Germany	01307
174	Universitätsklinikum Essen; Zentrum Für Frauenheilkunde	Essen		Germany	45122
175	Kliniken Essen Mitte Evang. Huyssens Stiftung/Knappschaft GmbH	Essen		Germany	45136
176	Universitätsklinikum Freiburg; Frauenklinik	Freiburg		Germany	79106
177	Universitätsklinikum Greifswald; Klinik für Frauenheilkunde und Brustzentrum	Greifswald		Germany	17475
178	Universitätsklinikum Hamburg-Eppendorf (UKE); Klinik und Poliklinik für Gynäkologie	Hamburg		Germany	20246
179	Medizinische Hochschule Hannover, Klinik für Frauenheilkunde und Geburtshilfe	Hannover		Germany	30625
180	Universitätsklinikum Heidelberg; Nationales Centrum für Tumorerkrankungen (NCT)	Heidelberg		Germany	69120
181	Klinikum Konstanz, Frauenklinik	Konstanz		Germany	78464
182	Universitätsklinikum Schleswig-Holstein / Campus Lübeck; Klinik für Frauenheilkunde und Geburtshilfe	Lübeck		Germany	23538
183	Universitätsmedizin Mainz; Klinik u. Poliklinik f. Geburtshilfe u. Frauenheilkunde	Mainz		Germany	55131
184	Klinikum der Universität München; Campus Großhadern; Klinik und Poliklinik für Frauenheilkunde	Muenchen		Germany	81377
185	Klinikum rechts der Isar der TU München; Klinik und Poliklinik für Frauenheilkunde	München		Germany	81675
186	Klinikum Südstadt	Rostock		Germany	18059
187	Universitätsklinikum Ulm Am Michelsberg; Frauenklinik	Ulm		Germany	89075
188	HELIOS Dr. Horst Schmidt Kliniken Wiesbaden; Klinik für Gynäkologie und gynäkologische Onkologie	Wiesbaden		Germany	65199
189	Alexandras Hospital; Dept. of Clin. Therapeutics, Athens Uni School of Medicine	Athens		Greece	115 28
190	Uni Hospital of Ioannina; Oncology Dept.	Ioannina		Greece	455 00
191	Agioi Anargyroi Cancer Hospital; 2Nd Oncology Dept.	Kifisia		Greece	145 64
192	University Hospital of Patras Medical Oncology	Patras		Greece	265 04
193	EUROMEDICA General Clinic of Thessaloniki; Medical Oncology Dept - Oncomedicare	Thessaloniki		Greece	546 45
194	Hillel Yaffe MC; Gynaecology	Hadera		Israel	3810101
195	Shaare Zedek Medical Center; Oncology Dept	Jerusalem		Israel	9103102
196	Meir Medical Center; Obstetrics and Gynecology	Kfar Saba		Israel	4428164
197	Chaim Sheba Medical Center; Obstetrics and Gynecology	Ramat Gan		Israel	5262100
198	Kaplan Medical Center; Oncology Inst.	Rehovot		Israel	7610001
199	Azienda Ospedaliera Universitaria Federico II	Napoli	Campania	Italy	80131
200	ISTITUTO NAZIONALE TUMORI IRCCS FONDAZIONE G. PASCALE; Dipartimento Uro-Ginecologico	Napoli	Campania	Italy	80131
201	Policlinico S.Orsola-Malpighi; Istituto Oncologia R. Addarii	Bologna	Emilia-Romagna	Italy	40138
202	Ospedale Degli Infermi - Faenza; Oncologia Medica	Faenza	Emilia-Romagna	Italy	48018
203	IRST Istituto Scientifico Romagnolo Per Lo Studio E Cura Dei Tumori, Sede Meldola; Oncologia Medica	Meldola	Emilia-Romagna	Italy	47014
204	Arcispedale Santa Maria Nuova; Oncologia	Reggio Emilia	Emilia-Romagna	Italy	42100
205	Policlinico A. Gemelli e C.I.C.; Area Salute della Donna	Roma	Lazio	Italy	00168
206	A.O.Spedali Civili; Ostetricia e Ginecologia	Brescia	Lombardia	Italy	25123
207	IRCCS S. Raffaele; Ginecologia Oncologica	Milano	Lombardia	Italy	20132
208	Istituto Nazionale dei Tumori; Divisione Oncologia Chirurgica e Ginecologica	Milano	Lombardia	Italy	20133
209	Irccs Istituto Europeo Di Oncologia (IEO); Oncologia Medica	Milano	Lombardia	Italy	20141
210	Asst Grande Ospedale Metropolitano Niguarda; Dipartimento Di Ematologia Ed Oncologia	Milano	Lombardia	Italy	20162
211	A.O. San Gerardo; Ginecologia	Monza	Lombardia	Italy	20052
212	A. O. Città della Salute e della Scienza; Unità di Oncologia Ginecologica	Torino	Piemonte	Italy	10126
213	Ospedale Mauriziano Umberto 1; Ginecologia - Oncologia	Torino	Piemonte	Italy	10128
214	Ospedale Antonio Perrino; Oncologia Medica	Brindisi	Puglia	Italy	72100
215	Ospedale Silvestrini; Oncologia ed Ematologia	Perugia	Umbria	Italy	06123
216	IRCCS Istituto Oncologico Veneto (IOV); Oncologia Medica Seconda	Padova	Veneto	Italy	35128
217	Nagoya University Hospital	Aichi		Japan	466-8560
218	National Hospital Organization Shikoku Cancer Center	Ehime		Japan	791-0280
219	Ehime University Hospital	Ehime		Japan	791-0295
220	NHO Kyushu Cancer Center	Fukuoka		Japan	811-1395
221	Kyushu University Hospital	Fukuoka		Japan	812-8582
222	Kurume University Hospital	Fukuoka		Japan	830-0011
223	Kure Medical Center	Hiroshima		Japan	737-0023
224	National Hospital Organization Hokkaido Cancer Center	Hokkaido		Japan	003-0804
225	Hyogo Cancer Center	Hyogo		Japan	673-0021
226	Iwate Medical University Hospital	Iwate		Japan	028-3695
227	Kagoshima University Hospital	Kagoshima		Japan	890-8520
228	Yokohama City University Hospital	Kanagawa		Japan	236-0004
229	Kyoto University Hospital	Kyoto		Japan	606-8507
230	Mie University Hospital	Mie		Japan	514-8507
231	Tohoku University Hospital	Miyagi		Japan	980-8574
232	Niigata University Medical & Dental Hospital	Niigata		Japan	951-8520
233	Osaka International Cancer Institute	Osaka		Japan	541-8567
234	Shizuoka Cancer Center	Shizuoka		Japan	411-8777
235	The Jikei University Hospital	Tokyo		Japan	105-8471
236	The University of Tokyo Hospital	Tokyo		Japan	113-8655
237	The Cancer Institute Hospital of JFCR	Tokyo		Japan	135-8550
238	Keio University Hospital	Tokyo		Japan	160-8582
239	National Cancer Center	Goyang-si		Korea, Republic of	10408
240	Seoul National University Hospital	Seoul		Korea, Republic of	03080
241	Asan Medical Center	Seoul		Korea, Republic of	05505
242	Samsung Medical Center	Seoul		Korea, Republic of	06351
243	Oslo Universitetssykehus HF; Radiumhospitalet	Oslo		Norway	0310
244	St. Olavs Hospital	Trondheim		Norway	7006
245	Centrum Onkologii Instytut im. M.Sklodowskiej-Curie; Klinika Ginekologii Onkologicznej	Krakow		Poland	31-115
246	Szpital Kliniczny im. Heliodora Święcickiego UM w Poznaniu; Oddział Ginekologii Onkologicznej	Poznań		Poland	60-569
247	Icu Spsk - 2	Szczecin		Poland	70-111
248	Narodowy Instytut Onkologii im. M.Sklodowskiej-Curie;Klinika Ginekologii Onkologicznej	Warszawa		Poland	02-781
249	Moscow City Oncology Hospital #62	Moscovskaya Oblast	Moskovskaja Oblast	Russian Federation	143423
250	Clinical Oncology Dispensary of Ministry of Health of Tatarstan	Kazan		Russian Federation	420029
251	N.N.Burdenko Main Military Clinical Hospital; Oncology Dept	Moscow		Russian Federation	105229
252	St. Petersburg Oncology & Gynecology; City Clinical Oncology Dispensary	Saint-Petersburg		Russian Federation	197022
253	Corporacio Sanitaria Parc Tauli; Servicio de Oncologia	Sabadell	Barcelona	Spain	8208
254	Hospital Universitario Son Espases	Palma de Mallorca	Islas Baleares	Spain	07010
255	Fundacion Hospital de Alcorcon; Servicio de Oncologia	Alcorcon	Madrid	Spain	28922
256	Hospital Universitari Dexeus - Grupo Quironsalud; Servicio de Oncologia Medica	Barcelona		Spain	08028
257	Hospital General Universitario Gregorio Marañon; Servicio de Oncologia	Madrid		Spain	28007
258	Centro Integral Oncologico Clara Campal; Servicio de Oncología	Madrid		Spain	28050
259	Hospital Clinico Universitario Virgen de la Victoria; Servicio de Oncologia	Malaga		Spain	29010
260	Hospital Universitario la Fe; Servicio de Oncologia	Valencia		Spain	46026
261	Hospital Universitario Miguel Servet; Servicio Oncologia	Zaragoza		Spain	50009
262	Uni Hospital Linkoeping; Dept. of Oncology	Linköping		Sweden	58185
263	Karolinska Hospital; Oncology - Radiumhemmet	Stockholm		Sweden	171 76
264	Baskent University Adana Dr. Turgut Noyan Practice and Research Hospital; Medical Oncology	Adana		Turkey	01230
265	Ankara University Medical Faculty; Medikal Onkoloji	Ankara		Turkey	06100
266	Baskent Universitesi Ankara Hastanesi; Tıbbi Onkoloji Bölümü	Ankara		Turkey	06490
267	Koc University Medical Faculty; Department of Gynecology & Obstetrics	Istanbul		Turkey	34010
268	Istanbul Uni Istanbul Medical Faculty	Istanbul		Turkey	34093
269	Istanbul University Cerrahpasa Medical Faculty; Obstetrics and Gynecology	Istanbul		Turkey	34098