Prasterone (Dehydroepiandrosterone) in Treating Postmenopausal Cancer Survivors With Vaginal Symptoms

Phase 3

Completed

Conditions: Breast Cancer
Gynecologic Cancer

Interventions: Drug: prasterone
Other: placebo

Registration Number: NCT01376349

Lead Sponsor: Alliance for Clinical Trials in Oncology

Brief Summary: RATIONALE: Dehydroepiandrosterone (DHEA) may help relieve vaginal symptoms in female cancer survivors.

PURPOSE: This randomized phase III trial studies DHEA to see how well it works compared to placebo in treating postmenopausal cancer survivors with vaginal symptoms.

Detailed Description: Primary Goal:

* To determine the effectiveness of two doses of daily vaginal prasterone (dehydroepiandrosterone \[DHEA\]) versus placebo for alleviation of the most bothersome vaginal symptom (vaginal dryness or dyspareunia) over 12 weeks.

Exploratory Goals:

* To evaluate any toxicities arising from DHEA in this patient population. (Exploratory)

* To evaluate the impact of vaginal DHEA on negative sexual thoughts, sexual function and urologic symptoms. (Exploratory)

* To explore the role of psychologic (mood, stress), physical (demographics and treatment variables) and situational factors (partner variables and fatigue) as predictors of vaginal dryness and performance outcomes at baseline and at various endpoints throughout the study. (Exploratory)

* To explore the characteristics of vaginal atrophy and the relationship between vaginal atrophy and quality-of-life questionnaire responses and exposure to hormonal therapy (tamoxifen, exemestane, anastrozole, or letrozole). (Exploratory)

* To examine the effects of the use of open-label vaginal DHEA gel over 8 weeks in women completing the placebo gel arm of the randomized trial. (Exploratory)

Correlative Research Goals:

* To evaluate the impact of vaginal DHEA on maturation index and pH (select institutions).

* To evaluate the impact of vaginal DHEA on sex steroid concentrations (estradiol, free testosterone, estrone, and DHEA-S) and markers of bone turnover (osteocalcin and bone alkaline phosphatase). (Correlative)

* As part of ongoing research for NCCTG Cancer Control studies, we are banking blood products for future studies. (Correlative)

OUTLINE: This is a multicenter study. Patients are stratified according to current tamoxifen therapy (yes vs no), concurrent aromatase inhibitor use (anastrozole/letrozole vs exemestane vs none), hysterectomy (yes vs no), and cigarette smoking (current vs past vs never). Patients are randomized to 1 of 3 treatment arms, patients receive low dose vaginal DHEA, high dose vaginal DHEA or vaginal placebo gel.

Participants may complete the Profile of Mood States (POMS), the Perceived Stress Scale (PSS), the Fatigue: Vitality subscale of the SF-36, the Vaginal Symptom Quality Questionnaire, the DHEA Side Effect Questionnaire, the Female Sexual Function Index (FSFI), the Sexually Related Intrusive Thoughts - ITS, Impact of Treatment Scale, the Urogenital Atrophy Questionnaire, and the Subject Global Impression of Change at baseline and periodically during study.

Recruitment & Eligibility

Status: COMPLETED

Sex: Female

Target Recruitment: 464

Inclusion Criteria

Age ≥ 18 years
Postmenopausal women with a history of breast or gynecologic cancer (currently no evidence of disease). Note: Postmenopausal status will be determined by the following criteria:
1. 12 months without a period or bilateral oophorectomy or complete chemical ovarian suppression for the past 12 months with continued suppression planned throughout the course of the study
2. menopausal status will be determined by an FSH and an estradiol value in the postmenopausal range (generally FSH > 40IU/L and estradiol < 10 pg/ml, depending on laboratory) if:
  - 9 months without a period or
  - post hysterectomy with at least one ovary remaining and less than 55 years old. Note: if age 55 or older with these criteria, then menopausal status does not need to be determined by labs
Significant vaginal complaints. Note: Defined as persistent vaginal dryness and/or pain with intercourse (dyspareunia) of sufficient severity to make a patient desire therapeutic intervention.
Eligibility questionnaire response must be moderate or worse levels of severity on one of the two symptoms, either dryness or dyspareunia. The protocol contains more information.
Vaginal symptoms must have been present ≥ 2 months prior to randomization.
Life expectancy > 12 months.
Ability to complete questionnaires by themselves or with assistance.
Eastern Cooperative Oncology Group (ECOG) Performance Status (PS) 0 or 1.
The patient must provide informed written consent.
Willing to return to the enrolling institution for follow-up.
Willing to provide blood samples for correlative research purposes.

Exclusion Criteria

Initiation or discontinuation of tamoxifen or aromatase inhibitors ≤ 2 months prior to randomization or plans to initiate or discontinue any of these medications during the 12-week study.
Current diagnosis of an active vaginal infection, if symptoms of vaginal infection, this must be ruled out (ie, foul discharge, fever).
Concurrent chemotherapy (long term adjuvant herceptin, lapatanib, and/or bevacizumab is allowed.
Planned use of any vaginal preparations during the study period (including any over the counter or herbal preparations). Note: Water-based lubricants (such as KY jelly) are allowed during sexual intercourse.
Use of any daily non-hormonal vaginal preparations ≤ 1 week prior to study entry.

Exception: Daily water-based lubricants for sexual intercourse. Note: Patients who stop agent may be enrolled after one week.
Current (≤ 4 weeks prior to randomization), or planned during the study period, use of any estrogen product or any kind of hormonal vaginal product including bioidentical hormones, estriol or any androgen product.
Use of pharmacologic soy or phytoestrogen preparations (Dietary intake of soy - ie milk is acceptable).
On a placebo controlled trial for endocrine therapy.
Prior or concurrent pelvic radiation therapy.
Prior radical pelvic surgery, specifically vaginectomy or pelvic exenteration (TAH/BSO) is allowed).
Diagnosis of any of the following conditions within the past five years:
1. Essential vulvodynia
2. Vulvar vestibulitis
3. Bartholin cyst/abscess
4. History of Bartholin gland surgery
5. Lichen sclerosis
6. Lichen planus of the vulvovaginal region
7. Desquamative vaginitis
History or current diagnosis of any of the following conditions:
1. Vulvar or vaginal dysplasia
2. Vaginal prolapse
Women of childbearing potential, premenopausal women.

Study & Design

Study Type: INTERVENTIONAL

Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Arm II high dose DHEA	prasterone	Participants apply a high dose (6.5 mg) of vaginal DHEA gel QD, at bed time, for 12 weeks. Treatment continues until unacceptable adverse events or patient refusal to continue participation on the study.
Arm III placebo	placebo	Participants apply a vaginal placebo gel QD, at bed time, for 12 weeks. There is an Optional Continuation Phase (for placebo arm only): Participants apply a high dose of vaginal DHEA gel QD, at bed time, for 12 weeks. Treatment continues until unacceptable adverse events or patient refusal to continue participation on the study.
Arm I low dose DHEA	prasterone	Participants apply a low dose (3.25 mg) of vaginal prasterone (dehydroepiandrosterone \[DHEA\]) gel once daily (QD), at bed time, for 12 weeks. Treatment continues until unacceptable adverse events or patient refusal to continue participation on the study.

Primary Outcome Measures

Name	Time	Method
Alleviation of the Most Bothersome Vaginal Symptom (Vaginal Dryness or Dyspareunia) Over 12 Weeks	At baseline and 12 weeks	The primary outcome is severity of the most bothersome vaginal symptom: dryness or dyspareunia. The Vaginal Symptom Measure (VSM) was used to evaluate the severity of vaginal dryness and dyspareunia. The VSM uses a 5- point ordinal response scale; 1="none", 2="mild", 3="moderate", 4="severe" and 5="very severe" to measure the severity associated with vaginal dryness and/or dyspareunia. For each patient, the change in severity was calculated by subtracting the baseline from the week 12 reported score. Therefore, the full range of scores ranges from -4 (greatest decrease in severity) to 4 (greatest increase in severity). A negative score indicates a decrease in severity from baseline, zero indicates no reported affect and positive scores indicate a more severe report at week 12. The primary assessment method will be a comparison of the averages of the changes over time in the severity items for the most bothersome symptom from baseline to 12 weeks (as indicated at baseline).

Secondary Outcome Measures

Name	Time	Method

Trial Locations

Locations (277): St. Mary - Corwin Regional Medical Center
🇺🇸
Pueblo, Colorado, United States
Illinois CancerCare - Macomb
🇺🇸
Macomb, Illinois, United States
Elkhart Clinic, LLC
🇺🇸
Elkhart, Indiana, United States
Elkhart General Hospital
🇺🇸
Elkhart, Indiana, United States
Siouxland Hematology-Oncology Associates, LLP
🇺🇸
Sioux City, Iowa, United States
Mercy Medical Center - Sioux City
🇺🇸
Sioux City, Iowa, United States
St. Luke's Regional Medical Center
🇺🇸
Sioux City, Iowa, United States
Cancer Center of Kansas-Independence
🇺🇸
Independence, Kansas, United States
Humphrey Cancer Center at North Memorial Outpatient Center
🇺🇸
Robbinsdale, Minnesota, United States
CentraCare Clinic - River Campus
🇺🇸
Saint Cloud, Minnesota, United States
St. James Healthcare Cancer Care
🇺🇸
Butte, Montana, United States
Licking Memorial Cancer Care Program at Licking Memorial Hospital
🇺🇸
Newark, Ohio, United States
Kalispell Regional Medical Center
🇺🇸
Kalispell, Montana, United States
UVMC Cancer Care Center at Upper Valley Medical Center
🇺🇸
Troy, Ohio, United States
Fredericksburg Oncology, Incorporated
🇺🇸
Fredericksburg, Virginia, United States
Riverside Methodist Hospital Cancer Care
🇺🇸
Columbus, Ohio, United States
Grant Medical Center Cancer Care
🇺🇸
Columbus, Ohio, United States
St. Francis Hospital Cancer Care Services
🇺🇸
Indianapolis, Indiana, United States
Virginia Piper Cancer Institute at Abbott - Northwestern Hospital
🇺🇸
Minneapolis, Minnesota, United States
Hennepin County Medical Center - Minneapolis
🇺🇸
Minneapolis, Minnesota, United States
CCOP - Wichita
🇺🇸
Wichita, Kansas, United States
Cancer Center of Kansas, PA - Medical Arts Tower
🇺🇸
Wichita, Kansas, United States
Cancer Center of Kansas, PA - Wichita
🇺🇸
Wichita, Kansas, United States
Cancer Center of Kansas, PA - Chanute
🇺🇸
Chanute, Kansas, United States
Cancer Center of Kansas, PA - Wellington
🇺🇸
Wellington, Kansas, United States
Cancer Center of Kansas, PA - Dodge City
🇺🇸
Dodge City, Kansas, United States
Cancer Center of Kansas, PA - McPherson
🇺🇸
McPherson, Kansas, United States
Cancer Center of Kansas - Fort Scott
🇺🇸
Fort Scott, Kansas, United States
Cancer Center of Kansas, PA - Liberal
🇺🇸
Liberal, Kansas, United States
Cancer Center of Kansas, PA - Parsons
🇺🇸
Parsons, Kansas, United States
Cancer Center of Kansas, PA - Newton
🇺🇸
Newton, Kansas, United States
Associates in Womens Health, PA - North Review
🇺🇸
Wichita, Kansas, United States
Via Christi Cancer Center at Via Christi Regional Medical Center
🇺🇸
Wichita, Kansas, United States
Cancer Center of Kansas, PA - Salina
🇺🇸
Salina, Kansas, United States
Cancer Center of Kansas, PA - El Dorado
🇺🇸
El Dorado, Kansas, United States
Cancer Center of Kansas, PA - Kingman
🇺🇸
Kingman, Kansas, United States
Cancer Center of Kansas, PA - Winfield
🇺🇸
Winfield, Kansas, United States
Boulder Community Hospital
🇺🇸
Boulder, Colorado, United States
Littleton Adventist Hospital
🇺🇸
Littleton, Colorado, United States
North Suburban Medical Center
🇺🇸
Thornton, Colorado, United States
Penrose Cancer Center at Penrose Hospital
🇺🇸
Colorado Springs, Colorado, United States
Hope Cancer Care Center at Longmont United Hospital
🇺🇸
Longmont, Colorado, United States
Kapiolani Medical Center at Pali Momi
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'Aiea, Hawaii, United States
North Colorado Medical Center
🇺🇸
Greeley, Colorado, United States
Maui Memorial Medical Center
🇺🇸
Wailuku, Hawaii, United States
Exempla Lutheran Medical Center
🇺🇸
Wheat Ridge, Colorado, United States
Pacific Cancer Institute - Maui
🇺🇸
Wailuku, Hawaii, United States
HealthEast Cancer Care at St. John's Hospital
🇺🇸
Maplewood, Minnesota, United States
Lawrence Memorial Hospital
🇺🇸
Lawrence, Kansas, United States
Cancer Center of Kansas, PA - Pratt
🇺🇸
Pratt, Kansas, United States
Mercy Clinic Cancer and Hematology - Rolla
🇺🇸
Rolla, Missouri, United States
Mount Carmel Health - West Hospital
🇺🇸
Columbus, Ohio, United States
Doctors Hospital at Ohio Health
🇺🇸
Columbus, Ohio, United States
CCOP - Dayton
🇺🇸
Dayton, Ohio, United States
Fairview Ridges Hospital
🇺🇸
Burnsville, Minnesota, United States
Blanchard Valley Medical Associates
🇺🇸
Findlay, Ohio, United States
Bon Secours St. Francis Health System
🇺🇸
Greenville, South Carolina, United States
Hematology Oncology Center
🇺🇸
Elyria, Ohio, United States
Toledo Hospital
🇺🇸
Toledo, Ohio, United States
Community Cancer Center of Monroe
🇺🇸
Monroe, Michigan, United States
Strecker Cancer Center at Marietta Memorial Hospital
🇺🇸
Marietta, Ohio, United States
Altru Cancer Center at Altru Hospital
🇺🇸
Grand Forks, North Dakota, United States
Wayne Hospital
🇺🇸
Greenville, Ohio, United States
CCOP - MeritCare Hospital
🇺🇸
Fargo, North Dakota, United States
St. Vincent Mercy Medical Center
🇺🇸
Toledo, Ohio, United States
CCOP - Toledo Community Hospital
🇺🇸
Toledo, Ohio, United States
New Ulm Medical Center
🇺🇸
New Ulm, Minnesota, United States
Regions Hospital Cancer Care Center
🇺🇸
Saint Paul, Minnesota, United States
Minnesota Oncology - Woodbury
🇺🇸
Woodbury, Minnesota, United States
CCOP - Columbus
🇺🇸
Columbus, Ohio, United States
CCOP - Cancer Research for the Ozarks
🇺🇸
Springfield, Missouri, United States
Good Samaritan Hospital
🇺🇸
Dayton, Ohio, United States
Samaritan North Cancer Care Center
🇺🇸
Dayton, Ohio, United States
St. Vincent Healthcare Cancer Care Services
🇺🇸
Billings, Montana, United States
Willmar Cancer Center at Rice Memorial Hospital
🇺🇸
Willmar, Minnesota, United States
Cancer Resource Center - Lincoln
🇺🇸
Lincoln, Nebraska, United States
Adena Regional Medical Center
🇺🇸
Chillicothe, Ohio, United States
Fairfield Medical Center
🇺🇸
Lancaster, Ohio, United States
Lima Memorial Hospital
🇺🇸
Lima, Ohio, United States
Northwest Ohio Oncology Center
🇺🇸
Maumee, Ohio, United States
Geisinger Cancer Institute at Geisinger Health
🇺🇸
Danville, Pennsylvania, United States
Dakota Cancer Institute at Dakota Clinic - South University
🇺🇸
Fargo, North Dakota, United States
Lehigh Valley Hospital - Muhlenberg
🇺🇸
Bethlehem, Pennsylvania, United States
St. Peter's Hospital
🇺🇸
Helena, Montana, United States
Sanford Cancer Center at Sanford USD Medical Center
🇺🇸
Sioux Falls, South Dakota, United States
Mount Carmel St. Ann's Cancer Center
🇺🇸
Westerville, Ohio, United States
Franciscan Skemp Healthcare - La Crosse Campus
🇺🇸
La Crosse, Wisconsin, United States
Wood County Oncology Center
🇺🇸
Bowling Green, Ohio, United States
Mercy Hospital of Tiffin
🇺🇸
Tiffin, Ohio, United States
Zangmeister Center
🇺🇸
Columbus, Ohio, United States
St. Mary's Hospital Medical Center - Green Bay
🇺🇸
Green Bay, Wisconsin, United States
Willamette Falls Hospital
🇺🇸
Oregon City, Oregon, United States
Rocky Mountain Oncology
🇺🇸
Casper, Wyoming, United States
Grandview Hospital
🇺🇸
Dayton, Ohio, United States
Toledo Clinic - Oregon
🇺🇸
Oregon, Ohio, United States
Southern Ohio Medical Center Cancer Center
🇺🇸
Portsmouth, Ohio, United States
Providence Milwaukie Hospital
🇺🇸
Milwaukie, Oregon, United States
Clackamas Radiation Oncology Center
🇺🇸
Clackamas, Oregon, United States
Morgan Cancer Center at Lehigh Valley Hospital - Cedar Crest
🇺🇸
Allentown, Pennsylvania, United States
CCOP - Upstate Carolina
🇺🇸
Spartanburg, South Carolina, United States
AnMed Cancer Center
🇺🇸
Anderson, South Carolina, United States
Toledo Clinic, Incorporated - Main Clinic
🇺🇸
Toledo, Ohio, United States
Avera Cancer Institute
🇺🇸
Sioux Falls, South Dakota, United States
Green Bay Oncology, Limited at St. Vincent Hospital Regional Cancer Center
🇺🇸
Green Bay, Wisconsin, United States
St. Charles Mercy Hospital
🇺🇸
Oregon, Ohio, United States
St. Vincent Hospital Regional Cancer Center
🇺🇸
Green Bay, Wisconsin, United States
Holy Family Memorial Medical Center Cancer Care Center
🇺🇸
Manitowoc, Wisconsin, United States
Knox Community Hospital
🇺🇸
Mount Vernon, Ohio, United States
Carolina Blood and Cancer Care Associates, PA
🇺🇸
Lancaster, South Carolina, United States
Carolina Blood and Cancer Care
🇺🇸
Rock Hill, South Carolina, United States
Northwest Cancer Specialists at Vancouver Cancer Center
🇺🇸
Vancouver, Washington, United States
Geisinger Hazleton Cancer Center
🇺🇸
Hazleton, Pennsylvania, United States
Green Bay Oncology, Limited - Sturgeon Bay
🇺🇸
Sturgeon Bay, Wisconsin, United States
Green Bay Oncology, Limited - Oconto Falls
🇺🇸
Oconto Falls, Wisconsin, United States
St. Nicholas Hospital
🇺🇸
Sheboygan, Wisconsin, United States
Welch Cancer Center at Sheridan Memorial Hospital
🇺🇸
Sheridan, Wyoming, United States
St. John's Regional Health Center
🇺🇸
Springfield, Missouri, United States
United Hospital
🇺🇸
Saint Paul, Minnesota, United States
Lakeview Hospital
🇺🇸
Stillwater, Minnesota, United States
Middletown Regional Hospital
🇺🇸
Franklin, Ohio, United States
St. Anne Mercy Hospital
🇺🇸
Toledo, Ohio, United States
United States Air Force Medical Center - Wright-Patterson
🇺🇸
Wright-Patterson Air Force Base, Ohio, United States
Fulton County Health Center
🇺🇸
Wauseon, Ohio, United States
Ruth G. McMillan Cancer Center at Greene Memorial Hospital
🇺🇸
Xenia, Ohio, United States
Genesis - Good Samaritan Hospital
🇺🇸
Zanesville, Ohio, United States
Foote Memorial Hospital
🇺🇸
Jackson, Michigan, United States
Frank M. and Dorothea Henry Cancer Center at Geisinger Wyoming Valley Medical Center
🇺🇸
Wilkes-Barre, Pennsylvania, United States
OSF St. Francis Medical Center
🇺🇸
Peoria, Illinois, United States
Green Bay Oncology, Limited at St. Mary's Hospital
🇺🇸
Green Bay, Wisconsin, United States
Bozeman Deaconess Cancer Center
🇺🇸
Bozeman, Montana, United States
CCOP - Carle Cancer Center
🇺🇸
Urbana, Illinois, United States
Grady Memorial Hospital
🇺🇸
Delaware, Ohio, United States
MeritCare Broadway
🇺🇸
Fargo, North Dakota, United States
McKee Medical Center
🇺🇸
Loveland, Colorado, United States
Charles F. Kettering Memorial Hospital
🇺🇸
Kettering, Ohio, United States
Sky Ridge Medical Center
🇺🇸
Lone Tree, Colorado, United States
Mayo Clinic Scottsdale
🇺🇸
Scottsdale, Arizona, United States
Parker Adventist Hospital
🇺🇸
Parker, Colorado, United States
Poudre Valley Hospital
🇺🇸
Fort Collins, Colorado, United States
Front Range Cancer Specialists
🇺🇸
Fort Collins, Colorado, United States
Mayo Clinic - Jacksonville
🇺🇸
Jacksonville, Florida, United States
Herbert D. Kerman Regional Oncology Center - Daytona Beach
🇺🇸
Daytona Beach, Florida, United States
Saint Francis/Mount Sinai Regional Cancer Center at Saint Francis Hospital and Medical Center
🇺🇸
Hartford, Connecticut, United States
Castle Medical Center
🇺🇸
Kailua, Hawaii, United States
Kauai Medical Clinic
🇺🇸
Lihue, Hawaii, United States
Saint Alphonsus Cancer Care Center at Saint Alphonsus Regional Medical Center
🇺🇸
Boise, Idaho, United States
St. Joseph Medical Center
🇺🇸
Bloomington, Illinois, United States
Idaho Urologic Institute, PA
🇺🇸
Meridian, Idaho, United States
Illinois CancerCare - Canton
🇺🇸
Canton, Illinois, United States
Illinois CancerCare - Bloomington
🇺🇸
Bloomington, Illinois, United States
Illinois CancerCare - Carthage
🇺🇸
Carthage, Illinois, United States
Illinois CancerCare - Eureka
🇺🇸
Eureka, Illinois, United States
Eureka Community Hospital
🇺🇸
Eureka, Illinois, United States
Illinois CancerCare - Kewanee Clinic
🇺🇸
Kewanee, Illinois, United States
Galesburg Clinic, PC
🇺🇸
Galesburg, Illinois, United States
Illinois CancerCare - Havana
🇺🇸
Havana, Illinois, United States
OSF Holy Family Medical Center
🇺🇸
Monmouth, Illinois, United States
Illinois CancerCare - Monmouth
🇺🇸
Monmouth, Illinois, United States
Trinity Cancer Center at Trinity Medical Center - 7th Street Campus
🇺🇸
Moline, Illinois, United States
BroMenn Regional Medical Center
🇺🇸
Normal, Illinois, United States
Illinois CancerCare - Community Cancer Center
🇺🇸
Normal, Illinois, United States
Community Cancer Center
🇺🇸
Elyria, Ohio, United States
Oncology Hematology Associates of Central Illinois, PC - Ottawa
🇺🇸
Ottawa, Illinois, United States
Community Hospital of Ottawa
🇺🇸
Ottawa, Illinois, United States
Cancer Treatment Center at Pekin Hospital
🇺🇸
Pekin, Illinois, United States
CCOP - Illinois Oncology Research Association
🇺🇸
Peoria, Illinois, United States
Proctor Hospital
🇺🇸
Peoria, Illinois, United States
Illinois CancerCare - Pekin
🇺🇸
Pekin, Illinois, United States
Illinois CancerCare - Peru
🇺🇸
Peru, Illinois, United States
Oncology Hematology Associates of Central Illinois, PC - Peoria
🇺🇸
Peoria, Illinois, United States
Methodist Medical Center of Illinois
🇺🇸
Peoria, Illinois, United States
Illinois Valley Community Hospital
🇺🇸
Peru, Illinois, United States
Illinois CancerCare - Princeton
🇺🇸
Princeton, Illinois, United States
Illinois CancerCare - Spring Valley
🇺🇸
Spring Valley, Illinois, United States
Michiana Hematology-Oncology, PC - Elkhart
🇺🇸
Elkhart, Indiana, United States
Howard Community Hospital
🇺🇸
Kokomo, Indiana, United States
Saint Anthony Memorial Health Centers
🇺🇸
Michigan City, Indiana, United States
Center for Cancer Therapy at LaPorte Hospital and Health Services
🇺🇸
La Porte, Indiana, United States
Michiana Hematology Oncology PC - Plymouth
🇺🇸
Plymouth, Indiana, United States
Saint Joseph Regional Medical Center
🇺🇸
Mishawaka, Indiana, United States
Michiana Hematology-Oncology, PC - South Bend
🇺🇸
Mishawaka, Indiana, United States
Reid Hospital & Health Care Services
🇺🇸
Richmond, Indiana, United States
Cedar Rapids Oncology Associates
🇺🇸
Cedar Rapids, Iowa, United States
CCOP - Northern Indiana CR Consortium
🇺🇸
South Bend, Indiana, United States
Memorial Hospital of South Bend
🇺🇸
South Bend, Indiana, United States
Medical Oncology and Hematology Associates - West Des Moines
🇺🇸
Clive, Iowa, United States
Michiana Hematology Oncology PC - La Porte
🇺🇸
Westville, Indiana, United States
Mercy Regional Cancer Center at Mercy Medical Center
🇺🇸
Cedar Rapids, Iowa, United States
Mercy Cancer Center - West Lakes
🇺🇸
Clive, Iowa, United States
Methodist West Hospital
🇺🇸
West Des Moines, Iowa, United States
Hickman Cancer Center at Bixby Medical Center
🇺🇸
Adrian, Michigan, United States
Oakwood Cancer Center at Oakwood Hospital and Medical Center
🇺🇸
Dearborn, Michigan, United States
Green Bay Oncology, Limited - Escanaba
🇺🇸
Escanaba, Michigan, United States
Hurley Medical Center
🇺🇸
Flint, Michigan, United States
Genesys Regional Medical Center
🇺🇸
Grand Blanc, Michigan, United States
Genesys Hurley Cancer Institute
🇺🇸
Flint, Michigan, United States
Van Elslander Cancer Center at St. John Hospital and Medical Center
🇺🇸
Grosse Pointe Woods, Michigan, United States
Dickinson County Healthcare System
🇺🇸
Iron Mountain, Michigan, United States
St. Mary Mercy Hospital
🇺🇸
Livonia, Michigan, United States
Sparrow Regional Cancer Center
🇺🇸
Lansing, Michigan, United States
Mercy Memorial Hospital - Monroe
🇺🇸
Monroe, Michigan, United States
St. Joseph Mercy Oakland
🇺🇸
Pontiac, Michigan, United States
Mercy Regional Cancer Center at Mercy Hospital
🇺🇸
Port Huron, Michigan, United States
Seton Cancer Institute at Saint Mary's - Saginaw
🇺🇸
Saginaw, Michigan, United States
MeritCare Bemidji
🇺🇸
Bemidji, Minnesota, United States
Lakeland Regional Cancer Care Center - St. Joseph
🇺🇸
Saint Joseph, Michigan, United States
Lakeside Cancer Specialists, PLLC
🇺🇸
Saint Joseph, Michigan, United States
St. John Macomb Hospital
🇺🇸
Warren, Michigan, United States
CCOP - Duluth
🇺🇸
Duluth, Minnesota, United States
Essentia Health - Duluth Clinic
🇺🇸
Duluth, Minnesota, United States
St. Joseph's Medical Center
🇺🇸
Brainerd, Minnesota, United States
Mercy and Unity Cancer Center at Mercy Hospital
🇺🇸
Coon Rapids, Minnesota, United States
Fairview Southdale Hospital
🇺🇸
Edina, Minnesota, United States
Miller - Dwan Medical Center
🇺🇸
Duluth, Minnesota, United States
Hutchinson Area Health Care
🇺🇸
Hutchinson, Minnesota, United States
Immanuel St. Joseph's
🇺🇸
Mankato, Minnesota, United States
Mercy and Unity Cancer Center at Unity Hospital
🇺🇸
Fridley, Minnesota, United States
Minnesota Oncology - Maplewood
🇺🇸
Maplewood, Minnesota, United States
Park Nicollet Cancer Center
🇺🇸
Saint Louis Park, Minnesota, United States
CCOP - Metro-Minnesota
🇺🇸
Saint Louis Park, Minnesota, United States
Coborn Cancer Center
🇺🇸
Saint Cloud, Minnesota, United States
St. Francis Cancer Center at St. Francis Medical Center
🇺🇸
Shakopee, Minnesota, United States
Ridgeview Medical Center
🇺🇸
Waconia, Minnesota, United States
Hulston Cancer Center at Cox Medical Center South
🇺🇸
Springfield, Missouri, United States
Billings Clinic - Downtown
🇺🇸
Billings, Montana, United States
Hematology-Oncology Centers of the Northern Rockies - Billings
🇺🇸
Billings, Montana, United States
Montana Cancer Specialists at Montana Cancer Center
🇺🇸
Missoula, Montana, United States
Montana Cancer Center at St. Patrick Hospital and Health Sciences Center
🇺🇸
Missoula, Montana, United States
University of New Mexico Cancer Center - South
🇺🇸
Las Cruces, New Mexico, United States
Rutherford Hospital
🇺🇸
Rutherfordton, North Carolina, United States
David L. Rike Cancer Center at Miami Valley Hospital
🇺🇸
Dayton, Ohio, United States
Flower Hospital Cancer Center
🇺🇸
Sylvania, Ohio, United States
Community Hospital of Springfield and Clark County
🇺🇸
Springfield, Ohio, United States
Medical University of Ohio Cancer Center
🇺🇸
Toledo, Ohio, United States
Providence Newberg Medical Center
🇺🇸
Newberg, Oregon, United States
Geisinger Medical Group - Scenery Park
🇺🇸
State College, Pennsylvania, United States
Gibbs Regional Cancer Center at Spartanburg Regional Medical Center
🇺🇸
Spartanburg, South Carolina, United States
Southwest Washington Medical Center Cancer Center
🇺🇸
Vancouver, Washington, United States
Bay Area Cancer Care Center at Bay Area Medical Center
🇺🇸
Marinette, Wisconsin, United States
Aurora Presbyterian Hospital
🇺🇸
Aurora, Colorado, United States
St. Anthony Central Hospital
🇺🇸
Denver, Colorado, United States
Presbyterian - St. Luke's Medical Center
🇺🇸
Denver, Colorado, United States
St. Joseph Hospital
🇺🇸
Denver, Colorado, United States
Porter Adventist Hospital
🇺🇸
Denver, Colorado, United States
Rose Medical Center
🇺🇸
Denver, Colorado, United States
CCOP - Colorado Cancer Research Program
🇺🇸
Denver, Colorado, United States
Saint Joseph Mercy Cancer Center
🇺🇸
Ann Arbor, Michigan, United States
Mayo Clinic Cancer Center
🇺🇸
Rochester, Minnesota, United States
CCOP - Michigan Cancer Research Consortium
🇺🇸
Ann Arbor, Michigan, United States
Creighton University Medical Center
🇺🇸
Omaha, Nebraska, United States
CCOP - Missouri Valley Cancer Consortium
🇺🇸
Omaha, Nebraska, United States
Immanuel Medical Center
🇺🇸
Omaha, Nebraska, United States
Alegant Health Cancer Center at Bergan Mercy Medical Center
🇺🇸
Omaha, Nebraska, United States
Lakeside Hospital
🇺🇸
Omaha, Nebraska, United States
Providence Cancer Center at Providence Portland Medical Center
🇺🇸
Portland, Oregon, United States
CCOP - Columbia River Oncology Program
🇺🇸
Portland, Oregon, United States
Providence St. Vincent Medical Center
🇺🇸
Portland, Oregon, United States
Swedish Medical Center
🇺🇸
Englewood, Colorado, United States
Benefis Sletten Cancer Institute
🇺🇸
Great Falls, Montana, United States
CCOP - Montana Cancer Consortium
🇺🇸
Billings, Montana, United States
University of Florida Shands Cancer Center
🇺🇸
Gainesville, Florida, United States
Cancer Research Center of Hawaii
🇺🇸
Honolulu, Hawaii, United States
OnCare Hawaii, Incorporated - Lusitana
🇺🇸
Honolulu, Hawaii, United States
Queen's Cancer Institute at Queen's Medical Center
🇺🇸
Honolulu, Hawaii, United States
Straub Clinic and Hospital, Incorporated
🇺🇸
Honolulu, Hawaii, United States
Hawaii Medical Center - East
🇺🇸
Honolulu, Hawaii, United States
OnCare Hawaii, Incorporated - Kuakini
🇺🇸
Honolulu, Hawaii, United States
Kapiolani Medical Center for Women and Children
🇺🇸
Honolulu, Hawaii, United States
CCOP - Iowa Oncology Research Association
🇺🇸
Des Moines, Iowa, United States
John Stoddard Cancer Center at Iowa Methodist Medical Center
🇺🇸
Des Moines, Iowa, United States
Medical Oncology and Hematology Associates at John Stoddard Cancer Center
🇺🇸
Des Moines, Iowa, United States
Medical Oncology and Hematology Associates at Mercy Cancer Center
🇺🇸
Des Moines, Iowa, United States
Mercy Cancer Center at Mercy Medical Center - Des Moines
🇺🇸
Des Moines, Iowa, United States
John Stoddard Cancer Center at Iowa Lutheran Hospital
🇺🇸
Des Moines, Iowa, United States
Lovelace Medical Center - Downtown
🇺🇸
Albuquerque, New Mexico, United States
Presbyterian Cancer Treatment Center at Presbyterian Kaseman Hospital
🇺🇸
Albuquerque, New Mexico, United States
University of New Mexico Cancer Center
🇺🇸
Albuquerque, New Mexico, United States