S0802 - Topotecan With or Without Aflibercept in Treating Patients With Extensive-Stage Small Cell Lung Cancer

Phase 2

Completed

Conditions: Extensive Stage Small Cell Lung Cancer
Recurrent Small Cell Lung Cancer

Interventions: Biological: ziv-aflibercept
Drug: topotecan hydrochloride

Registration Number: NCT00828139

Lead Sponsor: National Cancer Institute (NCI)

Brief Summary: This randomized phase II trial is studying topotecan to see how well it works when given with or without aflibercept in treating patients with extensive-stage small cell lung cancer. Drugs used in chemotherapy, such as topotecan, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Combinations of biological substances in aflibercept may be able to carry tumor-killing substances directly to small cell lung cancer cells. Aflibercept may also stop the growth of small cell lung cancer by blocking blood flow to the tumor. It is not yet known whether topotecan is more effective with or without aflibercept in treating patients with small cell lung cancer.

Detailed Description: PRIMARY OBJECTIVES:

I. Evaluate the efficacy of topotecan hydrochloride with vs without aflibercept (ziv-aflibercept), in terms of progression-free survival at 3 months, in patients with extensive stage small cell lung cancer previously treated with platinum-based therapy.

SECONDARY OBEJCTIVES:

I. Assess the response rate (confirmed and unconfirmed, complete and partial responses) in a subset of patients with measurable disease.

II. Assess the overall survival of these patients. III. Evaluate the frequency and severity of toxicities of these regimens in these patients.

OUTLINE: This is a multicenter study. Patients are stratified according to response to prior platinum-based therapy (platinum-sensitive disease vs platinum-refractory disease). Patients are randomized to 1 of 2 treatment arms.

ARM I: Patients receive ziv-aflibercept IV over 1 hour on day 1 and topotecan hydrochloride IV over 30 minutes on days 1, 8, and 15. Treatment repeats every 21 days for 4 courses in the absence of disease progression or unacceptable toxicity. Patients with responsive or stable disease after 4 courses may then receive ziv-aflibercept IV on day 1 and topotecan hydrochloride IV on days 1 and 8. Treatment repeats every 21 days in the absence of disease progression or unacceptable toxicity.

ARM II: Patients receive topotecan hydrochloride IV over 30 minutes on days 1, 8, and 15. Treatment repeats every 21 days for 4 courses in the absence of disease progression or unacceptable toxicity. Patients with responsive or stable disease after 4 courses may then receive topotecan hydrochloride IV on days 1 and 8. Treatment repeats every 21 days in the absence of disease progression or unacceptable toxicity.

After completion of study therapy, patients are followed periodically for up to 2 years.

Recruitment & Eligibility

Status: COMPLETED

Sex: All

Target Recruitment: 189

Inclusion Criteria

Histologically or cytologically confirmed extensive stage small cell lung cancer
- Progressive or recurrent disease following one (and only one) standard first-line platinum-containing regimen (cisplatin or carboplatin)
Measurable or non-measurable disease per RECIST criteria
- Disease must be outside a previously irradiated field OR a new lesion must be inside the irradiated field
- Disease must be outside a previously resected area OR a new lesion must be present
No known brain metastasis unless the metastasis has been treated and is stable for ≥ 3 months prior to study entry
No leptomeningeal involvement or brain stem metastasis
Zubrod performance status 0-1
ANC ≥ 1,500/mm^3
Platelet count ≥ 100,000/mm^3
Hemoglobin ≥ 10 g/dL
Serum creatinine ≤ 1.5 times upper limit of normal OR creatinine clearance ≥ 60 mL/min
Urine protein: creatinine ratio < 1 OR urine protein < 500 mg by 24-hour urine collection
Not pregnant or nursing
Fertile patients must use effective contraception
Willing to provide smoking history
No evidence of active infection
No active bleeding
No significant history of bleeding diathesis, including hemoptysis (½ teaspoon of hemoptysis within the past 3 months), or underlying coagulopathy
No history of recent arterial embolic events, including any of the following:
- Myocardial infarction
- Cerebrovascular accident
- Transient ischemic attack
- Worsening of pre-existing angina within the past 6 months
No uncontrolled hypertension (systolic BP > 150 mm Hg or diastolic BP > 100 mm Hg)
- History of hypertension allowed provided it is controlled on anti-hypertensive medications
No history of congestive heart failure
No history of encephalitis or encephalopathy of any cause
No diverticulitis, gastrointestinal bleeding, or peptic ulcer within the past 3 months
No known AIDS or HIV-1 associated complex
No known history of immune or immunodeficiency disorders
No unstable or pre-existing major medical conditions except for cancer-related abnormalities
No other prior malignancy except for any of the following:
- Adequately treated basal cell or squamous cell skin cancer
- In situ cervical cancer
- Adequately treated stage I or II cancer currently in complete remission
- Any other cancer from which the patient been disease-free for 5 years
Concurrent chronic therapeutic doses of low molecular weight heparin allowed
At least 21 days since prior and no concurrent radiotherapy and recovered
At least 28 days since prior and no concurrent surgery (e.g., thoracic or other major surgeries) and recovered
No prior bevacizumab or other anti-angiogenic therapies including, but not limited to, small molecule tyrosine kinase inhibitors
No concurrent enzyme-inducing anticonvulsant drugs
- Non-enzyme-inducing anticonvulsant drugs (e.g., Keppra) allowed
Concurrent chronic oral anticoagulation therapy allowed provided INR is maintained in the therapeutic range (INR 2-3)

Exclusion Criteria

Not provided

Study & Design

Study Type: INTERVENTIONAL

Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Arm I (ziv-aflibercept, topotecan hydrochloride)	topotecan hydrochloride	Patients receive ziv-aflibercept IV over 1 hour on day 1 and topotecan hydrochloride IV over 30 minutes on days 1, 8, and 15. Treatment repeats every 21 days for 4 courses in the absence of disease progression or unacceptable toxicity. Patients with responsive or stable disease after 4 courses may then receive ziv-aflibercept IV on day 1 and topotecan hydrochloride IV on days 1 and 8. Treatment repeats every 21 days in the absence of disease progression or unacceptable toxicity.
Arm I (ziv-aflibercept, topotecan hydrochloride)	ziv-aflibercept	Patients receive ziv-aflibercept IV over 1 hour on day 1 and topotecan hydrochloride IV over 30 minutes on days 1, 8, and 15. Treatment repeats every 21 days for 4 courses in the absence of disease progression or unacceptable toxicity. Patients with responsive or stable disease after 4 courses may then receive ziv-aflibercept IV on day 1 and topotecan hydrochloride IV on days 1 and 8. Treatment repeats every 21 days in the absence of disease progression or unacceptable toxicity.
Arm II (topotecan hydrochloride)	topotecan hydrochloride	Patients receive topotecan hydrochloride IV over 30 minutes on days 1, 8, and 15. Treatment repeats every 21 days for 4 courses in the absence of disease progression or unacceptable toxicity. Patients with responsive or stable disease after 4 courses may then receive topotecan hydrochloride IV on days 1 and 8. Treatment repeats every 21 days in the absence of disease progression or unacceptable toxicity.

Primary Outcome Measures

Name	Time	Method
Progression-free Survival (PFS)	Disease assessments were performed every 6 weeks, up to 2 years.	From the date of registration to date of first documentation of progression or symptomatic deterioration, or death due to any cause. Progression is defined as 20% increase in the sum of longest diameters of target measurable lesions over smallest sum observed (over baseline if no decrease during therapy) using the same techniques as baseline. Unequivocal progression of non-measurable disease in the opinion of the treating physician (an explanation must be provided). Appearance of any new lesion/site. Death due to disease without prior documentation of progression and without symptomatic deterioration.

Secondary Outcome Measures

Name	Time	Method
Response Rate (Confirmed and Unconfirmed, Complete and Partial Responses)	Disease assessment for response were performed every 6 weeks, up to 2 years.	The number of confirmed and unconfirmed complete and partial responses in the subset of patients with measurable disease per RECIST 1.0. Estimated to within at least 17% (95% confidence interval). Per Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.0) for target lesions and assessed by magnetic resonance imaging (MRI): Complete Response (CR), Disappearance of all target lesions; Partial Response (PR), \>=30% decrease in the sum of the longest diameter of target lesions; Overall Response (OR) = CR + PR.
Overall Survival	Weekly, up to 2 years.	Estimated to within at least 15% (95% confidence interval).
Number of Patients With Grade 3 Through 5 Adverse Events That Are Related to Study Drugs	Toxicity assessment was evaluated after each cycle (21 days), up to 2 years.	Adverse Events (AEs) are reported by CTCAE Version 3.0. Only adverse events that are possibly, probably or definitely related to study drug are reported. The events listed here are not necessary to be included in Serious Adverse Event. A serious event could be death, life-threatening, hospitalization, disability or permanent damage, congenital anomaly...Grade 3 through 5 adverse event may not meet the criterion of serious adverse event.

Trial Locations

Locations (257): NEA Baptist Memorial Hospital
🇺🇸
Jonesboro, Arkansas, United States
Cancer Care Center of Decatur
🇺🇸
Decatur, Illinois, United States
Good Samaritan Regional Health Center
🇺🇸
Mount Vernon, Illinois, United States
University of Mississippi Medical Center
🇺🇸
Jackson, Mississippi, United States
Glacier Oncology PLLC
🇺🇸
Kalispell, Montana, United States
Community Medical Hospital
🇺🇸
Missoula, Montana, United States
Providence Newberg Medical Center
🇺🇸
Newberg, Oregon, United States
Dekalb Medical Center
🇺🇸
Decatur, Georgia, United States
Memorial Health University Medical Center
🇺🇸
Savannah, Georgia, United States
Decatur Memorial Hospital
🇺🇸
Decatur, Illinois, United States
Lahey Hospital and Medical Center
🇺🇸
Burlington, Massachusetts, United States
Munson Medical Center
🇺🇸
Traverse City, Michigan, United States
Guardian Oncology and Center for Wellness
🇺🇸
Missoula, Montana, United States
Kettering Medical Center
🇺🇸
Kettering, Ohio, United States
Benefis Healthcare- Sletten Cancer Institute
🇺🇸
Great Falls, Montana, United States
Kalispell Medical Oncology
🇺🇸
Kalispell, Montana, United States
Berdeaux, Donald MD (UIA Investigator)
🇺🇸
Great Falls, Montana, United States
Montana Cancer Specialists
🇺🇸
Missoula, Montana, United States
Licking Memorial Hospital
🇺🇸
Newark, Ohio, United States
Sinai Hospital of Baltimore
🇺🇸
Baltimore, Maryland, United States
Piedmont Hospital
🇺🇸
Atlanta, Georgia, United States
Atlanta Regional CCOP
🇺🇸
Atlanta, Georgia, United States
Northside Hospital
🇺🇸
Atlanta, Georgia, United States
Saint Joseph's Hospital of Atlanta
🇺🇸
Atlanta, Georgia, United States
Doctors Hospital
🇺🇸
Columbus, Ohio, United States
Boston Medical Center
🇺🇸
Boston, Massachusetts, United States
Baylor College of Medicine
🇺🇸
Houston, Texas, United States
Saint Luke's Episcopal Hospital
🇺🇸
Houston, Texas, United States
Methodist Hospital
🇺🇸
Houston, Texas, United States
Fred Hutchinson Cancer Research Center/University of Washington Cancer Consortium
🇺🇸
Seattle, Washington, United States
Veterans Administration Medical Center
🇺🇸
Houston, Texas, United States
The Polyclinic
🇺🇸
Seattle, Washington, United States
Minor and James Medical PLLC
🇺🇸
Seattle, Washington, United States
Group Health Cooperative-Seattle
🇺🇸
Seattle, Washington, United States
University of Washington Medical Center
🇺🇸
Seattle, Washington, United States
Swedish Medical Center-First Hill
🇺🇸
Seattle, Washington, United States
University of Cincinnati
🇺🇸
Cincinnati, Ohio, United States
Southwest Oncology Group
🇺🇸
San Antonio, Texas, United States
Lawrence Memorial Hospital
🇺🇸
Lawrence, Kansas, United States
Cancer Center of Kansas - Pratt
🇺🇸
Pratt, Kansas, United States
Cancer Center of Kansas-Liberal
🇺🇸
Liberal, Kansas, United States
Cancer Center of Kansas - Parsons
🇺🇸
Parsons, Kansas, United States
Cancer Center of Kansas - Wellington
🇺🇸
Wellington, Kansas, United States
Rocky Mountain Oncology
🇺🇸
Casper, Wyoming, United States
Cancer Center of Kansas-Independence
🇺🇸
Independence, Kansas, United States
Associates In Womens Health
🇺🇸
Wichita, Kansas, United States
Wichita CCOP
🇺🇸
Wichita, Kansas, United States
Cancer Center of Kansas - Chanute
🇺🇸
Chanute, Kansas, United States
Cancer Center of Kansas - Dodge City
🇺🇸
Dodge City, Kansas, United States
Cancer Center of Kansas - Winfield
🇺🇸
Winfield, Kansas, United States
Hospital District Sixth of Harper County
🇺🇸
Anthony, Kansas, United States
Promise Regional Medical Center-Hutchinson
🇺🇸
Hutchinson, Kansas, United States
Olathe Cancer Center
🇺🇸
Olathe, Kansas, United States
Cancer Center of Kansas-Wichita Medical Arts Tower
🇺🇸
Wichita, Kansas, United States
Cancer Center of Kansas - Main Office
🇺🇸
Wichita, Kansas, United States
Cancer Center of Kansas - Fort Scott
🇺🇸
Fort Scott, Kansas, United States
Via Christi Hospital-Pittsburg
🇺🇸
Pittsburg, Kansas, United States
Saint Francis Hospital and Medical Center - Topeka
🇺🇸
Topeka, Kansas, United States
Salina Regional Health Center
🇺🇸
Salina, Kansas, United States
Stormont-Vail Regional Health Center
🇺🇸
Topeka, Kansas, United States
University of Rochester
🇺🇸
Rochester, New York, United States
Ozark Health Ventures LLC dba Cancer Research for The Ozarks Springfield
🇺🇸
Springfield, Missouri, United States
Novant Health Presbyterian Medical Center
🇺🇸
Charlotte, North Carolina, United States
Columbia University Medical Center
🇺🇸
New York, New York, United States
Saint John's Mercy Medical Center
🇺🇸
Saint Louis, Missouri, United States
Highland Hospital
🇺🇸
Rochester, New York, United States
Saint Patrick Hospital - Community Hospital
🇺🇸
Missoula, Montana, United States
Arnot Ogden Medical Center
🇺🇸
Elmira, New York, United States
Saint Louis-Cape Girardeau CCOP
🇺🇸
Saint Louis, Missouri, United States
Nevada Cancer Research Foundation CCOP
🇺🇸
Las Vegas, Nevada, United States
Oakwood Hospital
🇺🇸
Dearborn, Michigan, United States
Winthrop University Hospital
🇺🇸
Mineola, New York, United States
Randolph Hospital
🇺🇸
Asheboro, North Carolina, United States
CoxHealth South Hospital
🇺🇸
Springfield, Missouri, United States
Saint Mary Mercy Hospital
🇺🇸
Livonia, Michigan, United States
Riverside Methodist Hospital
🇺🇸
Columbus, Ohio, United States
University Medical Center of Southern Nevada
🇺🇸
Las Vegas, Nevada, United States
Adirondack Cancer Center
🇺🇸
Glens Falls, New York, United States
Carolinas Medical Center
🇺🇸
Charlotte, North Carolina, United States
Mercy Health Saint Mary's
🇺🇸
Grand Rapids, Michigan, United States
Carolinas Medical Center - Northeast
🇺🇸
Concord, North Carolina, United States
Adena Regional Medical Center
🇺🇸
Chillicothe, Ohio, United States
Upper Valley Medical Center
🇺🇸
Troy, Ohio, United States
Wayne Memorial Hospital
🇺🇸
Goldsboro, North Carolina, United States
Mary Rutan Hospital
🇺🇸
Bellefontaine, Ohio, United States
Margaret R Pardee Memorial Hospital
🇺🇸
Hendersonville, North Carolina, United States
Clinton Memorial Hospital
🇺🇸
Wilmington, Ohio, United States
Providence Milwaukie Hospital
🇺🇸
Milwaukie, Oregon, United States
Salem Hospital
🇺🇸
Salem, Oregon, United States
Grant Medical Center
🇺🇸
Columbus, Ohio, United States
McLeod Regional Medical Center
🇺🇸
Florence, South Carolina, United States
Samaritan North Health Center
🇺🇸
Dayton, Ohio, United States
Marietta Memorial Hospital
🇺🇸
Marietta, Ohio, United States
Saint Ann's Hospital
🇺🇸
Westerville, Ohio, United States
Highline Medical Center-Main Campus
🇺🇸
Burien, Washington, United States
Columbus CCOP
🇺🇸
Columbus, Ohio, United States
Springfield Regional Medical Center
🇺🇸
Springfield, Ohio, United States
Evergreen Hematology and Oncology PS
🇺🇸
Spokane, Washington, United States
AnMed Health Hospital
🇺🇸
Anderson, South Carolina, United States
Knox Community Hospital
🇺🇸
Mount Vernon, Ohio, United States
Harrison HealthPartners Hematology and Oncology-Poulsbo
🇺🇸
Poulsbo, Washington, United States
Welch Cancer Center
🇺🇸
Sheridan, Wyoming, United States
Ben Taub General Hospital
🇺🇸
Houston, Texas, United States
Scott and White Memorial Hospital
🇺🇸
Temple, Texas, United States
PeaceHealth Saint Joseph Medical Center
🇺🇸
Bellingham, Washington, United States
Harrison HealthPartners Hematology and Oncology-Bremerton
🇺🇸
Bremerton, Washington, United States
Skagit Valley Hospital
🇺🇸
Mount Vernon, Washington, United States
Wayne State University/Karmanos Cancer Institute
🇺🇸
Detroit, Michigan, United States
Saint John Hospital and Medical Center
🇺🇸
Detroit, Michigan, United States
Western Oncology Research Consortium
🇺🇸
Portland, Oregon, United States
Adventist 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 Louis University Hospital
🇺🇸
Saint Louis, Missouri, United States
Huntsman Cancer Institute/University of Utah
🇺🇸
Salt Lake City, Utah, United States
Interlakes Foundation Inc-Rochester
🇺🇸
Rochester, New York, United States
Harborview Medical Center
🇺🇸
Seattle, Washington, United States
Cancer Care Northwest - Spokane South
🇺🇸
Spokane, Washington, United States
Rockwood Clinic
🇺🇸
Spokane, Washington, United States
PeaceHealth Southwest Medical Center
🇺🇸
Vancouver, Washington, United States
Compass Oncology Vancouver
🇺🇸
Vancouver, Washington, United States
Dayton CCOP
🇺🇸
Dayton, Ohio, United States
Wayne Hospital
🇺🇸
Greenville, Ohio, United States
Fairfield Medical Center
🇺🇸
Lancaster, Ohio, United States
Southern Ohio Medical Center
🇺🇸
Portsmouth, Ohio, United States
Wright-Patterson Medical Center
🇺🇸
Wright-Patterson Air Force Base, Ohio, United States
Gaston Memorial Hospital
🇺🇸
Gastonia, North Carolina, United States
Cone Health Cancer Center
🇺🇸
Greensboro, North Carolina, United States
Iredell Memorial Hospital
🇺🇸
Statesville, North Carolina, United States
Rutherford Hospital
🇺🇸
Rutherfordton, North Carolina, United States
Highlands Oncology Group-Rogers
🇺🇸
Rogers, Arkansas, United States
Veterans Affairs Medical Center - Memphis
🇺🇸
Memphis, Tennessee, United States
Mount Carmel Health Center West
🇺🇸
Columbus, Ohio, United States
Mercy Hospital Springfield
🇺🇸
Springfield, Missouri, United States
Wenatchee Valley Medical Center
🇺🇸
Wenatchee, Washington, United States
Providence Portland Medical Center
🇺🇸
Portland, Oregon, United States
University of Tennessee - Memphis
🇺🇸
Memphis, Tennessee, United States
Danville Regional Medical Center
🇺🇸
Danville, Virginia, United States
Memorial Hospital Of Martinsville
🇺🇸
Martinsville, Virginia, United States
Northeast Alabama Regional Medical Center
🇺🇸
Anniston, Alabama, United States
Providence Hospital
🇺🇸
Mobile, Alabama, United States
Arizona Cancer Center at University Medical Center North
🇺🇸
Tucson, Arizona, United States
Arizona Cancer Center at UMC Orange Grove
🇺🇸
Tucson, Arizona, United States
University of Arizona Health Sciences Center
🇺🇸
Tucson, Arizona, United States
University of Arkansas for Medical Sciences
🇺🇸
Little Rock, Arkansas, United States
Eden Hospital Medical Center
🇺🇸
Castro Valley, California, United States
East Bay Radiation Oncology Center
🇺🇸
Castro Valley, California, United States
Valley Medical Oncology Consultants-Castro Valley
🇺🇸
Castro Valley, California, United States
Valley Medical Oncology Consultants-Fremont
🇺🇸
Fremont, California, United States
Contra Costa Regional Medical Center
🇺🇸
Martinez, California, United States
El Camino Hospital
🇺🇸
Mountain View, California, United States
City of Hope Medical Center
🇺🇸
Duarte, California, United States
Fremont - Rideout Cancer Center
🇺🇸
Marysville, California, United States
Highland General Hospital
🇺🇸
Oakland, California, United States
Larry G Strieff MD Medical Corporation
🇺🇸
Oakland, California, United States
Alta Bates Summit Medical Center - Summit Campus
🇺🇸
Oakland, California, United States
Bay Area Breast Surgeons Inc
🇺🇸
Oakland, California, United States
Bay Area Tumor Institute CCOP
🇺🇸
Oakland, California, United States
Tom K Lee Inc
🇺🇸
Oakland, California, United States
Valley Care Health System - Pleasanton
🇺🇸
Pleasanton, California, United States
Valley Medical Oncology Consultants
🇺🇸
Pleasanton, California, United States
Doctors Medical Center- JC Robinson Regional Cancer Center
🇺🇸
San Pablo, California, United States
The Shaw Regional Cancer Center
🇺🇸
Edwards, Colorado, United States
San Luis Valley Regional Medical Center
🇺🇸
Alamosa, Colorado, United States
Saint Mary's Hospital and Regional Medical Center
🇺🇸
Grand Junction, Colorado, United States
Valley View Hospital Cancer Center
🇺🇸
Glenwood Springs, Colorado, United States
Montrose Memorial Hospital
🇺🇸
Montrose, Colorado, United States
Saint Francis Hospital and Medical Center
🇺🇸
Hartford, Connecticut, United States
John B Amos Cancer Center
🇺🇸
Columbus, Georgia, United States
Well Star Cobb Hospital
🇺🇸
Austell, Georgia, United States
Piedmont Fayette Hospital
🇺🇸
Fayetteville, Georgia, United States
Wellstar Kennestone Hospital
🇺🇸
Marietta, Georgia, United States
Harbin Clinic Medical Oncology and Clinical Research
🇺🇸
Rome, Georgia, United States
Gwinnett Medical Center
🇺🇸
Lawrenceville, Georgia, United States
Saint Anthony's Health
🇺🇸
Alton, Illinois, United States
Southern Regional Medical Center
🇺🇸
Riverdale, Georgia, United States
South Georgia Medical Center
🇺🇸
Valdosta, Georgia, United States
Saint Alphonsus Regional Medical Center
🇺🇸
Boise, Idaho, United States
Saint Francis Hospital and Health Centers
🇺🇸
Beech Grove, Indiana, United States
Reid Hospital and Health Care Services
🇺🇸
Richmond, Indiana, United States
Loyola University Medical Center
🇺🇸
Maywood, Illinois, United States
Genesis Medical Center - East Campus
🇺🇸
Davenport, Iowa, United States
Memorial Medical Center
🇺🇸
Springfield, Illinois, United States
Genesis Medical Center - West Campus
🇺🇸
Davenport, Iowa, United States
Hays Medical Center
🇺🇸
Hays, Kansas, United States
Kansas City Cancer Center-West
🇺🇸
Kansas City, Kansas, United States
Cancer Center of Kansas-Kingman
🇺🇸
Kingman, Kansas, United States
Cancer Center of Kansas - Newton
🇺🇸
Newton, Kansas, United States
Cancer Center of Kansas - Salina
🇺🇸
Salina, Kansas, United States
Mary Bird Perkins Cancer Center
🇺🇸
Baton Rouge, Louisiana, United States
Via Christi Regional Medical Center
🇺🇸
Wichita, Kansas, United States
Baton Rouge General Medical Center
🇺🇸
Baton Rouge, Louisiana, United States
Holy Family Hospital
🇺🇸
Methuen, Massachusetts, United States
Bronson Battle Creek
🇺🇸
Battle Creek, Michigan, United States
Spectrum Health Big Rapids Hospital
🇺🇸
Big Rapids, Michigan, United States
Hurley Medical Center
🇺🇸
Flint, Michigan, United States
Spectrum Health at Butterworth Campus
🇺🇸
Grand Rapids, Michigan, United States
Allegiance Health
🇺🇸
Jackson, Michigan, United States
Grand Rapids Clinical Oncology Program
🇺🇸
Grand Rapids, Michigan, United States
Sparrow Hospital
🇺🇸
Lansing, Michigan, United States
Saint Mary's of Michigan
🇺🇸
Saginaw, Michigan, United States
Saint Joseph Mercy Oakland
🇺🇸
Pontiac, Michigan, United States
Mercy Health Mercy Campus
🇺🇸
Muskegon, Michigan, United States
Saint Joseph Mercy Port Huron
🇺🇸
Port Huron, Michigan, United States
Saint John Macomb-Oakland Hospital
🇺🇸
Warren, Michigan, United States
Metro Health Hospital
🇺🇸
Wyoming, Michigan, United States
Gulfport Memorial Hospital
🇺🇸
Gulfport, Mississippi, United States
Saint Francis Medical Center
🇺🇸
Cape Girardeau, Missouri, United States
Singing River Hospital
🇺🇸
Pascagoula, Mississippi, United States
Saint Louis Cancer and Breast Institute-South City
🇺🇸
Saint Louis, Missouri, United States
Bozeman Deaconess Cancer Center
🇺🇸
Bozeman, Montana, United States
Saint James Community Hospital and Cancer Treatment Center
🇺🇸
Butte, Montana, United States
Kalispell Regional Medical Center
🇺🇸
Kalispell, Montana, United States
High Point Regional Hospital
🇺🇸
High Point, North Carolina, United States
Annie Penn Memorial Hospital
🇺🇸
Reidsville, North Carolina, United States
Akron General Medical Center
🇺🇸
Akron, Ohio, United States
Blanchard Valley Hospital
🇺🇸
Findlay, Ohio, United States
Grady Memorial Hospital
🇺🇸
Delaware, Ohio, United States
Miami Valley Hospital
🇺🇸
Dayton, Ohio, United States
Good Samaritan Hospital - Dayton
🇺🇸
Dayton, Ohio, United States
Atrium Medical Center-Middletown Regional Hospital
🇺🇸
Franklin, Ohio, United States
Genesis HealthCare System
🇺🇸
Zanesville, Ohio, United States
Clackamas Radiation Oncology Center
🇺🇸
Clackamas, Oregon, United States
Providence Willamette Falls Medical Center
🇺🇸
Oregon City, Oregon, United States
Spartanburg Regional Medical Center
🇺🇸
Spartanburg, South Carolina, United States
Upstate Carolina CCOP
🇺🇸
Spartanburg, South Carolina, United States
University of Tennessee - Knoxville
🇺🇸
Knoxville, Tennessee, United States
University of Texas Medical Branch at Galveston
🇺🇸
Galveston, Texas, United States
Texas Tech University Health Sciences Center
🇺🇸
Lubbock, Texas, United States
Cancer Care Center at Island Hospital
🇺🇸
Anacortes, Washington, United States
Columbia Basin Hematology and Oncology PLLC
🇺🇸
Kennewick, Washington, United States
United General Hospital
🇺🇸
Sedro-Woolley, Washington, United States
Genesys Regional Medical Center-West Flint Campus
🇺🇸
Flint, Michigan, United States
University of California at Davis Cancer Center
🇺🇸
Sacramento, California, United States
University of Colorado Cancer Center - Anschutz Cancer Pavilion
🇺🇸
Aurora, Colorado, United States
Saint Joseph Mercy Hospital
🇺🇸
Ann Arbor, Michigan, United States
Michigan Cancer Research Consortium Community Clinical Oncology Program
🇺🇸
Ann Arbor, Michigan, United States
University of Michigan
🇺🇸
Ann Arbor, Michigan, United States
Northern Rockies Radiation Oncology Center
🇺🇸
Billings, Montana, United States
Saint Vincent Healthcare
🇺🇸
Billings, Montana, United States
Bozeman Deaconess Hospital
🇺🇸
Bozeman, Montana, United States
Big Sky Oncology
🇺🇸
Great Falls, Montana, United States
Hematology-Oncology Centers of the Northern Rockies PC
🇺🇸
Billings, Montana, United States
Billings Clinic
🇺🇸
Billings, Montana, United States
Great Falls Clinic
🇺🇸
Great Falls, Montana, United States
Saint Peter's Community Hospital
🇺🇸
Helena, Montana, United States
Northern Montana Hospital
🇺🇸
Havre, Montana, United States
Montana Cancer Consortium CCOP
🇺🇸
Billings, Montana, United States
Truman Medical Center
🇺🇸
Kansas City, Missouri, United States
Interim LSU Public Hospital
🇺🇸
New Orleans, Louisiana, United States
Louisiana State University Health Science Center
🇺🇸
New Orleans, Louisiana, United States
Kansas City Veterans Affairs Medical Center
🇺🇸
Kansas City, Missouri, United States
University of Kentucky
🇺🇸
Lexington, Kentucky, United States
Grandview Hospital
🇺🇸
Dayton, Ohio, United States
Cancer Center of Kansas - El Dorado
🇺🇸
El Dorado, Kansas, United States
Greene Memorial Hospital
🇺🇸
Xenia, Ohio, United States
University of Kansas Medical Center
🇺🇸
Kansas City, Kansas, United States