Bicalutamide and Goserelin or Leuprolide Acetate With or Without Cixutumumab in Treating Patients With Newly Diagnosed Metastatic Prostate Cancer
- Conditions
- Recurrent Prostate CarcinomaStage IV Prostate CancerProstate Adenocarcinoma
- Interventions
- Drug: BicalutamideBiological: CixutumumabDrug: Goserelin AcetateOther: Laboratory Biomarker AnalysisDrug: Leuprolide AcetateOther: Pharmacological Study
- Registration Number
- NCT01120236
- Lead Sponsor
- National Cancer Institute (NCI)
- Brief Summary
This randomized phase II trial is studying bicalutamide, goserelin, or leuprolide acetate to see how well they work when given with or without cixutumumab in treating patients with newly diagnosed metastatic prostate cancer. Androgens can cause the growth of prostate cancer cells. Antihormone therapy, such as bicalutamide, goserelin, or leuprolide acetate, may lessen the amount of androgens made by the body. Monoclonal antibodies, such as cixutumumab, can block tumor growth in different ways. Some block the ability of tumor cells to grow and spread. Others find tumor cells and help kill them or carry tumor-killing substances to them. It is not yet known whether bicalutamide, goserelin, or leuprolide acetate are more effective when given with or without cixutumumab in treating prostate cancer.
- Detailed Description
PRIMARY OBJECTIVES:
I. To compare the undetectable prostate-specific antigen (PSA) rate (PSA \< 0.2 ng/mL) after seven cycles (28 weeks) of protocol treatment between those randomized to a luteinizing hormone-releasing hormone (LHRH) agonist and bicalutamide and those randomized to a LHRH agonist, bicalutamide and IMC-A12 (cixutumumab).
SECONDARY OBJECTIVES:
I. To assess the safety and tolerability of the combination of IMC-A12 with a LHRH agonist and bicalutamide.
II. To compare the proportion of men who do not achieve a PSA of \< 4 ng/mL between the two groups.
III. To assess the accuracy of the prognostic model of undetectable PSA that was developed from Southwest Oncology Group (SWOG)-9346 using current trial data from each arm.
IV. To assess serum samples and peripheral blood mononuclear cells (PBMNC) for pharmacodynamic activity with potential biomarkers for IMC-A12 (including, but not limited to: insulin-like growth factor \[IGF\]-I, free IGF-I, IGF-II, IGF binding protein \[IGFBP\]2, IGFBP3, growth hormone, insulin and C-peptide) obtained from optional blood specimens both before initiation of androgen deprivation therapy and twelve weeks after initiation of combined therapy.
V. To determine baseline pre-treatment circulating tumor cell (CTC) quantities and response to therapy (for those patients with detectable CTC levels \>= 1) twelve weeks later.
VI. In the same subset of patients where CTC levels are obtained, determine baseline serum levels of micro-ribonucleic acids (RNAs) to include but not limited to microRNA (mi)-141 both before initiation of androgen deprivation therapy and twelve weeks after combined therapy.
OUTLINE: Patients are randomized to 1 of 2 treatment arms.
ARM I: Patients receive androgen deprivation therapy comprising bicalutamide orally (PO) once daily (QD) on days 1-28 and either goserelin acetate subcutaneously (SC) or leuprolide acetate intramuscularly (IM) every 1, 3, 4, 6, or 12 months. Patients also receive cixutumumab intravenously (IV) over 1 hour on days 1 and 15. Treatment repeats every 28 days for 7 courses in the absence of disease progression or unacceptable toxicity.
ARM II: Patients receive androgen deprivation therapy comprising bicalutamide and either goserelin acetate or leuprolide acetate as in arm I.
After completion of study treatment, patients are followed up every 6 months for 2 years and then annually for 3 years.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- Male
- Target Recruitment
- 211
-
All patients must have a histologically or cytologically proven diagnosis of adenocarcinoma of the prostate; note: If there is no formal biopsy report documenting the diagnosis of prostate cancer, the patient can be allowed on trial if the PSA level is at least 20, and there are at least three definitive metastatic lesions seen on scan; all patients must have had metastatic (M1) disease as evidenced by soft tissue and/or bony metastases prior to androgen deprivation therapy initiation; patients must have at least one of the following at the time they started androgen deprivation therapy:
- Visceral disease (liver, lung, or other viscera)
- Bone metastases to sites in either the axial (spine, pelvis, ribs, or skull) and/or the appendicular (clavicle, humerus, or femur) skeleton
- Lymph node disease not considered to be encompassed within a single radiotherapy port (e.g., above the aortic bifurcation, etc.)
-
Patients who have measurable disease must have radiographic assessment (at least an abdominal/pelvic computed tomography [CT]) within 28 days prior to registration; non-measurable disease must also be assessed (e.g., bone scan) in all patients within 56 days prior to registration; all disease must be assessed and documented on the Baseline Tumor Assessment Form
-
Patients must have a PSA >= 5 ng/mL obtained within 90 days prior to initiation of androgen deprivation therapy
-
Patients with known brain metastases are not eligible; brain imaging studies are not required for eligibility if the patient has no neurologic signs or symptoms, but if brain imaging studies are performed, they must be negative for disease
-
Patient must have had no more than 30 days of prior medical castration for metastatic prostate cancer (prior androgen deprivation therapy is allowed if it was received with curative intent in the neoadjuvant, concurrent, and/or adjuvant fashion and at least 2 years have elapsed since completion of androgen deprivation therapy); the start date of medical castration is considered the day the patient first received an injection of a LHRH agonist, not an oral antiandrogen; if the method of castration is luteinizing hormone releasing hormone (LHRH) agonists (i.e., leuprolide or goserelin), the patient must be willing to continue the use of LHRH agonists and add bicalutamide for combined androgen deprivation therapy (ADT) during protocol treatment; the 30 day window begins from the date of receiving the LHRH agonist, not the oral antiandrogen; if the patient was on a different antiandrogen (e.g. flutamide), the patient must be willing to switch over to bicalutamide; patients must not have received bilateral orchiectomy; patients must not have received or be planning to receive LHRH antagonists (i.e., Degarelix); however, if the patient was initiated on a LHRH antagonist within the 30 day window and is willing to switch to a LHRH agonist with bicalutamide, he may enroll on the late induction group
-
Patients who have not already started androgen deprivation therapy must be offered the opportunity to participate in the translational medicine studies; once a patient has started any form of antiandrogen (i.e., either bicalutamide or LHRH agonist), he is not eligible for any translational medicine studies
-
Patients must not have received any prior cytotoxic chemotherapy for metastatic prostate cancer; prior cytotoxic chemotherapy with curative intent in the neoadjuvant or adjuvant setting is allowed; patients must not have received any prior treatment with agents that directly inhibit IGF or IGFRs
-
Patients must not have received prior strontium-89, rhenium-186, rhenium-188, or samarium-153 radionuclide therapy within 28 days prior to registration
-
Patients may have received prior radiation therapy or biologic therapy (e.g. vaccines, immunotherapy, anti-sense, small molecules, monoclonal antibodies); however, at least 28 days must have elapsed since completion of therapy and patient must have recovered from all side effects
-
Patients may have received prior surgery; for all major surgeries, at least 28 days must have elapsed since completion and patient must have recovered from all side effects
-
Leukocytes >= 3,000 mcL
-
Absolute neutrophil count (ANC) >= 1,500 mcL
-
Hemoglobin >= 9 g/dL
-
Platelets >= 100,000/mcL
-
Bilirubin =< 1.5 times the institutional upper limit of normal (ULN) (unless documented Gilbert's disease)
-
Serum glutamic oxaloacetic transaminase (SGOT) (aspartate aminotransferase [AST]) and serum glutamate pyruvate transaminase (SGPT) (alanine aminotransferase [ALT]) =< 3 times the institutional ULN, or =< 5 times the institutional ULN if liver metastases are present
-
Creatinine =< 2.0 x the institutional ULN or calculated creatinine clearance >= 40 mL/min
-
International normalized ratio (INR) =< 1.5
-
Partial thromboplastin time (PTT) no more than 5 seconds above the institutional ULN
-
Patients receiving prophylactic low dose coumadin or low molecular weight heparin are eligible as long as they meet these coagulation criteria; patients requiring full-dose (therapeutic) anticoagulation are eligible provided that they have been on a stable dose of anticoagulation and the coagulation parameters are stable within the therapeutic range (e.g., INR 2-3 for patients on therapeutic warfarin)
-
Patients must have a hemoglobin A1c (HgA1c) =< 7% AND fasting glucose of < 160 mg/dL or below the institutional ULN within 14 days prior to registration; patients with diabetes mellitus who meet this criterion must be on a stable dietary or therapeutic regimen for this condition
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Patients must not have a history of symptomatic congestive heart failure or a known ejection fraction (left ventricular ejection fraction [LVEF]) that is >= 10% below the lower limit of normal (LLN); if left ventricular (LV) dysfunction is suspected, but not confirmed by review of past medical history, a multi gated acquisition scan (MUGA) or echocardiogram must be obtained within 90 days prior to registration
-
Patient must not have a history of allergic reaction attributed to compounds of similar chemical or biologic composition to IMC-A12; patients must not have received prior chimerized or murine monoclonal antibody therapy
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Patients must have a Zubrod performance status of 0 - 2; Zubrod performance status 3 will be allowed if from bone pain only
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Patients with human immunodeficiency virus (HIV) positivity requiring antiretroviral therapy are not eligible for this study
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Patients must have no plans to receive concurrent chemotherapy, hormonal therapy (other than the LHRH agonist and oral anti-androgen), radiotherapy, immunotherapy or any other type of therapy for treatment of cancer while on this protocol treatment; concurrent bone targeting agents that do not have effect on PSA (i.e. denosumab or zoledronic acid) are allowed
-
Patients must have no plans to receive concurrent five-alpha reductase inhibitors (e.g. finasteride and dutasteride), ketoconazole, diethylstilbestrol/DES, or other estrogen-based therapy while on this protocol treatment
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No other prior malignancy is allowed except for the following: adequately treated basal cell or squamous cell skin cancer, adequately treated stage I or II cancer from which the patient is currently in complete remission, or any other cancer from which the patient has been disease-free for 5 years
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Men of reproductive potential must have agreed to use an effective contraceptive method while receiving treatment on this study and for at least three months after protocol treatment ends
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All patients must be informed of the investigational nature of this study and must sign and give written informed consent in accordance with institutional and federal guidelines
-
As part of the OPEN registration process, the treating institution's identity is provided in order to ensure that the current (within 365 days) date of institutional review board approval for this study has been entered in the system
Not provided
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Arm I (androgen deprivation and cixutumumab) Goserelin Acetate Patients receive androgen deprivation therapy comprising bicalutamide PO QD on days 1-28 and either goserelin acetate SC or leuprolide acetate IM every 1, 3, 4, 6, or 12 months. Patients also receive cixutumumab IV over 1 hour on days 1 and 15. Treatment repeats every 28 days for 7 courses in the absence of disease progression or unacceptable toxicity. Arm I (androgen deprivation and cixutumumab) Leuprolide Acetate Patients receive androgen deprivation therapy comprising bicalutamide PO QD on days 1-28 and either goserelin acetate SC or leuprolide acetate IM every 1, 3, 4, 6, or 12 months. Patients also receive cixutumumab IV over 1 hour on days 1 and 15. Treatment repeats every 28 days for 7 courses in the absence of disease progression or unacceptable toxicity. Arm II (androgen deprivation therapy) Leuprolide Acetate Patients receive androgen deprivation therapy comprising bicalutamide and either goserelin acetate or leuprolide acetate as in arm I. Arm I (androgen deprivation and cixutumumab) Cixutumumab Patients receive androgen deprivation therapy comprising bicalutamide PO QD on days 1-28 and either goserelin acetate SC or leuprolide acetate IM every 1, 3, 4, 6, or 12 months. Patients also receive cixutumumab IV over 1 hour on days 1 and 15. Treatment repeats every 28 days for 7 courses in the absence of disease progression or unacceptable toxicity. Arm II (androgen deprivation therapy) Goserelin Acetate Patients receive androgen deprivation therapy comprising bicalutamide and either goserelin acetate or leuprolide acetate as in arm I. Arm II (androgen deprivation therapy) Laboratory Biomarker Analysis Patients receive androgen deprivation therapy comprising bicalutamide and either goserelin acetate or leuprolide acetate as in arm I. Arm I (androgen deprivation and cixutumumab) Laboratory Biomarker Analysis Patients receive androgen deprivation therapy comprising bicalutamide PO QD on days 1-28 and either goserelin acetate SC or leuprolide acetate IM every 1, 3, 4, 6, or 12 months. Patients also receive cixutumumab IV over 1 hour on days 1 and 15. Treatment repeats every 28 days for 7 courses in the absence of disease progression or unacceptable toxicity. Arm II (androgen deprivation therapy) Bicalutamide Patients receive androgen deprivation therapy comprising bicalutamide and either goserelin acetate or leuprolide acetate as in arm I. Arm I (androgen deprivation and cixutumumab) Pharmacological Study Patients receive androgen deprivation therapy comprising bicalutamide PO QD on days 1-28 and either goserelin acetate SC or leuprolide acetate IM every 1, 3, 4, 6, or 12 months. Patients also receive cixutumumab IV over 1 hour on days 1 and 15. Treatment repeats every 28 days for 7 courses in the absence of disease progression or unacceptable toxicity. Arm II (androgen deprivation therapy) Pharmacological Study Patients receive androgen deprivation therapy comprising bicalutamide and either goserelin acetate or leuprolide acetate as in arm I. Arm I (androgen deprivation and cixutumumab) Bicalutamide Patients receive androgen deprivation therapy comprising bicalutamide PO QD on days 1-28 and either goserelin acetate SC or leuprolide acetate IM every 1, 3, 4, 6, or 12 months. Patients also receive cixutumumab IV over 1 hour on days 1 and 15. Treatment repeats every 28 days for 7 courses in the absence of disease progression or unacceptable toxicity.
- Primary Outcome Measures
Name Time Method Undetectable PSA Rate 7 months Undetectable PSA rate (\<= 0.2 ng/mL) after seven cycles (28 weeks) of protocol treatment
- Secondary Outcome Measures
Name Time Method Toxicity Up to 28 weeks Only adverse events that are possibly, probably or definitely related to study drug are reported.
Proportion of Patients Who do Not Achieve a Partial PSA Response Up to 5 years A partial PSA response is considered \<= 4 ng/mL
Accuracy of the Prognostic Model of Undetectable PSA (Developed From SWOG-9346) Up to 5 years The logistic regression algorithm for predicting undetectable PSA that was developed for SWOG-9346 using its baseline risk factors (age at registration, performance status, baseline PSA, and bone pain) will be applied to each arm of this trial to evaluate the level of agreement between the observed and predicted undetectable PSA rates.
Correlation of microRNA Measures With 28-week PSA Response Baseline to 28 weeks The Friedman test will be used to evaluate correlations between microRNA measures (CT) and 28-week PSA response.
Correlation of microRNA Measures With Baseline Circulating Tumor Cell (CTC) Counts Baseline The Friedman test will be used to evaluate correlations between microRNA measures (CT) and Baseline CTCs.
Change in Level of CTCs Baseline to 28 weeks Will be correlated with 28-week PSA response.
Trial Locations
- Locations (170)
Fairbanks Memorial Hospital
🇺🇸Fairbanks, Alaska, United States
University of Arkansas for Medical Sciences
🇺🇸Little Rock, Arkansas, United States
Highlands Oncology Group-Rogers
🇺🇸Rogers, Arkansas, United States
Mercy Health Saint Mary's
🇺🇸Grand Rapids, Michigan, United States
Spectrum Health Big Rapids Hospital
🇺🇸Big Rapids, Michigan, United States
Allegiance Health
🇺🇸Jackson, Michigan, United States
Saint Joseph Mercy Oakland
🇺🇸Pontiac, Michigan, United States
Saint Joseph Mercy Port Huron
🇺🇸Port Huron, Michigan, United States
Billings Clinic Cancer Center
🇺🇸Billings, Montana, United States
Metro Health Hospital
🇺🇸Wyoming, Michigan, United States
Bozeman Deaconess Cancer Center
🇺🇸Bozeman, Montana, United States
Bozeman Deaconess Hospital
🇺🇸Bozeman, Montana, United States
Cedars-Sinai Medical Center
🇺🇸Los Angeles, California, United States
Smilow Cancer Hospital Care Center at Saint Francis
🇺🇸Hartford, Connecticut, United States
Saint Alphonsus Cancer Care Center-Boise
🇺🇸Boise, Idaho, United States
Heartland Cancer Research NCORP
🇺🇸Decatur, Illinois, United States
Loyola University Medical Center
🇺🇸Maywood, Illinois, United States
Highland Clinic
🇺🇸Shreveport, Louisiana, United States
Genesys Hurley Cancer Institute
🇺🇸Flint, Michigan, United States
Louisiana State University Health Sciences Center Shreveport
🇺🇸Shreveport, Louisiana, United States
Sparrow Hospital
🇺🇸Lansing, Michigan, United States
Munson Medical Center
🇺🇸Traverse City, Michigan, United States
Benefis Healthcare- Sletten Cancer Institute
🇺🇸Great Falls, Montana, United States
Great Falls Clinic
🇺🇸Great Falls, Montana, United States
Glacier Oncology PLLC
🇺🇸Kalispell, Montana, United States
Kalispell Regional Medical Center
🇺🇸Kalispell, Montana, United States
Montana Cancer Specialists
🇺🇸Missoula, Montana, United States
Saint Patrick Hospital - Community Hospital
🇺🇸Missoula, Montana, United States
Kettering Medical Center
🇺🇸Kettering, Ohio, United States
AnMed Health Cancer Center
🇺🇸Anderson, South Carolina, United States
MultiCare Good Samaritan Hospital
🇺🇸Puyallup, Washington, United States
Fred Hutchinson Cancer Research Center
🇺🇸Seattle, Washington, United States
Group Health Cooperative-Seattle
🇺🇸Seattle, Washington, United States
University of Washington Medical Center
🇺🇸Seattle, Washington, United States
Wenatchee Valley Hospital and Clinics
🇺🇸Wenatchee, Washington, United States
Nevada Cancer Research Foundation CCOP
🇺🇸Las Vegas, Nevada, United States
University Medical Center of Southern Nevada
🇺🇸Las Vegas, Nevada, United States
Queen's Medical Center
🇺🇸Honolulu, Hawaii, United States
University of Hawaii Cancer Center
🇺🇸Honolulu, Hawaii, United States
OnCare Hawaii-Kuakini
🇺🇸Honolulu, Hawaii, United States
Grandview Hospital
🇺🇸Dayton, Ohio, United States
Samaritan North Health Center
🇺🇸Dayton, Ohio, United States
Dayton NCI Community Oncology Research Program
🇺🇸Dayton, Ohio, United States
The Polyclinic
🇺🇸Seattle, Washington, United States
Cancer Care Northwest - Spokane South
🇺🇸Spokane, Washington, United States
United General Hospital
🇺🇸Sedro-Woolley, Washington, United States
Northwest NCI Community Oncology Research Program
🇺🇸Tacoma, Washington, United States
Saint Joseph Medical Center
🇺🇸Tacoma, Washington, United States
Huntsman Cancer Institute/University of Utah
🇺🇸Salt Lake City, Utah, United States
USC / Norris Comprehensive Cancer Center
🇺🇸Los Angeles, California, United States
Fremont - Rideout Cancer Center
🇺🇸Marysville, California, United States
Valley Medical Oncology Consultants
🇺🇸Pleasanton, California, United States
Saint Joseph Regional Medical Center
🇺🇸Lewiston, Idaho, United States
Hines Veterans Administration Hospital
🇺🇸Hines, Illinois, United States
Decatur Memorial Hospital
🇺🇸Decatur, Illinois, United States
Memorial Medical Center
🇺🇸Springfield, Illinois, United States
Franciscan Saint Francis Health-Beech Grove
🇺🇸Beech Grove, Indiana, United States
University Health-Conway
🇺🇸Monroe, Louisiana, United States
Beaumont Hospital-Dearborn
🇺🇸Dearborn, Michigan, United States
Saint John Macomb-Oakland Hospital
🇺🇸Warren, Michigan, United States
Saint Peter's Community Hospital
🇺🇸Helena, Montana, United States
University of Rochester
🇺🇸Rochester, New York, United States
Margaret R Pardee Memorial Hospital
🇺🇸Hendersonville, North Carolina, United States
Good Samaritan Hospital - Dayton
🇺🇸Dayton, Ohio, United States
Miami Valley Hospital
🇺🇸Dayton, Ohio, United States
Wayne Memorial Hospital
🇺🇸Goldsboro, North Carolina, United States
Iredell Memorial Hospital
🇺🇸Statesville, North Carolina, United States
Atrium Medical Center-Middletown Regional Hospital
🇺🇸Franklin, Ohio, United States
Blanchard Valley Hospital
🇺🇸Findlay, Ohio, United States
Wayne Hospital
🇺🇸Greenville, Ohio, United States
Upper Valley Medical Center
🇺🇸Troy, Ohio, United States
Clinton Memorial Hospital
🇺🇸Wilmington, Ohio, United States
Wright-Patterson Medical Center
🇺🇸Wright-Patterson Air Force Base, Ohio, United States
Saint Charles Medical Center-Bend
🇺🇸Bend, Oregon, United States
Spartanburg Medical Center
🇺🇸Spartanburg, South Carolina, United States
University of Texas Medical Branch
🇺🇸Galveston, Texas, United States
Brooke Army Medical Center
🇺🇸Fort Sam Houston, Texas, United States
Cancer Care Center at Island Hospital
🇺🇸Anacortes, Washington, United States
Danville Regional Medical Center
🇺🇸Danville, Virginia, United States
PeaceHealth Saint Joseph Medical Center
🇺🇸Bellingham, Washington, United States
Harrison HealthPartners Hematology and Oncology-Bremerton
🇺🇸Bremerton, Washington, United States
Highline Medical Center-Main Campus
🇺🇸Burien, Washington, United States
Saint Francis Hospital
🇺🇸Federal Way, Washington, United States
Providence Regional Cancer System-Centralia
🇺🇸Centralia, Washington, United States
Providence Regional Cancer Partnership
🇺🇸Everett, Washington, United States
Swedish Medical Center-First Hill
🇺🇸Seattle, Washington, United States
Swedish Cancer Institute-Issaquah
🇺🇸Issaquah, Washington, United States
Harborview Medical Center
🇺🇸Seattle, Washington, United States
Saint Clare Hospital
🇺🇸Lakewood, Washington, United States
Skagit Valley Hospital
🇺🇸Mount Vernon, Washington, United States
Harrison HealthPartners Hematology and Oncology-Poulsbo
🇺🇸Poulsbo, Washington, United States
Virginia Mason CCOP
🇺🇸Seattle, Washington, United States
Group Health Cooperative of Puget Sound Oncology Consortium
🇺🇸Seattle, Washington, United States
MultiCare Allenmore Hospital
🇺🇸Tacoma, Washington, United States
Cancer Center of Kansas-Kingman
🇺🇸Kingman, Kansas, United States
Wilcox Memorial Hospital and Kauai Medical Clinic
🇺🇸Lihue, Hawaii, United States
Cancer Center of Kansas-Wichita Medical Arts Tower
🇺🇸Wichita, Kansas, United States
Cancer Center of Kansas - El Dorado
🇺🇸El Dorado, Kansas, United States
Cancer Center of Kansas - Newton
🇺🇸Newton, Kansas, United States
Cancer Center of Kansas - Fort Scott
🇺🇸Fort Scott, Kansas, United States
Cancer Center of Kansas - Parsons
🇺🇸Parsons, Kansas, United States
Rocky Mountain Oncology
🇺🇸Casper, Wyoming, United States
Welch Cancer Center
🇺🇸Sheridan, Wyoming, United States
Wichita NCI Community Oncology Research Program
🇺🇸Wichita, Kansas, United States
Cancer Center of Kansas - Dodge City
🇺🇸Dodge City, Kansas, United States
Cancer Center of Kansas - Wichita
🇺🇸Wichita, Kansas, United States
Via Christi Regional Medical Center
🇺🇸Wichita, Kansas, United States
University of Kansas Cancer Center
🇺🇸Kansas City, Kansas, United States
Cancer Center of Kansas - Salina
🇺🇸Salina, Kansas, United States
Associates In Womens Health
🇺🇸Wichita, Kansas, United States
Tahoe Forest Cancer Center
🇺🇸Truckee, California, United States
Montrose Memorial Hospital
🇺🇸Montrose, Colorado, United States
Saint Mary's Hospital and Regional Medical Center
🇺🇸Grand Junction, Colorado, United States
City of Hope Comprehensive Cancer Center
🇺🇸Duarte, California, United States
Cancer Center of Kansas - Chanute
🇺🇸Chanute, Kansas, United States
Reid Health
🇺🇸Richmond, Indiana, United States
Cancer Center of Kansas-Liberal
🇺🇸Liberal, Kansas, United States
Valley View Hospital Cancer Center
🇺🇸Glenwood Springs, Colorado, United States
Pali Momi Medical Center
🇺🇸'Aiea, Hawaii, United States
Poudre Valley Hospital
🇺🇸Fort Collins, Colorado, United States
Front Range Cancer Specialists
🇺🇸Fort Collins, Colorado, United States
San Luis Valley Regional Medical Center
🇺🇸Alamosa, Colorado, United States
The Shaw Regional Cancer Center
🇺🇸Edwards, Colorado, United States
Oncare Hawaii Inc-Pali Momi
🇺🇸'Aiea, Hawaii, United States
Cancer Center of Kansas - Pratt
🇺🇸Pratt, Kansas, United States
Cancer Center of Kansas - Winfield
🇺🇸Winfield, Kansas, United States
Castle Medical Center
🇺🇸Kailua, Hawaii, United States
Spectrum Health at Butterworth Campus
🇺🇸Grand Rapids, Michigan, United States
Spectrum Health Reed City Hospital
🇺🇸Reed City, Michigan, United States
Bronson Battle Creek
🇺🇸Battle Creek, Michigan, United States
Cancer Center of Kansas-Independence
🇺🇸Independence, Kansas, United States
Saint Anthony's Health
🇺🇸Alton, Illinois, United States
Hurley Medical Center
🇺🇸Flint, Michigan, United States
Lawrence Memorial Hospital
🇺🇸Lawrence, Kansas, United States
Mercy Health Mercy Campus
🇺🇸Muskegon, Michigan, United States
Cancer Research Consortium of West Michigan NCORP
🇺🇸Grand Rapids, Michigan, United States
Saint Vincent Healthcare
🇺🇸Billings, Montana, United States
Saint Mary Mercy Hospital
🇺🇸Livonia, Michigan, United States
Saint Mary's of Michigan
🇺🇸Saginaw, Michigan, United States
Minor and James Medical PLLC
🇺🇸Seattle, Washington, United States
Pacific Medical Center-First Hill
🇺🇸Seattle, Washington, United States
Providence - Saint Peter Hospital
🇺🇸Olympia, Washington, United States
Evergreen Hematology and Oncology PS
🇺🇸Spokane, Washington, United States
Rockwood Clinic
🇺🇸Spokane, Washington, United States
Multicare Health System
🇺🇸Tacoma, Washington, United States
BCCA-Vancouver Cancer Centre
🇨🇦Vancouver, British Columbia, Canada
University of California Davis Comprehensive Cancer Center
🇺🇸Sacramento, California, United States
University of Colorado Cancer Center - Anschutz Cancer Pavilion
🇺🇸Aurora, Colorado, United States
Moffitt Cancer Center
🇺🇸Tampa, Florida, United States
Saint Joseph Mercy Hospital
🇺🇸Ann Arbor, Michigan, United States
Michigan Cancer Research Consortium NCORP
🇺🇸Ann Arbor, Michigan, United States
University of Michigan Comprehensive Cancer Center
🇺🇸Ann Arbor, Michigan, United States
Wayne State University/Karmanos Cancer Institute
🇺🇸Detroit, Michigan, United States
Henry Ford Hospital
🇺🇸Detroit, Michigan, United States
Saint John Hospital and Medical Center
🇺🇸Detroit, Michigan, United States
Southeast Clinical Oncology Research (SCOR) Consortium NCORP
🇺🇸Winston-Salem, North Carolina, United States
EvergreenHealth Medical Center
🇺🇸Kirkland, Washington, United States
UF Cancer Center at Orlando Health
🇺🇸Orlando, Florida, United States
Oncare Hawaii Inc-POB II
🇺🇸Honolulu, Hawaii, United States
Straub Clinic and Hospital
🇺🇸Honolulu, Hawaii, United States
Kapiolani Medical Center for Women and Children
🇺🇸Honolulu, Hawaii, United States
Kuakini Medical Center
🇺🇸Honolulu, Hawaii, United States
Tripler Army Medical Center
🇺🇸Honolulu, Hawaii, United States
Kansas City Veterans Affairs Medical Center
🇺🇸Kansas City, Missouri, United States
Medical University of South Carolina
🇺🇸Charleston, South Carolina, United States
Montana Cancer Consortium NCORP
🇺🇸Billings, Montana, United States
Frontier Cancer Center and Blood Institute-Billings
🇺🇸Billings, Montana, United States
Cancer Center of Kansas - Wellington
🇺🇸Wellington, Kansas, United States
Kadlec Clinic Hematology and Oncology
🇺🇸Kennewick, Washington, United States
Greene Memorial Hospital
🇺🇸Xenia, Ohio, United States