Sonocloud-9 in Verbindung mit Carboplatin im Vergleich zu Standard-Chemotherapien (CCNU oder TMZ) bei rezidivierendem GBM (SONOBIRD)
Eine randomisierte, offene, multizentrische, zweiarmige Zulassungsstudie mit SonoCloud-9 in Kombination mit Carboplatin (CBDCA) im Vergleich zu Standardtherapie Lomustin (CCNU) oder Temozolomid (TMZ) bei Patienten, die sich einer geplanten Resektion wegen erstmaligem Glioblastomrezidiv unterziehen.
The brain is protected from any toxic or inflammatory molecule by the blood-brain barrier (BBB). This physical barrier is located at the level of the blood vessel walls. Because of these barrier properties, the blood vessels are also impermeable to the passage of therapeutic molecules from the blood to the brain. The development of effective treatments against glioblastoma is thus limited due to the BBB that prevents most drugs injected in the bloodstream from getting into brain tissue where the tumour is seated. The SonoCloud-9 (SC9) is an investigational device using ultrasound technology and specially developed to open the BBB in the area of and surrounding the tumour. The transient opening of the BBB allows more drugs to reach the brain tumour tissue. Carboplatin is a chemotherapy that is approved to treat different cancer types alone or in combination with other drugs, and has been used in the treatment of glioblastoma. Despite its proven efficacy in the laboratory on glioblastoma cells, carboplatin does not readily cross the BBB in humans. A clinical trial has shown that in combination with the SonoCloud-9, more carboplatin can reach the brain tumour tissue. The objective of the proposed trial is to show that the association - carboplatin with the SonoCloud-9 - will increase efficacy of the drug in patients with recurrent glioblastoma.
Studienübersicht
Status
Status
Bedingungen
Bedingungen
Intervention / Behandlung
Intervention / Behandlung
Studientyp
Studientyp
Einschreibung (Geschätzt)
Einschreibung
Phase
Phase
- Phase 3
Kontakte und Standorte
Studienkontakt
Studienkontakt
- Name: Carole Desseaux
- Telefonnummer: +33 472 626 268
- E-Mail: contact@carthera.eu
Studienorte
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Brussels, Belgien
- Rekrutierung
- Universitair Ziekenhuis Brussel
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Kontakt:
- Duerinck Johnny, MD
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Leuven, Belgien
- Rekrutierung
- Universitair Ziekenhuis Leuven
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Kontakt:
- Steven de Vleeschouwer, MD
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Liège, Belgien
- Rekrutierung
- CHU de Liège
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Kontakt:
- Pierre Frères, MD
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Berlin, Deutschland, 10117
- Rekrutierung
- Charité Universitätsmedizin Berlin
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Kontakt:
- Martin Misch, MD
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Chemnitz, Deutschland, 09113
- Rekrutierung
- Klinikum Chemnitz gGmbH
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Kontakt:
- Sven-Axel May, MD
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Cologne, Deutschland
- Rekrutierung
- Neurochirurgie uniklinik Köln
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Kontakt:
- Roland Goldbrunner, MD
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Dresden, Deutschland, 01307
- Rekrutierung
- Universitätsklinikum Carl Gustav Carus Dresden
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Kontakt:
- Dietmar Krex, MD
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Essen, Deutschland, 45147
- Rekrutierung
- Universitätsklinikum Essen Klinik für Neurologie
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Kontakt:
- Sied Kebir, MD
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Münster, Deutschland, 48149
- Rekrutierung
- University Hospital Munster
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Kontakt:
- Walter Stummer, MD
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Copenhagen, Dänemark, 2100
- Rekrutierung
- Rigshospitalet
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Kontakt:
- Jane Skjøth-Rasmussen, MD
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Odense, Dänemark, 5000
- Rekrutierung
- Odense University Hospital
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Kontakt:
- Frantz Rom Poulsen, MD
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Bron, Frankreich
- Rekrutierung
- Hôpital Neurologique Pierre Wertheimer
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Kontakt:
- François Ducray, MD
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Marseille, Frankreich
- Rekrutierung
- Hôpital de La Timone
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Kontakt:
- Olivier Chinot, MD
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Paris, Frankreich
- Rekrutierung
- Hôpital de la Pitié-Salpêtrière
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Kontakt:
- Ahmed Idbaih, MD
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Suresnes, Frankreich, 92150
- Rekrutierung
- Hôpital Foch
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Kontakt:
- Nadia Younan, MD
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Bologna, Italien, 40139
- Rekrutierung
- Ospedale Bellaria
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Kontakt:
- Enrico Franceschi, MD
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Livorno, Italien, 57124
- Rekrutierung
- Ospedale Civile di Livorno
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Kontakt:
- Anna Luisa Di Stefano, MD
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Padua, Italien
- Rekrutierung
- Istituto Oncologico Veneto
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Kontakt:
- Giuseppe Lombardi, MD
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Roma, Italien
- Rekrutierung
- IFO - Istituto Nazionale Tumori Regina Elena
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Kontakt:
- Veronica Villani, MD
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Rozzano, Italien, 20089
- Rekrutierung
- Irccs Istituto Clinico Humanitas
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Kontakt:
- Matteo Simonelli, MD
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Torino, Italien, 10126
- Rekrutierung
- Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino
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Kontakt:
- Roberta Ruda, MD
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Rotterdam, Niederlande
- Rekrutierung
- Erasmus Medisch Centrum (Erasmus MC)
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Kontakt:
- Marjolein Geurts, MD
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The Hague, Niederlande, 2263
- Rekrutierung
- Haaglanden Medisch Centrum
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Kontakt:
- Marike Broekman, MD
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Gothenburg, Schweden, 413 45
- Rekrutierung
- Sahlgrenska University Hospital
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Kontakt:
- Louise Carstam, MD
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Uppsala, Schweden, 75185
- Rekrutierung
- Akademiska sjukhuset
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Kontakt:
- George Holgersson, MD
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Bern, Schweiz, 3010
- Rekrutierung
- Inselspital Bern
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Kontakt:
- Philippe Schucht, MD
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Lausanne, Schweiz, 1011
- Rekrutierung
- Centre Hospitalier Universitaire Vaudois (CHUV)
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Kontakt:
- Andreas Hottinger, MD
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Barcelona, Spanien, 08035
- Rekrutierung
- Vall d'Hebron Institute of Oncology (VHIO)
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Kontakt:
- Maria Vieito Villar, MD
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Barcelona, Spanien, 08036
- Rekrutierung
- Hospital Clinic de Barcelona
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Kontakt:
- Jose Juan Gonzalez Sanchez, MD
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Madrid, Spanien
- Rekrutierung
- Hospital Universitario 12 de Octubre
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Kontakt:
- Angel Perez-Nunez, MD
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Madrid, Spanien, 28050
- Rekrutierung
- Hospital Universitario HM Sanchinarro
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Kontakt:
- Juan Manuel Sepulveda Sanchez, MD
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Seville, Spanien, 41013
- Rekrutierung
- Hospital Universitario Virgen del Rocío
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Kontakt:
- Ignacio Martín Schrader, MD
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Arizona
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Phoenix, Arizona, Vereinigte Staaten, 805054
- Rekrutierung
- Mayo Clinic Arizona
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Kontakt:
- Maciej Mrugala, MD
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California
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Los Angeles, California, Vereinigte Staaten, 90095
- Noch keine Rekrutierung
- UCLA
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Kontakt:
- Richard Everson, MD
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Los Angeles, California, Vereinigte Staaten, 90027
- Noch keine Rekrutierung
- Kaiser Permanente
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Kontakt:
- Daniel Green, MD
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San Francisco, California, Vereinigte Staaten, 94143
- Rekrutierung
- University of California, San Francisco
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Kontakt:
- Nicholas Butowski, MD
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San Francisco, California, Vereinigte Staaten, 94109
- Rekrutierung
- Sutter Health - California Pacific Medical Center
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Kontakt:
- Lewis Leng, MD
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Colorado
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Aurora, Colorado, Vereinigte Staaten, 80011
- Rekrutierung
- UCHealth
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Kontakt:
- Kevin Lillehei, MD
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Florida
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Jacksonville, Florida, Vereinigte Staaten, 32224
- Rekrutierung
- Mayo Clinic of Jacksonville Florida
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Kontakt:
- Kaisorn Chaichana, MD
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Miami, Florida, Vereinigte Staaten, 33176
- Rekrutierung
- Miami Cancer Institute
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Kontakt:
- Michael Mc Dermott, MD
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Tampa, Florida, Vereinigte Staaten, 33612
- Rekrutierung
- Moffitt Cancer Center
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Kontakt:
- James Liu, MD
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Georgia
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Atlanta, Georgia, Vereinigte Staaten, 30322
- Rekrutierung
- Winship Cancer Institute at Emory University
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Kontakt:
- Edjah Nduom, MD
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Illinois
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Chicago, Illinois, Vereinigte Staaten, 60611
- Rekrutierung
- Northwestern University
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Kontakt:
- Rimas Lukas, MD
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Indiana
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Indianapolis, Indiana, Vereinigte Staaten, 46202
- Rekrutierung
- Indiana University Health
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Kontakt:
- Kathryn Nevel, MD
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Maryland
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Baltimore, Maryland, Vereinigte Staaten, 21287
- Rekrutierung
- John Hopkins University
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Kontakt:
- Chetan Bettegowda, MD
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Minnesota
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Rochester, Minnesota, Vereinigte Staaten, 55905
- Aktiv, nicht rekrutierend
- Mayo Clinic Rochester
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New York
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New York, New York, Vereinigte Staaten, 10021
- Rekrutierung
- Weill Cornell Medicine
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Kontakt:
- Rohan Ramakhrisna, MD
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New York, New York, Vereinigte Staaten, 10075
- Rekrutierung
- Lennox Hill Hospital
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Kontakt:
- Randy D'Amico, MD
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New York, New York, Vereinigte Staaten, 10032
- Rekrutierung
- NewYork-Presbyterian / Columbia University Irving Medical Center
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Kontakt:
- Telefonnummer: 212-342-5162
- E-Mail: cancerclinicaltrials@cumc.columbia.edu
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Kontakt:
- Brian JA Gill, MD
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North Carolina
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Chapel Hill, North Carolina, Vereinigte Staaten, 27516
- Rekrutierung
- University of North Carolina
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Kontakt:
- Carlos David, MD
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Ohio
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Cleveland, Ohio, Vereinigte Staaten, 44106
- Rekrutierung
- Neurological Institute Brain Tumor Centre Taussig Cancer Cente
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Kontakt:
- Matthew Grabowski, MD
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Pennsylvania
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Hershey, Pennsylvania, Vereinigte Staaten, 17033
- Rekrutierung
- Penn State Health Milton S. Hershey Medical Center
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Kontakt:
- Brad Zacharia, MD
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Texas
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Dallas, Texas, Vereinigte Staaten, 75390
- Rekrutierung
- University of Texas Southwestern Medical Center
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Kontakt:
- Toral Patel, MD
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Houston, Texas, Vereinigte Staaten, 77030
- Rekrutierung
- University of Texas Houston Health Science Center
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Kontakt:
- Yoshua Esquenazi, MD
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Utah
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Salt Lake City, Utah, Vereinigte Staaten, 84112
- Rekrutierung
- University of Utah, Hunstman Cancer Institute
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Kontakt:
- Randy Jenssen, MD
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Innsbruck, Österreich, 6020
- Rekrutierung
- Medizinische Universitaet Innsbruck
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Kontakt:
- Christian Freyschlag, MD
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Teilnahmekriterien
Zulassungskriterien
Zulassungskriterien
Studienberechtigtes Alter
Akzeptiert gesunde Freiwillige
Studienberechtigte Geschlechter
Beschreibung
Inclusion Criteria:
-
Histologically proven glioblastoma (WHO criteria 2021), absence of IDH mutation demonstrated by negative IDH1 R132H staining on Immunohistochemistry.
-
Patient must have received prior first line therapy that must have contained both:
- Prior surgery or biopsy and standard fractionated radiotherapy (1.8-2 Gy/fraction, ≥56 Gy<66 Gy) or hypofractionated radiotherapy (15 x 2.66 Gy or similar regimen)
- One line of maintenance chemotherapy and/or immune- or biological therapy, (with or without Tumor-Treating Fields)
-
First, unequivocal disease progression with
- measurable tumor (>100 mm2 or 1 cm3, based on RANO criteria) documented (e.g., increase of 25% in tumor diameter) on MRI and,
- interval of a minimum of 12 weeks since the completion of prior radiotherapy, unless there is a new lesion outside the radiation field or unequivocal evidence of viable tumor on histopathological sampling
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Patient is a candidate for craniotomy and at least 50% resection of enhancing region
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Maximal enhancing tumor diameter prior to inclusion ≤ 5 (+7%) cm on T1w on MRI performed within 14 days prior to inclusion§. (In case of planned lobectomy, post operative peritumoral brain or residual size ≤5 cm)
-
WHO performance status ≤ 2 (equivalent to Karnofsky Performance Status (KPS) ≥ 70)
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Age ≥ 18 years
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Participant must be recovered from acute toxic effects (≤ grade 2) of all prior anticancer therapy. Interval since last therapy to presumed date of surgery of at least:
-
≥ 4 weeks or 5 half-lives (whichever is shorter) for
- Cytotoxic
- Other small chemical entity (e.g., targeted therapy)
- For biologics (e.g., antibodies, except bevacizumab)
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≥ 6 weeks of prior bevacizumab
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Adequate hematologic, hepatic, and renal laboratory values within 14 days prior to inclusion§ i.e.:
- Hemoglobin ≥ 10 g/dL, platelets ≥ 100,000/mm3, neutrophils ≥ 1500/mm3.
- Liver function test with ≤ grade 1 alterations, except if due to antiepileptic drug therapy or isolated increased bilirubin due to Gilbert syndrome
- Estimated glomerular filtration rate (eGFR) of at least 60 mL/min/m2 using Appendix 12.4 formula
- AST(SGOT)/ALT(SPGT) ≤ 3 X institutional ULN (upper Limit of Normal)
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Patient able to understand clinical trial information and willing to provide signed and informed consent
-
Patient of childbearing potential must have a negative pregnancy test within 14 days prior to inclusion§ and must agree to use a medically-acceptable method of birth control during the treatment period and, if randomized in the experimental arm, for at least 1 month after the last cycle of carboplatin
-
A male patient must agree to use condoms during the treatment period and, if randomized in the experimental arm, for at least 3 months after the last cycle of carboplatin; the patient must also refrain from donating sperm during this period.
-
Patient must be a beneficiary of a health plan that covers routine patient care costs. Patient must be a beneficiary of or affiliated with a social security scheme (according to country-specific requirements)
(§) These exam/lab tests could be (re)evaluated before randomization if the corresponding selection criteria could not be fully met at time of inclusion. If not met before randomization, the patient will be considered as screen failure.
Non-Inclusion Criteria:
- Multifocal enhancing tumor on T1w (unless all localized in a 5 cm diameter area)
- Posterior fossa tumor
- Known BRAF/ NTKR mutated patients
- Patient at risk of surgery site infection (e.g., 2 or more previous craniotomies/neurosurgery within the last 3 months, poor skin condition, known impaired wound healing and/or previously infected surgical field, uncontrolled diabetes or any other condition that is of increased infectious risk in the opinion of the neurosurgeon)
- Patient treated at high, stable -or average- dose of corticosteroids (≥ 6 mg/day dexamethasone or equivalent) in the 7 days prior to inclusion. Patients on dexamethasone for reasons other than mass effect may still be enrolled.
- Contra-indication to carboplatin, CCNU or TMZ
- Known history of hypersensitivity reactions to perflutren lipid microsphere components or to any of the inactive ingredients in ultrasound resonator
- Patient has received bevacizumab for other reasons (such as tumor progression) than treating edema
- Peripheral neuropathy or neuropathy ≥ grade 2
- Uncontrolled epilepsy or evidence of intracranial pressure
- Patient with known intracranial aneurism or having presented intra-tumor significant spontaneous hemorrhage
- Patient with unremovable coils, clips, shunts, intravascular stents, and/or wafer, or reservoirs
- Patient with medical need to be on continued anti-platelet aggregation therapy and/or anticoagulation. Patients for whom anticoagulation/platelet aggregation can be temporarily interrupted may be eligible after discussion and prior authorization by the sponsor.
- Patient receiving enzyme-inducing antiepileptic drugs (namely phenytoin, carbamazepine and derivatives, phenobarbital), unless switched on another antiepileptic regimen
- History of other malignancy within 3 years prior to study start with the exception of adequately treated basal cell carcinoma, squamous cell carcinoma, non-melanomatous skin cancer or carcinoma in situ of the uterine cervix
- Patient with known or suspected active or chronic infections
- Patient with known significant cardiac disease, known to have right-to-left shunts, severe pulmonary hypertension (pulmonary artery pressure > 90 mm Hg), uncontrolled systemic hypertension, or acute respiratory distress syndrome
- Known sensitivity/allergy to gadolinium, or other intravascular contrast agents
- Patient with impaired thermo-regulation or temperature sensation
- Pregnant, or breastfeeding patient
- Any other serious patient medical or psychological condition that may interfere with adequate and safe delivery of treatment and care (e.g., positive human immunodeficiency virus [HIV] status, potential blood-borne infections, malnutrition…), circumstance (e.g., sinus opening during surgery), psychological, morphological characteristics (e.g., skin characteristics, bone thickness), or any pre-existing comorbidities that in the investigator's opinion may prevent the implantation of the device, may impair the ability of the patient to receive treatment with SonoCloud-9 or may be confounding for evaluation of the clinical trial endpoints
- Patients under guardianship, curatorship, under legal protection or deprived of liberty by an administrative or judicial decision
Exclusion Criterion:
Occurrence of any major medical illnesses or impairments that in the Investigator's opinion may hampered the ability of the patient to receive treatment with SonoCloud-9 or may be confounding for evaluation of the clinical endpoints.
Studienplan
Wie ist die Studie aufgebaut?
Designdetails
- Hauptzweck: Behandlung
- Zuteilung: Zufällig
- Interventionsmodell: Parallele Zuordnung
- Maskierung: Keine (Offenes Etikett)
Anzahl der Arme
Waffen und Interventionen
Teilnehmergruppe / ArmTeilnehmergruppe / Arm |
Intervention / BehandlungIntervention / Behandlung |
|---|---|
|
Experimental: Experimental Arm: SonoCloud-9 Ultrasound + Carboplatin
The SonoCloud-9 (SC9) device will be implanted in the skull bone window upon completion of tumor resection and routine craniotomy. Carboplatin (CBDCA) will be administered intravenously prior to sonication. The CBDCA/SC9 treatment will be repeated every 3 weeks (depending on patient's tolerability) until disease progression or as clinically indicated. Administration of up to 7 cycles is planned. |
Implantation of SC9 device and repeat activation at constant acoustic pressure Dose of carboplatin AUC 5 mg/ml.min-1 calculated using Calvert's formula: Dose (mg) = target AUC (mg/mL x minute) x [glomerular filtration rate (GFR) mL/minute + 25].
Andere Namen:
|
|
Aktiver Komparator: Control Arm: SoC single agent chemotherapy TMZ or CCNU
Standard of Care (SoC) treatment with either temozolomide (TMZ) or lomustine (CCNU). Standard TMZ chemotherapy as a single oral dose every 4 weeks for up to 6 cycles. Standard CCNU chemotherapy as a single oral dose every 6 weeks for up to 4 cycles. |
Dosed and administered per labelling.
Andere Namen:
Dosed and administered per labelling.
Andere Namen:
|
Was misst die Studie?
Primäre Ergebnismessungen
Primäre Ergebnismessungen
Ergebnis Maßnahme |
Maßnahmenbeschreibung |
Zeitfenster |
|---|---|---|
|
Overall survival (OS)
Zeitfenster: Up to 24 months
|
Survival status will be collected during the treatment period, for up to 7 months (short-term follow-up) and then every 3 months as standard of care follow-up (long-term follow-up) until participant's 'End of Study', defined as end of survival follow-up period, death, withdrawal of consent for the collection of data, or 'lost to follow-up' (whichever comes first). |
Up to 24 months
|
Sekundäre Ergebnismessungen
Sekundäre Ergebnismessungen
Ergebnis Maßnahme |
Maßnahmenbeschreibung |
Zeitfenster |
|---|---|---|
|
Tumor Growth Rate
Zeitfenster: Up to week 24
|
Tumor Growth Rate will be determined by measuring hyperintense tumor volume using T1w contrast-enhancing tumor-related region from post-surgery MRI baseline to unequivocal progression MRI (i.e., suspected radiologic progression confirmed by repeat scan). |
Up to week 24
|
|
Progression Free Survival (PFS)
Zeitfenster: Up to 24 months
|
Defined as the time from date of randomization to the earlier of the following events: unequivocal tumor progression as determined by IRC per RANO criteria or death due to any cause. |
Up to 24 months
|
|
Overall survival at 12 months (OS12)
Zeitfenster: 12 months
|
Defined as the proportion of participants alive at 12 months |
12 months
|
|
Overall survival at 18 months (OS18)
Zeitfenster: 18 months
|
Defined as the proportion of participants alive at 18 months |
18 months
|
|
Progression-free survival at 6 months (PFS6)
Zeitfenster: 6 months
|
Defined as the proportion of participants without disease progression or death due to any cause at 6 months. |
6 months
|
Andere Ergebnismessungen
Andere Ergebnismessungen
Ergebnis Maßnahme |
Maßnahmenbeschreibung |
Zeitfenster |
|---|---|---|
|
Safety and Tolerability
Zeitfenster: Up to week 24
|
Frequency and severity of adverse events scored according to the Common Terminology Criteria for Adverse Events (CTCAE), version 5.0, from surgery to End-of-Trial Intervention visit |
Up to week 24
|
Mitarbeiter und Ermittler
Sponsor
Sponsor
Publikationen und hilfreiche Links
Allgemeine Veröffentlichungen
- Carpentier A, Canney M, Vignot A, Reina V, Beccaria K, Horodyckid C, Karachi C, Leclercq D, Lafon C, Chapelon JY, Capelle L, Cornu P, Sanson M, Hoang-Xuan K, Delattre JY, Idbaih A. Clinical trial of blood-brain barrier disruption by pulsed ultrasound. Sci Transl Med. 2016 Jun 15;8(343):343re2. doi: 10.1126/scitranslmed.aaf6086.
- Sonabend AM, Gould A, Amidei C, Ward R, Schmidt KA, Zhang DY, Gomez C, Bebawy JF, Liu BP, Bouchoux G, Desseaux C, Helenowski IB, Lukas RV, Dixit K, Kumthekar P, Arrieta VA, Lesniak MS, Carpentier A, Zhang H, Muzzio M, Canney M, Stupp R. Repeated blood-brain barrier opening with an implantable ultrasound device for delivery of albumin-bound paclitaxel in patients with recurrent glioblastoma: a phase 1 trial. Lancet Oncol. 2023 May;24(5):509-522. doi: 10.1016/S1470-2045(23)00112-2.
Nützliche Links
Studienaufzeichnungsdaten
Haupttermine studieren
Studienbeginn (Tatsächlich)
Studienbeginn
Primärer Abschluss (Geschätzt)
Primärer Abschluss
Studienabschluss (Geschätzt)
Studienabschluss
Studienanmeldedaten
Zuerst eingereicht
Zuerst eingereicht
Zuerst eingereicht, das die QC-Kriterien erfüllt hat
Zuerst eingereicht, das die QC-Kriterien erfüllt hat
Zuerst gepostet (Tatsächlich)
Zuerst gepostet
Studienaufzeichnungsaktualisierungen
Letztes Update gepostet (Tatsächlich)
Letztes Update gepostet
Letztes eingereichtes Update, das die QC-Kriterien erfüllt
Letztes eingereichtes Update, das die QC-Kriterien erfüllt
Zuletzt verifiziert
Zuletzt verifiziert
Mehr Informationen
Begriffe im Zusammenhang mit dieser Studie
Schlüsselwörter
Zusätzliche relevante MeSH-Bedingungen
- Neubildungen
- Neubildungen nach histologischem Typ
- Neubildungen, Drüsen und Epithelien
- Astrozytom
- Gliom
- Neubildungen, Neuroepithel
- Neuroektodermale Tumoren
- Neoplasmen, Keimzelle und Embryonal
- Neubildungen, Nervengewebe
- Glioblastom
- Organische Chemikalien
- Heterocyclische Verbindungen, 1-Ring
- Heterocyclische Verbindungen
- Azolen
- Dacarbazin
- Triazenes
- Imidazoles
- Amides
- Koordinationskomplexe
- Nitrosurea -Verbindungen
- Harnstoff
- Nitrosoverbindungen
- Temozolomid
- Carboplatin
- Lomustine
Andere Studien-ID-Nummern
Andere Studien-ID-Nummern
- SC9-GBM-03
- 2023-505829-14-00 (Andere Kennung: EU CT Number)
- 2023 (US NIH Stipendium/Vertrag)
Plan für individuelle Teilnehmerdaten (IPD)
Planen Sie, individuelle Teilnehmerdaten (IPD) zu teilen?
Arzneimittel- und Geräteinformationen, Studienunterlagen
Studiert ein von der US-amerikanischen FDA reguliertes Arzneimittelprodukt
Studiert ein von der US-amerikanischen FDA reguliertes Geräteprodukt
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