A Randomized Phase II Study of Cisplatin and Etoposide in Combination With Either Hedgehog Inhibitor GDC-0449 or IGF-1R MOAB IMC-A12 for Patients With Extensive Stage

Phase 2

Completed

Conditions: Extensive Stage Small Cell Lung Carcinoma
Recurrent Small Cell Lung Carcinoma

Interventions: Drug: Cisplatin
Biological: Cixutumumab
Other: Laboratory Biomarker Analysis
Drug: Etoposide
Drug: Vismodegib

Registration Number: NCT00887159

Lead Sponsor: National Cancer Institute (NCI)

Brief Summary: This randomized phase II trial studies cisplatin and etoposide to see how well they work when given with or without Hedgehog inhibitor GDC-0449 (vismodegib) or IGF-1R MOAB IMC-A12 (cixutumumab) in treating patients with extensive-stage small cell lung cancer. Drugs used in chemotherapy, such as cisplatin, 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. Etoposide may slow the growth of tumor cells by blocking some of the enzymes needed for cell growth. Vismodegib may slow the growth of tumor cells. Monoclonal antibodies, such as cixutumumab, may interfere with the ability of tumor cells to grow and spread. It is not yet known whether giving cisplatin and etoposide are more effective when given together with vismodegib or cixutumumab in treating small cell lung cancer.

Detailed Description: PRIMARY OBJECTIVES:

I. To evaluate the progression-free survival (PFS) of patients with extensive stage small cell lung cancer (SCLC-ED) treated with cisplatin and etoposide (CE), CE with hedgehog (HH) inhibitor GDC-0449 (vismodegib), and CE with insulin-like growth factor-1 receptor (IGF-1R) monoclonal antibody (IMC-A12) (cixutumumab).

SECONDARY OBJECTIVES:

I. To evaluate response rate, overall survival, and toxicity for each arm. II. To explore putative correlates of clinical benefit from combination therapy in tumor and circulating tumor cells in patients treated on this protocol.

OUTLINE: Patients are randomized to 1 of 3 treatment arms.

ARM A (CE): Patients receive cisplatin (75 mg/m\^2) intravenously (IV) over 1-2 hours on day 1 and etoposide (100 mg/m\^2) IV over 1-2 hours on days 1-3. Treatment repeats every 21 days for 4 courses in the absence of disease progression or unacceptable toxicity.

ARM B (CE +GDC-0449): Patients receive cisplatin and etoposide as in Arm A and vismodegib (GDC-0449; 150 mg tablet) orally (PO) once daily (QD) on days 1-21. Treatment repeats every 21 days for 4 courses in the absence of disease progression or unacceptable toxicity. Patients then receive vismodegib alone QD in the absence of disease progression or unacceptable toxicity.

ARM C (CE + IMC-A12): Patients receive cisplatin and etoposide as in Arm A and cixutumumab (IMC-A12; 6 mg/kg) IV over 1 hour on days 1, 8, and 15. Treatment repeats every 21 days for 4 courses in the absence of disease progression or unacceptable toxicity. Patients then receive cixutumumab alone once weekly 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 1 year.

Recruitment & Eligibility

Status: COMPLETED

Sex: All

Target Recruitment: 168

Inclusion Criteria

Histologically or cytologically confirmed small cell lung cancer (SCLC)
Extensive stage SCLC
- Extensive stage disease: the extensive disease classification for this protocol includes all patients with disease sites not defined as limited stage; limited stage disease category includes patients with disease restricted to one hemithorax with regional lymph node metastases, including hilar, ipsilateral and contralateral mediastinal, and/or ipsilateral supraclavicular nodes; extensive disease patients are defined as those patients with extrathoracic metastatic disease, malignant pleural effusion, bilateral or contralateral supraclavicular adenopathy
Measurable disease based on Response Evaluation Criteria in Solid Tumors (RECIST); baseline measurements and evaluations of all sites of disease must be obtained =< 4 weeks prior to randomization
Eastern Cooperative Oncology Group (ECOG) performance status 0 or 1
Absolute neutrophil count (ANC) >= 1,500/mm^3
Platelets >= 100,000/mm^3
Total bilirubin =< 1.5 x institutional upper limit of normal (ULN)
Aspartate aminotransferase (AST) (serum glutamic oxaloacetic transaminase)/alanine aminotransferase (ALT) (serum glutamate pyruvate transaminase) =< 3 x institutional ULN (=< 5 x ULN if liver function test [LFT] elevations are due to liver metastases)
Creatinine =< 1.5 x institutional ULN OR creatinine clearance >= 60 mL/min/1.73 m^2 for patients with creatinine levels > 1.5 x institutional ULN
Leukocytes >= 3,000/mm^3
Hemoglobin >= 9 g/dL
Fasting serum glucose < 120 mg/dL or below institutional ULN =< 7 days prior to protocol randomization
Patients with central nervous system (CNS) metastases will be eligible if they have completed a course of CNS radiotherapy and have stable neurologic function for a minimum of 28 days prior to study randomization; radiotherapy must have been completed a minimum of 28 days prior to randomization, and patients must have recovered from any adverse events related to the radiotherapy (except alopecia and grade 1 neuropathy) and have stable neurologic function for a minimum of 28 days prior to study randomization
- NOTE: the use of prophylactic cranial irradiation (recommended dose 25 Gy) in those who completed protocol chemotherapy and have a response (in the absence of progressive disease [PD]) is allowed; for patients on Arms B and C, GDC-0449 and IMC-A12 will be held while patient is receiving prophylactic cranial irradiation (PCI); these agents can be reinstituted after PCI is completed
Women of child-bearing potential (WCBP) and men must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) prior to study entry and for the duration of study participation
- WCBP must agree to use two reliable forms of contraception simultaneously or to practice complete abstinence from heterosexual intercourse; the two methods of reliable contraception must include one highly effective method (i.e., intrauterine device [IUD], hormonal [birth control pills, injections, or implants], tubal ligation, partner?s vasectomy) and one additional effective (barrier) method (i.e., latex condom, diaphragm, cervical cap); WCBP must be referred to a qualified provider of contraceptive methods if needed
  - NOTE: the WCBP randomized to Arm B must agree to use two reliable forms of contraception simultaneously or to practice complete abstinence from heterosexual intercourse during the following two additional time periods related to this study: 1) while participating in the study; and 2) for at least 12 months after discontinuation from the study
- Before starting the study drugs, all WCBP must have a negative pregnancy test (sensitivity of at least 50 mIU/mL); the pregnancy test must be performed within 10-14 days prior to randomization
  - NOTE: the WCBP randomized to Arm B must have a second pregnancy test performed within the 24 hours prior to the start of the GDC-0449; the subject may not receive GDC-0449 until the investigator has verified that the results of these pregnancy tests are negative
- The WCBP randomized to Arm B will be warned that sharing the study drug is prohibited and will be counseled about pregnancy precautions and potential risks or fetal exposure; she must also agree to abstain from donating blood during study participation and at least 12 months after discontinuation from the study drug
  - NOTE: male subjects randomized to Arm B must agree to use a latex condom during sexual contact with WCBP while participating in the study and for at least 12 months following discontinuation from the study even if he has undergone a successful vasectomy
- Male subjects randomized to Arm B will be warned that sharing study drug is prohibited and will be counseled about pregnancy precautions and potential risks of fetal exposure; male subjects must agree to abstain from donating blood, semen, or sperm during study participation and for at least 3 months after discontinuation from the study drug

Exclusion Criteria

Pregnant or breastfeeding; all WCBP must have a blood test within 10-14 days prior to randomization to rule out pregnancy
Prior chemotherapy or biologic therapy for SCLC; patients with prior radiation may be eligible or after palliative radiotherapy for other sites of disease; patients receiving prior radiation cannot start therapy within 14 days after completion of radiation, and must have recovered from adverse events attributed to radiation; no previous irradiation to the only site of measurable or evaluable disease, unless that site had subsequent evidence of progression
Receiving any other investigational agents
History of allergic reactions attributed to compounds of similar chemical or biological composition to GDC-0449 and IMC-A12 or other agents used in the study
Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, uncontrolled cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements
Human immunodeficiency virus (HIV)-positive patients on combination antiretroviral therapy
Poorly controlled diabetes mellitus; patients with a history of diabetes mellitus are allowed to participate, provided that their blood glucose is within normal range (fasting < 120 mg/dL or below institutional upper limit of normal) and that they are on a stable dietary or therapeutic regimen for this condition
Patients with major surgery, hormonal therapy (other than replacement), within 4 weeks prior to entering the study or those who have not recovered from adverse events
Prior treatment with other agents targeting the IGFR or the Hedgehog signaling pathway

Study & Design

Study Type: INTERVENTIONAL

Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Arm A (CE)	Laboratory Biomarker Analysis	Patients receive cisplatin IV over 1-2 hours on day 1 and etoposide IV over 1-2 hours on days 1-3. Treatment repeats every 21 days for 4 courses in the absence of disease progression or unacceptable toxicity.
Arm C (CE + IMC-A12)	Laboratory Biomarker Analysis	Patients receive cisplatin and etoposide as in Arm A and cixutumumab IV over 1 hour on days 1, 8, and 15. Treatment repeats every 21 days for 4 courses in the absence of disease progression or unacceptable toxicity. Patients then receive cixutumumab alone once weekly in the absence of disease progression or unacceptable toxicity.
Arm C (CE + IMC-A12)	Cixutumumab	Patients receive cisplatin and etoposide as in Arm A and cixutumumab IV over 1 hour on days 1, 8, and 15. Treatment repeats every 21 days for 4 courses in the absence of disease progression or unacceptable toxicity. Patients then receive cixutumumab alone once weekly in the absence of disease progression or unacceptable toxicity.
Arm B (CE + GDC-0449)	Laboratory Biomarker Analysis	Patients receive cisplatin and etoposide as in Arm A and vismodegib PO QD on days 1-21. Treatment repeats every 21 days for 4 courses in the absence of disease progression or unacceptable toxicity. Patients then receive vismodegib alone QD in the absence of disease progression or unacceptable toxicity.
Arm C (CE + IMC-A12)	Etoposide	Patients receive cisplatin and etoposide as in Arm A and cixutumumab IV over 1 hour on days 1, 8, and 15. Treatment repeats every 21 days for 4 courses in the absence of disease progression or unacceptable toxicity. Patients then receive cixutumumab alone once weekly in the absence of disease progression or unacceptable toxicity.
Arm A (CE)	Etoposide	Patients receive cisplatin IV over 1-2 hours on day 1 and etoposide IV over 1-2 hours on days 1-3. Treatment repeats every 21 days for 4 courses in the absence of disease progression or unacceptable toxicity.
Arm A (CE)	Cisplatin	Patients receive cisplatin IV over 1-2 hours on day 1 and etoposide IV over 1-2 hours on days 1-3. Treatment repeats every 21 days for 4 courses in the absence of disease progression or unacceptable toxicity.
Arm B (CE + GDC-0449)	Cisplatin	Patients receive cisplatin and etoposide as in Arm A and vismodegib PO QD on days 1-21. Treatment repeats every 21 days for 4 courses in the absence of disease progression or unacceptable toxicity. Patients then receive vismodegib alone QD in the absence of disease progression or unacceptable toxicity.
Arm B (CE + GDC-0449)	Etoposide	Patients receive cisplatin and etoposide as in Arm A and vismodegib PO QD on days 1-21. Treatment repeats every 21 days for 4 courses in the absence of disease progression or unacceptable toxicity. Patients then receive vismodegib alone QD in the absence of disease progression or unacceptable toxicity.
Arm B (CE + GDC-0449)	Vismodegib	Patients receive cisplatin and etoposide as in Arm A and vismodegib PO QD on days 1-21. Treatment repeats every 21 days for 4 courses in the absence of disease progression or unacceptable toxicity. Patients then receive vismodegib alone QD in the absence of disease progression or unacceptable toxicity.
Arm C (CE + IMC-A12)	Cisplatin	Patients receive cisplatin and etoposide as in Arm A and cixutumumab IV over 1 hour on days 1, 8, and 15. Treatment repeats every 21 days for 4 courses in the absence of disease progression or unacceptable toxicity. Patients then receive cixutumumab alone once weekly in the absence of disease progression or unacceptable toxicity.

Primary Outcome Measures

Name	Time	Method
Progression-free Survival (PFS)	Assessed every 6 weeks while on treatment or observation; follow-up after discontinuation of treatment or observation: every 3 months if patient is < 2 years from study entry, every 6 months if patient is 2-3 years from study entry	Progression-free survival (PFS) is defined as the time from randomization to death or disease progression, whichever occurred first. Patients who were alive at the time of analysis are censored at the date at which they are last known to be alive and progression-free.

Secondary Outcome Measures

Name	Time	Method
Overall Survival (OS)	Assessed every 3 months if patient is < 2 years from study entry, every 6 months if patient is 2-3 years from study entry	Overall survival is defined as the time from randomization to death or date of last known alive.
Response Rate	Assessed every 6 weeks while on treatment or observation; follow-up after discontinuation of treatment or observation: every 3 months if patient is < 2 years from study entry, every 6 months if patient is 2-3 years from study entry	Response rate is defined as number of patients with complete response (CR) or partial response (PR) divided by all eligible and treated patients. Responses are evaluated using the Response Evaluation Criteria in Solid Tumors (RECIST) guideline. CR is defined as disappearance of all target and non-target lesions. PR is defined as at least a 30% decrease in the sum of the diameters of target lesions (taking as reference the baseline sum diameters), and persistence of one or more non-target lesion(s).
PFS	Assessed every 6 weeks while on treatment or observation; follow-up after discontinuation of treatment or observation: every 3 months if patient is < 2 years from study entry, every 6 months if patient is 2-3 years from study entry	Progression-free survival (PFS) is defined as the time from randomization to death or disease progression, whichever occurred first. Patients who were alive at the time of analysis are censored at the date at which they are last known to be alive and progression-free. This analysis is to evaluate the association between PFS and circulating tumor cells (CTCs).

Trial Locations

Locations (300): Boca Raton Regional Hospital
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Boca Raton, Florida, United States
Mason District Hospital
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Havana, Illinois, United States
Longmont United Hospital
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Longmont, Colorado, United States
Mcdonough District Hospital
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Macomb, Illinois, United States
Licking Memorial Hospital
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Newark, Ohio, United States
Perry Memorial Hospital
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Princeton, Illinois, United States
North Memorial Medical Health Center
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Robbinsdale, Minnesota, United States
Toledo Clinic Cancer Centers-Maumee
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Maumee, Ohio, United States
Greater Baltimore Medical Center
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Baltimore, Maryland, United States
Saint Luke's Hospital
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Maumee, Ohio, United States
Fisher-Titus Medical Center
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Norwalk, Ohio, United States
Dallas VA Medical Center
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Dallas, Texas, United States
Geisinger Medical Group
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State College, Pennsylvania, United States
Mount Nittany Medical Center
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State College, Pennsylvania, United States
Fredericksburg Oncology Inc
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Fredericksburg, Virginia, United States
Illinois CancerCare-Peru
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Peru, Illinois, United States
Illinois Valley Hospital
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Peru, Illinois, United States
Illinois CancerCare-Princeton
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Princeton, Illinois, United States
Swedish American Hospital
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Rockford, Illinois, United States
SwedishAmerican Regional Cancer Center/ACT
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Rockford, Illinois, United States
Hematology Oncology Associates of Illinois - Skokie
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Skokie, Illinois, United States
Illinois CancerCare-Spring Valley
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Spring Valley, Illinois, United States
Saint Margaret's Hospital
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Spring Valley, Illinois, United States
Memorial Medical Center
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Springfield, Illinois, United States
Medical Oncology and Hematology Associates-West Des Moines
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Clive, Iowa, United States
Constantinou, Costas L MD (UIA Investigator)
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Bettendorf, Iowa, United States
McFarland Clinic PC-William R Bliss Cancer Center
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Ames, Iowa, United States
Mercy Medical Center - North Iowa
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Mason City, Iowa, United States
Ottumwa Regional Health Center
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Ottumwa, Iowa, United States
Siouxland Regional Cancer Center
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Sioux City, Iowa, United States
Mercy Medical Center-Sioux City
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Sioux City, Iowa, United States
Saint Luke's Regional Medical Center
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Sioux City, Iowa, United States
Cancer Center of Kansas - Fort Scott
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Fort Scott, Kansas, United States
Lawrence Memorial Hospital
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Lawrence, Kansas, United States
Southwest Medical Center
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Liberal, Kansas, United States
Cancer Center of Kansas - Parsons
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Parsons, Kansas, United States
Cancer Center of Kansas - Winfield
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Winfield, Kansas, United States
Hickman Cancer Center
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Adrian, Michigan, United States
Hurley Medical Center
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Flint, Michigan, United States
Borgess Medical Center
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Kalamazoo, Michigan, United States
Saint Mary Mercy Hospital
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Livonia, Michigan, United States
Saint John Macomb-Oakland Hospital
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Warren, Michigan, United States
Fairview Ridges Hospital
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Burnsville, Minnesota, United States
Sanford Clinic North-Bemidgi
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Bemidji, Minnesota, United States
Mercy Hospital
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Scranton, Pennsylvania, United States
Unity Hospital
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Fridley, Minnesota, United States
Fairview-Southdale Hospital
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Edina, Minnesota, United States
Lake Region Healthcare Corporation-Cancer Care
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Fergus Falls, Minnesota, United States
Metro Minnesota Community Oncology Research Consortium
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Saint Louis Park, Minnesota, United States
Rice Memorial Hospital
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Willmar, Minnesota, United States
Sparta Cancer Treatment Center
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Sparta, New Jersey, United States
University of New Mexico Cancer Center
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Albuquerque, New Mexico, United States
Lovelace Medical Center-Saint Joseph Square
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Albuquerque, New Mexico, United States
Presbyterian Kaseman Hospital
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Albuquerque, New Mexico, United States
New York Oncology Hematology PC - Albany
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Albany, New York, United States
New York Oncology Hematology PC -Albany Medical Center
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Albany, New York, United States
New York Oncology Hematology PC - Amsterdam
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Amsterdam, New York, United States
New York Oncology Hematology PC - Clifton Park
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Clifton Park, New York, United States
New York Oncology Hematology PC-Hudson
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Hudson, New York, United States
Laura and Isaac Perlmutter Cancer Center at NYU Langone
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New York, New York, United States
New York Oncology Hematology PC - Rexford
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Rexford, New York, United States
New York Oncology Hematology PC - Troy
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Troy, New York, United States
Dickstein Cancer Treatment Center
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White Plains, New York, United States
Stony Brook University Medical Center
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Stony Brook, New York, United States
Sanford Broadway Medical Center
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Fargo, North Dakota, United States
Summa Barberton Hospital
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Barberton, Ohio, United States
Mary Rutan Hospital
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Bellefontaine, Ohio, United States
Summa Akron City Hospital/Cooper Cancer Center
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Akron, Ohio, United States
Toledo Clinic Cancer Centers-Bowling Green
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Bowling Green, Ohio, United States
Mercy Medical Center
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Canton, Ohio, United States
Aultman Health Foundation
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Canton, Ohio, United States
Riverside Methodist Hospital
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Columbus, Ohio, United States
Columbus NCI Community Oncology Research Program
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Columbus, Ohio, United States
Mount Carmel Health Center West
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Columbus, Ohio, United States
Adena Regional Medical Center
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Chillicothe, Ohio, United States
North Coast Cancer Care-Clyde
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Clyde, Ohio, United States
Grant Medical Center
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Columbus, Ohio, United States
Doctors Hospital
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Columbus, Ohio, United States
Grady Memorial Hospital
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Delaware, Ohio, United States
Hematology Oncology Center Incorporated
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Elyria, Ohio, United States
Mercy Cancer Center-Elyria
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Elyria, Ohio, United States
Fairfield Medical Center
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Lancaster, Ohio, United States
Saint Rita's Medical Center
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Lima, Ohio, United States
Lima Memorial Hospital
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Lima, Ohio, United States
Marietta Memorial Hospital
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Marietta, Ohio, United States
Toledo Radiation Oncology at Northwest Ohio Onocolgy Center
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Maumee, Ohio, United States
Knox Community Hospital
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Mount Vernon, Ohio, United States
Saint Charles Hospital
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Oregon, Ohio, United States
Toledo Clinic Cancer Centers-Oregon
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Oregon, Ohio, United States
North Coast Cancer Care
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Sandusky, Ohio, United States
Springfield Regional Medical Center
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Springfield, Ohio, United States
Flower Hospital
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Sylvania, Ohio, United States
Mercy Hospital of Tiffin
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Tiffin, Ohio, United States
The Toledo Hospital/Toledo Children's Hospital
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Toledo, Ohio, United States
Saint Vincent Mercy Medical Center
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Toledo, Ohio, United States
Toledo Community Hospital Oncology Program CCOP
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Toledo, Ohio, United States
University of Toledo
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Toledo, Ohio, United States
Mercy Saint Anne Hospital
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Toledo, Ohio, United States
Toledo Clinic Cancer Centers-Toledo
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Toledo, Ohio, United States
Saint Ann's Hospital
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Westerville, Ohio, United States
Fulton County Health Center
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Wauseon, Ohio, United States
Natalie Warren Bryant Cancer Center at Saint Francis
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Tulsa, Oklahoma, United States
Bryn Mawr Hospital
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Bryn Mawr, Pennsylvania, United States
Lehigh Valley Hospital-Cedar Crest
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Allentown, Pennsylvania, United States
Geisinger Medical Center
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Danville, Pennsylvania, United States
Ephrata Cancer Center
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Ephrata, Pennsylvania, United States
Adams Cancer Center
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Gettysburg, Pennsylvania, United States
Cherry Tree Cancer Center
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Hanover, Pennsylvania, United States
Geisinger Medical Center-Cancer Center Hazleton
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Hazleton, Pennsylvania, United States
Saint Mary Medical and Regional Cancer Center
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Langhorne, Pennsylvania, United States
Lewistown Hospital
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Lewistown, Pennsylvania, United States
Paoli Memorial Hospital
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Paoli, Pennsylvania, United States
University of Pennsylvania/Abramson Cancer Center
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Philadelphia, Pennsylvania, United States
Thomas Jefferson University Hospital
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Philadelphia, Pennsylvania, United States
Einstein Medical Center Philadelphia
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Philadelphia, Pennsylvania, United States
Guthrie Medical Group PC-Robert Packer Hospital
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Sayre, Pennsylvania, United States
Hematology and Oncology Associates of North East Pennsylvania
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Scranton, Pennsylvania, United States
Scranton Hematology Oncology
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Scranton, Pennsylvania, United States
Reading Hospital
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West Reading, Pennsylvania, United States
Geisinger Wyoming Valley/Henry Cancer Center
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Wilkes-Barre, Pennsylvania, United States
Lankenau Medical Center
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Wynnewood, Pennsylvania, United States
WellSpan Health-York Hospital
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York, Pennsylvania, United States
Sanford Cancer Center Oncology Clinic
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Sioux Falls, South Dakota, United States
UT Southwestern/Simmons Cancer Center-Dallas
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Dallas, Texas, United States
Parkland Memorial Hospital
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Dallas, Texas, United States
University of Virginia Cancer Center
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Charlottesville, Virginia, United States
West Virginia University Charleston
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Charleston, West Virginia, United States
Marshfield Clinic Cancer Center at Sacred Heart
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Eau Claire, Wisconsin, United States
Marshfield Clinic-Minocqua Center
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Minocqua, Wisconsin, United States
Case Western Reserve University
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Cleveland, Ohio, United States
Northwestern University
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Chicago, Illinois, United States
John H Stroger Jr Hospital of Cook County
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Chicago, Illinois, United States
Rush University Medical Center
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Chicago, Illinois, United States
Mayo Clinic in Arizona
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Scottsdale, Arizona, United States
Smilow Cancer Hospital Care Center at Saint Francis
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Hartford, Connecticut, United States
The Hospital of Central Connecticut
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New Britain, Connecticut, United States
Smilow Cancer Hospital-Torrington Care Center
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Torrington, Connecticut, United States
Tufts Medical Center
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Boston, Massachusetts, United States
The Memorial Hospital at Easton
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Easton, Maryland, United States
Johns Hopkins University/Sidney Kimmel Cancer Center
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Baltimore, Maryland, United States
Frederick Memorial Hospital
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Frederick, Maryland, United States
Bixby Medical Center
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Adrian, Michigan, United States
Beaumont Hospital-Dearborn
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Dearborn, Michigan, United States
Genesys Regional Medical Center-West Flint Campus
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Flint, Michigan, United States
Bronson Methodist Hospital
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Kalamazoo, Michigan, United States
Allegiance Health
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Jackson, Michigan, United States
West Michigan Cancer Center
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Kalamazoo, Michigan, United States
Sparrow Hospital
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Lansing, Michigan, United States
Mercy Memorial Hospital
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Monroe, Michigan, United States
Saint Joseph Mercy Oakland
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Pontiac, Michigan, United States
Saint Mary's of Michigan
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Saginaw, Michigan, United States
Lake Huron Medical Center
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Port Huron, Michigan, United States
Nebraska Cancer Research Center
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Lincoln, Nebraska, United States
Alegent Health Bergan Mercy Medical Center
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Omaha, Nebraska, United States
Hackensack University Medical Center
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Hackensack, New Jersey, United States
Veterans Adminstration New Jersey Health Care System
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East Orange, New Jersey, United States
Hunterdon Medical Center
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Flemington, New Jersey, United States
Wellmont Medical Associates Oncology and Hematology-Bristol
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Bristol, Tennessee, United States
Vanderbilt-Ingram Cancer Center Cool Springs
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Franklin, Tennessee, United States
Sanford USD Medical Center - Sioux Falls
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Sioux Falls, South Dakota, United States
Gundersen Lutheran Medical Center
🇺🇸
La Crosse, Wisconsin, United States
Avera Cancer Institute
🇺🇸
Sioux Falls, South Dakota, United States
Avera McKennan Hospital and University Health Center
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Sioux Falls, South Dakota, United States
Medical X-Ray Center
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Sioux Falls, South Dakota, United States
Marshfield Clinic-Rice Lake Center
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Rice Lake, Wisconsin, United States
Ascension Saint Mary's Hospital
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Rhinelander, Wisconsin, United States
Marshfield Clinic
🇺🇸
Marshfield, Wisconsin, United States
West Virginia University Healthcare
🇺🇸
Morgantown, West Virginia, United States
Wheeling Hospital/Schiffler Cancer Center
🇺🇸
Wheeling, West Virginia, United States
Marshfield Clinic-Chippewa Center
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Chippewa Falls, Wisconsin, United States
Marshfield Clinic - Weston Center
🇺🇸
Weston, Wisconsin, United States
Ascension Saint Michael's Hospital
🇺🇸
Stevens Point, Wisconsin, United States
ProHealth Oconomowoc Memorial Hospital
🇺🇸
Oconomowoc, Wisconsin, United States
Marshfield Clinic - Wisconsin Rapids Center
🇺🇸
Wisconsin Rapids, Wisconsin, United States
ProHealth Waukesha Memorial Hospital
🇺🇸
Waukesha, Wisconsin, United States
Nevada Cancer Research Foundation CCOP
🇺🇸
Las Vegas, Nevada, United States
Abbott-Northwestern Hospital
🇺🇸
Minneapolis, Minnesota, United States
Hennepin County Medical Center
🇺🇸
Minneapolis, Minnesota, United States
Vanderbilt University/Ingram Cancer Center
🇺🇸
Nashville, Tennessee, United States
SCL Health Lutheran Medical Center
🇺🇸
Wheat Ridge, Colorado, United States
Penrose-Saint Francis Healthcare
🇺🇸
Colorado Springs, Colorado, United States
Essentia Health Cancer Center
🇺🇸
Duluth, Minnesota, United States
Minnesota Oncology Hematology PA-Woodbury
🇺🇸
Woodbury, Minnesota, United States
Cancer Center of Kansas-Wichita Medical Arts Tower
🇺🇸
Wichita, Kansas, United States
Sanford Clinic North-Fargo
🇺🇸
Fargo, North Dakota, United States
North Suburban Medical Center
🇺🇸
Thornton, Colorado, United States
Cancer Center of Kansas - El Dorado
🇺🇸
El Dorado, Kansas, United States
Cancer Center of Kansas - Newton
🇺🇸
Newton, Kansas, United States
Lakeview Hospital
🇺🇸
Stillwater, Minnesota, United States
Cancer Center of Kansas - Wichita
🇺🇸
Wichita, Kansas, United States
Essentia Health Saint Mary's Medical Center
🇺🇸
Duluth, Minnesota, United States
Via Christi Regional Medical Center
🇺🇸
Wichita, Kansas, United States
North Colorado Medical Center
🇺🇸
Greeley, Colorado, United States
McKee Medical Center
🇺🇸
Loveland, Colorado, United States
Saint Mary's Hospital and Regional Medical Center
🇺🇸
Grand Junction, Colorado, United States
Hutchinson Area Health Care
🇺🇸
Hutchinson, Minnesota, United States
Regions Hospital
🇺🇸
Saint Paul, Minnesota, United States
Saint Mary Corwin Medical Center
🇺🇸
Pueblo, Colorado, United States
Associates In Womens Health
🇺🇸
Wichita, Kansas, United States
Swedish Medical Center
🇺🇸
Englewood, Colorado, United States
Minnesota Oncology Hematology PA-Maplewood
🇺🇸
Maplewood, Minnesota, United States
Sky Ridge Medical Center
🇺🇸
Lone Tree, Colorado, United States
Cancer Center of Kansas-Kingman
🇺🇸
Kingman, Kansas, United States
Cancer Center of Kansas - Salina
🇺🇸
Salina, Kansas, United States
Saint Francis Regional Medical Center
🇺🇸
Shakopee, Minnesota, United States
Cancer Center of Kansas-Independence
🇺🇸
Independence, Kansas, United States
Saint John's Hospital - Healtheast
🇺🇸
Maplewood, Minnesota, United States
Cancer Center of Kansas - Chanute
🇺🇸
Chanute, Kansas, United States
Cancer Center of Kansas - Pratt
🇺🇸
Pratt, Kansas, United States
Miller-Dwan Hospital
🇺🇸
Duluth, Minnesota, United States
Park Nicollet Clinic - Saint Louis Park
🇺🇸
Saint Louis Park, Minnesota, United States
Cancer Center of Kansas - Wellington
🇺🇸
Wellington, Kansas, United States
Wichita NCI Community Oncology Research Program
🇺🇸
Wichita, Kansas, United States
Cancer Center of Kansas - Dodge City
🇺🇸
Dodge City, Kansas, United States
Abington Memorial Hospital
🇺🇸
Abington, Pennsylvania, United States
Graham Hospital Association
🇺🇸
Canton, Illinois, United States
Porter Adventist Hospital
🇺🇸
Denver, Colorado, United States
Presbyterian - Saint Lukes Medical Center - Health One
🇺🇸
Denver, Colorado, United States
SCL Health Saint Joseph Hospital
🇺🇸
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
Mercy Capitol
🇺🇸
Des Moines, Iowa, United States
Iowa Methodist Medical Center
🇺🇸
Des Moines, Iowa, United States
Missouri Valley Cancer Consortium
🇺🇸
Omaha, Nebraska, United States
Creighton University Medical Center
🇺🇸
Omaha, Nebraska, United States
Alegent Health Immanuel Medical Center
🇺🇸
Omaha, Nebraska, United States
Columbia Saint Mary's Water Tower Medical Commons
🇺🇸
Milwaukee, Wisconsin, United States
Aurora Saint Luke's Medical Center
🇺🇸
Milwaukee, Wisconsin, United States
Penn State Milton S Hershey Medical Center
🇺🇸
Hershey, Pennsylvania, United States
The Medical Center of Aurora
🇺🇸
Aurora, Colorado, United States
Michigan Cancer Research Consortium NCORP
🇺🇸
Ann Arbor, Michigan, United States
Saint Joseph Mercy Hospital
🇺🇸
Ann Arbor, Michigan, United States
Butler Memorial Hospital
🇺🇸
Butler, Pennsylvania, United States
Stanford Cancer Institute Palo Alto
🇺🇸
Palo Alto, California, United States
Boulder Community Hospital
🇺🇸
Boulder, Colorado, United States
Saint Anthony Hospital
🇺🇸
Lakewood, Colorado, United States
Mayo Clinic in Florida
🇺🇸
Jacksonville, Florida, United States
Emory University Hospital/Winship Cancer Institute
🇺🇸
Atlanta, Georgia, United States
Medical Center of Central Georgia
🇺🇸
Macon, Georgia, United States
Illinois CancerCare-Bloomington
🇺🇸
Bloomington, Illinois, United States
Illinois CancerCare-Carthage
🇺🇸
Carthage, Illinois, United States
Illinois CancerCare-Canton
🇺🇸
Canton, Illinois, United States
Memorial Hospital
🇺🇸
Carthage, Illinois, United States
Hematology and Oncology Associates
🇺🇸
Chicago, Illinois, United States
Heartland Cancer Research NCORP
🇺🇸
Decatur, Illinois, United States
Presence Saint Joseph Hospital-Chicago
🇺🇸
Chicago, Illinois, United States
Decatur Memorial Hospital
🇺🇸
Decatur, Illinois, United States
Elmhurst Memorial Hospital
🇺🇸
Elmhurst, Illinois, United States
Ingalls Memorial Hospital
🇺🇸
Harvey, Illinois, United States
Illinois CancerCare-Eureka
🇺🇸
Eureka, Illinois, United States
Galesburg Cottage Hospital
🇺🇸
Galesburg, Illinois, United States
Illinois CancerCare-Havana
🇺🇸
Havana, Illinois, United States
Illinois CancerCare-Galesburg
🇺🇸
Galesburg, Illinois, United States
Hematology Oncology Associates of Illinois-Highland Park
🇺🇸
Highland Park, Illinois, United States
Joliet Oncology-Hematology Associates Limited
🇺🇸
Joliet, Illinois, United States
Hinsdale Hematology Oncology Associates Incorporated
🇺🇸
Hinsdale, Illinois, United States
Presence Saint Mary's Hospital
🇺🇸
Kankakee, Illinois, United States
NorthShore Hematology Oncology-Libertyville
🇺🇸
Libertyville, Illinois, United States
Illinois CancerCare-Kewanee Clinic
🇺🇸
Kewanee, Illinois, United States
Illinois CancerCare-Macomb
🇺🇸
Macomb, Illinois, United States
Garneau, Stewart C MD (UIA Investigator)
🇺🇸
Moline, Illinois, United States
Porubcin, Michael MD (UIA Investigator)
🇺🇸
Moline, Illinois, United States
Sharis, Christine M MD (UIA Investigator)
🇺🇸
Moline, Illinois, United States
Stoffel, Thomas J MD (UIA Investigator)
🇺🇸
Moline, Illinois, United States
Spector, David MD (UIA Investigator)
🇺🇸
Moline, Illinois, United States
Trinity Medical Center
🇺🇸
Moline, Illinois, United States
Holy Family Medical Center
🇺🇸
Monmouth, Illinois, United States
Bromenn Regional Medical Center
🇺🇸
Normal, Illinois, United States
Illinois CancerCare-Community Cancer Center
🇺🇸
Normal, Illinois, United States
Illinois CancerCare-Monmouth
🇺🇸
Monmouth, Illinois, United States
Community Cancer Center Foundation
🇺🇸
Normal, Illinois, United States
Illinois Cancer Specialists-Niles
🇺🇸
Niles, Illinois, United States
Illinois CancerCare-Ottawa Clinic
🇺🇸
Ottawa, Illinois, United States
Ottawa Regional Hospital and Healthcare Center
🇺🇸
Ottawa, Illinois, United States
Illinois CancerCare-Pekin
🇺🇸
Pekin, Illinois, United States
OSF Saint Francis Radiation Oncology at Pekin Cancer Treatment Center
🇺🇸
Pekin, Illinois, United States
Pekin Hospital
🇺🇸
Pekin, Illinois, United States
Proctor Hospital
🇺🇸
Peoria, Illinois, United States
Methodist Medical Center of Illinois
🇺🇸
Peoria, Illinois, United States
Illinois CancerCare-Peoria
🇺🇸
Peoria, Illinois, United States
Eureka Hospital
🇺🇸
Eureka, Illinois, United States
Lewis Cancer and Research Pavilion at Saint Joseph's/Candler
🇺🇸
Savannah, Georgia, United States
United Hospital
🇺🇸
Saint Paul, Minnesota, United States
NorthShore University HealthSystem-Evanston Hospital
🇺🇸
Evanston, Illinois, United States
Atlanta VA Medical Center
🇺🇸
Decatur, Georgia, United States
Doctors Carrol, Sheth, Raghavan
🇺🇸
Louisville, Kentucky, 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
Montefiore Medical Center-Weiler Hospital
🇺🇸
Bronx, New York, United States
Montefiore Medical Center - Moses Campus
🇺🇸
Bronx, New York, United States
Dean Hematology and Oncology Clinic
🇺🇸
Madison, Wisconsin, United States
Lancaster General Hospital
🇺🇸
Lancaster, Pennsylvania, United States
Toledo Clinic Cancer Centers-Monroe
🇺🇸
Monroe, Michigan, United States
Cancer Center of Kansas-Liberal
🇺🇸
Liberal, Kansas, United States
Ridgeview Medical Center
🇺🇸
Waconia, Minnesota, United States
Genesis Healthcare System Cancer Care Center
🇺🇸
Zanesville, Ohio, United States