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Trial details imported from ClinicalTrials.gov
For full trial details, please see the original record at
https://clinicaltrials.gov/study/NCT03924895
Registration number
NCT03924895
Ethics application status
Date submitted
22/04/2019
Date registered
23/04/2019
Titles & IDs
Public title
Perioperative Pembrolizumab (MK-3475) Plus Cystectomy or Perioperative Pembrolizumab Plus Enfortumab Vedotin Plus Cystectomy Versus Cystectomy Alone in Participants Who Are Cisplatin-ineligible or Decline Cisplatin With Muscle-invasive Bladder Cancer (MK-3475-905/KEYNOTE-905/EV-303)
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Scientific title
A Randomized Phase 3 Study Evaluating Cystectomy With Perioperative Pembrolizumab and Cystectomy With Perioperative Enfortumab Vedotin and Pembrolizumab Versus Cystectomy Alone in Participants Who Are Cisplatin-Ineligible or Decline Cisplatin With Muscle-Invasive Bladder Cancer (KEYNOTE-905/EV-303)
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Secondary ID [1]
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MK-3475-905
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Secondary ID [2]
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3475-905
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Universal Trial Number (UTN)
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Trial acronym
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Linked study record
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Health condition
Health condition(s) or problem(s) studied:
Urinary Bladder Cancer, Muscle-invasive
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Condition category
Condition code
Cancer
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Bladder - transitional cell cancer
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Cancer
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Other cancer types
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Intervention/exposure
Study type
Interventional
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Description of intervention(s) / exposure
Treatment: Drugs - Pembrolizumab
Treatment: Surgery - Surgery (radical cystectomy (RC) plus Pelvic Lymph Node Dissection [PLND])
Treatment: Drugs - Enfortumab Vedotin
Experimental: Arm A: Pembrolizumab + Surgery - Participants receive 3 preoperative cycles of pembrolizumab, followed by standard of care surgery, followed by 14 cycles of postoperative pembrolizumab. Each cycle is 21 days.
Active comparator: Arm B: Surgery alone - Participants receive standard of care surgery alone.
Experimental: Arm C: Enfortumab Vedotin + Pembrolizumab + Surgery - Participants receive 3 preoperative cycles of enfortumab vedotin + pembrolizumab, followed by standard of care surgery, followed by 6 cycles of postoperative enfortumab vedotin + pembrolizumab, followed by 8 cycles of pembrolizumab alone. Each cycle is 21 days.
Treatment: Drugs: Pembrolizumab
Pembrolizumab 200 mg by intravenous (IV) infusion, given on Day 1 of each 21-day cycle.
Treatment: Surgery: Surgery (radical cystectomy (RC) plus Pelvic Lymph Node Dissection [PLND])
Surgical RC+PLND will be done in accordance with the American Urological Association (AUA)/American Society of Clinical Oncology (ASCO)/American Society for Radiation Oncology (ASTRO)/Society of Urologic Oncology (SUO) guidelines.
Treatment: Drugs: Enfortumab Vedotin
Enfortumab vedotin 1.25 mg/kg by intravenous (IV) infusion, given on Days 1 and 8 of each 21-day cycle.
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Intervention code [1]
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Treatment: Drugs
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Intervention code [2]
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Treatment: Surgery
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Comparator / control treatment
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Control group
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Outcomes
Primary outcome [1]
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Event-Free Survival (EFS) between Arm C and Arm B
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Assessment method [1]
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EFS is defined as the time from randomization to the first occurrence of any of the following events: progression of disease that precludes RC surgery or failure to undergo RC surgery in participants with residual disease, gross residual disease left behind at the time of surgery, local or distant recurrence as assessed by imaging and/or biopsy, or death due to any cause.
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Timepoint [1]
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Up to approximately 7.7 years
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Secondary outcome [1]
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EFS between Arm A and Arm B
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Assessment method [1]
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EFS is defined as the time from randomization to the first occurrence of any of the following events: progression of disease that precludes RC surgery or failure to undergo RC surgery in participants with residual disease, gross residual disease left behind at the time of surgery, local or distant recurrence as assessed by imaging and/or biopsy, or death due to any cause.
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Timepoint [1]
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Up to approximately 7.7 years
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Secondary outcome [2]
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Overall Survival (OS) between Arm C and Arm B
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Assessment method [2]
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OS is defined as the time from randomization to death due to any cause.
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Timepoint [2]
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Up to approximately 8.4 years
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Secondary outcome [3]
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OS between Arm A and Arm B
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Assessment method [3]
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OS is defined as the time from randomization to death due to any cause.
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Timepoint [3]
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Up to approximately 8.4 years
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Secondary outcome [4]
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Pathologic Complete Response (pCR) Rate between Arm C and Arm B
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Assessment method [4]
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Pathologic complete response rate is defined as the percentage of participants having pCR. pCR is defined as absence of viable tumor (pT0N0) in examined tissue from RC and PLND, as determined centrally.
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Timepoint [4]
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Up to approximately 5.7 years
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Secondary outcome [5]
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pCR Rate between Arm A and Arm B
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Assessment method [5]
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Pathologic complete response rate is defined as the percentage of participants having pCR. pCR is defined as absence of viable tumor (pT0N0) in examined tissue from RC and PLND, as determined centrally.
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Timepoint [5]
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Up to approximately 5.7 years
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Secondary outcome [6]
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Disease-Free Survival (DFS)
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Assessment method [6]
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DFS is defined as the time from first post-surgery baseline scan until:
* local or distant recurrence as assessed by imaging and/or biopsy
* Death due to any cause
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Timepoint [6]
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Up to approximately 7.7 years
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Secondary outcome [7]
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Pathologic Downstaging (pDS) Rate between Arm A and Arm B
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Assessment method [7]
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Pathologic downstaging rate is defined as the percentage of participants having pDS. pDS is defined as participants with a tumor classification of \<pT2 (includes pT0, pTis, pTa, pT1) and N0 in examined tissue from RC and PLND.
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Timepoint [7]
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Up to approximately 5.7 years
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Secondary outcome [8]
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pDS Rate between Arm C and Arm B
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Assessment method [8]
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Pathologic downstaging rate is defined as the percentage of participants having pDS. pDS is defined as participants with a tumor classification of \<pT2 (includes pT0, pTis, pTa, pT1) and N0 in examined tissue from RC and PLND.
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Timepoint [8]
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Up to approximately 5.7 years
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Secondary outcome [9]
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Number of Participants Experiencing Adverse Events (AEs)
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Assessment method [9]
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An AE is defined as any unfavorable and unintended sign, symptom, or disease (new or worsening) temporally associated with the use of study therapy, regardless of whether or not a causal relationship with the study therapy can be determined.
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Timepoint [9]
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Up to approximately 8.4 years
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Secondary outcome [10]
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Number of Participants Discontinuing Study Drug Due to Adverse Events (AEs)
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Assessment method [10]
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An AE is defined as any unfavorable and unintended sign, symptom, or disease (new or worsening) temporally associated with the use of study therapy, regardless of whether or not a causal relationship with the study therapy can be determined.
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Timepoint [10]
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Up to approximately 1 year
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Secondary outcome [11]
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Number of Participants Experiencing Perioperative Complications
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Assessment method [11]
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The number of participants who experience perioperative complications will be presented.
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Timepoint [11]
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Up to approximately 1 year
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Eligibility
Key inclusion criteria
* Have a histologically confirmed diagnosis of urothelial carcinoma/muscle-invasive bladder cancer [MIBC] (cT2-T4aN0M0 or T1-T4aN1M0) with predominant (=50%) urothelial histology to be confirmed by Blinded Independent Central Review (BICR) (central pathology and/or imaging).
* Clinically nonmetastatic bladder cancer determined by imaging
* Eligible for radical cystectomy (RC) + pelvic lymph node dissection (PLND), and agreement to undergo curative intent standard RC + PLND (including prostatectomy if applicable)
* Ineligible for treatment with cisplatin, as defined by meeting at least one of the following criteria OR be eligible for treatment with cisplatin but decline treatment with cisplatin-based chemotherapy:
* Impaired renal function with measured or calculated creatinine clearance (CrCl) 30 to 59 mL/min (calculated by Cockcroft-Gault method, Modification of Diet of Renal Disease [MDRD] equations, or measured by 24-hour urine collection)
* Eastern Cooperative Oncology Group (ECOG) Performance Status 2
* Common Terminology Criteria for Adverse Events (CTCAE) v.4 Grade =2 audiometric hearing loss
* New York Heart Association (NYHA) Class III heart failure
* Transurethral resection (TUR) of a bladder tumor that is submitted for central pathology assessment and adequate to determine urothelial histology and PD-L1 expression assessment
* ECOG performance status of 0, 1, or 2
* Adequate organ function
* A male participant is eligible to participate if he agrees to use contraception and refrain from donating sperm during the intervention period and for at least 180 days after the last dose of enfortumab vedotin. If the male participants are receiving pembrolizumab only or undergoing surgery only, there are no contraception requirements
* A female participant is eligible to participate if she is not pregnant, not breastfeeding, and at least 1 of the following conditions applies: Not a (woman of childbearing potential) WOCBP or a WOCBP who agrees to use a highly effective contraceptive method or be abstinent from heterosexual intercourse (as their preferred and usual lifestyle) during the intervention period and for at least 120 days after the last dose of pembrolizumab and at least 180 days after the last dose of enfortumab vedotin; whichever comes last. A female participant must agree not to donate eggs during this period as well
* A WOCBP must have a negative highly sensitive pregnancy test within 24 hours before the first dose of study intervention
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Minimum age
18
Years
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Maximum age
No limit
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Sex
Both males and females
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Can healthy volunteers participate?
No
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Key exclusion criteria
* Known additional nonurothelial malignancy that is progressing or has required active anticancer treatment =3 years of study randomization, with certain exceptions
* Has = N2 or metastatic disease (M1) as identified by imaging
* Received any prior systemic treatment, chemoradiation, and/or radiation therapy for for muscle-invasive bladder cancer (MIBC) or non-muscle invasive bladder cancer (NMIBC)
* Received prior therapy with an anti-programmed cell death protein 1 (PD-1), anti-programmed death-ligand 1 (PD-L1), or anti-programmed cell death 1 ligand 2 (PD-L2), or with an agent directed to another stimulatory or coinhibitory T-cell receptor
* Received prior systemic anticancer therapy including investigational agents within 3 years prior to randomization
* Received any prior radiotherapy to the bladder
* Received a partial cystectomy of the bladder to remove any non-muscle-invasive bladder cancer (NMIBC) or MIBC
* Received a live or live-attenuated vaccine within 30 days before the first dose of study intervention
* Current participation in or participation in a study of an investigational agent or use of an investigational device within 4 weeks prior to the first dose of study intervention
* Ongoing sensory or motor neuropathy Grade 2 or higher
* Diagnosis of immunodeficiency or receipt of chronic systemic steroid therapy or any other form of immunosuppressive therapy within 7 days prior the first dose of study drug. Physiologic replacement doses of corticosteroids are permitted for participants with adrenal insufficiency.
* Hypersensitivity to monoclonal antibodies (including pembrolizumab) and/or any of their excipients
* Severe hypersensitivity (= Grade 3) to enfortumab vedotin or any excipient contained in the drug formulation of enfortumab vedotin
* Active keratitis or corneal ulcerations. Participants with superficial punctate keratitis are allowed if the disorder is being adequately treated in the opinion of the investigator
* Active autoimmune disease that has required systemic therapy in past 2 years (i.e., with use of disease modifying agents, corticosteroids or immunosuppressive drugs). Replacement therapy (e.g., thyroxine, insulin, or physiologic corticosteroid replacement therapy for adrenal or pituitary insufficiency) is not considered a form of systemic therapy and is allowed
* Has uncontrolled diabetes
* History of (noninfectious) pneumonitis that required steroids, or current pneumonitis
* Active infection requiring systemic therapy
* Has had an allogeneic tissue/solid organ transplant
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Study design
Purpose of the study
Treatment
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Allocation to intervention
Randomised controlled trial
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Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
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Methods used to generate the sequence in which subjects will be randomised (sequence generation)
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Masking / blinding
Open (masking not used)
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Who is / are masked / blinded?
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Intervention assignment
Parallel
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Other design features
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Phase
Phase 3
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Type of endpoint/s
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Statistical methods / analysis
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Recruitment
Recruitment status
Active, not recruiting
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Data analysis
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Reason for early stopping/withdrawal
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Other reasons
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Date of first participant enrolment
Anticipated
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Actual
24/07/2019
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Date of last participant enrolment
Anticipated
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Actual
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Date of last data collection
Anticipated
15/12/2027
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Actual
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Sample size
Target
857
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Accrual to date
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Final
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Recruitment in Australia
Recruitment state(s)
NSW,QLD,VIC
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Recruitment hospital [1]
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Western Sydney Local Health District ( Site 1259) - Blacktown
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Macquarie University ( Site 1251) - Macquarie Park
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Cairns Base Hospital ( Site 1257) - Cairns
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Mater Misericordiae Ltd ( Site 1258) - South Brisbane
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Eastern Health ( Site 1255) - Box Hill
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Monash Health ( Site 1260) - Clayton
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2148 - Blacktown
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2109 - Macquarie Park
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4870 - Cairns
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4101 - South Brisbane
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3128 - Box Hill
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3168 - Clayton
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Tel Aviv
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0
Israel
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0
Zerifin
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Italy
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0
Abruzzo
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0
Italy
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Lombardia
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Italy
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State/province [86]
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Piemonte
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Italy
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Veneto
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Italy
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Arezzo
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Italy
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Catania
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Italy
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State/province [90]
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Milano
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Italy
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Napoli
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Italy
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Pavia
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Italy
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Terni
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Japan
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State/province [94]
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Chiba
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Japan
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Ibaraki
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Japan
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Kanagawa
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Japan
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Miyagi
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Japan
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State/province [98]
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Nagano
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Japan
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Nara
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Japan
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Osaka
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Japan
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Saitama
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Japan
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State/province [102]
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Shizuoka
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Country [103]
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Japan
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State/province [103]
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Tokyo
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0
Japan
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State/province [104]
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Toyama
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Japan
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State/province [105]
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Gifu
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Japan
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State/province [106]
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Kagoshima
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Japan
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Nagasaki
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Korea, Republic of
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State/province [108]
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Kyonggi-do
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Korea, Republic of
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Seoul
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0
Korea, Republic of
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State/province [110]
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0
Taegu-Kwangyokshi
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Country [111]
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0
Malaysia
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State/province [111]
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0
Kuala Lumpur
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Country [112]
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Malaysia
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State/province [112]
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0
Pulau Pinang
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Malaysia
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Sarawak
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Mexico
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State/province [114]
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Nuevo Leon
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Mexico
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Aguascalientes
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Mexico
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State/province [116]
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Chihuahua
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Mexico
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Ciudad de Mexico
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Mexico
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Metepec
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Mexico
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Mexico City
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Philippines
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Iloilo
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Philippines
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National Capital Region
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0
Poland
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Dolnoslaskie
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Poland
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Kujawsko-pomorskie
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Poland
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Malopolskie
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Poland
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Mazowieckie
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Poland
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Podlaskie
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Poland
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Pomorskie
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Poland
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Slaskie
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Poland
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Wielkopolskie
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Russian Federation
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Baskortostan, Respublika
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Russian Federation
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Ivanovskaya Oblast
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Russian Federation
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Krasnoyarskiy Kray
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Russian Federation
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Kurskaya Oblast
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Russian Federation
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Moskva
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Russian Federation
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Murmanskaya Oblast
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Russian Federation
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Nizhegorodskaya Oblast
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Russian Federation
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Omskaya Oblast
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Russian Federation
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Sankt-Peterburg
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Russian Federation
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Saratovskaya Oblast
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Russian Federation
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Sverdlovskaya Oblast
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Russian Federation
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Tyumenskaya Oblast
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Singapore
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Central Singapore
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South Africa
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Gauteng
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South Africa
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Western Cape
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Spain
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Barcelona
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Spain
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Cataluna
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Spain
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Extremadura
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Spain
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Gerona
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Spain
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Madrid, Comunidad De
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Spain
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Valenciana, Comunitat
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Spain
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Madrid
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Spain
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Sevilla
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Sweden
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Jonkopings Lan
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Sweden
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Stockholms Lan
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Sweden
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Uppsala Lan
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Sweden
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Vasterbottens Lan
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Sweden
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Vastra Gotalands Lan
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Thailand
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Krung Thep Maha Nakhon
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Country [159]
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Thailand
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Chiang Mai
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Country [160]
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Thailand
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Khon Kaen
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Turkey
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Ankara
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Turkey
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Istanbul
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Turkey
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Konya
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Turkey
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Sakarya
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Turkey
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Trabzon
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Ukraine
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Cherkaska Oblast
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Ukraine
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Dnipropetrovska Oblast
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Ukraine
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Kharkivska Oblast
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Ukraine
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Khersonska Oblast
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Ukraine
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Kyivska Oblast
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Ukraine
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Lvivska Oblast
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Ukraine
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Zhytomyrska Oblast
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Ukraine
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Kyiv
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United Kingdom
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England
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United Kingdom
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Hertfordshire
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United Kingdom
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London, City Of
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United Kingdom
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Midlothian
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United Kingdom
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Truro
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United Kingdom
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Walsall
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United Kingdom
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Wirral
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Funding & Sponsors
Primary sponsor type
Commercial sector/industry
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Name
Merck Sharp & Dohme LLC
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Address
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Other collaborator category [1]
0
0
Commercial sector/industry
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Name [1]
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Seagen Inc.
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Address [1]
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0
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0
0
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Other collaborator category [2]
0
0
Commercial sector/industry
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Name [2]
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Astellas Pharma Global Development, Inc.
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Address [2]
0
0
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0
0
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Ethics approval
Ethics application status
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Summary
Brief summary
This is a study of perioperative pembrolizumab or enfortumab vedotin in combination with pembrolizumab in participants who are cisplatin-ineligible or decline cisplatin with muscle-invasive bladder cancer (MIBC). The primary hypothesis is that perioperative pembrolizumab plus radical cystectomy (RC) plus pelvic lymph node dissection (PLND) and perioperative enfortumab vedotin in combination with pembrolizumab plus RC+PLND will achieve superior event-free survival (EFS) compared with RC+PLND alone. With Amendment 5, outcome measures for programmed cell death ligand 1 (PD-L1) combined positive score (CPS) were removed. With Amendment 8, the primary outcome measure of pathologic complete response (pCR) rates was changed to a secondary outcome measure.
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Trial website
https://clinicaltrials.gov/study/NCT03924895
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Trial related presentations / publications
Galsky MD, Hoimes CJ, Necchi A, Shore N, Witjes JA, Steinberg G, Bedke J, Nishiyama H, Fang X, Kataria R, Sbar E, Jia X, Siefker-Radtke A. Perioperative pembrolizumab therapy in muscle-invasive bladder cancer: Phase III KEYNOTE-866 and KEYNOTE-905/EV-303. Future Oncol. 2021 Aug;17(24):3137-3150. doi: 10.2217/fon-2021-0273. Epub 2021 May 19.
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Public notes
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Contacts
Principal investigator
Name
0
0
Medical Director
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Address
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0
Merck Sharp & Dohme LLC
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0
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0
0
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0
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0
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Contact person for public queries
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Contact person for scientific queries
Data sharing statement
Will individual participant data (IPD) for this trial be available (including data dictionaries)?
Yes
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What data in particular will be shared?
http://engagezone.msd.com/doc/ProcedureAccessClinicalTrialData.pdf
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When will data be available (start and end dates)?
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Available to whom?
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Available for what types of analyses?
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How or where can data be obtained?
IPD available at link: http://engagezone.msd.com/ds_documentation.php
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What supporting documents are/will be available?
No Supporting Document Provided
Results publications and other study-related documents
No documents have been uploaded by study researchers.
Results not provided in
https://clinicaltrials.gov/study/NCT03924895