Testing the Addition of the Pill Chemotherapy, Cabozantinib, to the Standard Immune Therapy Nivolumab Compared to Standard Chemotherapy for Non-small Cell Lung Cancer

Phase 2

Active, not recruiting

• Conditions: Metastatic Lung Non-Squamous Non-Small Cell Carcinoma; Recurrent Lung Non-Squamous Non-Small Cell Carcinoma; Stage IV Lung Cancer AJCC v8
• Interventions: Procedure: Biospecimen Collection; Drug: Cabozantinib S-malate; Procedure: Computed Tomography; Drug: Docetaxel; Procedure: Echocardiography Test; Biological: Nivolumab; Drug: Gemcitabine Hydrochloride; Drug: Nab-paclitaxel; Drug: Paclitaxel; Biological: Ramucirumab

• Registration Number: NCT04310007
• Lead Sponsor: National Cancer Institute (NCI)

Brief Summary

This phase II trial compares cabozantinib alone and the combination of cabozantinib and nivolumab to standard chemotherapy in the treatment of patients with non-squamous non-small cell lung cancer (NSCLC). Cabozantinib may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Immunotherapy with monoclonal antibodies, such as nivolumab, may help the body's immune system attack the cancer, and may interfere with the ability of tumor cells to grow and spread. Ramucirumab is a monoclonal antibody that may interfere with the ability of tumor cells to grow and spread. Chemotherapy drugs, such as docetaxel, gemcitabine hydrochloride, paclitaxel, and nab-paclitaxel, 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. Giving cabozantinib alone or in combination with nivolumab may be more effective than standard chemotherapy in treating patients with non-small cell lung cancer.

Detailed Description

PRIMARY OBJECTIVE:

I. To determine whether cabozantinib alone, or the combination of nivolumab and cabozantinib, as compared to standard chemotherapy alone, extends progression-free survival (PFS) for this patient population with non squamous NSCLC.

SECONDARY OBJECTIVES:

I. To determine the overall survival for each arm of the trial. II. To evaluate the best overall radiographic response rate for each arm of the trial.

III. To evaluate and describe the toxicity profile of monotherapy with cabozantinib, and the combination of nivolumab and cabozantinib in this patient population with non-squamous NSCLC.

EXPLORATORY IMAGING OBJECTIVES:

I. To describe time point tumor response assessment, overall best response, progression-free survival and overall survival using the conventional Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 criteria and the exploratory revised CHOI criteria with all measurements performed by the central review.

II. To compare the progression-free survival using the RECIST1.1 imaging response assessment measurements by site study personnel to those performed by central review.

EXPLORATORY CORRELATIVE OBJECTIVE:

I. To perform correlative biomarker research on tissue and blood biospecimens collected within this trial.

OUTLINE:

STEP 1: Patients are randomized to 1 of 3 arms.

ARM A: Patients receive cabozantinib S-malate orally (PO) once daily (QD). Cycles repeat every 21 days in the absence of disease progression or unacceptable toxicity. Patients may continue to receive therapy after investigator-assessed RECIST 1.1 defined progression, including stable clinical and performance status and have potential for continued clinical benefit.

ARM B: Patients receive cabozantinib S-malate PO QD and nivolumab intravenously (IV) over 30 minutes on day 1. Cycles repeat every 21 days in the absence of disease progression or unacceptable toxicity. Patients may continue to receive therapy after investigator-assessed RECIST 1.1 defined progression, including stable clinical and performance status and have potential for continued clinical benefit.

ARM C: Patients receive ramucirumab IV over 30-60 minutes and docetaxel IV over 1 hour on day 1, or docetaxel IV over 1 hour on days 1 and 8, or gemcitabine hydrochloride IV on days 1 and 8, or paclitaxel IV over 3 hours on day 1, or nab-paclitaxel IV over 30 minutes on days 1 and 8. Cycles repeat every 21 days in the absence of disease progression or unacceptable toxicity and at the discretion of the treating physician.

STEP 2: Patients in Arm C experiencing disease progression are assigned to Arm Z.

ARM Z: Patients receive cabozantinib S-malate PO QD and nivolumab IV over 30 minutes on day 1. Cycles repeat every 21 days in the absence of disease progression or unacceptable toxicity. Patients may continue to receive therapy after investigator-assessed RECIST 1.1 defined progression, including stable clinical and performance status and have potential for continued clinical benefit.

Patients in all arms undergo echocardiogram (ECHO) as clinically indicated, computed tomography (CT) throughout the trial, and collection of blood on study.

After the completion of study treatment, patients are followed up every 3 months for up to 3 years.

Study Timeline

• Study First Submitted: 2020-03-16
• Study First Submitted QC: 2020-03-16
• Study First Posted: 2020-03-17
• Study Start: 2020-07-13
• Status Verified: 2025-03
• Last Update Submitted: 2025-05-09
• Last Update Posted: 2025-05-11
• Primary Completion: 2025-09-30
• Study Completion: 2025-09-30

Recruitment & Eligibility

• Status: ACTIVE_NOT_RECRUITING
• Sex: All
• Target Recruitment: 117

Inclusion Criteria

• RANDOMIZATION (STEP 1): Patient must be >= 18 years of age

• RANDOMIZATION (STEP 1): Patient must have pathologically confirmed non-squamous non-small cell lung carcinoma (NSCLC). Patients with NSCLC not otherwise specified (NOS) are eligible. Mixed tumors will be categorized by predominant cell type. If small cell elements are present, the patient is ineligible

• RANDOMIZATION (STEP 1): Patient must have metastatic stage IVA or IVB disease (includes M1a, M1b, and M1c), according to the 8th edition of the lung cancer TNM classification system. Recurrent metastatic NSCLC ineligible for curative therapy (in the treating investigator's opinion) is also allowed

• RANDOMIZATION (STEP 1): Patient's tumor must be known negative for EGFR tyrosine kinase inhibitor (TKI) sensitizing mutations (for example at a minimum, negative for EGFR Exon 19 deletions, EGFR exon 20 insertions, and Exon 21 L858R, L861Q mutations ) AND negative for ALK gene rearrangements (by fluorescence in situ hybridization [FISH], next generation sequencing [NGS], or immunohistochemistry [IHC]) by routine Clinical Laboratory Improvement Amendments (CLIA)- or Food and Drug Administration (FDA)-certified clinical testing methods. CLIA or FDA approved circulating tumor deoxyribonucleic acid (DNA) testing is acceptable as an alternative to tissue testing

• RANDOMIZATION (STEP 1): Patient must have radiographic and/or clinical progression (per local investigator assessment) following one, but only one, line of platinum-based chemotherapy AND one, but only one, line of prior checkpoint inhibitor (anti-PD-1 or PD-L1) immunotherapy, either concurrently or sequentially in either order. A minimum of two doses of prior immunotherapy is required. Only one prior line of therapy is allowed if patients received chemotherapy and immunotherapy together (patients may not receive subsequent single agent chemotherapy), and greater than two prior lines of therapy are not allowed.

  • NOTE: Lines of therapy are defined by clinical or radiographic progression. For patients with recurrent metastatic NSCLC following treatment for stage 1-3 NSCLC, platinum-based chemotherapy received within 12 months of recurrence and/or immunotherapy received within 6 months of recurrence will meet the requirement for prior chemotherapy and/or immunotherapy but subsequent receipt of more immunotherapy and/or platinum-based chemotherapy is also allowed.
  • NOTE: Prior anti-VEGF antibody therapy (ie bevacizumab) is allowed. Prior ipilimumab, or investigational agents not excluded below, in combination with the required prior therapies above are allowed.
  • NOTE: Prior receipt of one or two lines of targeted therapy for ROS1, RET, MET, BRAF, ERBB2/HER2, or KRAS G12C positive NSCLC is allowed and will not count toward the line of therapy limit. However, progression is still required after chemotherapy and immunotherapy as above. Patients with ROS1, RET, MET positive NSCLC are strongly encouraged to get appropriate targeted therapy (such as crizotinib, entrectinib, lorlatinib, selpercatinib, pralsetinib, capmatinib, tepotinib, or another investigational, off-label, or approved agent directed against ROS1, RET, or MET positive NSCLC) prior to participation and will be stratified.
  • NOTE: No prior predominantly VEGFR directed TKI therapy (such as cabozantinib, lenvatinib, or sitravantinib) is allowed, except for the agents named above.

• RANDOMIZATION (STEP 1): The investigator must document the intended chemotherapy regimen should their patient be randomized to Arm C (docetaxel and ramucirumab, OR single agent chemotherapy - docetaxel, gemcitabine, paclitaxel, nab-paclitaxel). The patient must not have received the selected chemotherapy agent previously for metastatic disease

• RANDOMIZATION (STEP 1): Any prior chemotherapy (based on administration schedule) must have been completed in greater than or equal to the following times prior to randomization:

  • FDA approved targeted oral therapy must be completed >= 1 week prior
  • Chemotherapy and/or immunotherapy must be completed >= 2 weeks prior
  • Prior investigational agents must be completed >= 4 weeks prior.

• RANDOMIZATION (STEP 1): Prior radiation therapy is allowed with a 2 week washout prior to randomization. Patient must not receive any systemic treatment with radionuclides within 6 weeks prior to randomization. Patient must have no clinically relevant ongoing complication from prior radiation therapy

• RANDOMIZATION (STEP 1): Patients with a prior or concurrent malignancy whose natural history or treatment does not have the potential to interfere with the safety or efficacy assessment of the investigational regimen (in the opinion of the treating physician) are eligible for this trial

• RANDOMIZATION (STEP 1): Patients with known history or current symptoms of cardiac disease, or history of treatment with cardiotoxic agents (such as anthracycline or HER2-directed antibody therapy, but not prior checkpoint inhibitor therapy), must have a clinical risk assessment of cardiac function using the New York Heart Association Functional Classification. To be eligible for this trial, patients must be class 2B or better

• RANDOMIZATION (STEP 1): Patient must have Eastern Cooperative Oncology Group (ECOG) performance status 0-1

• RANDOMIZATION (STEP 1 - ALL TREATMENT ARMS): Patient must have met the eligibility criteria outlined above

• RANDOMIZATION (STEP 1 - ALL TREATMENT ARMS): Patient must have measurable disease as defined by RECIST v1.1. Measurements must be obtained within 4 weeks prior to randomization/registration

• RANDOMIZATION (STEP 1 - ALL TREATMENT ARMS): Patient must have recovered to equal to or less than grade 1 toxicities related to prior treatment, unless toxicities are clinically non significant and/or stable on supportive therapy (as determined by the treating physician)

• RANDOMIZATION (STEP 1 - ALL TREATMENT ARMS): Absolute neutrophil count >= 1,500/mcL (obtained within 2 weeks prior to randomization)

• RANDOMIZATION (STEP 1 - ALL TREATMENT ARMS): Platelets >= 100,000/mcL (obtained within 2 weeks prior to randomization)

• RANDOMIZATION (STEP 1 - ALL TREATMENT ARMS): Hemoglobin >= 9 g/dL (obtained within 2 weeks prior to randomization)

• RANDOMIZATION (STEP 1 - ALL TREATMENT ARMS): Total bilirubin =< 1.5 x institutional upper limit of normal (ULN) (for patients with Gilbert's disease total bilirubin must be =< 3 x ULN) (obtained within 2 weeks prior to randomization)

• RANDOMIZATION (STEP 1 - ALL TREATMENT ARMS): Aspartate aminotransferase (AST)(serum glutamic oxaloacetic transaminase [SGOT]) and alanine aminotransferase (ALT)(serum glutamate pyruvate transaminase [SGPT]) =< 2.5 x ULN (obtained within 2 weeks prior to randomization)

• RANDOMIZATION (STEP 1 - ALL TREATMENT ARMS): Creatinine =< 1.5 x ULN OR calculated (Cockcroft-Gault formula) or measured creatinine clearance >= 50 mL/min/1.73m^2 (normalized to body surface area [BSA]) for patients with creatinine levels greater than 1.5 times the institutional normal creatinine =< 1.5 X ULN or creatinine clearance >= 50ml/min/1.73m^2 (obtained within 2 weeks prior to randomization)

• RANDOMIZATION (STEP 1 - ALL TREATMENT ARMS): Patients must not be pregnant or breast-feeding due to the unknown effects of cabozantinib and nivolumab on human development and for the potential risk for adverse events in nursing infants with the treatment regimens being used.

  • All patients of childbearing potential must have a blood test or urine study within 14 days prior to randomization/registration to rule out pregnancy.
  • A patient of childbearing potential is anyone, regardless of sexual orientation or whether they have undergone tubal ligation, who meets the following criteria: 1) has achieved menarche at some point, 2) has not undergone a hysterectomy or bilateral oophorectomy; or 3) has not been naturally postmenopausal (amenorrhea following cancer therapy does not rule out childbearing potential) for at least 24 consecutive months (i.e., has had menses at any time in the preceding 24 consecutive months).

• RANDOMIZATION (STEP 1 - ALL TREATMENT ARMS): Patients must not expect to conceive or father children by using accepted and effective method(s) of contraception or by abstaining from sexual intercourse for the duration of their participation in the study and for 6 months after completion of treatment on the study

• RANDOMIZATION (STEP 1 - ALL TREATMENT ARMS): Patients must not have clinically significant gastrointestinal bleeding within 6 months prior to randomization

• RANDOMIZATION (STEP 1 - ALL TREATMENT ARMS): Patients must not have pulmonary hemorrhage or hemoptysis of >= 0.5 teaspoon (2.5 mL) of red blood within 3 months prior to randomization

• RANDOMIZATION (STEP 1 - ALL TREATMENT ARMS): Patients must not have active drug induced pneumonitis within 3 months prior to randomization. Prior immune mediated pneumonitis of grade 3 or 4 are not eligible regardless of time window

• RANDOMIZATION (STEP 1 - ALL TREATMENT ARMS): Patients must not have current radiographic evidence of tumor invading major blood vessel, evidence of tumor cavitation > 1 cm, evidence of tumor invading the gastrointestinal (GI) tract (esophagus, stomach, small or large bowel, rectum or anus), or evidence of endotracheal or mainstem endobronchial tumor

• RANDOMIZATION (STEP 1 - ALL TREATMENT ARMS): Patients must not have peptic ulcer disease, known malabsorption syndrome, bowel obstruction or gastric outlet obstruction within 3 months prior to randomization

• RANDOMIZATION (STEP 1 - ALL TREATMENT ARMS): Patients must not have abdominal fistula, GI perforation, or intra-abdominal abscess within 6 months prior to randomization

• RANDOMIZATION (STEP 1 - ALL TREATMENT ARMS): Patients must not have grade 3 or greater infection, or infection requiring intravenous systemic treatment within 14 days prior to randomization. Patients must be off antibiotics at the time of randomization

• RANDOMIZATION (STEP 1 - ALL TREATMENT ARMS): Patients must not have serious non-healing wound/ulcer/bone fracture within 28 days prior to randomization

• RANDOMIZATION (STEP 1 - ALL TREATMENT ARMS): Patients must not have history of organ transplant

• RANDOMIZATION (STEP 1 - ALL TREATMENT ARMS): Patients must not have concurrent symptomatic untreated hypothyroidism

• RANDOMIZATION (STEP 1 - ALL TREATMENT ARMS): Patients must not have history of major surgery within 3 months prior to randomization, minor surgery within 28 days prior to randomization, other minor procedures within 7 days prior to randomization, or clinically relevant ongoing complications from prior procedures

• RANDOMIZATION (STEP 1 - ALL TREATMENT ARMS): Patients must not have concurrent uncontrolled hypertension defined as sustained blood pressure (BP) > 160 mm Hg systolic, or > 100 mm Hg diastolic despite optimal antihypertensive treatment

• RANDOMIZATION (STEP 1 - ALL TREATMENT ARMS): Patients must not have unstable angina pectoris, clinically-significant cardiac arrhythmias, stroke (including transient ischemic attack [TIA]), or myocardial infarction within 6 months prior to randomization

• RANDOMIZATION (STEP 1 - ALL TREATMENT ARMS): Patients must not have a diagnosis of deep vein thrombosis/pulmonary embolism (DVT/PE) within 6 months of randomization unless stable, asymptomatic, and treated with low-molecular-weight heparin (LMWH) or a permitted oral anticoagulant for at least 7 days before randomization

• RANDOMIZATION (STEP 1 - ALL TREATMENT ARMS): Patient must not be receiving anticoagulants (i.e., warfarin, aspirin, clopidogrel) except:

  • Prophylactic use of low-dose aspirin (100 mg po daily or less) and/or low dose molecular weight heparin (LMWH) is permitted.
  • Therapeutic doses of low dose molecular weight heparin (LMWH) or specified direct factor Xa inhibitors rivaroxaban, edoxaban, or apixaban are allowed in patients without untreated brain metastases who are on a stable dose 7 days prior to study randomization, and without clinically significant hemorrhagic complications from the anticoagulation regimen or the tumor

• RANDOMIZATION (STEP 1 - ALL TREATMENT ARMS): Patient must not receive strong CYP3A4 inducers (e.g., dexamethasone (> 1 mg daily dosing), phenytoin, carbamazepine, rifampin, rifabutin, rifapentine, phenobarbital, and St. John's Wort) within 7 days prior to randomization

• RANDOMIZATION (STEP 1 - ALL TREATMENT ARMS): Patient must have corrected QT interval calculated by the Fridericia formula (QTcF) =< 500 msec within 28 days prior to Step 1 randomization

• RANDOMIZATION (STEP 1 - ALL TREATMENT ARMS): Patient must be able to swallow tablets

• RANDOMIZATION (STEP 1 - ALL TREATMENT ARMS): Patient must not be on continuous systemic treatment with corticosteroids (> 10 mg daily prednisone equivalents) or other immunosuppressive medications within 7 days prior to randomization, with the following exceptions:

  • Inhaled or topical steroids and adrenal replacement doses =< 10 mg daily prednisone equivalents are permitted in the absence of active autoimmune disease.
  • Patients are permitted to use topical, ocular, intra-articular, intranasal, and inhalational corticosteroids (with minimal systemic absorption).
  • Physiologic replacement doses of systemic corticosteroids are permitted, if < 10 mg/day prednisone equivalents. A brief course of corticosteroids for prophylaxis (e.g., contrast dye allergy) or for treatment of non-autoimmune conditions (e.g., delayed-type hypersensitivity reaction caused by contact allergen) is permitted

• RANDOMIZATION (STEP 1 - ALL TREATMENT ARMS): Patients with brain metastases are eligible as follows:

  • Previously treated brain metastases must have been treated with radiation > 2 weeks prior to randomization or surgery > 3 months prior to randomization OR
  • Untreated (active) brain metastases are allowed if they are clinically asymptomatic, < 1 cm, non-hemorrhagic, the patient is not on systemic anticoagulation, and the investigator believes that central nervous system (CNS) specific treatment is unlikely to be required during the first 3 months of study treatment.
  • NOTE: Symptomatic leptomeningeal disease is NOT allowed

• RANDOMIZATION (STEP 1 - ALL TREATMENT ARMS): Patient must not have known active autoimmune disease or known history of autoimmune disease for which recurrence may affect vital organ function or require immune suppressive treatment including systemic corticosteroids (e.g., immune-related neurologic disease, multiple sclerosis, autoimmune neuropathy, Guillain-Barre syndrome, etc.).

• RANDOMIZATION (STEP 1 - ALL TREATMENT ARMS): Patients with known history of human immunodeficiency virus (HIV)-infection must be on effective anti-retroviral therapy with undetectable viral load within 6 months of randomization

• RANDOMIZATION (STEP 1 - ALL TREATMENT ARMS): Patients with known history of chronic hepatitis B virus (HBV) infection must have undetectable HBV viral at time of randomization (suppressive therapy is allowed, if indicated)

• RANDOMIZATION (STEP 1 - ALL TREATMENT ARMS): Patients with a known history of hepatitis C virus (HCV) infection must have been treated and cured. For patients with HCV infection who are currently on treatment, they are eligible if they have an undetectable HCV viral load at time of randomization

• RANDOMIZATION (STEP 1 - ALL TREATMENT ARMS): Patient must not have had any prior allergic reaction or hypersensitivity to study drug components or related drugs (multitargeted small molecule tyrosine kinase inhibitors or checkpoint inhibitor monoclonal antibodies)

• STEP 2 (CROSSOVER ARM Z): Patient must have met all eligibility requirements for Step 1 at time of registration to Step 1 to be eligible for Step 2

• STEP 2 (CROSSOVER ARM Z): Patient must have radiographic progressive disease per RECIST criteria after >= 2 cycles of therapy on Arm C. The scan showing progression must be completed within 6 weeks prior to Step 2 registration

• STEP 2 (CROSSOVER ARM Z): Patient must not have intervening anticancer treatment or major surgical procedure(s) between Step 1 and Step 2, except palliative radiation which was completed >= 1 week prior to registration to Step 2

• STEP 2 (CROSSOVER ARM Z): Patient may not have central nervous system progression, but patients with stable CNS disease are allowed

• STEP 2 (CROSSOVER ARM Z): Patient must have an ECOG performance status 0-2

• STEP 2 (CROSSOVER ARM Z): Patient must have recovered to equal to or less than grade 1 toxicities related to prior treatment, unless the adverse event(s) are clinically non significant and/or stable on supportive therapy (as determined by the treating physician)

• STEP 2 (CROSSOVER ARM Z): Absolute neutrophil count >= 1,500/mcL (obtained within 2 weeks prior to registration to Step 2)

• STEP 2 (CROSSOVER ARM Z): Platelets >= 100,000/mcL (obtained within 2 weeks prior to registration to Step 2)

• STEP 2 (CROSSOVER ARM Z): Hemoglobin >= 9 g/dL (obtained within 2 weeks prior to registration to Step 2)

• STEP 2 (CROSSOVER ARM Z): Total bilirubin =< 1.5 x institutional ULN (for patients with Gilbert's disease total bilirubin must be =< 3 x ULN) (obtained within 2 weeks prior to registration to Step 2)

• STEP 2 (CROSSOVER ARM Z): AST(SGOT) and ALT(SGPT) =< 2.5 x ULN (obtained within 2 weeks prior to registration to Step 2)

• STEP 2 (CROSSOVER ARM Z): Creatinine =< 1.5 x ULN OR calculated (Cockcroft-Gault formula) or measured creatinine clearance >= 50 mL/min/1.73m^2 (normalized to BSA) for patients with creatinine levels greater than 1.5 times the institutional normal creatinine =< 1.5 X ULN or creatinine clearance >= 50ml/min/1.73m^2 (obtained within 2 weeks prior to registration to Step 2)

• STEP 2 (CROSSOVER ARM Z): Patient must have corrected QT interval calculated by the Fridericia formula (QTcF) =< 500 ms within 28 days prior to Step 2 registration

• STEP 2 (CROSSOVER ARM Z): Patient must not have any intercurrent illness or disease complication that the investigator believes would limit the ability to safely tolerate the combination of cabozantinib and nivolumab

• STEP 2 (CROSSOVER ARM Z): Patient must not be pregnant or breast-feeding due to the unknown effects of cabozantinib and nivolumab on human development and for the potential risk for adverse events in nursing infants with the treatment regimens being used.

  • All patients of childbearing potential must have a blood test or urine study within 14 days prior to registration to Step 2 to rule out pregnancy.
  • A patient of childbearing potential is anyone, regardless of sexual orientation or whether they have undergone tubal ligation, who meets the following criteria: 1) has achieved menarche at some point, 2) has not undergone a hysterectomy or bilateral oophorectomy; or 3) has not been naturally postmenopausal (amenorrhea following cancer therapy does not rule out childbearing potential) for at least 24 consecutive months (i.e., has had menses at any time in the preceding 24 consecutive months).

• STEP 2 (CROSSOVER ARM Z): Patients must not expect to conceive or father children by using accepted and effective method(s) of contraception or by abstaining from sexual intercourse for the duration of their participation in the study and for 6 months after completion of treatment on the study

Exclusion Criteria

Not provided

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Step 1, Arm A (cabozantinib S-malate)	Biospecimen Collection	Patients in Step 1, Arm A receive cabozantinib S-malate PO QD. Cycles repeat every 21 days in the absence of disease progression or unacceptable toxicity. Patients may continue to receive therapy after investigator-assessed RECIST 1.1 defined progression, including stable clinical and performance status and have potential for continued clinical benefit. Patients also undergo ECHO as clinically indicated, CT throughout the trial, and collection of blood on study.
Step 1, Arm A (cabozantinib S-malate)	Cabozantinib S-malate	Patients in Step 1, Arm A receive cabozantinib S-malate PO QD. Cycles repeat every 21 days in the absence of disease progression or unacceptable toxicity. Patients may continue to receive therapy after investigator-assessed RECIST 1.1 defined progression, including stable clinical and performance status and have potential for continued clinical benefit. Patients also undergo ECHO as clinically indicated, CT throughout the trial, and collection of blood on study.
Step 1, Arm A (cabozantinib S-malate)	Computed Tomography	Patients in Step 1, Arm A receive cabozantinib S-malate PO QD. Cycles repeat every 21 days in the absence of disease progression or unacceptable toxicity. Patients may continue to receive therapy after investigator-assessed RECIST 1.1 defined progression, including stable clinical and performance status and have potential for continued clinical benefit. Patients also undergo ECHO as clinically indicated, CT throughout the trial, and collection of blood on study.
Step 1, Arm A (cabozantinib S-malate)	Echocardiography Test	Patients in Step 1, Arm A receive cabozantinib S-malate PO QD. Cycles repeat every 21 days in the absence of disease progression or unacceptable toxicity. Patients may continue to receive therapy after investigator-assessed RECIST 1.1 defined progression, including stable clinical and performance status and have potential for continued clinical benefit. Patients also undergo ECHO as clinically indicated, CT throughout the trial, and collection of blood on study.
Step 1, Arm B (cabozantinib S-malate, nivolumab)	Biospecimen Collection	Patients in Step 1, Arm B receive cabozantinib S-malate PO QD and nivolumab IV over 30 minutes on day 1. Cycles repeat every 21 days in the absence of disease progression or unacceptable toxicity. Patients may continue to receive therapy after investigator-assessed RECIST 1.1 defined progression, including stable clinical and performance status and have potential for continued clinical benefit. Patients also undergo ECHO as clinically indicated, CT throughout the trial, and collection of blood on study.
Step 1, Arm B (cabozantinib S-malate, nivolumab)	Cabozantinib S-malate	Patients in Step 1, Arm B receive cabozantinib S-malate PO QD and nivolumab IV over 30 minutes on day 1. Cycles repeat every 21 days in the absence of disease progression or unacceptable toxicity. Patients may continue to receive therapy after investigator-assessed RECIST 1.1 defined progression, including stable clinical and performance status and have potential for continued clinical benefit. Patients also undergo ECHO as clinically indicated, CT throughout the trial, and collection of blood on study.
Step 1, Arm B (cabozantinib S-malate, nivolumab)	Computed Tomography	Patients in Step 1, Arm B receive cabozantinib S-malate PO QD and nivolumab IV over 30 minutes on day 1. Cycles repeat every 21 days in the absence of disease progression or unacceptable toxicity. Patients may continue to receive therapy after investigator-assessed RECIST 1.1 defined progression, including stable clinical and performance status and have potential for continued clinical benefit. Patients also undergo ECHO as clinically indicated, CT throughout the trial, and collection of blood on study.
Step 1, Arm B (cabozantinib S-malate, nivolumab)	Echocardiography Test	Patients in Step 1, Arm B receive cabozantinib S-malate PO QD and nivolumab IV over 30 minutes on day 1. Cycles repeat every 21 days in the absence of disease progression or unacceptable toxicity. Patients may continue to receive therapy after investigator-assessed RECIST 1.1 defined progression, including stable clinical and performance status and have potential for continued clinical benefit. Patients also undergo ECHO as clinically indicated, CT throughout the trial, and collection of blood on study.
Step 1, Arm B (cabozantinib S-malate, nivolumab)	Nivolumab	Patients in Step 1, Arm B receive cabozantinib S-malate PO QD and nivolumab IV over 30 minutes on day 1. Cycles repeat every 21 days in the absence of disease progression or unacceptable toxicity. Patients may continue to receive therapy after investigator-assessed RECIST 1.1 defined progression, including stable clinical and performance status and have potential for continued clinical benefit. Patients also undergo ECHO as clinically indicated, CT throughout the trial, and collection of blood on study.
Step 1, Arm C (standard chemotherapy)	Biospecimen Collection	Patients in Step 1, Arm C receive ramucirumab IV over 30-60 minutes and docetaxel IV over 1 hour on day 1, or docetaxel IV over 1 hour on days 1 and 8, or gemcitabine hydrochloride IV on days 1 and 8, or paclitaxel IV over 3 hours on day 1, or nab-paclitaxel IV over 30 minutes on days 1 and 8. Cycles repeat every 21 days in the absence of disease progression or unacceptable toxicity and at the discretion of the treating physician. Patients also undergo ECHO as clinically indicated, CT throughout the trial, and collection of blood on study.
Step 1, Arm C (standard chemotherapy)	Computed Tomography	Patients in Step 1, Arm C receive ramucirumab IV over 30-60 minutes and docetaxel IV over 1 hour on day 1, or docetaxel IV over 1 hour on days 1 and 8, or gemcitabine hydrochloride IV on days 1 and 8, or paclitaxel IV over 3 hours on day 1, or nab-paclitaxel IV over 30 minutes on days 1 and 8. Cycles repeat every 21 days in the absence of disease progression or unacceptable toxicity and at the discretion of the treating physician. Patients also undergo ECHO as clinically indicated, CT throughout the trial, and collection of blood on study.
Step 1, Arm C (standard chemotherapy)	Docetaxel	Patients in Step 1, Arm C receive ramucirumab IV over 30-60 minutes and docetaxel IV over 1 hour on day 1, or docetaxel IV over 1 hour on days 1 and 8, or gemcitabine hydrochloride IV on days 1 and 8, or paclitaxel IV over 3 hours on day 1, or nab-paclitaxel IV over 30 minutes on days 1 and 8. Cycles repeat every 21 days in the absence of disease progression or unacceptable toxicity and at the discretion of the treating physician. Patients also undergo ECHO as clinically indicated, CT throughout the trial, and collection of blood on study.
Step 1, Arm C (standard chemotherapy)	Echocardiography Test	Patients in Step 1, Arm C receive ramucirumab IV over 30-60 minutes and docetaxel IV over 1 hour on day 1, or docetaxel IV over 1 hour on days 1 and 8, or gemcitabine hydrochloride IV on days 1 and 8, or paclitaxel IV over 3 hours on day 1, or nab-paclitaxel IV over 30 minutes on days 1 and 8. Cycles repeat every 21 days in the absence of disease progression or unacceptable toxicity and at the discretion of the treating physician. Patients also undergo ECHO as clinically indicated, CT throughout the trial, and collection of blood on study.
Step 1, Arm C (standard chemotherapy)	Gemcitabine Hydrochloride	Patients in Step 1, Arm C receive ramucirumab IV over 30-60 minutes and docetaxel IV over 1 hour on day 1, or docetaxel IV over 1 hour on days 1 and 8, or gemcitabine hydrochloride IV on days 1 and 8, or paclitaxel IV over 3 hours on day 1, or nab-paclitaxel IV over 30 minutes on days 1 and 8. Cycles repeat every 21 days in the absence of disease progression or unacceptable toxicity and at the discretion of the treating physician. Patients also undergo ECHO as clinically indicated, CT throughout the trial, and collection of blood on study.
Step 1, Arm C (standard chemotherapy)	Nab-paclitaxel	Patients in Step 1, Arm C receive ramucirumab IV over 30-60 minutes and docetaxel IV over 1 hour on day 1, or docetaxel IV over 1 hour on days 1 and 8, or gemcitabine hydrochloride IV on days 1 and 8, or paclitaxel IV over 3 hours on day 1, or nab-paclitaxel IV over 30 minutes on days 1 and 8. Cycles repeat every 21 days in the absence of disease progression or unacceptable toxicity and at the discretion of the treating physician. Patients also undergo ECHO as clinically indicated, CT throughout the trial, and collection of blood on study.
Step 1, Arm C (standard chemotherapy)	Paclitaxel	Patients in Step 1, Arm C receive ramucirumab IV over 30-60 minutes and docetaxel IV over 1 hour on day 1, or docetaxel IV over 1 hour on days 1 and 8, or gemcitabine hydrochloride IV on days 1 and 8, or paclitaxel IV over 3 hours on day 1, or nab-paclitaxel IV over 30 minutes on days 1 and 8. Cycles repeat every 21 days in the absence of disease progression or unacceptable toxicity and at the discretion of the treating physician. Patients also undergo ECHO as clinically indicated, CT throughout the trial, and collection of blood on study.
Step 1, Arm C (standard chemotherapy)	Ramucirumab	Patients in Step 1, Arm C receive ramucirumab IV over 30-60 minutes and docetaxel IV over 1 hour on day 1, or docetaxel IV over 1 hour on days 1 and 8, or gemcitabine hydrochloride IV on days 1 and 8, or paclitaxel IV over 3 hours on day 1, or nab-paclitaxel IV over 30 minutes on days 1 and 8. Cycles repeat every 21 days in the absence of disease progression or unacceptable toxicity and at the discretion of the treating physician. Patients also undergo ECHO as clinically indicated, CT throughout the trial, and collection of blood on study.
Step 2, Arm Z (cabozantinib S-malate, nivolumab)	Biospecimen Collection	Patients in Step 2, Arm Z receive cabozantinib S-malate PO QD and nivolumab IV over 30 minutes on day 1. Cycles repeat every 21 days in the absence of disease progression or unacceptable toxicity. Patients may continue to receive therapy after investigator-assessed RECIST 1.1 defined progression, including stable clinical and performance status and have potential for continued clinical benefit. Patients also undergo ECHO as clinically indicated, CT throughout the trial, and collection of blood on study.
Step 2, Arm Z (cabozantinib S-malate, nivolumab)	Cabozantinib S-malate	Patients in Step 2, Arm Z receive cabozantinib S-malate PO QD and nivolumab IV over 30 minutes on day 1. Cycles repeat every 21 days in the absence of disease progression or unacceptable toxicity. Patients may continue to receive therapy after investigator-assessed RECIST 1.1 defined progression, including stable clinical and performance status and have potential for continued clinical benefit. Patients also undergo ECHO as clinically indicated, CT throughout the trial, and collection of blood on study.
Step 2, Arm Z (cabozantinib S-malate, nivolumab)	Computed Tomography	Patients in Step 2, Arm Z receive cabozantinib S-malate PO QD and nivolumab IV over 30 minutes on day 1. Cycles repeat every 21 days in the absence of disease progression or unacceptable toxicity. Patients may continue to receive therapy after investigator-assessed RECIST 1.1 defined progression, including stable clinical and performance status and have potential for continued clinical benefit. Patients also undergo ECHO as clinically indicated, CT throughout the trial, and collection of blood on study.
Step 2, Arm Z (cabozantinib S-malate, nivolumab)	Echocardiography Test	Patients in Step 2, Arm Z receive cabozantinib S-malate PO QD and nivolumab IV over 30 minutes on day 1. Cycles repeat every 21 days in the absence of disease progression or unacceptable toxicity. Patients may continue to receive therapy after investigator-assessed RECIST 1.1 defined progression, including stable clinical and performance status and have potential for continued clinical benefit. Patients also undergo ECHO as clinically indicated, CT throughout the trial, and collection of blood on study.
Step 2, Arm Z (cabozantinib S-malate, nivolumab)	Nivolumab	Patients in Step 2, Arm Z receive cabozantinib S-malate PO QD and nivolumab IV over 30 minutes on day 1. Cycles repeat every 21 days in the absence of disease progression or unacceptable toxicity. Patients may continue to receive therapy after investigator-assessed RECIST 1.1 defined progression, including stable clinical and performance status and have potential for continued clinical benefit. Patients also undergo ECHO as clinically indicated, CT throughout the trial, and collection of blood on study.

Primary Outcome Measures

Name	Time	Method
Progression-free survival (PFS) for patient population with non-squamous no-small cell lung cancer (NSCLC)	After 58 events (From time of randomization to documented disease progression [site review of imaging] or death from any cause, whichever occurs first)	The final analysis of PFS will be performed when the full information of PFS is reached (i.e., 58 events for each of the two primary comparisons). The two primary comparisons of PFS will each use a logrank test stratified on the randomization stratification factors with a one-sided type I error rate of 10%. Estimates of PFS including medians and confidence intervals, will be calculated using the Kaplan-Meier method. Cox proportional hazards models, stratified, on the same factors, will be used to estimate the treatment hazard ratios. At the final analyses, in the event that both primary PFS comparisons of the combination of nivolumab with cabozantinib and cabozantinib alone versus the standard chemotherapy are statistically significant, PFS will be compared between the two experimental arms (combination of nivolumab with cabozantinib versus \[vs.\] cabozantinib alone), using a stratified log rank test with a one-sided type I error rate of 10%.

Secondary Outcome Measures

Name	Time	Method
Best objective response for each arm	Every 6 weeks for the first year on study, and then every 12 weeks after year one	Will be evaluated via Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 criteria. Response rates (complete response \[CR\] + partial response \[PR\]) and toxicity will be compared using Fisher's exact tests with a one-sided type I error rate of 10%; multivariable logistic regression modeling will be used to adjust for the effect of any covariates that are associated with these categorical outcomes. Modeling procedures will implement backward selection; variables significant at the 0.10 level in the univariate setting will be chosen for inclusion in an initial full model, and at each step the least significant variable will be removed from the model. Only those covariates with p \< 0.05 will remain in any final models, unless there are factors identified by the study team as crucial to model interpretation. Point estimates of all endpoints will be accompanied by the corresponding two-sided 80% confidence intervals.
Overall survival (OS) for each arm	From time of randomization to documented disease progression (site review of imaging) or death from any cause, whichever occurs first, assessed up to 3 years	The final analysis of OS will be performed when the full information of PFS is reached (i.e., 58 events for each of the two primary comparisons). OS will be tested in a hierarchical fashion if the primary comparison of PFS between treatment arms is statistically significant, using a log rank test stratified on the randomization stratification factors with a one-sided type I error rate of 10%. Estimates of OS, including medians and confidence intervals, will be calculated using the Kaplan-Meier method. Cox proportional hazards models, stratified, on the same factors, will be used to estimate the treatment hazard ratios. OS will be further tested in a hierarchical fashion if the comparison of PFS between the two experimental arms is statistically significant. Point estimates of all endpoints will be accompanied by the corresponding two-sided 80% confidence intervals. Subset analyses of PFS and OS by treatment arm will be estimated and compared within subsets.
Toxicity profile of monotherapy with cabozantinib, and the combination of nivolumab and cabozantinib	Up to 3 years after completion of study treatment	Will be determined using the Common Terminology Criteria for Adverse Events (CTCAE) criteria. Response rates (complete response \[CR\] + pathologic response \[PR\]) and toxicity will be compared using Fisher's exact tests with a one-sided type I error rate of 10%; multivariable logistic regression modeling will be used to adjust for the effect of any covariates that are associated with these categorical outcomes. Modeling procedures will implement backward selection; variables significant at the 0.10 level in the univariate setting will be chosen for inclusion in an initial full model, and at each step the least significant variable will be removed from the model. Only those covariates with p \< 0.05 will remain in any final models, unless there are factors identified by the study team as crucial to model interpretation. Point estimates of all endpoints will be accompanied by the corresponding two-sided 80% confidence intervals.

Trial Locations

Locations (616)

Commonwealth Cancer Center-Corbin; 🇺🇸 Corbin, Kentucky, United States

Saint Joseph Hospital; 🇺🇸 Lexington, Kentucky, United States

Bronson Battle Creek; 🇺🇸 Battle Creek, Michigan, United States

Trinity Health IHA Medical Group Hematology Oncology - Brighton; 🇺🇸 Brighton, Michigan, United States

Rice Memorial Hospital; 🇺🇸 Willmar, Minnesota, United States

Nebraska Medicine-Village Pointe; 🇺🇸 Omaha, Nebraska, United States

Alegent Health Immanuel Medical Center; 🇺🇸 Omaha, Nebraska, United States

Virtua Memorial; 🇺🇸 Mount Holly, New Jersey, United States

Virtua Voorhees; 🇺🇸 Voorhees, New Jersey, United States

University of New Mexico Cancer Center; 🇺🇸 Albuquerque, New Mexico, United States

Cleveland Clinic Foundation; 🇺🇸 Cleveland, Ohio, United States

Miami Valley Hospital; 🇺🇸 Dayton, Ohio, United States

Premier Blood and Cancer Center; 🇺🇸 Dayton, Ohio, United States

Dayton Physician LLC - Englewood; 🇺🇸 Dayton, Ohio, United States

Miami Valley Hospital North; 🇺🇸 Dayton, Ohio, United States

Armes Family Cancer Center; 🇺🇸 Findlay, Ohio, United States

Blanchard Valley Hospital; 🇺🇸 Findlay, Ohio, United States

Orion Cancer Care; 🇺🇸 Findlay, Ohio, United States

Atrium Medical Center-Middletown Regional Hospital; 🇺🇸 Franklin, Ohio, United States

Dayton Physicians LLC-Atrium; 🇺🇸 Franklin, Ohio, United States

Dayton Physicians LLC-Wayne; 🇺🇸 Greenville, Ohio, United States

Billings Clinic-Cody; 🇺🇸 Cody, Wyoming, United States

Welch Cancer Center; 🇺🇸 Sheridan, Wyoming, United States

Macomb Hematology Oncology PC; 🇺🇸 Warren, Michigan, United States

Veterans Administration Medical Center - Birmingham; 🇺🇸 Birmingham, Alabama, United States

Anchorage Associates in Radiation Medicine; 🇺🇸 Anchorage, Alaska, United States

Anchorage Radiation Therapy Center; 🇺🇸 Anchorage, Alaska, United States

Alaska Breast Care and Surgery LLC; 🇺🇸 Anchorage, Alaska, United States

Alaska Oncology and Hematology LLC; 🇺🇸 Anchorage, Alaska, United States

Alaska Women's Cancer Care; 🇺🇸 Anchorage, Alaska, United States

Anchorage Oncology Centre; 🇺🇸 Anchorage, Alaska, United States

Katmai Oncology Group; 🇺🇸 Anchorage, Alaska, United States

Providence Alaska Medical Center; 🇺🇸 Anchorage, Alaska, United States

Fairbanks Memorial Hospital; 🇺🇸 Fairbanks, Alaska, United States

CTCA at Western Regional Medical Center; 🇺🇸 Goodyear, Arizona, United States

Kingman Regional Medical Center; 🇺🇸 Kingman, Arizona, United States

Cancer Center at Saint Joseph's; 🇺🇸 Phoenix, Arizona, United States

Banner University Medical Center - Tucson; 🇺🇸 Tucson, Arizona, United States

University of Arizona Cancer Center-North Campus; 🇺🇸 Tucson, Arizona, United States

Mercy Hospital Fort Smith; 🇺🇸 Fort Smith, Arkansas, United States

CHI Saint Vincent Cancer Center Hot Springs; 🇺🇸 Hot Springs, Arkansas, United States

Mission Hope Medical Oncology - Arroyo Grande; 🇺🇸 Arroyo Grande, California, United States

PCR Oncology; 🇺🇸 Arroyo Grande, California, United States

Providence Saint Joseph Medical Center/Disney Family Cancer Center; 🇺🇸 Burbank, California, United States

Mercy Cancer Center - Carmichael; 🇺🇸 Carmichael, California, United States

Mercy San Juan Medical Center; 🇺🇸 Carmichael, California, United States

Mercy Cancer Center - Elk Grove; 🇺🇸 Elk Grove, California, United States

Washington Hospital; 🇺🇸 Fremont, California, United States

Fremont - Rideout Cancer Center; 🇺🇸 Marysville, California, United States

Saint Joseph Hospital - Orange; 🇺🇸 Orange, California, United States

Stanford Cancer Institute Palo Alto; 🇺🇸 Palo Alto, California, United States

Mercy Cancer Center - Rocklin; 🇺🇸 Rocklin, California, United States

Mercy Cancer Center - Sacramento; 🇺🇸 Sacramento, California, United States

University of California Davis Comprehensive Cancer Center; 🇺🇸 Sacramento, California, United States

Pacific Central Coast Health Center-San Luis Obispo; 🇺🇸 San Luis Obispo, California, United States

Mission Hope Medical Oncology - Santa Maria; 🇺🇸 Santa Maria, California, United States

Woodland Memorial Hospital; 🇺🇸 Woodland, California, United States

Rocky Mountain Cancer Centers-Aurora; 🇺🇸 Aurora, Colorado, United States

The Medical Center of Aurora; 🇺🇸 Aurora, Colorado, United States

Boulder Community Foothills Hospital; 🇺🇸 Boulder, Colorado, United States

Rocky Mountain Cancer Centers-Boulder; 🇺🇸 Boulder, Colorado, United States

Rocky Mountain Cancer Centers - Centennial; 🇺🇸 Centennial, Colorado, United States

Penrose-Saint Francis Healthcare; 🇺🇸 Colorado Springs, Colorado, United States

Rocky Mountain Cancer Centers-Penrose; 🇺🇸 Colorado Springs, Colorado, United States

Saint Francis Cancer Center; 🇺🇸 Colorado Springs, Colorado, United States

Cancer Center of Colorado at Sloan's Lake; 🇺🇸 Denver, Colorado, United States

National Jewish Health-Main Campus; 🇺🇸 Denver, Colorado, United States

The Women's Imaging Center; 🇺🇸 Denver, Colorado, United States

AdventHealth Porter; 🇺🇸 Denver, Colorado, United States

Colorado Blood Cancer Institute; 🇺🇸 Denver, Colorado, United States

Presbyterian - Saint Lukes Medical Center - Health One; 🇺🇸 Denver, Colorado, United States

Rocky Mountain Cancer Centers-Midtown; 🇺🇸 Denver, Colorado, United States

Saint Joseph Hospital - Cancer Centers of Colorado; 🇺🇸 Denver, Colorado, United States

Rocky Mountain Cancer Centers-Rose; 🇺🇸 Denver, Colorado, United States

Rose Medical Center; 🇺🇸 Denver, Colorado, United States

Western Surgical Care; 🇺🇸 Denver, Colorado, United States

Mercy Medical Center; 🇺🇸 Durango, Colorado, United States

Southwest Oncology PC; 🇺🇸 Durango, Colorado, United States

Mountain Blue Cancer Care Center - Swedish; 🇺🇸 Englewood, Colorado, United States

Rocky Mountain Cancer Centers - Swedish; 🇺🇸 Englewood, Colorado, United States

Swedish Medical Center; 🇺🇸 Englewood, Colorado, United States

The Melanoma and Skin Cancer Institute; 🇺🇸 Englewood, Colorado, United States

Poudre Valley Hospital; 🇺🇸 Fort Collins, Colorado, United States

Cancer Care and Hematology-Fort Collins; 🇺🇸 Fort Collins, Colorado, United States

National Jewish Health-Western Hematology Oncology; 🇺🇸 Golden, 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

UCHealth Greeley Hospital; 🇺🇸 Greeley, Colorado, United States

UCHealth Highlands Ranch Hospital; 🇺🇸 Highlands Ranch, Colorado, United States

Good Samaritan Hospital - Cancer Centers of Colorado; 🇺🇸 Lafayette, Colorado, United States

Rocky Mountain Cancer Centers-Lakewood; 🇺🇸 Lakewood, Colorado, United States

Saint Anthony Hospital; 🇺🇸 Lakewood, Colorado, United States

Rocky Mountain Cancer Centers-Littleton; 🇺🇸 Littleton, Colorado, United States

AdventHealth Littleton; 🇺🇸 Littleton, Colorado, United States

Rocky Mountain Cancer Centers-Sky Ridge; 🇺🇸 Lone Tree, Colorado, United States

Sky Ridge Medical Center; 🇺🇸 Lone Tree, Colorado, United States

Longmont United Hospital; 🇺🇸 Longmont, Colorado, United States

Rocky Mountain Cancer Centers-Longmont; 🇺🇸 Longmont, Colorado, United States

Medical Center of the Rockies; 🇺🇸 Loveland, Colorado, United States

Banner McKee Medical Center; 🇺🇸 Loveland, Colorado, United States

AdventHealth Parker; 🇺🇸 Parker, Colorado, United States

Saint Mary Corwin Medical Center; 🇺🇸 Pueblo, Colorado, United States

National Jewish Health-Northern Hematology Oncology; 🇺🇸 Thornton, Colorado, United States

Rocky Mountain Cancer Centers-Thornton; 🇺🇸 Thornton, Colorado, United States

Veterans Affairs Connecticut Healthcare System-West Haven Campus; 🇺🇸 West Haven, Connecticut, United States

Mount Sinai Comprehensive Cancer Center at Aventura; 🇺🇸 Aventura, Florida, United States

Holy Cross Hospital; 🇺🇸 Fort Lauderdale, Florida, United States

Mount Sinai Medical Center; 🇺🇸 Miami Beach, Florida, United States

Emory University Hospital Midtown; 🇺🇸 Atlanta, Georgia, United States

Emory University Hospital/Winship Cancer Institute; 🇺🇸 Atlanta, Georgia, United States

Lewis Cancer and Research Pavilion at Saint Joseph's/Candler; 🇺🇸 Savannah, Georgia, United States

Saint Alphonsus Cancer Care Center-Boise; 🇺🇸 Boise, Idaho, United States

Saint Luke's Cancer Institute - Boise; 🇺🇸 Boise, Idaho, United States

Saint Alphonsus Cancer Care Center-Caldwell; 🇺🇸 Caldwell, Idaho, United States

Kootenai Health - Coeur d'Alene; 🇺🇸 Coeur d'Alene, Idaho, United States

Walter Knox Memorial Hospital; 🇺🇸 Emmett, Idaho, United States

Saint Luke's Cancer Institute - Fruitland; 🇺🇸 Fruitland, Idaho, United States

Idaho Urologic Institute-Meridian; 🇺🇸 Meridian, Idaho, United States

Saint Luke's Cancer Institute - Meridian; 🇺🇸 Meridian, Idaho, United States

Saint Alphonsus Cancer Care Center-Nampa; 🇺🇸 Nampa, Idaho, United States

Saint Luke's Cancer Institute - Nampa; 🇺🇸 Nampa, Idaho, United States

Kootenai Clinic Cancer Services - Post Falls; 🇺🇸 Post Falls, Idaho, United States

Kootenai Clinic Cancer Services - Sandpoint; 🇺🇸 Sandpoint, Idaho, United States

Saint Luke's Cancer Institute - Twin Falls; 🇺🇸 Twin Falls, Idaho, United States

OSF Saint Anthony's Health Center; 🇺🇸 Alton, Illinois, United States

Rush - Copley Medical Center; 🇺🇸 Aurora, Illinois, United States

Advocate Good Shepherd Hospital; 🇺🇸 Barrington, Illinois, United States

Illinois CancerCare-Bloomington; 🇺🇸 Bloomington, Illinois, United States

Illinois CancerCare-Canton; 🇺🇸 Canton, Illinois, United States

Memorial Hospital of Carbondale; 🇺🇸 Carbondale, Illinois, United States

SIH Cancer Institute; 🇺🇸 Carterville, Illinois, United States

Illinois CancerCare-Carthage; 🇺🇸 Carthage, Illinois, United States

Advocate Good Samaritan Hospital; 🇺🇸 Downers Grove, Illinois, United States

Centralia Oncology Clinic; 🇺🇸 Centralia, Illinois, United States

Saint Mary's Hospital; 🇺🇸 Centralia, Illinois, United States

University of Illinois; 🇺🇸 Chicago, Illinois, United States

Advocate Illinois Masonic Medical Center; 🇺🇸 Chicago, Illinois, United States

AMG Crystal Lake - Oncology; 🇺🇸 Crystal Lake, Illinois, United States

Carle at The Riverfront; 🇺🇸 Danville, Illinois, United States

Cancer Care Specialists of Illinois - Decatur; 🇺🇸 Decatur, Illinois, United States

Decatur Memorial Hospital; 🇺🇸 Decatur, Illinois, United States

Illinois CancerCare-Dixon; 🇺🇸 Dixon, Illinois, United States

Carle Physician Group-Effingham; 🇺🇸 Effingham, Illinois, United States

Crossroads Cancer Center; 🇺🇸 Effingham, Illinois, United States

Advocate Sherman Hospital; 🇺🇸 Elgin, Illinois, United States

Illinois CancerCare-Eureka; 🇺🇸 Eureka, Illinois, United States

Illinois CancerCare-Galesburg; 🇺🇸 Galesburg, Illinois, United States

Western Illinois Cancer Treatment Center; 🇺🇸 Galesburg, Illinois, United States

Advocate South Suburban Hospital; 🇺🇸 Hazel Crest, Illinois, United States

Edward Hines Jr VA Hospital; 🇺🇸 Hines, Illinois, United States

Illinois CancerCare-Kewanee Clinic; 🇺🇸 Kewanee, Illinois, United States

AMG Libertyville - Oncology; 🇺🇸 Libertyville, Illinois, United States

Condell Memorial Hospital; 🇺🇸 Libertyville, Illinois, United States

Illinois CancerCare-Macomb; 🇺🇸 Macomb, Illinois, United States

Carle Physician Group-Mattoon/Charleston; 🇺🇸 Mattoon, Illinois, United States

SSM Health Good Samaritan; 🇺🇸 Mount Vernon, Illinois, United States

Cancer Care Center of O'Fallon; 🇺🇸 O'Fallon, Illinois, United States

Advocate Christ Medical Center; 🇺🇸 Oak Lawn, Illinois, United States

Illinois CancerCare-Ottawa Clinic; 🇺🇸 Ottawa, Illinois, United States

Advocate Lutheran General Hospital; 🇺🇸 Park Ridge, Illinois, United States

Illinois CancerCare-Pekin; 🇺🇸 Pekin, Illinois, United States

Illinois CancerCare-Peoria; 🇺🇸 Peoria, Illinois, United States

Methodist Medical Center of Illinois; 🇺🇸 Peoria, Illinois, United States

Illinois CancerCare-Peru; 🇺🇸 Peru, Illinois, United States

Valley Radiation Oncology; 🇺🇸 Peru, Illinois, United States

Illinois CancerCare-Princeton; 🇺🇸 Princeton, Illinois, United States

UW Health Carbone Cancer Center Rockford; 🇺🇸 Rockford, Illinois, United States

Southern Illinois University School of Medicine; 🇺🇸 Springfield, Illinois, United States

Springfield Clinic; 🇺🇸 Springfield, Illinois, United States

Springfield Memorial Hospital; 🇺🇸 Springfield, Illinois, United States

Southwest Illinois Health Services LLP; 🇺🇸 Swansea, Illinois, United States

Carle Cancer Center; 🇺🇸 Urbana, Illinois, United States

The Carle Foundation Hospital; 🇺🇸 Urbana, Illinois, United States

Illinois CancerCare - Washington; 🇺🇸 Washington, Illinois, United States

Rush-Copley Healthcare Center; 🇺🇸 Yorkville, Illinois, United States

Reid Health; 🇺🇸 Richmond, Indiana, United States

Memorial Hospital of South Bend; 🇺🇸 South Bend, Indiana, United States

Mary Greeley Medical Center; 🇺🇸 Ames, Iowa, United States

McFarland Clinic - Ames; 🇺🇸 Ames, Iowa, United States

University of Iowa Healthcare Cancer Services Quad Cities; 🇺🇸 Bettendorf, Iowa, United States

McFarland Clinic - Boone; 🇺🇸 Boone, Iowa, United States

Saint Anthony Regional Hospital; 🇺🇸 Carroll, Iowa, United States

Mercy Cancer Center-West Lakes; 🇺🇸 Clive, Iowa, United States

UI Health Care Mission Cancer and Blood - West Des Moines Clinic; 🇺🇸 Clive, Iowa, United States

Alegent Health Mercy Hospital; 🇺🇸 Council Bluffs, Iowa, United States

Heartland Oncology and Hematology LLP; 🇺🇸 Council Bluffs, Iowa, United States

Methodist Jennie Edmundson Hospital; 🇺🇸 Council Bluffs, Iowa, United States

Greater Regional Medical Center; 🇺🇸 Creston, Iowa, United States

Iowa Methodist Medical Center; 🇺🇸 Des Moines, Iowa, United States

UI Health Care Mission Cancer and Blood - Des Moines Clinic; 🇺🇸 Des Moines, Iowa, United States

Broadlawns Medical Center; 🇺🇸 Des Moines, Iowa, United States

Mercy Medical Center - Des Moines; 🇺🇸 Des Moines, Iowa, United States

UI Health Care Mission Cancer and Blood - Laurel Clinic; 🇺🇸 Des Moines, Iowa, United States

Iowa Lutheran Hospital; 🇺🇸 Des Moines, Iowa, United States

McFarland Clinic - Trinity Cancer Center; 🇺🇸 Fort Dodge, Iowa, United States

Trinity Regional Medical Center; 🇺🇸 Fort Dodge, Iowa, United States

University of Iowa/Holden Comprehensive Cancer Center; 🇺🇸 Iowa City, Iowa, United States

McFarland Clinic - Jefferson; 🇺🇸 Jefferson, Iowa, United States

McFarland Clinic - Marshalltown; 🇺🇸 Marshalltown, Iowa, United States

Methodist West Hospital; 🇺🇸 West Des Moines, Iowa, United States

Mercy Medical Center-West Lakes; 🇺🇸 West Des Moines, Iowa, United States

Central Care Cancer Center - Garden City; 🇺🇸 Garden City, Kansas, United States

Central Care Cancer Center - Great Bend; 🇺🇸 Great Bend, Kansas, United States

HaysMed; 🇺🇸 Hays, Kansas, United States

Lawrence Memorial Hospital; 🇺🇸 Lawrence, Kansas, United States

The University of Kansas Cancer Center - Olathe; 🇺🇸 Olathe, Kansas, United States

Saint Luke's South Hospital; 🇺🇸 Overland Park, Kansas, United States

Freeman Physician Group of Pittsburg; 🇺🇸 Pittsburg, Kansas, United States

Mercy Hospital Pittsburg; 🇺🇸 Pittsburg, Kansas, United States

Salina Regional Health Center; 🇺🇸 Salina, Kansas, United States

University of Kansas Health System Saint Francis Campus; 🇺🇸 Topeka, Kansas, United States

Flaget Memorial Hospital; 🇺🇸 Bardstown, Kentucky, United States

Saint Joseph Radiation Oncology Resource Center; 🇺🇸 Lexington, Kentucky, United States

Saint Joseph Hospital East; 🇺🇸 Lexington, Kentucky, United States

Saint Joseph London; 🇺🇸 London, Kentucky, United States

Jewish Hospital; 🇺🇸 Louisville, Kentucky, United States

Saints Mary and Elizabeth Hospital; 🇺🇸 Louisville, Kentucky, United States

UofL Health Medical Center Northeast; 🇺🇸 Louisville, Kentucky, United States

Saint Joseph Mount Sterling; 🇺🇸 Mount Sterling, Kentucky, United States

Owensboro Health Mitchell Memorial Cancer Center; 🇺🇸 Owensboro, Kentucky, United States

Mercy Health - Paducah Cancer Center; 🇺🇸 Paducah, Kentucky, United States

Jewish Hospital Medical Center South; 🇺🇸 Shepherdsville, Kentucky, United States

LSU Health Baton Rouge-North Clinic; 🇺🇸 Baton Rouge, Louisiana, United States

Our Lady of the Lake Physician Group; 🇺🇸 Baton Rouge, Louisiana, United States

Our Lady of The Lake; 🇺🇸 Baton Rouge, Louisiana, United States

Louisiana Hematology Oncology Associates LLC; 🇺🇸 Baton Rouge, Louisiana, United States

Mary Bird Perkins Cancer Center; 🇺🇸 Baton Rouge, Louisiana, United States

Northshore Oncology Associates-Covington; 🇺🇸 Covington, Louisiana, United States

Terrebonne General Medical Center; 🇺🇸 Houma, Louisiana, United States

Harold Alfond Center for Cancer Care; 🇺🇸 Augusta, Maine, United States

MaineHealth Maine Medical Center - Biddeford; 🇺🇸 Biddeford, Maine, United States

MaineHealth Cancer Care and IV Therapy - Sanford; 🇺🇸 Sanford, Maine, United States

MaineHealth Cancer Care and IV Therapy - South Portland; 🇺🇸 South Portland, Maine, United States

Saint Agnes Hospital; 🇺🇸 Baltimore, Maryland, United States

Boston Medical Center; 🇺🇸 Boston, Massachusetts, United States

UMass Memorial Medical Center - University Campus; 🇺🇸 Worcester, Massachusetts, United States

Hickman Cancer Center; 🇺🇸 Adrian, Michigan, United States

Trinity Health Saint Joseph Mercy Hospital Ann Arbor; 🇺🇸 Ann Arbor, Michigan, United States

Trinity Health Medical Center - Brighton; 🇺🇸 Brighton, Michigan, United States

Trinity Health IHA Medical Group Hematology Oncology - Canton; 🇺🇸 Canton, Michigan, United States

Trinity Health Medical Center - Canton; 🇺🇸 Canton, Michigan, United States

Caro Cancer Center; 🇺🇸 Caro, Michigan, United States

Chelsea Hospital; 🇺🇸 Chelsea, Michigan, United States

Trinity Health IHA Medical Group Hematology Oncology - Chelsea Hospital; 🇺🇸 Chelsea, Michigan, United States

Hematology Oncology Consultants-Clarkston; 🇺🇸 Clarkston, Michigan, United States

Newland Medical Associates-Clarkston; 🇺🇸 Clarkston, Michigan, United States

Henry Ford Health Saint John Hospital; 🇺🇸 Detroit, Michigan, United States

Henry Ford River District Hospital; 🇺🇸 East China Township, Michigan, United States

Cancer Hematology Centers - Flint; 🇺🇸 Flint, Michigan, United States

Genesee Hematology Oncology PC; 🇺🇸 Flint, Michigan, United States

Genesys Hurley Cancer Institute; 🇺🇸 Flint, Michigan, United States

Hurley Medical Center; 🇺🇸 Flint, Michigan, United States

Corewell Health Grand Rapids Hospitals - Butterworth Hospital; 🇺🇸 Grand Rapids, Michigan, United States

Corewell Health Grand Rapids Hospitals - Helen DeVos Children's Hospital; 🇺🇸 Grand Rapids, Michigan, United States

Trinity Health Grand Rapids Hospital; 🇺🇸 Grand Rapids, Michigan, United States

Henry Ford Saint John Hospital - Academic; 🇺🇸 Grosse Pointe Woods, Michigan, United States

Henry Ford Saint John Hospital - Breast; 🇺🇸 Grosse Pointe Woods, Michigan, United States

Henry Ford Saint John Hospital - Van Elslander; 🇺🇸 Grosse Pointe Woods, Michigan, United States

Bronson Methodist Hospital; 🇺🇸 Kalamazoo, Michigan, United States

West Michigan Cancer Center; 🇺🇸 Kalamazoo, Michigan, United States

Ascension Borgess Cancer Center; 🇺🇸 Kalamazoo, Michigan, United States

Ascension Borgess Hospital; 🇺🇸 Kalamazoo, Michigan, United States

University of Michigan Health - Sparrow Lansing; 🇺🇸 Lansing, Michigan, United States

Hope Cancer Clinic; 🇺🇸 Livonia, Michigan, United States

Trinity Health Saint Mary Mercy Livonia Hospital; 🇺🇸 Livonia, Michigan, United States

Henry Ford Saint John Hospital - Macomb Medical; 🇺🇸 Macomb, Michigan, United States

Henry Ford Warren Hospital - Breast Macomb; 🇺🇸 Macomb, Michigan, United States

Saint Mary's Oncology/Hematology Associates of Marlette; 🇺🇸 Marlette, Michigan, United States

Toledo Clinic Cancer Centers-Monroe; 🇺🇸 Monroe, Michigan, United States

Trinity Health Muskegon Hospital; 🇺🇸 Muskegon, Michigan, United States

Corewell Health Lakeland Hospitals - Niles Hospital; 🇺🇸 Niles, Michigan, United States

Cancer and Hematology Centers of Western Michigan - Norton Shores; 🇺🇸 Norton Shores, Michigan, United States

Henry Ford Health Providence Novi Hospital; 🇺🇸 Novi, Michigan, United States

Hope Cancer Center; 🇺🇸 Pontiac, Michigan, United States

Michigan Healthcare Professionals Pontiac; 🇺🇸 Pontiac, Michigan, United States

Newland Medical Associates-Pontiac; 🇺🇸 Pontiac, Michigan, United States

Trinity Health Saint Joseph Mercy Oakland Hospital; 🇺🇸 Pontiac, Michigan, United States

Corewell Health Reed City Hospital; 🇺🇸 Reed City, Michigan, United States

Henry Ford Rochester Hospital; 🇺🇸 Rochester Hills, Michigan, United States

MyMichigan Medical Center Saginaw; 🇺🇸 Saginaw, Michigan, United States

Oncology Hematology Associates of Saginaw Valley PC; 🇺🇸 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 Providence Southfield Hospital; 🇺🇸 Southfield, Michigan, United States

Bhadresh Nayak MD PC-Sterling Heights; 🇺🇸 Sterling Heights, Michigan, United States

MyMichigan Medical Center Tawas; 🇺🇸 Tawas City, Michigan, United States

Munson Medical Center; 🇺🇸 Traverse City, Michigan, United States

Advanced Breast Care Center PLLC; 🇺🇸 Warren, Michigan, United States

Henry Ford Health Warren Hospital; 🇺🇸 Warren, Michigan, United States

Henry Ford Madison Heights Hospital - Breast; 🇺🇸 Warren, Michigan, United States

Henry Ford Warren Hospital - GLCMS; 🇺🇸 Warren, Michigan, United States

Saint Mary's Oncology/Hematology Associates of West Branch; 🇺🇸 West Branch, Michigan, United States

University of Michigan Health - West; 🇺🇸 Wyoming, Michigan, United States

Huron Gastroenterology PC; 🇺🇸 Ypsilanti, Michigan, United States

Trinity Health IHA Medical Group Hematology Oncology Ann Arbor Campus; 🇺🇸 Ypsilanti, Michigan, United States

Riverwood Healthcare Center; 🇺🇸 Aitkin, Minnesota, United States

Essentia Health - Baxter Clinic; 🇺🇸 Baxter, Minnesota, United States

Essentia Health Saint Joseph's Medical Center; 🇺🇸 Brainerd, Minnesota, United States

Fairview Ridges Hospital; 🇺🇸 Burnsville, Minnesota, United States

Minnesota Oncology - Burnsville; 🇺🇸 Burnsville, Minnesota, United States

Cambridge Medical Center; 🇺🇸 Cambridge, Minnesota, United States

Mercy Hospital; 🇺🇸 Coon Rapids, Minnesota, United States

Essentia Health - Deer River Clinic; 🇺🇸 Deer River, Minnesota, United States

Essentia Health Saint Mary's - Detroit Lakes Clinic; 🇺🇸 Detroit Lakes, 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

Essentia Health - Ely Clinic; 🇺🇸 Ely, Minnesota, United States

Lake Region Healthcare Corporation-Cancer Care; 🇺🇸 Fergus Falls, Minnesota, United States

Essentia Health - Fosston; 🇺🇸 Fosston, Minnesota, United States

Unity Hospital; 🇺🇸 Fridley, Minnesota, United States

Ridgeview Medical Center; 🇺🇸 Waconia, Minnesota, United States

Essentia Health Hibbing Clinic; 🇺🇸 Hibbing, Minnesota, United States

Essentia Health - International Falls Clinic; 🇺🇸 International Falls, Minnesota, United States

Fairview Clinics and Surgery Center Maple Grove; 🇺🇸 Maple Grove, 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

Health Partners Inc; 🇺🇸 Minneapolis, Minnesota, United States

Monticello Cancer Center; 🇺🇸 Monticello, Minnesota, United States

Essentia Health - Moose Lake Clinic; 🇺🇸 Moose Lake, Minnesota, United States

New Ulm Medical Center; 🇺🇸 New Ulm, Minnesota, United States

Essentia Health - Park Rapids; 🇺🇸 Park Rapids, Minnesota, United States

Fairview Northland Medical Center; 🇺🇸 Princeton, Minnesota, United States

North Memorial Medical Health Center; 🇺🇸 Robbinsdale, 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

Essentia Health Sandstone; 🇺🇸 Sandstone, Minnesota, United States

Saint Francis Regional Medical Center; 🇺🇸 Shakopee, Minnesota, United States

Lakeview Hospital; 🇺🇸 Stillwater, Minnesota, United States

Essentia Health Virginia Clinic; 🇺🇸 Virginia, Minnesota, United States

Minnesota Oncology Hematology PA-Woodbury; 🇺🇸 Woodbury, Minnesota, United States

Fairview Lakes Medical Center; 🇺🇸 Wyoming, Minnesota, United States

Saint Louis Cancer and Breast Institute-Ballwin; 🇺🇸 Ballwin, Missouri, United States

Central Care Cancer Center - Bolivar; 🇺🇸 Bolivar, Missouri, United States

Cox Cancer Center Branson; 🇺🇸 Branson, Missouri, United States

Mercy Cancer Center - Cape Girardeau; 🇺🇸 Cape Girardeau, Missouri, United States

Saint Francis Medical Center; 🇺🇸 Cape Girardeau, Missouri, United States

MU Health - University Hospital/Ellis Fischel Cancer Center; 🇺🇸 Columbia, Missouri, United States

Siteman Cancer Center at West County Hospital; 🇺🇸 Creve Coeur, Missouri, United States

Parkland Health Center - Farmington; 🇺🇸 Farmington, Missouri, United States

MU Health Care Goldschmidt Cancer Center; 🇺🇸 Jefferson City, Missouri, United States

Freeman Health System; 🇺🇸 Joplin, Missouri, United States

Mercy Hospital Joplin; 🇺🇸 Joplin, Missouri, United States

University Health Truman Medical Center; 🇺🇸 Kansas City, Missouri, United States

Saint Luke's Hospital of Kansas City; 🇺🇸 Kansas City, Missouri, United States

Saint Luke's East - Lee's Summit; 🇺🇸 Lee's Summit, Missouri, United States

Mercy Clinic-Rolla-Cancer and Hematology; 🇺🇸 Rolla, Missouri, United States

Phelps Health Delbert Day Cancer Institute; 🇺🇸 Rolla, Missouri, United States

Heartland Regional Medical Center; 🇺🇸 Saint Joseph, Missouri, United States

Saint Louis Cancer and Breast Institute-South City; 🇺🇸 Saint Louis, Missouri, United States

Washington University School of Medicine; 🇺🇸 Saint Louis, Missouri, United States

Mercy Hospital South; 🇺🇸 Saint Louis, Missouri, United States

Siteman Cancer Center-South County; 🇺🇸 Saint Louis, Missouri, United States

Missouri Baptist Medical Center; 🇺🇸 Saint Louis, Missouri, United States

Siteman Cancer Center at Christian Hospital; 🇺🇸 Saint Louis, Missouri, United States

Mercy Hospital Saint Louis; 🇺🇸 Saint Louis, Missouri, United States

Siteman Cancer Center at Saint Peters Hospital; 🇺🇸 Saint Peters, Missouri, United States

Sainte Genevieve County Memorial Hospital; 🇺🇸 Sainte Genevieve, Missouri, United States

Mercy Hospital Springfield; 🇺🇸 Springfield, Missouri, United States

CoxHealth South Hospital; 🇺🇸 Springfield, Missouri, United States

Missouri Baptist Sullivan Hospital; 🇺🇸 Sullivan, Missouri, United States

BJC Outpatient Center at Sunset Hills; 🇺🇸 Sunset Hills, Missouri, United States

Mercy Hospital Washington; 🇺🇸 Washington, Missouri, United States

Community Hospital of Anaconda; 🇺🇸 Anaconda, Montana, United States

Billings Clinic Cancer Center; 🇺🇸 Billings, Montana, United States

Saint Vincent Healthcare; 🇺🇸 Billings, Montana, United States

Saint Vincent Frontier Cancer Center; 🇺🇸 Billings, Montana, United States

Bozeman Health Deaconess Hospital; 🇺🇸 Bozeman, Montana, United States

Benefis Sletten Cancer Institute; 🇺🇸 Great Falls, Montana, United States

Great Falls Clinic; 🇺🇸 Great Falls, Montana, United States

Logan Health Medical Center; 🇺🇸 Kalispell, Montana, United States

Saint Patrick Hospital - Community Hospital; 🇺🇸 Missoula, Montana, United States

Community Medical Center; 🇺🇸 Missoula, Montana, United States

Nebraska Medicine-Bellevue; 🇺🇸 Bellevue, Nebraska, United States

Nebraska Cancer Specialists/Oncology Hematology West PC; 🇺🇸 Grand Island, Nebraska, United States

CHI Health Good Samaritan; 🇺🇸 Kearney, Nebraska, United States

Saint Elizabeth Regional Medical Center; 🇺🇸 Lincoln, Nebraska, United States

Nebraska Cancer Specialists/Oncology Hematology West PC - MECC; 🇺🇸 Omaha, Nebraska, United States

Nebraska Methodist Hospital; 🇺🇸 Omaha, Nebraska, United States

Oncology Associates PC; 🇺🇸 Omaha, Nebraska, United States

Alegent Health Bergan Mercy Medical Center; 🇺🇸 Omaha, Nebraska, United States

Alegent Health Lakeside Hospital; 🇺🇸 Omaha, Nebraska, United States

Creighton University Medical Center; 🇺🇸 Omaha, Nebraska, United States

University of Nebraska Medical Center; 🇺🇸 Omaha, Nebraska, United States

Midlands Community Hospital; 🇺🇸 Papillion, Nebraska, United States

Carson Tahoe Regional Medical Center; 🇺🇸 Carson City, Nevada, United States

Cancer and Blood Specialists-Henderson; 🇺🇸 Henderson, Nevada, United States

Comprehensive Cancer Centers of Nevada - Henderson; 🇺🇸 Henderson, Nevada, United States

Comprehensive Cancer Centers of Nevada-Horizon Ridge; 🇺🇸 Henderson, Nevada, United States

Las Vegas Cancer Center-Henderson; 🇺🇸 Henderson, Nevada, United States

OptumCare Cancer Care at Seven Hills; 🇺🇸 Henderson, Nevada, United States

Comprehensive Cancer Centers of Nevada-Southeast Henderson; 🇺🇸 Henderson, Nevada, United States

GenesisCare USA - Henderson; 🇺🇸 Henderson, Nevada, United States

Las Vegas Urology - Green Valley; 🇺🇸 Henderson, Nevada, United States

Las Vegas Urology - Pebble; 🇺🇸 Henderson, Nevada, United States

Urology Specialists of Nevada - Green Valley; 🇺🇸 Henderson, Nevada, United States

Las Vegas Urology - Pecos; 🇺🇸 Las Vegas, Nevada, United States

Desert West Surgery; 🇺🇸 Las Vegas, Nevada, United States

OptumCare Cancer Care at Charleston; 🇺🇸 Las Vegas, Nevada, United States

University Medical Center of Southern Nevada; 🇺🇸 Las Vegas, Nevada, United States

Hope Cancer Care of Nevada; 🇺🇸 Las Vegas, Nevada, United States

Cancer and Blood Specialists-Shadow; 🇺🇸 Las Vegas, Nevada, United States

Radiation Oncology Centers of Nevada Central; 🇺🇸 Las Vegas, Nevada, United States

Urology Specialists of Nevada - Central; 🇺🇸 Las Vegas, Nevada, United States

GenesisCare USA - Las Vegas; 🇺🇸 Las Vegas, Nevada, United States

HealthCare Partners Medical Group Oncology/Hematology-Maryland Parkway; 🇺🇸 Las Vegas, Nevada, United States

Sunrise Hospital and Medical Center; 🇺🇸 Las Vegas, Nevada, United States

HealthCare Partners Medical Group Oncology/Hematology-San Martin; 🇺🇸 Las Vegas, Nevada, United States

Las Vegas Prostate Cancer Center; 🇺🇸 Las Vegas, Nevada, United States

Las Vegas Urology - Sunset; 🇺🇸 Las Vegas, Nevada, United States

Urology Specialists of Nevada - Southwest; 🇺🇸 Las Vegas, Nevada, United States

Radiation Oncology Centers of Nevada Southeast; 🇺🇸 Las Vegas, Nevada, United States

Ann M Wierman MD LTD; 🇺🇸 Las Vegas, Nevada, United States

Cancer and Blood Specialists-Tenaya; 🇺🇸 Las Vegas, Nevada, United States

Comprehensive Cancer Centers of Nevada - Northwest; 🇺🇸 Las Vegas, Nevada, United States

GenesisCare USA - Vegas Tenaya; 🇺🇸 Las Vegas, Nevada, United States

HealthCare Partners Medical Group Oncology/Hematology-Tenaya; 🇺🇸 Las Vegas, Nevada, United States

Las Vegas Urology - Cathedral Rock; 🇺🇸 Las Vegas, Nevada, United States

Las Vegas Urology - Smoke Ranch; 🇺🇸 Las Vegas, Nevada, United States

OptumCare Cancer Care at MountainView; 🇺🇸 Las Vegas, Nevada, United States

Urology Specialists of Nevada - Northwest; 🇺🇸 Las Vegas, Nevada, United States

Alliance for Childhood Diseases/Cure 4 the Kids Foundation; 🇺🇸 Las Vegas, Nevada, United States

Comprehensive Cancer Centers of Nevada - Town Center; 🇺🇸 Las Vegas, Nevada, United States

Comprehensive Cancer Centers of Nevada-Summerlin; 🇺🇸 Las Vegas, Nevada, United States

Summerlin Hospital Medical Center; 🇺🇸 Las Vegas, Nevada, United States

Las Vegas Cancer Center-Medical Center; 🇺🇸 Las Vegas, Nevada, United States

Comprehensive Cancer Centers of Nevada; 🇺🇸 Las Vegas, Nevada, United States

GenesisCare USA - Fort Apache; 🇺🇸 Las Vegas, Nevada, United States

OptumCare Cancer Care at Fort Apache; 🇺🇸 Las Vegas, Nevada, United States

HealthCare Partners Medical Group Oncology/Hematology-Centennial Hills; 🇺🇸 Las Vegas, Nevada, United States

Comprehensive Cancer Centers of Nevada - Central Valley; 🇺🇸 Las Vegas, Nevada, United States

University Cancer Center; 🇺🇸 Las Vegas, Nevada, United States

Hope Cancer Care of Nevada-Pahrump; 🇺🇸 Pahrump, Nevada, United States

Renown Regional Medical Center; 🇺🇸 Reno, Nevada, United States

Saint Mary's Regional Medical Center; 🇺🇸 Reno, Nevada, United States

Radiation Oncology Associates; 🇺🇸 Reno, Nevada, United States

New Hampshire Oncology Hematology PA-Concord; 🇺🇸 Concord, New Hampshire, United States

Elliot Hospital; 🇺🇸 Manchester, New Hampshire, United States

Solinsky Center for Cancer Care; 🇺🇸 Manchester, New Hampshire, United States

Virtua Samson Cancer Center; 🇺🇸 Moorestown, New Jersey, United States

Montefiore Medical Center-Einstein Campus; 🇺🇸 Bronx, New York, United States

Montefiore Medical Center-Weiler Hospital; 🇺🇸 Bronx, New York, United States

Montefiore Medical Center - Moses Campus; 🇺🇸 Bronx, New York, United States

Glens Falls Hospital; 🇺🇸 Glens Falls, New York, United States

ECU Health Oncology Kenansville; 🇺🇸 Kenansville, North Carolina, United States

ECU Health Oncology Kinston; 🇺🇸 Kinston, North Carolina, United States

FirstHealth of the Carolinas-Moore Regional Hospital; 🇺🇸 Pinehurst, North Carolina, United States

ECU Health Oncology Richlands; 🇺🇸 Richlands, North Carolina, United States

Marion L Shepard Cancer Center - ECU Health Beaufort Hospital; 🇺🇸 Washington, North Carolina, United States

Essentia Health Cancer Center-South University Clinic; 🇺🇸 Fargo, North Dakota, United States

Essentia Health - Jamestown Clinic; 🇺🇸 Jamestown, North Dakota, United States

Aultman Alliance Community Hospital; 🇺🇸 Alliance, Ohio, United States

Indu and Raj Soin Medical Center; 🇺🇸 Beavercreek, Ohio, United States

Saint Elizabeth Boardman Hospital; 🇺🇸 Boardman, Ohio, United States

Cleveland Clinic Mercy Hospital; 🇺🇸 Canton, Ohio, United States

Mercy Hematology and Oncology Associates Inc; 🇺🇸 Canton, Ohio, United States

Aultman Health Foundation; 🇺🇸 Canton, Ohio, United States

Dayton Physicians LLC-Miami Valley South; 🇺🇸 Centerville, Ohio, United States

Miami Valley Hospital South; 🇺🇸 Centerville, Ohio, United States

Good Samaritan Hospital - Cincinnati; 🇺🇸 Cincinnati, Ohio, United States

Oncology Hematology Care Inc-Kenwood; 🇺🇸 Cincinnati, Ohio, United States

Bethesda North Hospital; 🇺🇸 Cincinnati, Ohio, United States

TriHealth Cancer Institute-Westside; 🇺🇸 Cincinnati, Ohio, United States

TriHealth Cancer Institute-Anderson; 🇺🇸 Cincinnati, Ohio, United States

Cleveland Clinic Cancer Center/Fairview Hospital; 🇺🇸 Cleveland, Ohio, United States

Miami Valley Cancer Care and Infusion; 🇺🇸 Greenville, Ohio, United States

Wayne Hospital; 🇺🇸 Greenville, Ohio, United States

Greater Dayton Cancer Center; 🇺🇸 Kettering, Ohio, United States

First Dayton Cancer Care; 🇺🇸 Kettering, Ohio, United States

Kettering Medical Center; 🇺🇸 Kettering, Ohio, United States

Cleveland Clinic Cancer Center Mansfield; 🇺🇸 Mansfield, Ohio, United States

Toledo Clinic Cancer Centers-Maumee; 🇺🇸 Maumee, Ohio, United States

Hillcrest Hospital Cancer Center; 🇺🇸 Mayfield Heights, Ohio, United States

Mercy Health - Perrysburg Hospital; 🇺🇸 Perrysburg, Ohio, United States

North Coast Cancer Care; 🇺🇸 Sandusky, Ohio, United States

Springfield Regional Cancer Center; 🇺🇸 Springfield, Ohio, United States

Springfield Regional Medical Center; 🇺🇸 Springfield, Ohio, United States

Cleveland Clinic Cancer Center Strongsville; 🇺🇸 Strongsville, Ohio, United States

Mercy Health - Saint Anne Hospital; 🇺🇸 Toledo, Ohio, United States

Toledo Clinic Cancer Centers-Toledo; 🇺🇸 Toledo, Ohio, United States

Dayton Physicians LLC - Troy; 🇺🇸 Troy, Ohio, United States

Upper Valley Medical Center; 🇺🇸 Troy, Ohio, United States

South Pointe Hospital; 🇺🇸 Warrensville Heights, Ohio, United States

Saint Joseph Warren Hospital; 🇺🇸 Warren, Ohio, United States

Cleveland Clinic Wooster Family Health and Surgery Center; 🇺🇸 Wooster, Ohio, United States

Wright-Patterson Medical Center; 🇺🇸 Wright-Patterson Air Force Base, Ohio, United States

Saint Elizabeth Youngstown Hospital; 🇺🇸 Youngstown, Ohio, United States

Mercy Hospital Oklahoma City; 🇺🇸 Oklahoma City, Oklahoma, United States

Saint Alphonsus Cancer Care Center-Baker City; 🇺🇸 Baker City, Oregon, United States

Saint Charles Health System; 🇺🇸 Bend, Oregon, United States

Clackamas Radiation Oncology Center; 🇺🇸 Clackamas, Oregon, United States

Providence Cancer Institute Clackamas Clinic; 🇺🇸 Clackamas, Oregon, United States

Bay Area Hospital; 🇺🇸 Coos Bay, Oregon, United States

Providence Newberg Medical Center; 🇺🇸 Newberg, Oregon, United States

Saint Alphonsus Cancer Care Center-Ontario; 🇺🇸 Ontario, Oregon, United States

Providence Willamette Falls Medical Center; 🇺🇸 Oregon City, Oregon, United States

Providence Portland Medical Center; 🇺🇸 Portland, Oregon, United States

Providence Saint Vincent Medical Center; 🇺🇸 Portland, Oregon, United States

Oregon Health and Science University; 🇺🇸 Portland, Oregon, United States

Saint Charles Health System-Redmond; 🇺🇸 Redmond, Oregon, United States

Lehigh Valley Hospital-Cedar Crest; 🇺🇸 Allentown, Pennsylvania, United States

Saint Luke's Cancer Center - Allentown; 🇺🇸 Allentown, Pennsylvania, United States

Saint Luke's University Hospital-Bethlehem Campus; 🇺🇸 Bethlehem, Pennsylvania, United States

Lehigh Valley Hospital - Muhlenberg; 🇺🇸 Bethlehem, Pennsylvania, United States

Bryn Mawr Hospital; 🇺🇸 Bryn Mawr, Pennsylvania, United States

Chambersburg Hospital; 🇺🇸 Chambersburg, Pennsylvania, United States

WellSpan Medical Oncology and Hematology; 🇺🇸 Hanover, Pennsylvania, United States

Main Line Health Center-Collegeville; 🇺🇸 Collegeville, Pennsylvania, United States

Pocono Medical Center; 🇺🇸 East Stroudsburg, Pennsylvania, United States

Saint Luke's Hospital-Anderson Campus; 🇺🇸 Easton, Pennsylvania, United States

Ephrata Cancer Center; 🇺🇸 Ephrata, Pennsylvania, United States

Main Line Health Center-Exton; 🇺🇸 Exton, Pennsylvania, United States

Adams Cancer Center; 🇺🇸 Gettysburg, Pennsylvania, United States

Lehigh Valley Hospital-Hazleton; 🇺🇸 Hazleton, Pennsylvania, United States

Sechler Family Cancer Center; 🇺🇸 Lebanon, Pennsylvania, United States

Riddle Memorial Hospital; 🇺🇸 Media, Pennsylvania, United States

Bryn Mawr Health Center; 🇺🇸 Newtown Square, Pennsylvania, United States

Paoli Memorial Hospital; 🇺🇸 Paoli, Pennsylvania, United States

Penn Presbyterian Medical Center; 🇺🇸 Philadelphia, Pennsylvania, United States

University of Pennsylvania/Abramson Cancer Center; 🇺🇸 Philadelphia, Pennsylvania, United States

Pottstown Hospital; 🇺🇸 Pottstown, Pennsylvania, United States

Saint Luke's Hospital - Upper Bucks Campus; 🇺🇸 Quakertown, Pennsylvania, United States

Saint Luke's Hospital-Quakertown Campus; 🇺🇸 Quakertown, Pennsylvania, United States

Guthrie Medical Group PC-Robert Packer Hospital; 🇺🇸 Sayre, Pennsylvania, United States

Lankenau Medical Center; 🇺🇸 Wynnewood, Pennsylvania, United States

Cancer Care Associates of York; 🇺🇸 York, Pennsylvania, United States

WellSpan Health-York Cancer Center; 🇺🇸 York, Pennsylvania, United States

WellSpan Health-York Hospital; 🇺🇸 York, Pennsylvania, United States

Self Regional Healthcare; 🇺🇸 Greenwood, South Carolina, United States

Saint Joseph Regional Cancer Center; 🇺🇸 Bryan, Texas, United States

Bon Secours Memorial Regional Medical Center; 🇺🇸 Mechanicsville, Virginia, United States

Bon Secours Westchester Emergency Center; 🇺🇸 Midlothian, Virginia, United States

Bon Secours Saint Francis Medical Center; 🇺🇸 Midlothian, Virginia, United States

Bon Secours DePaul Medical Center; 🇺🇸 Norfolk, Virginia, United States

Bon Secours Maryview Medical Center; 🇺🇸 Portsmouth, Virginia, United States

Bon Secours Richmond Community Hospital; 🇺🇸 Richmond, Virginia, United States

Bon Secours Saint Mary's Hospital; 🇺🇸 Richmond, Virginia, United States

Bon Secours Cancer Institute at Reynolds Crossing; 🇺🇸 Richmond, Virginia, United States

VCU Massey Cancer Center at Stony Point; 🇺🇸 Richmond, Virginia, United States

Virginia Commonwealth University/Massey Cancer Center; 🇺🇸 Richmond, Virginia, United States

Bon Secours Health Center at Harbour View; 🇺🇸 Suffolk, Virginia, United States

Providence Regional Cancer System-Aberdeen; 🇺🇸 Aberdeen, Washington, United States

Overlake Medical Center; 🇺🇸 Bellevue, Washington, United States

PeaceHealth Saint Joseph Medical Center; 🇺🇸 Bellingham, Washington, United States

Highline Medical Center-Main Campus; 🇺🇸 Burien, Washington, United States

Providence Regional Cancer System-Centralia; 🇺🇸 Centralia, Washington, United States

Swedish Cancer Institute-Edmonds; 🇺🇸 Edmonds, Washington, United States

Saint Elizabeth Hospital; 🇺🇸 Enumclaw, Washington, United States

Providence Regional Cancer Partnership; 🇺🇸 Everett, Washington, United States

Saint Francis Hospital; 🇺🇸 Federal Way, Washington, United States

Swedish Cancer Institute-Issaquah; 🇺🇸 Issaquah, Washington, United States

Kadlec Clinic Hematology and Oncology; 🇺🇸 Kennewick, Washington, United States

Providence Regional Cancer System-Lacey; 🇺🇸 Lacey, Washington, United States

Saint Clare Hospital; 🇺🇸 Lakewood, Washington, United States

PeaceHealth Saint John Medical Center; 🇺🇸 Longview, Washington, United States

Jefferson Healthcare; 🇺🇸 Port Townsend, Washington, United States

Harrison HealthPartners Hematology and Oncology-Poulsbo; 🇺🇸 Poulsbo, Washington, United States

Valley Medical Center; 🇺🇸 Renton, Washington, United States

Pacific Gynecology Specialists; 🇺🇸 Seattle, Washington, United States

Swedish Medical Center-Ballard Campus; 🇺🇸 Seattle, Washington, United States

Swedish Medical Center-Cherry Hill; 🇺🇸 Seattle, Washington, United States

Swedish Medical Center-First Hill; 🇺🇸 Seattle, Washington, United States

PeaceHealth United General Medical Center; 🇺🇸 Sedro-Woolley, Washington, United States

Providence Regional Cancer System-Shelton; 🇺🇸 Shelton, Washington, United States

Saint Michael Cancer Center; 🇺🇸 Silverdale, Washington, United States

Franciscan Research Center-Northwest Medical Plaza; 🇺🇸 Tacoma, Washington, United States

Northwest Medical Specialties PLLC; 🇺🇸 Tacoma, Washington, United States

PeaceHealth Southwest Medical Center; 🇺🇸 Vancouver, Washington, United States

Providence Saint Mary Regional Cancer Center; 🇺🇸 Walla Walla, Washington, United States

North Star Lodge Cancer Center at Yakima Valley Memorial Hospital; 🇺🇸 Yakima, Washington, United States

Providence Regional Cancer System-Yelm; 🇺🇸 Yelm, Washington, United States

Edwards Comprehensive Cancer Center; 🇺🇸 Huntington, West Virginia, United States

ThedaCare Regional Cancer Center; 🇺🇸 Appleton, Wisconsin, United States

Duluth Clinic Ashland; 🇺🇸 Ashland, Wisconsin, United States

Northwest Wisconsin Cancer Center; 🇺🇸 Ashland, Wisconsin, United States

ThedaCare Cancer Care - Berlin; 🇺🇸 Berlin, Wisconsin, United States

Aurora Cancer Care-Southern Lakes VLCC; 🇺🇸 Burlington, Wisconsin, United States

Marshfield Clinic-Chippewa Center; 🇺🇸 Chippewa Falls, Wisconsin, United States

Aurora Saint Luke's South Shore; 🇺🇸 Cudahy, Wisconsin, United States

Marshfield Medical Center-EC Cancer Center; 🇺🇸 Eau Claire, Wisconsin, United States

Aurora Health Care Germantown Health Center; 🇺🇸 Germantown, Wisconsin, United States

Aurora Cancer Care-Grafton; 🇺🇸 Grafton, Wisconsin, United States

Aurora BayCare Medical Center; 🇺🇸 Green Bay, Wisconsin, United States

Essentia Health-Hayward Clinic; 🇺🇸 Hayward, Wisconsin, United States

Aurora Cancer Care-Kenosha South; 🇺🇸 Kenosha, Wisconsin, United States

Gundersen Lutheran Medical Center; 🇺🇸 La Crosse, Wisconsin, United States

Marshfield Medical Center - Ladysmith; 🇺🇸 Ladysmith, Wisconsin, United States

Aurora Bay Area Medical Group-Marinette; 🇺🇸 Marinette, Wisconsin, United States

Marshfield Medical Center-Marshfield; 🇺🇸 Marshfield, Wisconsin, United States

Aurora Cancer Care-Milwaukee; 🇺🇸 Milwaukee, Wisconsin, United States

Aurora Saint Luke's Medical Center; 🇺🇸 Milwaukee, Wisconsin, United States

Aurora Sinai Medical Center; 🇺🇸 Milwaukee, Wisconsin, United States

Marshfield Medical Center - Minocqua; 🇺🇸 Minocqua, Wisconsin, United States

ProHealth D N Greenwald Center; 🇺🇸 Mukwonago, Wisconsin, United States

Cancer Center of Western Wisconsin; 🇺🇸 New Richmond, Wisconsin, United States

ProHealth Oconomowoc Memorial Hospital; 🇺🇸 Oconomowoc, Wisconsin, United States

Vince Lombardi Cancer Clinic - Oshkosh; 🇺🇸 Oshkosh, Wisconsin, United States

Aurora Cancer Care-Racine; 🇺🇸 Racine, Wisconsin, United States

Marshfield Medical Center-Rice Lake; 🇺🇸 Rice Lake, Wisconsin, United States

Vince Lombardi Cancer Clinic-Sheboygan; 🇺🇸 Sheboygan, Wisconsin, United States

Essentia Health-Spooner Clinic; 🇺🇸 Spooner, Wisconsin, United States

Marshfield Medical Center-River Region at Stevens Point; 🇺🇸 Stevens Point, Wisconsin, United States

Aurora Medical Center in Summit; 🇺🇸 Summit, Wisconsin, United States

Essentia Health Saint Mary's Hospital - Superior; 🇺🇸 Superior, Wisconsin, United States

Vince Lombardi Cancer Clinic-Two Rivers; 🇺🇸 Two Rivers, Wisconsin, United States

ProHealth Waukesha Memorial Hospital; 🇺🇸 Waukesha, Wisconsin, United States

UW Cancer Center at ProHealth Care; 🇺🇸 Waukesha, Wisconsin, United States

Marshfield Clinic-Wausau Center; 🇺🇸 Wausau, Wisconsin, United States

Aurora Cancer Care-Milwaukee West; 🇺🇸 Wauwatosa, Wisconsin, United States

Marshfield Medical Center - Weston; 🇺🇸 Weston, Wisconsin, United States

Marshfield Clinic - Wisconsin Rapids Center; 🇺🇸 Wisconsin Rapids, Wisconsin, United States

Cheyenne Regional Medical Center-West; 🇺🇸 Cheyenne, Wyoming, United States