Effect of Tumor Treating Fields (TTFields, 150 kHz) as Front-Line Treatment of Locally-advanced Pancreatic Adenocarcinoma Concomitant With Gemcitabine and Nab-paclitaxel (PANOVA-3)

Phase 3

Completed

• Conditions: Pancreas Adenocarcinoma
• Interventions: Device: NovoTTF-200T; Drug: Gemcitabine; Drug: nab paclitaxel

• Registration Number: NCT03377491
• Lead Sponsor: NovoCure Ltd.

Brief Summary

Brief Summary:

The study is a prospective, randomized controlled phase III trial aimed to test the efficacy and safety of Tumor Treating Fields (TTFields) in combination with gemcitabine and nab-paclitaxel, for front line treatment of locally-advanced pancreatic adenocarcinoma.The device is an experimental, portable, battery operated device for chronic administration of alternating electric fields (termed TTFields or TTF) to the region of the malignant tumor, by means of surface, insulated electrode arrays.

Detailed Description

PAST PRE-CLINICAL AND CLINICAL EXPERIENCE:

The effect of the electric fields (TTFields, TTF) has demonstrated significant activity in in vitro and in vivo pancreatic adenocarcinoma pre-clinical models both as a single modality treatment and in combination with chemotherapies. TTFields have been demonstrated to act synergistically with taxanes and have been shown to be additive when combined with other chemotherapies including gemcitabine. In addition, TTFields have shown to inhibit metastatic spread of malignant melanoma in in vivo experiment.

In a pilot study, 40 patients with locally advanced or metastatic pancreatic adenocarcinoma received gemcitabine together with TTFields (150 kHz) or gemcitabine and nab-paclitaxel together with TTFields (150 kHz) applied to the abdomen until disease progression. The combination was well tolerated and the only device-related adverse event was contact dermatitis.

In addition, a phase III trial of Optune® (200 kHz) as monotherapy compared to active chemotherapy in recurrent glioblastoma patients showed TTFields to be equivalent to active chemotherapy in extending survival, associated with minimal toxicity, good quality of life, and activity within the brain (14% response rate) (Stupp R., et al., EJC 2012). Finally, a phase III trial of Optune® combined with maintenance temozolomide compared to maintenance temozolomide alone has shown that combined therapy led to a significant improvement in both progression free survival and overall survival in patients with newly diagnosed glioblastoma without the addition of high grade toxicity and without decline in quality of life (Stupp R., et al., JAMA 2017).

DESCRIPTION OF THE TRIAL:

All patients included in this trial are patients with locally advanced pancreatic adenocarcinoma. In addition, all patients must meet all eligibility criteria.

Eligible patients will be randomly assigned to one of two groups:

1. Patients receive gemcitabine and nab-paclitaxel in combination with TTFields using the NovoTTF-200T System.

2. Patients receive gemcitabine and nab-paclitaxel without TTFields.

Patients will be randomized at a 1:1 ratio. Baseline tests will be performed in patients enrolled in both arms. If assigned to the NovoTTF-200T group, the patients will be treated continuously with the device until progression in the abdomen. On both arms, patients who have progression outside the abdomen will switch to a second line treatment according to local practice.

SCIENTIFIC BACKGROUND:

Electric fields exert forces on electric charges similar to the way a magnet exerts forces on metallic particles within a magnetic field. These forces cause movement and rotation of electrically charged biological building blocks, much like the alignment of metallic particles seen along the lines of force radiating outwards from a magnet.

Electric fields can also cause muscles to twitch and if strong enough may heat tissues. TTFields are alternating electric fields of low intensity. This means that they change their direction repetitively many times a second. Since they change direction very rapidly (150 thousand times a second), they do not cause muscles to twitch, nor do they have any effects on other electrically activated tissues in the body (brain, nerves and heart). Since the intensities of TTFields in the body are very low, they do not cause heating.

The breakthrough finding made by Novocure was that finely tuned alternating fields of very low intensity, now termed TTFields (Tumor Treating Fields), cause a significant slowing in the growth of cancer cells. Due to the unique geometric shape of cancer cells when they are multiplying, TTFields cause electrically-charged cellular components of these cells to change their location within the dividing cell, disrupting their normal function and ultimately leading to cell death. In addition, cancer cells also contain miniature building blocks which act as tiny motors in moving essential parts of the cells from place to place. TTFields interfere with the normal orientation of these tiny motors related to other cellular components since they are electrically-charged as well. As a result of these two effects, tumor cell division is slowed, results in cellular death or reverses after continuous exposure to TTFields.

Other cells in the body (normal healthy tissues) are affected much less than cancer cells since they multiply at a much slower rate if at all. In addition TTFields can be directed to a certain part of the body, leaving sensitive areas out of their reach. Finally, the frequency of TTFields applied to each type of cancer is specific and may not damage normally dividing cells in healthy tissues.

In conclusion, TTFields hold the promise of serving as a brand new treatment for pancreatic adenocarcinoma with very few side effects.

Study Timeline

• Study First Submitted: 2017-12-06
• Study First Submitted QC: 2017-12-18
• Study First Posted: 2017-12-19
• Study Start: 2018-02-10
• Status Verified: 2024-10
• Primary Completion: 2024-10-16
• Study Completion: 2024-10-16
• Last Update Submitted: 2024-10-28
• Last Update Posted: 2024-10-31

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 571

Inclusion Criteria

1. 18 years of age and older

2. Life expectancy of ≥ 3 months

3. Histological/cytological diagnosis of de novo adenocarcinoma of the pancreas

4. Unresectable, locally advanced stage disease according to the following criteria:

   • Head/uncinate process:

     1. Solid tumor contact with SMA>180°
     2. Solid tumor contact with the CA>180°
     3. Solid tumor contact with the first jejunal SMA branch
     4. Unreconstructible SMV/PV due to tumor involvement or occlusion (can be d/t tumor or bland thrombus)
     5. Contact with most proximal draining jejunal branch into SMV

   • Body and tail

     1. Solid tumor contact of >180° with the SMA or CA
     2. Solid tumor contact with the CA and aortic involvement
     3. Unreconstructible SMV/PV due to tumor involvement or occlusion (can be d/t tumor or bland thrombus)

   • No distant metastasis, including non-regional lymph node metastasis

   • No borderline resectable (per Al-Hawary MM, et al., Radiology 201414)

5. ECOG score 0-2

6. Amenable and assigned by the investigator to receive therapy with gemcitabine and nab-paclitaxel

7. Able to operate the NovoTTF-200T System independently or with the help of a caregiver

8. Signed informed consent form for the study protocol

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Exclusion Criteria

1. Prior palliative treatment (e.g. surgery, radiation) to the tumor

2. Cancer requiring anti-tumor treatment within the 5 years before inclusion, excluding treated stage I prostate cancer, in situ cervical or uterus cancer, in situ breast cancer and non-melanomatous skin cancer.

3. Serious co-morbidities:

   1. Clinically significant (as determined by the investigator) hematological, hepatic and renal dysfunction, defined as: Neutrophil count < 1.5 x 10^9/L and platelet count < 100 x 10^9/L; bilirubin > 1.5 x Upper Limit of Normal (ULN); AST and/or ALT > 2.5 x ULN; and serum creatinine > 1.5 x ULN.
   2. History of significant cardiovascular disease unless the disease is well controlled. Significant cardiac disease includes second/third degree heart block; significant ischemic heart disease; poorly controlled hypertension; congestive heart failure of the New York Heart Association (NYHA) Class II or worse (slight limitation of physical activity; comfortable at rest, but ordinary activity results in fatigue, palpitation or dyspnea).
   3. History of arrhythmia that is symptomatic or requires treatment. Patients with atrial fibrillation or flutter controlled by medication are not excluded from participation in the trial.
   4. History of cerebrovascular accident (CVA) within 6 months prior to randomization or that is not stable.
   5. Active infection or serious underlying medical condition that would impair the ability of the patient to receive protocol therapy.
   6. History of any psychiatric condition that might impair patient's ability to understand or comply with the requirements of the study or to provide consent.

4. Concurrent anti-tumor therapy beyond gemcitabine and nab-paclitaxel

5. Implantable electronic medical devices in the torso, such as pacemakers

6. Known severe hypersensitivities to medical adhesives or hydrogel, or to one of the chemotherapies used in this trial.

7. Pregnancy or breast-feeding (female patients with reproductive potential and their partners must accept to use effective contraception throughout the entire study period and for 3 months after the end of treatment). All patients who are capable of becoming pregnant must take a pregnancy test which is negative within 72 hours before beginning treatment. The definition of effective contraception is left up to the decision of the investigator.

8. Unable to follow the protocol for medical, psychological, familial, geographic or other reasons.

9. Admitted to an institution by administrative or court order.

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Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
NovoTTF-200T	NovoTTF-200T	Patients receive TTFields using the NovoTTF-200T System together with gemcitabine and nab-Paclitaxel
NovoTTF-200T	Gemcitabine	Patients receive TTFields using the NovoTTF-200T System together with gemcitabine and nab-Paclitaxel
NovoTTF-200T	nab paclitaxel	Patients receive TTFields using the NovoTTF-200T System together with gemcitabine and nab-Paclitaxel
Best Standard of Care	Gemcitabine	Patients receive best standard of care with gemcitabine and nab-Paclitaxel
Best Standard of Care	nab paclitaxel	Patients receive best standard of care with gemcitabine and nab-Paclitaxel

Primary Outcome Measures

Name	Time	Method
Overall survival	4 years

Secondary Outcome Measures

Name	Time	Method
Progression-free survival	4 years
Puncture-free survival	4 years
Resectability rate	4 years
Local progression-free survival	4 years
Objective response rate	4 years
One-year survival rate	4 years
Quality of life	4 years	Quality of life will be assessed using the EORTC QLQ C-30 questionnaire with EORTC QLQ-PAN26 (Pancreatic Cancer symptom) supplement.
Pain-free survival	4 years	Pain-free survival will measured as the duration between the time of randomization until a greater than or equal to two-point decline from a baseline measurement in a patient self-reported visual analogue scale (VAS) is recorded or death, whichever occurs first.
Toxicity profile	4 years	Toxicity profile in patients treated with TTFields in combination with gemcitabine and nab-paclitaxel compared to the toxicity profile of patients treated with chemotherapy alone, measured by the rate of treatment-emergent toxicities in both arms. Adverse events will be collected and recorded based on the revised Common Terminology Criteria for Adverse Events (CTCAE) version 4.03.

Trial Locations

Locations (199)

St. John of God Murdoch Hospital; 🇦🇺 Murdoch, Western Australia, Australia

Monash Medical Centre; 🇦🇺 Clayton, Australia

Sydney Adventist Hospital; 🇦🇺 Wahroonga, Australia

Westmead Hosptial; 🇦🇺 Westmead, Australia

Klinikum Klagenfurt am Wörthersee; 🇦🇹 Klagenfurt, Wörthersee, Austria

Medical University Graz; 🇦🇹 Graz, Austria

Univ. Klinik für Innere Medizin III der PMU; 🇦🇹 Salzburg, Austria

Landes-Krankenhaus Steyr; 🇦🇹 Steyr, Austria

Faculté de Médecine Campus Erasme; 🇧🇪 Anderlecht, Belgium

UZ Leuven; 🇧🇪 Leuven, Belgium

Clinique Universutaire Saint Luc - Institut Roi Albert II; 🇧🇪 Woluwe-Saint-Lambert, Belgium

Centro de Pesquisa Clínica e Ensino Florianópolis LTDA; 🇧🇷 Florianópolis, Brazil

Oncosite - Centro de Pesquisa Clinica Em Oncologia Ltda; 🇧🇷 Ijuí, Brazil

Irmandade da Santa Casa de Misericórdia de Porto Alegre; 🇧🇷 Porto Alegre, Brazil

Hospital de Clínicas de Porto Alegre; 🇧🇷 Porto Alegre, Brazil

Hospital São Lucas da PUCRS; 🇧🇷 Porto Alegre, Brazil

IRPCc - Instituto Ribeirãopretano de Combate ao Câncer; 🇧🇷 Ribeirão Preto, Brazil

Oncoclinicas Group Botafogo; 🇧🇷 Rio De Janeiro, Brazil

Instituto D'Or de Pesquisa e Ensino - Rio De Janeiro; 🇧🇷 Rio De Janeiro, Brazil

Groupo Clinicas Oncologicas Integradas (COI) - Barra da Tijuca; 🇧🇷 Rio De Janeiro, Brazil

Instituto D´Or de Pesquisa e Ensino - Hospital São Rafael; 🇧🇷 São Marcos, Brazil

Hospital São Rafael; 🇧🇷 São Marcos, Brazil

Núcleo de Pesquisa Clínica da Rede São Camilo; 🇧🇷 São Paulo, Brazil

Onco Star SP Oncologia LTDA; 🇧🇷 São Paulo, Brazil

Clínica OncoStar - REDE D´OR; 🇧🇷 São Paulo, Brazil

London Regional Cancer Program, London Health Sciences Centre; 🇨🇦 London, Ontario, Canada

Centre Hospitalier de I'Universitaire de de Montreal (CHUM); 🇨🇦 Montréal, Quebec, Canada

Centre Hospitalier Universitaire de Sherbrooke CIUSSS de l'Estrie - CHUS; 🇨🇦 Sherbrooke, Quebec, Canada

Sun Yat-sen Memorial Hospital Sun Yat-sen University; 🇨🇳 Guangzhou, Guangdong, China

Harbin Medical University Cancer Hospital; 🇨🇳 Harbin, Heilongjiang, China

Union Hospital affiliated to Tongji Medical College of Huazhong University of Science and Technology; 🇨🇳 Wuhan, Hubei, China

Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology; 🇨🇳 Wuhan, Hubei, China

The First Affiliated Hospital of Xi 'an Jiaotong University; 🇨🇳 Xi'an, Shaanxi, China

Linyi Cancer Hospital; 🇨🇳 Linyi, Shandong, China

Sir Run Run Shaw Hospital, Zhejiang University School of Medicine; 🇨🇳 Hangzhou, Zhejiang, China

Beijing Cancer Hospital; 🇨🇳 Beijing, China

Peking University People'S Hospital; 🇨🇳 Beijing, China

The first hospital of Jilin University; 🇨🇳 Changchun, China

Jilin Guowen Hospital; 🇨🇳 Jilin, China

Guangdong provincial people's hospital; 🇨🇳 Guangzhou, China

Shanghai Changhai Hospital; 🇨🇳 Shanghai, China

Shanxi Provincial Cancer Hospital; 🇨🇳 Shanxi, China

Xingtai People's Hospital; 🇨🇳 Xingtai, China

The First Affiliated Hospital of Zhengzhou University; 🇨🇳 Zhengzhou, China

Henan Provincial Peoples Hospital; 🇨🇳 Zhengzhou, China

University Hospital Centre Zagreb; 🇭🇷 Zagreb, Croatia

Masaryk Institute of Oncology; 🇨🇿 Brno Střed, Czechia

Nemocnice Nový Jičín; 🇨🇿 Nový Jičín, Czechia

University Hospital Olomouc; 🇨🇿 Olomouc, Czechia

General University Hospital in Prague; 🇨🇿 Praha 2, Czechia

Nemocnice Na Bulovce; 🇨🇿 Praha 8, Czechia

Hopital haut-Léveque CHU Bordeaux - Service d'Hépato- Gastroentérologie et d'Oncologie digestive; 🇫🇷 Pessac, Bordeaux, France

Institut de Cancérologie de l'Ouest; 🇫🇷 Angers cedex, France

Centre Hospitalier de Bretagne Sud /Site du Scorff; 🇫🇷 Lorient, France

Centre Léon Bérard; 🇫🇷 Lyon, France

Service d'Oncologie médicale du Pr. Andre, Hôpital Saint-Antoine; 🇫🇷 Paris, France

Hôpital Privé des Côtes d'Armor; 🇫🇷 Plérin, France

Centre de Lutte Contre le Cancer (CLCC) - Centre Paul Strauss; 🇫🇷 Strasbourg, France

Clinique Sainte Anne - Groupe Hospitalier Saint-Vincent, Strasbourg Oncologie Libérale; 🇫🇷 Strasbourg, France

Klinikum Chemnitz gGmbH; 🇩🇪 Chemnitz, Germany

Medizinische Hochschule Hannover, Klinik fur Gastroenterologie, Hepatologie und Endokrinologie; 🇩🇪 Hannover, Germany

VK und K Studien GbR Landshut-Achdorf; 🇩🇪 Landshut, Germany

Bonifatius Hospital Hematology and Oncology; 🇩🇪 Lingen, Germany

Carl-von-Basedow-klinikum Saalekrei; 🇩🇪 Merseburg, Germany

Klinikum München Bogenhausen, Klinik für Gastroenterologie und Gastroenterologische Onkologie; 🇩🇪 München, Germany

Universitätsklinikum Ulm; 🇩🇪 Ulm, Germany

Queen Mary Hospital; 🇭🇰 Hong Kong, Hong Kong

National Institute of Oncology; 🇭🇺 Budapest, Hungary

Bekes County Hospital; 🇭🇺 Gyula, Hungary

Bacs-Kiskun County Hospital; 🇭🇺 Kecskemét, Hungary

Tolna County Hospital; 🇭🇺 Szekszárd, Hungary

Jasz-Nagykun-Szolnok County Hospital; 🇭🇺 Szolnok, Hungary

Rambam Health Care Campus, Oncology Institute; 🇮🇱 Haifa, Israel

Rabin Medical Center; 🇮🇱 Petah tikva, Israel

Hadassah Medical Center; 🇮🇱 Ramat Gan, Israel

Sheba Pancreatic Cancer Center - SPCC; 🇮🇱 Ramat Gan, Israel

Sourasky Medical Center, Oncology Department; 🇮🇱 Tel Aviv, Israel

A.O. SS Antonio e Biagio e Cesare Arrigo; 🇮🇹 Alessandria, Italy

Azienda Ospedaliero-Universitaria Careggi; 🇮🇹 Firenze, Italy

Università Campus Bio-Medico di Rome; 🇮🇹 Roma, Italy

Ospedale San Giovanni Calibita Fatebenefratelli Isola Tiberina; 🇮🇹 Roma, Italy

A.O.U Città della Salute e della Scienza di Torino; 🇮🇹 Torino, Italy

Dong-A University Hospital; 🇰🇷 Seogu, Busan, Korea, Republic of

Seoul National University Bundang Hospital; 🇰🇷 Seongnam-si, Gyeonggi-do, Korea, Republic of

Keimyung University, Dongsan hospital; 🇰🇷 Daegu, Korea, Republic of

National Cancer Center; 🇰🇷 Gyeonggi-do, Korea, Republic of

Chonnam National University Hwasun Hospital; 🇰🇷 Hwasun, Korea, Republic of

Gachon University Gil Hospital; 🇰🇷 Incheon, Korea, Republic of

Inha University Hospital; 🇰🇷 Incheon, Korea, Republic of

CHA Bundang Medical Center, CHA University; 🇰🇷 Seongnam-si, Korea, Republic of

Severance Hospital, Yonsei University Health System; 🇰🇷 Seoul, Korea, Republic of

Samsung Medical Center; 🇰🇷 Seoul, Korea, Republic of

The Catholic University of Korea, Seoul St. Mary's Hospital; 🇰🇷 Seoul, Korea, Republic of

Korea University Guro Hospital; 🇰🇷 Seoul, Korea, Republic of

Ajou University Hospital; 🇰🇷 Suwon, Korea, Republic of

Mediadvance Clinical; 🇲🇽 Chihuahua, Chih., Mexico

Accelerium S de RL de C.V.; 🇲🇽 Monterrey, NL, Mexico

Centro de Estudios de Alta Especialidad de Sinaloa, ubicado; 🇲🇽 Mazatlán, Sinaloa, Mexico

Centro de Investigación Médica Aguascalientes (CIMA),; 🇲🇽 Aguascalientes, Mexico

Clinstile S.A. de C.V.,; 🇲🇽 Cuauhtémoc, Mexico

Phylasis Clinicas Research S. de R.L. de C.V.; 🇲🇽 Cuautitlán Izcalli, Mexico

Hospitales Star Medica - Luna Parc; 🇲🇽 Estado De México, Mexico

Universidad Autonoma de Nuevo Leon - Hospital Universitario "Dr. Jose Eleuterio Gonzalez"; 🇲🇽 Monterrey, Mexico

Oncocenter - Puebla; 🇲🇽 Puebla, Mexico

Hospital Angeles San Luis; 🇲🇽 San Luis Potosí, Mexico

Centro Potosino de Investigación Médica SC,; 🇲🇽 San Luis Potosí, Mexico

Centro Hemato-Oncologico Privado CHOP; 🇲🇽 Toluca de Lerdo, Mexico

Phylasis Clinicas Research S.de R.L. de C.V. (PCR)-Toluca; 🇲🇽 Toluca De Lerdo, Mexico

FAICIC Clinical Research; 🇲🇽 Veracruz, Mexico

Oncology Clinic Clinical Hospital of Przemienienia Pańskiego UM in Poznaniu; 🇵🇱 Poznań, Poland

Centrum Medyczne MrukMed; 🇵🇱 Rzeszów, Poland

Oncology and Radiotherapy Clinic, Oncology Center - Institute; 🇵🇱 Warsaw, Poland

Oncology and Radiotherapy Clinic University Clinical Center Non-Invasive Medicine Center; 🇵🇱 Warsaw, Poland

Jan Mikulicz-Radecki University Teaching Hospital; 🇵🇱 Wrocław, Poland

Instituto Oncòlogico Dr. Rosell; 🇪🇸 Barcelona, Spain

Vall d´Hebron University Hospital; 🇪🇸 Barcelona, Spain

Hospital General Universitario de Elche; 🇪🇸 Elche, Spain

HM Hospitales - Centro Integral Oncologico Clara Campal - CIOCC; 🇪🇸 Madrid, Spain

Hospital Regional Universitario de Málaga; 🇪🇸 Málaga, Spain

Clinica Universiatria de Navarra; 🇪🇸 Pamplona, Spain

Hospital Universitario Marqués de Valdecilla; 🇪🇸 Santander, Spain

Instituto Valenciano de Oncología IVO; 🇪🇸 Valencia, Spain

Hôpital Fribourgeois/Freiburger Spital; 🇨🇭 Fribourg, Switzerland

KS Winterthur; 🇨🇭 Winterthur, Switzerland

Peking Union Medical College Hospital; 🇨🇳 Beijing, China

Grandview Medical Center, Cancer Center; 🇺🇸 Birmingham, Alabama, United States

Infirmary Cancer Care; 🇺🇸 Mobile, Alabama, United States

Banner MD Anderson Cancer Center; 🇺🇸 Gilbert, Arizona, United States

Arizona Oncology Associates, PC- HOPE - US Oncology Research; 🇺🇸 Tucson, Arizona, United States

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

Pacific Cancer Medical Center; 🇺🇸 Anaheim, California, United States

St. Joseph Heritage Healthcare - Virginia K. Crosson Cancer Center; 🇺🇸 Fullerton, California, United States

Cedars-Sinai Medical Center; 🇺🇸 Los Angeles, California, United States

Dignity Health - Mercy Cancer Centers; 🇺🇸 Sacramento, California, United States

Sutter Cancer Center Sacramento; 🇺🇸 Sacramento, California, United States

Adventist Health St. Helena - Martin-O'Neil Cancer Center (MOCC); 🇺🇸 Saint Helena, California, United States

Ridley-Tree Cancer Center; 🇺🇸 Santa Barbara, California, United States

Associated Neurologists of Southern Connecticut, P.C.; 🇺🇸 Milford, Connecticut, United States

Boca Raton Regional Hospital, Lynn Cancer Institute; 🇺🇸 Boca Raton, Florida, United States

Florida Cancer Specialists & Research Institute - Colonial Office; 🇺🇸 Fort Myers, Florida, United States

Mayo Clinic Hospital - Florida; 🇺🇸 Jacksonville, Florida, United States

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

AdventHealth Neuro Oncology; 🇺🇸 Orlando, Florida, United States

BRCR Medical Center INC; 🇺🇸 Plantation, Florida, United States

Florida Cancer Specialists; 🇺🇸 Saint Petersburg, Florida, United States

Florida Hospital Tampa; 🇺🇸 Tampa, Florida, United States

Piedmont Cancer Institute; 🇺🇸 Atlanta, Georgia, United States

Illinois Cancer Specialist - US Oncology Research; 🇺🇸 Arlington Heights, Illinois, United States

Rush University Medical Center; 🇺🇸 Chicago, Illinois, United States

NorthShore University HealthSystem; 🇺🇸 Evanston, Illinois, United States

Loyola University Medical Center; 🇺🇸 Maywood, Illinois, United States

University of Kansas Medical Cancer Center; 🇺🇸 Fairway, Kansas, United States

Cotton O'Neil Cancer Center (Stormont-Vail Cancer Center); 🇺🇸 Topeka, Kansas, United States

Saint Elizabeth Healthcare; 🇺🇸 Edgewood, Kentucky, United States

Norton Cancer Institute, Norton Healthcare Pavilion; 🇺🇸 Louisville, Kentucky, United States

Ochsner Medical Center; 🇺🇸 New Orleans, Louisiana, United States

Central Maine Medical Center, Clinical Research Department; 🇺🇸 Lewiston, Maine, United States

University of Maryland Comprehensive Cancer Center; 🇺🇸 Baltimore, Maryland, United States

Maryland Oncology Hematology, P.A - US Oncology Research; 🇺🇸 Columbia, Maryland, United States

Beth Israel Deaconess Medical Center; 🇺🇸 Boston, Massachusetts, United States

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

Karmanos Cancer Institute; 🇺🇸 Detroit, Michigan, United States

Cancer and Hematology Centers of Western Michigan, PC; 🇺🇸 Grand Rapids, Michigan, United States

University of Minnesota; 🇺🇸 Minneapolis, Minnesota, United States

MidAmerica Division; 🇺🇸 Kansas City, Missouri, United States

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

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

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

Renown Institute for Heart & Vascular Health; 🇺🇸 Reno, Nevada, United States

Astera Cancer Care; 🇺🇸 East Brunswick, New Jersey, United States

Kaleida Health; 🇺🇸 Buffalo, New York, United States

Bassett Medical Center; 🇺🇸 Cooperstown, New York, United States

New York Hospital Queens; 🇺🇸 Flushing, New York, United States

NYU Langone Arena Oncology; 🇺🇸 Lake Success, New York, United States

White Plains Hospital - Center for Cancer Care; 🇺🇸 White Plains, New York, United States

Novant Health Oncology Specialists; 🇺🇸 Winston-Salem, North Carolina, United States

Gabrail Cancer Research Center; 🇺🇸 Canton, Ohio, United States

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

University of Oklahoma Health Sciences Center; 🇺🇸 Oklahoma City, Oklahoma, United States

Willamette Valley Cancer Institute and Research Center - US Oncology Research; 🇺🇸 Eugene, Oregon, United States

Geisinger Medical Center; 🇺🇸 Danville, Pennsylvania, United States

Vita Medical Associates, P.C.; 🇺🇸 Fountain Hill, Pennsylvania, United States

UT/Erlanger Oncology & Hematology; 🇺🇸 Chattanooga, Tennessee, United States

Tennessee Cancer Specialists; 🇺🇸 Knoxville, Tennessee, United States

Tennessee Oncology; 🇺🇸 Nashville, Tennessee, United States

Texas Oncology - Beaumont Mamie McFaddin Ward Cancer Center - US Oncology Research; 🇺🇸 Beaumont, Texas, United States

Texas Oncology - Bedford - US Oncology Reasearch; 🇺🇸 Bedford, Texas, United States

Methodist Regional Cancer Center; 🇺🇸 Dallas, Texas, United States

Texas Oncology - Baylor - US Oncology Research; 🇺🇸 Dallas, Texas, United States

Texas Oncology - El Paso Cancer Treatment Center Gateway - US Oncology Research; 🇺🇸 El Paso, Texas, United States

Houston Methodist Cancer Center; 🇺🇸 Houston, Texas, United States

Baylor Scott and White Medical Center; 🇺🇸 Temple, Texas, United States

Texas Oncology - Tyler - US Oncology Research; 🇺🇸 Tyler, Texas, United States

Oncology and Hematology Associates of Southwest Virginia, Inc., DBA Blue Ridge Cancer Care - US Oncology Research; 🇺🇸 Roanoke, Virginia, United States

Vista Oncology Inc PS; 🇺🇸 Olympia, Washington, United States

Virginia Mason Medical Center; 🇺🇸 Seattle, Washington, United States

Seattle Cancer Care Alliance; 🇺🇸 Seattle, Washington, United States

West Virginia University Cancer Institute; 🇺🇸 Morgantown, West Virginia, United States

Greenslopes Private Hospital; 🇦🇺 Greenslopes, Queensland, Australia