Sponsor: AVEO Pharmaceuticals, Inc. (industry)
Phase: 3
Start date: Jan. 11, 2024
Planned enrollment: 410
Ficlatuzumab (AV-299; also SCH 900105) is an investigational humanized IgG1κ monoclonal antibody that neutralizes hepatocyte growth factor (HGF), thereby blocking HGF-mediated activation of the MET receptor. It has been evaluated across tumor types including recurrent/metastatic head and neck squamous cell carcinoma (HNSCC), acute myeloid leukemia (AML), non–small cell lung cancer (NSCLC), and pancreatic ductal adenocarcinoma (PDAC). (accp1.onlinelibrary.wiley.com)
Head and neck squamous cell carcinoma (HNSCC) - Randomized, noncomparative phase II in pan-refractory, cetuximab-resistant R/M HNSCC (n=60): ficlatuzumab + cetuximab met the primary endpoint with median PFS 3.7 months; ORR 19% (6/32; 2 CR, 4 PR). The monotherapy arm closed for futility (median PFS 1.8 months; ORR 4%). Exploratory analysis suggested greater activity in HPV-negative disease (ORR 38% vs 0% in HPV-positive; median PFS 4.1 vs 2.3 months). (ascopubs.org)
Acute myeloid leukemia (AML) - Phase Ib (n=17) of ficlatuzumab + cytarabine in relapsed/refractory or early-relapse AML: overall response rate 53%, all complete remissions; 4 responders were MRD-negative. Most frequent treatment-related AE was febrile neutropenia. Correlative analyses showed on-target suppression of p-MET. (aacrjournals.org)
Non–small cell lung cancer (NSCLC) - Randomized phase II in Asian patients with advanced pulmonary adenocarcinoma: ficlatuzumab + gefitinib did not improve ORR, PFS, or OS vs gefitinib alone overall. A retrospective proteomic subgroup (VeriStrat “Poor”) showed improved outcomes with the combination (exploratory). (pubmed.ncbi.nlm.nih.gov) - Smaller phase 1b study of ficlatuzumab + gefitinib reported an ORR of 33% at the 20 mg/kg dose (n=12), supporting tolerability and combinability but was noncomparative. (accp1.onlinelibrary.wiley.com)
Pancreatic ductal adenocarcinoma (PDAC) - Phase Ib dose-escalation/expansion of ficlatuzumab + gemcitabine/nab‑paclitaxel in untreated metastatic PDAC (n=26; 21 treated at MTD): best responses were PR 29% and SD 57%; median PFS 11.0 months and OS 16.2 months in the expansion cohort. (pubmed.ncbi.nlm.nih.gov)
Class toxicities attributable to HGF/MET-ligand inhibition include hypoalbuminemia and peripheral edema: - In R/M HNSCC, common AEs on the ficlatuzumab + cetuximab arm were acneiform rash (EGFR class effect), hypoalbuminemia (76%), and edema (44%); infections were more frequent on combination therapy. Ficlatuzumab monotherapy commonly caused hypoalbuminemia (66%) and edema (25%). (ascopubs.org) - In PDAC phase Ib, ficlatuzumab-attributed AEs included hypoalbuminemia (any grade 52%; grade 3, 16%) and edema (any grade 48%; grade 3, 8%). (pubmed.ncbi.nlm.nih.gov) - In AML phase Ib, the most frequent treatment-related AE was febrile neutropenia; no DLTs were observed and 20 mg/kg q2w was selected as the recommended dose. (aacrjournals.org) - Early-phase PK/PD work in solid tumors also noted decreased serum albumin across patients and supported a 20 mg/kg every-2-weeks dosing schedule. (pubmed.ncbi.nlm.nih.gov)
Notes: Ficlatuzumab remains investigational. The most convincing efficacy signals to date are in pan-refractory HNSCC when combined with cetuximab (especially HPV-negative disease) and in early-phase AML combination therapy; confirmatory studies would be required to establish clinical benefit. (ascopubs.org)
Last updated: Oct 2025
Goal: Evaluate whether adding ficlatuzumab to cetuximab improves outcomes versus cetuximab alone (placebo-controlled) in recurrent/metastatic HPV-negative head and neck squamous cell carcinoma after prior platinum and PD-1/PD-L1 inhibitor therapy, with superiority assessed by overall survival and progression-free survival.
Patients: Adults (≥18) with histologically/cytologically confirmed recurrent or metastatic HPV-negative HNSCC (p16-negative if oropharyngeal), inoperable/incurable, ECOG 0–1, at least one measurable non-previously irradiated lesion (or documented progression if previously irradiated), and prior exposure and failure/intolerance to both platinum-based chemotherapy and an anti–PD-1/PD-L1 checkpoint inhibitor given sequentially or in combination in the locally advanced or R/M setting. Key exclusions include >2 prior systemic lines in the R/M setting or prior EGFR inhibitor for R/M HNSCC, uncontrolled/untreated brain metastases, significant cardiovascular disease, unresolved >Grade 2 toxicities, active hepatitis B/C with evidence of hepatitis, ILD/pulmonary fibrosis, and pregnancy/breastfeeding. Archived tumor tissue (or fresh biopsy if unavailable) is required for c-MET analysis.
Design: Multicenter, randomized, double-blind, placebo-controlled phase 3 trial with three arms comparing two ficlatuzumab dose levels plus cetuximab versus placebo plus cetuximab. Approximately 410 participants will be randomized. Stratification and blinding apply to investigational product; assessments follow RECIST v1.1 with scheduled imaging intervals.
Treatments: Arm 1: Ficlatuzumab dose A IV on Days 1 and 15 of each 28-day cycle plus cetuximab IV on Days 1 and 15. Arm 2: Ficlatuzumab dose B IV on the same schedule plus cetuximab. Arm 3: Placebo IV on Days 1 and 15 plus cetuximab on the same schedule. Ficlatuzumab is a humanized IgG1 monoclonal antibody that binds and neutralizes hepatocyte growth factor (HGF), blocking HGF–MET signaling implicated in tumor growth, invasion, and resistance; the commonly used dose in prior studies is 20 mg/kg IV every 2 weeks. In a randomized phase 2 study in pan-refractory R/M HNSCC, ficlatuzumab plus cetuximab achieved a median PFS of approximately 3.7–4.1 months and ORR up to 38% in HPV-negative disease, while ficlatuzumab monotherapy showed minimal activity; safety was characterized by edema, hypoalbuminemia, and dermatologic toxicity, with rare pneumonitis. Cetuximab is an EGFR-directed monoclonal antibody with established activity in R/M HNSCC, commonly producing acneiform rash and infusion reactions.
Outcomes: Primary: Overall survival from randomization to death from any cause. Key secondary: Progression-free survival per RECIST v1.1; objective response rate; disease control rate; duration of response; safety and tolerability (AEs, labs); pharmacokinetics of ficlatuzumab; immunogenicity via anti-drug and neutralizing antibodies; and health-related quality of life, including time to clinically meaningful deterioration. Imaging is performed every 8 weeks in year 1, every 12 weeks in years 2–3, then every 6 months.
Burden on patient: Moderate. Patients receive IV infusions twice per 28-day cycle for both cetuximab and ficlatuzumab/placebo, requiring regular clinic visits. Imaging every 8 weeks in the first year, then less frequently, aligns with standard metastatic surveillance but adds visit frequency. Blood draws for safety labs are routine; additional PK and immunogenicity sampling for ficlatuzumab increase phlebotomy beyond usual care. An archived tumor block is required, with a fresh biopsy only if archived tissue is unavailable, which may add procedural burden for some. Overall, while procedures are typical for antibody-based phase 3 trials, the biweekly infusion schedule plus PK/ADA sampling and potential biopsy contribute to a moderate visit and testing load.
Last updated: Oct 2025
Inclusion Criteria:
* Male or female and ≥ 18 years of age
* Histologically and/or cytologically confirmed primary diagnosis of R/M HNSCC
* Participants with oropharyngeal cancer will be required to have proof of p16 negative status submitted on the basis of a pathology report
* At least 1 measurable lesion by contrast CT or MRI scan according to RECIST v.1.1. Such lesions must not have been previously irradiated; if the measurable lesion(s) has been irradiated, clear progression must be documented
* Participants must have failed prior therapy with an anti-PD-1/PD-L1 ICI and with platinum-based chemotherapy administered in combination or sequentially, in either the locally advanced or R/M setting. Failure of prior treatment may be due to progression of disease or intolerance to treatment
* Patient's tumor must be considered inoperable and incurable
* Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1 with a life expectancy of at least 12 weeks
* For women of childbearing potential (WOCBP), documentation of negative serum pregnancy test within 30 days of randomization
* For WOCBP and male participants whose sexual partners are of childbearing potential, agreement to use an effective method of contraception during the study and for at least 5 months after the last dose of study treatment. Birth control methods which may be considered highly effective include methods that achieve a failure rate of less than 1% per year when used consistently and correctly.
* Ability to give written informed consent and comply with protocol requirements
* Patients with feeding tubes are eligible for the study.
* Archived tissue sample must be submitted to the Sponsor-designated laboratory within 60 days of randomization for c-Met analysis (if a tissue sample is not available, a fresh biopsy may be required prior to enrollment)
Exclusion Criteria:
* Participants who have received \> 2 prior lines of anticancer therapy or prior treatment with cetuximab/alternative EGFR inhibitors for the treatment of R/M HNSCC
* History of severe allergic or anaphylactic reactions or hypersensitivity to recombinant proteins or excipients in the investigational agent or cetuximab
* Known or suspected untreated and uncontrolled brain metastases or leptomeningeal carcinomatosis Note: Participants with locally treated brain metastases are eligible provided 2 weeks have elapsed since local therapy. Participants are allowed to continue steroid taper during the start of study treatment.
* Prior treatment with any other investigational drug or biologic agent or radiation therapy before a washout has been completed (must be completed prior to randomization):
1. 2 weeks (14 days) or 5 half-lives, whichever is shorter, for chemotherapeutic agents, small molecules, and checkpoint inhibitors
2. 3 weeks (21 days) or 5 half-lives, whichever is shorter, for antibody-drug conjugates
3. 4 weeks (28 days) for cell therapies
4. 2 weeks (14 days) for radiation therapy
* Any unresolved and significant toxicity (National Cancer Institute Common Terminology Criteria for Adverse Events \[NCI-CTCAE\] version 5.0) Grade \> 2 from previous anticancer therapy (including radiation therapy), other than alopecia
* Significant cardiovascular disease, including: Cardiac failure New York Heart Association class III or IV; Myocardial infarction, severe or unstable angina within 6 months prior to randomization; History of serious ventricular arrhythmia (i.e., ventricular tachycardia or ventricular fibrillation)
* Any other medical condition or psychiatric condition that, in the opinion of the Investigator, might interfere with the participant's involvement in the study or interfere with the interpretation of study results
* History of prior malignancy within 2 years prior to randomization (except for adequately treated non-melanoma skin cancer, carcinoma in situ of the breast or cervix, superficial bladder cancer, or early-stage prostate cancer, without evidence of recurrence; participants may or may not be on maintenance therapy)
* Participants who are positive for HBV or HCV with indication of acute or chronic hepatitis (as defined in protocol)
* Radiographic evidence (historical or at screening) of interstitial lung disease or idiopathic pulmonary fibrosis
* Female participants who are pregnant or breastfeeding
A full list of inclusion and exclusion criteria can be found in the protocol.
Kogarah, New South Wales, 2217, Australia
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Sydney, New South Wales, 2010, Australia
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Brisbane, Queensland, 4102, Australia
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Murdoch, Western Australia, 6150, Australia
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Liège, 4000, Belgium
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Namur, B5000, Belgium
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Sint-Niklaas, 9100, Belgium
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Panagyurishte, 4500, Bulgaria
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Edmonton, Alberta, T6G 1Z2, Canada
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Calgary, Alberta, T3N 4N1, Canada
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Toronto, Ontario, M5G 2M9, Canada
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Ottawa, Ontario, K1H 8L6, Canada
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Montreal, Quebec, H4A3J1, Canada
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Prague, 13400, Czechia
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Olomouc, 77900, Czechia
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Brno, 60200, Czechia
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Prague, Czechia
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Brno, 65653, Czechia
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Marseille, 13005, France
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Lyon, 69008, France
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Brest, 29200, France
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Plérin, 22190, France
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Paris, 75248, France
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Villejuif, 94805, France
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Chambray-lès-Tours, 37170, France
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Berlin, 12200, Germany
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Munich, 81377, Germany
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Freiburg im Breisgau, 79106, Germany
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Nyíregyháza, 4400, Hungary
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Pécs, 7624, Hungary
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Florence, 51134, Italy
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Novara, 28100, Italy
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Milan, 20133, Italy
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Pavia, 27100, Italy
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Milan, 20089, Italy
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Bologna, 40139, Italy
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Milan, 20132, Italy
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Padua, 35128, Italy
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Pavia, 27100, Italy
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Amsterdam, 1066, Netherlands
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Nijmegen, 6525, Netherlands
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Bydgoszcz, 85-796, Poland
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Gliwice, 44-100, Poland
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Floreşti, 407280, Romania
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Cluj-Napoca, 400641, Romania
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Kamenitz, Serbia
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Suwon, 16499, South Korea
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Daegu, 42601, South Korea
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Seoul, 02841, South Korea
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Seoul, 06351, South Korea
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Seoul, 03080, South Korea
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Seoul, 03722, South Korea
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Seoul, 03312, South Korea
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Madrid, 28051, Spain
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Valencia, Spain
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Málaga, 29004, Spain
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Madrid, 28046, Spain
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Alicante, 03293, Spain
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Madrid, Spain
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Cadiz, 11407, Spain
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Barcelona, 08908, Spain
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Badalona, 08907, Spain
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Barcelona, 08017, Spain
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Barcelona, Spain
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Kaohsiung City, 833401, Taiwan
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Taoyuan District, 33305, Taiwan
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Changhua, 500, Taiwan
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Taichung, 40447, Taiwan
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Tainan City, 704017, Taiwan
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Taipei, 100, Taiwan
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Taipei, 112201, Taiwan
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Nottingham, NG5 1PB, United Kingdom
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Aberdeen, AB25 2ZN, United Kingdom
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London, W1G 6AD, United Kingdom
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Sutton, SM2 5PT, United Kingdom
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London, SW3 6JJ, United Kingdom
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Torquay, TQ2 7AA, United Kingdom
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Gilbert, Arizona, 85212, United States
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Tucson, Arizona, 85719, United States
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Westwood, Los Angeles, California, 90024, United States
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New Haven, Connecticut, 06511, United States
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Washington D.C., District of Columbia, 20052-0042, United States
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Orlando, Florida, 32804, United States
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Atlanta, Georgia, 30308, United States
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Chicago, Illinois, 60612, United States
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Westwood, Kansas, 66205, United States
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Baton Rouge, Louisiana, 70809, United States
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South Portland, Maine, 04106, United States
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Baltimore, Maryland, 21201, United States
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Boston, Massachusetts, 02215, United States
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St Louis, Missouri, 63110, United States
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New York, New York, 10065, United States
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The Bronx, New York, 10461, United States
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Lake Success, New York, 10042, United States
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Columbus, Ohio, 43210, United States
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Cincinnati, Ohio, 45219, United States
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Philadelphia, Pennsylvania, 19111, United States
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Pittsburgh, Pennsylvania, 15232, United States
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Charleston, South Carolina, 29425, United States
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Houston, Texas, 77030, United States
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Houston, Texas, 77030, United States
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Richmond, Virginia, 23298, United States
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Milwaukee, Wisconsin, 53202, United States
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Budapest, 1122, Hungary
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Status: Not yet recruiting
Salgótarján, 3100, Hungary
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Status: Not yet recruiting
Belgrade, Serbia
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Status: Not yet recruiting
Kragujevac, Serbia
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Santander, Spain
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Status: Not yet recruiting
Győr, 9024, Hungary
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Status: Withdrawn
Roma, 00168, Italy
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Status: Withdrawn