MedPath

Ipilimumab With or Without Sargramostim in Treating Patients With Stage III or Stage IV Melanoma That Cannot Be Removed by Surgery

Phase 2
Active, not recruiting
Conditions
Advanced Melanoma
Stage IIIB Cutaneous Melanoma AJCC v7
Stage IIIC Cutaneous Melanoma AJCC v7
Recurrent Melanoma
Stage IV Cutaneous Melanoma AJCC v6 and v7
Stage IIIA Cutaneous Melanoma AJCC v7
Unresectable Melanoma
Metastatic Melanoma
Stage III Cutaneous Melanoma AJCC v7
Interventions
Registration Number
NCT01134614
Lead Sponsor
National Cancer Institute (NCI)
Brief Summary

This randomized phase II trial is studying how well giving ipilimumab with or without sargramostim (GM-CSF) works in treating patients with stage III or stage IV melanoma that cannot be removed by surgery (unresectable). Ipilimumab works by activating the patient's immune system to fight cancer. Colony-stimulating factors, such as sargramostim, may increase the number of immune cells found in bone marrow or peripheral blood and may help the immune system recover from the side effects of treatment. It is not yet known whether giving ipilimumab together with sargramostim is more effective than ipilimumab alone in treating melanoma.

Detailed Description

PRIMARY OBJECTIVES:

I. To evaluate the overall survival for the combination of sargramostim (GM-CSF) plus ipilimumab and ipilimumab alone in patients with advanced melanoma.

SECONDARY OBJECTIVES:

I. To evaluate the progression-free survival, response rate, safety and tolerability for the combination of GM-CSF plus ipilimumab and ipilimumab alone in patients with advanced melanoma.

II. To explore the utility of immune related response criteria (irRC) prospectively in patients receiving ipilimumab.

OUTLINE: Patients are randomized to 1 of 2 treatment arms.

ARM A: Patients receive induction therapy comprising ipilimumab intravenously (IV) over 90 minutes on day 1 and sargramostim subcutaneously (SC) once daily on days 1-14. Treatment repeats every 21 days for 4 cycles. After 12 weeks of induction treatment, anti-tumor response is assessed and patients then receive maintenance therapy comprising ipilimumab IV over 90 minutes on day 1 and sargramostim SC once daily on days 1-14. Treatment with ipilimumab repeats every 12 weeks and treatment with sargramostim repeats every 21 days. After 12 weeks of maintenance therapy, anti-tumor response is reassessed and patients with responsive or stable disease then continue maintenance therapy until disease progression or unacceptable toxicity.

ARM B: Patients receive induction therapy comprising ipilimumab IV over 90 minutes on day 1. Treatment repeats every 21 days for 4 cycles. After 12 weeks of induction treatment, anti-tumor response is assessed and patients then receive maintenance therapy of ipilimumab IV over 90 minutes on day 1. Treatment with ipilimumab repeats every 12 weeks. After 12 weeks of maintenance therapy, anti-tumor response is reassessed and cycles repeat every 12 weeks in the absence of disease progression or unacceptable toxicity.

After completion of study therapy, patients are followed up every 3 months for 2 years and then every 6 months for 3 years.

Recruitment & Eligibility

Status
ACTIVE_NOT_RECRUITING
Sex
All
Target Recruitment
245
Inclusion Criteria
  • All sites of disease must be evaluated within 4 weeks prior to randomization; patients must have measurable disease as defined by Response Evaluation Criteria in Solid Tumors (RECIST)
  • No more than one prior systemic therapeutic regimen for unresectable stage III or stage IV melanoma; this includes chemotherapy, biologic therapy, biochemotherapy, or investigational treatment; this does not include any therapies given in the adjuvant setting
  • Histologic diagnosis of metastatic melanoma; for unknown primary disease, diagnosis of metastatic disease by cytology fine needle aspiration (FNA) is not acceptable
  • Women must not be pregnant or breast-feeding due to unknown effects of ipilimumab and GM-CSF on the unborn fetus; all women of childbearing potential must have a blood test within 72 hours prior to randomization to rule out pregnancy; women of childbearing potential and sexually active males must be strongly advised to use an accepted and effective method of contraception; women of childbearing potential (WOCBP) must be using an adequate method of contraception to avoid pregnancy throughout the study and for up to 12 weeks after the last dose of investigational product, in such a manner that the risk of pregnancy is minimized; sexually mature females who have not undergone a hysterectomy or who have not been postmenopausal naturally for at least 24 consecutive months (i.e., who have had menses at some time in the preceding 24 consecutive months) are considered to be of childbearing potential; women who are using oral contraceptives, other hormonal contraceptives (vaginal products, skin patches, or implanted or injectable products), or mechanical products such as an intrauterine device or barrier methods (diaphragm, condoms, spermicides) to prevent pregnancy, or are practicing abstinence or where their partner is sterile (e.g., vasectomy) should be considered to be of childbearing potential
  • White blood cells (WBC) >= 2000/uL (obtained =< 4 weeks prior to randomization)
  • Absolute neutrophil count (ANC) >= 1500/mcL (obtained =< 4 weeks prior to randomization)
  • Platelets >= 100,000/mcL (obtained =< 4 weeks prior to randomization)
  • Hemoglobin >= 8 g/dL (obtained =< 4 weeks prior to randomization)
  • Creatinine =< 3.0 x upper limit of normal (ULN) (obtained =< 4 weeks prior to randomization)
  • Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) =< 2.5 x ULN (obtained =< 4 weeks prior to randomization)
  • Bilirubin =< 3.0 x ULN, (except patients with Gilbert's syndrome, who must have a total bilirubin less than 3.0 mg/dL) (obtained =< 4 weeks prior to randomization)
  • No concomitant therapy with any of the following: interleukin (IL) 2, interferon, or other non-study immunotherapy regimens; cytotoxic chemotherapy; immunosuppressive agents; other investigation therapies; or chronic use of systemic corticosteroids; must have been discontinued >= 4 weeks
  • No infection with human immunodeficiency virus (HIV); due to the mechanism of action of ipilimumab and GM-CSF, activity and side effects in an immune compromised patient are unknown
  • No active infection with hepatitis B
  • No active or chronic infection with hepatitis C
  • Eastern Cooperative Oncology Group (ECOG) performance status 0 or 1
Read More
Exclusion Criteria
  • Patients with any history of central nervous system (CNS) metastases are excluded
  • Patients are excluded if they have a history of any other malignancy from which the patient has been disease-free for less than 2 years, with the exception of adequately treated and cured basal or squamous cell skin cancer, superficial bladder cancer or carcinoma in situ of the cervix
  • Patients are excluded if they have a history of any autoimmune disease; patients with a history of autoimmune thyroiditis are eligible if their current thyroid disorder is treated and stable with replacement or other medical therapy
  • Patients are excluded for any underlying medical or psychiatric condition, which in the opinion of the investigator, will make the administration of study drug hazardous or obscure the interpretation of adverse events, such as a condition associated with frequent diarrhea
  • Patients are excluded for receiving any non-oncology vaccine therapy used for prevention of infectious diseases for up to four weeks (28 days) prior to or after any dose of ipilimumab
  • Patients are excluded if they have a history of prior treatment with ipilimumab or prior cluster of differentiation (CD)137 agonist or cytotoxic T-lymphocyte antigen 4 (CTLA-4) inhibitor or agonist
  • Any concurrent medical condition requiring the use of systemic steroids is not permitted (the use of inhaled or topical steroids is permitted)
Read More

Study & Design

Study Type
INTERVENTIONAL
Study Design
PARALLEL
Arm && Interventions
GroupInterventionDescription
Arm A (ipilimumab and sargramostim)IpilimumabPatients receive induction therapy comprising ipilimumab IV over 90 minutes on day 1 and sargramostim SC once daily on days 1-14. Treatment repeats every 21 days for 4 cycles. After 12 weeks of induction treatment, anti-tumor response is assessed and patients then receive maintenance therapy comprising ipilimumab IV over 90 minutes on day 1 and sargramostim SC once daily on days 1-14. Treatment with ipilimumab repeats every 12 weeks and treatment with sargramostim repeats every 21 days. After 12 weeks of maintenance therapy, anti-tumor response is reassessed and patients with responsive or stable disease then continue maintenance therapy until disease progression or unacceptable toxicity.
Arm B (ipilimumab)IpilimumabPatients receive induction therapy comprising ipilimumab IV over 90 minutes on day 1. Treatment repeats every 21 days for 4 cycles. After 12 weeks of induction treatment, anti-tumor response is assessed and patients then receive maintenance therapy of ipilimumab IV over 90 minutes on day 1. Treatment with ipilimumab repeats every 12 weeks. After 12 weeks of maintenance therapy, anti-tumor response is reassessed and cycles repeat every 12 weeks in the absence of disease progression or unacceptable toxicity
Arm A (ipilimumab and sargramostim)SargramostimPatients receive induction therapy comprising ipilimumab IV over 90 minutes on day 1 and sargramostim SC once daily on days 1-14. Treatment repeats every 21 days for 4 cycles. After 12 weeks of induction treatment, anti-tumor response is assessed and patients then receive maintenance therapy comprising ipilimumab IV over 90 minutes on day 1 and sargramostim SC once daily on days 1-14. Treatment with ipilimumab repeats every 12 weeks and treatment with sargramostim repeats every 21 days. After 12 weeks of maintenance therapy, anti-tumor response is reassessed and patients with responsive or stable disease then continue maintenance therapy until disease progression or unacceptable toxicity.
Primary Outcome Measures
NameTimeMethod
Overall SurvivalAssessed every 3 months for 2 years, then every 6 months for 3 years

Overall survival is defined as the time from randomization to death from any cause.

Secondary Outcome Measures
NameTimeMethod
Progression-free Survival (PFS)Assessed every 3 months for 2 years, then every 6 months for 3 years

Progression-free survival is defined as the time from randomization to disease progression or death, whichever occurs first. Response and disease progression will be evaluated using the international criteria proposed by the revised Response Evaluation Criteria in Solid Tumors (RECIST) guideline (version 1.1). Disease progression is defined as \>= 20% increase in the sum of the diameters of target lesions, taking as reference the smallest sum on study (this includes the baseline sum if that is the smallest on study) and the sum must also demonstrate an absolute increase of at least 5 mm. The appearance of one or more new lesions and/or unequivocal progression of existing non-target lesions is also considered progression.

Proportion of Patients With Objective ResponseAssessed every 3 months for 2 years, then every 6 months for 3 years

Objective response was evaluated using RECIST (Response Evaluation Criteria in Solid Tumors) 1.1 criteria. Per RECIST criteria, complete response (CR) = disappearance of all target and non-target lesions and normalization of tumor marker level. All lymph nodes must be non-pathological in size (\<10 mm short axis). Partial response (PR)= At least a 30% decrease in the sum of the diameters of target lesions, taking as reference the baseline sum diameters. To be assigned a status of partial response, changes in tumor measurements must be confirmed by a repeat assessment performed no less than four weeks after the criteria for response is met. Objective response = CR + PR.

Trial Locations

Locations (257)

Penrose-Saint Francis Healthcare

🇺🇸

Colorado Springs, Colorado, United States

Porter Adventist Hospital

🇺🇸

Denver, Colorado, United States

Iowa Methodist Medical Center

🇺🇸

Des Moines, Iowa, United States

Iowa-Wide Oncology Research Coalition NCORP

🇺🇸

Des Moines, Iowa, United States

Mission Cancer and Blood - Des Moines

🇺🇸

Des Moines, Iowa, United States

Mercy Medical Center - Des Moines

🇺🇸

Des Moines, Iowa, United States

Saint Rita's Medical Center

🇺🇸

Lima, Ohio, United States

Saint Charles Hospital

🇺🇸

Oregon, Ohio, United States

ProMedica Flower Hospital

🇺🇸

Sylvania, Ohio, United States

ProMedica Toledo Hospital/Russell J Ebeid Children's Hospital

🇺🇸

Toledo, Ohio, United States

Mercy Health - Saint Vincent Hospital

🇺🇸

Toledo, Ohio, United States

University of Virginia Cancer Center

🇺🇸

Charlottesville, Virginia, United States

West Virginia University Healthcare

🇺🇸

Morgantown, West Virginia, United States

Wheeling Hospital/Schiffler Cancer Center

🇺🇸

Wheeling, West Virginia, United States

Jefferson Abington Hospital

🇺🇸

Abington, Pennsylvania, United States

Lehigh Valley Hospital-Cedar Crest

🇺🇸

Allentown, Pennsylvania, United States

Saint Luke's University Hospital-Bethlehem Campus

🇺🇸

Bethlehem, Pennsylvania, United States

Bryn Mawr Hospital

🇺🇸

Bryn Mawr, Pennsylvania, United States

Geisinger Medical Center

🇺🇸

Danville, Pennsylvania, United States

Doylestown Hospital

🇺🇸

Doylestown, Pennsylvania, United States

Geisinger Medical Center-Cancer Center Hazleton

🇺🇸

Hazleton, Pennsylvania, United States

Saint Mary Medical and Regional Cancer Center

🇺🇸

Langhorne, Pennsylvania, United States

Paoli Memorial Hospital

🇺🇸

Paoli, Pennsylvania, United States

Thomas Jefferson University Hospital

🇺🇸

Philadelphia, Pennsylvania, United States

University of Pittsburgh Cancer Institute (UPCI)

🇺🇸

Pittsburgh, Pennsylvania, United States

Pottstown Hospital

🇺🇸

Pottstown, Pennsylvania, United States

Guthrie Medical Group PC-Robert Packer Hospital

🇺🇸

Sayre, Pennsylvania, United States

Hematology and Oncology Associates of North East Pennsylvania

🇺🇸

Scranton, Pennsylvania, United States

Reading Hospital

🇺🇸

West Reading, Pennsylvania, United States

Geisinger Wyoming Valley/Henry Cancer Center

🇺🇸

Wilkes-Barre, Pennsylvania, United States

Lankenau Medical Center

🇺🇸

Wynnewood, Pennsylvania, United States

Sanford Cancer Center Oncology Clinic

🇺🇸

Sioux Falls, South Dakota, United States

Avera Cancer Institute

🇺🇸

Sioux Falls, South Dakota, United States

Medical X-Ray Center

🇺🇸

Sioux Falls, South Dakota, United States

Avera McKennan Hospital and University Health Center

🇺🇸

Sioux Falls, South Dakota, United States

Sanford USD Medical Center - Sioux Falls

🇺🇸

Sioux Falls, South Dakota, United States

Erlanger Medical Center

🇺🇸

Chattanooga, Tennessee, United States

Jackson-Madison County General Hospital

🇺🇸

Jackson, Tennessee, United States

Vanderbilt University/Ingram Cancer Center

🇺🇸

Nashville, Tennessee, United States

Parkland Memorial Hospital

🇺🇸

Dallas, Texas, United States

UT Southwestern/Simmons Cancer Center-Dallas

🇺🇸

Dallas, Texas, United States

West Virginia University Charleston Division

🇺🇸

Charleston, West Virginia, United States

Langlade Hospital and Cancer Center

🇺🇸

Antigo, Wisconsin, United States

ThedaCare Regional Cancer Center

🇺🇸

Appleton, Wisconsin, United States

Marshfield Clinic-Chippewa Center

🇺🇸

Chippewa Falls, Wisconsin, United States

Marshfield Clinic Cancer Center at Sacred Heart

🇺🇸

Eau Claire, Wisconsin, United States

Saint Vincent Hospital Cancer Center Green Bay

🇺🇸

Green Bay, Wisconsin, United States

Aurora BayCare Medical Center

🇺🇸

Green Bay, Wisconsin, United States

Mercyhealth Hospital and Cancer Center - Janesville

🇺🇸

Janesville, Wisconsin, United States

University of Wisconsin Carbone Cancer Center - Johnson Creek

🇺🇸

Johnson Creek, Wisconsin, United States

Gundersen Lutheran Medical Center

🇺🇸

La Crosse, Wisconsin, United States

SSM Health Dean Medical Group - South Madison Campus

🇺🇸

Madison, Wisconsin, United States

University of Wisconsin Carbone Cancer Center - University Hospital

🇺🇸

Madison, Wisconsin, United States

Holy Family Memorial Hospital

🇺🇸

Manitowoc, Wisconsin, United States

Aurora Bay Area Medical Group-Marinette

🇺🇸

Marinette, Wisconsin, United States

Bay Area Medical Center

🇺🇸

Marinette, Wisconsin, United States

Marshfield Medical Center-Marshfield

🇺🇸

Marshfield, Wisconsin, United States

Marshfield Medical Center - Minocqua

🇺🇸

Minocqua, Wisconsin, United States

ProHealth Oconomowoc Memorial Hospital

🇺🇸

Oconomowoc, Wisconsin, United States

Aspirus Cancer Care - James Beck Cancer Center

🇺🇸

Rhinelander, Wisconsin, United States

Marshfield Medical Center-Rice Lake

🇺🇸

Rice Lake, Wisconsin, United States

HSHS Saint Nicholas Hospital

🇺🇸

Sheboygan, Wisconsin, United States

Vince Lombardi Cancer Clinic-Sheboygan

🇺🇸

Sheboygan, Wisconsin, United States

Aspirus Cancer Care - Stevens Point

🇺🇸

Stevens Point, Wisconsin, United States

Aurora Medical Center in Summit

🇺🇸

Summit, Wisconsin, United States

Vince Lombardi Cancer Clinic-Two Rivers

🇺🇸

Two Rivers, Wisconsin, United States

ProHealth Waukesha Memorial Hospital

🇺🇸

Waukesha, Wisconsin, United States

Aspirus Regional Cancer Center

🇺🇸

Wausau, Wisconsin, United States

Marshfield Clinic-Wausau Center

🇺🇸

Wausau, Wisconsin, United States

Marshfield Medical Center - Weston

🇺🇸

Weston, Wisconsin, United States

Marshfield Clinic - Wisconsin Rapids Center

🇺🇸

Wisconsin Rapids, Wisconsin, United States

Saint Joseph Hospital - Cancer Centers of Colorado

🇺🇸

Denver, Colorado, United States

University of Alabama at Birmingham Cancer Center

🇺🇸

Birmingham, Alabama, United States

Stanford Cancer Institute Palo Alto

🇺🇸

Palo Alto, California, United States

VA Palo Alto Health Care System

🇺🇸

Palo Alto, California, United States

Eisenhower Medical Center

🇺🇸

Rancho Mirage, California, United States

The Medical Center of Aurora

🇺🇸

Aurora, Colorado, United States

Boulder Community Hospital

🇺🇸

Boulder, Colorado, United States

Presbyterian - Saint Lukes Medical Center - Health One

🇺🇸

Denver, Colorado, United States

Rose Medical Center

🇺🇸

Denver, Colorado, United States

Western States Cancer Research NCORP

🇺🇸

Denver, Colorado, United States

Swedish Medical Center

🇺🇸

Englewood, Colorado, United States

Poudre Valley Hospital

🇺🇸

Fort Collins, Colorado, United States

Saint Mary's Hospital and Regional Medical Center

🇺🇸

Grand Junction, Colorado, United States

Banner North Colorado Medical Center

🇺🇸

Greeley, Colorado, United States

Saint Anthony Hospital

🇺🇸

Lakewood, Colorado, United States

Sky Ridge Medical Center

🇺🇸

Lone Tree, Colorado, United States

Longmont United Hospital

🇺🇸

Longmont, Colorado, United States

Banner McKee Medical Center

🇺🇸

Loveland, Colorado, United States

Saint Mary Corwin Medical Center

🇺🇸

Pueblo, Colorado, United States

North Suburban Medical Center

🇺🇸

Thornton, Colorado, United States

Intermountain Health Lutheran Hospital

🇺🇸

Wheat Ridge, Colorado, United States

Smilow Cancer Hospital Care Center at Saint Francis

🇺🇸

Hartford, Connecticut, United States

Manchester Memorial Hospital

🇺🇸

Manchester, Connecticut, United States

The Hospital of Central Connecticut

🇺🇸

New Britain, Connecticut, United States

Yale University

🇺🇸

New Haven, Connecticut, United States

Eastern Connecticut Hematology and Oncology Associates

🇺🇸

Norwich, Connecticut, United States

Beebe Medical Center

🇺🇸

Lewes, Delaware, United States

Christiana Care Health System-Christiana Hospital

🇺🇸

Newark, Delaware, United States

Boca Raton Regional Hospital

🇺🇸

Boca Raton, Florida, United States

Lakeland Regional Health Hollis Cancer Center

🇺🇸

Lakeland, Florida, United States

21st Century Oncology-Orange Park

🇺🇸

Orange Park, Florida, United States

University Cancer and Blood Center LLC

🇺🇸

Athens, Georgia, United States

Emory University Hospital/Winship Cancer Institute

🇺🇸

Atlanta, Georgia, United States

Augusta University Medical Center

🇺🇸

Augusta, Georgia, United States

Lewis Cancer and Research Pavilion at Saint Joseph's/Candler

🇺🇸

Savannah, Georgia, United States

Rush - Copley Medical Center

🇺🇸

Aurora, Illinois, United States

MacNeal Hospital and Cancer Center

🇺🇸

Berwyn, Illinois, United States

OSF Saint Joseph Medical Center

🇺🇸

Bloomington, Illinois, United States

Graham Hospital Association

🇺🇸

Canton, Illinois, United States

Memorial Hospital

🇺🇸

Carthage, Illinois, United States

Hematology and Oncology Associates

🇺🇸

Chicago, Illinois, United States

Northwestern University

🇺🇸

Chicago, Illinois, United States

Rush University Medical Center

🇺🇸

Chicago, Illinois, United States

Decatur Memorial Hospital

🇺🇸

Decatur, Illinois, United States

Heartland Cancer Research NCORP

🇺🇸

Decatur, Illinois, United States

Eureka Hospital

🇺🇸

Eureka, Illinois, United States

Illinois CancerCare-Galesburg

🇺🇸

Galesburg, Illinois, United States

Mason District Hospital

🇺🇸

Havana, Illinois, United States

Hematology Oncology Associates of Illinois-Highland Park

🇺🇸

Highland Park, Illinois, United States

Hinsdale Hematology Oncology Associates Incorporated

🇺🇸

Hinsdale, Illinois, United States

Duly Health and Care Joliet

🇺🇸

Joliet, Illinois, United States

Presence Saint Mary's Hospital

🇺🇸

Kankakee, Illinois, United States

AMG Libertyville - Oncology

🇺🇸

Libertyville, Illinois, United States

Mcdonough District Hospital

🇺🇸

Macomb, Illinois, United States

Trinity Medical Center

🇺🇸

Moline, Illinois, United States

DuPage Medical Group-Ogden

🇺🇸

Naperville, Illinois, United States

Illinois Cancer Specialists-Niles

🇺🇸

Niles, Illinois, United States

Carle BroMenn Medical Center

🇺🇸

Normal, Illinois, United States

Carle Cancer Institute Normal

🇺🇸

Normal, Illinois, United States

Ottawa Regional Hospital and Healthcare Center

🇺🇸

Ottawa, Illinois, United States

OSF Saint Francis Radiation Oncology at Pekin

🇺🇸

Pekin, Illinois, United States

Proctor Hospital

🇺🇸

Peoria, Illinois, United States

Illinois CancerCare-Peoria

🇺🇸

Peoria, Illinois, United States

Methodist Medical Center of Illinois

🇺🇸

Peoria, Illinois, United States

OSF Saint Francis Medical Center

🇺🇸

Peoria, Illinois, United States

Illinois Valley Hospital

🇺🇸

Peru, Illinois, United States

Perry Memorial Hospital

🇺🇸

Princeton, Illinois, United States

Swedish American Hospital

🇺🇸

Rockford, Illinois, United States

UW Health Carbone Cancer Center Rockford

🇺🇸

Rockford, Illinois, United States

Hematology Oncology Associates of Illinois - Skokie

🇺🇸

Skokie, Illinois, United States

Springfield Memorial Hospital

🇺🇸

Springfield, Illinois, United States

Carle Cancer Center

🇺🇸

Urbana, Illinois, United States

Elkhart General Hospital

🇺🇸

Elkhart, Indiana, United States

Indiana University/Melvin and Bren Simon Cancer Center

🇺🇸

Indianapolis, Indiana, United States

Community Howard Regional Health

🇺🇸

Kokomo, Indiana, United States

IU Health La Porte Hospital

🇺🇸

La Porte, Indiana, United States

Franciscan Saint Anthony Health-Michigan City

🇺🇸

Michigan City, Indiana, United States

Saint Joseph Regional Medical Center-Mishawaka

🇺🇸

Mishawaka, Indiana, United States

IU Health Ball Memorial Hospital

🇺🇸

Muncie, Indiana, United States

Memorial Hospital of South Bend

🇺🇸

South Bend, Indiana, United States

Northern Indiana Cancer Research Consortium

🇺🇸

South Bend, Indiana, United States

McFarland Clinic - Ames

🇺🇸

Ames, Iowa, United States

Mercy Hospital

🇺🇸

Coon Rapids, Minnesota, United States

Oncology Associates at Mercy Medical Center

🇺🇸

Cedar Rapids, Iowa, United States

Mission Cancer and Blood - West Des Moines

🇺🇸

Clive, Iowa, United States

Mission Cancer and Blood - Laurel

🇺🇸

Des Moines, Iowa, United States

Iowa Lutheran Hospital

🇺🇸

Des Moines, Iowa, United States

Mercy Medical Center - North Iowa

🇺🇸

Mason City, Iowa, United States

Siouxland Regional Cancer Center

🇺🇸

Sioux City, Iowa, United States

Mercy Medical Center-Sioux City

🇺🇸

Sioux City, Iowa, United States

Saint Luke's Regional Medical 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-Kingman

🇺🇸

Kingman, Kansas, United States

Lawrence Memorial Hospital

🇺🇸

Lawrence, Kansas, United States

Cancer Center of Kansas-Liberal

🇺🇸

Liberal, Kansas, United States

Cancer Center of Kansas - Newton

🇺🇸

Newton, Kansas, United States

Cancer Center of Kansas - Parsons

🇺🇸

Parsons, Kansas, United States

Cancer Center of Kansas - Pratt

🇺🇸

Pratt, Kansas, United States

Cancer Center of Kansas - Salina

🇺🇸

Salina, Kansas, United States

Cancer Center of Kansas - Wellington

🇺🇸

Wellington, Kansas, United States

Associates In Womens Health

🇺🇸

Wichita, Kansas, United States

Cancer Center of Kansas-Wichita Medical Arts Tower

🇺🇸

Wichita, Kansas, United States

Ascension Via Christi Hospitals Wichita

🇺🇸

Wichita, Kansas, United States

Cancer Center of Kansas - Wichita

🇺🇸

Wichita, Kansas, United States

Wichita NCI Community Oncology Research Program

🇺🇸

Wichita, Kansas, United States

Cancer Center of Kansas - Winfield

🇺🇸

Winfield, Kansas, United States

Owensboro Health Mitchell Memorial Cancer Center

🇺🇸

Owensboro, Kentucky, United States

Ochsner Health Center-Summa

🇺🇸

Baton Rouge, Louisiana, United States

Ochsner Health Center-Covington

🇺🇸

Covington, Louisiana, United States

Ochsner Medical Center Jefferson

🇺🇸

New Orleans, Louisiana, United States

Greater Baltimore Medical Center

🇺🇸

Baltimore, Maryland, United States

Johns Hopkins University/Sidney Kimmel Cancer Center

🇺🇸

Baltimore, Maryland, United States

Christiana Care - Union Hospital

🇺🇸

Elkton, Maryland, United States

Massachusetts General Hospital Cancer Center

🇺🇸

Boston, Massachusetts, United States

Beth Israel Deaconess Medical Center

🇺🇸

Boston, Massachusetts, United States

Dana-Farber Cancer Institute

🇺🇸

Boston, Massachusetts, United States

Baystate Medical Center

🇺🇸

Springfield, Massachusetts, United States

Michigan Cancer Research Consortium NCORP

🇺🇸

Ann Arbor, Michigan, United States

Trinity Health Saint Joseph Mercy Hospital Ann Arbor

🇺🇸

Ann Arbor, Michigan, United States

Corewell Health Dearborn Hospital

🇺🇸

Dearborn, Michigan, United States

Henry Ford Health Saint John Hospital

🇺🇸

Detroit, Michigan, United States

Hurley Medical Center

🇺🇸

Flint, Michigan, United States

Genesys Regional Medical Center-West Flint Campus

🇺🇸

Flint, Michigan, United States

Allegiance Health

🇺🇸

Jackson, Michigan, United States

Bronson Methodist Hospital

🇺🇸

Kalamazoo, Michigan, United States

West Michigan Cancer Center

🇺🇸

Kalamazoo, Michigan, United States

Ascension Borgess Hospital

🇺🇸

Kalamazoo, Michigan, United States

University of Michigan Health - Sparrow Lansing

🇺🇸

Lansing, Michigan, United States

Trinity Health Saint Mary Mercy Livonia Hospital

🇺🇸

Livonia, Michigan, United States

Trinity Health Saint Joseph Mercy Oakland Hospital

🇺🇸

Pontiac, Michigan, United States

Lake Huron Medical Center

🇺🇸

Port Huron, Michigan, United States

MyMichigan Medical Center Saginaw

🇺🇸

Saginaw, Michigan, United States

Corewell Health Lakeland Hospitals - Marie Yeager Cancer Center

🇺🇸

Saint Joseph, Michigan, United States

Corewell Health Lakeland Hospitals - Saint Joseph Hospital

🇺🇸

Saint Joseph, Michigan, United States

Henry Ford Health Warren Hospital

🇺🇸

Warren, Michigan, United States

Fairview Ridges Hospital

🇺🇸

Burnsville, Minnesota, United States

Essentia Health Cancer Center

🇺🇸

Duluth, Minnesota, United States

Essentia Health Saint Mary's Medical Center

🇺🇸

Duluth, Minnesota, United States

Miller-Dwan Hospital

🇺🇸

Duluth, Minnesota, United States

Fairview Southdale Hospital

🇺🇸

Edina, Minnesota, United States

Unity Hospital

🇺🇸

Fridley, Minnesota, United States

Hutchinson Area Health Care

🇺🇸

Hutchinson, Minnesota, United States

Minnesota Oncology Hematology PA-Maplewood

🇺🇸

Maplewood, Minnesota, United States

Saint John's Hospital - Healtheast

🇺🇸

Maplewood, Minnesota, United States

Abbott-Northwestern Hospital

🇺🇸

Minneapolis, Minnesota, United States

Hennepin County Medical Center

🇺🇸

Minneapolis, Minnesota, United States

North Memorial Medical Health Center

🇺🇸

Robbinsdale, Minnesota, United States

Metro Minnesota Community Oncology Research Consortium

🇺🇸

Saint Louis Park, Minnesota, United States

Park Nicollet Clinic - Saint Louis Park

🇺🇸

Saint Louis Park, Minnesota, United States

Regions Hospital

🇺🇸

Saint Paul, Minnesota, United States

United Hospital

🇺🇸

Saint Paul, Minnesota, United States

Saint Francis Regional Medical Center

🇺🇸

Shakopee, Minnesota, United States

Lakeview Hospital

🇺🇸

Stillwater, Minnesota, United States

Ridgeview Medical Center

🇺🇸

Waconia, Minnesota, United States

Rice Memorial Hospital

🇺🇸

Willmar, Minnesota, United States

Minnesota Oncology Hematology PA-Woodbury

🇺🇸

Woodbury, Minnesota, United States

Nebraska Cancer Research Center

🇺🇸

Lincoln, 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

Nevada Cancer Institute-Summerlin Campus

🇺🇸

Las Vegas, Nevada, United States

Nevada Cancer Research Foundation NCORP

🇺🇸

Las Vegas, Nevada, United States

Cooper Hospital University Medical Center

🇺🇸

Camden, New Jersey, United States

Hunterdon Medical Center

🇺🇸

Flemington, New Jersey, United States

Hackensack University Medical Center

🇺🇸

Hackensack, New Jersey, United States

Morristown Medical Center

🇺🇸

Morristown, New Jersey, United States

Virtua Memorial

🇺🇸

Mount Holly, New Jersey, United States

Rutgers Cancer Institute of New Jersey

🇺🇸

New Brunswick, New Jersey, United States

Overlook Hospital

🇺🇸

Summit, New Jersey, United States

University of New Mexico Cancer Center

🇺🇸

Albuquerque, New Mexico, United States

Presbyterian Kaseman Hospital

🇺🇸

Albuquerque, New Mexico, United States

San Juan Oncology Associates

🇺🇸

Farmington, New Mexico, United States

New York Oncology Hematology PC - Albany Medical Center

🇺🇸

Albany, New York, United States

Mary Imogene Bassett Hospital

🇺🇸

Cooperstown, New York, United States

Laura and Isaac Perlmutter Cancer Center at NYU Langone

🇺🇸

New York, New York, United States

Stony Brook University Medical Center

🇺🇸

Stony Brook, New York, United States

Sanford Broadway Medical Center

🇺🇸

Fargo, North Dakota, United States

Summa Health System - Akron Campus

🇺🇸

Akron, Ohio, United States

Cleveland Clinic Mercy Hospital

🇺🇸

Canton, Ohio, United States

Aultman Health Foundation

🇺🇸

Canton, Ohio, United States

The Christ Hospital

🇺🇸

Cincinnati, Ohio, United States

Case Western Reserve University

🇺🇸

Cleveland, Ohio, United States

MetroHealth Medical Center

🇺🇸

Cleveland, Ohio, United States

Cleveland Clinic Foundation

🇺🇸

Cleveland, Ohio, United States

© Copyright 2025. All Rights Reserved by MedPath