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Spots Global Cancer Trial Database for A Study of Trastuzumab Emtansine (T-DM1) Plus Pertuzumab/Pertuzumab Placebo Versus Trastuzumab [Herceptin] Plus a Taxane in Participants With Metastatic Breast Cancer (MARIANNE)

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Trial Identification

Brief Title: A Study of Trastuzumab Emtansine (T-DM1) Plus Pertuzumab/Pertuzumab Placebo Versus Trastuzumab [Herceptin] Plus a Taxane in Participants With Metastatic Breast Cancer (MARIANNE)

Official Title: A Randomized, 3 Arm, Multicenter, Phase III Study to Evaluate the Efficacy and the Safety of T-DM1 Combined With Pertuzumab or T-DM1 Combined With Pertuzumab-Placebo (Blinded for Pertuzumab), Versus the Combination of Trastuzumab Plus Taxane, as First Line Treatment in HER2 Positive Progressive or Recurrent Locally Advanced or Metastatic Breast Cancer

Study ID: NCT01120184

Conditions

Breast Cancer

Study Description

Brief Summary: This randomized, 3-arm, multicenter, phase III study will evaluate the efficacy and safety of trastuzumab emtansine (T-DM1) with pertuzumab or trastuzumab emtansine (T-DM1) with pertuzumab-placebo (blinded for pertuzumab), versus the combination of trastuzumab (Herceptin) plus taxane (docetaxel or paclitaxel) in participants with HER2-positive progressive or recurrent locally advanced or previously untreated metastatic breast cancer. Participants will be randomized to 1 of 3 treatment arms (Arms A, B or C). Arm A will be open-label, whereas Arms B and C will be blinded.

Detailed Description:

Keywords

Eligibility

Minimum Age: 18 Years

Eligible Ages: ADULT, OLDER_ADULT

Sex: ALL

Healthy Volunteers: No

Locations

Uni of Arkansas For Medical Sciences; Arkansas Cancer Research Center, Little Rock, Arkansas, United States

Scripps Cancer Center, La Jolla, California, United States

University of California; Moores Cancer Center, La Jolla, California, United States

Clnc L Trials & Rsch Assoc-Inc, Montebello, California, United States

Southern California Kaiser Permanente, San Diego, California, United States

Breastlink Medical Group Inc, Santa Ana, California, United States

Kaiser Permanente; Oncology Clinical Trials, Vallejo, California, United States

Smilow Cancer Hospital at Yale New Haven, New Haven, Connecticut, United States

Innovative Medical Research of South Florida, Aventura, Florida, United States

Northwest Oncology/ Hematology Assoc., Coral Springs, Florida, United States

Florida Cancer Specialists; SCRI, Fort Myers, Florida, United States

Mayo Clinic-Jacksonville, Jacksonville, Florida, United States

Uni of Miami School of Medicine; Sylvester Comprehensive Cancer Center, Miami, Florida, United States

University Cancer & Blood Center, LLC; Research, Athens, Georgia, United States

Cancer Research Center of Hawaii; Clinical Sciences, Honolulu, Hawaii, United States

Mountain States Tumor Inst., Boise, Idaho, United States

Uni of Chicago, Chicago, Illinois, United States

Decatur Memorial Hospital, Decatur, Illinois, United States

Ingalls Memorial Hospital, Harvey, Illinois, United States

Loyola University Med Center, Maywood, Illinois, United States

Illinois Cancer Care, Peoria, Illinois, United States

Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, Indiana, United States

Horizon Oncology Research, Inc., Lafayette, Indiana, United States

James Graham Brown Cancer Center, University of Louisville, Louisville, Kentucky, United States

New England Cancer Specialists, Scarborough, Maine, United States

Anne Arundel Health System Research Instit-Annapolis Oncology Ctr, Annapolis, Maryland, United States

Boston Medical Center, Boston, Massachusetts, United States

Spectrum Health Grand Rapids, Grand Rapids, Michigan, United States

University of Minnesota., Minneapolis, Minnesota, United States

Mayo Clinic Rochester, Rochester, Minnesota, United States

St. John'S Mercy Medical Center; David C. Pratt Cancer Center, Saint Louis, Missouri, United States

Mercy Clinic Cancer & Hematology, Springfield, Missouri, United States

Dartmouth Hitchcock Med Center, Lebanon, New Hampshire, United States

Hackensack Uni Medical Center; Northern Nj Cancer Center, Hackensack, New Jersey, United States

Cancer Inst. of New Jersey, New Brunswick, New Jersey, United States

San Juan Oncology Associates, Farmington, New Mexico, United States

Queens Medical Associates, Fresh Meadows, New York, United States

Queens Hospital Center, Jamaica, New York, United States

Arena Oncology Associates, Lake Success, New York, United States

Icahn School of Medicine at Mount Sinai, New York, New York, United States

Weill Medical College of Cornell Uni, New York, New York, United States

Carolinas Hem-Oncology Assoc, Charlotte, North Carolina, United States

Carolina Oncology Specialists, PA - Hickory, Hickory, North Carolina, United States

Marion L. Shepard Cancer Center, Washington, North Carolina, United States

Sanford Roger Maris Cancer Center, Fargo, North Dakota, United States

Oncology Hematology Care - SCRI, Cincinnati, Ohio, United States

Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, United States

Charleston Oncology, P .A, Charleston, South Carolina, United States

Medical University of SC (MUSC), Charleston, South Carolina, United States

South Carolina Oncology Associates - SCRI, Columbia, South Carolina, United States

Avera Cancer Institute, Sioux Falls, South Dakota, United States

SCRI Tennessee Oncology Chattanooga, Chattanooga, Tennessee, United States

West Clinic, Germantown, Tennessee, United States

Tennessee Onc., PLLC - SCRI, Nashville, Tennessee, United States

Vanderbilt-Ingram Cancer Ctr, Nashville, Tennessee, United States

The Don & Sybil Harrington Cancer Center; Department of Clinical Research, Amarillo, Texas, United States

Uni of Texas Southwestern Medical Center, Dallas, Texas, United States

Uni of Texas - Md Anderson Cancer Center; Dept of Breast Medical Oncology, Houston, Texas, United States

Northern Utah Associates, Ogden, Utah, United States

The Providence Regional Medical Center Everett, Everett, Washington, United States

University of Washington, Seattle, Washington, United States

Northwest Medical Specialties, Tacoma, Washington, United States

FundaciĂłn Investigar, Buenos Aires, , Argentina

Centro Medico San Roque, San Miguel de Tucuman, , Argentina

Mater Misericordiae Hospital; Chemotherapy Cottage, Sydney, New South Wales, Australia

Calvary Mater Newcastle; Medical Oncology, Waratah, New South Wales, Australia

Wesley Medical Centre; Clinic For Haematology and Oncology, Auchenflower, Queensland, Australia

Royal Adelaide Hospital; Oncology, Adelaide, South Australia, Australia

Peter Maccallum Cancer Institute; Medical Oncology, Melbourne, Victoria, Australia

Lkh Salzburg - Univ. Klinikum Salzburg; Iii. Medizinische Abt., Salzburg, , Austria

Medizinische UniversitĂ€t Wien; Univ.Klinik fĂŒr Innere Medizin I - Abt. fĂŒr Onkologie, Wien, , Austria

Oncology Consultants Limited, Nassau, , Bahamas

Cliniques Universitaires St-Luc, Bruxelles, , Belgium

Clinique Ste-Elisabeth, Namur, , Belgium

Sint Augustinus Wilrijk, Wilrijk, , Belgium

University Clinical Centre of the Republic of Srpska, Banja Luka, , Bosnia and Herzegovina

Clinic of Oncology, University Clinical Center Sarajevo, Sarajevo, , Bosnia and Herzegovina

*X*Instituto Nacional do Cancer - INCA, Rio de Janeiro, RJ, Brazil

Liga Norte Riograndense Contra O CĂąncer, Natal, RN, Brazil

Hospital Nossa Senhora da Conceicao, Porto Alegre, RS, Brazil

Clinica de Oncologia de Porto Alegre - CliniOnco, Porto Alegre, RS, Brazil

Hospital Sao Lucas - PUCRS, Porto Alegre, RS, Brazil

Clinica de Neoplasias Litoral, Itajai, SC, Brazil

Instituto do Cancer do Estado de Sao Paulo - ICESP, Sao Paulo, SP, Brazil

Hospital Perola Byington, Sao Paulo, SP, Brazil

Cross Cancer Institute; Clinical Trials, Edmonton, Alberta, Canada

North York General Hospital, Toronto, Ontario, Canada

Cuse - Centre Universitaire De Sante; Site Fleurimont, Sherbrooke, Quebec, Canada

CHU de Québec ? HÎpital du Saint-Sacrement / ONCOLOGY, Quebec, , Canada

Clinica del Country, Bogota, , Colombia

Instituto Colombiano Para El Avance De La Medicina: Icamedic, Bucaramanga, , Colombia

Centro Medico Imbanaco, Cali, , Colombia

Instituto Cancerologico de Nariño, Pasto, , Colombia

Masarykuv onkologicky ustav, Brno, , Czechia

Fakultni nemocnice Olomouc; Onkologicka klinika, Olomouc, , Czechia

Fakultni Poliklinika Vseobecne Fakultni Niemocnice; Onkologicka Klinika, Praha 2, , Czechia

Fakultni Nemocnice Na Bulovce; Ustav Radiacni Onkologie, Praha, , Czechia

Vejle Sygehus; Onkologisk Afdeling, Vejle, , Denmark

HOPITAL JEAN MINJOZ; Oncologie, Besancon, , France

Centre Jean Perrin; Hopital De Jour, Clermont Ferrand, , France

Centre Oscar Lambret; Senologie, Lille, , France

Institut Paoli Calmettes; Oncologie Medicale, Marseille, , France

Institut régional du Cancer Montpellier, Montpellier, , France

Centre D'Oncologie de Gentilly; Oncology, Nancy, , France

Institut Curie; Oncologie Medicale, Paris, , France

Hopital Saint Louis; Service Onco Thoracique, Paris, , France

HOPITAL TENON; Cancerologie Medicale, Paris, , France

Chu La Miletrie; Radiotherapie, Poitiers, , France

Centre Rene Huguenin; ONCOLOGIE GENETIQUE, Saint Cloud, , France

Institut de Cancerologie de La Loire; Radiotherapie, St Priest En Jarez, , France

Klinikum Essen-Mitte Ev. Huyssens-Stiftung / Knappschafts GmbH; Klinik fĂŒr Senologie / Brustzentrum, Essen, , Germany

UniversitĂ€tsklinikum Halle (Saale); UniversitĂ€tsklinik Und Poliklinik FĂŒr GynĂ€kologie, Halle, , Germany

Facharztzentrum Eppendorf, Studien GbR, Hamburg, , Germany

MVZ Onko Medical GmbH Hannover, Ralf Lohse (GeschĂ€ftsfĂŒhrer), Hannover, , Germany

Nationales Centrum fĂŒr Tumorerkrankungen (NCT) ; Gyn. Onk. Frauenklinik; Uniklinikum Heidelberg, Heidelberg, , Germany

UniversitÀtsklinikum Magdeburg; Frauenheilkunde & Geburtshilfe, Magdeburg, , Germany

UniversitÀtsmedizin Mainz; Klinik u. Poliklinik f. Geburtshilfe u. Frauenheilkunde, Mainz, , Germany

MĂŒhlenkreiskliniken; Johannes Wesling Klinikum Minden; Klinik fĂŒr Frauenheilkunde und Geburtshilfe, Minden, , Germany

Rotkreuzklinikum MĂŒnchen; Frauenklinik, Muenchen, , Germany

Klinikum Mutterhaus der Borromaeerinnen gGmbH; Haematologie/Onkologie, Trier, , Germany

Alexandras General Hospital of Athens; Oncology Department, Athens, , Greece

Univ General Hosp Heraklion; Medical Oncology, Heraklion, , Greece

University Hospital of Larissa; Oncology, Larissa, , Greece

Grupo Angeles, Guatemala City, , Guatemala

Centro OncolĂłgico Sixtino / Centro OncolĂłgico SA, Guatemala, , Guatemala

Szent Margit Hospital; Dept. of Oncology, Budapest, , Hungary

Semmelweis Egyetem Onkologiai Központ, Budapest, , Hungary

Semmelweis Egyetem Aok; Iii.Sz. Belgyogyaszati Klinika, Budapest, , Hungary

Pécsi Tudomånyegyetem; Klinikai Központ Onkoteråpiås Intézet, Pécs, , Hungary

Campus Universitario S.Venuta; Centro Oncologico T.Campanella, Catanzaro, Calabria, Italy

IRST Istituto Scientifico Romagnolo Per Lo Studio E Cura Dei Tumori, Sede Meldola; Oncologia Medica, Meldola, Emilia-Romagna, Italy

A.O. Universitaria Policlinico Di Modena; Ematologia, Modena, Emilia-Romagna, Italy

Arcispedale Santa Maria Nuova; Oncologia, Reggio Emilia, Emilia-Romagna, Italy

Ospedale Degli Infermi; Divisione Di Oncologia, Rimini, Emilia-Romagna, Italy

Azienda Ospedaliero-Universitaria Dipartimento Interaziendale Di Oncologia, Udine, Friuli-Venezia Giulia, Italy

Istituto Europeo Di Oncologia, Milano, Lombardia, Italy

Fondazione Salvatore Maugeri, Pavia, Lombardia, Italy

IRCCS Istituto Clinico Humanitas; Oncologia, Rozzano (MI), Lombardia, Italy

Centro Catanese Di Oncologia; Oncologia Medica, Catania, Sicilia, Italy

Ospedale Papardo- Piemonte;Oncologia Medica, Messina, Sicilia, Italy

Ospedale Misericordia E Dolce; Oncologia Medica, Prato, Toscana, Italy

Azienda Ospedaliera Di Perugia Ospedale s. Maria Della Misericordia; Oncologia Medica, Perugia, Umbria, Italy

Aichi Cancer Center Hospital, Breast Oncology, Aichi, , Japan

Natl Hosp Org Shikoku; Cancer Ctr, Surgery, Ehime, , Japan

National Hospital Organization Kyushu Cancer Center;Breast Oncology, Fukuoka, , Japan

Gifu University Hospital; Digestive Surgery, Gifu, , Japan

Hiroshima University Hospital; Breast Surgery, Hiroshima, , Japan

National Hospital Organization Hokkaido Cancer Center; Breast Surgery, Hokkaido, , Japan

Hyogo College Of Medicine; Breast And Endocrine Surgery, Hyogo, , Japan

Hyogo Cancer Center; Breast Surgery, Hyogo, , Japan

Kanazawa University Hospital; Breast Oncology, Ishikawa, , Japan

Iwate Med Univ School of Med; Surgery, Iwate, , Japan

Sagara Hospital; Breast Surgery, Kagoshima, , Japan

Tokai University Hospital, Breast Surgery, Kanagawa, , Japan

Kumamoto University Hospital; Breast and Endocrine Surgery, Kumamoto, , Japan

Kumamoto City Hospital, Breast and Endocrine Surgery, Kumamoto, , Japan

Kyoto University Hospital; Breast Surgery, Kyoto, , Japan

Tohoku University Hospital; General Surgery, Miyagi, , Japan

Niigata Cancer Ctr Hospital; Breast Surgery, Niigata, , Japan

Kawasaki Medical School Hospital; Breast and Thyroid Surgery, Okayama, , Japan

National Hospital Organization Osaka National Hospital; Breast Surgery, Osaka, , Japan

Osaka University Hospital; Breast and Endocrine Surgery, Osaka, , Japan

Saitama Medical University International Medical Center; Medical Oncology, Saitama, , Japan

Saitama Cancer Center, Breast Oncology, Saitama, , Japan

Shizuoka Cancer Center; Breast Surgery, Shizuoka, , Japan

Shizuoka General Hospital; Breast Surgery, Shizuoka, , Japan

National Cancer Center Hospital; Medical Oncology, Tokyo, , Japan

Toranomon Hospital; Breast and Endocrine Surgery, Tokyo, , Japan

The Cancer Inst. Hosp. of JFCR; Breast Oncology Center, Tokyo, , Japan

Tokyo Medical Uni. Hospital; Breast Oncology, Tokyo, , Japan

Seoul National University Bundang Hospital; Hematology Medical Oncology, Gyeonggi-do, , Korea, Republic of

Seoul National Uni Hospital; Dept. of Internal Medicine/Hematology/Oncology, Seoul, , Korea, Republic of

Samsung Medical Centre; Division of Hematology/Oncology, Seoul, , Korea, Republic of

Asan Medical Center, Uni Ulsan Collegemedicine; Dept.Internal Medicine / Divisionhematology/Oncology, Seoul, , Korea, Republic of

Korea University Guro Hospital; Oncology, Seoul, , Korea, Republic of

Pantai Hospital Kuala Lumpur; Dept of Oncology & Radiotherapy, Kuala Lumpur, FED. Territory OF Kuala Lumpur, Malaysia

Beacon International Specialist Centre, Petaling Jaya, Selangor, Selangor, Malaysia

Sunway Medical Centre, Selangor, , Malaysia

Centro de Investigacion; Clinica Del Pacifico, Acapulco, Guerrero, Mexico

Centro Universitario Contra El Cancer, Monterrey, Nuevo LEON, Mexico

Oaxaca Site Management Organization, Oaxaca de JuĂĄrez, Oaxaca, Mexico

Hospital Privado San Jose; Oncologia, Obregon, Sonora, Mexico

Centenario Hospital Miguel Hidalgo, Aguascalientes, , Mexico

Centro OncolĂłgico Estatal; ISSSEMYM OncologĂ­a, Toluca, , Mexico

Auckland city hospital; Auckland Regional Cancer Centre and Blood Service, Auckland, , New Zealand

Waikato Hospital; Regional Cancer Center, Hamilton, , New Zealand

Private Health Organization Acibadem Sistina Hospital, Skopje, , North Macedonia

The Panama Clinic, Panama, , Panama

Hospital Nacional Carlos Alberto Seguin Escobedo-Essalud; Oncology & Haemathology, Arequipa, , Peru

Hospital Nacional Edgardo Rebagliati Martins; Oncologia, Lima, , Peru

Unidad de Investigacion Oncologia Clinica ? Piura; Unidad de OncologĂ­a ClĂ­nica, Piura, , Peru

Cebu Cancer Institute; Perpetual Succour Hospital, Cebu City, , Philippines

Cardinal Santos Medical Center, San Juan, , Philippines

Centrum Onkologii;Im. Franciszka Lukaszczyka;Onkologii, Bydgoszcz, , Poland

Medical University of Gdansk, Gdansk, , Poland

Centrum Onkologii, Instytut, Klinika Chemioterapii; Oddzial Chemoterapii, Krakow, , Poland

COZL Oddzial Onkologii Klinicznej z pododdzialem Chemioterapii Dziennej, Lublin, , Poland

Cent.Onkologii-Instytut im. M. S-Curie, Klinika Now. Piersi i Chirurgii Rekon, Warszawa, , Poland

IPO do Porto; Servico de Oncologia Medica, Porto, , Portugal

Coltea Hospital; Oncology, Bucharest, , Romania

Prof. Dr. I. Chiricuta Institute of Oncology, Cluj Napoca, , Romania

Cluj Clinical County Hospital; Oncology Dept, Cluj-Napoca, , Romania

Moscow city oncology hospital; #62 of Moscow Healthcare Department, Moscow, Moskovskaja Oblast, Russian Federation

Blokhin Cancer Research Center; Combined Treatment, Moskva, Moskovskaja Oblast, Russian Federation

Ryazan State Medical University Named after I.P.Pavlov, Ryazan, Rjazan, Russian Federation

State Budget Institution of Healthcare of Stavropol region Pyatigorsk Oncology Dispensary, Pyatigorsk, Stavropol, Russian Federation

Clinical Oncology Dispensary of Ministry of Health of Tatarstan, Kazan, Tatarstan, Russian Federation

Ivanovo Regional Oncology Dispensary, Ivanovo, , Russian Federation

SBI of Healthcare Samara Regional Clinical Oncology Dispensary, Samara, , Russian Federation

SBI of Healthcare of Stavropol region Stavropol Regional Clinical Oncology Dispensary, Stavropol, , Russian Federation

Tula Regional Oncology Dispensary, Tula, , Russian Federation

GUZ Vladimir Regional Clinical Oncological Dispensary, Vladimir, , Russian Federation

Hospital General Universitario de Elche; Servicio de Oncologia, Elche, Alicante, Spain

Hospital Univ Vall d'Hebron; Servicio de Oncologia, Sant Andreu de La Barca, Barcelona, Spain

Complejo Hospitalario Universitario de Santiago (CHUS) ; Servicio de Oncologia, Santiago de Compostela, LA Coruña, Spain

Hospital del Mar; Servicio de Oncologia, Barcelona, , Spain

Complejo Hospitalario de Jaen-Hospital Universitario Medico Quirurgico; Servicio de Oncologia, Jaen, , Spain

Complejo Hospitalario Universitario A Coruña (CHUAC, Materno Infantil), Oncología, La Coruña, , Spain

Hospital General Universitario Gregorio Marañon; Servicio de Oncologia, Madrid, , Spain

Hospital Universitario 12 de Octubre; Servicio de Oncologia, Madrid, , Spain

Hospital Universitario La Paz; Servicio de Oncologia, Madrid, , Spain

Hospital Clinico Universitario Virgen de la Victoria; Servicio de Oncologia, Malaga, , Spain

Hospital Clinico Universitario de Valencia; Servicio de Onco-hematologia, Valencia, , Spain

SkÄnes Universitetssjukhus; Kliniska Forskningsenheten Onkologimottagning medicinsk behandling, Malmö, , Sweden

Kantonsspital Baden; Medizinische Klinik, Onkologie, Baden, , Switzerland

Universitaetsspital Basel; Onkologie, Basel, , Switzerland

Kantonsspital GraubĂŒnden Medizin Onkologie; Onkologie und HĂ€matologie, Chur, , Switzerland

Changhua Christian Hospital; Hematology-Oncology, Changhua, , Taiwan

Kaohsiung Medical Uni Chung-Ho Hospital; Dept of Surgery, Kaohsiung, , Taiwan

National Taiwan Uni Hospital; Dept of Oncology, Taipei, , Taiwan

Tri-Service General Hospital; Hematology and Oncology, Taipei, , Taiwan

National Cancer Inst., Bangkok, , Thailand

Rajavithi Hospital; Division of Medical Oncology, Bangkok, , Thailand

Ramathibodi Hospital; Dept of Med.-Div. of Med. Onc, Bangkok, , Thailand

Faculty of Med. Siriraj Hosp.; Med.-Div. of Med. Oncology, Bangkok, , Thailand

Maharaj Nakorn Hospital; Internal Medicine, Chiang Mai, , Thailand

Songklanagarind Hospital; Department of Oncology, Songkhla, , Thailand

Baskent University Adana Dr. Turgut Noyan Practice and Research Hospital; Medical Oncology, Adana, , Turkey

Cukurova Uni Faculty of Medicine; Medical Oncology, Adana, , Turkey

Gazi Uni Medical Faculty Hospital; Oncology Dept, Ankara, , Turkey

Ege Uni Medical Faculty Hospital; Oncology Dept, Izmir, , Turkey

Bristol Haematology and Oncology centre, Bristol, , United Kingdom

Cambridge University Hospitals NHS Foundation Trust, Cambridge, , United Kingdom

Royal Cornwall Hospital; Dept of Clinical Oncology, Cornwall, , United Kingdom

The Beatson West of Scotland Cancer Centre; Cancer Clinical Trials Unit, Glasgow, , United Kingdom

Leicester Royal Infirmary; Dept. of Medical Oncology, Leicester, , United Kingdom

Royal Free Hospital; Dept of Oncology, London, , United Kingdom

Guys Hospital; Management Offices, London, , United Kingdom

Royal Marsden Hospital; Dept of Med-Onc, London, , United Kingdom

Christie Hospital; Breast Cancer Research Office, Manchester, , United Kingdom

Nottingham City Hospital; Oncology, Nottingham, , United Kingdom

Peterborough City Hospital; Oncology Ward, Peterborough, , United Kingdom

Queen Alexandra Hospital, Portsmouth, Portsmouth, , United Kingdom

Weston Park Hospital; Cancer Clinical Trials Centre, Sheffield, , United Kingdom

Southampton General Hospital; Somers Cancer Research Building, Southampton, , United Kingdom

Uni Hospital of North Staffordshire; Staffordshire Oncology Centre, Stoke-on-Trent, , United Kingdom

Royal Marsden Hospital; Dept of Medical Oncology, Sutton, , United Kingdom

Contact Details

Name: Clinical Trials

Affiliation: Hoffmann-La Roche

Role: STUDY_DIRECTOR

Useful links and downloads for this trial

Clinicaltrials.gov

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