Paclitaxel, Carboplatin, and Bevacizumab With or Without Cixutumumab in Treating Patients With Stage IV or Recurrent Non-small Cell Lung Cancer
- Conditions
- Recurrent Non-Small Cell Lung CarcinomaLarge Cell Lung CarcinomaLung AdenocarcinomaStage IV Non-Small Cell Lung CancerBronchioloalveolar Lung Carcinoma
- Interventions
- Registration Number
- NCT00955305
- Lead Sponsor
- National Cancer Institute (NCI)
- Brief Summary
This randomized phase II trial studies how well carboplatin, paclitaxel, and bevacizumab (CPB) work when given with or without cixutumumab in treating patients with non-small cell lung cancer that is stage IV or has come back (recurrent). Drugs used in chemotherapy, such as paclitaxel and carboplatin, work in different ways to stop the growth of tumor cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Monoclonal antibodies, such as bevacizumab, may interfere with the ability of tumor cells to grow and spread. Other types of monoclonal antibodies, such as cixutumumab, may find tumor cells and help kill them. It is not yet known whether giving more than one drug (combination chemotherapy) together with bevacizumab is more effective when given with or without cixutumumab in treating patients with non-small cell lung cancer.
- Detailed Description
PRIMARY OBJECTIVES:
I. To evaluate the progression-free survival with the combination of carboplatin, paclitaxel, and bevacizumab, and +/- IMC-A12 (cixutumumab) in patients with advanced, non-squamous, non-small cell lung cancer.
SECONDARY OBJECTIVES:
I. To evaluate overall survival and response rate of the above combination in patients with non-squamous, advanced non-small cell lung cancer.
II. To evaluate the toxicities of the above combination in patients with non-squamous advanced non-small cell lung cancer.
OUTLINE: Patients are randomized to 1 of 2 treatment arms.
ARM A (CPB): Patients receive carboplatin intravenously (IV) over 30 minutes, paclitaxel IV over 3 hours, and bevacizumab IV over 30-90 minutes on day 1.
ARM B (CPB+cixutumumab): Patients receive carboplatin, paclitaxel, and bevacizumab as in Arm A. Patients also receive cixutumumab (IMC-A12) IV over 1 hour on days 1, 8, and 15.
In both arms, treatment repeats every 21 days for 6 courses in the absence of disease progression or unacceptable toxicity. Treatment with bevacizumab and cixutumumab may continue in the absence of disease progression or unacceptable toxicity.
After completion of study treatment, patients are followed up every 3 months for 2 years and then every 6 months for 3 years.
Recruitment & Eligibility
- Status
- TERMINATED
- Sex
- All
- Target Recruitment
- 175
- Histologically or cytologically confirmed with non-squamous, non-small cell lung cancer (NSCLC)
- Advanced NSCLC defined as either recurrent disease after prior radiation or surgery or stage IV (M1a or M1b) based on the TNM staging system (American Joint Committee on Cancer [AJCC] 2009)
- Measurable disease as defined by the revised Response Evaluation Criteria in Solid Tumors (RECIST version 1.1). All sites of disease (of target and non-target disease sites) must be obtained within 4 weeks prior to randomization
- A head computed tomography (CT) or magnetic resonance imaging (MRI) required within 4 weeks prior to randomization
- Prior radiation therapy (RT) is allowed if it has been completed 3 weeks prior to randomization and patient has recovered from any adverse events related to RT
- Brain metastases are allowed, provided they have been treated with surgery and/or radiotherapy, the patient is neurologically stable, and repeat brain imaging shows no progression in the brain; at least 6 weeks should have elapsed from the time of craniotomy and at least 4 weeks from radiotherapy
- Eastern Cooperative Oncology Group (ECOG) performance status 0-1
- Absolute neutrophil count (ANC) ≥ 1500/mm³
- Platelet count ≥ 100,000/mm³
- Total bilirubin within institutional upper limit of normal (ULN)
- Serum creatinine ≤ 1.5 x ULN
- Fasting blood glucose within normal range (fasting < 120 mg/dL or below ULN)
- Alkaline phosphatase (ALP) ≤ 3 x ULN
- Aspartate transaminase (AST) and alanine transaminase (ALT) ≤ 3 x ULN
- Urine dipstick must be ≤ 0-1+ within 2 weeks (14 days) of randomization; if urine dipstick result is > 1+, a calculation of urine protein creatinine (UPC) ratio is required; patients must have a UPC ratio < 1.0 to participate in the study
- Neuropathy, if present at baseline, must be ≤ Common Terminology Criteria for Adverse Events (CTCAE) grade 1
- Patients with a history of hypertension must be well-controlled (≤ 150/90) on a stable regimen of anti-hypertensive therapy
- Women of childbearing potential and sexually active males should use an accepted and effective method of contraception while on treatment and for 3 months thereafter
-
Prior chemotherapy or biologic/molecular targeted therapy for advanced NSCLC. Prior chemotherapy and/or biological/molecular targeted therapy as part of initial potentially curative therapy (one regimen of induction and/or adjuvant and/or concurrent chemoradiotherapy) was allowed provided it had been completed 1 year or more prior to randomization
-
Prior treatment with IMC-A12 or another insulin-like growth factor 1 receptor (IGF-1R) inhibitor
-
Patients on therapeutic anticoagulation; patient's international normalized ratio (INR) must be ≤ 1.5 or partial thromboplastin time (PTT) ≤ upper limits of normal within 2 weeks prior to randomization to be eligible; prophylactic anticoagulation of venous access devices is allowed provided the above criteria have been met
-
Prior allergic reaction to compounds of chemical or biologic composition similar to those of IMC-A12
-
Hypersensitivity to any component of bevacizumab
-
Poorly controlled diabetes mellitus
-
History of other invasive malignancies unless there is no active disease and all treatment has been completed ≥ 3 years prior to randomization; patients with history of in-situ malignancies and curatively resected nonmelanomatous skin cancer are eligible
-
History of thrombotic or hemorrhagic disorders
-
History of bleeding diathesis or coagulopathy
-
≥ grade 2 bleeding or any bleeding requiring intervention within 4 weeks prior to randomization
-
History of gross hemoptysis (defined as ≥ 1/2 teaspoon of bright red blood)
-
Any of the following within 6 months prior to randomization:
- Abdominal fistula
- Gastrointestinal perforation
- Intra-abdominal abscess
- Previous myocardial infarction
- History of any central nervous system (CNS) cerebrovascular ischemia
- New York Heart Association (NYHA) > class II congestive heart failure or severe heart failure
- Unstable or symptomatic angina pectoris
- History of stroke
- Significant vascular disease
- Symptomatic peripheral vascular disease
-
Ongoing, serious cardiac arrhythmia requiring medication at time of randomization
-
Ongoing, active infection or ongoing fever at the time of randomization or any co-existing medical condition, psychiatric illness or limitations that would interfere with compliance of study requirements
-
History of hypertensive crisis or hypertensive encephalopathy
-
Any of the following within 4 weeks prior to randomization: a serious non-healing wound, ulcer, bone fracture, or major surgical procedure
-
Anticipated major surgical procedure(s) during the course of the study
-
Receiving daily treatment with aspirin (> 325 mg/day) or non-steroidal anti-inflammatory agents (NSAIDs) known to inhibit platelet function for chronic conditions; patients must not be receiving treatment with dipyridamole (Persantine), ticlopidine (Ticlid), clopidogrel (Plavix), and/or cilostazol (Pletal); if patient was receiving any of the following: aspirin (> 325 mg/day), NSAID, and/or anti-platelet drugs, patient must have discontinued its use ≥ 1 week prior to randomization
-
Pregnant or breast-feeding
-
Human immunodeficiency virus (HIV)-positive patients on combination antiretroviral therapy
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Arm A (CPB) Bevacizumab Patients receive carboplatin intravenously (IV) over 30 minutes, paclitaxel IV over 3 hours, and bevacizumab IV over 30-90 minutes on day 1. Treatment repeats every 21 days for 6 courses in the absence of disease progression or unacceptable toxicity. Treatment with bevacizumab may continue in the absence of disease progression or unacceptable toxicity. Arm B (CPB+cixutumumab) Bevacizumab Patients receive carboplatin, paclitaxel, and bevacizumab as in Arm A. Patients also receive cixutumumab (IMC-A12) IV over 1 hour on days 1, 8, and 15. Treatment repeats every 21 days for 6 courses in the absence of disease progression or unacceptable toxicity. Treatment with bevacizumab and cixutumumab may continue in the absence of disease progression or unacceptable toxicity. Arm B (CPB+cixutumumab) Cixutumumab Patients receive carboplatin, paclitaxel, and bevacizumab as in Arm A. Patients also receive cixutumumab (IMC-A12) IV over 1 hour on days 1, 8, and 15. Treatment repeats every 21 days for 6 courses in the absence of disease progression or unacceptable toxicity. Treatment with bevacizumab and cixutumumab may continue in the absence of disease progression or unacceptable toxicity. Arm A (CPB) Carboplatin Patients receive carboplatin intravenously (IV) over 30 minutes, paclitaxel IV over 3 hours, and bevacizumab IV over 30-90 minutes on day 1. Treatment repeats every 21 days for 6 courses in the absence of disease progression or unacceptable toxicity. Treatment with bevacizumab may continue in the absence of disease progression or unacceptable toxicity. Arm A (CPB) Paclitaxel Patients receive carboplatin intravenously (IV) over 30 minutes, paclitaxel IV over 3 hours, and bevacizumab IV over 30-90 minutes on day 1. Treatment repeats every 21 days for 6 courses in the absence of disease progression or unacceptable toxicity. Treatment with bevacizumab may continue in the absence of disease progression or unacceptable toxicity. Arm B (CPB+cixutumumab) Carboplatin Patients receive carboplatin, paclitaxel, and bevacizumab as in Arm A. Patients also receive cixutumumab (IMC-A12) IV over 1 hour on days 1, 8, and 15. Treatment repeats every 21 days for 6 courses in the absence of disease progression or unacceptable toxicity. Treatment with bevacizumab and cixutumumab may continue in the absence of disease progression or unacceptable toxicity. Arm B (CPB+cixutumumab) Paclitaxel Patients receive carboplatin, paclitaxel, and bevacizumab as in Arm A. Patients also receive cixutumumab (IMC-A12) IV over 1 hour on days 1, 8, and 15. Treatment repeats every 21 days for 6 courses in the absence of disease progression or unacceptable toxicity. Treatment with bevacizumab and cixutumumab may continue in the absence of disease progression or unacceptable toxicity.
- Primary Outcome Measures
Name Time Method Progression-free Survival (PFS) Assessed every 3 months if patient is < 2 years from study entry; every 6 months if patient is 2 - 5 years from study entry; up to 5 years Progression-free survival was defined as the time from randomization to progression or death without documentation of progression. For cases without progression, follow-up was censored at the date of last disease assessment without progression, unless death occurs within 3 months following the date last known progression-free, in which case the death was counted as a failure.
Progression was evaluated using RECIST 1.1 criteria and defined as:
1. At least a 20% increase in the sum of the diameters of target lesions, taking as reference the smallest sum on study and the sum must also demonstrate an absolute increase of at least 5 mm.
OR
2. Appearance of one or more new lesions and/or unequivocal progression of existing non-target lesions.
- Secondary Outcome Measures
Name Time Method Proportion of Patients With Objective Response Assessed every 3 months if patient is < 2 years from study entry and every 6 months if patient is 2-5 years from study entry; up to 5 years Objective response was evaluated using the RECIST 1.1 criteria.
Objective response includes complete response (CR) and partial response (PR). Objective response is defined as disappearance of all target lesions or at least a 30% decrease in the sum of the diameters of target lesions. In addition, non-target lesions do not meet the criteria for disease progression and no new lesions were observed.Overall Survival (OS) Assessed every 3 months if patient is < 2 years from study entry; every 6 months if patient is 2 - 5 years from study entry; up to 5 years Overall survival is defined as the time from randomization to death or date last known alive.
Trial Locations
- Locations (164)
Longmont United Hospital
🇺🇸Longmont, Colorado, United States
Smilow Cancer Hospital Care Center at Saint Francis
🇺🇸Hartford, Connecticut, United States
Hurley Medical Center
🇺🇸Flint, Michigan, United States
Mercy Medical Center
🇺🇸Canton, Ohio, United States
Bronson Methodist Hospital
🇺🇸Kalamazoo, Michigan, United States
Essentia Health Cancer Center
🇺🇸Duluth, Minnesota, United States
Essentia Health Saint Mary's Medical Center
🇺🇸Duluth, Minnesota, United States
University of Pennsylvania/Abramson Cancer Center
🇺🇸Philadelphia, Pennsylvania, United States
Geisinger Wyoming Valley/Henry Cancer Center
🇺🇸Wilkes-Barre, Pennsylvania, United States
Dallas VA Medical Center
🇺🇸Dallas, Texas, United States
Parkland Memorial Hospital
🇺🇸Dallas, Texas, United States
UT Southwestern/Simmons Cancer Center-Dallas
🇺🇸Dallas, Texas, United States
West Virginia University Charleston
🇺🇸Charleston, West Virginia, United States
Fox Valley Hematology and Oncology
🇺🇸Appleton, Wisconsin, United States
Waukesha Memorial Hospital
🇺🇸Waukesha, Wisconsin, United States
Saint Joseph Hospital
🇺🇸Chicago, Illinois, United States
Tufts Medical Center
🇺🇸Boston, Massachusetts, United States
Riverside Methodist Hospital
🇺🇸Columbus, Ohio, United States
Columbus NCI Community Oncology Research Program
🇺🇸Columbus, Ohio, United States
University of Pittsburgh Cancer Institute (UPCI)
🇺🇸Pittsburgh, Pennsylvania, United States
The Christ Hospital
🇺🇸Cincinnati, Ohio, United States
Hennepin County Medical Center
🇺🇸Minneapolis, Minnesota, United States
Porter Adventist Hospital
🇺🇸Denver, Colorado, United States
Presbyterian - Saint Lukes Medical Center - Health One
🇺🇸Denver, Colorado, United States
Rose Medical Center
🇺🇸Denver, Colorado, United States
Colorado Cancer Research Program NCORP
🇺🇸Denver, Colorado, United States
Saint John Hospital and Medical Center
🇺🇸Detroit, Michigan, United States
Associates In Womens Health
🇺🇸Wichita, Kansas, United States
Cancer Center of Kansas - Main Office
🇺🇸Wichita, Kansas, United States
SCL Health Lutheran Medical Center
🇺🇸Wheat Ridge, Colorado, United States
Lewis Cancer and Research Pavilion at Saint Joseph's/Candler
🇺🇸Savannah, Georgia, United States
Littleton Adventist Hospital
🇺🇸Littleton, Colorado, United States
Sky Ridge Medical Center
🇺🇸Lone Tree, Colorado, United States
Charlotte Hungerford Hospital Center for Cancer Care
🇺🇸Torrington, Connecticut, United States
SwedishAmerican Regional Cancer Center/ACT
🇺🇸Rockford, Illinois, United States
North Suburban Medical Center
🇺🇸Thornton, Colorado, United States
Saint Mary Corwin Medical Center
🇺🇸Pueblo, Colorado, United States
Medical Oncology and Hematology Associates-West Des Moines
🇺🇸Clive, Iowa, United States
Cancer Center of Kansas - McPherson
🇺🇸McPherson, Kansas, United States
Cancer Center of Kansas-Wichita Medical Arts Tower
🇺🇸Wichita, Kansas, United States
Wichita NCI Community Oncology Research Program
🇺🇸Wichita, Kansas, United States
Cancer Center of Kansas - Newton
🇺🇸Newton, Kansas, United States
Cancer Center of Kansas - Salina
🇺🇸Salina, Kansas, United States
Cancer Center of Kansas-Liberal
🇺🇸Liberal, Kansas, United States
Oakwood Hospital and Medical Center
🇺🇸Dearborn, Michigan, United States
Cancer Center of Kansas - Winfield
🇺🇸Winfield, Kansas, United States
Sparrow Hospital
🇺🇸Lansing, Michigan, United States
Essentia Health Saint Joseph's Medical Center
🇺🇸Brainerd, Minnesota, United States
North Memorial Medical Health Center
🇺🇸Robbinsdale, Minnesota, United States
Metro Minnesota Community Oncology Research Consortium
🇺🇸Saint Louis Park, Minnesota, United States
Saint John's Hospital - Healtheast
🇺🇸Maplewood, Minnesota, United States
Minnesota Oncology Hematology PA-Maplewood
🇺🇸Maplewood, Minnesota, United States
New Ulm Medical Center
🇺🇸New Ulm, Minnesota, United States
Park Nicollet Clinic - Saint Louis Park
🇺🇸Saint Louis Park, Minnesota, United States
United Hospital
🇺🇸Saint Paul, Minnesota, United States
Minnesota Oncology and Hematology PA-Woodbury
🇺🇸Woodbury, Minnesota, United States
Abbott-Northwestern Hospital
🇺🇸Minneapolis, Minnesota, United States
Rice Memorial Hospital
🇺🇸Willmar, Minnesota, United States
Sanford Medical Center-Fargo
🇺🇸Fargo, North Dakota, United States
Fairfield Medical Center
🇺🇸Lancaster, Ohio, United States
Mary Rutan Hospital
🇺🇸Bellefontaine, Ohio, United States
Marietta Memorial Hospital
🇺🇸Marietta, Ohio, United States
Knox Community Hospital
🇺🇸Mount Vernon, Ohio, United States
Licking Memorial Hospital
🇺🇸Newark, Ohio, United States
Mount Carmel Health Center West
🇺🇸Columbus, Ohio, United States
Grady Memorial Hospital
🇺🇸Delaware, Ohio, United States
Springfield Regional Medical Center
🇺🇸Springfield, Ohio, United States
Bryn Mawr Hospital
🇺🇸Bryn Mawr, Pennsylvania, United States
Geisinger Medical Center-Cancer Center Hazleton
🇺🇸Hazleton, Pennsylvania, United States
PinnacleHealth Cancer Center-Community Campus
🇺🇸Harrisburg, Pennsylvania, United States
Oconomowoc Memorial Hospital-ProHealth Care Inc
🇺🇸Oconomowoc, Wisconsin, United States
Geisinger Medical Center
🇺🇸Danville, Pennsylvania, United States
Pottstown Memorial Medical Center
🇺🇸Pottstown, Pennsylvania, United States
Marshfield Clinic Cancer Center at Sacred Heart
🇺🇸Eau Claire, Wisconsin, United States
Mercy Cancer Center-West Lakes
🇺🇸Clive, Iowa, United States
Rutgers New Jersey Medical School
🇺🇸Newark, New Jersey, United States
Paoli Memorial Hospital
🇺🇸Paoli, Pennsylvania, United States
Geisinger Medical Group
🇺🇸State College, Pennsylvania, United States
Genesys Hurley Cancer Institute
🇺🇸Flint, Michigan, United States
Borgess Medical Center
🇺🇸Kalamazoo, Michigan, United States
Saint Joseph Mercy Port Huron
🇺🇸Port Huron, Michigan, United States
Saint Mary Mercy Hospital
🇺🇸Livonia, Michigan, United States
Saint Mary's of Michigan
🇺🇸Saginaw, Michigan, United States
Case Western Reserve University
🇺🇸Cleveland, Ohio, United States
Grant Medical Center
🇺🇸Columbus, Ohio, United States
Southern Ohio Medical Center
🇺🇸Portsmouth, Ohio, United States
Cancer Center of Western Wisconsin
🇺🇸New Richmond, Wisconsin, United States
Veterans Adminstration New Jersey Health Care System
🇺🇸East Orange, New Jersey, United States
Saint John Macomb-Oakland Hospital
🇺🇸Warren, Michigan, United States
Cancer Center of Kansas - Parsons
🇺🇸Parsons, Kansas, United States
Genesys Regional Medical Center-West Flint Campus
🇺🇸Flint, Michigan, United States
Miller-Dwan Hospital
🇺🇸Duluth, Minnesota, United States
Roger Maris Cancer Center
🇺🇸Fargo, North Dakota, United States
Hunterdon Medical Center
🇺🇸Flemington, New Jersey, United States
Sanford Clinic North-Fargo
🇺🇸Fargo, North Dakota, United States
Boulder Community Hospital
🇺🇸Boulder, Colorado, United States
Penrose-Saint Francis Healthcare
🇺🇸Colorado Springs, Colorado, United States
SCL Health Saint Joseph Hospital
🇺🇸Denver, Colorado, United States
Swedish Medical Center
🇺🇸Englewood, Colorado, United States
North Colorado Medical Center
🇺🇸Greeley, Colorado, United States
Saint Anthony Hospital
🇺🇸Lakewood, Colorado, United States
Saint Mary's Hospital and Regional Medical Center
🇺🇸Grand Junction, Colorado, United States
McKee Medical Center
🇺🇸Loveland, Colorado, United States
The Hospital of Central Connecticut
🇺🇸New Britain, Connecticut, United States
Eastern Connecticut Hematology and Oncology Associates
🇺🇸Norwich, Connecticut, United States
Ingalls Memorial Hospital
🇺🇸Harvey, Illinois, United States
Lakeland Regional Cancer Center
🇺🇸Lakeland, Florida, United States
Saint Alphonsus Cancer Care Center-Boise
🇺🇸Boise, Idaho, United States
Mercy Hospital
🇺🇸Coon Rapids, Minnesota, United States
McFarland Clinic PC-William R Bliss Cancer Center
🇺🇸Ames, Iowa, United States
Swedish American Hospital
🇺🇸Rockford, Illinois, United States
Hinsdale Hematology Oncology Associates Incorporated
🇺🇸Hinsdale, Illinois, United States
Oncology Associates at Mercy Medical Center
🇺🇸Cedar Rapids, Iowa, United States
Ottumwa Regional Health Center
🇺🇸Ottumwa, Iowa, United States
Mercy Medical Center-Sioux City
🇺🇸Sioux City, Iowa, United States
Saint Luke's Regional Medical Center
🇺🇸Sioux City, Iowa, United States
Siouxland Regional Cancer Center
🇺🇸Sioux City, Iowa, United States
Cancer Center of Kansas - Chanute
🇺🇸Chanute, Kansas, United States
Cancer Center of Kansas - Dodge City
🇺🇸Dodge City, Kansas, United States
Cancer Center of Kansas - El Dorado
🇺🇸El Dorado, Kansas, United States
Cancer Center of Kansas - Fort Scott
🇺🇸Fort Scott, Kansas, United States
Cancer Center of Kansas-Independence
🇺🇸Independence, Kansas, United States
Cancer Center of Kansas-Kingman
🇺🇸Kingman, Kansas, United States
Lawrence Memorial Hospital
🇺🇸Lawrence, Kansas, United States
Cancer Center of Kansas - Pratt
🇺🇸Pratt, Kansas, United States
Via Christi Regional Medical Center
🇺🇸Wichita, Kansas, United States
Allegiance Health
🇺🇸Jackson, Michigan, United States
West Michigan Cancer Center
🇺🇸Kalamazoo, Michigan, United States
Saint Joseph Mercy Oakland
🇺🇸Pontiac, Michigan, United States
Sanford Clinic North-Bemidgi
🇺🇸Bemidji, Minnesota, United States
Fairview Ridges Hospital
🇺🇸Burnsville, Minnesota, United States
Fairview-Southdale Hospital
🇺🇸Edina, Minnesota, United States
Unity Hospital
🇺🇸Fridley, Minnesota, United States
Hutchinson Area Health Care
🇺🇸Hutchinson, Minnesota, United States
Regions Hospital
🇺🇸Saint Paul, Minnesota, United States
Lakeview Hospital
🇺🇸Stillwater, Minnesota, United States
Saint Francis Regional Medical Center
🇺🇸Shakopee, Minnesota, United States
Ridgeview Medical Center
🇺🇸Waconia, Minnesota, United States
Summa Akron City Hospital/Cooper Cancer Center
🇺🇸Akron, Ohio, United States
Adena Regional Medical Center
🇺🇸Chillicothe, Ohio, United States
Doctors Hospital
🇺🇸Columbus, Ohio, United States
Saint Rita's Medical Center
🇺🇸Lima, Ohio, United States
Genesis Healthcare System Cancer Care Center
🇺🇸Zanesville, Ohio, United States
Saint Mary Medical and Regional Cancer Center
🇺🇸Langhorne, Pennsylvania, United States
Albert Einstein Medical Center
🇺🇸Philadelphia, Pennsylvania, United States
Avera Cancer Institute
🇺🇸Sioux Falls, South Dakota, United States
Lankenau Medical Center
🇺🇸Wynnewood, Pennsylvania, United States
Avera McKennan Hospital and University Health Center
🇺🇸Sioux Falls, South Dakota, United States
Main Line Health NCORP
🇺🇸Wynnewood, Pennsylvania, United States
University of Texas Health Science Center at San Antonio
🇺🇸San Antonio, Texas, United States
The Medical Center of Aurora
🇺🇸Aurora, Colorado, United States
Saint Joseph Mercy Hospital
🇺🇸Ann Arbor, Michigan, United States
Michigan Cancer Research Consortium CCOP
🇺🇸Ann Arbor, Michigan, United States
Alegent Health Lakeside Hospital
🇺🇸Omaha, Nebraska, United States
Froedtert and the Medical College of Wisconsin
🇺🇸Milwaukee, Wisconsin, United States
Iowa Methodist Medical Center
🇺🇸Des Moines, Iowa, United States
Iowa-Wide Oncology Research Coalition NCORP
🇺🇸Des Moines, Iowa, United States
Medical Oncology and Hematology Associates-Des Moines
🇺🇸Des Moines, Iowa, United States
Medical Oncology and Hematology Associates-Laurel
🇺🇸Des Moines, Iowa, United States
Mercy Medical Center - Des Moines
🇺🇸Des Moines, Iowa, United States
Iowa Lutheran Hospital
🇺🇸Des Moines, Iowa, United States
Dean Hematology and Oncology Clinic
🇺🇸Madison, Wisconsin, United States
Cancer Center of Kansas - Wellington
🇺🇸Wellington, Kansas, United States
Reading Hospital
🇺🇸West Reading, Pennsylvania, United States