Platinum Chemotherapy Plus Paclitaxel With Bevacizumab and Atezolizumab in Metastatic Carcinoma of the Cervix

NCT ID: NCT03556839

Last Updated: 2025-01-08

Basic Information

• Recruitment Status: ACTIVE_NOT_RECRUITING
• Clinical Phase: PHASE3
• Total Enrollment: 410 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2018-09-25
• Study Completion Date: 2025-08-31

Brief Summary

The study will integrate the efficacy of combining the anti programmed death-ligand 1 (anti-PD-L1) agent atezolizumab with the current standard of care in Stage IVB , persistent or recurrent carcinoma of the cervix, namely cisplatin or carboplatin/paclitaxel/bevacizumab. It will be explored the combination of bevacizumab plus atezolizumab, with no patient selection based on PD-L1 expression, allowing an all-comer assessment of atezolizumab activity.

The study is a randomized open label phase III trial to investigate the impact of atezolizumab in combination with bevacizumab and cisplatin or carboplatin /paclitaxel chemotherapy on overall survival and will employ the intent to treat principle, and random assignment to one of the 2 arms will be balanced according to disease histology (squamous cell carcinoma vs adenocarcinoma), prior platinum therapy as a radiation sensitizer (no prior cis-Radiotherapy (RT) versus prior cis-RT) and chemotherapy backbone (cisplatin vs carboplatin).

This trial will be run in an open label design due to the following considerations: the control arm is the standard of care for women diagnosed with metastatic, persistant or recurrent cervical cancer because of its impact on overall survival and the primary endpoint of the study is overall survival (OS), so blinding is not needed to ensure a robust assessment.

Detailed Description

Given that both Vascular Endothelial Growth Factor (VEGF) and PD-L1 appear important in cervical cancer pathogenesis, this study is designed to test the hypothesis that breaking of immune tolerance by PD-1/PD-L1 blockade will enhance the efficacy of anti-VEGF therapy in the treatment of patients with metastatic , persistent or recurrent cervical cancer. There are several data suggesting that atezolizumab and bevacizumab may be synergistic. Enhanced tumor angiogenesis is commonly associated with absence of tumor-infiltrating T cells in patients. There is evidence in ovarian cancer that tumor expression of VEGF is negatively correlated to the density of CD8+ TILs and this phenotype is associated with early recurrence, consistent with prior studies showing a correlation of VEGF to early recurrence and short survival. Furthermore, in ascites, high levels of VEGF correlate to low numbers of NK T-like CD3+CD56+ cells.

In addition to promoting tumor angiogenesis, there is increasing evidence that VEGF plays a role in cancer immune evasion through several different mechanisms. Indeed, emerging evidence suggests that the endothelium acts as a selective barrier, allowing certain T cell subsets, notably T regulatory (Treg) cells, to traffic more effectively into the tumor contributing to tumor immune tolerance. In addition, some experiments have shown that tumour hypoxia promotes the recruitment of regulatory T (T reg) cells through induction of expression of the chemokine CC-chemokine ligand 28 (CCL28), which, in turn, promotes tumour tolerance and angiogenesis.

Some immunosuppressive activities of VEGF, however, can be reversed by inhibition of VEGF signaling. Mice exposed to pathophysiologic levels of VEGF exhibited impaired dendritic cell function, which could be restored by blockade of VEGFR2.

In turn, the anti-tumor effect of angiogenesis blockade requires CD8+ T cells supporting the notion that VEGF-A do not simply promote tumor growth through angiogenesis. Thus, peripheral immune tolerance and angiogenesis programs seem closely connected and cooperating to sustain tumour growth.

In addition, there is evidence that anti-VEGF therapy and immunotherapy act synergistically. Motz et al have suggested that the combination of anti-VEGF-A antibody and immunotherapy with adoptive T cell transfer led to a superior infiltration of tumor-reactive T cells than any single approach. Indeed, in a murine melanoma model, VEGF blockade synergized with adoptive immunotherapy, as evidenced by improved anti-tumor activity, prolonged survival, and increased trafficking of T cells into tumors. These data are reminiscent of the additive benefit observed in patients by combining recombinant interferon-alpha therapy and bevacizumab, a recombinant, humanized therapeutic antibody directed against VEGF, for the treatment of metastatic renal cell carcinoma.

More evidence has come from a clinical study of subjects with melanoma combining the checkpoint inhibitor (anti-CTLA-4) ipilimumab and bevacizumab. In 46 patients, the combined therapy yielded a 19.6% objective response rate, stable disease in 13%. All responses were durable >6 months and median survival was 25.1 months, much prolonged compared to ipilimumab's expectation in metastatic melanoma. Activated vessel endothelium with extensive CD8+ T cell and macrophage cell infiltration was observed in post-treatment biopsies, as well as marked increases in CD4/CCR7/CD45ROm central memory cells in peripheral blood in the majority of patients.

Thus, an emerging paradigm supported by the data above is that angiogenesis and immune suppression are two facets of a linked biological program. Tumors seem to co-opt these existing mechanisms that are normally required to limit excessive inflammation and promote tissue recovery during infection or wound healing. The execution of this program sustains tumor growth and promotes immunologic tolerance. Because of the intimate relationship between angiogenesis and immunosuppression, it is thus expected that inhibiting both pathways will result in improved and more durable clinical benefit.

Conditions

Carcinoma of the Cervix, Stage IVB

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: NONE

Study Groups

Arm A

Cisplatin 50mg/m2 or carboplatin AUC 5 + paclitaxel 175mg/m2+ bevacizumab 15mg/kg i.v D1 Q3W. Patients who achieve a complete response after ≥6 treatment cycles may be allowed to continue only on biologic therapy, namely bevacizumab, upon investigator discussion.

Group Type: ACTIVE_COMPARATOR

Bevacizumab

Intervention Type: DRUG

Intravenous Infusion

Cisplatin/Carboplatin

Intervention Type: DRUG

Intravenous Infusion

Paclitaxel

Intervention Type: DRUG

Intravenous Infusion

Arm B

cisplatin 50mg/m2 or carboplatin AUC 5 + paclitaxel 175mg/m2 + bevacizumab 15mg/kg + atezolizumab 1200mg i.v, D1 Q3W.Patients who achieve a complete response after ≥6 treatment cycles may be allowed to continue only on biologics therapy, namely bevacizumab plus atezolizumab, upon investigator discussion.

Group Type: EXPERIMENTAL

Atezolizumab

Intervention Type: DRUG

Intravenous Infusion

Bevacizumab

Intervention Type: DRUG

Intravenous Infusion

Cisplatin/Carboplatin

Intervention Type: DRUG

Intravenous Infusion

Paclitaxel

Intervention Type: DRUG

Intravenous Infusion

Interventions

Atezolizumab

Intravenous Infusion

Intervention Type: DRUG

Bevacizumab

Intravenous Infusion

Intervention Type: DRUG

Cisplatin/Carboplatin

Intravenous Infusion

Intervention Type: DRUG

Paclitaxel

Intravenous Infusion

Intervention Type: DRUG

Other Intervention Names

Tecentriq; Avastin

Eligibility Criteria

Inclusion Criteria

1. Female patients must be ≥18 years of age.

2. Signed informed consent before any study-specific procedure

3. Able (in the investigator´s judgment) to comply with the study protocol

4. GOG/Eastern Cooperative Oncology Group (ECOG) performance status of 0-1

5. Life expectancy ≥3 months

6. Histologically- or cytologically-confirmed diagnosis of metastatic (stage IVB), persistent, or recurrent cervical cancer (histologies other than squamous cell, adenocarcinoma, or adenosquamous will be excluded) not amenable for curative treatment with surgery and/or radiation therapy. The inclusion of patients with adenocarcinoma histology will be capped to 20% of the whole study population.

7. No prior systemic anti-cancer therapy for metastatic or recurrent disease.

8. Measureable disease by RECIST v1.1 criteria.

9. A tumor specimen is mandatory at study entry.

10. Adequate organ function:

Hemoglobin ≥9 g/dL ANC ≥1.5 × 109/L Lymphocyte count ≥0.5 × 109/L Platelet count ≥100 x 109/L

11. Adequate liver function:

Serum albumin ≥2.5 g/dL Total serum bilirubin ≤1.5 ×ULN AST and ALT ≤2.5 × upper limit normal (ULN) or ≤5 × ULN if tumor involvement (liver) is present

12. Adequate renal function:

Patients with serum creatinine <1.5 × ULN Urine dipstick for proteinuria <2+.

13. Adequate coagulation:

Blood coagulation parameters (PTT, PT/INR): PT such that international normalized ratio (INR) is ≤ 1.5 (or an in-range INR, usually between 2 and 3, if a patient is on a stable dose of therapeutic warfarin for management of venous thrombosis including pulmonary thromboembolus) and a PTT <1.5 × ULN.

14. Negative Test Results for Hepatitis:

Negative hepatitis B surface antigen (HBsAg) test at screening Negative total hepatitis B core antibody (HBcAb) test at screening, or positive total HBcAb test followed by a negative hepatitis B virus (HBV) DNA test at screening.The HBV DNA test will be performed only for patients who have a positive total HBcAb test.

Negative hepatitis C virus (HCV) antibody test at screening, or positive HCV antibody test followed by a negative HCV RNA test at screening.The HCV RNA test will be performed only for patients who have a positive HCV antibody test.

15. Toxicities related to previous treatments must be recovered to < grade 2 (with the exception of alopecia).

16. Female participants must be postmenopausal (≥ 12 months of non-therapy-induced amenorrhoea) or surgically sterile (absence of ovaries and/or uterus, or who received therapeutic radiation to the pelvis) or otherwise have a negative serum pregnancy test within 7 days of the first study treatment and agree to abstain from heterosexual intercourse or use single or combined contraceptive methods that result in a failure rate of <1% per year during the whole treatment period of the study and for at least 5 months (if the last study dose contained atezolizumab) or 6 months (if the last study dose contained bevacizumab) after the last dose of study treatment.

• Abstinence is acceptable only if it is in line with the preferred and usual lifestyle of the patient. Periodic abstinence (e.g., calendar, ovulation, symptothermal or postovulation methods) and withdrawal are not acceptable methods of contraception

Exclusion Criteria

1. Disease that is suitable for local therapy administered with curative intent

2. Prior radiotherapy delivered using cobalt (rather than a linear accelerator)

3. Patients with Stage IVA not amendable to concurrent chemo-radiation as primary treatment will not be eligible.

4. Ongoing disease involving the bladder or rectum at screening/baseline

5. Evidence of abdominal free air

6. Bilateral hydronephrosis, unless it can be alleviated by ureteral stent(s) or percutaneous drainage

7. Patients previously treated with chemotherapy except when used concurrently with radiation therapy. Patients who have received either concurrent paclitaxel with radiation therapy or carboplatin/paclitaxel as adjuvant therapy are ineligible for the study.

8. Prior treatment with any anti-VEGF drug, including bevacizumab, CD137 agonists or immune checkpoint blockade therapies, anti-PD1, or anti-PDL1 therapeutic antibodies or anti-CTLA 4.

9. Patients with a concomitant malignancy other than non-melanoma skin cancer. Patients with a prior invasive malignancy (except non-melanoma skin cancer ) who have had any evidence of disease within the last 5 years or whose prior malignancy treatment contraindicates the current protocol therapy.

10. Known brain metastases or spinal cord compression. It is mandatory to perform a scan of the brain in cases of suspected brain metastases (CT or MRI) or spinal cord compression (MRI).

11. History or evidence, following a neurological examination, of central nervous system (CNS) disorders, unless properly treated with standard medical treatment,(e.g. uncontrolled epileptic seizures). History of cerebrovascular accident (CVA, stroke), transient ischemic attack (TIA) or subarachnoid hemorrhage within six months of the first date of treatment on this study.

12. Patients with serious non-healing wound, ulcer, or bone fracture.

13. Acute intestinal obstruction or sub-occlusion episode in the last 6 months.

14. Active GI bleeding or GI ulcer

15. History of Crohn's disease or inflammatory bowel disease

16. Prior bowel resection ≤6 weeks preceding first study dose

17. History of diverticulitis requiring medical intervention

18. NCI CTCAE (version 5.0) grade ≥2 enteritis

19. Major surgical procedure, open biopsy or significant traumatic injury within 28 days prior to Day 1, Cycle 1.

20. Core biopsy or other minor surgical procedure, excluding placement of a vascular access device, within 7 days prior to Day 1, Cycle 1.

21. Patients with active bleeding or pathologic conditions that carry high risk of bleeding, such as known bleeding disorder, coagulopathy, or tumor involving major vessels.

22. Current or recent (within 10 days before the first dose of study drug) chronic daily treatment with aspirin (>325 mg/day), clopidogrel (>75 mg/day), or current or recent (within 10 days before first dose of bevacizumab) use of therapeutic oral or parenteral anticoagulants or thrombolytic agents for therapeutic purposes.

23. Patients with pre-existing Grade 2 or greater peripheral neuropathy.

24. History of any grade ≥3 venous thromboembolic event (VTE)

25. Patients with clinically significant cardiovascular disease.

26. Left ventricular ejection fraction defined by MUGA/ECHO below the institutional lower limit of normal.

27. Uncontrolled tumor-related pain

28. Uncontrolled pleural effusion, pericardial effusion, or ascites requiring recurrent drainage procedures (once monthly or more frequently). Patients with indwelling catheters (e.g., PleurX) are allowed.

29. Uncontrolled hypercalcemia (>1.5 mmol/L ionized calcium or calcium >12 mg/dL or corrected serum calcium > ULN) or symptomatic hypercalcemia requiring continued use of bisphosphonate therapy or denosumab.

30. History of autoimmune disease, including but not limited to myasthenia gravis, myositis, autoimmune hepatitis, systemic lupus erythematosus, rheumatoid arthritis, inflammatory bowel disease, vascular thrombosis associated with antiphospholipid syndrome, Wegener's granulomatosis, Sjögren's syndrome, Guillain-Barré syndrome, multiple sclerosis, vasculitis, glomerulonephritis or celiac disease.

History of idiopathic pulmonary fibrosis, organizing pneumonia (e.g., bronchiolitis obliterans), drug-induced pneumonitis, idiopathic pneumonitis, or evidence of active pneumonitis on screening chest CT scan

31. History of radiation pneumonitis in the radiation field (fibrosis) is permitted.

32. Active tuberculosis

33. Severe infections within 4 weeks prior to Cycle 1, Day 1, including but not limited to hospitalization for complications of infection, bacteremia, or severe pneumonia

34. Signs or symptoms of infection within 2 weeks prior to Cycle 1, Day 1

35. Received therapeutic oral or IV antibiotics within 2 weeks prior to Cycle 1, Day 1

36. Known human immunodeficiency virus (HIV)

37. Administration of a live, attenuated vaccine within 4 weeks before Cycle 1, Day 1 or anticipation that such a live attenuated vaccine will be required during the study Influenza vaccination should be given during influenza season only

38. Any other diseases, metabolic dysfunction, physical examination finding, or clinical laboratory finding giving reasonable suspicion of a disease or condition that contraindicates the use of an investigational drug or that may affect the interpretation of the results or render the patient at high risk from treatment complications

39. Treatment with systemic immunostimulatory agents (including but not limited to IFNs, IL-2) within 6 weeks or 5 half-lives of the drug, whichever is shorter, prior to Cycle 1, Day 1

40. Treatment with systemic immunosuppressive medications (including but not limited to prednisone, cyclophosphamide, azathioprine, methotrexate, thalidomide, and anti-tumor necrosis factor [anti-TNF] agents) within 2 weeks prior to Cycle 1, Day 1 The use of corticosteroids is allowed as premedication for paclitaxel-based regimen. All patients should be premedicated prior to receiving chemotherapy (including with corticosteroids) according to the prescription information of paclitaxel and cisplatin/carboplatin and the institutional standard of care guidance.

41. Currently participating or has participated in a study of an investigational agent and received study therapy or used an investigational device within 4 weeks prior to the first dose of study treatment.

42. Prior anti-cancer monoclonal antibody (mAb), prior chemotherapy, targeted small molecule therapy as first line treatment for the treatment of metastatic or recurrent cervical cancer.

43. Women that are breastfeeding or pregnant

44. Known hypersensitivity to bevacizumab, atezolizumab or any of theirs excipients (including Cremophor)

45. Demonstration of any other neurological or metabolic dysfunction, found upon physical examination or laboratory tests involving a reasonable suspicion of the existence of a disease or condition that contraindicates the use of an experimental drug, or that involves an increased risk to the patient of treatment-related complications

46. No medical or psychiatric illness that may impede the performance of a systemic or surgical treatment.

• Minimum Eligible Age: 18 Years
• Eligible Sex: FEMALE
• Accepts Healthy Volunteers: No

Sponsors

ARCAGY/ GINECO GROUP

OTHER

Sponsor Role: collaborator

Multicenter Italian Trials in Ovarian cancer and gynecologic malignancies

UNKNOWN

Sponsor Role: collaborator

MaNGO

UNKNOWN

Sponsor Role: collaborator

NSGO

UNKNOWN

Sponsor Role: collaborator

Japanese Gynecologic Oncology Group

OTHER

Sponsor Role: collaborator

Gynecologic Oncology Group Foundation

UNKNOWN

Sponsor Role: collaborator

AGO Study Group

OTHER

Sponsor Role: collaborator

Apices Soluciones S.L.

INDUSTRY

Sponsor Role: collaborator

Hoffmann-La Roche

INDUSTRY

Sponsor Role: collaborator

Grupo Español de Investigación en Cáncer de Ovario

OTHER

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

Ana Oaknin, MD PhD

Role: PRINCIPAL_INVESTIGATOR

Vall d´Hebron University Hospital

Locations

Willis Knighton Cancer Center

Shreveport, Louisiana, United States

Massey Cancer Center

Richmond, Virginia, United States

ICO Paul Papin

Angers, , France

CHU Jean Minjoz

Besançon, , France

Institut Bergonié

Bordeaux, , France

Centre François Baclesse

Caen, , France

Centre Oscar Lambret

Lille, , France

Centre Léon Bérard

Lyon, , France

ICM Val d'Aurelle

Montpellier, , France

Hôpital Privé du Confluent S.A.S.

Nantes, , France

Centre Antoine Lacassagne

Nice, , France

Groupe Hospitalier Diaconesses-Croix Saint-Simon

Paris, , France

HEGP

Paris, , France

Centre Hospitalier Lyon Sud

Pierre-Bénite, , France

Centre CARIO-HPCA

Plérin, , France

ICO Centre René Gauducheau

Saint-Herblain, , France

Hôpitaux Universitaires

Strasbourg, , France

Institut Claudius Régaud

Toulouse, , France

Gustave Roussy

Villejuif, , France

Universitätsmedizin Mainz

Mainz, , Germany

Helios-Klinikum Wuppertal

Wuppertal, , Germany

Fondazione Del Piemonte Per L'Oncologia

Candiolo, , Italy

Azienda Ospedaliero-Universitaria Di Ferrara

Ferrara, , Italy

Ospedale Lecce 'Vito Fazzi'

Lecce, , Italy

ASST Lecco

Lecco, , Italy

Irst Irccs

Meldola FC, , Italy

Irccs S. Raffaele - Milano

Milan, , Italy

Istituto Europeo di Oncologia

Milan, , Italy

Ospedale San Gerardo

Monza, , Italy

Istituto Nazionale Tumori Di Napoli Irccs Pascale

Napoli, , Italy

Istituto Oncologico Veneto (IOV) IRCCS

Padua, , Italy

Azienda Ospedaliero Universitaria Pisana

Pisa, , Italy

AUSL Romagna - P.O. di Ravenna, Lugo, Faenza, Rimini e Cattolica

Ravenna, , Italy

Azienda Usl - Irccs Di Reggio Emilia

Reggio Emilia, , Italy

Policlinico Universitario A. Gemelli

Roma, , Italy

AOU Città della Salute e della Scienza di Torino, Presidio Sant'Anna

Torino, , Italy

Ospedale Ordine Mauriziano

Torino, , Italy

Azienda Sanitaria Universitaria Integrata Di Udine

Udine, , Italy

Kurume University Hospital

Fukuoka, , Japan

Saitama medical university international medical center

Hidaka, , Japan

Hokkaido Cancer Center

Hokkaido, , Japan

Hyogo Cancer Center

Hyōgo, , Japan

Cancer Institute Hospital

Kōtoku, , Japan

Niigata University Medical & Dental Hospital

Niigata, , Japan

Shizuoka Cancer Center

Shizuoka, , Japan

Keio University Hospital

Tokyo, , Japan

Haukeland University Hospital

Bergen, , Norway

Oslo University Hospital

Oslo, , Norway

University Hospital of North Norway

Tromsø, , Norway

Hospital Universitario Son Espases

Palma de Mallorca, Balearic Islands, Spain

Intitut Català d' Oncolgia L' Hospitalet

L'Hospitalet de Llobregat, Barcelona, Spain

Parc Taulí

Sabadell, Barcelona, Spain

Hospital Universitario Donostia- Donostia Unibertsitate Ospitalea

Donostia / San Sebastian, Gipuzkoa, Spain

Hospital de la Vall d'Hebron

Barcelona, , Spain

H. Clínic Barcelona

Barcelona, , Spain

Hospital Reina Sofía Cordoba

Córdoba, , Spain

ICO Girona

Girona, , Spain

Hospital Ramon y Cajal

Madrid, , Spain

Hospital Universitario 12 de Octubre

Madrid, , Spain

Hospital Universitario La Paz

Madrid, , Spain

Complejo Hospitalario Regional de Málaga

Málaga, , Spain

Hospital Clinico Universitario Virgen Arrixaca

Murcia, , Spain

Hosptial Clinico Universitario de Santiago de Compostela

Santiago de Compostela, , Spain

Hospital Virgen de la Salud

Toledo, , Spain

Instituto Valenciano de Oncología

Valencia, , Spain

Hospital Clínico Universitario de Valencia

Valencia, , Spain

Hospital Quirón de Valencia

Valencia, , Spain

Hospital Miguel Servet

Zaragoza, , Spain

Lindköping University Hospital

Linköping, , Sweden

Skane University Hospital

Lund, , Sweden

Karolinska University Hospital

Stockholm, , Sweden

Uppsala University Hospital

Uppsala, , Sweden

Countries

United States; France; Germany; Italy; Japan; Norway; Spain; Sweden

References

Takekuma M, Nishio S, Yamaguchi S, Yunokawa M, Nishio H, Nishino K, Kurosaki A, Minobe S, Villacampa G, Oaknin A, Okamoto A. Atezolizumab, bevacizumab, and platinum chemotherapy in cervical cancer: results of Japanese population from BEATcc. J Gynecol Oncol. 2025 May 19. doi: 10.3802/jgo.2025.36.e116. Online ahead of print.

Reference Type: DERIVED

PMID: 40968753 (View on PubMed)

Oaknin A, Gladieff L, Martinez-Garcia J, Villacampa G, Takekuma M, De Giorgi U, Lindemann K, Woelber L, Colombo N, Duska L, Leary A, Godoy-Ortiz A, Nishio S, Angelergues A, Rubio MJ, Farinas-Madrid L, Yamaguchi S, Lorusso D, Ray-Coquard I, Manso L, Joly F, Alarcon J, Follana P, Romero I, Lebreton C, Perez-Fidalgo JA, Yunokawa M, Dahlstrand H, D'Hondt V, Randall LM; ENGOT-Cx10-GEICO 68-C-JGOG1084-GOG-3030 Investigators. Atezolizumab plus bevacizumab and chemotherapy for metastatic, persistent, or recurrent cervical cancer (BEATcc): a randomised, open-label, phase 3 trial. Lancet. 2024 Jan 6;403(10421):31-43. doi: 10.1016/S0140-6736(23)02405-4. Epub 2023 Dec 1.

Reference Type: DERIVED

PMID: 38048793 (View on PubMed)

Grau JF, Farinas-Madrid L, Oaknin A. A randomized phase III trial of platinum chemotherapy plus paclitaxel with bevacizumab and atezolizumab versus platinum chemotherapy plus paclitaxel and bevacizumab in metastatic (stage IVB), persistent, or recurrent carcinoma of the cervix: the BEATcc study (ENGOT-Cx10/GEICO 68-C/JGOG1084/GOG-3030). Int J Gynecol Cancer. 2020 Jan;30(1):139-143. doi: 10.1136/ijgc-2019-000880. Epub 2019 Oct 23.

Reference Type: DERIVED

PMID: 31645423 (View on PubMed)

Other Identifiers

2018-000367-83

Identifier Type: EUDRACT_NUMBER

Identifier Source: secondary_id

ENGOT-Cx10

Identifier Type: OTHER

Identifier Source: secondary_id

GEICO 68-C

Identifier Type: OTHER

Identifier Source: secondary_id

JGOG1084

Identifier Type: OTHER

Identifier Source: secondary_id

GOG-3030

Identifier Type: OTHER

Identifier Source: secondary_id

2024-514179-17-00

Identifier Type: CTIS

Identifier Source: secondary_id

ENGOT-Cx10 / BEATcc

Identifier Type: -

Identifier Source: org_study_id