Sargramostim, Vaccine Therapy, or Sargramostim and Vaccine Therapy in Preventing Disease Recurrence in Patients With Melanoma That Has Been Removed By Surgery

Phase 3

Completed

Conditions: Medium/Large Size Posterior Uveal Melanoma
Stage IIIB Uveal Melanoma AJCC v7
Iris Melanoma
Mucosal Melanoma
Recurrent Melanoma
Stage IIA Cutaneous Melanoma AJCC v6 and v7
Stage IIIB Cutaneous Melanoma AJCC v7
Stage IIIC Uveal Melanoma AJCC v7
Ocular Melanoma With Extraocular Extension
Recurrent Uveal Melanoma

Interventions: Other: Laboratory Biomarker Analysis
Other: Placebo
Biological: Tyrosinase Peptide
Biological: Sargramostim

Registration Number: NCT01989572

Lead Sponsor: National Cancer Institute (NCI)

Brief Summary: This randomized phase III trial studies sargramostim or vaccine therapy alone to see how well they work compared to sargramostim and vaccine therapy together in preventing disease recurrence in patients with melanoma that has been removed by surgery. Sargramostim may stimulate the immune system in different ways and stop tumor cells from growing. Vaccines made from peptides may help the body build an effective immune response to kill tumor cells. It is not yet known whether yeast derived sargramostim and vaccine therapy are more effective alone or together in preventing recurrence of melanoma.

Detailed Description: PRIMARY OBJECTIVES:

I. To compare overall survival and disease-free survival of patients with completely resected stage IV melanoma or stage III melanoma with gross extranodal extension, satellites, and/or intransit lesions, treated with granulocyte macrophage colony-stimulating factor (GM-CSF) (sargramostim) vs. no GM-CSF, or other high risk patients listed in the eligibility section.

SECONDARY OBJECTIVES:

I. To compare, using a 2 x 2 factorial design, overall survival and disease-free survival of human leukocyte antigen (HLA)-A2 positive patients treated with peptide vaccination vs. no peptide vaccination.

II. The following descriptive evaluations of survival and disease-free survival are planned for the HLA-A2 positive patients: (1) GM-CSF plus peptide vaccination vs. peptide vaccination alone; (2) GM-CSF plus peptide vaccination vs. GM-CSF alone; (3) GM-CSF plus peptide vaccination vs. placebo.

III. Survival and disease-free survival of HLA-A2 positive patients not receiving peptide vaccination will be compared to that of HLA-A2 negative patients not receiving peptide vaccination.

IV. To determine the influence of GM-CSF on circulating dendritic cell numbers and subpopulations in peripheral blood of patients receiving and not receiving GM-CSF.

V. To determine, in HLA-A2 positive patients, whether immunization with peptides with or without GM-CSF elicits a measurable T-cell response as assessed by enzyme-linked immunosorbent spot (ELISPOT) and the major histocompatibility complex (MHC) tetramer assay, and to determine the functionality of these cells by intracellular cytokine staining.

OUTLINE: HLA-A2 positive patients are randomized to 1 of 4 treatment regimens (Arms I-IV). HLA-A2 negative patients are randomized to 1 of 2 treatment arms (Arms V-VI).

ARM I: Patients receive sargramostim subcutaneously (SC) on days 1-14 and peptide vaccine comprising tyrosinase, gp100 antigen, and MART-1 antigen mixed with either incomplete Freund's adjuvant or Montanide ISA-51 VG SC on days 1 and 15 (course 1) and day 1 (course 2 and subsequent courses).

ARM II: Patients receive sargramostim placebo SC on days 1-14 and peptide vaccine comprising tyrosinase, gp100 antigen, and MART-1 antigen mixed with either incomplete Freund's adjuvant or Montanide ISA-51 VG SC on days 1 and 15 (course 1) and day 1 (course 2 and subsequent courses).

ARM III: Patients receive sargramostim SC on days 1-14 and peptide placebo mixed with either incomplete Freund's adjuvant or Montanide ISA-51 VG SC on days 1 and 15 (course 1) and day 1 (course 2 and subsequent courses).

ARM IV: Patients receive sargramostim placebo SC on days 1-14 and peptide placebo mixed with either incomplete Freund's adjuvant or Montanide ISA-51 VG SC on days 1 and 15 (course 1) and day 1 (course 2 and subsequent courses).

ARM V: Patients receive sargramostim SC on days 1-14.

ARM VI: Patients receive sargramostim placebo SC on days 1-14.

In all arms, treatment repeats every 28 days for up to 13 courses in the absence of disease progression or unacceptable toxicity.

In the event of recurrence, patients who undergo complete resection of the recurrence may continue treatment for 6 courses or until completion of 1 year of therapy (whichever is longer). For patients with recurrence that is not surgically resectable or experiencing second recurrence, treatment will be discontinued.

After completion of study treatment, patients are followed up every 3 months for 2 years, every 6 months for 3 years, and then every 12 months for 10 years.

Recruitment & Eligibility

Status: COMPLETED

Sex: All

Target Recruitment: 815

Inclusion Criteria

Patients must have HLA-A2 status known prior to randomization; typing may be obtained through a local laboratory facility or through a reference lab utilized by the initiating institution; if typing is not available through these means, it may be obtained from the University of Pittsburgh
All patients must have disease completely resected with one of the following in order to be eligible:
- Completely resected disease
- Any locoregional recurrence after prior adjuvant interferon or failure on S008
- Any local recurrence of disease after adequate surgical excision of the original primary
- Mucosal melanoma
- Stage IV melanoma (cutaneous, ocular, mucosal, or unknown primary)
The following groups of patients may be entered onto this trial only if they are ineligible for S0008 or are, in the opinion of the managing physician, medically unfit to receive standard high-dose interferon:
- Any clinically evident satellite or in-transit disease
- Stage II disease with gross extracapsular extension
- Recurrence in a previously resected nodal basin
- Four or more involved lymph nodes or matted lymph nodes
- Ulcerated primary melanoma and any involved lymph nodes
  - NOTE: Patients who are eligible for S0008 will be strongly encouraged to participate in that study in preference to this one
Patients must have been surgically rendered free of disease with negative margins on resected specimens; patients rendered free of disease by non-surgical means are not eligible
Patients must be randomized within 112 days (16 weeks) of surgical resection; if more than one surgical procedure is required to render the patient disease-free, all required surgeries must be accomplished within this 16 week time period
Patients must not have received any adjuvant treatment (chemotherapy, biotherapy, or limb perfusion) after the resection(s) that make(s) them eligible for this trial; one systemic treatment after a prior surgery is allowed, and must have been completed >= 8 weeks prior to randomization; (when chemotherapy and biotherapy are given together as one planned treatment [biochemotherapy], this counts as one regimen); NOTE: Previous radiation therapy, including after the resection, is allowed as long as 30 days elapse between the radiation and initiation of therapy
Prior treatment with GM-CSF or any peptides used in this protocol, is not allowed
Patients must have Eastern Cooperative Oncology Group (ECOG) performance status of 0-1
Patients must not have an active infection requiring treatment with parenteral antibiotics
Patients must not have other significant medical, surgical, or psychiatric conditions or require any medication or treatment that may interfere with compliance on any of the E4697 treatment regimens
Patients must not have a diagnosis or evidence of organic brain syndrome or significant impairment of basal cognitive function or any psychiatric disorder that might preclude participation in the full protocol
Patients must be able to self-administer or arrange for administration of subcutaneous injections
Patients who have other current malignancies are not eligible
Patients with prior history at any time of any in situ cancer, lobular carcinoma of the breast in situ, cervical cancer in situ, atypical melanocytic hyperplasia or Clark I melanoma in situ are eligible; patients who meet this criteria must be disease-free at time of randomization
Patients with prior history of basal or squamous skin cancer are eligible; patients who meet this criteria must be disease-free at time of randomization
Patients who have had multiple primary melanomas are eligible
Patients with other malignancies are eligible if they have been continuously disease free for > 5 years prior to the time of randomization
Patients must not have autoimmune disorders, conditions of immunosuppression or treatment with systemic corticosteroids, including oral steroids (i.e., prednisone, dexamethasone), continuous use of topical steroid creams or ointments, or any steroid containing inhalers; replacement doses of steroids for patients with adrenal insufficiency are allowed; patients who discontinue use of these classes of medication for at least 2 weeks prior to randomization are eligible if, in the judgment of the treating physician, the patient is not likely to require these classes of drugs during the study
Women of childbearing potential must not be pregnant (negative beta human chorionic gonadotropin [bHCG] within 2 weeks prior to randomization) or breast-feeding
Women of childbearing potential and sexually active males must be counseled to use an accepted and effective method of contraception (including abstinence) while on treatment and for a period of 18 months after completing or discontinuing treatment
All patients must have brain computed tomography (CT) or magnetic resonance imaging (MRI), chest CT or chest x-ray (CXR), and abdominal (liver) CT or MRI within 4 weeks prior to randomization; positron emission tomography (PET) scans are also acceptable in place of CT, CXR and/or abdominal MRI if obtained within 4 weeks prior to randomization; patients with lesions on the lower extremity must also have pelvic imaging within this time period; this is also strongly recommended for patients with lesions on the lower trunk; PET scans are acceptable
Patients with resection of visceral disease must have imaging of the affected area/organ documenting disease-free status within 2 weeks prior to randomization
White blood cells (WBC) >= 3,000/mm?
Platelet count >= 100,000/mm?
Serum glutamic oxaloacetic transaminase (SGOT) (aspartate aminotransferase [AST]) =< 2 x institutional upper limit (IUL) of normal
Bilirubin =< 2 x IUL of normal
Serum creatinine =< 1.8 mg/dl
Alkaline phosphatase and lactate dehydrogenase (LDH) must be performed within 4 weeks prior to randomization; LDH must be normal; patients with abnormal alkaline phosphatase which is =< 1.25 times the institutional upper limit of normal who have a negative CT or MRI of the liver and negative bone scan or a negative PET scan are eligible
Patients with bone pain must have a bone scan within 4 weeks prior to randomization to document the absence of tumor

Exclusion Criteria

Not provided

Study & Design

Study Type: INTERVENTIONAL

Study Design: FACTORIAL

Arm && Interventions

Group	Intervention	Description
Arm I (sargramostim, peptide vaccine)	Tyrosinase Peptide	Patients receive sargramostim SC on days 1-14 and peptide vaccine comprising tyrosinase, gp100 antigen, and MART-1 antigen mixed with either incomplete Freund's adjuvant or Montanide ISA-51 VG SC on days 1 and 15 (course 1) and day 1 (course 2 and subsequent courses).
Arm III (sargramostim, peptide placebo)	Sargramostim	Patients receive sargramostim SC on days 1-14 and peptide placebo mixed with either incomplete Freund's adjuvant or Montanide ISA-51 VG SC on days 1 and 15 (course 1) and day 1 (course 2 and subsequent courses).
Arm V (sargramostim)	Laboratory Biomarker Analysis	Patients receive sargramostim SC on days 1-14.
Arm I (sargramostim, peptide vaccine)	Laboratory Biomarker Analysis	Patients receive sargramostim SC on days 1-14 and peptide vaccine comprising tyrosinase, gp100 antigen, and MART-1 antigen mixed with either incomplete Freund's adjuvant or Montanide ISA-51 VG SC on days 1 and 15 (course 1) and day 1 (course 2 and subsequent courses).
Arm II (sargramostim placebo, peptide vaccine)	Placebo	Patients receive sargramostim placebo SC on days 1-14 and peptide vaccine comprising tyrosinase, gp100 antigen, and MART-1 antigen mixed with either incomplete Freund's adjuvant or Montanide ISA-51 VG SC on days 1 and 15 (course 1) and day 1 (course 2 and subsequent courses).
Arm I (sargramostim, peptide vaccine)	Sargramostim	Patients receive sargramostim SC on days 1-14 and peptide vaccine comprising tyrosinase, gp100 antigen, and MART-1 antigen mixed with either incomplete Freund's adjuvant or Montanide ISA-51 VG SC on days 1 and 15 (course 1) and day 1 (course 2 and subsequent courses).
Arm II (sargramostim placebo, peptide vaccine)	Tyrosinase Peptide	Patients receive sargramostim placebo SC on days 1-14 and peptide vaccine comprising tyrosinase, gp100 antigen, and MART-1 antigen mixed with either incomplete Freund's adjuvant or Montanide ISA-51 VG SC on days 1 and 15 (course 1) and day 1 (course 2 and subsequent courses).
Arm III (sargramostim, peptide placebo)	Laboratory Biomarker Analysis	Patients receive sargramostim SC on days 1-14 and peptide placebo mixed with either incomplete Freund's adjuvant or Montanide ISA-51 VG SC on days 1 and 15 (course 1) and day 1 (course 2 and subsequent courses).
Arm IV (placebo, peptide placebo)	Laboratory Biomarker Analysis	Patients receive placebo SC on days 1-14 and peptide placebo on days 1 and 15 (course 1) and day 1 (course 2 and subsequent courses).
Arm IV (placebo, peptide placebo)	Placebo	Patients receive placebo SC on days 1-14 and peptide placebo on days 1 and 15 (course 1) and day 1 (course 2 and subsequent courses).
Arm III (sargramostim, peptide placebo)	Placebo	Patients receive sargramostim SC on days 1-14 and peptide placebo mixed with either incomplete Freund's adjuvant or Montanide ISA-51 VG SC on days 1 and 15 (course 1) and day 1 (course 2 and subsequent courses).
Arm II (sargramostim placebo, peptide vaccine)	Laboratory Biomarker Analysis	Patients receive sargramostim placebo SC on days 1-14 and peptide vaccine comprising tyrosinase, gp100 antigen, and MART-1 antigen mixed with either incomplete Freund's adjuvant or Montanide ISA-51 VG SC on days 1 and 15 (course 1) and day 1 (course 2 and subsequent courses).
Arm VI (sargramostim placebo)	Placebo	Patients receive sargramostim placebo SC on days 1-14.
Arm V (sargramostim)	Sargramostim	Patients receive sargramostim SC on days 1-14.
Arm VI (sargramostim placebo)	Laboratory Biomarker Analysis	Patients receive sargramostim placebo SC on days 1-14.

Primary Outcome Measures

Name	Time	Method
Recurrence Free Survival	assessed every 3 months if patient is < 2 years from study entry and every 6 months if patient is 2-5 years from study entry, and annually if >5 years, up to year 15	Recurrence free survival is defined as time from randomization to first disease recurrence or death from any cause (whichever occur first), censoring cases without recurrence or death at the last date of known free of recurrence free survival events. Disease recurrence was determined based on positive cytology or biopsy in the presence of a single new lesion or the appearance of multiple lesions consistent with metastatic disease, or a positive brain CT or MRI scan or CSF cytology.
Overall Survival	assessed every 3 months if patient is < 2 years from study entry and every 6 months if patient is 2-5 years from study entry, and annually if >5 years, up to year 15	Overall survival is defined as time from randomization to death from any cause.

Secondary Outcome Measures

Name	Time	Method
5-year Recurrence Free Survival Rate	assessed every 3 months if patient is < 2 years from study entry and every 6 months if patient is 2-5 years from study entry, and annually if >5 years, up to year 15	Recurrence free survival is defined as time from randomization to first disease recurrence or death from any cause (whichever occur first), censoring cases without recurrence or death at the last date of known free of recurrence free survival events, and 5-year overall survival rate is estimated via Kaplan-Meier method. Disease recurrence was determined based on positive cytology or biopsy in the presence of a single new lesion or the appearance of multiple lesions consistent with metastatic disease, or a positive brain CT or MRI scan or CSF cytology.
Recurrence Free Survival in HLA-A2 Positive Patients	assessed every 3 months if patient is < 2 years from study entry and every 6 months if patient is 2-5 years from study entry, and annually if >5 years, up to year 15	Recurrence free survival is defined as time from randomization to first disease recurrence or death from any cause (whichever occur first), censoring cases without recurrence or death at the last date of known free of recurrence free survival events. Disease recurrence was determined based on positive cytology or biopsy in the presence of a single new lesion or the appearance of multiple lesions consistent with metastatic disease, or a positive brain CT or MRI scan or CSF cytology.
Overall Survival in Human Leukocyte Antigens-A2 (HLA-A2) Positive Patients	assessed every 3 months if patient is < 2 years from study entry and every 6 months if patient is 2-5 years from study entry, and annually if >5 years,up to year 15	Overall survival is defined as time from randomization to death from any cause.
5-year Overall Survival Rate	assessed every 3 months if patient is < 2 years from study entry and every 6 months if patient is 2-5 years from study entry, and annually if >5 years, up to year 15	Overall survival is defined as time from randomization to death from any cause, and 5-year overall survival rate is estimated via Kaplan-Meier method.

Trial Locations

Locations (148): University of Pittsburgh Cancer Institute (UPCI)
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Pittsburgh, Pennsylvania, United States
Johns Hopkins University/Sidney Kimmel Cancer Center
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Baltimore, Maryland, United States
Tufts Medical Center
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Boston, Massachusetts, United States
Beth Israel Deaconess Medical Center
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Boston, Massachusetts, United States
Case Western Reserve University
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Cleveland, Ohio, United States
Stanford Cancer Institute Palo Alto
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Palo Alto, California, United States
McFarland Clinic PC - Ames
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Ames, Iowa, United States
Mobile Infirmary Medical Center
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Mobile, Alabama, United States
Swedish Medical Center
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Englewood, Colorado, United States
Florida Cancer Specialists-West Palm Beach
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West Palm Beach, Florida, United States
Augusta University Medical Center
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Augusta, Georgia, United States
Baptist MD Anderson Cancer Center
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Jacksonville, Florida, United States
Memorial Medical Center
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Springfield, Illinois, United States
IU Health Ball Memorial Hospital
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Muncie, Indiana, United States
Franklin Medical Center
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Greenfield, Massachusetts, United States
Manchester Memorial Hospital
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Manchester, Connecticut, United States
Ochsner Health Center-Summa
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Baton Rouge, Louisiana, United States
Emory University Hospital/Winship Cancer Institute
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Atlanta, Georgia, United States
Cleveland Clinic-Weston
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Weston, Florida, United States
Lakeland Regional Health Hollis Cancer Center
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Lakeland, Florida, United States
Loyola University Medical Center
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Maywood, Illinois, United States
Sinai Hospital of Baltimore
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Baltimore, Maryland, United States
Iowa-Wide Oncology Research Coalition NCORP
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Des Moines, Iowa, United States
VA Palo Alto Health Care System
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Palo Alto, California, United States
Saint Joseph Hospital - Orange
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Orange, California, United States
Medical Center of Central Georgia
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Macon, Georgia, United States
Carle Cancer Center
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Urbana, Illinois, United States
Eastern Maine Medical Center
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Bangor, Maine, United States
Jupiter Medical Center
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Jupiter, Florida, United States
Saint Louis-Cape Girardeau CCOP
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Saint Louis, Missouri, United States
Medical Oncology and Hematology Associates-Des Moines
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Des Moines, Iowa, United States
University of Missouri - Ellis Fischel
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Columbia, Missouri, United States
Genesis Medical Center - East Campus
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Davenport, Iowa, United States
Cancer Research Consortium of West Michigan NCORP
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Grand Rapids, Michigan, United States
Greater Baltimore Medical Center
🇺🇸
Baltimore, Maryland, United States
The Cancer Institute of New Jersey Hamilton
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Hamilton, New Jersey, United States
Cleveland Clinic Foundation
🇺🇸
Cleveland, Ohio, United States
Iowa Methodist Medical Center
🇺🇸
Des Moines, Iowa, United States
Massachusetts General Hospital Cancer Center
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Boston, Massachusetts, United States
Ochsner Medical Center Jefferson
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New Orleans, Louisiana, United States
Delaware County Memorial Hospital
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Drexel Hill, Pennsylvania, United States
Lehigh Valley Hospital-Cedar Crest
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Allentown, Pennsylvania, United States
Montefiore Medical Center-Wakefield Campus
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Bronx, New York, United States
CHI Health Saint Francis
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Grand Island, Nebraska, United States
Saint Mary Medical and Regional Cancer Center
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Langhorne, Pennsylvania, United States
Guthrie Medical Group PC-Robert Packer Hospital
🇺🇸
Sayre, Pennsylvania, United States
Dartmouth Hitchcock Medical Center
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Lebanon, New Hampshire, United States
West Virginia University Charleston Division
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Charleston, West Virginia, United States
Dayton NCI Community Oncology Research Program
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Dayton, Ohio, United States
Ohio State University Comprehensive Cancer Center
🇺🇸
Columbus, Ohio, United States
Saint John Medical Center
🇺🇸
Tulsa, Oklahoma, United States
MetroHealth Medical Center
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Cleveland, Ohio, United States
Sanford Cancer Center Oncology Clinic
🇺🇸
Sioux Falls, South Dakota, United States
East Tennessee State University
🇺🇸
Johnson City, Tennessee, United States
Medical University of South Carolina
🇺🇸
Charleston, South Carolina, United States
Pottstown Hospital
🇺🇸
Pottstown, Pennsylvania, United States
Fox Chase Cancer Center
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Philadelphia, Pennsylvania, United States
Saint Vincent Hospital Cancer Center Green Bay
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Green Bay, Wisconsin, United States
ProHealth Oconomowoc Memorial Hospital
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Oconomowoc, Wisconsin, United States
Swedish Medical Center-First Hill
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Seattle, Washington, United States
University Medical Center of Southern Nevada
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Las Vegas, Nevada, United States
Nevada Cancer Research Foundation CCOP
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Las Vegas, Nevada, United States
IU Health Methodist Hospital
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Indianapolis, Indiana, United States
Kaiser Permanente-San Diego Mission
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San Diego, California, United States
Naval Medical Center -San Diego
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San Diego, California, United States
Veterans Administration-San Diego Medical Center
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San Diego, California, United States
Duke University Medical Center
🇺🇸
Durham, North Carolina, United States
University of Kansas Cancer Center
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Kansas City, Kansas, United States
Wichita NCI Community Oncology Research Program
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Wichita, Kansas, United States
New York Medical College
🇺🇸
Valhalla, New York, United States
Baystate Medical Center
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Springfield, Massachusetts, United States
University of Alabama at Birmingham Cancer Center
🇺🇸
Birmingham, Alabama, United States
Huntsman Cancer Institute/University of Utah
🇺🇸
Salt Lake City, Utah, United States
SCL Health Saint Joseph Hospital
🇺🇸
Denver, Colorado, United States
University of Nebraska Medical Center
🇺🇸
Omaha, Nebraska, United States
Mayo Clinic
🇺🇸
Rochester, Minnesota, United States
Alegent Health Bergan Mercy Medical Center
🇺🇸
Omaha, Nebraska, United States
Nebraska Methodist Hospital
🇺🇸
Omaha, Nebraska, United States
University of Arkansas for Medical Sciences
🇺🇸
Little Rock, Arkansas, United States
Banner University Medical Center - Tucson
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Tucson, Arizona, United States
City of Hope Comprehensive Cancer Center
🇺🇸
Duarte, California, United States
Alta Bates Summit Medical Center-Herrick Campus
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Berkeley, California, United States
UC San Diego Moores Cancer Center
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La Jolla, California, United States
Saint Mary's Hospital and Regional Medical Center
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Grand Junction, Colorado, United States
Southwest Florida Regional Medical Center
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Fort Myers, Florida, United States
Mayo Clinic in Florida
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Jacksonville, Florida, United States
Mount Sinai Medical Center
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Miami Beach, Florida, United States
Eisenhower Army Medical Center
🇺🇸
Fort Gordon, Georgia, United States
Indiana University/Melvin and Bren Simon Cancer Center
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Indianapolis, Indiana, United States
South Georgia Medical Center/Pearlman Cancer Center
🇺🇸
Valdosta, Georgia, United States
Saint Luke's Mountain States Tumor Institute
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Boise, Idaho, United States
Rush - Copley Medical Center
🇺🇸
Aurora, Illinois, United States
University of Chicago Comprehensive Cancer Center
🇺🇸
Chicago, Illinois, United States
Northwestern University
🇺🇸
Chicago, Illinois, United States
Siouxland Regional Cancer Center
🇺🇸
Sioux City, Iowa, United States
Anne Arundel Medical Center
🇺🇸
Annapolis, Maryland, United States
Dana-Farber Cancer Institute
🇺🇸
Boston, Massachusetts, United States
North Memorial Medical Health Center
🇺🇸
Robbinsdale, Minnesota, United States
West Michigan Cancer Center
🇺🇸
Kalamazoo, Michigan, United States
Hattiesburg Clinic - Hematology/Oncology Clinic
🇺🇸
Hattiesburg, Mississippi, United States
Cancer Research for the Ozarks NCORP
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Springfield, Missouri, United States
Montana Cancer Consortium NCORP
🇺🇸
Billings, Montana, United States
Saint Vincent Healthcare
🇺🇸
Billings, Montana, United States
Alegent Health Immanuel Medical Center
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Omaha, Nebraska, United States
Creighton University Medical Center
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Omaha, Nebraska, United States
Veterans Adminstration New Jersey Health Care System
🇺🇸
East Orange, New Jersey, United States
Orange Regional Medical Center
🇺🇸
Middletown, New York, United States
Laura and Isaac Perlmutter Cancer Center at NYU Langone
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New York, New York, United States
University of Rochester
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Rochester, New York, United States
Stony Brook University Medical Center
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Stony Brook, New York, United States
Carolinas Medical Center/Levine Cancer Institute
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Charlotte, North Carolina, United States
Mid Dakota Clinic
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Bismarck, North Dakota, United States
University of Cincinnati/Barrett Cancer Center
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Cincinnati, Ohio, United States
Aultman Health Foundation
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Canton, Ohio, United States
Sanford Bismarck Medical Center
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Bismarck, North Dakota, United States
Paoli Memorial Hospital
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Paoli, Pennsylvania, United States
Natalie Warren Bryant Cancer Center at Saint Francis
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Tulsa, Oklahoma, United States
Geisinger Medical Center
🇺🇸
Danville, Pennsylvania, United States
University of Pennsylvania/Abramson Cancer Center
🇺🇸
Philadelphia, Pennsylvania, United States
Thomas Jefferson University Hospital
🇺🇸
Philadelphia, Pennsylvania, United States
Vanderbilt University/Ingram Cancer Center
🇺🇸
Nashville, Tennessee, United States
Medical City Dallas Hospital
🇺🇸
Dallas, Texas, United States
University of Vermont and State Agricultural College
🇺🇸
Burlington, Vermont, United States
Skagit Valley Hospital
🇺🇸
Mount Vernon, Washington, United States
Kaiser Permanente Washington
🇺🇸
Seattle, Washington, United States
Aurora Cancer Care-Glendale
🇺🇸
Glendale, Wisconsin, United States
University of Wisconsin Hospital and Clinics
🇺🇸
Madison, Wisconsin, United States
Holy Family Memorial Hospital
🇺🇸
Manitowoc, Wisconsin, United States
ProHealth Waukesha Memorial Hospital
🇺🇸
Waukesha, Wisconsin, United States
Marshfield Medical Center-Marshfield
🇺🇸
Marshfield, Wisconsin, United States
Interlakes Foundation Inc-Rochester
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Rochester, New York, United States
Glens Falls Hospital
🇺🇸
Glens Falls, New York, United States
Mayo Clinic in Arizona
🇺🇸
Scottsdale, Arizona, United States
Wayne Memorial Hospital
🇺🇸
Goldsboro, North Carolina, United States
Novant Health Presbyterian Medical Center
🇺🇸
Charlotte, North Carolina, United States
University of New Mexico Cancer Center
🇺🇸
Albuquerque, New Mexico, United States
Boulder Community Hospital
🇺🇸
Boulder, Colorado, United States
Atlanta VA Medical Center
🇺🇸
Decatur, Georgia, United States
Providence Portland Medical Center
🇺🇸
Portland, Oregon, United States
Rutgers Cancer Institute of New Jersey
🇺🇸
New Brunswick, New Jersey, United States
Cancer Centers of Southwest Oklahoma Research
🇺🇸
Lawton, Oklahoma, United States
Saint Luke's University Hospital-Bethlehem Campus
🇺🇸
Bethlehem, Pennsylvania, United States
University of California Davis Comprehensive Cancer Center
🇺🇸
Sacramento, California, United States
The Medical Center of Aurora
🇺🇸
Aurora, Colorado, United States
AdventHealth Orlando
🇺🇸
Orlando, Florida, United States
The James Graham Brown Cancer Center at University of Louisville
🇺🇸
Louisville, Kentucky, United States
University of Michigan Comprehensive Cancer Center
🇺🇸
Ann Arbor, Michigan, United States
Southeast Clinical Oncology Research (SCOR) Consortium NCORP
🇺🇸
Winston-Salem, North Carolina, United States