Sponsor: AstraZeneca (industry)
Phase: 1/2
Start date: June 5, 2023
Planned enrollment: 506
AZD5305 (saruparib) is an oral, next‑generation, highly selective PARP1 inhibitor and trapper being developed for tumors with homologous recombination repair (HRR) defects. Compared with first‑generation dual PARP1/2 inhibitors, saruparib was designed to retain antitumor activity while reducing PARP2‑related hematologic toxicity, thereby broadening combination potential. Preclinical and early‑phase clinical data support activity with a favorable tolerability profile, and multiple phase 3 studies are underway. (pubmed.ncbi.nlm.nih.gov)
In HER2‑negative, HRR‑deficient advanced breast cancer treated at the recommended phase 2 dose (RP2D) of 60 mg once daily, the objective response rate (ORR) was 48.4%, median progression‑free survival (PFS) 9.1 months, and median duration of response (DoR) 7.3 months (data presented at AACR 2024). Dose exploration also showed activity at 20 mg and 90 mg, but 60 mg was selected as RP2D based on the totality of efficacy, PK/PD, and safety. (aacr.org)
Preclinical translational data:
In patient‑derived xenograft models with BRCA1/2 alterations, saruparib achieved higher complete response rates and markedly longer preclinical PFS than olaparib; combinations with carboplatin or the ATR inhibitor ceralasertib further enhanced activity, including in models with acquired PARPi resistance. (genomemedicine.biomedcentral.com)
Ongoing/late‑phase development:
Among 141 patients who received 60 mg, adverse events occurred in 92.2%, treatment‑related AEs in 76.6%, serious treatment‑related AEs in 2.1%, and discontinuations due to treatment‑related AEs in 3.5%. Reported common AEs included anemia, neutropenia, thrombocytopenia, fatigue, and asthenia. (aacr.org)
PETRANHA (NCT05367440), phase I/II study in metastatic prostate cancer combining saruparib (60 mg) with enzalutamide, abiraterone/prednisone, or darolutamide:
Notes: As of October 7, 2025, peer‑reviewed, full manuscripts of PETRA clinical outcomes beyond meeting presentations/press materials were not identified; ongoing trials may yield updated efficacy and safety results. (aacrmeetingnews.org)
Last updated: Oct 2025
AZD9574 (palacaparib) is an investigational, brain‑penetrant, PARP1‑selective inhibitor and PARP1‑DNA trapper being developed for cancers with homologous recombination repair deficiency (HRD) and for primary or secondary brain tumors. A modular, first‑in‑human Phase I/IIa study (CERTIS1; NCT05417594) is ongoing to evaluate monotherapy and combinations (including temozolomide) across advanced solid tumors; as of the latest postings, no peer‑reviewed human efficacy outcomes have been reported. (cdek.pharmacy.purdue.edu)
Human clinical efficacy results have not yet been published in peer‑reviewed literature as of October 7, 2025.
Key preclinical findings include:
- Potent single‑agent antitumor activity in HRD models (e.g., BRCA1/2‑deficient breast/ovarian models) with tumor regressions in xenografts. (aacrjournals.org)
- Activity in intracranial xenograft models consistent with CNS penetration. (aacrjournals.org)
- Synergy with temozolomide (TMZ) in MGMT‑methylated orthotopic glioma models, prolonging survival versus TMZ alone. (aacrjournals.org)
No peer‑reviewed human safety outcomes have been published yet. In preclinical assessments:
- AZD9574 showed minimal single‑agent hematotoxicity in vitro versus olaparib and manageable hematologic effects in rat models. (aacrjournals.org)
- The PARP1‑selective profile (sparing PARP2) is proposed to contribute to a more favorable therapeutic index; this remains to be established clinically. (aacrjournals.org)
If additional peer‑reviewed clinical data become available, the efficacy and safety sections should be updated accordingly.
Last updated: Oct 2025
AZD5335 (nonproprietary name: torvutatug samrotecan) is an antibody–drug conjugate (ADC) that targets folate receptor alpha (FRα/FOLR1), which is frequently overexpressed in epithelial ovarian cancer and present in subsets of other solid tumors (for example, lung adenocarcinoma). It is being evaluated in the modular, first‑in‑human Phase 1/2a FONTANA trial as monotherapy and in combinations (e.g., with PARP inhibitors, bevacizumab, and carboplatin). Early clinical signals of activity and a manageable safety profile were reported in platinum‑resistant recurrent ovarian cancer (PRROC) at ESMO 2024, and preclinical combination data were presented at AACR 2025. (oncologypro.esmo.org)
Clinical (early, PRROC; FONTANA M1A, ESMO 2024) - In dose‑escalation (data cutoff March 30, 2024; n=28 treated), confirmed responses were observed at all dose levels. Among evaluable patients with high FRα expression (≥75% tumor cells at ≥2+ intensity; n=8), 5 had an objective radiologic response (1 pending confirmation). In those with high FRα given the top three dose levels (n=5), 4 had an objective response (1 pending confirmation). (oncologypro.esmo.org) - Additional summary data reported by a patient/scientific foundation (sourced to the Annals of Oncology ESMO 2024 abstract/poster 754P) indicate observed activity even in FRα‑low tumors: FRα‑low cohort ORR 35.7% (n=14); FRα‑low at doses ≥1.6 mg/kg ORR 41.7% (n=12). These figures should be considered preliminary from early phase cohorts. (clearityfoundation.org)
Preclinical - AZD5335 demonstrated robust antitumor activity in FRα‑expressing ovarian cancer models, including patient‑derived xenografts, and showed superior activity versus a microtubule‑inhibitor FRα‑ADC benchmark in low‑to‑medium FRα expression models. (aacrjournals.org) - In ovarian cancer xenograft models, combinations with bevacizumab, paclitaxel, and/or carboplatin yielded more durable tumor control than monotherapy, supporting ongoing clinical combination exploration. (aacrjournals.org)
ESMO 2024 (FONTANA M1A, n=28 treated; investigator‑attributed, any grade unless noted) - Most common treatment‑related adverse events (≥15%): nausea (61%; no grade 3–4), anemia (25%; grade 3–4 in 18%), decreased neutrophil count (21%; grade 3–4 in 7%), pyrexia (21%; no grade 3–4). No dose‑limiting toxicities or treatment‑related deaths were reported; maximum tolerated dose not reached at the time of analysis. Pharmacokinetics were linear over the evaluated dose range. (oncologypro.esmo.org) - A foundation summary of the same ESMO 2024 dataset reported overall grade 3–4 adverse events in 43.6%, with neutropenia 17.9% and anemia 15.4%; serious adverse events 15.4%. These are early, preliminary safety data. (clearityfoundation.org)
Notes - Human efficacy and safety data are from early, small, dose‑escalation cohorts and remain preliminary; dose optimization and expansion are ongoing as of October 7, 2025. (oncologypro.esmo.org)
Last updated: Oct 2025
Goal: Assess safety, tolerability, pharmacokinetics, and preliminary antitumor activity of the folate receptor‑alpha–targeted antibody‑drug conjugate AZD5335 given alone and in combinations with other anticancer agents in advanced solid tumors, and identify recommended doses/regimens for further study.
Patients: Adults (≥18 years) with advanced, measurable solid tumors per RECIST v1.1, ECOG 0–1, adequate organ function, life expectancy ≥12 weeks, and prior standard therapy or in whom a trial is the best option. Archival and/or fresh tumor tissue is required; a fresh biopsy is preferred if there has been prior targeted therapy such as an ADC. Key exclusions include uncontrolled brain metastases, active serious infections (uncontrolled HIV, active HBV/HCV), prior significant ILD/pneumonitis, significant cardiovascular disease or QTcF >470 msec, unresolved ≥Grade 2 toxicities, and recent live vaccination. Contraception requirements apply to participants of childbearing potential and their partners.
Design: Modular, open-label, multi-center Phase I/IIa study with randomized allocation across modules. Dose escalation and expansion evaluate AZD5335 as monotherapy and in combinations to define safety, dose-limiting toxicities, pharmacokinetics, and preliminary efficacy.
Treatments: Module 1: AZD5335 monotherapy. AZD5335 (proposed INN: torvutatug samrotecan) is an investigational FRα-targeted antibody-drug conjugate delivering a topoisomerase I inhibitor payload (DAR8) designed for potent DNA damage with a bystander effect in FRα-expressing tumors. Early first-in-human data in heavily pretreated, platinum-resistant ovarian cancer show objective responses, particularly in tumors with high FRα expression, with a manageable safety profile dominated by low-grade gastrointestinal events and hematologic toxicities (notably anemia and neutropenia); the maximum tolerated dose had not been reached in dose escalation at last report. Module 2: AZD5335 plus saruparib (AZD5305), a selective PARP1 inhibitor engineered to maintain efficacy with potentially reduced hematologic toxicity versus nonselective PARP inhibitors. Module 3: AZD5335 plus bevacizumab, an anti-VEGF monoclonal antibody used widely with chemotherapy and biologics in solid tumors. Module 4: AZD5335 plus carboplatin with or without bevacizumab; carboplatin is a standard DNA-damaging platinum agent. Module 5: AZD5335 plus AZD9574, a brain-penetrant, selective PARP1 inhibitor under early clinical evaluation with preclinical activity in HRD models, including intracranial disease.
Outcomes: Primary endpoints include safety and tolerability: incidence of adverse events and serious adverse events, and dose-limiting toxicities during Cycle 1 (21 days). Key secondary endpoints include pharmacokinetics for AZD5335 and combination partners (AUC, Cmax, Tmax, clearance, half-life), immunogenicity (anti-drug antibodies), exploratory pharmacodynamic/biomarker assessments of target expression, and antitumor activity by RECIST v1.1: objective response rate, duration of response, disease control rate, progression-free survival, and overall survival. PK sampling is performed at predefined intervals for approximately 12 weeks; time-to-event endpoints are followed for up to about 2 years.
Burden on patient: High. As a Phase I/IIa modular study with dose escalation and multiple combinations, participants can expect frequent clinic visits, intensive pharmacokinetic blood sampling over the first 12 weeks, serial safety assessments (labs, ECGs, vitals, physical exams), and protocol-mandated tumor imaging. Tumor tissue submission is required, and fresh biopsies may be requested, especially after prior targeted therapies such as ADCs. Combination modules with cytotoxics and biologics add infusion time and potential supportive care visits. Travel frequency and time in clinic will exceed typical standard-of-care schedules, particularly during early cycles and PK time points.
Last updated: Oct 2025
Core Inclusion Criteria:
* Capable of giving signed informed consent, which includes compliance with the requirements and restrictions listed in the ICF and in this protocol.
* Provision of signed and dated written Optional Genetic Research Information informed consent prior to collection of samples for optional genetic research that supports Genomic Initiative. Participants who do not provide informed consent for Optional Genetic Research may still be enrolled in the study.
* Participant must be ≥ 18 years at the time of signing the informed consent.
* Willing to provide adequate archival and/or baseline tumor sample as applicable per module-specific criteria.
* For participants who have previously received targeted therapies such as ADCs, a fresh baseline biopsy will be required unless the most recent archival tissue sample was collected after receipt of such treatment.
* Eastern Cooperative Oncology Group Performance Status of 0 or 1.
* Participants with advanced solid tumors must have received prior adequate therapy in accordance with local practice for their tumor type and stage of disease, or, in the opinion of the Investigator, a clinical trial is the best option for the next treatment based on response and/or tolerability to prior therapy. Participants with contraindications or who refuse therapy in accordance with local practice may also be considered provided that it is documented that he/she was informed about all therapeutic options.
* Participants must have measurable disease per RECIST v1.1,
1. A previously irradiated lesion can be considered a target lesion if the lesion is progressing and well defined.
2. For participants who undergo biopsies at screening and/or on treatment, it is preferred though not required, that the biopsied lesion, be distinct from any target lesion used in the RECIST v1.1 evaluation.
* Life expectancy ≥ 12 weeks.
* Adequate organ and marrow function.
* Contraceptive use by men or women should be consistent with local regulations regarding the methods of contraception for those participating in clinical studies.
(a) Male participants: (i) Male participants who are sexually active with a female partner of childbearing potential must use a male condom (plus an additional contraceptive method) post-screening through 5 months following the last dose of study intervention. It is strongly recommended for the female partner of a male participant to also use a highly effective method of contraception throughout this period. In addition, male participants must refrain from freezing or donating sperm while on study and for 5 months following the last dose of study intervention.
(b) Female participants: (i) Females of childbearing potential must have a negative urine or serum pregnancy test within 72 hours prior to receiving the first dose of study intervention and a negative urine or serum pregnancy test prior to starting their next cycle of treatment. If the urine test is positive or cannot be confirmed as negative, a serum pregnancy test will be required.
(ii) (ii) Sex and Contraceptive/Barrier Requirements: Highly effective birth control methods include: Total sexual abstinence is an acceptable method provided it is the usual lifestyle of the participant (defined as refraining from heterosexual intercourse during the entire period of risk associated with the study treatments) \[(periodic abstinence e.g., calendar, ovulation, symptothermal, post-ovulation methods), declaration of abstinence for the duration of exposure to study intervention, and withdrawal are not acceptable methods of contraception\], a vasectomized partner, Implanon®, bilateral tubal occlusion, intrauterine device/levonorgestrel intrauterine system, Depo Provera™ injections, oral contraceptive associated with inhibition of ovulation, and Evra Patch™, Xulane™, or NuvaRing®.
Female participants of childbearing potential who are sexually active with a non-sterilized male partner must agree to use one highly effective method of birth control (defined as one that can achieve a failure rate of less than 1% per year when used consistently and correctly), from enrolment throughout the study and for 8 months following the last dose of study intervention. The male partner of a female participant of childbearing potential must also use a male condom (plus spermicide, if available) throughout this period. Cessation of contraception after this point should be discussed with a responsible physician. In addition, female participants must not donate or retrieve for their own use, ova while on study and for 8 months following the last dose of study intervention.
Core Exclusion Criteria:
* Patients with spinal cord compression or a history of leptomeningeal carcinomatosis.
* Patients with brain metastases unless, asymptomatic, stable, and not requiring continuous corticosteroids at a dose of \> 10 mg prednisone/day or equivalent for at least 4 weeks prior to first dose of study intervention.
* Treatment with any of the protocol defined medications, without adequate washout periods or time before the first dose of study intervention.
* Unresolved toxicities of Grade ≥ 2 (National Cancer Institute \[NCI\] CTCAE v5.0) from prior therapy (excluding vitiligo, alopecia, and endocrine disorders that are controlled with replacement hormone therapy). Participants with stable ≤ Grade 2 neuropathy are eligible.
* Active infection, including tuberculosis and infections with hepatitis B virus (HBV; verified by known positive hepatitis B surface antigen \[HBsAg\] result), hepatitis C virus (HCV) or known HIV infection that is not well controlled. All of the following criteria are required to define an HIV infection that is well controlled: undetectable viral RNA, CD4+ count ≥ 350/mm3, no history of acquired immune deficiency syndrome-defining opportunistic infection within the past 12 months, and stable for at least 4 weeks on the same anti-HIV medications (meaning there are no expected further changes in that time to the number or type of antiretroviral drugs in the regimen).
Patients with a past or resolved HBV/HCV infection are eligible if:
1. Negative for HBsAg and positive for anti-hepatitis B virus core protein (HBc) or
2. Are HBsAg + with chronic HBV infection (lasting 6 months or longer) and meet conditions i-iii below:
(i) HBV DNA viral load \<100 IU/mL. (ii) Have normal transaminase values, or, if liver metastases are present, abnormal transaminases, with a result of aspartate aminotransferase (AST)/alanine aminotransferase (ALT) \<3 x upper limit of normal (ULN), which are not attributable to HBV infection.
(iii) Start or maintain antiviral treatment if clinically indicated as per the Investigator or as per local guideline.
Note for Japan: Japanese patients with positive anti-HBs/anti-HBc and negative HBsAg will be assessed following local guidelines.
(c) Participants testing positive for HCV antibody are eligible only if the polymerase chain reaction test result is negative for HCV RNA.
* Patient has ILD/pneumonitis or has a history of (non-infectious) ILD/pneumonitis that required oral or IV steroids or supplemental oxygen, or where suspected ILD/pneumonitis cannot be ruled out by imaging at screening.
* Patients with a history of radiation pneumonitis which has clinically and radiologically resolved and not requiring treatment with steroids may be eligible.
* History of another malignancy except for:
* Malignancy treated with curative intent and with no known active disease for at least 2 years prior to screening of study intervention and with low potential risk for recurrence.
* Adequately treated non-melanoma skin cancer or lentigo maligna without evidence of disease.
* Adequately treated carcinoma in situ without evidence of disease.
* Localized non-invasive solid organ primary disease under surveillance.
* Patients with any of the following cardiac criteria:
* History of arrhythmia (such as multifocal premature ventricular contractions, bigeminy, trigeminy, and ventricular tachycardia), which is symptomatic or requires treatment NCI CTCAE v5.0 Grade 3 except for:
(i) Rate controlled asymptomatic atrial fibrillation.
* NOTE: significant abnormalities in serum electrolytes that can increase the risk of arrhythmic events (ie, sodium, potassium, calcium, and magnesium) should be corrected before starting the study intervention.
* Uncontrolled hypertension.
* Acute coronary syndrome/acute myocardial infarction, unstable angina pectoris, coronary intervention procedure with percutaneous coronary intervention, or coronary artery bypass grafting within 6 months of screening.
* History of brain perfusion problems (eg, carotid stenosis) or stroke, or transient ischemic attack in the last 6 months prior to screening.
* Symptomatic heart failure (as defined by New York Heart Association class ≥ 2).
* Prior or current diagnosis of cardiomyopathy considered clinically relevant per investigator's judgement.
* Severe uncorrected valvular heart disease.
* Mean resting QTcF \> 470 msec obtained from triplicate electrocardiograms (ECGs) and averaged, recorded within 5 minutes.
* Any factor that, in the opinion of the investigator, increases the proarrhythmic risk of QT prolongation, such as congenital long QT syndrome, family history of long QT syndrome, hypertrophic cardiomyopathy, or unexplained sudden cardiac death under 40 years of age.
* Uncontrolled and/or unresolved intercurrent illness within 12 months prior to screening, including but not limited to serious chronic gastrointestinal conditions associated with diarrhea, or illness (including psychiatric illness) and/or social situations, in the opinion of the investigator, that would limit compliance with study requirements and activities, substantially increase risk of incurring AEs or compromise the ability of the participant to give written informed consent.
* Substance abuse or any other medical conditions that would increase the safety risk to the participant or interfere with participation of the participant or evaluation of the clinical study in the opinion of the Investigator.
* Receipt of live attenuated vaccine within 30 days prior to the first dose of study intervention. Note: Participants, if enrolled, should not receive live vaccine whilst receiving study intervention and up to 3 months after the last dose of study intervention. Participants can receive Coronavirus (COVID)-19 vaccines, at the discretion of the Investigator, following a benefit/risk evaluation for the individual participant and in accordance with local rules and regulations and vaccination guidelines. Note: If a COVID-19 vaccine is administered it should be done \> 72 hours prior to study intervention initiation or after completion of the DLT period.
* For women only - currently pregnant (confirmed with positive pregnancy test or suspected), lactating, breastfeeding, or intention to become pregnant during the study period.
* Concurrent enrolment in another clinical study, unless it is an observational (non interventional) clinical study or during the follow-up period of an interventional study.
* Patients with a known hypersensitivity to study intervention or any of the excipients of the product.
* Involvement in the planning and/or conduct of the study (applies to both AstraZeneca staff and/or staff at the study site).
* Judgment by the Investigator that the patient should not participate in the study if the patient is unlikely to comply with study procedures, restrictions and requirements.
* Previous enrolment in the present study. \*\*Other module specific criteria may apply
Liverpool, 2170, Australia
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Status: Recruiting
Melbourne, 3000, Australia
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Status: Recruiting
Edmonton, Alberta, T6G 1Z2, Canada
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Status: Recruiting
Toronto, Ontario, M5G 2M9, Canada
No email / No phone
Status: Recruiting
London, Ontario, N6A 5W9, Canada
No email / No phone
Status: Recruiting
Montreal, Quebec, H4A 3J1, Canada
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Status: Recruiting
Montreal, Quebec, H2X 0A9, Canada
No email / No phone
Status: Recruiting
Guangzhou, 510060, China
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Status: Recruiting
Jinan, 250117, China
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Status: Recruiting
Xi'an, 710061, China
No email / No phone
Status: Recruiting
Zhengzhou, 450008, China
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Status: Recruiting
Chengdu, 610041, China
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Status: Recruiting
Chongqing, 400030, China
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Status: Recruiting
Guangzhou, 510000, China
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Status: Recruiting
Mannheim, 68167, Germany
No email / No phone
Status: Recruiting
Haifa, 3109601, Israel
No email / No phone
Status: Recruiting
Ramat Gan, 52621, Israel
No email / No phone
Status: Recruiting
Kashiwa, 227-8577, Japan
No email / No phone
Status: Recruiting
Tokyo, 104-0045, Japan
No email / No phone
Status: Recruiting
Sunto-gun, 411-8777, Japan
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Status: Recruiting
Hidaka-shi, 350-1298, Japan
No email / No phone
Status: Recruiting
Kōtoku, 135-8550, Japan
No email / No phone
Status: Recruiting
Seoul, 06351, South Korea
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Status: Recruiting
Seoul, 03080, South Korea
No email / No phone
Status: Recruiting
Madrid, 28050, Spain
No email / No phone
Status: Recruiting
Málaga, 29010, Spain
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Status: Recruiting
Barcelona, 8035, Spain
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Status: Recruiting
Madrid, 28041, Spain
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Status: Recruiting
Taipei, 10002, Taiwan
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Status: Recruiting
Taipei, 11259, Taiwan
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Status: Recruiting
Tainan, 70403, Taiwan
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Status: Recruiting
Taichung, 40705, Taiwan
No email / No phone
Status: Recruiting
Ankara, 06200, Turkey (Türkiye)
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Status: Recruiting
Ankara, 06050, Turkey (Türkiye)
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Status: Recruiting
Ankara, 06800, Turkey (Türkiye)
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Status: Recruiting
Istanbul, 34718, Turkey (Türkiye)
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Status: Recruiting
Glasgow, Scotland, G12 0YN, United Kingdom
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Status: Recruiting
London, SW3 6JJ, United Kingdom
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Status: Recruiting
Sutton, SM2 5PT, United Kingdom
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Status: Recruiting
Cambridge, CB2 0XY, United Kingdom
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Status: Recruiting
Duarte, California, 91010, United States
No email / No phone
Status: Recruiting
Irvine, California, 92618, United States
No email / No phone
Status: Recruiting
Aurora, Colorado, 80045, United States
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Status: Recruiting
Boston, Massachusetts, 02114, United States
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Status: Recruiting
Detroit, Michigan, 48201, United States
No email / No phone
Status: Recruiting
Columbus, Ohio, 43201, United States
No email / No phone
Status: Recruiting
Portland, Oregon, 97239, United States
No email / No phone
Status: Recruiting
Providence, Rhode Island, 02905, United States
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Status: Recruiting
Providence, Rhode Island, 02903, United States
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Status: Recruiting
Houston, Texas, 77030, United States
No email / No phone
Status: Recruiting
Fairfax, Virginia, 22031, United States
No email / No phone
Status: Recruiting
Berlin, 13353, Germany
No email / No phone
Status: Not yet recruiting
Freiburg im Breisgau, 79106, Germany
No email / No phone
Status: Not yet recruiting
Hanover, 30625, Germany
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Status: Not yet recruiting
Leipzig, 04103, Germany
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Status: Not yet recruiting
Regensburg, 93053, Germany
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Status: Not yet recruiting
Essen, 45136, Germany
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Status: Not yet recruiting
London, SE1 9RT, United Kingdom
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Status: Not yet recruiting
La Jolla, California, 92093, United States
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Status: Withdrawn
Louisville, Kentucky, 40202, United States
No email / No phone
Status: TERMINATED