Carboplatin and Paclitaxel With or Without Bevacizumab in Treating Patients With Newly Diagnosed Ovarian Epithelial Cancer, Fallopian Tube Cancer, or Primary Peritoneal Cavity Cancer

Last updated: August 9, 2013
Sponsor: Medical Research Council
Overall Status: Completed

Phase

3

Condition

Malignant Ascites

Fallopian Tube Cancer

Digestive System Neoplasms

Treatment

N/A

Clinical Study ID

NCT00483782
MREC-ICON7
ISRCTN91273375
EUDRACT-2005-003929-22
MREC-06/MRE02/52
ROCHE-MREC-ICON7
CDR0000548777
EU-20730
  • Ages > 18
  • Female

Study Summary

RATIONALE: Drugs used in chemotherapy, such as carboplatin and paclitaxel, work in different ways to stop the growth of tumor cells, either by killing the cells or stopping them from dividing. Monoclonal antibodies, such as bevacizumab, can block tumor growth in different ways. Some block the ability of tumor cells to grow and spread. Others find tumor cells and help kill them or carry tumor-killing substances to them. Bevacizumab may also stop the growth of tumor cells by blocking blood flow to the tumor. It is not yet known whether giving carboplatin and paclitaxel together with bevacizumab is more effective than carboplatin and paclitaxel alone in treating patients with ovarian epithelial cancer, fallopian tube cancer, or primary peritoneal cavity cancer.

PURPOSE: This randomized phase III trial is studying carboplatin, paclitaxel, and bevacizumab to see how well they work compared with carboplatin and paclitaxel alone in treating patients with newly diagnosed ovarian epithelial cancer, fallopian tube cancer, or primary peritoneal cavity cancer.

Eligibility Criteria

Inclusion

DISEASE CHARACTERISTICS:

  • Histologically confirmed ovarian epithelial, fallopian tube, or primary peritoneal cavity cancer

  • Newly diagnosed disease

  • Meets 1 of the following staging criteria:

  • High-risk stage I or IIA disease (grade 3 disease or clear cell carcinoma only)

  • Stage IIB-IV disease (all grades and all histological types)

  • Must have undergone initial surgery (e.g., debulking cytoreductive surgery or a biopsy if the patient has stage IV disease) within the past 6 weeks

  • Patients with stage IV disease for which initial surgical debulking was not appropriate are eligible provided the following criteria are met:

  • Stage IV disease diagnosed by histology

  • No planned surgery prior to disease progression, including interval debulking surgery

  • Patients with prior early-stage ovarian epithelial or fallopian tube carcinoma treated with surgery alone are eligible at the time of diagnosis of abdominopelvic recurrence provided no further interval cytoreductive therapy is planned prior to disease progression

  • Synchronous primary endometrial carcinoma or a past history of primary endometrial carcinoma allowed provided the following criteria are met:

  • Disease ≤ stage IB

  • No more than superficial myometrial invasion

  • No lymphovascular invasion

  • Not poorly differentiated (i.e., no grade 3, papillary serous, or clear cell disease)

  • Measurable or nonmeasurable disease

  • No ovarian nonepithelial cancer, including malignant mixed Müllerian tumors

  • No borderline tumors (e.g., tumors of low malignant potential)

  • No history or clinical suspicion of brain metastases or spinal cord compression

  • CT scan or MRI of the brain is mandatory (within 4 weeks prior to randomization) in case of suspected brain metastases

  • Spinal MRI is mandatory (within 4 weeks prior to randomization) in case of suspected spinal cord compression

PATIENT CHARACTERISTICS:

  • ECOG performance status 0-2

  • Life expectancy > 12 weeks

  • ANC ≥ 1,500/mm^3

  • Platelet count ≥ 100,000/mm^3

  • Hemoglobin ≥ 9 g/dL (can be post-transfusion)

  • INR ≤ 1.5

  • APTT ≤ 1.5 times upper limit of normal (ULN)

  • Bilirubin ≤ 1.5 times ULN

  • ALT and AST ≤ 2.5 times ULN

  • Creatinine ≤ 2.0 mg/dL

  • Proteinuria ≤ 1+ by urine dipstick OR ≤ 1 g by 24-hour urine collection

  • Not pregnant or nursing

  • Negative pregnancy test

  • Fertile patients must use effective contraception during and for ≥ 6 weeks after completion of study therapy

  • No significant traumatic injury within the past 4 weeks

  • No cerebrovascular accident, transient ischemic attack, or subarachnoid hemorrhage within the past 6 months

  • No other malignancies within the past 5 years except for adequately treated carcinoma in situ of the cervix, and/or basal cell skin cancer, and/or early endometrial carcinoma

  • No pre-existing sensory or motor neuropathy ≥ grade 2

  • No history or evidence of CNS disease (e.g., uncontrolled seizures) by neurological examination unless adequately treated with standard medical therapy

  • No history or evidence of thrombotic or hemorrhagic disorders

  • No uncontrolled hypertension (i.e., blood pressure > 150/100 mm Hg despite antihypertensive therapy)

  • No known hypersensitivity to bevacizumab and its excipients, chemotherapy, or Cremophor EL

  • No nonhealing wound, ulcer, or bone fracture

  • Patients with granulating incisions healing by secondary intention with no evidence of facial dehiscence or infection are eligible but require three weekly wound examinations

  • No clinically significant cardiovascular disease, including any of the following:

  • Myocardial infarction or unstable angina within the past 6 months

  • New York Heart Association class II-IV congestive heart failure

  • Poorly controlled cardiac arrhythmia despite medication

  • Rate-controlled atrial fibrillation allowed

  • Peripheral vascular disease ≥ grade 3 (i.e., symptomatic and interfering with activities of daily living requiring repair or revision)

  • No evidence of other disease or condition, metabolic dysfunction, physical examination findings, or laboratory findings that would contraindicate the use of an investigational drug or put the patient at high-risk for treatment-related complications

PRIOR CONCURRENT THERAPY:

  • See Disease Characteristics

  • More than 4 weeks since other prior surgery or open biopsy

  • No prior systemic therapy for ovarian cancer (e.g., chemotherapy, monoclonal antibody therapy, tyrosine kinase inhibitor therapy, or hormonal therapy)

  • Prior adjuvant chemotherapy allowed for other malignancies (e.g., breast or colorectal carcinoma) if malignancy was diagnosed over 5 years ago with no evidence of subsequent recurrence

  • No prior mouse CA 125 antibody

  • No prior radiotherapy to the abdomen or pelvis

  • More than 10 days since prior and no concurrent chronic use of acetylsalicylic acid (> 325 mg/day)

  • Low-dose (< 325 mg/day) acetylsalicylic acid allowed

  • More than 10 days since prior and no concurrent full-dose oral or parenteral anticoagulants or thrombolytic agents for therapeutic purposes

  • Use of therapy for line patency allowed provided INR < 1.5

  • More than 30 days since prior and no other concurrent investigational agent or participation in another clinical trial

  • No other concurrent systemic antitumor agents

  • No concurrent surgery

  • No concurrent maintenance chemotherapy or intraperitoneal chemotherapy (including cytotoxic chemotherapy)

Study Design

Total Participants: 1520
Study Start date:
April 01, 2006
Estimated Completion Date:

Study Description

OBJECTIVES:

Primary

  • Compare the progression-free survival and overall survival of patients with newly diagnosed ovarian epithelial, fallopian tube, or primary peritoneal cavity cancer treated with carboplatin and paclitaxel with vs without bevacizumab.

Secondary

  • Compare the response rate in patients treated with these regimens.

  • Compare the duration of tumor response in patients treated with these regimens.

  • Compare the biological progression-free interval, as measured by increasing CA 125 levels, in patients treated with these regimens.

  • Compare the safety (e.g., adverse events, laboratory results, and performance status) of these regimens in these patients.

  • Compare the quality of life of patients treated with these regimens.

  • Compare the cost-effectiveness of these regimens in these patients.

OUTLINE: This is a multicenter, open-label, randomized, controlled study. Patients are stratified according to FIGO stage (stage I-III with residual disease ≤ 1 cm vs stage I-III with residual disease > 1 cm vs stage IV disease), intended time to start chemotherapy after surgery (≤ 4 weeks vs > 4 weeks), and participating center. Patients are randomized to 1 of 2 treatment arms.

  • Arm I (control): Patients receive paclitaxel IV over 3 hours followed by carboplatin IV over 30-60 minutes on day 1. Treatment repeats every 3 weeks for up to 6 courses in the absence of disease progression or unacceptable toxicity.

  • Arm II: Patients receive bevacizumab IV over 30-90 minutes followed by paclitaxel IV over 3 hours and carboplatin IV over 30-60 minutes on day 1. Treatment repeats every 3 weeks for up to 6 courses in the absence of disease progression or unacceptable toxicity. Patients then continue to receive bevacizumab alone every 3 weeks for 12 courses.

Quality of life is assessed at baseline, before every course, every 6 weeks for 1 year, every 3 months until disease progression or for up to 2 years, and then at 3 years. Health economic data is assessed periodically, including days of inpatient hospitalization visits, outpatient visits, and use of anticancer therapies.

After completion of study treatment, patients are followed every 3-6 months for 5 years and then annually thereafter.

Peer Reviewed and Funded or Endorsed by Cancer Research UK.

Connect with a study center

  • Cancer Therapy Centre at Liverpool Hospital

    Liverpool, New South Wales 2170
    Australia

    Site Not Available

  • Prince of Wales Private Hospital

    Randwick, New South Wales 2031
    Australia

    Site Not Available

  • Royal North Shore Hospital

    St. Leonards, New South Wales 2065
    Australia

    Site Not Available

  • Sydney Cancer Centre at Royal Prince Alfred Hospital

    Sydney, New South Wales 2050
    Australia

    Site Not Available

  • Newcastle Mater Misericordiae Hospital

    Waratah, New South Wales 2298
    Australia

    Site Not Available

  • Westmead Institute for Cancer Research at Westmead Hospital

    Wentworthville, New South Wales 2145
    Australia

    Site Not Available

  • Royal Brisbane and Women's Hospital

    Brisbane, Queensland 4029
    Australia

    Site Not Available

  • Mater Adult Hospital

    South Brisbane, Queensland 4101
    Australia

    Site Not Available

  • Royal Adelaide Hospital Cancer Centre

    Adelaide, South Australia 5000
    Australia

    Site Not Available

  • Royal Hobart Hospital

    Hobart, Tasmania 7000
    Australia

    Site Not Available

  • Box Hill Hospital

    Box Hill, Victoria 3128
    Australia

    Site Not Available

  • Royal Women's Hospital

    Carlton, Victoria 3053
    Australia

    Site Not Available

  • Mercy Hospital for Women

    East Melbourne, Victoria 3002
    Australia

    Site Not Available

  • Frankston Hospital

    Frankston, Victoria 3199
    Australia

    Site Not Available

  • Murray Valley Private Hospital and Cancer Treatment Centre

    Wodonga, Victoria 3690
    Australia

    Site Not Available

  • Sir Charles Gairdner Hospital - Perth

    Perth, Western Australia 6009
    Australia

    Site Not Available

  • Centre Paul Papin

    Angers, 49100
    France

    Site Not Available

  • Institut Sainte Catherine

    Avignon, 84082
    France

    Site Not Available

  • Clinique Tivoli

    Bordeaux, F-33000
    France

    Site Not Available

  • Institut Bergonie

    Bordeaux, 33076
    France

    Site Not Available

  • Polyclinique Bordeaux Nord Aquitaine

    Bordeaux, 33300
    France

    Site Not Available

  • Centre Regional Francois Baclesse

    Caen, 14076
    France

    Site Not Available

  • Centre Jean Perrin

    Clermont-Ferrand, 63011
    France

    Site Not Available

  • Hopital Louis Pasteur

    Colmar, 68024
    France

    Site Not Available

  • CHU de Grenoble - Hopital de la Tronche

    Grenoble, 38043
    France

    Site Not Available

  • Institut Prive de Cancerologie

    Grenoble, 38100
    France

    Site Not Available

  • Hopital Andre Mignot

    Le Chesnay, 78157
    France

    Site Not Available

  • Centre Jean Bernard

    Le Mans, 72000
    France

    Site Not Available

  • Centre Leon Berard

    Lyon, 69373
    France

    Site Not Available

  • Centre Regional de Lutte Contre le Cancer - Centre Val d'Aurelle

    Montpellier, 34298
    France

    Site Not Available

  • Centre D'Oncologie De Gentilly

    Nancy, 54100
    France

    Site Not Available

  • Centre Catherine de Sienne

    Nantes, 02
    France

    Site Not Available

  • Centre Regional Rene Gauducheau

    Nantes-Saint Herblain, 44805
    France

    Site Not Available

  • Hopital Cochin

    Paris, 75674
    France

    Site Not Available

  • Hopital Europeen Georges Pompidou

    Paris, 75015
    France

    Site Not Available

  • Hopital Tenon

    Paris, 75970
    France

    Site Not Available

  • Hotel Dieu de Paris

    Paris, 75181
    France

    Site Not Available

  • Institut Curie Hopital

    Paris, 75020
    France

    Site Not Available

  • Centre Hospitalier Lyon Sud

    Pierre Benite, 69495
    France

    Site Not Available

  • Centre Henri Becquerel

    Rouen, 76038
    France

    Site Not Available

  • Clinique Armoricaine De Radiologie

    Saint Brieuc, F-22015
    France

    Site Not Available

  • Centre Rene Huguenin

    Saint Cloud, 92211
    France

    Site Not Available

  • Hopital Universitaire Hautepierre

    Strasbourg, 67098
    France

    Site Not Available

  • Centre Hospitalier Universitaire Bretonneau de Tours

    Tours, 37044
    France

    Site Not Available

  • Centre Alexis Vautrin

    Vandoeuvre-les-Nancy, 54511
    France

    Site Not Available

  • Charite University Hospital - Campus Virchow Klinikum

    Berlin, D-13353
    Germany

    Site Not Available

  • Evang. Waldkrankenhaus Spandau

    Berlin, 13589
    Germany

    Site Not Available

  • Klinikum Bremen-Mitte

    Bremen, D-28205
    Germany

    Site Not Available

  • Praxis Dres. F.& G. Doering

    Bremen, D-28205
    Germany

    Site Not Available

  • Klinikum Chemnitz gGmbH

    Chemnitz, D-09116
    Germany

    Site Not Available

  • Universitatsklinikum Carl Gustav Carus

    Dresden, D-01307
    Germany

    Site Not Available

  • Kreiskrankenhaus

    Ebersberg, D-85560
    Germany

    Site Not Available

  • Elisabeth-Krankenhaus

    Essen, D-45138
    Germany

    Site Not Available

  • Universitaetsklinikum Essen

    Essen, D-45122
    Germany

    Site Not Available

  • Staedtische Kliniken Esslingen

    Esslingen, D-73730
    Germany

    Site Not Available

  • Klinikum der J.W. Goethe Universitaet

    Frankfurt, D-60590
    Germany

    Site Not Available

  • Onkologie Bethanien

    Frankfurt, D-60389
    Germany

    Site Not Available

  • Staedtische Kliniken Frankfurt am Main - Hoechst

    Frankfurt, D-65929
    Germany

    Site Not Available

  • Universitaetsfrauenklinik Freiburg

    Freiburg, D-79106
    Germany

    Site Not Available

  • Franziskus Hospital Hardenberg

    Georgsmarienhuette, D-49124
    Germany

    Site Not Available

  • Klinik Fuer Innere Medizin, Hematology/Oncology, Ernst Moritz Armdt Universitaet

    Greifswald, D-17487
    Germany

    Site Not Available

  • Universitaetsklinikum Halle

    Halle, D-06097
    Germany

    Site Not Available

  • Henriettenstiftung Frauenklinik

    Hannover, D-30559
    Germany

    Site Not Available

  • Medizinische Hochschule Hannover

    Hannover, D-30625
    Germany

    Site Not Available

  • St. Vincentius - Kliniken

    Karlsruhe, D-76137
    Germany

    Site Not Available

  • Klinikum Kassel

    Kassel, D-34125
    Germany

    Site Not Available

  • University Hospital Schleswig-Holstein - Kiel Campus

    Kiel, D-24105
    Germany

    Site Not Available

  • Kreiskrankenhaus Lahr

    Lahr, D-77993
    Germany

    Site Not Available

  • Kreiskrankenhaus Leonberg - Frauenklinik

    Leonberg, D-71229
    Germany

    Site Not Available

  • Asklepios Klinik Lich

    Lich, D-35423
    Germany

    Site Not Available

  • St. Vincenz Hospital Limburg

    Limburg, D-65549
    Germany

    Site Not Available

  • Universitaetsklinikum Schleswig-Holstein - Campus Luebeck

    Luebeck, D-23538
    Germany

    Site Not Available

  • Staedtisches Klinikum Lueneburg

    Lueneburg, D-21339
    Germany

    Site Not Available

  • Klinik St. Marienstift Magdeburg

    Magdeburg, D-39110
    Germany

    Site Not Available

  • St. Vincenz und Elisabeth Hospital

    Mainz, 55131
    Germany

    Site Not Available

  • Universitaetsklinikum Giessen und Marburg GmbH - Marburg

    Marburg, D-35043
    Germany

    Site Not Available

  • Klinikum Minden

    Minden, D-32423
    Germany

    Site Not Available

  • I. Frauenklinik und Hebammenschule der Ludwig-Maximillians Universitaet Muenchen

    Munich, D-80337
    Germany

    Site Not Available

  • Klinikum Rechts Der Isar - Technische Universitaet Muenchen

    Munich, D-81675
    Germany

    Site Not Available

  • Klinikum der Universitaet Muenchen - Grosshadern Campus

    Munich, D-81377
    Germany

    Site Not Available

  • Staedtisches Klinikum Neunkirchen gGmbH

    Neunkirchen, D-66538
    Germany

    Site Not Available

  • Lukaskrankenhaus Neuss

    Neuss, D-41464
    Germany

    Site Not Available

  • Klinikum Offenback GmbH

    Offenbach, D-63069
    Germany

    Site Not Available

  • Saint Vincenz-Krankenhaus Paderborn

    Paderborn, 33098
    Germany

    Site Not Available

  • Klinikum Dorothea Christiane Erxleben - Quedlingburg

    Quedlinburg, D-06484
    Germany

    Site Not Available

  • Krankenhaus St. Elisabeth - Ravensburg

    Ravensburg, D-88212
    Germany

    Site Not Available

  • St. Marien - Krankenhaus Siegen GMBH

    Siegen, D-57072
    Germany

    Site Not Available

  • Kliniken Landkreis Sigmaringen GMBH

    Sigmaringen, D-72488
    Germany

    Site Not Available

  • Marienhospital Stuttgart

    Stuttgart, D-70199
    Germany

    Site Not Available

  • Robert-Bosch-Krankenhaus

    Stuttgart, 70376
    Germany

    Site Not Available

  • Comprehensive Cancer Center Ulm at Universitaetsklinikum Ulm

    Ulm, D-89081
    Germany

    Site Not Available

  • Dr. Horst-Schmidt-Kliniken

    Wiesbaden, D-65199
    Germany

    Site Not Available

  • Marien-Hospital Witten

    Witten, 58452
    Germany

    Site Not Available

  • Klinikum der Stadt Wolfsburg

    Wolfsburg, D-38440
    Germany

    Site Not Available

  • Praxis Fuer Haemotologie Und Internistischer Onkologie

    Wuppertal, 42105
    Germany

    Site Not Available

  • Norwegian Radium Hospital

    Oslo, N-0310
    Norway

    Site Not Available

  • North Devon District Hospital

    Barnstaple, England EX31 4JB
    United Kingdom

    Site Not Available

  • Broomfield Hospital

    Broomfield, England CM1 7ET
    United Kingdom

    Site Not Available

  • Queen's Hospital

    Burton-upon-Trent, England DE13 0RB
    United Kingdom

    Site Not Available

  • Addenbrooke's Hospital

    Cambridge, England CB2 2QQ
    United Kingdom

    Site Not Available

  • Gloucestershire Oncology Centre at Cheltenham General Hospital

    Cheltenham, England GL53 7AN
    United Kingdom

    Site Not Available

  • Royal Devon and Exeter Hospital

    Exeter, England EX2 5DW
    United Kingdom

    Site Not Available

  • Queen Elizabeth Hospital

    Gateshead, England NE9 6SX
    United Kingdom

    Site Not Available

  • St. Luke's Cancer Centre at Royal Surrey County Hospital

    Guildford, England GU2 7XX
    United Kingdom

    Site Not Available

  • Princess Royal Hospital at Hull and East Yorkshire NHS Trust

    Hull, England HU8 9HE
    United Kingdom

    Site Not Available

  • Ipswich Hospital

    Ipswich, England IP4 5PD
    United Kingdom

    Site Not Available

  • Airedale General Hospital

    Keighley, England BD20 6TD
    United Kingdom

    Site Not Available

  • Leeds Cancer Centre at St. James's University Hospital

    Leeds, England LS9 7TF
    United Kingdom

    Site Not Available

  • Guy's Hospital

    London, England SE1 9RT
    United Kingdom

    Site Not Available

  • Hammersmith Hospital

    London, England W12 OHS
    United Kingdom

    Site Not Available

  • St. George's Hospital

    London, England SW17 0QT
    United Kingdom

    Site Not Available

  • University College of London Hospitals

    London, England NW1 2PG
    United Kingdom

    Site Not Available

  • Mid Kent Oncology Centre at Maidstone Hospital

    Maidstone, England ME16 9QQ
    United Kingdom

    Site Not Available

  • Christie Hospital

    Manchester, England M20 4BX
    United Kingdom

    Site Not Available

  • Queen Elizabeth The Queen Mother Hospital

    Margate, England CT9 4AN
    United Kingdom

    Site Not Available

  • Clatterbridge Centre for Oncology

    Merseyside, England CH63 4JY
    United Kingdom

    Site Not Available

  • James Cook University Hospital

    Middlesbrough, England TS4 3BW
    United Kingdom

    Site Not Available

  • Northern Centre for Cancer Treatment at Newcastle General Hospital

    Newcastle-Upon-Tyne, England NE4 6BE
    United Kingdom

    Site Not Available

  • Northampton General Hospital

    Northampton, England NN1 5BD
    United Kingdom

    Site Not Available

  • Mount Vernon Cancer Centre at Mount Vernon Hospital

    Northwood, England HA6 2RN
    United Kingdom

    Site Not Available

  • Norfolk and Norwich University Hospital

    Norwich, England NR4 7UY
    United Kingdom

    Site Not Available

  • Nottingham City Hospital

    Nottingham, England NG5 1PB
    United Kingdom

    Site Not Available

  • Churchill Hospital

    Oxford, England OX3 7LJ
    United Kingdom

    Site Not Available

  • Derriford Hospital

    Plymouth, England PL6 8DH
    United Kingdom

    Site Not Available

  • Dorset Cancer Centre

    Poole Dorset, England BH15 2JB
    United Kingdom

    Site Not Available

  • Portsmouth Oncology Centre at Saint Mary's Hospital

    Portsmouth Hants, England PO3 6AD
    United Kingdom

    Site Not Available

  • Cancer Research Centre at Weston Park Hospital

    Sheffield, England S1O 2SJ
    United Kingdom

    Site Not Available

  • Royal Shrewsbury Hospital

    Shrewsbury, England SY3 8XQ
    United Kingdom

    Site Not Available

  • Stoke Mandeville Hospital

    Shrewsbury, England SY3 8XQ
    United Kingdom

    Site Not Available

  • Wexham Park Hospital

    Slough, Berkshire, England SL2 4HL
    United Kingdom

    Site Not Available

  • Southampton General Hospital

    Southampton, England SO16 6YD
    United Kingdom

    Site Not Available

  • Staffordshire General Hospital

    Stafford, England ST16 3SA
    United Kingdom

    Site Not Available

  • Royal Marsden - Surrey

    Sutton, England SM2 5PT
    United Kingdom

    Site Not Available

  • Great Western Hospital

    Swindon, England SN3 6BB
    United Kingdom

    Site Not Available

  • Royal Cornwall Hospital

    Truro, Cornwall, England TR1 3LJ
    United Kingdom

    Site Not Available

  • Yeovil District Hospital

    Yeovil - Somerset, England BA21 4AT
    United Kingdom

    Site Not Available

  • Centre for Cancer Research and Cell Biology at Queen's University Belfast

    Belfast, Northern Ireland BT9 7AB
    United Kingdom

    Site Not Available

  • Aberdeen Royal Infirmary

    Aberdeen, Scotland AB25 2ZN
    United Kingdom

    Site Not Available

  • Ninewells Hospital

    Dundee, Scotland DD1 9SY
    United Kingdom

    Site Not Available

  • Edinburgh Cancer Centre at Western General Hospital

    Edinburgh, Scotland EH4 2XU
    United Kingdom

    Site Not Available

  • Ysbyty Gwynedd

    Bangor, Wales LL57 2PW
    United Kingdom

    Site Not Available

  • South West Wales Cancer Institute

    Swansea, Wales SA2 8QA
    United Kingdom

    Site Not Available

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