Chemotherapy and Radiation Therapy With or Without Metformin Hydrochloride in Treating Patients With Stage III Non-small Cell Lung Cancer

Phase 2

Active, not recruiting

Conditions: Adenosquamous Lung Carcinoma
Bronchioloalveolar Carcinoma
Large Cell Lung Carcinoma
Stage IIIB Non-Small Cell Lung Cancer
Non-Small Cell Lung Carcinoma
Squamous Cell Lung Carcinoma
Stage IIIA Non-Small Cell Lung Cancer
Lung Adenocarcinoma
Recurrent Non-Small Cell Lung Carcinoma

Interventions: Radiation: Radiation Therapy
Drug: Carboplatin
Drug: Paclitaxel
Drug: Metformin

Registration Number: NCT02186847

Lead Sponsor: NRG Oncology

Brief Summary: This randomized phase II trial studies how well chemotherapy and radiation therapy given with or without metformin hydrochloride works in treating patients with stage III non-small cell lung cancer. Drugs used in chemotherapy, such as carboplatin and paclitaxel, work in different ways to stop the growth of tumor cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Radiation therapy uses high-energy x-rays to kill tumor cells and shrink tumors. Metformin hydrochloride may shrink tumors and keep them from coming back. It is not yet known whether chemotherapy and radiation therapy is more effective when given with or without metformin hydrochloride in treating stage III non-small cell lung cancer.

Detailed Description: PRIMARY OBJECTIVES:

I. To determine whether metformin hydrochloride (MET) added to chemoradiotherapy can improve progression-free survival (PFS) in patients with locally advanced non-small cell lung cancer (NSCLC).

SECONDARY OBJECTIVES:

I. Determine the effects of MET on overall survival (OS), time to local-regional progression (LRP), and time to distant metastasis (DM).

II. Evaluate the effect of MET on chemoradiotherapy toxicity (Common Terminology Criteria for Adverse Events, version 4 \[CTCAE, v. 4\]) within 1 year of completion of all treatment.

III. Collect biospecimens to develop biomarkers of MET activity.

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

After completion of study treatment, patients are followed up at 4-6 weeks, every 3 months for 2 years, every 6 months for 3 years, and then annually thereafter.

Recruitment & Eligibility

Status: ACTIVE_NOT_RECRUITING

Sex: All

Target Recruitment: 170

Inclusion Criteria

Pathologically (histologically or cytologically) proven diagnosis of stage IIIA or IIIB non-small cell lung cancer within 84 days of registration; eligible histologies include adenocarcinoma, adenosquamous, large cell carcinoma, squamous carcinoma, non-lobar and non-diffuse bronchoalveolar cell carcinoma or non-small cell lung cancer not otherwise specified)
Patients must have measurable disease
Patients must have unresectable disease, be medically inoperable, or unwilling to undergo surgical management
Appropriate stage for protocol entry, including no distant metastases, based upon the following minimum diagnostic workup:
- History/physical examination, including documentation of height, weight, body surface area, and vital signs, within 30 days prior to registration
- Computed tomography (CT) with IV contrast or magnetic resonance imaging (MRI) imaging (if CT scan with contrast is medically contraindicated) of the lung and upper abdomen through the adrenal glands, required within 45 days prior to registration (recommended within 30 days prior to registration
- MRI of the brain with contrast (or CT with contrast if MRI is medically contraindicated) within 45 days prior to registration; note: the use of intravenous contrast is required for the MRI or CT; an MRI without contrast is only permitted if the patient has a contrast allergy
- Whole-body fludeoxyglucose (FDG)-positron emission tomography (PET)/CT required within 45 days prior to registration (recommended within 30 days prior to registration; note: patients do not need to have a separate CT of the chest and upper abdomen with contrast if PET/CT imaging includes a high quality CT with contrast
Zubrod performance status 0-1
Absolute neutrophil count (ANC) >= 1,500 cells/mm^3
Complete blood count(CBC)/differential obtained within 14 days prior to registration on study, with adequate bone marrow function defined as follows:
- Absolute neutrophil count (ANC) ≥ 1,500 cells/mm3
- Platelets >= 100,000 cells/mm^3
- Hemoglobin >= 8.0 g/dl (note: the use of transfusion or other intervention to achieve hemoglobin [Hgb] >= 8.0 g/dl is acceptable)
Adequate renal function within 14 days prior to registration, defined as serum creatinine within normal institutional limits or creatinine clearance must be at least 60 ml/min;
Adequate hepatic function within 14 days prior to registration, defined as total bilirubin ≤ 1.5 x upper limit of normal (ULN) for the institution and alanine aminotransferase (ALT), aspartate aminotransferase (AST), and alkaline phosphatase ≤ 2.5 x ULN for the institution;
Fasting blood glucose ≤ 125 mg/dL within 14 days prior to registration;
Serum albumin > 3.0 g/dl within 14 days prior to registration;
For women of childbearing potential, a serum pregnancy test within 72 hours prior to registration;
Patients with post-obstructive pneumonia are eligible provided they no longer require intravenous antibiotics at registration;
Patients must be at least 3 weeks from prior thoracotomy (if performed);
If a pleural effusion is present, the following criteria must be met at registration to exclude malignant involvement (incurable M1a disease):
- When pleural fluid is visible on both the CT scan and on a chest x-ray, a pleuracentesis is required to confirm that the pleural fluid is cytologically negative;
- Effusions that are minimal (i.e. not visible under ultrasound guidance) and that are too small to safely tap are eligible.
Women of childbearing potential and male participants must practice adequate contraception throughout the study;

Exclusion Criteria

Patients with mixed small cell and non-small cell histologies
Patients with distant metastasis
Prior invasive malignancy (except non-melanomatous skin cancer) unless disease free for a minimum of 3 years (for example, carcinoma in situ of the breast, oral cavity, or cervix are all permissible)
Prior systemic chemotherapy for the study cancer; note that prior chemotherapy for a different cancer is allowable
Prior radiotherapy to the region of the study cancer that would result in overlap of radiation therapy fields
Patients currently using metformin (metformin hydrochloride), other oral hypoglycemic agents or insulin
Patients with any history of allergic reaction to paclitaxel or other taxanes or carboplatin
Patients with a history of chronic kidney disease or lactic acidosis
Patients with >= 10% weight loss within the past month
Severe, active co-morbidity, defined as follows:
- Diagnosis of type I or type II diabetes mellitus
- Uncontrolled neuropathy >= grade 2 regardless of cause
- Unstable angina and/or congestive heart failure requiring hospitalization within the last 6 months
- Transmural myocardial infarction within the last 6 months
- Acute bacterial or fungal infection requiring intravenous antibiotics at the time of registration
- Chronic obstructive pulmonary disease exacerbation or other respiratory illness requiring hospitalization or precluding study therapy within 30 days of registration
- Severe hepatic disease, defined as a diagnosis of Child-Pugh class B or C hepatic disease
- Human immunodeficiency virus (HIV) positive with cluster of differentiation (CD)4 count < 200 cells/microliter; note that patients who are HIV positive are eligible, provided they are under treatment with highly active antiretroviral therapy (HAART) and have a CD4 count >= 200 cells/microliter within 30 days prior to registration; note also that HIV testing is not required for eligibility for this protocol
- End-stage renal disease (ie, on dialysis or dialysis has been recommended)
Pregnancy or women of childbearing potential and men who are sexually active and not willing/able to use medically acceptable forms of contraception

Study & Design

Study Type: INTERVENTIONAL

Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Chemoradiation	Radiation Therapy	60 Gy Radiation therapy with concurrent paclitaxel and carboplatin followed by consolidation paclitaxel and carboplatin
Metformin + Chemoradiation	Radiation Therapy	Metformin plus 60 Gy Radiation therapy with concurrent paclitaxel and carboplatin followed by consolidation paclitaxel and carboplatin
Chemoradiation	Carboplatin	60 Gy Radiation therapy with concurrent paclitaxel and carboplatin followed by consolidation paclitaxel and carboplatin
Chemoradiation	Paclitaxel	60 Gy Radiation therapy with concurrent paclitaxel and carboplatin followed by consolidation paclitaxel and carboplatin
Metformin + Chemoradiation	Carboplatin	Metformin plus 60 Gy Radiation therapy with concurrent paclitaxel and carboplatin followed by consolidation paclitaxel and carboplatin
Metformin + Chemoradiation	Metformin	Metformin plus 60 Gy Radiation therapy with concurrent paclitaxel and carboplatin followed by consolidation paclitaxel and carboplatin
Metformin + Chemoradiation	Paclitaxel	Metformin plus 60 Gy Radiation therapy with concurrent paclitaxel and carboplatin followed by consolidation paclitaxel and carboplatin

Primary Outcome Measures

Name	Time	Method
Percentage of Participants Alive Without Progression (Progression-free Survival)	From randomization to last follow-up. Maximum follow-up at time of analysis was 47.2 months.	Progression is defined per RECIST v1.1 as change in a known lesion(s) meeting one of the following criteria: \[1\] At least a 20% increase in the sum of the longest diameter of target lesions such that the absolute increase must be \> 5 mm. \[2\] Appearance of ≥1 new lesions. Progression-free survival time is defined as time from randomization to the date of first progression, death, or last known follow-up (censored). Progression-free survival rates are estimated using the Kaplan-Meier method. The protocol specifies that the distributions of failure times be compared between the arms, which is reported in the statistical analysis results. One-year rates are provided. Analysis occurred after 102 progression-free survival events were reported.

Secondary Outcome Measures

Name	Time	Method
Percentage of Participants With Distant Metastases	From randomization to last follow-up. Maximum follow-up at time of analysis was 47.2 months.	Distant metastasis (DM) is defined as the appearance of ≥ 1 new lesions at any site (including pleural or pericardial effusion) outside of the following: the planned treatment volume, the same lobe(s) of the lung as the primary tumor, or regional lymph nodes. Time to DM is defined as time from randomization to the date of first DM, death without DM (competing risk), or last known follow-up (censored). DM rates are estimated using the cumulative incidence method. The protocol specifies that the distributions of failure times be compared between the arms, which is reported in the statistical analysis results. One-year rates are provided. Analysis occurred after 102 progression-free survival events were reported.
Percentage of Participants With Treatment-related Grade 3 or Higher Adverse Events	From start of treatment to last follow-up. Maximum follow-up at time of analysis was 47.2 months.	Adverse events (AE) were graded using the Common Terminology Criteria for Adverse Events (CTCAE) v4.0. Grade refers to the severity of the AE. The CTCAE v4.0 assigns Grades 1 through 5 with unique clinical descriptions of severity for each AE based on this general guideline: Grade 1 Mild, Grade 2 Moderate, Grade 3 Severe, Grade 4 Life-threatening or disabling, Grade 5 Death related to adverse event. "Treatment-related" is defined definitely, probably, or possibly related to treatment.
Percentage of Participants Alive (Overall Survival)	From randomization to last follow-up. Maximum follow-up at time of analysis was 47.2 months.	Overall survival time is defined as time from randomization to the date of death from any cause or last known follow-up (censored). Overall survival rates are estimated using the Kaplan-Meier method. The protocol specifies that the distributions of failure times be compared between the arms, which is reported in the statistical analysis results. One-year rates are provided. Analysis occurred after 102 progression-free survival events were reported.
Percentage of Participants With Local-regional Progression	From randomization to last follow-up. Maximum follow-up at time of analysis was 47.2 months.	Local-regional progression (LRP) is defined as progression within the planned treatment volume (PTV) or outside the PTV but within the same lobe(s) of the lung as the primary tumor or in regional lymph nodes. Progression is defined as change in a known lesion(s) meeting one of the following criteria: \[1\] ≥ 20% increase in the sum of the longest diameter of target lesions such that the absolute increase must be \> 5 mm. \[2\] Appearance of ≥1 new lesions. LRP time is defined as time from randomization to the date of first LRP, death without LRP (competing risk), or last known follow-up (censored). LRP rates are estimated using the cumulative incidence method. The protocol specifies that the distributions of failure times be compared between the arms, which is reported in the statistical analysis results. One-year rates are provided. Analysis occurred after 102 LRP events were reported.

Trial Locations

Locations (222): Mercy Hospital
🇺🇸
Coon Rapids, Minnesota, United States
FirstHealth of the Carolinas-Moore Regional Hospital
🇺🇸
Pinehurst, North Carolina, United States
Geisinger Medical Center
🇺🇸
Danville, Pennsylvania, United States
Thomas Jefferson University Hospital
🇺🇸
Philadelphia, Pennsylvania, United States
Geisinger Wyoming Valley/Henry Cancer Center
🇺🇸
Wilkes-Barre, Pennsylvania, United States
Allan Blair Cancer Centre
🇨🇦
Regina, Saskatchewan, Canada
Bay Area Medical Center
🇺🇸
Marinette, Wisconsin, United States
Diagnostic and Treatment Center
🇺🇸
Weston, Wisconsin, United States
Riverside Methodist Hospital
🇺🇸
Columbus, Ohio, United States
The Mark H Zangmeister Center
🇺🇸
Columbus, Ohio, United States
Mount Carmel Health Center West
🇺🇸
Columbus, Ohio, United States
William Beaumont Hospital-Royal Oak
🇺🇸
Royal Oak, Michigan, United States
McLaren Cancer Institute-Owosso
🇺🇸
Owosso, Michigan, United States
Sanford Joe Lueken Cancer Center
🇺🇸
Bemidji, Minnesota, United States
MD Anderson League City
🇺🇸
Nassau Bay, Texas, United States
Saskatoon Cancer Centre
🇨🇦
Saskatoon, Saskatchewan, Canada
John H Stroger Jr Hospital of Cook County
🇺🇸
Chicago, Illinois, United States
Case Western Reserve University
🇺🇸
Cleveland, Ohio, United States
Cleveland Clinic Cancer Center/Fairview Hospital
🇺🇸
Cleveland, Ohio, United States
Cleveland Clinic Foundation
🇺🇸
Cleveland, Ohio, United States
UPMC-Shadyside Hospital
🇺🇸
Pittsburgh, Pennsylvania, United States
M D Anderson Cancer Center
🇺🇸
Houston, Texas, United States
MD Anderson in Katy
🇺🇸
Houston, Texas, United States
Franciscan Health Indianapolis
🇺🇸
Indianapolis, Indiana, United States
University of Cincinnati/Barrett Cancer Center
🇺🇸
Cincinnati, Ohio, United States
UCSF Medical Center-Mount Zion
🇺🇸
San Francisco, California, United States
Penrose-Saint Francis Healthcare
🇺🇸
Colorado Springs, Colorado, United States
Sanford Roger Maris Cancer Center
🇺🇸
Fargo, North Dakota, United States
Lawrence Memorial Hospital
🇺🇸
Lawrence, Kansas, United States
The Cancer Center of Hawaii-Pali Momi
🇺🇸
'Aiea, Hawaii, United States
UCHealth Memorial Hospital Central
🇺🇸
Colorado Springs, Colorado, United States
University of Kansas Cancer Center-Overland Park
🇺🇸
Overland Park, Kansas, United States
North Colorado Medical Center
🇺🇸
Greeley, Colorado, United States
McKee Medical Center
🇺🇸
Loveland, Colorado, United States
SCL Health Lutheran Medical Center
🇺🇸
Wheat Ridge, Colorado, United States
Queen's Medical Center
🇺🇸
Honolulu, Hawaii, United States
The Cancer Center of Hawaii-Liliha
🇺🇸
Honolulu, Hawaii, United States
University of Kansas Cancer Center
🇺🇸
Kansas City, Kansas, United States
Boston Medical Center
🇺🇸
Boston, Massachusetts, United States
University of Rochester
🇺🇸
Rochester, New York, United States
Henry Ford Hospital
🇺🇸
Detroit, Michigan, United States
University of Oklahoma Health Sciences Center
🇺🇸
Oklahoma City, Oklahoma, United States
Nebraska Methodist Hospital
🇺🇸
Omaha, Nebraska, United States
University of Nebraska Medical Center
🇺🇸
Omaha, Nebraska, United States
Ascension Columbia Saint Mary's Water Tower Medical Commons
🇺🇸
Milwaukee, Wisconsin, United States
Aurora Saint Luke's Medical Center
🇺🇸
Milwaukee, Wisconsin, United States
Medical College of Wisconsin
🇺🇸
Milwaukee, Wisconsin, United States
Zablocki Veterans Administration Medical Center
🇺🇸
Milwaukee, Wisconsin, United States
Sanford Bismarck Medical Center
🇺🇸
Bismarck, North Dakota, United States
Banner University Medical Center - Tucson
🇺🇸
Tucson, Arizona, United States
Sutter Cancer Centers Radiation Oncology Services-Auburn
🇺🇸
Auburn, California, United States
Lewis and Faye Manderson Cancer Center
🇺🇸
Tuscaloosa, Alabama, United States
Sutter Cancer Centers Radiation Oncology Services-Cameron Park
🇺🇸
Cameron Park, California, United States
Eden Hospital Medical Center
🇺🇸
Castro Valley, California, United States
UC San Diego Moores Cancer Center
🇺🇸
La Jolla, California, United States
Memorial Medical Center
🇺🇸
Springfield, Illinois, United States
Kaiser Permanente Oakland-Broadway
🇺🇸
Oakland, California, United States
Rohnert Park Cancer Center
🇺🇸
Rohnert Park, California, United States
The Permanente Medical Group-Roseville Radiation Oncology
🇺🇸
Roseville, California, United States
Sutter Medical Center Sacramento
🇺🇸
Sacramento, California, United States
Sutter Cancer Centers Radiation Oncology Services-Roseville
🇺🇸
Roseville, California, United States
Kaiser Permanente-Rancho Cordova Cancer Center
🇺🇸
Rancho Cordova, California, United States
South Sacramento Cancer Center
🇺🇸
Sacramento, California, United States
Kaiser Permanente Cancer Treatment Center
🇺🇸
South San Francisco, California, United States
Sutter Cancer Centers Radiation Oncology Services-Vacaville
🇺🇸
Vacaville, California, United States
University of Colorado Hospital
🇺🇸
Aurora, Colorado, United States
Christiana Care Health System-Christiana Hospital
🇺🇸
Newark, Delaware, United States
UF Cancer Center at Orlando Health
🇺🇸
Orlando, Florida, United States
21st Century Oncology-Palatka
🇺🇸
Palatka, Florida, United States
Piedmont Hospital
🇺🇸
Atlanta, Georgia, United States
Memorial Health University Medical Center
🇺🇸
Savannah, Georgia, United States
Dekalb Medical Center
🇺🇸
Decatur, Georgia, United States
John B Amos Cancer Center
🇺🇸
Columbus, Georgia, United States
Kootenai Cancer Center
🇺🇸
Post Falls, Idaho, United States
Northwest Community Hospital
🇺🇸
Arlington Heights, Illinois, United States
Saint Luke's Mountain States Tumor Institute-Twin Falls
🇺🇸
Twin Falls, Idaho, United States
Decatur Memorial Hospital
🇺🇸
Decatur, Illinois, United States
Rush University Medical Center
🇺🇸
Chicago, Illinois, United States
OSF Saint Francis Radiation Oncology at Peoria Cancer Center
🇺🇸
Peoria, Illinois, United States
Good Samaritan Regional Health Center
🇺🇸
Mount Vernon, Illinois, United States
Methodist Medical Center of Illinois
🇺🇸
Peoria, Illinois, United States
OSF Saint Francis Radiation Oncology at Pekin Cancer Treatment Center
🇺🇸
Pekin, Illinois, United States
OSF Saint Francis Medical Center
🇺🇸
Peoria, Illinois, United States
IU Health Bloomington
🇺🇸
Bloomington, Indiana, United States
Parkview Hospital Randallia
🇺🇸
Fort Wayne, Indiana, United States
Ascension Via Christi Hospitals Wichita
🇺🇸
Wichita, Kansas, United States
Wesley Medical Center
🇺🇸
Wichita, Kansas, United States
Hardin Memorial Hospital
🇺🇸
Elizabethtown, Kentucky, United States
University of Kentucky/Markey Cancer Center
🇺🇸
Lexington, Kentucky, United States
LSU Health Baton Rouge-North Clinic
🇺🇸
Baton Rouge, Louisiana, United States
Louisiana Hematology Oncology Associates LLC
🇺🇸
Baton Rouge, Louisiana, United States
Our Lady of the Lake Physicians Group - Medical Oncology
🇺🇸
Baton Rouge, Louisiana, United States
Mary Bird Perkins Cancer Center
🇺🇸
Baton Rouge, Louisiana, United States
Mary Bird Perkins Cancer Center - Covington
🇺🇸
Covington, Louisiana, United States
Maine Medical Center- Scarborough Campus
🇺🇸
Scarborough, Maine, United States
Mary Bird Perkins Cancer Center - Houma
🇺🇸
Houma, Louisiana, United States
University of Maryland/Greenebaum Cancer Center
🇺🇸
Baltimore, Maryland, United States
UM Upper Chesapeake Medical Center
🇺🇸
Bel Air, Maryland, United States
UM Baltimore Washington Medical Center/Tate Cancer Center
🇺🇸
Glen Burnie, Maryland, United States
Peninsula Regional Medical Center
🇺🇸
Salisbury, Maryland, United States
Lowell General Hospital
🇺🇸
Lowell, Massachusetts, United States
Mercy Health Saint Mary's
🇺🇸
Grand Rapids, Michigan, United States
Spectrum Health at Butterworth Campus
🇺🇸
Grand Rapids, Michigan, United States
McLaren Cancer Institute-Flint
🇺🇸
Flint, Michigan, United States
McLaren Cancer Institute-Lapeer Region
🇺🇸
Lapeer, Michigan, United States
McLaren Cancer Institute-Macomb
🇺🇸
Mount Clemens, Michigan, United States
Mercy Health Mercy Campus
🇺🇸
Muskegon, Michigan, United States
McLaren Cancer Institute-Central Michigan
🇺🇸
Mount Pleasant, Michigan, United States
McLaren Cancer Institute-Northern Michigan
🇺🇸
Petoskey, Michigan, United States
Lakeland Medical Center Saint Joseph
🇺🇸
Saint Joseph, Michigan, United States
Fairview-Southdale Hospital
🇺🇸
Edina, Minnesota, United States
Abbott-Northwestern Hospital
🇺🇸
Minneapolis, Minnesota, United States
Hennepin County Medical Center
🇺🇸
Minneapolis, Minnesota, United States
Regions Hospital
🇺🇸
Saint Paul, Minnesota, United States
Rice Memorial Hospital
🇺🇸
Willmar, Minnesota, United States
University of Mississippi Medical Center
🇺🇸
Jackson, Mississippi, United States
Saint Francis Medical Center
🇺🇸
Cape Girardeau, Missouri, United States
North Kansas City Hospital
🇺🇸
Kansas City, Missouri, United States
The University of Kansas Cancer Center-North
🇺🇸
Kansas City, Missouri, United States
Southeast Cancer Center
🇺🇸
Cape Girardeau, Missouri, United States
The University of Kansas Cancer Center-South
🇺🇸
Kansas City, Missouri, United States
The University of Kansas Cancer Center-Lee's Summit
🇺🇸
Lee's Summit, Missouri, United States
Delbert Day Cancer Institute at PCRMC
🇺🇸
Rolla, Missouri, United States
Missouri Baptist Medical Center
🇺🇸
Saint Louis, Missouri, United States
Billings Clinic Cancer Center
🇺🇸
Billings, Montana, United States
Community Medical Hospital
🇺🇸
Missoula, Montana, United States
Mercy Hospital Saint Louis
🇺🇸
Saint Louis, Missouri, United States
CHI Health Good Samaritan
🇺🇸
Kearney, Nebraska, United States
CHI Health Saint Francis
🇺🇸
Grand Island, Nebraska, United States
Wentworth-Douglass Hospital
🇺🇸
Dover, New Hampshire, United States
Virtua Memorial
🇺🇸
Mount Holly, New Jersey, United States
Community Medical Center
🇺🇸
Toms River, New Jersey, United States
Virtua Voorhees
🇺🇸
Voorhees, New Jersey, United States
University of New Mexico Cancer Center
🇺🇸
Albuquerque, New Mexico, United States
New Mexico Oncology Hematology Consultants
🇺🇸
Albuquerque, New Mexico, United States
Gaston Hematology and Oncology Associates-Belmont
🇺🇸
Belmont, North Carolina, United States
New York-Presbyterian/Brooklyn Methodist Hospital
🇺🇸
Brooklyn, New York, United States
CaroMont Regional Medical Center
🇺🇸
Gastonia, North Carolina, United States
Gaston Hematology and Oncology Associates
🇺🇸
Gastonia, North Carolina, United States
UHHS-Chagrin Highlands Medical Center
🇺🇸
Beachwood, Ohio, United States
Mercy Medical Center
🇺🇸
Canton, Ohio, United States
Aultman Health Foundation
🇺🇸
Canton, Ohio, United States
Adena Regional Medical Center
🇺🇸
Chillicothe, Ohio, United States
Geauga Hospital
🇺🇸
Chardon, Ohio, United States
Ohio State University Comprehensive Cancer Center
🇺🇸
Columbus, Ohio, United States
Kettering Medical Center
🇺🇸
Kettering, Ohio, United States
Good Samaritan Hospital - Dayton
🇺🇸
Dayton, Ohio, United States
Cleveland Clinic Cancer Center Independence
🇺🇸
Independence, Ohio, United States
Mercy Cancer Center-Elyria
🇺🇸
Elyria, Ohio, United States
UH Seidman Cancer Center at Lake Health Mentor Campus
🇺🇸
Mentor, Ohio, United States
Hillcrest Hospital Cancer Center
🇺🇸
Mayfield Heights, Ohio, United States
Newark Radiation Oncology
🇺🇸
Newark, Ohio, United States
UH Seidman Cancer Center at Southwest General Hospital
🇺🇸
Middleburg Heights, Ohio, United States
University Hospitals Parma Medical Center
🇺🇸
Parma, Ohio, United States
Southern Ohio Medical Center
🇺🇸
Portsmouth, Ohio, United States
North Coast Cancer Care
🇺🇸
Sandusky, Ohio, United States
Cleveland Clinic Cancer Center Strongsville
🇺🇸
Strongsville, Ohio, United States
UH Seidman Cancer Center at Firelands Regional Medical Center
🇺🇸
Sandusky, Ohio, United States
University Pointe
🇺🇸
West Chester, Ohio, United States
UHHS-Westlake Medical Center
🇺🇸
Westlake, Ohio, United States
Cleveland Clinic Wooster Family Health and Surgery Center
🇺🇸
Wooster, Ohio, United States
Northeast Radiation Oncology Center
🇺🇸
Dunmore, Pennsylvania, United States
Genesis Healthcare System Cancer Care Center
🇺🇸
Zanesville, Ohio, United States
The Regional Cancer Center
🇺🇸
Erie, Pennsylvania, United States
Reading Hospital
🇺🇸
West Reading, Pennsylvania, United States
Lankenau Medical Center
🇺🇸
Wynnewood, Pennsylvania, United States
AnMed Health Cancer Center
🇺🇸
Anderson, South Carolina, United States
Greenville Health System Cancer Institute-Faris
🇺🇸
Greenville, South Carolina, United States
Saint Francis Cancer Center
🇺🇸
Greenville, South Carolina, United States
Greenville Health System Cancer Institute-Greer
🇺🇸
Greer, South Carolina, United States
Greenville Health System Cancer Institute-Eastside
🇺🇸
Greenville, South Carolina, United States
Self Regional Healthcare
🇺🇸
Greenwood, South Carolina, United States
Gibbs Cancer Center-Pelham
🇺🇸
Greer, South Carolina, United States
Greenville Health System Cancer Institute-Seneca
🇺🇸
Seneca, South Carolina, United States
Greenville Health System Cancer Institute-Spartanburg
🇺🇸
Spartanburg, South Carolina, United States
University of Texas Medical Branch
🇺🇸
Galveston, Texas, United States
The Methodist Hospital System
🇺🇸
Houston, Texas, United States
Sanford USD Medical Center - Sioux Falls
🇺🇸
Sioux Falls, South Dakota, United States
UTMB Cancer Center at Victory Lakes
🇺🇸
League City, Texas, United States
MD Anderson in Sugar Land
🇺🇸
Sugar Land, Texas, United States
Central Vermont Medical Center/National Life Cancer Treatment
🇺🇸
Berlin, Vermont, United States
MD Anderson in The Woodlands
🇺🇸
The Woodlands, Texas, United States
Intermountain Medical Center
🇺🇸
Murray, Utah, United States
University of Vermont Medical Center
🇺🇸
Burlington, Vermont, United States
Norris Cotton Cancer Center-North
🇺🇸
Saint Johnsbury, Vermont, United States
Harrison Medical Center
🇺🇸
Bremerton, Washington, United States
PeaceHealth Saint John Medical Center
🇺🇸
Longview, Washington, United States
PeaceHealth Southwest Medical Center
🇺🇸
Vancouver, Washington, United States
Augusta Health Center for Cancer and Blood Disorders
🇺🇸
Fishersville, Virginia, United States
Wheeling Hospital/Schiffler Cancer Center
🇺🇸
Wheeling, West Virginia, United States
Aurora Cancer Care-Grafton
🇺🇸
Grafton, Wisconsin, United States
Community Memorial Hospital
🇺🇸
Menomonee Falls, Wisconsin, United States
Marshfield Clinic-Minocqua Center
🇺🇸
Minocqua, Wisconsin, United States
Cancer Center of Western Wisconsin
🇺🇸
New Richmond, Wisconsin, United States
Marshfield Medical Center-Rice Lake
🇺🇸
Rice Lake, Wisconsin, United States
Saint Michael's Hospital
🇺🇸
Stevens Point, Wisconsin, United States
Vince Lombardi Cancer Clinic-Two Rivers
🇺🇸
Two Rivers, Wisconsin, United States
Aurora Medical Center in Summit
🇺🇸
Summit, Wisconsin, United States
Aurora West Allis Medical Center
🇺🇸
West Allis, Wisconsin, United States
The Alyce and Elmore Kraemer Cancer Care Center
🇺🇸
West Bend, Wisconsin, United States
Aspirus UW Cancer Center
🇺🇸
Wisconsin Rapids, Wisconsin, United States
Jewish General Hospital
🇨🇦
Montreal, Quebec, Canada
Chaim Sheba Medical Center
🇮🇱
Tel Hashomer, Israel
Lewis Cancer and Research Pavilion at Saint Joseph's/Candler
🇺🇸
Savannah, Georgia, United States
Saint Alphonsus Cancer Care Center-Boise
🇺🇸
Boise, Idaho, United States
Carle Cancer Center
🇺🇸
Urbana, Illinois, United States
West Michigan Cancer Center
🇺🇸
Kalamazoo, Michigan, United States
Saint Luke's Hospital of Duluth
🇺🇸
Duluth, Minnesota, United States
Spartanburg Medical Center
🇺🇸
Spartanburg, South Carolina, United States
Radiation Oncology Associates PC
🇺🇸
Fort Wayne, Indiana, United States
Dartmouth Hitchcock Medical Center
🇺🇸
Lebanon, New Hampshire, United States
United Hospital
🇺🇸
Saint Paul, Minnesota, United States
Aurora BayCare Medical Center
🇺🇸
Green Bay, Wisconsin, United States
CoxHealth South Hospital
🇺🇸
Springfield, Missouri, United States
Aurora Cancer Care-Kenosha South
🇺🇸
Kenosha, Wisconsin, United States
Swedish Medical Center
🇺🇸
Englewood, Colorado, United States
Abington Memorial Hospital
🇺🇸
Abington, Pennsylvania, United States
Saint Joseph Mercy Oakland
🇺🇸
Pontiac, Michigan, United States
Marshfield Medical Center-Marshfield
🇺🇸
Marshfield, Wisconsin, United States
Ascension Columbia Saint Mary's Hospital Ozaukee
🇺🇸
Mequon, Wisconsin, United States
Baptist Health Lexington
🇺🇸
Lexington, Kentucky, United States
William Beaumont Hospital - Troy
🇺🇸
Troy, Michigan, United States