Grant Request Form Please submit your grant request: Step 1 of 4 - Applicant 0% Applicant DetailsApplicant Contact Details* First Name Last Name Where is this application being submitted from:*United StatesRest of the WorldContact email address* Enter Email Confirm Email Applicant Phone Number*Please provide full telephone number e.g. (###) ###-####Applicant Phone Number*Please provide full telephone number including international dialling code e.g. +41 ## ### ## ## Primary InvestigatorPrimary Investigator Details* MrMrsMissMsDrProf. Title First Name Last Name Primary Investigator Email* Primary Investigator Phone*Please provide full telephone number e.g. (###) ###-####Primary Investigator Phone*Please provide full telephone number including international dialling code e.g. +41 ## ### ## ##Institution DetailsInstitution Name*Institution Address* Street Address Address Line 2 City County / State / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican 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IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country State Licence NumberNPISubinvestigator(s)First Name(s) and Last Name(s) Study Details and RationaleStudy Title*Therapeutic Area*Cancer Supportive CareOncologyHemato-OncologyClinical or Pre-Clinical*Pre-clinicalClinicalHelsinn Product*Akynzeo IVAkynzeo OralAloxi IVAloxi OralAnamorelinInfigratinib OncologyLedaga / ValchlorHelsinn Product*Akynzeo IVAkynzeo OralAloxi IVAloxi OralAnamorelinValchlorStudy Rationale and Background*Study Objectives*Examples:- To demonstrate the non-inferiority in terms of efficacy of Drug A compared to Drug B - To demonstrate the superiority in terms of efficacy of Drug A compared to Drug B - To evaluate the Quality of Life in patients receiving Drug A compared to Standard of Care - To describe the safety profile of Drug A Study Type*InterventionalNon-interventional / Observational / Real WorldRetrospective Data ReviewFor Non-interventional / Observational / Real World*EpidemiologyOutcomes ResearchRegistry (retrospective/prospective)Study Phase*Phase I/IIPhase IIIPhase IVStudy Design* Single-Blind Double-Blind Open Label Placebo Control Active Control Historic Control Single Arm Parallel Arm Cross Over Dose Comparison Other Please add all that applyOtherPlease provide detailsPrimary Objectives* Efficacy Effectiveness (Measure of treatment success in the real world) Pharmacokinetics Safety Outcomes Research Pharmacogenomics Quality of Life Other Please add all that applyOther Primary Objectives - Please Specify*Primary Endpoint(s)*Secondary Endpoint(s)*Treatment Group (Study Arm 1)*Treatment Group (Study Arm 2)OptionalStudy Population and DurationStudy Population*e.g. breast cancer, elderly, etcSample Size*Please enter a number from 0 to 100000.Sample Size CalculationIf applicable.Number of centers*Study Duration*e.g. Number of cycles, observational period, total duration, estimated study 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