MedPath

A Study Evaluating Whether Pembrolizumab Alone or in Combination With CMP-001 Improves Efficacy of Treatment in Patients With Operable Melanoma

Phase 2
Suspended
Conditions
Clinical Stage III Cutaneous Melanoma AJCC v8
Melanoma of Unknown Primary
Pathologic Stage IIIB Cutaneous Melanoma AJCC v8
Pathologic Stage IIIC Cutaneous Melanoma AJCC v8
Pathologic Stage IIID Cutaneous Melanoma AJCC v8
Recurrent Cutaneous Melanoma
Interventions
Procedure: Biopsy
Procedure: Biospecimen Collection
Procedure: Computed Tomography
Biological: Pembrolizumab
Procedure: Positron Emission Tomography
Procedure: Surgical Procedure
Drug: VLP-encapsulated TLR9 Agonist CMP-001
Registration Number
NCT04708418
Lead Sponsor
National Cancer Institute (NCI)
Brief Summary

This phase II trial studies the effect of pembrolizumab alone or in combination with CMP-001 in treating patients with melanoma that can be treated by surgery (operable). Immunotherapy with monoclonal antibodies, such as pembrolizumab, may help the body's immune system attack the cancer, and may interfere with the ability of tumor cells to grow and spread. Immunotherapy with CMP-001 may induce changes in body's immune system and may interfere with the ability of tumor cells to grow and spread. The addition of CMP-001 to pembrolizumab could improve the ability of the immune system to shrink tumors and to prevent them from returning.

Detailed Description

PRIMARY OBJECTIVE:

I. To evaluate the rate of pathologic complete response (pCR) rate in patients in each arm.

SECONDARY OBJECTIVES:

I. To evaluate the rate of pathologic near-complete/major response (pMR) of the neoadjuvant therapy in each arm.

II. To evaluate the pathologic response rate of un-injected lesions on the combination arm (Arm B).

III. To evaluate relapse-free survival (RFS) in each arm. IV. To evaluate overall survival (OS) in each arm. V. To evaluate the preoperative radiographic response rate in each arm. VI. To evaluate safety and toxicity of neoadjuvant therapy in each arm.

OUTLINE: Patients are randomized to 1 of 2 arms.

ARM A:

NEOADJUVANT PHASE: Patients receive pembrolizumab intravenously (IV) over 30 minutes on day 1 of each cycle. Treatment repeats every 21 days for up to 3 cycles in the absence of disease progression or unacceptable toxicity.

SURGERY: Patients undergo surgery 1-2 weeks after completion of neoadjuvant phase.

ADJUVANT PHASE: After recovery from surgery, patients receive pembrolizumab IV over 30 minutes on day 1 of every other cycle. Treatment repeats every 21 days for up to 16 cycles in the absence of disease progression or unacceptable toxicity.

Patients also undergo computed tomography (CT) or positron emission tomography (PET)/CT throughout the trial and may undergo optional biopsy at baseline and disease progression and optional collection of blood samples throughout the trial.

ARM B:

NEOADJUVANT PHASE: Patients receive VLP-encapsulated TLR9 agonist CMP-001 (CMP-001) subcutaneously (SC) on day 1 of cycle 1 and then intratumorally on days 8 and 15 of cycle 1, days 1, 8, and 15 of cycle 2, and day 1 of cycle 3. Patients also receive pembrolizumab IV over 30 minutes on day 8 of each cycle. Treatment repeats every 21 days for up to 3 cycles in the absence of disease progression or unacceptable toxicity.

SURGERY: Patients undergo surgery 1-2 weeks after completion of neoadjuvant phase.

ADJUVANT PHASE: After recovery from surgery, patients receive pembrolizumab IV over 30 minutes on day 1 of every other cycle. Treatment repeats every 21 days for up to 16 cycles in the absence of disease progression or unacceptable toxicity.

Patients also undergo CT or PET/CT throughout the trial and may undergo optional biopsy at baseline and disease progression and optional collection of blood samples throughout the trial.

After completion of study treatment, patients are followed up at 30 days and then every 3 months if \< 2 years from study entry, every 6 months if 2-5 years from study entry, and every 12 months if \> 5 years from study entry for up to 10 years (15 years total follow up).

Recruitment & Eligibility

Status
SUSPENDED
Sex
All
Target Recruitment
60
Inclusion Criteria
  • Patient must be >= 18 years of age

  • Patient must have an Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1

  • Patient must have a histologic diagnosis of melanoma belonging to the following American Joint Committee on Cancer (AJCC) 8th edition TNM stages:

    • T0, Tx or T1-4; and
    • N1b, N2b, N2c, N3b or N3c
  • Patients may have a presentation with primary melanoma with concurrent regional nodal and/or in-transit metastasis; or patients may have a history of primary melanoma or unknown primary melanoma presenting with clinically detected regional nodal and/or in-transit recurrence; and may belong to any of the following groups:

    • Primary cutaneous melanoma with clinically apparent regional lymph node metastases and/or in-transit metastases

    • Clinically detected recurrent melanoma at the proximal regional lymph node(s) basin

    • Primary cutaneous melanoma with concurrent nodal disease involving a single (or multiple) regional nodal group(s) if considered potentially surgically resectable at baseline

    • Clinically detected nodal melanoma (if single site) arising from an unknown primary

    • In-transit cutaneous metastases with or without regional lymph node involvement permitted if considered potentially surgically resectable at baseline

      • NOTE: Patients with mucosal and/or uveal melanoma are not eligible for the study
  • Patient must be a candidate for definitive surgery and have met with the treating surgical oncologist prior to randomization

  • Patient must not have received any live vaccine within 30 days prior to randomization and while participating in the study. Live vaccines include, but are not limited to, the following: measles, mumps, rubella, chicken pox, yellow fever, rabies, Bacillus Calmette-Guerin (BCG), and typhoid (oral) vaccine. Patients are permitted to receive inactivated vaccines and any non-live vaccines including those for the seasonal influenza and COVID-19 (Note: intranasal influenza vaccines, such as Flu-Mist [registered trademark] are live attenuated vaccines and are not allowed). If possible, it is recommended to separate study drug administration from vaccine administration by about a week (primarily, in order to minimize an overlap of adverse events)

  • Patient must have the presence of injectable and measurable disease based on Response Evaluation Criteria in Solid Tumors (RECIST) 1.1, documented by scans obtained within 4 weeks prior to randomization

    • NOTE: Injectable disease is defined as an accessible lesion in the skin, subcutaneous tissue or lymph nodes (LN) close to the skin and palpable by physical examination or approachable with ultrasound guidance
  • Absolute neutrophil count (ANC) >= 1,500 /mcL (obtained within 4 weeks prior to randomization)

  • Hemoglobin (Hgb) >= 9 g/dL or >= 5.6 mmol/L (obtained within 4 weeks prior to randomization)

  • Platelets >= 100,000 / mcL (obtained within 4 weeks prior to randomization)

  • Serum creatinine =< 1.5 x institutional upper limit of normal (ULN) or measured or calculated creatinine clearance > 60 mL/min (glomerular filtration rate [GFR] can also be used in place of creatinine or creatinine clearance [CrCl] for patients with creatinine levels > 1.5 x institutional ULN) (obtained within 4 weeks prior to randomization)

  • Serum total bilirubin =< 1.5 x institutional ULN; for total bilirubin level > 1.5 x ULN but =< 3 x ULN, the direct bilirubin must be =< the institutional ULN (obtained within 4 weeks prior to randomization)

  • Aspartate aminotransferase (AST) (serum glutamic-oxaloacetic transaminase [SGOT]) and alanine aminotransferase (ALT) (serum glutamate pyruvate transaminase [SGPT]) =< 2.5 x institutional ULN (obtained within 4 weeks prior to randomization)

  • International normalized ratio (INR) or prothrombin time (PT) =< 1.5 x institutional ULN unless patient is receiving anticoagulant therapy as long as PT or partial thromboplastin time (PTT) is within therapeutic range of intended use of anticoagulants (obtained within 4 weeks prior to randomization)

  • Activated partial thromboplastin time (aPTT) =< 1.5 x institutional ULN unless patient is receiving anticoagulant therapy as long as PT or PTT is within therapeutic range of intended use of anticoagulants (obtained within 4 weeks prior to randomization)

  • Patients must not be pregnant or breast-feeding due to the potential harm to an unborn fetus and possible risk for adverse events in nursing infants with the treatment regimens being used. All patients of childbearing potential must have a blood test or urine study within 14 days prior to randomization to rule out pregnancy. A urine or serum pregnancy test must be repeated within 72 hours prior to receiving the first dose of pembrolizumab if the test done for eligibility/randomization is done outside of this 72 hour window. If the urine test is positive or cannot be confirmed as negative, a serum pregnancy test will be required. A patient of childbearing potential is defined as anyone, regardless of sexual orientation or whether they have undergone tubal ligation, who meets the following criteria: 1) has achieved menarche at some point, 2) has not undergone a hysterectomy or bilateral oophorectomy; or 3) has not been naturally postmenopausal (amenorrhea following cancer therapy does not rule out childbearing potential) for at least 24 consecutive months (i.e., has had menses at any time in the preceding 24 consecutive months)

  • Patients must not expect to conceive or father children by using accepted and effective method(s) of contraception or abstaining from sexual intercourse from time of randomization, while on study treatment, and continue for 26 weeks after the last dose of protocol treatment

  • Patient must have the ability to understand and the willingness to sign a written informed consent document. Patients with impaired decision-making capacity (IDMC) who have a legally authorized representative (LAR) or caregiver and/or family member available will also be considered eligible

  • Patient must not have received prior systemic therapy for melanoma including systemic therapy with an anti-PD-1, anti-PD-L1, anti-CTLA-4, BRAF/MEK inhibitor combination and/or TLR-9 agonist

  • Patient must not have a diagnosis of immunodeficiency or be receiving systemic steroid therapy or any other form of immunosuppressive therapy within 7 days prior to randomization, except as noted here

    • Patients who are currently receiving steroids at a dose of prednisone =< 5 mg daily (or equivalent) are permitted to enroll
    • Patients who require topical, ophthalmologic and inhalational steroids are permitted to enroll
    • Patients with hypothyroidism who are stable on hormone replacement are permitted to enroll
    • Patients who require active immunosuppression with corticosteroids at a dose of prednisone > 5 mg daily (or equivalent) for any reason are ineligible
    • Patients with adrenal insufficiency are ineligible
    • Patients who have developed autoimmune disorders of grade 4 while on prior immunotherapy are not permitted to enroll on this study. Patients who developed autoimmune disorders of grade =< 3 may enroll if the disorder has resolved to grade =< 1 and the patient has been off systemic corticosteroids at doses > 5 mg for at least 2 weeks prior to randomization
  • Human immunodeficiency virus (HIV)-infected patients on effective anti-retroviral therapy with undetectable viral load within 6 months prior to randomization are eligible for this trial

  • For patients with evidence of chronic hepatitis B virus (HBV) infection, the HBV viral load must be undetectable on suppressive therapy, if indicated

  • Patients with a history of hepatitis C virus (HCV) infection must have been treated and cured. For patients with HCV infection who are currently on treatment, they are eligible if they have an undetectable HCV viral load

  • Patients with a history of brain metastases are not eligible for this study as they do not meet the eligibility staging criteria

  • Patients with a prior or concurrent malignancy whose natural history or treatment does not have the potential to interfere with the safety or efficacy assessment of the investigational regimen are eligible for this trial

  • Patients with known history or current symptoms of cardiac disease, or history of treatment with cardiotoxic agents, should have a clinical risk assessment of cardiac function using the New York Heart Association Functional Classification. To be eligible for this trial, patients should be class 2B or better

  • Patient must not have had an allogeneic tissue/solid organ transplant

  • Patient must not have a history of (non-infectious) pneumonitis that required steroids or current pneumonitis

  • Patient must not have severe hypersensitivity (>= grade 3) to pembrolizumab and/or any of its excipients

  • Patient must not have an active infection requiring systemic therapy

  • Patient must not have a known psychiatric or substance abuse disorder that would interfere with the patient's ability to cooperate with the requirements of the study

Read More
Exclusion Criteria

Not provided

Read More

Study & Design

Study Type
INTERVENTIONAL
Study Design
PARALLEL
Arm && Interventions
GroupInterventionDescription
Arm A (pembrolizumab)BiopsyNEOADJUVANT PHASE: Patients receive pembrolizumab IV over 30 minutes on day 1 of each cycle. Treatment repeats every 21 days for up to 3 cycles in the absence of disease progression or unacceptable toxicity. SURGERY: Patients undergo surgery 1-2 weeks after completion of neoadjuvant phase. ADJUVANT PHASE: After recovery from surgery, patients receive pembrolizumab IV over 30 minutes on day 1 of every other cycle. Treatment repeats every 21 days for up to 16 cycles in the absence of disease progression or unacceptable toxicity. Patients also undergo CT or PET/CT throughout the trial and may undergo optional biopsy at baseline and disease progression and optional collection of blood samples throughout the trial.
Arm A (pembrolizumab)Biospecimen CollectionNEOADJUVANT PHASE: Patients receive pembrolizumab IV over 30 minutes on day 1 of each cycle. Treatment repeats every 21 days for up to 3 cycles in the absence of disease progression or unacceptable toxicity. SURGERY: Patients undergo surgery 1-2 weeks after completion of neoadjuvant phase. ADJUVANT PHASE: After recovery from surgery, patients receive pembrolizumab IV over 30 minutes on day 1 of every other cycle. Treatment repeats every 21 days for up to 16 cycles in the absence of disease progression or unacceptable toxicity. Patients also undergo CT or PET/CT throughout the trial and may undergo optional biopsy at baseline and disease progression and optional collection of blood samples throughout the trial.
Arm A (pembrolizumab)Computed TomographyNEOADJUVANT PHASE: Patients receive pembrolizumab IV over 30 minutes on day 1 of each cycle. Treatment repeats every 21 days for up to 3 cycles in the absence of disease progression or unacceptable toxicity. SURGERY: Patients undergo surgery 1-2 weeks after completion of neoadjuvant phase. ADJUVANT PHASE: After recovery from surgery, patients receive pembrolizumab IV over 30 minutes on day 1 of every other cycle. Treatment repeats every 21 days for up to 16 cycles in the absence of disease progression or unacceptable toxicity. Patients also undergo CT or PET/CT throughout the trial and may undergo optional biopsy at baseline and disease progression and optional collection of blood samples throughout the trial.
Arm A (pembrolizumab)PembrolizumabNEOADJUVANT PHASE: Patients receive pembrolizumab IV over 30 minutes on day 1 of each cycle. Treatment repeats every 21 days for up to 3 cycles in the absence of disease progression or unacceptable toxicity. SURGERY: Patients undergo surgery 1-2 weeks after completion of neoadjuvant phase. ADJUVANT PHASE: After recovery from surgery, patients receive pembrolizumab IV over 30 minutes on day 1 of every other cycle. Treatment repeats every 21 days for up to 16 cycles in the absence of disease progression or unacceptable toxicity. Patients also undergo CT or PET/CT throughout the trial and may undergo optional biopsy at baseline and disease progression and optional collection of blood samples throughout the trial.
Arm A (pembrolizumab)Positron Emission TomographyNEOADJUVANT PHASE: Patients receive pembrolizumab IV over 30 minutes on day 1 of each cycle. Treatment repeats every 21 days for up to 3 cycles in the absence of disease progression or unacceptable toxicity. SURGERY: Patients undergo surgery 1-2 weeks after completion of neoadjuvant phase. ADJUVANT PHASE: After recovery from surgery, patients receive pembrolizumab IV over 30 minutes on day 1 of every other cycle. Treatment repeats every 21 days for up to 16 cycles in the absence of disease progression or unacceptable toxicity. Patients also undergo CT or PET/CT throughout the trial and may undergo optional biopsy at baseline and disease progression and optional collection of blood samples throughout the trial.
Arm A (pembrolizumab)Surgical ProcedureNEOADJUVANT PHASE: Patients receive pembrolizumab IV over 30 minutes on day 1 of each cycle. Treatment repeats every 21 days for up to 3 cycles in the absence of disease progression or unacceptable toxicity. SURGERY: Patients undergo surgery 1-2 weeks after completion of neoadjuvant phase. ADJUVANT PHASE: After recovery from surgery, patients receive pembrolizumab IV over 30 minutes on day 1 of every other cycle. Treatment repeats every 21 days for up to 16 cycles in the absence of disease progression or unacceptable toxicity. Patients also undergo CT or PET/CT throughout the trial and may undergo optional biopsy at baseline and disease progression and optional collection of blood samples throughout the trial.
Arm B (CMP-001, pembrolizumab)BiopsyNEOADJUVANT PHASE: Patients receive CMP-001 SC on day 1 of cycle 1 and then intratumorally on days 8 and 15 of cycle 1, days 1, 8, and 15 of cycle 2, and day 1 of cycle 3. Patients also receive pembrolizumab IV over 30 minutes on day 8 of each cycle. Treatment repeats every 21 days for up to 3 cycles in the absence of disease progression or unacceptable toxicity. SURGERY: Patients undergo surgery 1-2 weeks after completion of neoadjuvant phase. ADJUVANT PHASE: After recovery from surgery, patients receive pembrolizumab IV over 30 minutes on day 1 of every other cycle. Treatment repeats every 21 days for up to 16 cycles in the absence of disease progression or unacceptable toxicity. Patients also undergo CT or PET/CT throughout the trial and may undergo optional biopsy at baseline and disease progression and optional collection of blood samples throughout the trial.
Arm B (CMP-001, pembrolizumab)Biospecimen CollectionNEOADJUVANT PHASE: Patients receive CMP-001 SC on day 1 of cycle 1 and then intratumorally on days 8 and 15 of cycle 1, days 1, 8, and 15 of cycle 2, and day 1 of cycle 3. Patients also receive pembrolizumab IV over 30 minutes on day 8 of each cycle. Treatment repeats every 21 days for up to 3 cycles in the absence of disease progression or unacceptable toxicity. SURGERY: Patients undergo surgery 1-2 weeks after completion of neoadjuvant phase. ADJUVANT PHASE: After recovery from surgery, patients receive pembrolizumab IV over 30 minutes on day 1 of every other cycle. Treatment repeats every 21 days for up to 16 cycles in the absence of disease progression or unacceptable toxicity. Patients also undergo CT or PET/CT throughout the trial and may undergo optional biopsy at baseline and disease progression and optional collection of blood samples throughout the trial.
Arm B (CMP-001, pembrolizumab)Computed TomographyNEOADJUVANT PHASE: Patients receive CMP-001 SC on day 1 of cycle 1 and then intratumorally on days 8 and 15 of cycle 1, days 1, 8, and 15 of cycle 2, and day 1 of cycle 3. Patients also receive pembrolizumab IV over 30 minutes on day 8 of each cycle. Treatment repeats every 21 days for up to 3 cycles in the absence of disease progression or unacceptable toxicity. SURGERY: Patients undergo surgery 1-2 weeks after completion of neoadjuvant phase. ADJUVANT PHASE: After recovery from surgery, patients receive pembrolizumab IV over 30 minutes on day 1 of every other cycle. Treatment repeats every 21 days for up to 16 cycles in the absence of disease progression or unacceptable toxicity. Patients also undergo CT or PET/CT throughout the trial and may undergo optional biopsy at baseline and disease progression and optional collection of blood samples throughout the trial.
Arm B (CMP-001, pembrolizumab)PembrolizumabNEOADJUVANT PHASE: Patients receive CMP-001 SC on day 1 of cycle 1 and then intratumorally on days 8 and 15 of cycle 1, days 1, 8, and 15 of cycle 2, and day 1 of cycle 3. Patients also receive pembrolizumab IV over 30 minutes on day 8 of each cycle. Treatment repeats every 21 days for up to 3 cycles in the absence of disease progression or unacceptable toxicity. SURGERY: Patients undergo surgery 1-2 weeks after completion of neoadjuvant phase. ADJUVANT PHASE: After recovery from surgery, patients receive pembrolizumab IV over 30 minutes on day 1 of every other cycle. Treatment repeats every 21 days for up to 16 cycles in the absence of disease progression or unacceptable toxicity. Patients also undergo CT or PET/CT throughout the trial and may undergo optional biopsy at baseline and disease progression and optional collection of blood samples throughout the trial.
Arm B (CMP-001, pembrolizumab)Positron Emission TomographyNEOADJUVANT PHASE: Patients receive CMP-001 SC on day 1 of cycle 1 and then intratumorally on days 8 and 15 of cycle 1, days 1, 8, and 15 of cycle 2, and day 1 of cycle 3. Patients also receive pembrolizumab IV over 30 minutes on day 8 of each cycle. Treatment repeats every 21 days for up to 3 cycles in the absence of disease progression or unacceptable toxicity. SURGERY: Patients undergo surgery 1-2 weeks after completion of neoadjuvant phase. ADJUVANT PHASE: After recovery from surgery, patients receive pembrolizumab IV over 30 minutes on day 1 of every other cycle. Treatment repeats every 21 days for up to 16 cycles in the absence of disease progression or unacceptable toxicity. Patients also undergo CT or PET/CT throughout the trial and may undergo optional biopsy at baseline and disease progression and optional collection of blood samples throughout the trial.
Arm B (CMP-001, pembrolizumab)Surgical ProcedureNEOADJUVANT PHASE: Patients receive CMP-001 SC on day 1 of cycle 1 and then intratumorally on days 8 and 15 of cycle 1, days 1, 8, and 15 of cycle 2, and day 1 of cycle 3. Patients also receive pembrolizumab IV over 30 minutes on day 8 of each cycle. Treatment repeats every 21 days for up to 3 cycles in the absence of disease progression or unacceptable toxicity. SURGERY: Patients undergo surgery 1-2 weeks after completion of neoadjuvant phase. ADJUVANT PHASE: After recovery from surgery, patients receive pembrolizumab IV over 30 minutes on day 1 of every other cycle. Treatment repeats every 21 days for up to 16 cycles in the absence of disease progression or unacceptable toxicity. Patients also undergo CT or PET/CT throughout the trial and may undergo optional biopsy at baseline and disease progression and optional collection of blood samples throughout the trial.
Arm B (CMP-001, pembrolizumab)VLP-encapsulated TLR9 Agonist CMP-001NEOADJUVANT PHASE: Patients receive CMP-001 SC on day 1 of cycle 1 and then intratumorally on days 8 and 15 of cycle 1, days 1, 8, and 15 of cycle 2, and day 1 of cycle 3. Patients also receive pembrolizumab IV over 30 minutes on day 8 of each cycle. Treatment repeats every 21 days for up to 3 cycles in the absence of disease progression or unacceptable toxicity. SURGERY: Patients undergo surgery 1-2 weeks after completion of neoadjuvant phase. ADJUVANT PHASE: After recovery from surgery, patients receive pembrolizumab IV over 30 minutes on day 1 of every other cycle. Treatment repeats every 21 days for up to 16 cycles in the absence of disease progression or unacceptable toxicity. Patients also undergo CT or PET/CT throughout the trial and may undergo optional biopsy at baseline and disease progression and optional collection of blood samples throughout the trial.
Primary Outcome Measures
NameTimeMethod
Pathologic complete response rateUp to 15 years

Will be estimated by the percentage of patients who achieve complete response, partial response or stable disease by Response Evaluation Criteria in Solid Tumors (RECIST) and Immune-Modified RECIST criteria, with exact 90% confidence intervals.

Secondary Outcome Measures
NameTimeMethod
Radiographic response rateUp to 15 years

Will be assessed using RECIST.

Relapse-free survivalFrom randomization to relapse or death (whichever occurs first), assessed up to 15 years
Overall survivalFrom randomization to death from any cause, assessed up to 15 years
Incidence of adverse eventsUp to 30 days after the last study drug administration

Patients will be monitored for adverse events using the National Cancer Institute's Common Terminology Criteria for Adverse Events.

Trial Locations

Locations (188)

Springfield Memorial Hospital

🇺🇸

Springfield, Illinois, United States

Marshfield Medical Center - Minocqua

🇺🇸

Minocqua, Wisconsin, United States

Anchorage Associates in Radiation Medicine

🇺🇸

Anchorage, Alaska, United States

Alaska Breast Care and Surgery LLC

🇺🇸

Anchorage, Alaska, United States

Alaska Oncology and Hematology LLC

🇺🇸

Anchorage, Alaska, United States

Alaska Women's Cancer Care

🇺🇸

Anchorage, Alaska, United States

Anchorage Oncology Centre

🇺🇸

Anchorage, Alaska, United States

Katmai Oncology Group

🇺🇸

Anchorage, Alaska, United States

Providence Alaska Medical Center

🇺🇸

Anchorage, Alaska, United States

Fairbanks Memorial Hospital

🇺🇸

Fairbanks, Alaska, United States

Banner University Medical Center - Tucson

🇺🇸

Tucson, Arizona, United States

University of Arizona Cancer Center-North Campus

🇺🇸

Tucson, Arizona, United States

Mercy Hospital Fort Smith

🇺🇸

Fort Smith, Arkansas, United States

Providence Saint Joseph Medical Center/Disney Family Cancer Center

🇺🇸

Burbank, California, United States

Epic Care-Dublin

🇺🇸

Dublin, California, United States

Bay Area Breast Surgeons Inc

🇺🇸

Emeryville, California, United States

Epic Care Partners in Cancer Care

🇺🇸

Emeryville, California, United States

Contra Costa Regional Medical Center

🇺🇸

Martinez, California, United States

Alta Bates Summit Medical Center - Summit Campus

🇺🇸

Oakland, California, United States

Bay Area Tumor Institute

🇺🇸

Oakland, California, United States

Saint Joseph Hospital - Orange

🇺🇸

Orange, California, United States

UC Irvine Health/Chao Family Comprehensive Cancer Center

🇺🇸

Orange, California, United States

Epic Care Cyberknife Center

🇺🇸

Walnut Creek, California, United States

Rocky Mountain Cancer Centers-Aurora

🇺🇸

Aurora, Colorado, United States

The Medical Center of Aurora

🇺🇸

Aurora, Colorado, United States

Rocky Mountain Cancer Centers-Boulder

🇺🇸

Boulder, Colorado, United States

Rocky Mountain Cancer Centers - Centennial

🇺🇸

Centennial, Colorado, United States

Presbyterian - Saint Lukes Medical Center - Health One

🇺🇸

Denver, Colorado, United States

Rocky Mountain Cancer Centers-Midtown

🇺🇸

Denver, Colorado, United States

Rocky Mountain Cancer Centers-Rose

🇺🇸

Denver, Colorado, United States

Mountain Blue Cancer Care Center - Swedish

🇺🇸

Englewood, Colorado, United States

Rocky Mountain Cancer Centers - Swedish

🇺🇸

Englewood, Colorado, United States

Swedish Medical Center

🇺🇸

Englewood, Colorado, United States

The Melanoma and Skin Cancer Institute

🇺🇸

Englewood, Colorado, United States

Banner North Colorado Medical Center

🇺🇸

Greeley, Colorado, United States

Rocky Mountain Cancer Centers-Littleton

🇺🇸

Littleton, Colorado, United States

Rocky Mountain Cancer Centers-Sky Ridge

🇺🇸

Lone Tree, Colorado, United States

Sky Ridge Medical Center

🇺🇸

Lone Tree, Colorado, United States

Banner McKee Medical Center

🇺🇸

Loveland, Colorado, United States

Rocky Mountain Cancer Centers-Thornton

🇺🇸

Thornton, Colorado, United States

UM Sylvester Comprehensive Cancer Center at Aventura

🇺🇸

Aventura, Florida, United States

UM Sylvester Comprehensive Cancer Center at Coral Gables

🇺🇸

Coral Gables, Florida, United States

UM Sylvester Comprehensive Cancer Center at Deerfield Beach

🇺🇸

Deerfield Beach, Florida, United States

University of Miami Miller School of Medicine-Sylvester Cancer Center

🇺🇸

Miami, Florida, United States

UM Sylvester Comprehensive Cancer Center at Plantation

🇺🇸

Plantation, Florida, United States

Saint Luke's Cancer Institute - Boise

🇺🇸

Boise, Idaho, United States

Saint Luke's Cancer Institute - Fruitland

🇺🇸

Fruitland, Idaho, United States

Saint Luke's Cancer Institute - Meridian

🇺🇸

Meridian, Idaho, United States

Saint Luke's Cancer Institute - Nampa

🇺🇸

Nampa, Idaho, United States

Saint Luke's Cancer Institute - Twin Falls

🇺🇸

Twin Falls, Idaho, United States

Illinois CancerCare-Bloomington

🇺🇸

Bloomington, Illinois, United States

Illinois CancerCare-Canton

🇺🇸

Canton, Illinois, United States

Memorial Hospital of Carbondale

🇺🇸

Carbondale, Illinois, United States

SIH Cancer Institute

🇺🇸

Carterville, Illinois, United States

Illinois CancerCare-Carthage

🇺🇸

Carthage, Illinois, United States

Centralia Oncology Clinic

🇺🇸

Centralia, Illinois, United States

University of Illinois

🇺🇸

Chicago, Illinois, United States

Cancer Care Specialists of Illinois - Decatur

🇺🇸

Decatur, Illinois, United States

Decatur Memorial Hospital

🇺🇸

Decatur, Illinois, United States

Illinois CancerCare-Dixon

🇺🇸

Dixon, Illinois, United States

Crossroads Cancer Center

🇺🇸

Effingham, Illinois, United States

Illinois CancerCare-Eureka

🇺🇸

Eureka, Illinois, United States

Illinois CancerCare-Galesburg

🇺🇸

Galesburg, Illinois, United States

Western Illinois Cancer Treatment Center

🇺🇸

Galesburg, Illinois, United States

Illinois CancerCare-Kewanee Clinic

🇺🇸

Kewanee, Illinois, United States

Illinois CancerCare-Macomb

🇺🇸

Macomb, Illinois, United States

Good Samaritan Regional Health Center

🇺🇸

Mount Vernon, Illinois, United States

Cancer Care Center of O'Fallon

🇺🇸

O'Fallon, Illinois, United States

Illinois CancerCare-Ottawa Clinic

🇺🇸

Ottawa, Illinois, United States

Illinois CancerCare-Pekin

🇺🇸

Pekin, Illinois, United States

Illinois CancerCare-Peoria

🇺🇸

Peoria, Illinois, United States

Methodist Medical Center of Illinois

🇺🇸

Peoria, Illinois, United States

Illinois CancerCare-Peru

🇺🇸

Peru, Illinois, United States

Valley Radiation Oncology

🇺🇸

Peru, Illinois, United States

Illinois CancerCare-Princeton

🇺🇸

Princeton, Illinois, United States

Southern Illinois University School of Medicine

🇺🇸

Springfield, Illinois, United States

Springfield Clinic

🇺🇸

Springfield, Illinois, United States

Illinois CancerCare - Washington

🇺🇸

Washington, Illinois, United States

Reid Health

🇺🇸

Richmond, Indiana, United States

Mary Greeley Medical Center

🇺🇸

Ames, Iowa, United States

McFarland Clinic - Ames

🇺🇸

Ames, Iowa, United States

McFarland Clinic - Boone

🇺🇸

Boone, Iowa, United States

McFarland Clinic - Trinity Cancer Center

🇺🇸

Fort Dodge, Iowa, United States

McFarland Clinic - Jefferson

🇺🇸

Jefferson, Iowa, United States

McFarland Clinic - Marshalltown

🇺🇸

Marshalltown, Iowa, United States

Central Care Cancer Center - Garden City

🇺🇸

Garden City, Kansas, United States

Central Care Cancer Center - Great Bend

🇺🇸

Great Bend, Kansas, United States

Louisiana Hematology Oncology Associates LLC

🇺🇸

Baton Rouge, Louisiana, United States

Mary Bird Perkins Cancer Center

🇺🇸

Baton Rouge, Louisiana, United States

Terrebonne General Medical Center

🇺🇸

Houma, Louisiana, United States

Bronson Battle Creek

🇺🇸

Battle Creek, Michigan, United States

Corewell Health Grand Rapids Hospitals - Butterworth Hospital

🇺🇸

Grand Rapids, Michigan, United States

Corewell Health Grand Rapids Hospitals - Helen DeVos Children's Hospital

🇺🇸

Grand Rapids, Michigan, United States

Trinity Health Grand Rapids Hospital

🇺🇸

Grand Rapids, Michigan, United States

Bronson Methodist Hospital

🇺🇸

Kalamazoo, Michigan, United States

West Michigan Cancer Center

🇺🇸

Kalamazoo, Michigan, United States

Ascension Borgess Cancer Center

🇺🇸

Kalamazoo, Michigan, United States

Ascension Borgess Hospital

🇺🇸

Kalamazoo, Michigan, United States

Trinity Health Muskegon Hospital

🇺🇸

Muskegon, Michigan, United States

Corewell Health Lakeland Hospitals - Niles Hospital

🇺🇸

Niles, Michigan, United States

Cancer and Hematology Centers of Western Michigan - Norton Shores

🇺🇸

Norton Shores, Michigan, United States

Corewell Health Reed City Hospital

🇺🇸

Reed City, 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

Munson Medical Center

🇺🇸

Traverse City, Michigan, United States

University of Michigan Health - West

🇺🇸

Wyoming, Michigan, United States

Saint Louis Cancer and Breast Institute-Ballwin

🇺🇸

Ballwin, Missouri, United States

Central Care Cancer Center - Bolivar

🇺🇸

Bolivar, Missouri, United States

Saint Francis Medical Center

🇺🇸

Cape Girardeau, Missouri, United States

Southeast Cancer Center

🇺🇸

Cape Girardeau, Missouri, United States

Parkland Health Center - Farmington

🇺🇸

Farmington, Missouri, United States

MU Health Care Goldschmidt Cancer Center

🇺🇸

Jefferson City, Missouri, United States

Freeman Health System

🇺🇸

Joplin, Missouri, United States

Mercy Hospital Joplin

🇺🇸

Joplin, Missouri, United States

Delbert Day Cancer Institute at PCRMC

🇺🇸

Rolla, Missouri, United States

Mercy Clinic-Rolla-Cancer and Hematology

🇺🇸

Rolla, Missouri, United States

Heartland Regional Medical Center

🇺🇸

Saint Joseph, Missouri, United States

Mercy Hospital South

🇺🇸

Saint Louis, Missouri, United States

Missouri Baptist Medical Center

🇺🇸

Saint Louis, Missouri, United States

Mercy Hospital Saint Louis

🇺🇸

Saint Louis, Missouri, United States

Sainte Genevieve County Memorial Hospital

🇺🇸

Sainte Genevieve, Missouri, United States

Mercy Hospital Springfield

🇺🇸

Springfield, Missouri, United States

CoxHealth South Hospital

🇺🇸

Springfield, Missouri, United States

Missouri Baptist Sullivan Hospital

🇺🇸

Sullivan, Missouri, United States

BJC Outpatient Center at Sunset Hills

🇺🇸

Sunset Hills, Missouri, United States

Saint Patrick Hospital - Community Hospital

🇺🇸

Missoula, Montana, United States

Indu and Raj Soin Medical Center

🇺🇸

Beavercreek, Ohio, United States

Dayton Physicians LLC-Miami Valley South

🇺🇸

Centerville, Ohio, United States

Miami Valley Hospital South

🇺🇸

Centerville, Ohio, United States

Oncology Hematology Care Inc-Kenwood

🇺🇸

Cincinnati, Ohio, United States

Miami Valley Hospital

🇺🇸

Dayton, Ohio, United States

Dayton Physician LLC - Englewood

🇺🇸

Dayton, Ohio, United States

Miami Valley Hospital North

🇺🇸

Dayton, Ohio, United States

Armes Family Cancer Center

🇺🇸

Findlay, Ohio, United States

Blanchard Valley Hospital

🇺🇸

Findlay, Ohio, United States

Orion Cancer Care

🇺🇸

Findlay, Ohio, United States

Atrium Medical Center-Middletown Regional Hospital

🇺🇸

Franklin, Ohio, United States

Dayton Physicians LLC-Atrium

🇺🇸

Franklin, Ohio, United States

Dayton Physicians LLC-Wayne

🇺🇸

Greenville, Ohio, United States

Kettering Medical Center

🇺🇸

Kettering, Ohio, United States

Wayne Hospital

🇺🇸

Greenville, Ohio, United States

Greater Dayton Cancer Center

🇺🇸

Kettering, Ohio, United States

Springfield Regional Cancer Center

🇺🇸

Springfield, Ohio, United States

Springfield Regional Medical Center

🇺🇸

Springfield, Ohio, United States

Dayton Physicians LLC - Troy

🇺🇸

Troy, Ohio, United States

Upper Valley Medical Center

🇺🇸

Troy, Ohio, United States

Mercy Hospital Oklahoma City

🇺🇸

Oklahoma City, Oklahoma, United States

Saint Charles Health System

🇺🇸

Bend, Oregon, United States

Clackamas Radiation Oncology Center

🇺🇸

Clackamas, Oregon, United States

Providence Cancer Institute Clackamas Clinic

🇺🇸

Clackamas, Oregon, United States

Bay Area Hospital

🇺🇸

Coos Bay, Oregon, United States

Providence Newberg Medical Center

🇺🇸

Newberg, Oregon, United States

Providence Portland Medical Center

🇺🇸

Portland, Oregon, United States

Providence Saint Vincent Medical Center

🇺🇸

Portland, Oregon, United States

Saint Luke's Cancer Center - Allentown

🇺🇸

Allentown, Pennsylvania, United States

Saint Luke's University Hospital-Bethlehem Campus

🇺🇸

Bethlehem, Pennsylvania, United States

Saint Luke's Hospital-Anderson Campus

🇺🇸

Easton, Pennsylvania, United States

University of Pittsburgh Cancer Institute (UPCI)

🇺🇸

Pittsburgh, Pennsylvania, United States

Saint Luke's Hospital-Quakertown Campus

🇺🇸

Quakertown, Pennsylvania, United States

Guthrie Medical Group PC-Robert Packer Hospital

🇺🇸

Sayre, Pennsylvania, United States

Avera Cancer Institute-Aberdeen

🇺🇸

Aberdeen, South Dakota, United States

Avera Cancer Institute

🇺🇸

Sioux Falls, South Dakota, United States

Huntsman Cancer Institute/University of Utah

🇺🇸

Salt Lake City, Utah, United States

Central Vermont Medical Center/National Life Cancer Treatment

🇺🇸

Berlin, Vermont, United States

University of Vermont Medical Center

🇺🇸

Burlington, Vermont, United States

University of Virginia Cancer Center

🇺🇸

Charlottesville, Virginia, United States

Providence Regional Cancer System-Aberdeen

🇺🇸

Aberdeen, Washington, United States

PeaceHealth Saint Joseph Medical Center

🇺🇸

Bellingham, Washington, United States

Providence Regional Cancer System-Centralia

🇺🇸

Centralia, Washington, United States

Swedish Cancer Institute-Edmonds

🇺🇸

Edmonds, Washington, United States

Providence Regional Cancer Partnership

🇺🇸

Everett, Washington, United States

Swedish Cancer Institute-Issaquah

🇺🇸

Issaquah, Washington, United States

Virginia Commonwealth University/Massey Cancer Center

🇺🇸

Richmond, Virginia, United States

Kadlec Clinic Hematology and Oncology

🇺🇸

Kennewick, Washington, United States

Providence Regional Cancer System-Lacey

🇺🇸

Lacey, Washington, United States

Swedish Medical Center-Ballard Campus

🇺🇸

Seattle, Washington, United States

Swedish Medical Center-First Hill

🇺🇸

Seattle, Washington, United States

PeaceHealth United General Medical Center

🇺🇸

Sedro-Woolley, Washington, United States

PeaceHealth Southwest Medical Center

🇺🇸

Vancouver, Washington, United States

PeaceHealth Saint John Medical Center

🇺🇸

Longview, Washington, United States

Jefferson Healthcare

🇺🇸

Port Townsend, Washington, United States

Providence Saint Mary Regional Cancer Center

🇺🇸

Walla Walla, Washington, United States

Marshfield Medical Center-EC Cancer Center

🇺🇸

Eau Claire, Wisconsin, United States

Marshfield Medical Center-Marshfield

🇺🇸

Marshfield, Wisconsin, United States

Medical College of Wisconsin

🇺🇸

Milwaukee, Wisconsin, United States

Marshfield Medical Center-Rice Lake

🇺🇸

Rice Lake, Wisconsin, United States

Marshfield Medical Center-River Region at Stevens Point

🇺🇸

Stevens Point, Wisconsin, United States

Marshfield Medical Center - Weston

🇺🇸

Weston, Wisconsin, United States

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