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BNC105P in Combination With Everolimus/Following Everolimus For Progressive Metastatic Clear Cell Renal Cell Carcinoma

7 juli 2022 bijgewerkt door: Hoosier Cancer Research Network

Phase I/II Study of BNC105P in Combination With Everolimus or Following Everolimus For Progressive Metastatic Clear Cell Renal Cell Carcinoma Following Prior Tyrosine Kinase Inhibitors

The purpose of this study is to determine whether BNC105P in combination with/following everolimus is effective in the treatment of progressive metastatic clear cell renal cell carcinoma following prior tyrosine kinase inhibitors.

Studie Overzicht

Toestand

Voltooid

Conditie

Gedetailleerde beschrijving

OUTLINE: This is a multi-center study.

Phase I: Patients will be accrued in the classic 3 patients per dose per cohort design, 21-day cycle

  • Dose Level 1 Everolimus 10 mg BNC105P 4.2 mg/m2
  • Dose Level 2 Everolimus 10 mg BNC105P 8.4 mg/m2
  • Dose Level 3 Everolimus 10 mg BNC105P 12.6 mg/m2
  • Dose Level 4 Everolimus 10 mg BNC105P 16 mg/m2

Phase II: Patients will be randomized 1:1 to Arm A or Arm B

Combination Arm A: Everolimus 10 mg + BNC105P MTD (from Phase 1 study) 21 day cycle

Sequential Arm B: Everolimus 10 mg 21 day cycle

  • Patients to receive BNC105P monotherapy at 16 mg/m2 following progression or intolerable toxicity on everolimus therapy.

Karnofsky Performance Score (KPS) ≥70 within 7 days prior to registration for protocol therapy.

Life Expectancy: Not specified

Hematopoietic:

  • White blood cell count (WBC) > 3.5 K/mm3
  • Hemoglobin (Hgb) > 8.5 g/dL
  • Platelets > 100 K/mm3
  • Absolute neutrophil count (ANC) > 1.5 K/mm3

Hepatic:

  • Total Bilirubin < 1.25 x ULN
  • Aminotransferase (AST and ALT) < 2.5 x ULN

Renal:

  • Serum Creatinine < 2.5 x ULN (upper limit normal)

Cardiovascular:

  • No significant cardiovascular events within 6 months (CVA, CAD, peripheral arterial obstruction, arrhythmias, cardiac dysfunction) of registration for protocol therapy
  • No history of clinical CHF or LVEF <50% by Echo (or MUGA) within 30 days prior to registration for protocol therapy.

Studietype

Ingrijpend

Inschrijving (Werkelijk)

154

Fase

  • Fase 2
  • Fase 1

Contacten en locaties

In dit gedeelte vindt u de contactgegevens van degenen die het onderzoek uitvoeren en informatie over waar dit onderzoek wordt uitgevoerd.

Studie Locaties

    • New South Wales
      • Camperdown, New South Wales, Australië, 2050
        • Royal Prince Alfred Hospital: Sydney Cancer Centre
      • Randwick, New South Wales, Australië, 2031
        • Prince of Wales Hospital
      • Wahroonga, New South Wales, Australië, 2076
        • Sydney Adventist Hospital Ltd.
    • Queensland
      • Greenslopes, Queensland, Australië, 4120
        • Gallipoli Medical Research Foundation: Greenslopes Private Hospital
      • Herston, Queensland, Australië, 4029
        • Royal Brisbane & Women's Hospital
      • Woolloongabba, Queensland, Australië, 4201
        • Princess Alexandra Hospital
    • South Australia
      • Adelaide, South Australia, Australië, 5000
        • Royal Adelaide Hospital
      • Kurralta Park, South Australia, Australië, 5037
        • Ashford Cancer Centre
    • Tasmania
      • Launceston, Tasmania, Australië, 7250
        • Gallipoli Medical Research Foundation: Launceston General Hospital
    • Victoria
      • Frankston, Victoria, Australië, 3199
        • Peninsula Oncology Centre
      • Heidelberg, Victoria, Australië, 3084
        • Austin Hospital
      • Melbourne, Victoria, Australië, 3004
        • Alfred Hospital
    • Western Australia
      • Perth, Western Australia, Australië, 6000
        • Royal Perth Hospital
      • Singapore, Singapore, 169610
        • National Cancer Centre Singapore
    • Alabama
      • Muscle Shoals, Alabama, Verenigde Staten, 35661
        • Northwest Alabama Cancer Center
    • Arkansas
      • Hot Springs, Arkansas, Verenigde Staten, 71913
        • Genesis Cancer Center
    • California
      • Burbank, California, Verenigde Staten, 91505
        • Providence Health System: Roy and Patricia Disney Family Cancer Center
      • Corona, California, Verenigde Staten, 92879
        • Compassionate Cancer Care Medical Group, Inc.
      • Corona, California, Verenigde Staten, 92879
        • Compassionate Cancer Care Medical Group
      • Duarte, California, Verenigde Staten, 91010
        • City of Hope
      • Fountain Valley, California, Verenigde Staten, 92708
        • Robert A. Moss, M.D., FACP, Inc.
      • Fresno, California, Verenigde Staten, 93720
        • California Cancer Associates for Research and Excellence
      • Greenbrae, California, Verenigde Staten, 94904
        • Marin Specialty Care
      • Los Angeles, California, Verenigde Staten, 90017
        • Good Samaritan Hospital
      • Los Angeles, California, Verenigde Staten, 90095
        • UCLA Med - Hematology & Oncology
      • Riverside, California, Verenigde Staten, 92501
        • Compassionate Cancer Care Medical Group
      • Whittier, California, Verenigde Staten, 90603
        • American Institute of Research
    • Colorado
      • Denver, Colorado, Verenigde Staten, 80210
        • Centura Health Research Center
      • Golden, Colorado, Verenigde Staten, 80401
        • Western Oncology & Hematology
    • Florida
      • Brooksville, Florida, Verenigde Staten, 34613
        • Cancer Care Centers of Florida: Brooksville
      • Fort Lauderdale, Florida, Verenigde Staten, 33308
        • Broward Oncology Associates
      • Gainesville, Florida, Verenigde Staten, 32610
        • University of Florida, Shands Cancer Center
      • Jacksonville, Florida, Verenigde Staten, 32256
        • Cancer Specialists of North Florida
      • Miami, Florida, Verenigde Staten, 33136
        • Advanced Pharma Cr, Llc
      • New Port Richey, Florida, Verenigde Staten, 34652
        • Cancer Care Centers of Florida
      • Ocala, Florida, Verenigde Staten, 34471
        • Ocala Cancer Institute
      • Rockledge, Florida, Verenigde Staten, 32955
        • Cancer Care Centers of Brevard
    • Georgia
      • Athens, Georgia, Verenigde Staten, 30607
        • Northeast Georgia Cancer Care, LLC
      • Dublin, Georgia, Verenigde Staten, 31021
        • Dublin Hematology & Oncology Care
    • Idaho
      • Post Falls, Idaho, Verenigde Staten, 83854
        • Kootenai Cancer Center
    • Illinois
      • Chicago, Illinois, Verenigde Staten, 60611
        • Northwestern University, Robert H. Lurie Comprehensive Cancer Center
      • Galesburg, Illinois, Verenigde Staten, 61401
        • Medical & Surgical Specialists, LLC
      • Skokie, Illinois, Verenigde Staten, 60076
        • Edward H. Kaplan, M.D., & Associates
    • Indiana
      • Evansville, Indiana, Verenigde Staten, 47713
        • Deaconess Clinic
      • Fort Wayne, Indiana, Verenigde Staten, 46815
        • Fort Wayne Oncology & Hematology, Inc
      • Goshen, Indiana, Verenigde Staten, 46527
        • IU Health Goshen
      • Indianapolis, Indiana, Verenigde Staten, 46202
        • Indiana University Melvin and Bren Simon Cancer Center
      • Indianapolis, Indiana, Verenigde Staten, 46219
        • IU Health Central Indiana Cancer Centers
      • Indianapolis, Indiana, Verenigde Staten, 46256
        • Community Regional Cancer Center
      • Lafayette, Indiana, Verenigde Staten, 47905
        • Horizon Oncology Research
      • Muncie, Indiana, Verenigde Staten, 47303
        • IU Health at Ball Memorial Hospital Cancer Center
      • Munster, Indiana, Verenigde Staten, 46321
        • Monroe Medical Associates
      • Newburgh, Indiana, Verenigde Staten, 47630
        • Oncology Hematology Associates of SW Indiana
      • South Bend, Indiana, Verenigde Staten, 46601
        • Northern Indiana Cancer Research Consortium
    • Iowa
      • Sioux City, Iowa, Verenigde Staten, 51101
        • Siouxland Hematology Oncology Associates, LLP, Nylen Cancer Center
    • Kansas
      • Wichita, Kansas, Verenigde Staten, 67214
        • Cancer Center of Kansas
    • Kentucky
      • Hazard, Kentucky, Verenigde Staten, 41701
        • Kentucky Cancer Clinic
      • Paducah, Kentucky, Verenigde Staten, 42001
        • Purchase Cancer Group
    • Louisiana
      • Baton Rouge, Louisiana, Verenigde Staten, 70809
        • Medical Oncology LLC
      • Metairie, Louisiana, Verenigde Staten, 70006
        • Metairie Oncologists
    • Massachusetts
      • Boston, Massachusetts, Verenigde Staten, 02111
        • Tufts Medical Center
    • Michigan
      • Ann Arbor, Michigan, Verenigde Staten, 48106
        • St. Joseph Mercy Hospital
      • Grand Rapids, Michigan, Verenigde Staten, 49546
        • Cancer and Hematology Centers of Western Michigan
      • Wyoming, Michigan, Verenigde Staten, 49519
        • Metro Health Cancer Care
    • Minnesota
      • Rochester, Minnesota, Verenigde Staten, 55905
        • Mayo Clinic
    • Montana
      • Bozeman, Montana, Verenigde Staten, 59715
        • Bozeman Deaconness Cancer Center
      • Great Falls, Montana, Verenigde Staten, 59405
        • Sletten Cancer Specialists
    • Nebraska
      • Omaha, Nebraska, Verenigde Staten, 68114
        • Methodist Cancer Center
    • New Hampshire
      • Manchester, New Hampshire, Verenigde Staten, 03102
        • Dartmouth-Hitchcock Medical Center
    • New Jersey
      • Elizabeth, New Jersey, Verenigde Staten, 07202
        • Trinitas Regional Medical Center
      • Somerville, New Jersey, Verenigde Staten, 08876
        • Somerset Hematology Oncology Associates
    • New Mexico
      • Albuquerque, New Mexico, Verenigde Staten, 87110
        • Presbyterian Medical Group
      • Albuquerque, New Mexico, Verenigde Staten, 87131
        • University of New Mexico Cancer Center: Albuquerque
    • New York
      • Albany, New York, Verenigde Staten, 12208
        • New York Oncology Hematology, PC
      • Buffalo, New York, Verenigde Staten, 14263
        • Roswell Park Cancer Institute
      • Lake Success, New York, Verenigde Staten, 11042
        • NYU Langone Arena Oncology
      • New York, New York, Verenigde Staten, 10029
        • Tisch Cancer Institute at Mount Sinai Medical Center
      • Nyack, New York, Verenigde Staten, 10960
        • Hematology Oncology Associates of Rockland
    • North Carolina
      • Pinehurst, North Carolina, Verenigde Staten, 28374
        • First Health of the Carolinas
    • Ohio
      • Middletown, Ohio, Verenigde Staten, 45042
        • Signal Point Clinical Research Center
      • Wooster, Ohio, Verenigde Staten, 44691
        • Lawrence M. Stallings, M.D.
    • Oklahoma
      • Oklahoma City, Oklahoma, Verenigde Staten, 73120
        • Mercy Physicians Of Oklahoma
    • Oregon
      • Springfield, Oregon, Verenigde Staten, 97477
        • Willamette Valley Cancer Institute
    • Pennsylvania
      • Danville, Pennsylvania, Verenigde Staten, 17822
        • Geisinger Medical Center
      • Gettysburg, Pennsylvania, Verenigde Staten, 17235
        • Gettysburg Cancer Center
      • Pittsburgh, Pennsylvania, Verenigde Staten, 15212
        • Allegheny Cancer Center
      • State College, Pennsylvania, Verenigde Staten, 16803
        • Mount Nittany Medical Center
      • West Reading, Pennsylvania, Verenigde Staten, 19611
        • Berks Hematology Oncology Associates
    • Rhode Island
      • Cranston, Rhode Island, Verenigde Staten, 02920
        • Hematology and Oncology Associates of Rhode Island
    • South Carolina
      • Charleston, South Carolina, Verenigde Staten, 29425
        • MUSC Hollings Cancer Center
      • Hilton Head Island, South Carolina, Verenigde Staten, 29926
        • South Carolina Cancer Specialists
    • Tennessee
      • Germantown, Tennessee, Verenigde Staten, 38138
        • The Jones Clinic, PC
    • Texas
      • Austin, Texas, Verenigde Staten, 78758
        • Texas Oncology: Austin North
      • Bedford, Texas, Verenigde Staten, 76022
        • Texas Oncology: Bedford
      • Dallas, Texas, Verenigde Staten, 75246
        • Texas Oncology, PA
      • Fort Worth, Texas, Verenigde Staten, 76104
        • Texas Oncology: Fort Worth
      • Houston, Texas, Verenigde Staten, 77030
        • Methodist Hospital Research Institute
      • Houston, Texas, Verenigde Staten, 77024
        • Texas Oncology: Houston Memorial City
      • Houston, Texas, Verenigde Staten, 77055
        • Houston Cancer Center
      • Lubbock, Texas, Verenigde Staten, 79410
        • Joe Arrington Cancer Research and Treatment Center
      • San Antonio, Texas, Verenigde Staten, 78229
        • CTRC at the UT Health Science Center at San Antonio
    • Virginia
      • Lynchburg, Virginia, Verenigde Staten, 24501
        • Lynchburg Hematology Oncology Clinic, Inc.
    • Washington
      • Bremerton, Washington, Verenigde Staten, 98310
        • Harrison HealthPartners Bremerton Hematology & Oncology
      • Kirkland, Washington, Verenigde Staten, 98034
        • Cascade Cancer Center
      • Seattle, Washington, Verenigde Staten, 98109
        • University of Washington, Seattle Cancer Care Alliance
      • Seattle, Washington, Verenigde Staten, 98109
        • Group Health Medical Centers
      • Spokane, Washington, Verenigde Staten, 99204
        • Rockwood Clinic
    • Wisconsin
      • Milwaukee, Wisconsin, Verenigde Staten, 53226
        • University of Wisconsin, Clinical Cancer Center

Deelname Criteria

Onderzoekers zoeken naar mensen die aan een bepaalde beschrijving voldoen, de zogenaamde geschiktheidscriteria. Enkele voorbeelden van deze criteria zijn iemands algemene gezondheidstoestand of eerdere behandelingen.

Geschiktheidscriteria

Leeftijden die in aanmerking komen voor studie

18 jaar en ouder (Volwassen, Oudere volwassene)

Accepteert gezonde vrijwilligers

Nee

Geslachten die in aanmerking komen voor studie

Allemaal

Beschrijving

Inclusion Criteria:

  • Histological or cytological proof of component (any percent) of clear cell RCC (renal cell carcinoma).
  • Metastatic or locally advanced unresectable RCC. NOTE: Prior nephrectomy is not mandatory.
  • Progressive disease after 1-2 prior VEGF-directed tyrosine kinase inhibitors (TKIs).
  • Measurable disease according to RECIST and obtained by imaging within 30 days prior to registration for protocol therapy.
  • Written informed consent and HIPAA authorization for release of personal health information.
  • Age > 18 years at the time of consent.
  • Females of childbearing potential and males must be willing to use an effective method of contraception (hormonal or barrier method of birth control; abstinence) from the time consent is signed until 4 weeks after treatment discontinuation.
  • Females of childbearing potential must have a negative pregnancy test within 7 days prior to registration for protocol therapy.

Exclusion Criteria:

  • No active brain metastases. Patients with neurological symptoms must undergo a head CT scan or brain MRI to exclude brain metastasis within 30 days prior to registration on protocol therapy. NOTE: A patient with prior brain metastasis are eligible if they have completed their radiation treatment for brain metastasis ≥30 days prior to registration for protocol therapy, are off steroids, and are asymptomatic.
  • No other currently active malignancy.
  • No treatment with any investigational agent within 14 days prior to registration for protocol therapy. NOTE: If treated with investigational agent within 14 days prior to registration, AE must be resolved back to baseline.
  • Prior cancer treatment must be completed at least 14 days prior to registration for protocol therapy and the patient must have recovered from the acute toxic effects of the regimen. With the exception of Bevacizumab treatment, which must be completed 30 days prior to registration for protocol therapy.
  • Prior radiation therapy to < 25% of the bone marrow [see bone marrow radiation chart in the study procedure manual (SPM)] allowed if completed within 30 days prior to registration for protocol therapy.
  • Corrected QT interval (QTc) ≤ 450 msec at least 7 days prior to registration for protocol therapy.
  • No clinically significant infections as judged by the treating investigator.
  • No liver disease such as cirrhosis, chronic active hepatitis or chronic persistent hepatitis.
  • No collecting duct, medullary or sarcomatoid histology.
  • No prior treatment with temsirolimus or everolimus in the phase II component of the study. NOTE: Prior treatment with these agents is permitted in the phase I component of the study.
  • No use of full dose, therapeutic anti-coagulation with warfarin or related anti-coagulants or unfractionated or low molecular weight heparins.
  • No uncontrolled hypertension (BP >150/100mmHg despite full doses of 1 anti-hypertensive medication).
  • No thrombotic event within 6 months (deep vein thrombosis, pulmonary embolism) of registration for protocol therapy.
  • No grade 2 or greater peripheral neuropathy.

Studie plan

Dit gedeelte bevat details van het studieplan, inclusief hoe de studie is opgezet en wat de studie meet.

Hoe is de studie opgezet?

Ontwerpdetails

  • Primair doel: Behandeling
  • Toewijzing: Gerandomiseerd
  • Interventioneel model: Parallelle opdracht
  • Masker: Geen (open label)

Wapens en interventies

Deelnemersgroep / Arm
Interventie / Behandeling
Actieve vergelijker: Combination Arm A: Everolimus + BNC105P
Combination Arm A: Everolimus 10 mg, BNC105P MTD (from Phase 1 study) 21 day cycle
Everolimus 10 mg. Taken orally, every evening, 1 hr before or 2 hrs after meals
BNC105P, up to 16 mg/m^2
Actieve vergelijker: Sequential Arm B:Everolimus followed by BNC105P Monotherapy

Sequential Arm B: Everolimus 10 mg, 21 day cycle

Patients to receive BNC105P monotherapy at 16 mg/m2 following progression or intolerable toxicity on everolimus therapy.

Everolimus 10 mg. Taken orally, every evening, 1 hr before or 2 hrs after meals
BNC105P, up to 16 mg/m^2

Wat meet het onderzoek?

Primaire uitkomstmaten

Uitkomstmaat
Maatregel Beschrijving
Tijdsspanne
Phase I: Maximum Tolerated Dose of BNC105P in Combination With Everolimus.
Tijdsspanne: Until disease progression or unacceptable toxicity, up to 24 cycles or 24 months
Phase I
Until disease progression or unacceptable toxicity, up to 24 cycles or 24 months
Phase I: Toxicities of BNC105P in Combination With Everolimus.
Tijdsspanne: Until disease progression or unacceptable toxicity, up to 24 cycles or 24 months
Determine the toxicities of BNC105P in combination with everolimus. Drug-related treatment emergent adverse events by CTCAE grade 2 or greater are reported
Until disease progression or unacceptable toxicity, up to 24 cycles or 24 months
Phase II: 6-month Progression Free Survival (PFS) With the Addition of BNC105P to Everolimus.
Tijdsspanne: 6 months
Improvement in 6-month PFS with the addition of BNC105P to everolimus. Progression is defined using RECIST criteria as at least a 20% increase in the sum of the LD of target lesions, taking as reference the smallest sum LD recorded since the treatment started or the appearance of one or more new lesions
6 months

Secundaire uitkomstmaten

Uitkomstmaat
Maatregel Beschrijving
Tijdsspanne
Phase I: Response Rate of BNC105P in Combination With Everolimus.
Tijdsspanne: Until disease progression or unacceptable toxicity, up to 24 cycles or 24 months
Number of objective responses per RECIST criteria. Complete Response (CR): Disappearance of all target lesions. Partial Response (PR): At least a 30% decrease in the sum of the LD of target lesions, taking as reference the baseline sum LD. Progressive Disease (PD): At least a 20% increase in the sum of the LD of target lesions, taking as reference the smallest sum LD recorded since the treatment started or the appearance of one or more new lesions. Stable Disease (SD): Neither sufficient shrinkage to qualify for PR nor sufficient increase to qualify for PD, taking as reference the smallest sum LD since the treatment started.
Until disease progression or unacceptable toxicity, up to 24 cycles or 24 months
Geometric Mean Half-life of BNC105 and BNC105P in Combination With Everolimus.
Tijdsspanne: 12 months
Determine the PK Profile for BN105P in combination with everolimus by calculating the geometric mean half-life of BNC105P
12 months
Phase II: Response Rate With Combination Therapy Compared to Everolimus Alone
Tijdsspanne: 12 months
Objective response is defined as a confirmed CR or PR per RECIST criteria. Complete Response (CR): Disappearance of all target lesions. Partial Response (PR): At least a 30% decrease in the sum of the LD of target lesions, taking as reference the baseline sum LD. Progressive Disease (PD): At least a 20% increase in the sum of the LD of target lesions, taking as reference the smallest sum LD recorded since the treatment started or the appearance of one or more new lesions. Stable Disease (SD): Neither sufficient shrinkage to qualify for PR nor sufficient increase to qualify for PD, taking as reference the smallest sum LD since the treatment started.
12 months
Phase II: Progression Free Survival (PFS) With BNC105P Alone in Patients After Progressing on Everolimus.
Tijdsspanne: 12 months
Median time to progression for arm P participants who crossed over to BNC105P monotherapy after progression. Progression is defined per RECIST criteria as at least a 20% increase in the sum of the LD of target lesions, taking as reference the smallest sum LD recorded since the treatment started or the appearance of one or more new lesions
12 months
Phase II: Adverse Events of Everolimus and BNC105P When Administered as a Combination or Sequential Regimen.
Tijdsspanne: 12 months
Determine adverse events of everolimus and BNC105P when administered as a combination or sequential regimen. Total number of serious and non-serious adverse events for Arm A and Arm B are summarized. Complete adverse event information is supplied in the Adverse Events reporting section.
12 months
Phase II: Overall Survival
Tijdsspanne: 60 months
Determine overall survival probability, up to a maximum of 5 years from registration for protocol therapy.
60 months
Exploratory Objective: Correlation of PFS With Biomarkers
Tijdsspanne: 6 months
Exploratory analysis of serum biomarkers were undertaken to generate a potential signature for response. The correlation with 6 month progression free survival P value for four plasma biomarkers is reported.
6 months

Medewerkers en onderzoekers

Hier vindt u mensen en organisaties die betrokken zijn bij dit onderzoek.

Medewerkers

Onderzoekers

  • Studie stoel: Thomas Hutson, D.O., Hoosier Cancer Research Network

Publicaties en nuttige links

De persoon die verantwoordelijk is voor het invoeren van informatie over het onderzoek stelt deze publicaties vrijwillig ter beschikking. Dit kan gaan over alles wat met het onderzoek te maken heeft.

Algemene publicaties

Studie record data

Deze datums volgen de voortgang van het onderzoeksdossier en de samenvatting van de ingediende resultaten bij ClinicalTrials.gov. Studieverslagen en gerapporteerde resultaten worden beoordeeld door de National Library of Medicine (NLM) om er zeker van te zijn dat ze voldoen aan specifieke kwaliteitscontrolenormen voordat ze op de openbare website worden geplaatst.

Bestudeer belangrijke data

Studie start

1 januari 2010

Primaire voltooiing (Werkelijk)

1 december 2016

Studie voltooiing (Werkelijk)

1 december 2016

Studieregistratiedata

Eerst ingediend

15 december 2009

Eerst ingediend dat voldeed aan de QC-criteria

15 december 2009

Eerst geplaatst (Schatting)

17 december 2009

Updates van studierecords

Laatste update geplaatst (Werkelijk)

11 juli 2022

Laatste update ingediend die voldeed aan QC-criteria

7 juli 2022

Laatst geverifieerd

1 april 2017

Meer informatie

Deze informatie is zonder wijzigingen rechtstreeks van de website clinicaltrials.gov gehaald. Als u verzoeken heeft om uw onderzoeksgegevens te wijzigen, te verwijderen of bij te werken, neem dan contact op met register@clinicaltrials.gov. Zodra er een wijziging wordt doorgevoerd op clinicaltrials.gov, wordt deze ook automatisch bijgewerkt op onze website .

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