Everolimus and Octreotide Acetate With or Without Bevacizumab in Treating Patients With Locally Advanced or Metastatic Pancreatic Neuroendocrine Tumors That Cannot Be Removed by Surgery

Phase 2

Completed

Conditions: Advanced Pancreatic Neuroendocrine Tumor
Locally Advanced Pancreatic Neuroendocrine Tumor
Pancreatic Gastrinoma
Pancreatic Neuroendocrine Tumor G1
Pancreatic Neuroendocrine Tumor G2
Pancreatic Vipoma

Interventions: Biological: Bevacizumab
Drug: Everolimus
Drug: Octreotide Acetate

Registration Number: NCT01229943

Lead Sponsor: National Cancer Institute (NCI)

Brief Summary: This randomized phase II trial studies how well everolimus and octreotide acetate with or without bevacizumab works in treating patients with pancreatic neuroendocrine tumors that cannot be removed by surgery and have spread nearby or to other places in the body. Everolimus may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Octreotide acetate may interfere with and slow the growth of tumor cells. Monoclonal antibodies, such as bevacizumab, may interfere with the ability of tumor cells to grow and spread. Bevacizumab and everolimus also may stop the growth of pancreatic neuroendocrine tumors by blocking blood flow to the tumor. It is not yet known whether giving everolimus and octreotide acetate together is more effective with or without bevacizumab in treating pancreatic neuroendocrine tumors.

Detailed Description: PRIMARY OBJECTIVES:

l. To assess the progression-free survival rate of patients with locally advanced or metastatic pancreatic neuroendocrine tumors treated with everolimus alone or everolimus plus bevacizumab.

SECONDARY OBJECTIVES:

I. To compare progression-free survival (PFS) among treatment arms shown to be efficacious.

II. To estimate the overall tumor response rate in patients with metastatic pancreatic neuroendocrine tumors treated with one of two novel regimens.

III. To estimate the overall biochemical response rate (as measured by plasma chromogranin A levels) in patients with metastatic pancreatic neuroendocrine tumors treated with these regimens.

IV. To assess the toxicity of each regimen in patients with metastatic pancreatic neuroendocrine tumors.

V. To assess the overall survival of patients with pancreatic neuroendocrine tumors treated with these regimens.

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

ARM I: Patients receive everolimus orally (PO) once daily (QD) on days 1-28 and octreotide acetate intramuscularly (IM) on day 1.

ARM II: Patients receive everolimus and octreotide acetate as in Arm I. Patients also receive bevacizumab intravenously (IV) over 30-90 minutes on days 1 and 15.

In both arms, courses repeat every 28 days in the absence of disease progression or unacceptable toxicity.

After completion of study treatment, patients are followed up every 3-6 months for 3 years.

Recruitment & Eligibility

Status: COMPLETED

Sex: All

Target Recruitment: 150

Inclusion Criteria

Patients must have histologic documentation of well-differentiated or moderately differentiated neuroendocrine tumor from either a primary or metastatic site
- If different histologic classification schemes are used, equivalent histologic classifications (for example "grade 1", "low-grade", or "intermediate-grade") are allowed
- Patients with poorly differentiated neuroendocrine carcinoma or small cell carcinoma are excluded
- Documentation from a metastatic disease site is sufficient if there is clinical evidence of a pancreatic primary site
Locally unresectable or metastatic disease
Patients must have either histologic documentation of a pancreatic primary site, or clinical evidence of a pancreatic neuroendocrine primary tumor as determined by the treating physician
- Patients with neuroendocrine tumors (e.g., gastrinoma, VIPoma) in whom a pancreatic or peripancreatic primary site is strongly suspected are also eligible
Patients must have evidence of disease (measurable or non-measurable) with evidence of progression within the past 12 months
Measurable disease:

Lesions that can be accurately measured in at least one dimension (longest diameter to be recorded) as >= 2 cm with conventional techniques or as >= 1 cm with spiral computed tomography (CT) scan

Non-measurable disease:

All other lesions, including small lesions (longest diameter < 20 mm with conventional techniques or < 10 mm with spiral CT scan) and truly non-measurable lesions; lesions that are considered non-measurable include the following:

Bone lesions
Leptomeningeal disease
Ascites
Pleural/pericardial effusion
Inflammatory breast disease
Lymphangitis cutis/pulmonis
Abdominal masses that are not confirmed and followed by imaging techniques
Cystic lesions
- No prior treatment with bevacizumab, everolimus, or other mammalian target of rapamycin (mTOR) inhibitors
- Other prior treatments, including but not limited to prior cytotoxic chemotherapy, alpha interferon, tyrosine kinase inhibitors, external beam radiation therapy, and radiopeptide therapy are allowed
There is no limit on the number of prior treatment regimens
Any prior treatment (with the exception of octreotide) must be completed at least 4 weeks prior to initiation of treatment
- Prior treatment with embolization or ablative therapies is allowed if measurable disease remains outside of the treated area
There is no limit on the prior number of procedures
- Treatment with somatostatin analogs is a requirement of the study
Patients receiving octreotide at the time of study entry may continue at the same dose level for the duration of the study
Patients not receiving octreotide will initiate treatment according to study guidelines
Prior progression on somatostatin analogs or a negative octreotide scan does not exclude patient participation in this study
- Patients should have completed any major surgery >= 4 weeks from start of treatment
Patients must have completed any minor surgery >= 2 weeks prior to start of treatment
Patients must have fully recovered from the procedure
Insertion of a vascular access device is not considered major or minor surgery
- Patients should not receive immunization with attenuated live vaccines within one week prior to registration or during protocol therapy
- No concurrent condition resulting in immune compromise, including chronic treatment with corticosteroids or other immuno suppressive agents
- No active or severe liver disease (e.g., acute or chronic hepatitis, cirrhosis); no positive anti-hepatitis B virus (HBV); HBV seropositive patients (hepatitis B surface antigen [HBsAg] positive) are eligible if they are closely monitored for evidence of active HBV infection by HBV deoxyribonucleic acid (DNA) testing, and they agree to receive suppressive therapy with lamivudine or other HBV-suppressive therapy until at least 4 weeks after the last dose of everolimus; patients who are hepatitis C antibody positive are eligible provided that hepatitis C viral load (hepatitis C ribonucleic acid [RNA]) is undetectable
- No clinical evidence of brain metastases or carcinomatous meningitis
- No history of gastrointestinal (GI) perforation within 12 months prior to registration
- No history of clinically significant bleeding episodes
- Patients on therapeutic anticoagulation are eligible for the study provided that they are on a stable dose of anticoagulants
- No uncontrolled diabetes mellitus
- Patients with a history of severely impaired lung function as defined as spirometry and diffusing capacity of the lung for carbon monoxide (DLCO) that is 50% of the normal predicted value and/or oxygen (O2) saturation that is 88% or less at rest on room air are excluded
- Patients with fasting serum cholesterol >= 300 mg/dL OR >= 7.75 mmol/L AND fasting triglycerides >= 2.5 X upper limit of normal (ULN) should initiate lipid-lowering medications with the goal of achieving levels below these thresholds
- No history of intolerance or allergies to octreotide
- Patients with a history of hypertension must be adequately controlled (baseline blood pressure [BP] < 150/90 mm Hg) on antihypertensives
- No current congestive heart failure (New York Heart Association class II, III, or IV)
- No symptomatic arterial peripheral vascular disease
- No history of aortic aneurysm, aortic dissection, angina, myocardial infarction, stroke, or other arterial thrombotic events within 6 months of registration
- Eastern Cooperative Oncology Group (ECOG) performance status 0-1
- Women must not be pregnant or lactating; both men and women of childbearing potential must be advised of the importance of using effective birth control measures during the course of the study
- Granulocytes >= 1,500/uL
- Platelets >= 100,000/uL
- Creatinine =< 1.5 x upper limit of normal
- Bilirubin =< 1.5 x upper limit of normal
- Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) =< 2.5 x upper limit of normal (=< 5 x upper limit of normal if liver metastases present)
- Urine protein =< 1+ OR urine creatinine ratio =< 1 (by urinalysis)
If urine protein creatinine (UPC) ratio is > 1 on urinalysis, then 24-hour urine collection for protein must be obtained and level must be < 1,000 mg for patient enrollment

Exclusion Criteria

Not provided

Study & Design

Study Type: INTERVENTIONAL

Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Arm I (octreotide acetate and everolimus)	Octreotide Acetate	Patients receive 28-day cycles until progression or unacceptable toxicity consisting of: everolimus 10 mg PO QD on days 1-28 and octreotide acetate 20 mg IM on day 1.
Arm II (octreotide acetate, everolimus, and bevacizumab)	Bevacizumab	Patients receive 28-day cycles until progression or unacceptable toxicity consisting of: everolimus 10 mg PO QD on days 1-28, octreotide acetate 20 mg IM on day 1 and bevacizumab 10 mg/kg IV on days 1 and 15.
Arm II (octreotide acetate, everolimus, and bevacizumab)	Octreotide Acetate	Patients receive 28-day cycles until progression or unacceptable toxicity consisting of: everolimus 10 mg PO QD on days 1-28, octreotide acetate 20 mg IM on day 1 and bevacizumab 10 mg/kg IV on days 1 and 15.
Arm I (octreotide acetate and everolimus)	Everolimus	Patients receive 28-day cycles until progression or unacceptable toxicity consisting of: everolimus 10 mg PO QD on days 1-28 and octreotide acetate 20 mg IM on day 1.
Arm II (octreotide acetate, everolimus, and bevacizumab)	Everolimus	Patients receive 28-day cycles until progression or unacceptable toxicity consisting of: everolimus 10 mg PO QD on days 1-28, octreotide acetate 20 mg IM on day 1 and bevacizumab 10 mg/kg IV on days 1 and 15.

Primary Outcome Measures

Name	Time	Method
Progression Free Survival	From study entry to the date of documented progression or death from any cause, up to 3 years	Progression Free Survival (PFS) was defined as the time from study entry until disease progression or death, whichever occurs first. The median PFS was estimated using the Kaplan-Meier method. Progression was assessed per RECIST criteria, and defined as at least a 20% increase in the sum of the longest diameters of target lesions (and an absolute increase of at least 0.5 cm) or the appearance of new lesions.

Secondary Outcome Measures

Name	Time	Method
Overall Response Rate	Up to 3 years	The proportion of patients who respond (completely or partially) to each combination regimen will be estimated. Response was defined using Response Evaluation Criteria In Solid Tumors (RECIST) criteria: Complete Response (CR): disappearance of all target lesions; Partial Response (PR) 30% decrease in sum of longest diameter of target lesions.
Overall Survival (OS)	From registration to time of death, assessed up to 3 years	Overall survival (OS) is defined as the time from study entry to death from any cause. The median OS was estimated using the Kaplan-Meier method.

Trial Locations

Locations (394): Alta Bates Summit Medical Center-Herrick Campus
🇺🇸
Berkeley, California, United States
Kaiser Permanente-Redwood City
🇺🇸
Redwood City, California, United States
Kalispell Medical Oncology
🇺🇸
Kalispell, Montana, United States
Longmont United Hospital
🇺🇸
Longmont, Colorado, United States
Saint Luke's Regional Medical Center
🇺🇸
Sioux City, Iowa, United States
Licking Memorial Hospital
🇺🇸
Newark, Ohio, United States
Geisinger Medical Group
🇺🇸
State College, Pennsylvania, United States
Riverside Methodist Hospital
🇺🇸
Columbus, Ohio, United States
Cedars Sinai Medical Center
🇺🇸
Los Angeles, California, United States
Montana Cancer Consortium NCORP
🇺🇸
Billings, Montana, United States
Harborview Medical Center
🇺🇸
Seattle, Washington, United States
Kaiser Permanente Washington
🇺🇸
Seattle, Washington, United States
University of Washington Medical Center - Montlake
🇺🇸
Seattle, Washington, United States
Sidney and Lois Eskenazi Hospital
🇺🇸
Indianapolis, Indiana, United States
Kaiser Permanente-San Diego Mission
🇺🇸
San Diego, California, United States
Kaiser Permanente-San Diego Zion
🇺🇸
San Diego, California, United States
Kaiser Permanente-San Rafael
🇺🇸
San Rafael, California, United States
Kaiser Permanente-South San Francisco
🇺🇸
South San Francisco, California, United States
The Hospital of Central Connecticut
🇺🇸
New Britain, Connecticut, United States
Christiana Care Health System-Christiana Hospital
🇺🇸
Newark, Delaware, United States
Boulder Community Hospital
🇺🇸
Boulder, Colorado, United States
Smilow Cancer Hospital Care Center at Saint Francis
🇺🇸
Hartford, Connecticut, United States
Kaiser Permanente Medical Center-Vacaville
🇺🇸
Vacaville, California, United States
Porubcin, Michael MD (UIA Investigator)
🇺🇸
Moline, Illinois, United States
Maui Memorial Medical Center
🇺🇸
Wailuku, Hawaii, United States
Kaiser Permanente-Anaheim
🇺🇸
Anaheim, California, United States
Kaiser Permanente-Stockton
🇺🇸
Stockton, California, United States
Kaiser Permanente-Santa Rosa
🇺🇸
Santa Rosa, California, United States
Kaiser Permanente Medical Center - Santa Clara
🇺🇸
Santa Clara, California, United States
Swedish Medical Center
🇺🇸
Englewood, Colorado, United States
Kaiser Permanente-Vallejo
🇺🇸
Vallejo, California, United States
Sutter Solano Medical Center/Cancer Center
🇺🇸
Vallejo, California, United States
Sutter Pacific Medical Foundation
🇺🇸
Santa Rosa, California, United States
North Colorado Medical Center
🇺🇸
Greeley, Colorado, United States
Kaiser Permanente-Woodland Hills
🇺🇸
Woodland Hills, California, United States
Saint Mary's Hospital and Regional Medical Center
🇺🇸
Grand Junction, Colorado, United States
Beebe Medical Center
🇺🇸
Lewes, Delaware, United States
Kaiser Permanente-Walnut Creek
🇺🇸
Walnut Creek, California, United States
Littleton Adventist Hospital
🇺🇸
Littleton, Colorado, United States
Lakeland Regional Health Hollis Cancer Center
🇺🇸
Lakeland, Florida, United States
North Suburban Medical Center
🇺🇸
Thornton, Colorado, United States
Kaiser Permanente-San Marcos
🇺🇸
San Marcos, California, United States
Indiana University/Melvin and Bren Simon Cancer Center
🇺🇸
Indianapolis, Indiana, United States
Saint Alphonsus Cancer Care Center-Boise
🇺🇸
Boise, Idaho, United States
SCL Health Lutheran Medical Center
🇺🇸
Wheat Ridge, Colorado, United States
MedStar Washington Hospital Center
🇺🇸
Washington, District of Columbia, United States
Hematology Oncology Associates of Illinois-Highland Park
🇺🇸
Highland Park, Illinois, United States
Garneau, Stewart C MD (UIA Investigator)
🇺🇸
Moline, Illinois, United States
University of Chicago Comprehensive Cancer Center
🇺🇸
Chicago, Illinois, United States
Spector, David MD (UIA Investigator)
🇺🇸
Moline, Illinois, United States
Reid Health
🇺🇸
Richmond, Indiana, United States
Pacific Cancer Institute of Maui
🇺🇸
Wailuku, Hawaii, United States
Hematology and Oncology Associates
🇺🇸
Chicago, Illinois, United States
Northwestern University
🇺🇸
Chicago, Illinois, United States
McFarland Clinic PC - Ames
🇺🇸
Ames, Iowa, United States
Wilcox Memorial Hospital and Kauai Medical Clinic
🇺🇸
Lihue, Hawaii, United States
Mercy Cancer Center-West Lakes
🇺🇸
Clive, Iowa, United States
Illinois Cancer Specialists-Niles
🇺🇸
Niles, Illinois, United States
Swedish American Hospital
🇺🇸
Rockford, Illinois, United States
Loyola University Medical Center
🇺🇸
Maywood, Illinois, United States
Pali Momi Medical Center
🇺🇸
'Aiea, Hawaii, United States
Franciscan Saint Francis Health-Beech Grove
🇺🇸
Beech Grove, Indiana, United States
AMITA Health Adventist Medical Center
🇺🇸
La Grange, Illinois, United States
Minnesota Oncology Hematology PA-Maplewood
🇺🇸
Maplewood, Minnesota, United States
Borgess Medical Center
🇺🇸
Kalamazoo, Michigan, United States
William Beaumont Hospital-Royal Oak
🇺🇸
Royal Oak, Michigan, United States
Genesys Regional Medical Center
🇺🇸
Grand Blanc, Michigan, United States
Allegiance Health
🇺🇸
Jackson, Michigan, United States
Mercy Memorial Hospital
🇺🇸
Monroe, Michigan, United States
Cancer Research Consortium of West Michigan NCORP
🇺🇸
Grand Rapids, Michigan, United States
Genesys Regional Medical Center-West Flint Campus
🇺🇸
Flint, Michigan, United States
Green Bay Oncology - Escanaba
🇺🇸
Escanaba, Michigan, United States
Green Bay Oncology - Iron Mountain
🇺🇸
Iron Mountain, Michigan, United States
Ascension Saint John Hospital
🇺🇸
Detroit, Michigan, United States
Essentia Health Saint Joseph's Medical Center
🇺🇸
Brainerd, Minnesota, United States
Hurley Medical Center
🇺🇸
Flint, Michigan, United States
Essentia Health Saint Mary's Medical Center
🇺🇸
Duluth, Minnesota, United States
Roswell Park Cancer Institute
🇺🇸
Buffalo, New York, United States
Ascension Saint Mary's Hospital
🇺🇸
Saginaw, Michigan, United States
Benefis Healthcare- Sletten Cancer Institute
🇺🇸
Great Falls, Montana, United States
Southeast Cancer Center
🇺🇸
Cape Girardeau, Missouri, United States
SSM Health Saint Louis University Hospital
🇺🇸
Saint Louis, Missouri, United States
Miller-Dwan Hospital
🇺🇸
Duluth, Minnesota, United States
Ridgeview Medical Center
🇺🇸
Waconia, Minnesota, United States
Saint James Community Hospital and Cancer Treatment Center
🇺🇸
Butte, Montana, United States
Saint Vincent Frontier Cancer Center
🇺🇸
Billings, Montana, United States
United Hospital
🇺🇸
Saint Paul, Minnesota, United States
New York Oncology Hematology PC - Albany
🇺🇸
Albany, New York, United States
Essentia Health Cancer Center
🇺🇸
Duluth, Minnesota, United States
Montana Cancer Specialists
🇺🇸
Missoula, Montana, United States
Missouri Baptist Medical Center
🇺🇸
Saint Louis, Missouri, United States
Glacier Oncology PLLC
🇺🇸
Kalispell, Montana, United States
Fairview Southdale Hospital
🇺🇸
Edina, Minnesota, United States
Regions Hospital
🇺🇸
Saint Paul, Minnesota, United States
University of Missouri - Ellis Fischel
🇺🇸
Columbia, Missouri, United States
Lake Region Healthcare Corporation-Cancer Care
🇺🇸
Fergus Falls, Minnesota, United States
Saint Francis Regional Medical Center
🇺🇸
Shakopee, Minnesota, United States
Rice Memorial Hospital
🇺🇸
Willmar, Minnesota, United States
CHI Health Saint Francis
🇺🇸
Grand Island, Nebraska, United States
Norris Cotton Cancer Center-Manchester
🇺🇸
Manchester, New Hampshire, United States
Minnesota Oncology Hematology PA-Woodbury
🇺🇸
Woodbury, Minnesota, United States
Kalispell Regional Medical Center
🇺🇸
Kalispell, Montana, United States
Bozeman Deaconess Hospital
🇺🇸
Bozeman, Montana, United States
Capital Region Southwest Campus
🇺🇸
Jefferson City, Missouri, United States
Rutgers New Jersey Medical School
🇺🇸
Newark, New Jersey, United States
Saint Patrick Hospital - Community Hospital
🇺🇸
Missoula, Montana, United States
Dartmouth Hitchcock Medical Center
🇺🇸
Lebanon, New Hampshire, United States
Great Plains Health Callahan Cancer Center
🇺🇸
North Platte, Nebraska, United States
New York Oncology Hematology PC - Troy
🇺🇸
Troy, New York, United States
Sanford Broadway Medical Center
🇺🇸
Fargo, North Dakota, United States
Northern Montana Hospital
🇺🇸
Havre, Montana, United States
Grant Medical Center
🇺🇸
Columbus, Ohio, United States
Doctors Hospital
🇺🇸
Columbus, Ohio, United States
Novant Health Presbyterian Medical Center
🇺🇸
Charlotte, North Carolina, United States
Toledo Clinic Cancer Centers-Bowling Green
🇺🇸
Bowling Green, Ohio, United States
Glens Falls Hospital
🇺🇸
Glens Falls, New York, United States
Sanford Bismarck Medical Center
🇺🇸
Bismarck, North Dakota, United States
North Coast Cancer Care-Clyde
🇺🇸
Clyde, Ohio, United States
Mary Rutan Hospital
🇺🇸
Bellefontaine, Ohio, United States
Adena Regional Medical Center
🇺🇸
Chillicothe, Ohio, United States
Cancer Center of Kansas-Independence
🇺🇸
Independence, Kansas, United States
Cancer Center of Kansas - Newton
🇺🇸
Newton, Kansas, United States
Cancer Center of Kansas - Dodge City
🇺🇸
Dodge City, Kansas, United States
Lawrence Memorial Hospital
🇺🇸
Lawrence, Kansas, United States
Cancer Center of Kansas - Pratt
🇺🇸
Pratt, Kansas, United States
Menorah Medical Center
🇺🇸
Overland Park, Kansas, United States
Ascension Via Christi Hospitals Wichita
🇺🇸
Wichita, Kansas, United States
Cancer Center of Kansas - Wichita
🇺🇸
Wichita, Kansas, United States
Cotton O'Neil Cancer Center / Stormont Vail Health
🇺🇸
Topeka, Kansas, United States
Kansas City NCI Community Oncology Research Program
🇺🇸
Prairie Village, Kansas, United States
Associates In Womens Health
🇺🇸
Wichita, Kansas, United States
Cancer Center of Kansas-Kingman
🇺🇸
Kingman, Kansas, United States
Cancer Center of Kansas-Liberal
🇺🇸
Liberal, Kansas, United States
Rocky Mountain Oncology
🇺🇸
Casper, Wyoming, United States
Saint Luke's South Hospital
🇺🇸
Overland Park, Kansas, United States
Cancer Center of Kansas-Wichita Medical Arts Tower
🇺🇸
Wichita, Kansas, United States
Wichita NCI Community Oncology Research Program
🇺🇸
Wichita, Kansas, United States
Cancer Center of Kansas - Salina
🇺🇸
Salina, Kansas, United States
California Pacific Medical Center-Pacific Campus
🇺🇸
San Francisco, California, United States
Kaiser Permanente-San Francisco
🇺🇸
San Francisco, California, United States
UCSF Medical Center-Mount Zion
🇺🇸
San Francisco, California, United States
Abbott-Northwestern Hospital
🇺🇸
Minneapolis, Minnesota, United States
Hennepin County Medical Center
🇺🇸
Minneapolis, Minnesota, United States
Huntsman Cancer Institute/University of Utah
🇺🇸
Salt Lake City, Utah, United States
Washington University School of Medicine
🇺🇸
Saint Louis, Missouri, United States
University of Oklahoma Health Sciences Center
🇺🇸
Oklahoma City, Oklahoma, United States
Porter Adventist Hospital
🇺🇸
Denver, Colorado, United States
Presbyterian - Saint Lukes Medical Center - Health One
🇺🇸
Denver, Colorado, United States
Rose Medical Center
🇺🇸
Denver, Colorado, United States
Western States Cancer Research NCORP
🇺🇸
Denver, Colorado, United States
Providence Portland Medical Center
🇺🇸
Portland, Oregon, United States
QEII Health Sciences Centre/Nova Scotia Health Authority
🇨🇦
Halifax, Nova Scotia, Canada
Liberty Radiation Oncology Center
🇺🇸
Liberty, Missouri, United States
Heartland Regional Medical Center
🇺🇸
Saint Joseph, Missouri, United States
Saint Joseph Oncology Inc
🇺🇸
Saint Joseph, Missouri, United States
Castle Medical Center
🇺🇸
Kailua, Hawaii, United States
Garnet Health Medical Center
🇺🇸
Middletown, New York, United States
Unity Hospital
🇺🇸
Fridley, Minnesota, United States
New Ulm Medical Center
🇺🇸
New Ulm, Minnesota, United States
North Memorial Medical Health Center
🇺🇸
Robbinsdale, Minnesota, United States
SCL Health Saint Joseph Hospital
🇺🇸
Denver, Colorado, United States
Spectrum Health at Butterworth Campus
🇺🇸
Grand Rapids, Michigan, United States
Mercy Health Saint Mary's
🇺🇸
Grand Rapids, Michigan, United States
Sparrow Hospital
🇺🇸
Lansing, Michigan, United States
Saint Joseph Mercy Oakland
🇺🇸
Pontiac, Michigan, United States
Toledo Clinic Cancer Centers-Monroe
🇺🇸
Monroe, Michigan, United States
Lake Huron Medical Center
🇺🇸
Port Huron, Michigan, United States
Saint John Macomb-Oakland Hospital
🇺🇸
Warren, Michigan, United States
Ohio State University Comprehensive Cancer Center
🇺🇸
Columbus, Ohio, United States
Saint Ann's Hospital
🇺🇸
Westerville, Ohio, United States
Methodist West Hospital
🇺🇸
West Des Moines, Iowa, United States
University of Tennessee - Knoxville
🇺🇸
Knoxville, Tennessee, United States
West Michigan Cancer Center
🇺🇸
Kalamazoo, Michigan, United States
Kaiser Permanente West Los Angeles
🇺🇸
Los Angeles, California, United States
Kaiser Permanente-Irvine
🇺🇸
Irvine, California, United States
Mercy Cancer Center-Elyria
🇺🇸
Elyria, Ohio, United States
Kaiser Permanente-Baldwin Park
🇺🇸
Baldwin Park, California, United States
Kaiser Permanente-Bellflower
🇺🇸
Bellflower, California, United States
Mercy Hospital
🇺🇸
Coon Rapids, Minnesota, United States
Advocate Sherman Hospital
🇺🇸
Elgin, Illinois, United States
Trinity Health Saint Mary Mercy Livonia Hospital
🇺🇸
Livonia, Michigan, United States
Grady Memorial Hospital
🇺🇸
Delaware, Ohio, United States
Bronson Battle Creek
🇺🇸
Battle Creek, Michigan, United States
Bixby Medical Center
🇺🇸
Adrian, Michigan, United States
Sanford Joe Lueken Cancer Center
🇺🇸
Bemidji, Minnesota, United States
Comprehensive Cancer Care PC
🇺🇸
Saint Louis, Missouri, United States
Hutchinson Area Health Care
🇺🇸
Hutchinson, Minnesota, United States
Saint John's Hospital - Healtheast
🇺🇸
Maplewood, Minnesota, United States
Providence Hospital
🇺🇸
Mobile, Alabama, United States
Kaiser Permanente-Deer Valley Medical Center
🇺🇸
Antioch, California, United States
Mills-Peninsula Medical Center
🇺🇸
Burlingame, California, United States
Kaiser Permanente-Fontana
🇺🇸
Fontana, California, United States
Kaiser Permanente - Harbor City
🇺🇸
Harbor City, California, United States
Kaiser Permanente-Fresno
🇺🇸
Fresno, California, United States
Kaiser Permanente-Fremont
🇺🇸
Fremont, California, United States
Sutter Cancer Research Consortium
🇺🇸
Novato, California, United States
Kaiser Permanente Los Angeles Medical Center
🇺🇸
Los Angeles, California, United States
Stanford Cancer Institute Palo Alto
🇺🇸
Palo Alto, California, United States
Kaiser Permanente-Oakland
🇺🇸
Oakland, California, United States
Kaiser Permanente - Panorama City
🇺🇸
Panorama City, California, United States
Kaiser Permanente-Richmond
🇺🇸
Richmond, California, United States
Kaiser Permanente-Riverside
🇺🇸
Riverside, California, United States
Kaiser Permanente-Roseville
🇺🇸
Roseville, California, United States
Kaiser Permanente-Santa Teresa-San Jose
🇺🇸
San Jose, California, United States
Kaiser Permanente San Leandro
🇺🇸
San Leandro, California, United States
Penrose-Saint Francis Healthcare
🇺🇸
Colorado Springs, Colorado, United States
Saint Anthony Hospital
🇺🇸
Lakewood, Colorado, United States
McKee Medical Center
🇺🇸
Loveland, Colorado, United States
Sky Ridge Medical Center
🇺🇸
Lone Tree, Colorado, United States
Parker Adventist Hospital
🇺🇸
Parker, Colorado, United States
Saint Mary Corwin Medical Center
🇺🇸
Pueblo, Colorado, United States
MedStar Georgetown University Hospital
🇺🇸
Washington, District of Columbia, United States
Augusta University Medical Center
🇺🇸
Augusta, Georgia, United States
AMG Libertyville - Oncology
🇺🇸
Libertyville, Illinois, United States
Presence Saint Mary's Hospital
🇺🇸
Kankakee, Illinois, United States
Trinity Medical Center
🇺🇸
Moline, Illinois, United States
Hematology Oncology Associates of Illinois - Skokie
🇺🇸
Skokie, Illinois, United States
Medical Oncology and Hematology Associates-West Des Moines
🇺🇸
Clive, Iowa, United States
Constantinou, Costas L MD (UIA Investigator)
🇺🇸
Bettendorf, Iowa, United States
University of Iowa/Holden Comprehensive Cancer Center
🇺🇸
Iowa City, Iowa, United States
Ottumwa Regional Health Center
🇺🇸
Ottumwa, Iowa, United States
Siouxland Regional Cancer Center
🇺🇸
Sioux City, Iowa, United States
Mercy Medical Center-Sioux City
🇺🇸
Sioux City, Iowa, United States
Mercy Medical Center-West Lakes
🇺🇸
West Des Moines, Iowa, United States
Ochsner Health Center-Covington
🇺🇸
Covington, Louisiana, United States
Dana-Farber Cancer Institute
🇺🇸
Boston, Massachusetts, United States
Mercy Medical Center
🇺🇸
Baltimore, Maryland, United States
Massachusetts General Hospital Cancer Center
🇺🇸
Boston, Massachusetts, United States
Christiana Care - Union Hospital
🇺🇸
Elkton, Maryland, United States
Hickman Cancer Center
🇺🇸
Adrian, Michigan, United States
Spectrum Health Big Rapids Hospital
🇺🇸
Big Rapids, Michigan, United States
Beaumont Hospital - Dearborn
🇺🇸
Dearborn, Michigan, United States
Bronson Methodist Hospital
🇺🇸
Kalamazoo, Michigan, United States
Mercy Health Mercy Campus
🇺🇸
Muskegon, Michigan, United States
Spectrum Health Reed City Hospital
🇺🇸
Reed City, Michigan, United States
Munson Medical Center
🇺🇸
Traverse City, Michigan, United States
Fairview Ridges Hospital
🇺🇸
Burnsville, Minnesota, United States
Lakeview Hospital
🇺🇸
Stillwater, Minnesota, United States
Metro Minnesota Community Oncology Research Consortium
🇺🇸
Saint Louis Park, Minnesota, United States
Park Nicollet Clinic - Saint Louis Park
🇺🇸
Saint Louis Park, Minnesota, United States
Saint Luke's East - Lee's Summit
🇺🇸
Lee's Summit, Missouri, United States
Saint Vincent Healthcare
🇺🇸
Billings, Montana, United States
Billings Clinic Cancer Center
🇺🇸
Billings, Montana, United States
Saint Peter's Community Hospital
🇺🇸
Helena, Montana, United States
Great Falls Clinic
🇺🇸
Great Falls, Montana, United States
New York Oncology Hematology PC - Amsterdam
🇺🇸
Amsterdam, New York, United States
Cooper Hospital University Medical Center
🇺🇸
Camden, New Jersey, United States
New York Oncology Hematology PC - Clifton Park
🇺🇸
Clifton Park, New York, United States
New York Oncology Hematology PC - Albany Medical Center
🇺🇸
Albany, New York, United States
Hematology Oncology Associates of Central New York-East Syracuse
🇺🇸
East Syracuse, New York, United States
Mid Dakota Clinic
🇺🇸
Bismarck, North Dakota, United States
Iredell Memorial Hospital
🇺🇸
Statesville, North Carolina, United States
Wayne Memorial Hospital
🇺🇸
Goldsboro, North Carolina, United States
New York Oncology Hematology PC-Hudson
🇺🇸
Hudson, New York, United States
Saint Alexius Medical Center
🇺🇸
Bismarck, North Dakota, United States
Columbus NCI Community Oncology Research Program
🇺🇸
Columbus, Ohio, United States
Mount Carmel Health Center West
🇺🇸
Columbus, Ohio, United States
Grandview Hospital
🇺🇸
Dayton, Ohio, United States
Miami Valley Hospital North
🇺🇸
Dayton, Ohio, United States
Saint Luke's Hospital
🇺🇸
Maumee, Ohio, United States
Blanchard Valley Hospital
🇺🇸
Findlay, Ohio, United States
Dayton NCI Community Oncology Research Program
🇺🇸
Dayton, Ohio, United States
Hematology Oncology Center Incorporated
🇺🇸
Elyria, Ohio, United States
Atrium Medical Center-Middletown Regional Hospital
🇺🇸
Franklin, Ohio, United States
Wayne Hospital
🇺🇸
Greenville, Ohio, United States
Fairfield Medical Center
🇺🇸
Lancaster, Ohio, United States
Kettering Medical Center
🇺🇸
Kettering, Ohio, United States
Lima Memorial Hospital
🇺🇸
Lima, Ohio, United States
Knox Community Hospital
🇺🇸
Mount Vernon, Ohio, United States
Toledo Clinic Cancer Centers-Maumee
🇺🇸
Maumee, Ohio, United States
Toledo Radiation Oncology at Northwest Ohio Onocolgy Center
🇺🇸
Maumee, Ohio, United States
Marietta Memorial Hospital
🇺🇸
Marietta, Ohio, United States
Fisher-Titus Medical Center
🇺🇸
Norwalk, Ohio, United States
Saint Charles Hospital
🇺🇸
Oregon, Ohio, United States
North Coast Cancer Care
🇺🇸
Sandusky, Ohio, United States
Springfield Regional Medical Center
🇺🇸
Springfield, Ohio, United States
Toledo Clinic Cancer Centers-Oregon
🇺🇸
Oregon, Ohio, United States
Southern Ohio Medical Center
🇺🇸
Portsmouth, Ohio, United States
Mercy Hospital of Tiffin
🇺🇸
Tiffin, Ohio, United States
ProMedica Toledo Hospital/Russell J Ebeid Children's Hospital
🇺🇸
Toledo, Ohio, United States
University of Toledo
🇺🇸
Toledo, Ohio, United States
Saint Vincent Mercy Medical Center
🇺🇸
Toledo, Ohio, United States
Toledo Community Hospital Oncology Program CCOP
🇺🇸
Toledo, Ohio, United States
Mercy Health - Saint Anne Hospital
🇺🇸
Toledo, Ohio, United States
Upper Valley Medical Center
🇺🇸
Troy, Ohio, United States
Toledo Clinic Cancer Centers-Toledo
🇺🇸
Toledo, Ohio, United States
Fulton County Health Center
🇺🇸
Wauseon, Ohio, United States
Greene Memorial Hospital
🇺🇸
Xenia, Ohio, United States
Clinton Memorial Hospital
🇺🇸
Wilmington, Ohio, United States
Genesis Healthcare System Cancer Care Center
🇺🇸
Zanesville, Ohio, United States
Clackamas Radiation Oncology Center
🇺🇸
Clackamas, Oregon, United States
Providence Newberg Medical Center
🇺🇸
Newberg, Oregon, United States
Providence Milwaukie Hospital
🇺🇸
Milwaukie, Oregon, United States
Providence Willamette Falls Medical Center
🇺🇸
Oregon City, Oregon, United States
Providence Saint Vincent Medical Center
🇺🇸
Portland, Oregon, United States
Adventist Medical Center
🇺🇸
Portland, Oregon, United States
Geisinger Medical Center
🇺🇸
Danville, Pennsylvania, United States
Geisinger Medical Center-Cancer Center Hazleton
🇺🇸
Hazleton, Pennsylvania, United States
Pottstown Hospital
🇺🇸
Pottstown, Pennsylvania, United States
Reading Hospital
🇺🇸
West Reading, Pennsylvania, United States
Geisinger Wyoming Valley/Henry Cancer Center
🇺🇸
Wilkes-Barre, Pennsylvania, United States
Prisma Health Cancer Institute - Spartanburg
🇺🇸
Boiling Springs, South Carolina, United States
Saint Francis Hospital
🇺🇸
Greenville, South Carolina, United States
Prisma Health Cancer Institute - Faris
🇺🇸
Greenville, South Carolina, United States
Prisma Health Cancer Institute - Butternut
🇺🇸
Greenville, South Carolina, United States
Prisma Health Greenville Memorial Hospital
🇺🇸
Greenville, South Carolina, United States
Prisma Health Cancer Institute - Eastside
🇺🇸
Greenville, South Carolina, United States
Avera McKennan Hospital and University Health Center
🇺🇸
Sioux Falls, South Dakota, United States
Self Regional Healthcare
🇺🇸
Greenwood, South Carolina, United States
Thompson Cancer Survival Center
🇺🇸
Knoxville, Tennessee, United States
Prisma Health Cancer Institute - Seneca
🇺🇸
Seneca, South Carolina, United States
Avera Cancer Institute
🇺🇸
Sioux Falls, South Dakota, United States
The Don and Sybil Harrington Cancer Center
🇺🇸
Amarillo, Texas, United States
Parkland Memorial Hospital
🇺🇸
Dallas, Texas, United States
UT Southwestern/Simmons Cancer Center-Dallas
🇺🇸
Dallas, Texas, United States
Cancer Care Center at Island Hospital
🇺🇸
Anacortes, Washington, United States
Fredericksburg Oncology Inc
🇺🇸
Fredericksburg, Virginia, United States
Highline Medical Center-Main Campus
🇺🇸
Burien, Washington, United States
Harrison HealthPartners Hematology and Oncology-Bremerton
🇺🇸
Bremerton, Washington, United States
PeaceHealth Saint Joseph Medical Center
🇺🇸
Bellingham, Washington, United States
Swedish Cancer Institute-Issaquah
🇺🇸
Issaquah, Washington, United States
Harrison HealthPartners Hematology and Oncology-Poulsbo
🇺🇸
Poulsbo, Washington, United States
Skagit Valley Hospital
🇺🇸
Mount Vernon, Washington, United States
Fred Hutchinson Cancer Research Center
🇺🇸
Seattle, Washington, United States
Swedish Medical Center-First Hill
🇺🇸
Seattle, Washington, United States
Kadlec Clinic Hematology and Oncology
🇺🇸
Kennewick, Washington, United States
Cancer Care Northwest - Spokane South
🇺🇸
Spokane, Washington, United States
PeaceHealth United General Medical Center
🇺🇸
Sedro-Woolley, Washington, United States
Evergreen Hematology and Oncology PS
🇺🇸
Spokane, Washington, United States
PeaceHealth Southwest Medical Center
🇺🇸
Vancouver, Washington, United States
Wenatchee Valley Hospital and Clinics
🇺🇸
Wenatchee, Washington, United States
Compass Oncology Vancouver
🇺🇸
Vancouver, Washington, United States
Saint Vincent Hospital Cancer Center Green Bay
🇺🇸
Green Bay, Wisconsin, United States
Green Bay Oncology at Saint Vincent Hospital
🇺🇸
Green Bay, Wisconsin, United States
Green Bay Oncology Limited at Saint Mary's Hospital
🇺🇸
Green Bay, Wisconsin, United States
Gundersen Lutheran Medical Center
🇺🇸
La Crosse, Wisconsin, United States
Saint Vincent Hospital Cancer Center at Saint Mary's
🇺🇸
Green Bay, Wisconsin, United States
Mayo Clinic Health System-Franciscan Healthcare
🇺🇸
La Crosse, Wisconsin, United States
Holy Family Memorial Hospital
🇺🇸
Manitowoc, Wisconsin, United States
Bay Area Medical Center
🇺🇸
Marinette, Wisconsin, United States
Saint Vincent Hospital Cancer Center at Oconto Falls
🇺🇸
Oconto Falls, Wisconsin, United States
HSHS Saint Nicholas Hospital
🇺🇸
Sheboygan, Wisconsin, United States
BCCA-Vancouver Cancer Centre
🇨🇦
Vancouver, British Columbia, Canada
Green Bay Oncology - Sturgeon Bay
🇺🇸
Sturgeon Bay, Wisconsin, United States
Welch Cancer Center
🇺🇸
Sheridan, Wyoming, United States
The Vitalite Health Network - Dr Leon Richard Oncology Centre
🇨🇦
Moncton, New Brunswick, Canada
Allan Blair Cancer Centre
🇨🇦
Regina, Saskatchewan, Canada
University Health Network-Princess Margaret Hospital
🇨🇦
Toronto, Ontario, Canada
Ottawa Hospital and Cancer Center-General Campus
🇨🇦
Ottawa, Ontario, Canada
Ochsner Health Center-Summa
🇺🇸
Baton Rouge, Louisiana, United States
Good Samaritan Hospital - Dayton
🇺🇸
Dayton, Ohio, United States
Miami Valley Hospital
🇺🇸
Dayton, Ohio, United States
Prisma Health Cancer Institute - Greer
🇺🇸
Greer, South Carolina, United States
ProMedica Flower Hospital
🇺🇸
Sylvania, Ohio, United States
Kaiser Permanente-South Sacramento
🇺🇸
Sacramento, California, United States
Kaiser Permanente - Sacramento
🇺🇸
Sacramento, California, United States
The Medical Center of Aurora
🇺🇸
Aurora, Colorado, United States
Michigan Cancer Research Consortium NCORP
🇺🇸
Ann Arbor, Michigan, United States
Saint Joseph Mercy Hospital
🇺🇸
Ann Arbor, Michigan, United States
Mayo Clinic in Rochester
🇺🇸
Rochester, Minnesota, United States
Nebraska Methodist Hospital
🇺🇸
Omaha, Nebraska, United States
University of Nebraska Medical Center
🇺🇸
Omaha, Nebraska, United States
Wake Forest University Health Sciences
🇺🇸
Winston-Salem, North Carolina, United States
Butler Memorial Hospital
🇺🇸
Butler, Pennsylvania, United States
AdventHealth Orlando
🇺🇸
Orlando, Florida, United States
Hawaii Cancer Care Inc - Waterfront Plaza
🇺🇸
Honolulu, Hawaii, United States
Straub Clinic and Hospital
🇺🇸
Honolulu, Hawaii, United States
Queen's Medical Center
🇺🇸
Honolulu, Hawaii, United States
University of Hawaii Cancer Center
🇺🇸
Honolulu, Hawaii, United States
Queen's Cancer Center - Kuakini
🇺🇸
Honolulu, Hawaii, United States
Hawaii Cancer Care Inc-Liliha
🇺🇸
Honolulu, Hawaii, United States
Kapiolani Medical Center for Women and Children
🇺🇸
Honolulu, Hawaii, United States
The Cancer Center of Hawaii-Liliha
🇺🇸
Honolulu, Hawaii, United States
Kaiser Permanente Moanalua Medical Center
🇺🇸
Honolulu, Hawaii, United States
Ochsner Baptist Medical Center
🇺🇸
New Orleans, Louisiana, United States
Ochsner Medical Center Jefferson
🇺🇸
New Orleans, Louisiana, United States
Saint Luke's Hospital of Kansas City
🇺🇸
Kansas City, Missouri, United States
Heartland Hematology and Oncology Associates Incorporated
🇺🇸
Kansas City, Missouri, United States
North Kansas City Hospital
🇺🇸
Kansas City, Missouri, United States
Research Medical Center
🇺🇸
Kansas City, Missouri, United States
Roper Hospital
🇺🇸
Charleston, South Carolina, United States
Iowa-Wide Oncology Research Coalition NCORP
🇺🇸
Des Moines, Iowa, United States
Medical Oncology and Hematology Associates-Des Moines
🇺🇸
Des Moines, Iowa, United States
Medical Oncology and Hematology Associates-Laurel
🇺🇸
Des Moines, Iowa, United States
Iowa Lutheran Hospital
🇺🇸
Des Moines, Iowa, United States
Iowa Methodist Medical Center
🇺🇸
Des Moines, Iowa, United States
Mercy Medical Center - Des Moines
🇺🇸
Des Moines, Iowa, United States
Cancer Center of Kansas - Wellington
🇺🇸
Wellington, Kansas, United States
Cancer Center of Kansas - Winfield
🇺🇸
Winfield, Kansas, United States
Cancer Center of Kansas - Parsons
🇺🇸
Parsons, Kansas, United States
Cancer Center of Kansas - McPherson
🇺🇸
McPherson, Kansas, United States
Cancer Center of Kansas - Fort Scott
🇺🇸
Fort Scott, Kansas, United States
Cancer Center of Kansas - Chanute
🇺🇸
Chanute, Kansas, United States
Cancer Center of Kansas - El Dorado
🇺🇸
El Dorado, Kansas, United States