Paclitaxel With or Without Cixutumumab as Second-Line Therapy in Treating Patients With Metastatic Esophageal Cancer or Gastroesophageal Junction Cancer

Phase 2

Active, not recruiting

Conditions: Metastatic Esophageal Adenocarcinoma
Metastatic Esophageal Squamous Cell Carcinoma
Metastatic Gastroesophageal Junction Adenocarcinoma
Recurrent Esophageal Adenocarcinoma
Recurrent Esophageal Carcinoma
Recurrent Esophageal Squamous Cell Carcinoma
Recurrent Gastroesophageal Junction Adenocarcinoma
Stage IV Esophageal Cancer AJCC v7

Interventions: Other: Laboratory Biomarker Analysis
Biological: Cixutumumab
Other: Pharmacological Study
Drug: Paclitaxel

Registration Number: NCT01142388

Lead Sponsor: National Cancer Institute (NCI)

Brief Summary: This randomized phase II trial studies how well paclitaxel with or without cixutumumab works in treating patients with esophageal cancer or gastroesophageal junction cancer that has spread to other places in the body (metastatic). Drugs used in chemotherapy, such as 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. Cixutumumab may kill cancer cells by blocking the action of a protein needed for cancer cell growth. Giving paclitaxel with or without cixutumumab may kill more tumor cells.

Detailed Description: PRIMARY OBJECTIVES:

I. To evaluate the progression-free survival of paclitaxel plus cixutumumab (IMC-A12) versus paclitaxel alone as second-line therapy in patients with metastatic esophagus or gastroesophageal (GE) junction cancer.

SECONDARY OBJECTIVES:

I. To evaluate the overall survival of paclitaxel plus cixutumumab (IMC-A12) versus paclitaxel alone in this patient population.

II. To evaluate the response rate of paclitaxel plus cixutumumab (IMC-A12) versus paclitaxel alone in this patient population.

III. To evaluate the toxicity of cixutumumab (IMC-A12) plus paclitaxel versus paclitaxel alone in this patient population.

IV. Exploratory analyses will assess potentially relevant cixutumumab (IMC-A12) pharmacodynamic biomarkers obtained from serum samples, including but not limited to, insulin-like growth factor (IGF)-I, IGF-II, insulin-like growth factor binding protein (IGFBP)-2, and IGFBP-3.

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

ARM I: Patients receive paclitaxel intravenously (IV) over 1 hour at a dose of 80 mg/m\^2 on days 1, 8, and 15 of every 28 day cycle.

ARM II: Patients receive cixutumumab IV over 1 hour at a dose of 10 mg/kg on days 1 and 15 of every 28 day cycle and paclitaxel as in Arm I.

In both arms, courses repeat every 28 days in the absence of disease progression or unacceptable toxicity.

After completion of study treatment, patients are followed up every 3 months for 2 years.

Recruitment & Eligibility

Status: ACTIVE_NOT_RECRUITING

Sex: All

Target Recruitment: 94

Inclusion Criteria

Life expectancy >= 12 weeks
Women must not be pregnant or breast-feeding due to potential harm to fetus from cixutumumab (IMC-A12) and paclitaxel; all females of childbearing potential must have a blood test or urine study within 48 hours prior to registration to rule out pregnancy
Women of child-bearing potential and men must agree to use adequate contraception (hormonal or barrier method or birth control; abstinence) for the duration of study therapy and for 3 months after the last dose of cixutumumab (IMC-A12); should a woman become pregnant or suspect she is pregnant while participating in this study, she should inform her treating physician immediately
Patients must have measurable disease
Patients must have metastatic disease of the esophagus or gastroesophageal junction
- Histologic, cytologic or radiologic documentation of metastatic squamous cell carcinoma or adenocarcinoma of the esophagus or gastroesophageal junction; radiologic, endoscopic, histologic or cytologic evidence of locally recurrent or locally residual (post-resection) disease is also permitted
- For the purposes of this study, undifferentiated adenocarcinomas and adenosquamous tumors will be considered as adenocarcinomas; in addition, tumors involving the gastroesophageal junction will be defined by the Siewert classification
Patients with gastroesophageal junction tumors who are eligible:
- Adenocarcinoma of the esophageal junction (AEG) Type I: adenocarcinoma of the distal esophagus which usually arises from an area with specialized intestinal metaplasia of the esophagus, i.e., Barrett's esophagus, and may infiltrate the esophagogastric junction from above
- AEG Type II: true carcinoma of the cardia arising from the cardiac epithelium or short segments with intestinal metaplasia at the esophagogastric junction
Patients with gastroesophageal junction tumors who are NOT eligible:
- AEG Type III: subcardial gastric carcinoma which infiltrates the esophagogastric junction and distal esophagus from below
Patients must have received and progressed on one and only one line of prior systemic therapy for esophagus or esophagogastric cancer; this could have included one regimen for metastatic disease, or one regimen with radiotherapy for initially locally advanced disease; prior radiation therapy is permitted
- If patients progress or recur within 6 months of neoadjuvant/adjuvant therapy, this will be considered one line of therapy; for patients progressing or recurring more than 6 months after neoadjuvant/adjuvant therapy, they will need to receive one line of therapy for recurrent disease to be eligible
- If patients receive one regimen in which a chemotherapy agent is dropped for toxicity without progression, this treatment will be considered one line of therapy; however, substitution or addition of a new agent will be considered a second line of therapy
Eastern Cooperative Oncology Group (ECOG) performance status 0-2
Leukocytes > 3,000/mcL
Absolute neutrophil count >= 1,500/mcL
Hemoglobin >= 9 g/dL
Platelets >= 100,000/mcL
Total bilirubin =< institutional upper limit of normal (ULN)
Aspartate transaminase (AST) (serum glutamic oxaloacetic transaminase [SGOT])/alanine transaminase (ALT) (serum glutamate pyruvate transaminase [SGPT]) =< 3 X institutional ULN
Creatinine =< 1.5 X institutional ULN or creatinine clearance >= 60 mL/min/1.73m^2 for patients with creatinine levels above institutional normal
Patients must have fasting serum glucose =< 160 mg/dL (8.8 mmol/L) or =< ULN, and hemoglobin A1C =< 7% (0.07 International System of Units [SI units]) within 14 days of registration; if baseline nonfasting glucose =< 160 mg/dL (8.8 mmol/L), fasting glucose measurement is not required
Registration no fewer than 28 days from last chemotherapy
A "currently active" second malignancy other than non-melanoma skin cancers are not to be registered; patients are not considered to have a "currently active" malignancy if they have completed therapy and are considered by their physician to be at less than 30% risk of relapse

Exclusion Criteria

Patients have received prior taxane or anti-insulin growth factor receptor (IGFR) therapy
Patients must not have any of the following conditions:
- Poorly controlled diabetes mellitus; patients with a history of diabetes mellitus are allowed to participate, provided that their blood glucose is within normal range (fasting glucose =< 160 mg/dL [8.8 mmol/L] or below the ULN and hemoglobin A1C =< 7% [0.07 SI units]) and that they are on a stable dietary or therapeutic regimen for this condition
- Recent major surgery, hormonal therapy (other than replacement) or chemotherapy, within 4 weeks prior to entering the study or those who have not recovered from adverse events
- History of allergic reactions attributed to compounds of similar chemical or biologic composition to cixutumumab (IMC-A12)
- Psychiatric illness that would prevent the patient from giving informed consent
Medical conditions such as active/uncontrolled infection (including HIV) or cardiac disease that would make this protocol unreasonably hazardous for the patient in the opinion of the treating physician; cardiac disease may include uncontrolled high blood pressure, unstable angina, or serious uncontrolled cardiac arrhythmia

Study & Design

Study Type: INTERVENTIONAL

Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Arm I (paclitaxel)	Laboratory Biomarker Analysis	Patients receive paclitaxel IV over 1 hour on days 1, 8, and 15.
Arm I (paclitaxel)	Pharmacological Study	Patients receive paclitaxel IV over 1 hour on days 1, 8, and 15.
Arm II (cixutumumab, paclitaxel)	Cixutumumab	Patients receive cixutumumab IV over 1 hour on days 1 and 15, and paclitaxel as in Arm I.
Arm II (cixutumumab, paclitaxel)	Laboratory Biomarker Analysis	Patients receive cixutumumab IV over 1 hour on days 1 and 15, and paclitaxel as in Arm I.
Arm II (cixutumumab, paclitaxel)	Paclitaxel	Patients receive cixutumumab IV over 1 hour on days 1 and 15, and paclitaxel as in Arm I.
Arm II (cixutumumab, paclitaxel)	Pharmacological Study	Patients receive cixutumumab IV over 1 hour on days 1 and 15, and paclitaxel as in Arm I.
Arm I (paclitaxel)	Paclitaxel	Patients receive paclitaxel IV over 1 hour on days 1, 8, and 15.

Primary Outcome Measures

Name	Time	Method
Progression-free Survival	assessed every 3 months for 2 years after registration	Progression-free survival (PFS) is defined as the time from randomization to progression or death without evidence of progression. For cases without documentation of progression, follow-up was censored at the date of last disease assessment without progression, unless death occurred within a short period of time (4 months) following the date last known progression-free, in which case the death was counted as an event, or in the case of death within 4 months of randomization in the absence of disease evaluation before that time. PFS was estimated using the Kaplan-Meier method, with 90% confidence intervals calculated using Greenwood's formula, and compared by the log rank test.

Secondary Outcome Measures

Name	Time	Method
Overall Survival	assessed every 3 months for 2 years after registration	Overall survival (OS) is defined as the time from randomization until death (event), or censored at last date known alive. OS was estimated using the Kaplan-Meier method, with 90% confidence intervals calculated using Greenwood's formula, and compared by the log rank test.
Objective Response Rate	assessed every 8 weeks while on treatment and every 3 months after treatment for 2 years	Objective response rate is defined as number of patients with complete response (CR) or partial response (PR) divided by all eligible patients. Responses are evaluated using the revised Response Evaluation Criteria in Solid Tumors (RECIST) guideline. CR is defined as disappearance of all target and non-target lesions and normalization of tumor marker level. PR is defined as disappearance of target lesions or at least a 30% decrease in the sum of the diameters of target lesions (taking as reference the baseline sum diameters), and persistence of one or more non-target lesion(s) and/or maintenance of tumor marker level above the normal limits.

Trial Locations

Locations (232): AdventHealth Parker
🇺🇸
Parker, Colorado, United States
Sky Ridge Medical Center
🇺🇸
Lone Tree, Colorado, United States
Mcdonough District Hospital
🇺🇸
Macomb, Illinois, United States
Trinity Medical Center
🇺🇸
Moline, Illinois, United States
DuPage Medical Group-Ogden
🇺🇸
Naperville, Illinois, United States
Illinois Cancer Specialists-Niles
🇺🇸
Niles, Illinois, United States
Iowa Methodist Medical Center
🇺🇸
Des Moines, Iowa, United States
Cancer Center of Kansas - Dodge City
🇺🇸
Dodge City, Kansas, United States
North Coast Cancer Care-Clyde
🇺🇸
Clyde, Ohio, United States
Hematology Oncology Center Incorporated
🇺🇸
Elyria, Ohio, United States
UI Health Care Mission Cancer and Blood - West Des Moines Clinic
🇺🇸
Clive, Iowa, United States
UI Health Care Mission Cancer and Blood - Des Moines Clinic
🇺🇸
Des Moines, Iowa, United States
UI Health Care Mission Cancer and Blood - Laurel Clinic
🇺🇸
Des Moines, Iowa, United States
Mayo Clinic in Arizona
🇺🇸
Scottsdale, Arizona, United States
Stanford Cancer Institute Palo Alto
🇺🇸
Palo Alto, California, United States
Saint Anthony Hospital
🇺🇸
Lakewood, Colorado, United States
The Medical Center of Aurora
🇺🇸
Aurora, Colorado, United States
Boulder Community Hospital
🇺🇸
Boulder, Colorado, United States
Penrose-Saint Francis Healthcare
🇺🇸
Colorado Springs, Colorado, United States
AdventHealth Porter
🇺🇸
Denver, Colorado, United States
Presbyterian - Saint Lukes Medical Center - Health One
🇺🇸
Denver, Colorado, United States
Saint Joseph Hospital - Cancer Centers of Colorado
🇺🇸
Denver, Colorado, United States
Rose Medical Center
🇺🇸
Denver, Colorado, United States
Western States Cancer Research NCORP
🇺🇸
Denver, Colorado, United States
Swedish Medical Center
🇺🇸
Englewood, Colorado, United States
Saint Mary's Hospital and Regional Medical Center
🇺🇸
Grand Junction, Colorado, United States
Banner North Colorado Medical Center
🇺🇸
Greeley, Colorado, United States
Longmont United Hospital
🇺🇸
Longmont, Colorado, United States
Banner McKee Medical Center
🇺🇸
Loveland, Colorado, United States
Saint Mary Corwin Medical Center
🇺🇸
Pueblo, Colorado, United States
North Suburban Medical Center
🇺🇸
Thornton, Colorado, United States
Intermountain Health Lutheran Hospital
🇺🇸
Wheat Ridge, Colorado, United States
Beebe Medical Center
🇺🇸
Lewes, Delaware, United States
Smilow Cancer Hospital Care Center at Saint Francis
🇺🇸
Hartford, Connecticut, United States
Christiana Care Health System-Christiana Hospital
🇺🇸
Newark, Delaware, United States
Mayo Clinic in Florida
🇺🇸
Jacksonville, Florida, 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
Rush - Copley Medical Center
🇺🇸
Aurora, Illinois, United States
MacNeal Hospital and Cancer Center
🇺🇸
Berwyn, Illinois, United States
OSF Saint Joseph Medical Center
🇺🇸
Bloomington, Illinois, United States
Graham Hospital Association
🇺🇸
Canton, Illinois, United States
Northwestern University
🇺🇸
Chicago, Illinois, United States
Memorial Hospital
🇺🇸
Carthage, Illinois, United States
Eureka Hospital
🇺🇸
Eureka, Illinois, United States
Hinsdale Hematology Oncology Associates Incorporated
🇺🇸
Hinsdale, Illinois, United States
Hematology and Oncology Associates
🇺🇸
Chicago, Illinois, United States
Decatur Memorial Hospital
🇺🇸
Decatur, Illinois, United States
Ingalls Memorial Hospital
🇺🇸
Harvey, Illinois, United States
Duly Health and Care Joliet
🇺🇸
Joliet, Illinois, United States
Heartland Cancer Research NCORP
🇺🇸
Decatur, Illinois, United States
Illinois CancerCare-Galesburg
🇺🇸
Galesburg, Illinois, United States
Mason District Hospital
🇺🇸
Havana, Illinois, United States
AMG Libertyville - Oncology
🇺🇸
Libertyville, Illinois, United States
Hematology Oncology Associates of Illinois-Highland Park
🇺🇸
Highland Park, Illinois, United States
Presence Saint Mary's Hospital
🇺🇸
Kankakee, Illinois, United States
Carle BroMenn Medical Center
🇺🇸
Normal, Illinois, United States
Illinois CancerCare-Peoria
🇺🇸
Peoria, Illinois, United States
Swedish American Hospital
🇺🇸
Rockford, Illinois, United States
Springfield Memorial Hospital
🇺🇸
Springfield, Illinois, United States
Carle Cancer Institute Normal
🇺🇸
Normal, Illinois, United States
Ottawa Regional Hospital and Healthcare Center
🇺🇸
Ottawa, Illinois, United States
Methodist Medical Center of Illinois
🇺🇸
Peoria, Illinois, United States
OSF Saint Francis Radiation Oncology at Pekin
🇺🇸
Pekin, Illinois, United States
Proctor Hospital
🇺🇸
Peoria, Illinois, United States
OSF Saint Francis Medical Center
🇺🇸
Peoria, Illinois, United States
Illinois Valley Hospital
🇺🇸
Peru, Illinois, United States
Perry Memorial Hospital
🇺🇸
Princeton, Illinois, United States
West Suburban Medical Center
🇺🇸
River Forest, Illinois, United States
Hematology Oncology Associates of Illinois - Skokie
🇺🇸
Skokie, Illinois, United States
Carle Cancer Center
🇺🇸
Urbana, Illinois, United States
Elkhart General Hospital
🇺🇸
Elkhart, Indiana, United States
Indiana University/Melvin and Bren Simon Cancer Center
🇺🇸
Indianapolis, Indiana, United States
Richard L. Roudebush Veterans Affairs Medical Center
🇺🇸
Indianapolis, Indiana, United States
Sidney and Lois Eskenazi Hospital
🇺🇸
Indianapolis, Indiana, United States
IU Health Central Indiana Cancer Centers-East
🇺🇸
Indianapolis, Indiana, United States
Community Howard Regional Health
🇺🇸
Kokomo, Indiana, United States
IU Health La Porte Hospital
🇺🇸
La Porte, Indiana, United States
Franciscan Saint Anthony Health-Michigan City
🇺🇸
Michigan City, Indiana, United States
Saint Joseph Regional Medical Center-Mishawaka
🇺🇸
Mishawaka, Indiana, United States
IU Health Ball Memorial Hospital
🇺🇸
Muncie, Indiana, United States
Memorial Hospital of South Bend
🇺🇸
South Bend, Indiana, United States
Northern Indiana Cancer Research Consortium
🇺🇸
South Bend, Indiana, United States
McFarland Clinic - Ames
🇺🇸
Ames, Iowa, United States
Mercy Hospital
🇺🇸
Coon Rapids, Minnesota, United States
Oncology Associates at Mercy Medical Center
🇺🇸
Cedar Rapids, Iowa, United States
Iowa-Wide Oncology Research Coalition NCORP
🇺🇸
Des Moines, Iowa, United States
Mercy Medical Center - Des Moines
🇺🇸
Des Moines, Iowa, United States
Iowa Lutheran Hospital
🇺🇸
Des Moines, Iowa, United States
Mercy Medical Center - North Iowa
🇺🇸
Mason City, Iowa, United States
Siouxland Regional Cancer Center
🇺🇸
Sioux City, Iowa, United States
Mercy Medical Center-Sioux City
🇺🇸
Sioux City, Iowa, United States
Saint Luke's Regional Medical Center
🇺🇸
Sioux City, Iowa, United States
Cancer Center of Kansas - Chanute
🇺🇸
Chanute, Kansas, United States
Cancer Center of Kansas - El Dorado
🇺🇸
El Dorado, Kansas, United States
Cancer Center of Kansas - Fort Scott
🇺🇸
Fort Scott, Kansas, United States
Cancer Center of Kansas-Independence
🇺🇸
Independence, Kansas, United States
Cancer Center of Kansas - Newton
🇺🇸
Newton, Kansas, United States
Cancer Center of Kansas - Pratt
🇺🇸
Pratt, Kansas, United States
Cancer Center of Kansas-Kingman
🇺🇸
Kingman, Kansas, United States
Cancer Center of Kansas-Liberal
🇺🇸
Liberal, Kansas, United States
Lawrence Memorial Hospital
🇺🇸
Lawrence, Kansas, United States
Cancer Center of Kansas - Parsons
🇺🇸
Parsons, Kansas, United States
Cancer Center of Kansas - Salina
🇺🇸
Salina, Kansas, United States
Cancer Center of Kansas - Winfield
🇺🇸
Winfield, Kansas, United States
Cancer Center of Kansas - McPherson
🇺🇸
McPherson, Kansas, United States
Ascension Via Christi Hospitals Wichita
🇺🇸
Wichita, Kansas, United States
Wichita NCI Community Oncology Research Program
🇺🇸
Wichita, Kansas, United States
Louisiana State University Health Science Center
🇺🇸
New Orleans, Louisiana, United States
University Medical Center New Orleans
🇺🇸
New Orleans, Louisiana, United States
Johns Hopkins University/Sidney Kimmel Cancer Center
🇺🇸
Baltimore, Maryland, United States
Christiana Care - Union Hospital
🇺🇸
Elkton, Maryland, United States
Cancer Center of Kansas - Wellington
🇺🇸
Wellington, Kansas, United States
Associates In Womens Health
🇺🇸
Wichita, Kansas, United States
Cancer Center of Kansas - Wichita
🇺🇸
Wichita, Kansas, United States
Cancer Center of Kansas-Wichita Medical Arts Tower
🇺🇸
Wichita, Kansas, United States
Mary Bird Perkins Cancer Center
🇺🇸
Baton Rouge, Louisiana, United States
Bixby Medical Center
🇺🇸
Adrian, Michigan, United States
Hickman Cancer Center
🇺🇸
Adrian, Michigan, United States
Michigan Cancer Research Consortium NCORP
🇺🇸
Ann Arbor, Michigan, United States
Trinity Health Saint Joseph Mercy Hospital Ann Arbor
🇺🇸
Ann Arbor, Michigan, United States
Corewell Health Dearborn Hospital
🇺🇸
Dearborn, Michigan, United States
Henry Ford Health Saint John Hospital
🇺🇸
Detroit, Michigan, United States
Hurley Medical Center
🇺🇸
Flint, Michigan, United States
Genesys Regional Medical Center-West Flint Campus
🇺🇸
Flint, Michigan, United States
Allegiance Health
🇺🇸
Jackson, Michigan, United States
Bronson Methodist Hospital
🇺🇸
Kalamazoo, Michigan, United States
West Michigan Cancer Center
🇺🇸
Kalamazoo, Michigan, United States
Ascension Borgess Hospital
🇺🇸
Kalamazoo, Michigan, United States
University of Michigan Health - Sparrow Lansing
🇺🇸
Lansing, Michigan, United States
Trinity Health Saint Mary Mercy Livonia Hospital
🇺🇸
Livonia, Michigan, United States
Mercy Memorial Hospital
🇺🇸
Monroe, Michigan, United States
Toledo Clinic Cancer Centers-Monroe
🇺🇸
Monroe, Michigan, United States
Trinity Health Saint Joseph Mercy Oakland Hospital
🇺🇸
Pontiac, Michigan, United States
Lake Huron Medical Center
🇺🇸
Port Huron, Michigan, United States
MyMichigan Medical Center Saginaw
🇺🇸
Saginaw, Michigan, United States
Corewell Health Lakeland Hospitals - Marie Yeager Cancer Center
🇺🇸
Saint Joseph, Michigan, United States
Corewell Health Lakeland Hospitals - Saint Joseph Hospital
🇺🇸
Saint Joseph, Michigan, United States
Henry Ford Health Warren Hospital
🇺🇸
Warren, Michigan, United States
Essentia Health Saint Joseph's Medical Center
🇺🇸
Brainerd, Minnesota, United States
Fairview Ridges Hospital
🇺🇸
Burnsville, Minnesota, United States
Essentia Health Cancer Center
🇺🇸
Duluth, Minnesota, United States
Essentia Health Saint Mary's Medical Center
🇺🇸
Duluth, Minnesota, United States
Miller-Dwan Hospital
🇺🇸
Duluth, Minnesota, United States
Fairview Southdale Hospital
🇺🇸
Edina, Minnesota, United States
Unity Hospital
🇺🇸
Fridley, Minnesota, United States
Hutchinson Area Health Care
🇺🇸
Hutchinson, Minnesota, United States
Minnesota Oncology Hematology PA-Maplewood
🇺🇸
Maplewood, Minnesota, United States
Saint John's Hospital - Healtheast
🇺🇸
Maplewood, Minnesota, United States
Abbott-Northwestern Hospital
🇺🇸
Minneapolis, Minnesota, United States
Hennepin County Medical Center
🇺🇸
Minneapolis, Minnesota, United States
New Ulm Medical Center
🇺🇸
New Ulm, Minnesota, United States
North Memorial Medical Health Center
🇺🇸
Robbinsdale, Minnesota, United States
Mayo Clinic in Rochester
🇺🇸
Rochester, Minnesota, United States
Metro Minnesota Community Oncology Research Consortium
🇺🇸
Saint Louis Park, Minnesota, United States
Park Nicollet Clinic - Saint Louis Park
🇺🇸
Saint Louis Park, Minnesota, United States
Regions Hospital
🇺🇸
Saint Paul, Minnesota, United States
United Hospital
🇺🇸
Saint Paul, Minnesota, United States
Saint Francis Regional Medical Center
🇺🇸
Shakopee, Minnesota, United States
Lakeview Hospital
🇺🇸
Stillwater, Minnesota, United States
Ridgeview Medical Center
🇺🇸
Waconia, Minnesota, United States
Minnesota Oncology Hematology PA-Woodbury
🇺🇸
Woodbury, Minnesota, United States
Alegent Health Bergan Mercy Medical Center
🇺🇸
Omaha, Nebraska, United States
CentraState Medical Center
🇺🇸
Freehold, New Jersey, United States
Rice Memorial Hospital
🇺🇸
Willmar, Minnesota, United States
Nebraska Cancer Research Center
🇺🇸
Lincoln, Nebraska, United States
Missouri Valley Cancer Consortium
🇺🇸
Omaha, Nebraska, United States
Alegent Health Lakeside Hospital
🇺🇸
Omaha, Nebraska, United States
Cooper Hospital University Medical Center
🇺🇸
Camden, New Jersey, United States
Rutgers Cancer Institute of New Jersey
🇺🇸
New Brunswick, New Jersey, United States
Rutgers New Jersey Medical School
🇺🇸
Newark, New Jersey, United States
Newark Beth Israel Medical Center
🇺🇸
Newark, New Jersey, United States
Alegent Health Immanuel Medical Center
🇺🇸
Omaha, Nebraska, United States
The Cancer Institute of New Jersey Hamilton
🇺🇸
Hamilton, New Jersey, United States
Creighton University Medical Center
🇺🇸
Omaha, Nebraska, United States
Veterans Adminstration New Jersey Health Care System
🇺🇸
East Orange, New Jersey, United States
New York Oncology Hematology PC - Albany Medical Center
🇺🇸
Albany, New York, United States
Essentia Health Cancer Center-South University Clinic
🇺🇸
Fargo, North Dakota, United States
Summa Health System - Akron Campus
🇺🇸
Akron, Ohio, United States
Toledo Clinic Cancer Centers-Bowling Green
🇺🇸
Bowling Green, Ohio, United States
Cleveland Clinic Mercy Hospital
🇺🇸
Canton, Ohio, United States
MetroHealth Medical Center
🇺🇸
Cleveland, Ohio, United States
Mercy Cancer Center-Elyria
🇺🇸
Elyria, Ohio, United States
Saint Rita's Medical Center
🇺🇸
Lima, Ohio, United States
Lima Memorial Hospital
🇺🇸
Lima, Ohio, United States
Saint Luke's Hospital
🇺🇸
Maumee, Ohio, United States
Toledo Clinic Cancer Centers-Maumee
🇺🇸
Maumee, Ohio, United States
Fisher-Titus Medical Center
🇺🇸
Norwalk, Ohio, United States
Saint Charles Hospital
🇺🇸
Oregon, Ohio, United States
Toledo Clinic Cancer Centers-Oregon
🇺🇸
Oregon, Ohio, United States
North Coast Cancer Care
🇺🇸
Sandusky, Ohio, United States
ProMedica Flower Hospital
🇺🇸
Sylvania, Ohio, United States
Mercy Hospital of Tiffin
🇺🇸
Tiffin, Ohio, United States
ProMedica Toledo Hospital/Russell J Ebeid Children's Hospital
🇺🇸
Toledo, Ohio, United States
Mercy Health - Saint Vincent Hospital
🇺🇸
Toledo, Ohio, United States
University of Toledo
🇺🇸
Toledo, Ohio, United States
Toledo Community Hospital Oncology Program CCOP
🇺🇸
Toledo, Ohio, United States
Mercy Health - Saint Anne Hospital
🇺🇸
Toledo, Ohio, United States
Toledo Clinic Cancer Centers-Toledo
🇺🇸
Toledo, Ohio, United States
Fulton County Health Center
🇺🇸
Wauseon, Ohio, United States
Saint Luke's University Hospital-Bethlehem Campus
🇺🇸
Bethlehem, Pennsylvania, United States
Bryn Mawr Hospital
🇺🇸
Bryn Mawr, Pennsylvania, United States
Butler Memorial Hospital
🇺🇸
Butler, Pennsylvania, United States
Geisinger Medical Center
🇺🇸
Danville, Pennsylvania, United States
Geisinger Medical Center-Cancer Center Hazleton
🇺🇸
Hazleton, Pennsylvania, United States
Paoli Memorial Hospital
🇺🇸
Paoli, Pennsylvania, United States
Thomas Jefferson University Hospital
🇺🇸
Philadelphia, Pennsylvania, United States
Fox Chase Cancer Center
🇺🇸
Philadelphia, Pennsylvania, United States
University of Pittsburgh Cancer Institute (UPCI)
🇺🇸
Pittsburgh, Pennsylvania, United States
Pottstown Hospital
🇺🇸
Pottstown, Pennsylvania, United States
Hematology and Oncology Associates of North East Pennsylvania
🇺🇸
Scranton, Pennsylvania, United States
Geisinger Medical Group
🇺🇸
State College, Pennsylvania, United States
Reading Hospital
🇺🇸
West Reading, Pennsylvania, United States
Geisinger Wyoming Valley/Henry Cancer Center
🇺🇸
Wilkes-Barre, Pennsylvania, United States
Lankenau Medical Center
🇺🇸
Wynnewood, Pennsylvania, United States
Main Line Health NCORP
🇺🇸
Wynnewood, Pennsylvania, United States
Jackson-Madison County General Hospital
🇺🇸
Jackson, Tennessee, United States
Fredericksburg Oncology Inc
🇺🇸
Fredericksburg, Virginia, United States
Wheeling Hospital/Schiffler Cancer Center
🇺🇸
Wheeling, West Virginia, United States
Langlade Hospital and Cancer Center
🇺🇸
Antigo, Wisconsin, United States
Saint Vincent Hospital Cancer Center Green Bay
🇺🇸
Green Bay, Wisconsin, United States
University of Wisconsin Carbone Cancer Center - Johnson Creek
🇺🇸
Johnson Creek, Wisconsin, United States
Gundersen Lutheran Medical Center
🇺🇸
La Crosse, Wisconsin, United States
SSM Health Dean Medical Group - South Madison Campus
🇺🇸
Madison, Wisconsin, United States
HSHS Saint Nicholas Hospital
🇺🇸
Sheboygan, Wisconsin, United States
University of Wisconsin Carbone Cancer Center - University Hospital
🇺🇸
Madison, Wisconsin, United States
Holy Family Memorial Hospital
🇺🇸
Manitowoc, Wisconsin, United States
Bay Area Medical Center
🇺🇸
Marinette, Wisconsin, United States
Aspirus Regional Cancer Center
🇺🇸
Wausau, Wisconsin, United States
Aspirus Cancer Care - Wisconsin Rapids
🇺🇸
Wisconsin Rapids, Wisconsin, United States
AdventHealth Littleton
🇺🇸
Littleton, Colorado, United States