A Study of Bortezomib, Lenalidomide and Dexamethasone (VRd) Followed by Cilta-cel, a CAR-T Therapy D

A Study of Bortezomib, Lenalidomide and Dexamethasone (VRd) Followed by Cilta-cel, a CAR-T Therapy Directed Against BCMA Versus VRd Followed by Lenalidomide and Dexamethasone (Rd) Therapy in Participants With Newly Diagnosed Multiple Myeloma for Whom ASCT is Not Planned as Initial Therapy (CARTITUDE-5)

Last Updated August 7, 2024

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CR109015

OVERVIEW

Sexes Eligible for Study
all
Age
18+ years
Phase
phase 3

3
Sites
136 Sites
Status

Recruiting

SUMMARY

Multiple myeloma (MM) is a malignant plasma cell disorder characterized by the production of monoclonal immunoglobulin (Ig) proteins or protein fragments (M proteins) that have lost their function. JNJ-68284528 (ciltacabtagene autoleucel [cilta-cel]) is an autologous chimeric antigen receptor T cell (CAR-T) therapy that targets B-cell maturation antigen (BCMA), a molecule expressed on the surface of mature B lymphocytes and malignant plasma cells. The primary hypothesis of this study is that in participants with newly diagnosed MM, treatment with VRd induction followed by a single administration of cilta-cel will significantly improve progression free survival compared to Bortezomib, Lenalidomide and Dexamethasone (VRd) induction followed by Rd maintenance. The study will screen participants with newly diagnosed MM who are not planned to receive autologous stem cell transplant (ASCT) as initial therapy. This study will be conducted in 4 phases: Screening (up to 28 days), Pre-randomization Treatment, Treatment, and Follow-up. Assessments like patient-reported outcome(s) (PROs), electrocardiogram (ECG), vital signs and pharmacokinetics will be performed during the study. Safety evaluations will include review of adverse events, laboratory test results, vital sign measurements, physical examination findings, assessment of cardiac function, Immune-Effector Cell-Associated Encephalopathy (ICE) and handwriting assessments (only for Arm B) and Eastern Cooperative Oncology Group (ECOG) performance status. Safety data will be periodically reviewed by an Independent Data Monitoring Committee (IDMC). The duration of the study is approximately 12 years 5 months.

CONDITIONS

Multiple Myeloma

ELIGIBILITY

Inclusion Criteria:

* Documented diagnosis of multiple myeloma (MM) according to International Myeloma Working Group (IMWG) diagnostic criteria
* Measurable disease at screening as defined by any of the following: Serum monoclonal paraprotein (M-protein) level greater than or equal to (>=)1.0 gram per deciliter (g/dL) or urine M-protein level >=200 milligram (mg)/24 hours; or Light chain MM in whom only measurable disease is by serum free light chain (FLC) levels: Serum immunoglobin (Ig) free light chain >=10 milligrams per deciliter (mg/dL) and abnormal serum Ig kappa/lambda FLC ratio
* Eastern Cooperative Oncology Group Performance Status grade of 0 or 1
* Not considered for high-dose chemotherapy with Autologous Stem Cell Transplant (ASCT) due to: Ineligible due to advanced age; or Ineligible due to presence of comorbid condition(s) likely to have a negative impact on tolerability of high-dose chemotherapy with ASCT; or Deferral of high-dose chemotherapy with ASCT as initial treatment
* A woman of childbearing potential (WOCBP) must have 2 negative highly sensitive serum or urine pregnancy tests (beta-human chorionic gonadotropin) prior to starting Bortezomib, Lenalidomide and Dexamethasone (VRd) and must agree to further testing during the study.
* Clinical laboratory values meeting the following criteria during the screening phase: hemoglobin greater than or equal to (>=) 8.0 g/dL (>=5 millimoles per liter [mmol/L]), recombinant human erythropoietin use is permitted; platelets >=75 *10^9/L; absolute lymphocyte count >=0.3 *10^9/L; absolute neutrophil count (ANC) >=1.0 ×10^9/L (prior growth factor support is permitted but must be without support in the 7 days prior to the laboratory test); aspartate aminotransferase (AST) and alanine aminotransferase (ALT) less than or equal to (<=) 3.0 * upper limit of normal (ULN); estimated glomerular filtration rate >=40 milliliter per minute/1.73 meter square (mL/min/1.73 m^2) based upon modified diet in renal disease formula (MDRD-4) calculation or a 24-hour urine collection; total bilirubin <=2.0 * ULN; except in participants with congenital hyperbilirubinemia, such as Gilbert syndrome (in which case direct bilirubin <=2.0 * ULN is required)

Exclusion Criteria:

* Frailty index of >=2 according to Myeloma Geriatric Assessment score
* Peripheral neuropathy or neuropathic pain Grade 2 or higher, as defined by the National Cancer Institute-Common Terminology Criteria for Adverse Events (NCI-CTCAE) Version 5
* Known active, or prior history of central nervous system (CNS) involvement or clinical signs of meningeal involvement of MM
* Stroke or seizure within 6 months of signing Informed Consent Form (ICF)
* Seropositive for human immunodeficiency virus (HIV)
* Vaccinated with live, attenuated vaccine within 4 weeks prior to first dose of VRd
* Participant must not require continuous supplemental oxygen
* Hepatitis B infection
* Hepatitis C infection
* Prior treatment with chimeric antigen receptor T (CAR-T) therapy directed at any target
* Any therapy that is targeted to B-cell maturation antigen (BCMA)

Inclusion Criteria:

More...

DETAILS

LOCATIONS

Locations in:

United States, Argentina, Australia, Austria, Belgium, Brazil, Canada, Czechia, Denmark, Finland, France, Germany, Greece, Hungary, Ireland, Israel, Japan, South Korea, Netherlands, Norway, Poland, Portugal, Spain, Sweden, Switzerland, United Kingdom

Country (26)	City or Province (136)	Status
United States	San Francisco UCSF	COMPLETED
United States	New Haven Yale Cancer Center	ACTIVE_NOT_RECRUITING
United States	Miami University of Miami Health System	ACTIVE_NOT_RECRUITING
United States	Orlando AdventHealth Cancer Institute	ACTIVE_NOT_RECRUITING
United States	Iowa City University of Iowa Hospitals & Clinics	ACTIVE_NOT_RECRUITING
United States	Lexington University of Kentucky	COMPLETED
United States	Louisville Norton Cancer Institute	ACTIVE_NOT_RECRUITING
United States	Baltimore University Of Maryland Medical Center	ACTIVE_NOT_RECRUITING
United States	Boston Beth Israel Deaconess Medical Center	RECRUITING
United States	Detroit Barbara Ann Karmanos Cancer Institute	RECRUITING
United States	Detroit Henry Ford Cancer Institute	ACTIVE_NOT_RECRUITING
United States	New York Columbia University Medical Center	ACTIVE_NOT_RECRUITING
United States	New York Memorial Sloan-Kettering Cancer Center	ACTIVE_NOT_RECRUITING
United States	New York New York Presbyterian-Weill Cornell Medical College	ACTIVE_NOT_RECRUITING
United States	Charlotte Levine Cancer Institute	ACTIVE_NOT_RECRUITING
United States	Philadelphia Thomas Jefferson University	ACTIVE_NOT_RECRUITING
United States	Pittsburgh University of Pittsburgh Medical Center	ACTIVE_NOT_RECRUITING
United States	Charlottesville University of Virginia	ACTIVE_NOT_RECRUITING
United States	Milwaukee Medical College Of Wisconsin	ACTIVE_NOT_RECRUITING
Argentina	Buenos Aires Hospital Aleman	ACTIVE_NOT_RECRUITING
Argentina	Buenos Aires Hospital Italiano de Buenos Aires	ACTIVE_NOT_RECRUITING
Argentina	Cordoba Hospital Privado Centro Medico de Cordoba	ACTIVE_NOT_RECRUITING
Australia	Camperdown Royal Prince Alfred Hospital	ACTIVE_NOT_RECRUITING
Australia	Fitzroy St Vincents Hospital Melbourne	ACTIVE_NOT_RECRUITING
Australia	Heidelberg Austin Health	ACTIVE_NOT_RECRUITING
Australia	Herston Royal Brisbane and Womens Hospital	ACTIVE_NOT_RECRUITING
Australia	Melbourne Alfred Health	ACTIVE_NOT_RECRUITING
Australia	Melbourne Peter MacCallum Cancer Centre	ACTIVE_NOT_RECRUITING
Australia	Murdoch Fiona Stanley Hospital	ACTIVE_NOT_RECRUITING
Australia	Waratah Calvary Mater Newcastle Hospital	ACTIVE_NOT_RECRUITING
Australia	Westmead Western Sydney Local Health District	ACTIVE_NOT_RECRUITING
Austria	Graz Medizinische Universität Graz, LKH-Univ.Klinikum Graz, Klinische Abteilung für Hämatologie	COMPLETED
Austria	Linz Krankenhaus der Elisabethinen Linz	ACTIVE_NOT_RECRUITING
Austria	Salzburg LKH - Universitätsklinikum der PMU Salzburg	ACTIVE_NOT_RECRUITING
Austria	Vienna Medical University of Vienna Universitatsklinik fur Innere Medizin I	ACTIVE_NOT_RECRUITING
Belgium	Antwerp Universitair Ziekenhuis - Antwerpen	ACTIVE_NOT_RECRUITING
Belgium	Brugge AZ St.-Jan Brugge-Oostende AV	ACTIVE_NOT_RECRUITING
Belgium	Gent UZ Gent	COMPLETED
Belgium	Leuven UZ Leuven	COMPLETED
Belgium	Liege Centre Hospitalier Universitaire de Liege Domaine Universitaire du Sart Tilman	COMPLETED
Brazil	Salvador Hospital Sao Rafael	ACTIVE_NOT_RECRUITING
Brazil	Sao Paulo Fundacao Antonio Prudente A C Camargo Cancer Center	ACTIVE_NOT_RECRUITING
Brazil	São Paulo Sociedade Beneficente Israelita Brasileira Hospital Albert Einstein	ACTIVE_NOT_RECRUITING
Canada	Calgary Tom Baker Cancer Centre	ACTIVE_NOT_RECRUITING
Canada	Vancouver Vancouver General Hospital	ACTIVE_NOT_RECRUITING
Canada	Hamilton Juravinski Cancer Centre	ACTIVE_NOT_RECRUITING
Canada	Toronto Princess Margaret Cancer Centre University Health Network	ACTIVE_NOT_RECRUITING
Canada	Montréal Hopital Maisonneuve-Rosemont	ACTIVE_NOT_RECRUITING
Czechia	Brno Fakultni nemocnice Brno	ACTIVE_NOT_RECRUITING
Czechia	Hradec Kralove Fakultni nemocnice Hradec Kralove	ACTIVE_NOT_RECRUITING
Czechia	Ostrava - Poruba Fakultni Nemocnice Ostrava	ACTIVE_NOT_RECRUITING
Czechia	Praha 2 Vseobecna fakultni nemocnice v Praze	ACTIVE_NOT_RECRUITING
Denmark	Aarhus C Aarhus University Hospital	ACTIVE_NOT_RECRUITING
Denmark	Copenhagen Rigshospitalet	ACTIVE_NOT_RECRUITING
Denmark	Odense C Odense Universitetshospital	ACTIVE_NOT_RECRUITING
Finland	Helsinki Helsinki University Hospital	ACTIVE_NOT_RECRUITING
Finland	Oulu Oulu University Hospital	ACTIVE_NOT_RECRUITING
Finland	Turku Turku University Hospital	ACTIVE_NOT_RECRUITING
France	Lille Cedex Centre Hospitalier Régional Universitaire de Lille, Hôpital Claude Huriez	ACTIVE_NOT_RECRUITING
France	Nantes C.H.U. Hotel Dieu - France	COMPLETED
France	Paris cedex 10 Hopital Saint Louis	ACTIVE_NOT_RECRUITING
France	Poitiers CHU Poitiers - Hopital la Miletrie	ACTIVE_NOT_RECRUITING
France	Toulouse cedex 9 Institut Universitaire du cancer de Toulouse-Oncopole	ACTIVE_NOT_RECRUITING
Germany	Berlin Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin	ACTIVE_NOT_RECRUITING
Germany	Dresden Universitaetsklinikum Carl Gustav Carus TU Dresden	ACTIVE_NOT_RECRUITING
Germany	Freiburg Universitatsklinikum Freiburg	ACTIVE_NOT_RECRUITING
Germany	Hamburg Universitaetsklinikum Hamburg Eppendorf	ACTIVE_NOT_RECRUITING
Germany	Heidelberg Universitaetsklinikum Heidelberg	ACTIVE_NOT_RECRUITING
Germany	Leipzig Universitaetsklinikum Leipzig	ACTIVE_NOT_RECRUITING
Germany	Mainz Universitätsmedizin der Johannes Gutenberg-Universität Mainz	ACTIVE_NOT_RECRUITING
Germany	München Klinikum Großhadern der Ludwig-Maximilians-Universität	ACTIVE_NOT_RECRUITING
Germany	Regensburg Universitaetsklinikum Regensburg	ACTIVE_NOT_RECRUITING
Germany	Tubingen Klinikum der Eberhard Karls Universitaet Abt fur innere Med II Haematologie Onkologie Germany	ACTIVE_NOT_RECRUITING
Germany	Wuerzburg Universitatsklinikum Wurzburg	ACTIVE_NOT_RECRUITING
Greece	Athens Alexandra General Hospital of Athens	ACTIVE_NOT_RECRUITING
Greece	Athens Attikon University General Hospital of Attica	ACTIVE_NOT_RECRUITING
Greece	Thessaloniki G.Papanikolaou	ACTIVE_NOT_RECRUITING
Hungary	Budapest Del Pesti Centrumkorhaz Orszagos Hematologiai es Infektologiai Intezet Szent Laszlo Telephely	RECRUITING
Hungary	Debrecen Debreceni Egyetem Klinikai Kozpont	COMPLETED
Ireland	Dublin St James Hospital	RECRUITING
Israel	Jerusalem Hadassah University Hospita Ein Kerem	ACTIVE_NOT_RECRUITING
Israel	Ramat Gan Sheba Medical Center Tel Hashomer	ACTIVE_NOT_RECRUITING
Israel	Tel Aviv Tel Aviv Sourasky Medical Center	ACTIVE_NOT_RECRUITING
Japan	Bunkyo Ku Juntendo University Hospital	ACTIVE_NOT_RECRUITING
Japan	Fukuoka Kyushu University Hospital	ACTIVE_NOT_RECRUITING
Japan	Hyôgo Hyogo Medical University Hospital	ACTIVE_NOT_RECRUITING
Japan	Kanazawa Kanazawa University Hospital	ACTIVE_NOT_RECRUITING
Japan	Kyoto University Hospital Kyoto Prefectural University of Medicine	ACTIVE_NOT_RECRUITING
Japan	Nagoya Nagoya City University Hospital	COMPLETED
Japan	Okayama Okayama University Hospital	ACTIVE_NOT_RECRUITING
Japan	Sapporo Hokkaido University Hospital	ACTIVE_NOT_RECRUITING
Japan	Sendai Tohoku University Hospital	ACTIVE_NOT_RECRUITING
Japan	Shibuya Japanese Red Cross Medical Center	ACTIVE_NOT_RECRUITING
South Korea	Jeollanam-do Chonnam National University Hwasun Hospital	ACTIVE_NOT_RECRUITING
South Korea	Seoul Seoul National University Hospital	ACTIVE_NOT_RECRUITING
South Korea	Seoul Severance Hospital Yonsei University Health System	ACTIVE_NOT_RECRUITING
South Korea	Seoul Asan Medical Center	ACTIVE_NOT_RECRUITING
South Korea	Seoul Samsung Medical Center	ACTIVE_NOT_RECRUITING
South Korea	Seoul The Catholic University of Korea Seoul St Marys Hospital	ACTIVE_NOT_RECRUITING
Netherlands	Amsterdam VU Medisch Centrum	COMPLETED
Netherlands	Groningen University Medical Center Groningen	ACTIVE_NOT_RECRUITING
Netherlands	Nijmegen UMC Radboud	ACTIVE_NOT_RECRUITING
Netherlands	Rotterdam Erasmus MC	ACTIVE_NOT_RECRUITING
Norway	Oslo Oslo universitetssykehus HF, Rikshospitalet	ACTIVE_NOT_RECRUITING
Poland	Gdansk Uniwersyteckie Centrum Kliniczne	ACTIVE_NOT_RECRUITING
Poland	Gliwice Narodowy Instytut Onkologii im.Marii Sklodowskiej Curie Panstwowy Instytut BadawczyOddz. w Gliwicach	ACTIVE_NOT_RECRUITING
Poland	Lublin Centrum Onkologii Ziemi Lubelskiej im. sw. Jana z Dukli	ACTIVE_NOT_RECRUITING
Poland	Poznan Uniwersytecki Szpital Kliniczny w Poznaniu	ACTIVE_NOT_RECRUITING
Poland	Warszawa Instytut Hematologii i Transfuzjologii	ACTIVE_NOT_RECRUITING
Poland	Wroclaw Uniwersytecki Szpital Kliniczny im. Jana Mikulicza-Radeckiego we Wroclawiu	ACTIVE_NOT_RECRUITING
Portugal	Lisboa Instituto Portugues de Oncologia	ACTIVE_NOT_RECRUITING
Portugal	Porto Instituto Portugues de Oncologia	ACTIVE_NOT_RECRUITING
Spain	Barcelona Hosp. de La Santa Creu I Sant Pau	ACTIVE_NOT_RECRUITING
Spain	Barcelona Hosp Univ Vall D Hebron	ACTIVE_NOT_RECRUITING
Spain	L'Hospitalet de Llobregat Instituto Catalan Deoncologia Hospital Duran I Reynals	ACTIVE_NOT_RECRUITING
Spain	Madrid Hosp. Gral. Univ. Gregorio Maranon	ACTIVE_NOT_RECRUITING
Spain	Madrid Hosp. Univ. 12 de Octubre	ACTIVE_NOT_RECRUITING
Spain	Murcia Hosp. Univ. Virgen de La Arrixaca	ACTIVE_NOT_RECRUITING
Spain	Pamplona Clinica Univ. de Navarra	ACTIVE_NOT_RECRUITING
Spain	Salamanca Hosp Clinico Univ de Salamanca	ACTIVE_NOT_RECRUITING
Spain	Santander Hosp. Univ. Marques de Valdecilla	ACTIVE_NOT_RECRUITING
Spain	Sevilla Hosp. Virgen Del Rocio	ACTIVE_NOT_RECRUITING
Spain	Valencia Hosp. Univ. I Politecni La Fe	ACTIVE_NOT_RECRUITING
Sweden	Goteborg Sahlgrenska University Hospital	COMPLETED
Sweden	Linköping Universitetssjukhuset	ACTIVE_NOT_RECRUITING
Sweden	Lund Skane University Hospital	ACTIVE_NOT_RECRUITING
Switzerland	Basel Universitatsspital Basel	RECRUITING
Switzerland	Bern INSELSPITAL Universitatsspital Bern	RECRUITING
Switzerland	St. Gallen Kantonsspital St Gallen	RECRUITING
United Kingdom	Birmingham University Hospitals Birmingham NHS Trust,	ACTIVE_NOT_RECRUITING
United Kingdom	Bristol Bristol Royal Infirmary	ACTIVE_NOT_RECRUITING
United Kingdom	Leeds, Leeds Teaching Hospitals NHS Trust	ACTIVE_NOT_RECRUITING
United Kingdom	London University College Hospital	ACTIVE_NOT_RECRUITING
United Kingdom	London Kings College Hospital	ACTIVE_NOT_RECRUITING
United Kingdom	Manchester Manchester Royal Infirmary	ACTIVE_NOT_RECRUITING
United Kingdom	Surrey The Royal Marsden NHS Trust Sutton	ACTIVE_NOT_RECRUITING

Geo Locations

37.77493, -122.41942

41.30815, -72.92816

25.77427, -80.19366

28.53834, -81.37924

41.66113, -91.53017

37.98869, -84.47772

38.25424, -85.75941

39.29038, -76.61219

42.35843, -71.05977

42.33143, -83.04575

40.71427, -74.00597

35.22709, -80.84313

39.95233, -75.16379

40.44062, -79.99589

38.02931, -78.47668

43.0389, -87.90647

-34.61315, -58.37723

-31.4135, -64.18105

-33.88965, 151.17642

-37.79839, 144.97833

-37.75, 145.06667

-27.44453, 153.01852

-37.814, 144.96332

-32.06987, 115.83757

-32.90667, 151.72647

-33.80383, 150.98768

47.06667, 15.45

48.30639, 14.28611

47.79941, 13.04399

48.20849, 16.37208

51.21989, 4.40346

51.20892, 3.22424

51.05, 3.71667

50.87959, 4.70093

50.63373, 5.56749

-12.97111, -38.51083

-23.5475, -46.63611

51.05011, -114.08529

49.24966, -123.11934

43.25011, -79.84963

43.70011, -79.4163

45.50884, -73.58781

49.19522, 16.60796

50.20923, 15.83277

49.83465, 18.28204

50.08804, 14.42076

56.15674, 10.21076

55.67594, 12.56553

55.39594, 10.38831

60.16952, 24.93545

65.01236, 25.46816

60.45148, 22.26869

50.63297, 3.05858

47.21725, -1.55336

48.85341, 2.3488

46.58333, 0.33333

43.60426, 1.44367

52.52437, 13.41053

51.05089, 13.73832

47.9959, 7.85222

53.57532, 10.01534

49.40768, 8.69079

51.33962, 12.37129

49.98419, 8.2791

48.13743, 11.57549

49.01513, 12.10161

48.52266, 9.05222

49.79391, 9.95121

37.97945, 23.71622

40.64361, 22.93086

47.49801, 19.03991

47.53333, 21.63333

53.33306, -6.24889

31.76904, 35.21633

32.08227, 34.81065

32.08088, 34.78057

35.37517, 139.92991

33.6, 130.41667

34.7186409, 135.3791966

36.6, 136.61667

35.02107, 135.75385

35.18147, 136.90641

34.65, 133.93333

43.06667, 141.35

38.26667, 140.86667

35.469, 140.29807

35.056264, 127.0025403

37.566, 126.9784

52.37403, 4.88969

53.21917, 6.56667

51.8425, 5.85278

51.9225, 4.47917

59.91273, 10.74609

54.35205, 18.64637

50.29761, 18.67658

51.25, 22.56667

52.40692, 16.92993

52.22977, 21.01178

51.1, 17.03333

38.71667, -9.13333

41.14961, -8.61099

41.38879, 2.15899

41.35967, 2.10028

40.4165, -3.70256

37.98704, -1.13004

42.81687, -1.64323

40.96882, -5.66388

43.46472, -3.80444

37.38283, -5.97317

39.46975, -0.37739

57.70716, 11.96679

58.41086, 15.62157

55.70584, 13.19321

47.55839, 7.57327

46.94809, 7.44744

47.42391, 9.37477

52.48142, -1.89983

51.45523, -2.59665

53.79648, -1.54785

51.50853, -0.12574

53.48095, -2.23743

51.3434765, -0.1910896

Indicates 50+ sites in this region: click to zoom in.

Indicates 10+ sites in this region: click to zoom in.

Indicates < 10 sites in this region: click to zoom in.

Corresponds to individual site.

OVERVIEW

Sexes Eligible for Study

Age

Phase

Sites

Status

SUMMARY

CONDITIONS

ELIGIBILITY

DETAILS

LOCATIONS

37.77493, -122.41942

41.30815, -72.92816

25.77427, -80.19366

28.53834, -81.37924

41.66113, -91.53017

37.98869, -84.47772

38.25424, -85.75941

39.29038, -76.61219

42.35843, -71.05977

42.33143, -83.04575

42.33143, -83.04575

40.71427, -74.00597

40.71427, -74.00597

40.71427, -74.00597

35.22709, -80.84313

39.95233, -75.16379

40.44062, -79.99589

38.02931, -78.47668

43.0389, -87.90647

-34.61315, -58.37723

-34.61315, -58.37723

-31.4135, -64.18105

-33.88965, 151.17642

-37.79839, 144.97833

-37.75, 145.06667

-27.44453, 153.01852

-37.814, 144.96332

-37.814, 144.96332

-32.06987, 115.83757

-32.90667, 151.72647

-33.80383, 150.98768

47.06667, 15.45

48.30639, 14.28611

47.79941, 13.04399

48.20849, 16.37208

51.21989, 4.40346

51.20892, 3.22424

51.05, 3.71667

50.87959, 4.70093

50.63373, 5.56749

-12.97111, -38.51083

-23.5475, -46.63611

-23.5475, -46.63611

51.05011, -114.08529

49.24966, -123.11934

43.25011, -79.84963

43.70011, -79.4163

45.50884, -73.58781

49.19522, 16.60796

50.20923, 15.83277

49.83465, 18.28204

50.08804, 14.42076

56.15674, 10.21076

55.67594, 12.56553

55.39594, 10.38831

60.16952, 24.93545

65.01236, 25.46816

60.45148, 22.26869

50.63297, 3.05858

47.21725, -1.55336

48.85341, 2.3488

46.58333, 0.33333

43.60426, 1.44367

52.52437, 13.41053

51.05089, 13.73832

47.9959, 7.85222

53.57532, 10.01534

49.40768, 8.69079

51.33962, 12.37129