Imatinib Mesylate in Treating Patients With Recurrent Brain Tumor

Phase 1

Completed

Conditions: Adult Anaplastic Oligodendroglioma
Recurrent Adult Brain Neoplasm
Adult Mixed Glioma
Adult Oligodendroglioma

Interventions: Drug: Imatinib Mesylate
Other: Laboratory Biomarker Analysis
Other: Pharmacological Study

Registration Number: NCT00049127

Lead Sponsor: Alliance for Clinical Trials in Oncology

Brief Summary: This phase I/II trial is studying the side effects and best dose of imatinib mesylate and to see how well it works in treating patients with a recurrent brain tumor that has not responded to previous surgery and radiation therapy. Imatinib mesylate may stop the growth of tumor cells by blocking the enzymes necessary for tumor cell growth.

Detailed Description: PRIMARY OBJECTIVES:

I. To identify the maximum tolerated dose of imatinib (imatinib mesylate) in patients with recurrent oligodendroglioma and mixed oligoastrocytoma that are currently on enzyme inducing anticonvulsant therapy. (Study 1) II. To assess the efficacy of imatinib in patients with recurrent oligodendrogliomas and mixed oligoastrocytomas (with pathologic evidence of oligodendrogliomatous component) as measured by progression-free survival, response, and overall survival. (Study 2) III. To acquire pilot data on a patient group not traditionally eligible for recurrent oligodendroglioma and mixed oligoastrocytoma clinical trials (those having \> 2 prior chemotherapy regimens or 2 prior chemotherapy regimens for recurrent/progressive disease). (Study 3) IV. To examine the toxicity and safety of imatinib in patients with recurrent oligodendrogliomas and mixed oligoastrocytomas (with pathologic evidence of oligodendrogliomatous component). (Studies 1, 2, and 3) V. To perform a preliminary correlative study of 1p/19q alterations, alpha platelet-derived growth factor receptor (PDFGR) gene amplification and levels of related downstream signaling elements in tumor tissue, with clinical study endpoints. (Studies 1, 2, and 3) VI. To perform a descriptive correlative analysis of steady state pharmacokinetic data regarding imatinib and active metabolites with the study endpoints. (Studies 1, 2, and 3)

OUTLINE: This is a phase I, dose-escalation study followed by a phase II and a pilot study.

Recruitment & Eligibility

Status: COMPLETED

Sex: All

Target Recruitment: 64

Inclusion Criteria

Study 1 Arm C:
- Currently on anticonvulsants which can induce cytochrome p450 (phenytoin, carbamazepine, barbiturates, primidone and if unsure contact study chair)
- =< 2 prior chemotherapy regimens (with maximum of 1 prior chemotherapy regimen for recurrent disease)
Study 2 Arms A and B:
- On or off anticonvulsants
- =< 2 prior chemotherapy regimens (with maximum of 1 prior chemotherapy regimen for recurrent disease)
Study 3 Arms D and E:
- On or off anticonvulsants
- > 2 chemotherapy regimens or 2 prior chemotherapy regimens for progressive/recurrent disease
All Arms:
Histological confirmation of a grade 2-4 oligodendroglioma, or mixed oligoastrocytoma grade 2-4 containing oligodendrogliomatous component on central pathology review prior to study registration, and a diagnosis of recurrence; tissues from all available prior surgeries should be sent, in particular those from time of initial diagnosis
Measurable or evaluable disease by magnetic resonance imaging (MRI) or computed tomography (CT) scan
Fixed dose of corticosteroids (or no corticosteroids) for at least 1 week prior to the pre-study baseline scan
Patients undergoing surgery for initial or progressive disease, must be at least 2 weeks from the date of surgery, must have recovered from the effects of their surgery, and must have unequivocal tumor growth on the pre-study baseline neuroimaging study as compared to the first post-operative scan, unless there is a separate lesion or residual disease compatible with tumor that is not within the surgical bed
Unequivocal evidence of tumor progression by MRI or CT scan performed =< 21days prior to study registration
Must have failed surgery/radiotherapy (RT) and Temozolomide or nitrosourea based therapy
>= 12 weeks since the completion of RT
Absolute neutrophil count (ANC) >= 1500/mm^3
Platelets (PLT) >= 100,000/mm^3
Hemoglobin (Hgb) >= 9 g/dL
Total bilirubin =< 1.5 mg/dL
Serum glutamic oxaloacetic transaminase (SGOT) (aspartate aminotransferase [AST]) =< 3 x upper limit of normal (ULN)
Creatinine =< 2.0 mg/dL
Eastern Cooperative Oncology Group (ECOG) performance status (PS) of 0, 1, or 2
>= 6 weeks since the last day of nitrosourea-based chemotherapy prior to study entry
>= 4 weeks from any investigational agents prior to study entry
>= 4 weeks from other chemotherapy prior to study entry
>= 2 weeks from vincristine and biologic non-cytotoxic agents, e.g., tamoxifen, thalidomide, cis-retinoic acid, interferon, etc, prior to study entry
Patients or designated individual(s) with durable medical power of attorney for the patient must be able to provide informed, written consent, and complete any required study questionnaire(s) within the specifications of this study

Exclusion Criteria

All Arms
Receiving warfarin or heparin
Received prior stereotactic radiosurgery, interstitial brachytherapy, or interstitial chemotherapy including carmustine (BCNU) wafers unless there is a separate lesion on MRI, which is not part of the previous treatment field
Active uncontrolled infection
History of myocardial infarction =< 6 months or congestive heart failure (CHF) requiring use of ongoing maintenance therapy for life-threatening ventricular arrhythmias; patients must have a New York Heart Association (NYHA) of class II or less; (NYHA class I: patients with no limitation of activities; they suffer no symptoms from ordinary activities; class II: patients with slight, mild limitation of activity; they are comfortable with rest or with mild exertion; class III: patients with marked limitation of activity; they are comfortable only at rest; class IV: patients who should be at complete rest, confined to bed or chair; any physical activity brings on discomfort and symptoms occur at rest)
Other severe concurrent disease which, in the judgment of the investigator, would make the patient inappropriate for entry into this study or interfere significantly with the interpretation of potential drug-induced toxicities
Women of child-bearing potential, pregnant or nursing; such patients must have a negative pregnancy test (b-HCG) =< 7 days prior to study registration
Men or women of childbearing potential, not willing to employ adequate contraception (condoms, diaphragm, birth control pills, injections, intrauterine device [IUD], surgical sterilization, subcutaneous implants, or abstinence, etc.); the efficacy of oral contraceptives may be decreased in patients who receive p450-inducing anticonvulsants; for these patients, use of a second mode of contraception is recommended; patients of childbearing potential must utilize effective contraception and avoid becoming pregnant or fathering a child for 6 months after completing study drug
Other active malignancy, besides skin carcinomas (must not be melanoma)
Concomitant serious immunocompromised status (other than that related to concomitant steroids); patients that are human immunodeficiency virus (HIV) positive are eligible, provided that there is no other reason for exclusion, based on the eligibility as outlined elsewhere in this section
Significant intratumoral hemorrhage on baseline MRI or CT, or other history of significant intratumoral hemorrhage

Study & Design

Study Type: INTERVENTIONAL

Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Phase II (Group 2)	Imatinib Mesylate	Patients receive standard-dose imatinib mesylate PO BID for 4 weeks.
Phase II (Group 2)	Pharmacological Study	Patients receive standard-dose imatinib mesylate PO BID for 4 weeks.
Phase II (Group 1)	Laboratory Biomarker Analysis	Patients receive imatinib mesylate PO, at the MTD determined in phase I, BID for 4 weeks.
Phase II (Group 1)	Pharmacological Study	Patients receive imatinib mesylate PO, at the MTD determined in phase I, BID for 4 weeks.
Phase II (Group 2)	Laboratory Biomarker Analysis	Patients receive standard-dose imatinib mesylate PO BID for 4 weeks.
Phase II (Group 1)	Imatinib Mesylate	Patients receive imatinib mesylate PO, at the MTD determined in phase I, BID for 4 weeks.

Primary Outcome Measures

Name	Time	Method
6-month Progression-free Survival (PFS), Defined as a Patient Being Alive and Progression-free 183 Days After the Date of Registration.	6 months	The proportion of successes will be estimated using the Binomial point estimator (number of successes divided by the total number of evaluable patients) and the Binomial 90% confidence interval estimated using the Duffy-Santer algorithm. Progression is defined using response criteria (the neurologic examination and the MRI and/or CT), \>25% increase in product of perpendicular diameters of contrast enhancement or mass or appearance of new lesions.

Secondary Outcome Measures

Name	Time	Method
Confirmed Response (i.e., an Objective Status of Complete Response (CR), Partial Response (PR), or Regression (REGR) on 2 Successive Evaluations at Least 4 Weeks Apart After the Start of Study Treatment).	Up to 5 years	Complete Response (CR) is defined using response criteria (the neurologic examination and the Magnetic resonance imaging (MRI) and/or Computerized Tomography (CT)), total disappearance of all tumor with patient off corticosteroids or only on adrenal replacement maintenance. Partial Response (PR) is defined using response criteria (the neurologic examination and the MRI and/or CT), \>=50% reduction in product of perpendicular diameters of contrast enhancement or mass with no new lesions with the patient being on stable or decreased steroid dose. Regression (REGR) is defined using response criteria (the neurologic examination and the MRI and/or CT), unequivocal reduction in size of contrast-enhancement or decrease in mass effect as agreed upon independently by primary physician and quality control physicians; no new lesions. Patient should be on stable or decreased steroid dose.
Percentage of Patients Progression-free	Time from study registration to date of disease progression or last follow-up, assessed up to 5 years	The percentage of patient progression-free at 12 months, 18 months, and PFS will be estimated. Kaplan-Meier survival curves and logrank tests will be used to estimate progression-time distributions. Progression is defined using response criteria (the neurologic examination and the MRI and/or CT), \>25% increase in product of perpendicular diameters of contrast enhancement or mass or appearance of new lesions.
Overall Time to Death	Time from date of registration to date of death due to any cause or last follow-up, assessed up to 5 years	Kaplan-Meier survival curves and logrank tests will be used to estimate survival distributions.

Trial Locations

Locations (226): Illinois CancerCare Galesburg
🇺🇸
Galesburg, Illinois, United States
Mason District Hospital
🇺🇸
Havana, Illinois, United States
Mcdonough District Hospital
🇺🇸
Macomb, Illinois, United States
Perry Memorial Hospital
🇺🇸
Princeton, Illinois, United States
Saint Luke's Hospital
🇺🇸
Maumee, Ohio, United States
Cancer Center of Kansas-Independence
🇺🇸
Independence, Kansas, United States
Mercy Hospital
🇺🇸
Coon Rapids, Minnesota, United States
Saint Luke's Regional Medical Center
🇺🇸
Sioux City, Iowa, United States
Essentia Health Cancer Center
🇺🇸
Duluth, Minnesota, United States
Meeker County Memorial Hospital
🇺🇸
Litchfield, Minnesota, United States
Coborn Cancer Center at Saint Cloud Hospital
🇺🇸
Saint Cloud, Minnesota, United States
Metro-Minnesota NCI Community Oncology Research Program
🇺🇸
Saint Louis Park, Minnesota, United States
Park Nicollet Clinic - Saint Louis Park
🇺🇸
Saint Louis Park, Minnesota, United States
Saint Joseph's Hospital - Healtheast
🇺🇸
Saint Paul, Minnesota, United States
Great Falls Clinic
🇺🇸
Great Falls, Montana, United States
Kalispell Medical Oncology
🇺🇸
Kalispell, Montana, United States
Montana Cancer Specialists
🇺🇸
Missoula, Montana, United States
Fisher-Titus Medical Center
🇺🇸
Norwalk, Ohio, United States
Saint Elizabeth Regional Medical Center
🇺🇸
Lincoln, Nebraska, United States
Sanford Bismarck Medical Center
🇺🇸
Bismarck, North Dakota, United States
Geisinger Medical Group
🇺🇸
State College, Pennsylvania, United States
AnMed Health Hospital
🇺🇸
Anderson, South Carolina, United States
Allegheny General Hospital
🇺🇸
Pittsburgh, Pennsylvania, United States
Rush - Copley Medical Center
🇺🇸
Aurora, Illinois, United States
Mayo Clinic in Arizona
🇺🇸
Scottsdale, Arizona, United States
Bromenn Regional Medical Center
🇺🇸
Normal, Illinois, United States
Saint Francis Hospital and Medical Center
🇺🇸
Hartford, Connecticut, United States
Stoffel, Thomas J MD (UIA Investigator)
🇺🇸
Moline, Illinois, United States
Community Cancer Center Foundation
🇺🇸
Normal, Illinois, United States
Oncology Associates at Mercy Medical Center
🇺🇸
Cedar Rapids, Iowa, United States
Franciscan Saint Anthony Health-Michigan City
🇺🇸
Michigan City, Indiana, United States
Western Illinois Cancer Treatment Center
🇺🇸
Galesburg, Illinois, United States
Carle Clinic-Urbana Main
🇺🇸
Urbana, Illinois, United States
Mayo Clinic in Florida
🇺🇸
Jacksonville, Florida, United States
Pekin Cancer Treatment Center
🇺🇸
Pekin, Illinois, United States
Pekin Hospital
🇺🇸
Pekin, Illinois, United States
OSF Saint Francis Medical Center
🇺🇸
Peoria, Illinois, United States
Sharis, Christine M MD (UIA Investigator)
🇺🇸
Moline, Illinois, United States
Joliet Oncology-Hematology Associates Limited
🇺🇸
Joliet, Illinois, United States
Saint Margaret's Hospital
🇺🇸
Spring Valley, Illinois, United States
Carle Cancer Center
🇺🇸
Urbana, Illinois, United States
Siouxland Regional Cancer Center
🇺🇸
Sioux City, Iowa, United States
Porubcin, Michael MD (UIA Investigator)
🇺🇸
Moline, Illinois, United States
Cancer Center of Kansas-Kingman
🇺🇸
Kingman, Kansas, United States
Constantinou, Costas L MD (UIA Investigator)
🇺🇸
Bettendorf, Iowa, United States
Mercy Medical Center - North Iowa
🇺🇸
Mason City, Iowa, United States
Mercy Medical Center-Sioux City
🇺🇸
Sioux City, Iowa, United States
Illinois Valley Hospital
🇺🇸
Peru, Illinois, United States
Cedar Rapids Oncology Association
🇺🇸
Cedar Rapids, Iowa, United States
Cancer Center of Kansas - El Dorado
🇺🇸
El Dorado, Kansas, United States
Wichita CCOP
🇺🇸
Wichita, Kansas, United States
Oakwood Hospital and Medical Center
🇺🇸
Dearborn, Michigan, United States
Allegiance Health
🇺🇸
Jackson, Michigan, United States
Center for Hematology- Oncology of Southern Michigan PLC
🇺🇸
Jackson, Michigan, United States
Cancer Center of Kansas - Winfield
🇺🇸
Winfield, Kansas, United States
Cancer Center of Kansas - Ottawa
🇺🇸
Ottawa, Kansas, United States
Saint Joseph Mercy Oakland
🇺🇸
Pontiac, Michigan, United States
Chippewa County - Montevideo Hospital
🇺🇸
Montevideo, Minnesota, United States
Northern Rockies Radiation Oncology Center
🇺🇸
Billings, Montana, United States
Minnesota Oncology Hematology PA-Maplewood
🇺🇸
Maplewood, Minnesota, United States
Saint Vincent Healthcare
🇺🇸
Billings, Montana, United States
Bozeman Deaconess Cancer Center
🇺🇸
Bozeman, Montana, United States
Regions Hospital
🇺🇸
Saint Paul, Minnesota, United States
Lakeview Hospital
🇺🇸
Stillwater, Minnesota, United States
Billings Clinic Cancer Center
🇺🇸
Billings, Montana, United States
Fremont Memorial Hospital
🇺🇸
Fremont, Ohio, United States
Avera Cancer Institute
🇺🇸
Sioux Falls, South Dakota, United States
Medical X-Ray Center
🇺🇸
Sioux Falls, South Dakota, United States
Welch Cancer Center
🇺🇸
Sheridan, Wyoming, United States
Rocky Mountain Oncology
🇺🇸
Casper, Wyoming, United States
Graham Hospital Association
🇺🇸
Canton, Illinois, United States
Abbott-Northwestern Hospital
🇺🇸
Minneapolis, Minnesota, United States
Virginia Piper Cancer Institute
🇺🇸
Minneapolis, Minnesota, United States
Saint John Hospital and Medical Center
🇺🇸
Detroit, Michigan, United States
Hutchinson Area Health Care
🇺🇸
Hutchinson, Minnesota, United States
Essentia Health Saint Mary's Medical Center
🇺🇸
Duluth, Minnesota, United States
North Memorial Medical Health Center
🇺🇸
Robbinsdale, Minnesota, United States
Swenson, Wade II, MD (UIA Investigator)
🇺🇸
Fergus Falls, Minnesota, United States
Hennepin County Medical Center
🇺🇸
Minneapolis, Minnesota, United States
Saint Cloud Hospital
🇺🇸
Saint Cloud, Minnesota, United States
United Hospital
🇺🇸
Saint Paul, Minnesota, United States
Cancer Center of Kansas - Parsons
🇺🇸
Parsons, Kansas, United States
Via Christi Regional Medical Center
🇺🇸
Wichita, Kansas, United States
Saint Joseph Medical Center
🇺🇸
Bloomington, Illinois, United States
Alegent Health Mercy Hospital
🇺🇸
Council Bluffs, Iowa, United States
Burgess Memorial Hospital
🇺🇸
Onawa, Iowa, United States
Toledo Clinic Cancer Centers-Bowling Green
🇺🇸
Bowling Green, Ohio, United States
Bozeman Deaconess Hospital
🇺🇸
Bozeman, Montana, United States
Internal Medicine of Bozeman
🇺🇸
Bozeman, Montana, United States
Methodist Medical Center of Illinois
🇺🇸
Peoria, Illinois, United States
McFarland Clinic PC-William R Bliss Cancer Center
🇺🇸
Ames, Iowa, United States
Saint Anthony Regional Hospital
🇺🇸
Carroll, Iowa, United States
Hopedale Medical Complex - Hospital
🇺🇸
Hopedale, Illinois, United States
Garneau, Stewart C MD (UIA Investigator)
🇺🇸
Moline, Illinois, United States
Medical Oncology and Hematology Associates-West Des Moines
🇺🇸
Clive, Iowa, United States
Cancer Center of Kansas - Dodge City
🇺🇸
Dodge City, Kansas, United States
Cancer Center of Kansas - Newton
🇺🇸
Newton, Kansas, United States
Community Memorial Hospital
🇺🇸
Missouri Valley, Iowa, United States
Hospital District Sixth of Harper County
🇺🇸
Anthony, Kansas, United States
Memorial Hospital of Arkansas City
🇺🇸
Arkansas City, Kansas, United States
Cancer Center of Kansas - Chanute
🇺🇸
Chanute, Kansas, United States
Bixby Medical Center
🇺🇸
Adrian, Michigan, United States
Mid Dakota Clinic
🇺🇸
Bismarck, North Dakota, United States
Cancer Center of Kansas-Wichita Medical Arts Tower
🇺🇸
Wichita, Kansas, United States
Lawrence Memorial Hospital
🇺🇸
Lawrence, Kansas, United States
Associates In Womens Health
🇺🇸
Wichita, Kansas, United States
Cancer Center of Kansas - Salina
🇺🇸
Salina, Kansas, United States
Southwest Medical Center
🇺🇸
Liberal, Kansas, United States
Cancer Center of Kansas - Main Office
🇺🇸
Wichita, Kansas, United States
Saint Mary Mercy Hospital
🇺🇸
Livonia, Michigan, United States
Toledo Clinic Cancer Centers-Monroe
🇺🇸
Monroe, Michigan, United States
Hurley Medical Center
🇺🇸
Flint, Michigan, United States
Genesys Regional Medical Center-West Flint Campus
🇺🇸
Flint, Michigan, United States
Sparrow Hospital
🇺🇸
Lansing, Michigan, United States
Saint John Macomb-Oakland Hospital
🇺🇸
Warren, Michigan, United States
Mercy Memorial Hospital
🇺🇸
Monroe, Michigan, United States
Saint Joseph Mercy Port Huron
🇺🇸
Port Huron, Michigan, United States
Saint Mary's of Michigan
🇺🇸
Saginaw, Michigan, United States
Medini, Eitan MD (UIA Investigator)
🇺🇸
Alexandria, Minnesota, United States
Essentia Health Saint Joseph's Medical Center
🇺🇸
Brainerd, Minnesota, United States
Miller-Dwan Hospital
🇺🇸
Duluth, Minnesota, United States
Brainerd Medical Center Inc
🇺🇸
Brainerd, Minnesota, United States
Fairview Ridges Hospital
🇺🇸
Burnsville, Minnesota, United States
Etzell, Paul S MD (UIA Investigator)
🇺🇸
Fergus Falls, Minnesota, United States
Unity Hospital
🇺🇸
Fridley, Minnesota, United States
Saint Francis Regional Medical Center
🇺🇸
Shakopee, Minnesota, United States
Saint Alexius Medical Center
🇺🇸
Bismarck, North Dakota, United States
Adult and Pediatric Urology PLLP
🇺🇸
Sartell, Minnesota, United States
Rice Memorial Hospital
🇺🇸
Willmar, Minnesota, United States
Guthrie Medical Group PC-Robert Packer Hospital
🇺🇸
Sayre, Pennsylvania, United States
Bromenn Lifecare Center
🇺🇸
Bloomington, Illinois, United States
Memorial Hospital
🇺🇸
Carthage, Illinois, United States
Galesburg Cottage Hospital
🇺🇸
Galesburg, Illinois, United States
Eureka Hospital
🇺🇸
Eureka, Illinois, United States
Kewanee Hospital
🇺🇸
Kewanee, Illinois, United States
Illinois CancerCare-Peoria
🇺🇸
Peoria, Illinois, United States
Proctor Hospital
🇺🇸
Peoria, Illinois, United States
Illinois CancerCare-Ottawa Clinic
🇺🇸
Ottawa, Illinois, United States
Valley Radiation Oncology
🇺🇸
Peru, Illinois, United States
Illinois Oncology Research Association CCOP
🇺🇸
Peoria, Illinois, United States
Sarah Culbertson Memorial Hospital
🇺🇸
Rushville, Illinois, United States
Fairview-Southdale Hospital
🇺🇸
Edina, Minnesota, United States
Saint John's Hospital - Healtheast
🇺🇸
Maplewood, Minnesota, United States
Ridgeview Medical Center
🇺🇸
Waconia, Minnesota, United States
Minnesota Oncology and Hematology PA-Woodbury
🇺🇸
Woodbury, Minnesota, United States
Woodwinds Health Campus
🇺🇸
Woodbury, Minnesota, United States
Montana Cancer Consortium NCORP
🇺🇸
Billings, Montana, United States
Deaconess Medical Center
🇺🇸
Billings, Montana, United States
Frontier Cancer Center and Blood Institute-Billings
🇺🇸
Billings, Montana, United States
Saint James Community Hospital and Cancer Treatment Center
🇺🇸
Butte, Montana, United States
Benefis Healthcare- Sletten Cancer Institute
🇺🇸
Great Falls, Montana, United States
Northern Montana Hospital
🇺🇸
Havre, Montana, United States
Berdeaux, Donald MD (UIA Investigator)
🇺🇸
Great Falls, Montana, United States
Saint Peter's Community Hospital
🇺🇸
Helena, Montana, United States
Kalispell Regional Medical Center
🇺🇸
Kalispell, Montana, United States
Eastern Montana Cancer Center
🇺🇸
Miles City, Montana, United States
Glacier Oncology PLLC
🇺🇸
Kalispell, Montana, United States
Saint Patrick Hospital - Community Hospital
🇺🇸
Missoula, Montana, United States
Guardian Oncology and Center for Wellness
🇺🇸
Missoula, Montana, United States
Community Medical Hospital
🇺🇸
Missoula, Montana, United States
Fremont Area Medical Center
🇺🇸
Fremont, Nebraska, United States
Bryan LGH Medical Center East
🇺🇸
Lincoln, Nebraska, United States
Bryan LGH Medical Center West
🇺🇸
Lincoln, Nebraska, United States
Nebraska Cancer Research Center
🇺🇸
Lincoln, Nebraska, United States
Mount Sinai Medical Center
🇺🇸
New York, New York, United States
Midlands Community Hospital
🇺🇸
Papillion, Nebraska, United States
Rutherford Hospital
🇺🇸
Rutherfordton, North Carolina, United States
Mercy Cancer Center-Elyria
🇺🇸
Elyria, Ohio, United States
North Coast Cancer Care-Clyde
🇺🇸
Clyde, Ohio, United States
Cole, Sharon, K. M.D. (UIA Investigator)
🇺🇸
Kenton, Ohio, United States
Hematology Oncology Center Incorporated
🇺🇸
Elyria, Ohio, United States
Blanchard Valley Hospital
🇺🇸
Findlay, Ohio, United States
Lima Memorial Hospital
🇺🇸
Lima, Ohio, United States
Toledo Radiation Oncology at Northwest Ohio Onocolgy Center
🇺🇸
Maumee, Ohio, United States
Toledo Clinic Cancer Centers-Maumee
🇺🇸
Maumee, Ohio, United States
Saint Charles Hospital
🇺🇸
Oregon, Ohio, United States
Firelands Regional Medical Center
🇺🇸
Sandusky, Ohio, United States
Toledo Clinic Cancer Centers-Oregon
🇺🇸
Oregon, Ohio, United States
North Coast Cancer Care
🇺🇸
Sandusky, Ohio, United States
The Toledo Hospital/Toledo Children's Hospital
🇺🇸
Toledo, Ohio, United States
Mercy Hospital of Tiffin
🇺🇸
Tiffin, Ohio, United States
Flower Hospital
🇺🇸
Sylvania, Ohio, United States
Saint Vincent Mercy Medical Center
🇺🇸
Toledo, Ohio, United States
Toledo Community Hospital Oncology Program CCOP
🇺🇸
Toledo, Ohio, United States
University of Toledo
🇺🇸
Toledo, Ohio, United States
Stark, Michael, Edward. M.D. (UIA Investigator)
🇺🇸
Toledo, Ohio, United States
Mercy Saint Anne Hospital
🇺🇸
Toledo, Ohio, United States
Toledo Clinic Cancer Centers-Toledo
🇺🇸
Toledo, Ohio, United States
Geisinger Medical Center
🇺🇸
Danville, Pennsylvania, United States
Lehigh Valley Hospital-Cedar Crest
🇺🇸
Allentown, Pennsylvania, United States
Fulton County Health Center
🇺🇸
Wauseon, Ohio, United States
Sharon Regional Cancer Center
🇺🇸
Hermitage, Pennsylvania, United States
Geisinger Medical Center-Cancer Center Hazleton
🇺🇸
Hazleton, Pennsylvania, United States
Medical Center Clinic-Allegheny General Hospital
🇺🇸
Pittsburgh, Pennsylvania, United States
Geisinger Wyoming Valley/Henry Cancer Center
🇺🇸
Wilkes-Barre, Pennsylvania, United States
Spartanburg Medical Center
🇺🇸
Spartanburg, South Carolina, United States
Rapid City Regional Hospital
🇺🇸
Rapid City, South Dakota, United States
Sanford Cancer Center-Oncology Clinic
🇺🇸
Sioux Falls, South Dakota, United States
Sanford USD Medical Center - Sioux Falls
🇺🇸
Sioux Falls, South Dakota, United States
Sanford NCI Community Oncology Research Program of the North Central Plains
🇺🇸
Sioux Falls, South Dakota, United States
Avera McKennan Hospital and University Health Center
🇺🇸
Sioux Falls, South Dakota, United States
Fredericksburg Oncology Inc
🇺🇸
Fredericksburg, Virginia, United States
University of Virginia Cancer Center
🇺🇸
Charlottesville, Virginia, United States
Michigan Cancer Research Consortium CCOP
🇺🇸
Ann Arbor, Michigan, United States
Saint Joseph Mercy Hospital
🇺🇸
Ann Arbor, Michigan, United States
Mayo Clinic
🇺🇸
Rochester, Minnesota, United States
Missouri Valley Cancer Consortium
🇺🇸
Omaha, Nebraska, United States
Alegent Health Immanuel Medical Center
🇺🇸
Omaha, Nebraska, United States
Alegent Health Bergan Mercy Medical Center
🇺🇸
Omaha, Nebraska, United States
Creighton University Medical Center
🇺🇸
Omaha, Nebraska, United States
Southeast Cancer Consortium-Upstate NCORP
🇺🇸
Winston-Salem, North Carolina, United States
Medical Center Clinic-Butler Office
🇺🇸
Butler, Pennsylvania, United States
Mercy Capitol
🇺🇸
Des Moines, Iowa, United States
Iowa Methodist Medical Center
🇺🇸
Des Moines, Iowa, United States
Mercy Medical Center - Des Moines
🇺🇸
Des Moines, Iowa, United States
Iowa Oncology Research Association CCOP
🇺🇸
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
Iowa Lutheran Hospital
🇺🇸
Des Moines, Iowa, United States
Vigliotti, Antonio, P.G. M.D. (UIA Investigator)
🇺🇸
Moline, Illinois, United States
Ottawa Regional Hospital and Healthcare Center
🇺🇸
Ottawa, Illinois, United States
Cancer Center of Kansas - Fort Scott
🇺🇸
Fort Scott, Kansas, United States
Cancer Center of Kansas - Pratt
🇺🇸
Pratt, Kansas, United States
Cancer Center of Kansas-Liberal
🇺🇸
Liberal, Kansas, United States
Hickman Cancer Center
🇺🇸
Adrian, Michigan, United States
Cancer Center of Kansas - Wellington
🇺🇸
Wellington, Kansas, United States