Cisplatin or Carboplatin, and Etoposide With or Without Sunitinib Malate in Treating Patients With Extensive-Stage Small Cell Lung Cancer

Phase 1

Completed

Conditions: Extensive Stage Lung Small Cell Carcinoma
Recurrent Lung Small Cell Carcinoma

Interventions: Drug: Carboplatin
Drug: Cisplatin
Drug: Etoposide
Other: Laboratory Biomarker Analysis
Other: Placebo Administration
Drug: Sunitinib Malate

Registration Number: NCT00453154

Lead Sponsor: National Cancer Institute (NCI)

Brief Summary: This partially randomized phase I/II trial studies the side effects and best dose of sunitinib malate and to see how well it works when given together with cisplatin or carboplatin and etoposide in treating patients with extensive-stage small cell lung cancer. Drugs used in chemotherapy, such as cisplatin, carboplatin, and etoposide, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Sunitinib malate may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth and by blocking blood flow to the tumor. It is not yet known whether cisplatin or carboplatin and etoposide are more effective when given with or without sunitinib malate in treating small cell lung cancer.

Detailed Description: PRIMARY OBJECTIVES:

I. To determine the phase II dose for sunitinib (sunitinib malate) combined with cisplatin and etoposide. (Phase IB) II. To compare the progression-free survival of patients with extensive stage small cell lung cancer treated with cisplatin or carboplatin and etoposide followed by maintenance sunitinib to patients receiving the same chemotherapy followed by placebo. (Phase II)

SECONDARY OBJECTIVES:

I. To assess the single agent response rate for sunitinib given as monotherapy after chemotherapy. (Phase II) II. To assess the overall survival of patients treated with cisplatin or carboplatin and etoposide followed by sunitinib. (Phase II) III. To evaluate the toxicity and tolerability of maintenance sunitinib after cisplatin or carboplatin and etoposide. (Phase II) IV. To determine the association between vascular endothelial growth factor (VEGF) plasma levels and tumor response. (Phase II)

OUTLINE: This is a phase I, dose-escalation study of sunitinib malate followed by a randomized phase II study.

PHASE I (close to accrual 5/17/08):

COMBINATION THERAPY: Patients receive cisplatin or carboplatin intravenously (IV) on day 1, etoposide IV on days 1-3, and sunitinib malate orally (PO) once daily (QD) on days 1-14. Treatment repeats every 21 days for up to 6 courses in the absence of disease progression or unacceptable toxicity.

MAINTENANCE THERAPY: Patients receive sunitinib malate PO alone QD. Treatment continues in the absence of disease progression or unacceptable toxicity.

PHASE II:

COMBINATION THERAPY: Patients receive cisplatin or carboplatin and etoposide as in Phase I. Treatment repeats every 21 days for up to 6 courses in the absence of disease progression or unacceptable toxicity.

MAINTENANCE THERAPY: Beginning 3-8 weeks after completion of combination chemotherapy or \>= 4 courses of combination therapy, patients with a responding or stable disease are randomized to 1 of 2 treatment arms. All patients must be euthyroid before starting on maintenance therapy.

ARM I: Patients receive sunitinib malate PO QD. Courses repeat every 3 weeks in the absence of disease progression or unacceptable toxicity.

ARM II: Patients receive placebo PO QD. Courses repeat every 3 weeks in the absence of disease progression or unacceptable toxicity. Patients with disease progression may cross over to Arm I.

After completion of study treatment, patients are followed up every 3 months for 1 year and then every 6 months for 2 years.

Recruitment & Eligibility

Status: COMPLETED

Sex: All

Target Recruitment: 156

Inclusion Criteria

All patients must have histologically or cytologically documented small cell lung cancer
- Eligible disease stages: the extensive disease classification for this protocol includes all patients with disease sites not defined as limited stage; limited stage disease category includes patients with disease restricted to one hemithorax with regional lymph node metastases, including hilar, ipsilateral and contralateral mediastinal, and/or ipsilateral supraclavicular nodes; extensive stage patients are defined as those patients with extrathoracic metastatic, malignant pleural effusion, bilateral or contralateral supraclavicular adenopathy or contralateral hilar adenopathy
All patients must have measurable disease:
- Measurable disease is defined as at least one lesion that can be accurately measured in at least one dimension (longest diameter to be recorded) as >= 20 mm with conventional techniques or as >= 10 mm with spiral computed tomography (CT) scan
- Lesions that are considered non-measurable, which would make the patient not eligible, include the following:
  - Bone lesions
  - Leptomeningeal disease
  - Ascites
  - Pleural/pericardial effusion
  - Lymphangitis cutis/pulmonis
  - Abdominal masses that are not confirmed and followed by imaging techniques
  - Cystic lesions
No prior chemotherapy for small cell lung cancer (SCLC)
Radiation therapy must have been completed at least one week before initiation of protocol therapy
Common Toxicity Criteria (CTC) performance status:
- Phase IB: 0-1
- Phase II: 0-2
No "currently active" second malignancy other than non-melanoma skin cancers
No history of brain metastases, spinal cord compression, or carcinomatous meningitis
No ongoing cardiac dysrhythmias, atrial fibrillation, or QTc interval >= 500 msec; the use of agents with proarrhythmic potential (e.g., quinidine, procainamide, disopyramide, sotalol, probucol, pedridel, haloperidol, risperidone, indapamide, flecainide) is not recommended while on protocol therapy
Patients with class I New York Heart Association (NYHA) are eligible; patients with a history of class II NYHA are eligible, provided they meet the following criteria:
- Patients with a history of class II heart failure who are asymptomatic on treatment
- Patients with prior anthracycline exposure
- Patients who have received central thoracic radiation that included the heart in the radiotherapy port
Patients with a history of class III or IV NYHA heart failure within 12 months prior to registration are not eligible
Additionally, no myocardial infarction, severe/unstable angina, coronary/peripheral artery bypass graft or stenting, cerebrovascular accident including transient ischemic attack, or pulmonary embolism within the last year
Patients with hypertension that cannot be controlled by medications (> 150/100 mmHg despite optimal medical therapy) are not eligible
Patients who require use of therapeutic doses of coumarin-derivative anticoagulants such as warfarin are excluded, although doses of up to 2 mg daily are permitted for prophylaxis of thrombosis; Note: Low molecular weight heparin is permitted provided the patient's prothrombin time (PT) international normalized ratio (INR) is =< 1.5
No evidence of hemoptysis within 4 weeks prior to starting study treatment; patients with blood-tinged or blood streaked sputum will be permitted on study if the hemoptysis amounts to less than 5 mL of blood per episode and less than 10 mL of blood per 24-hour period in the best estimate of the investigator
None of the following within 28 days of treatment: abdominal fistula, gastrointestinal perforation, intra-abdominal abscess, serious or non-healing wound, ulcer, or bone fracture
The use of the following specific inhibitors and inducers of cytochrome p450, family 3, subfamily A, polypeptide 4 (CYP3A4) is not permitted; the following inhibitors of CYP3A4 are prohibited within 7 days before and during treatment with sunitinib: azole antifungals (ketoconazole, itraconazole), diltiazem, clarithromycin, erythromycin, verapamil, delavirdine, and human immunodeficiency virus (HIV) protease inhibitors (indinavir, saquinavir, ritonavir, atazanavir, nelfinavir); the following inducers of CYP3A4 are prohibited within 12 days before beginning and during treatment with sunitinib: rifampin, rifabutin, carbamazepine, phenobarbital, phenytoin, St. John's Wort, efavirenz, tipranavir
- Other inhibitors and inducers of CYP3A4 may be used if necessary, but there use is discouraged
Non-pregnant and non-nursing
Granulocytes >= 1,500/ul
Platelets >= 100,000/ul
Creatinine clearance >= 70 ml/min
Total bilirubin =< 1.5 mg/dl
Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) =< 2.5 x upper limit of normal (ULN) (patients w/ liver metastases may have AST/ALT =< 5 x ULN)
Partial thromboplastin time (PTT) =< 1.5 x ULN

Exclusion Criteria

Not provided

Study & Design

Study Type: INTERVENTIONAL

Study Design: CROSSOVER

Arm && Interventions

Group	Intervention	Description
Arm II (Combination Chemotherapy + Placebo Maintenance)	Laboratory Biomarker Analysis	Participants will receive the following combination chemotherapy for 4-6 cycles (21 days): Cisplatin 80 mg/m\^2 by IV over 1 hour on day 1 every cycle OR Carboplatin AUC = 5\* by IV Etoposide 100 mg/m2 by IV over 1 hour on days 1, 2, and 3 every cycle Maintenance: Following 4-6 cycles of combination chemotherapy, start placebo at 150 mg on day 1, then 37.5 daily until disease progression.
Arm II (Combination Chemotherapy + Placebo Maintenance)	Placebo Administration	Participants will receive the following combination chemotherapy for 4-6 cycles (21 days): Cisplatin 80 mg/m\^2 by IV over 1 hour on day 1 every cycle OR Carboplatin AUC = 5\* by IV Etoposide 100 mg/m2 by IV over 1 hour on days 1, 2, and 3 every cycle Maintenance: Following 4-6 cycles of combination chemotherapy, start placebo at 150 mg on day 1, then 37.5 daily until disease progression.
Arm I (Combination Chemotherapy + Sunitinib Maintenance)	Laboratory Biomarker Analysis	Participants will receive the following combination chemotherapy for 4-6 cycles (21 days): Cisplatin 80 mg/m\^2 by IV over 1 hour on day 1 every cycle OR Carboplatin AUC = 5\* by IV Etoposide 100 mg/m\^2 by IV over 1 hour on days 1, 2, and 3 every cycle Maintenance: Following 4-6 cycles of combination chemotherapy, start sunitinib at 150 mg on day 1, then 37.5 daily until disease progression.
Arm I (Combination Chemotherapy + Sunitinib Maintenance)	Carboplatin	Participants will receive the following combination chemotherapy for 4-6 cycles (21 days): Cisplatin 80 mg/m\^2 by IV over 1 hour on day 1 every cycle OR Carboplatin AUC = 5\* by IV Etoposide 100 mg/m\^2 by IV over 1 hour on days 1, 2, and 3 every cycle Maintenance: Following 4-6 cycles of combination chemotherapy, start sunitinib at 150 mg on day 1, then 37.5 daily until disease progression.
Arm I (Combination Chemotherapy + Sunitinib Maintenance)	Cisplatin	Participants will receive the following combination chemotherapy for 4-6 cycles (21 days): Cisplatin 80 mg/m\^2 by IV over 1 hour on day 1 every cycle OR Carboplatin AUC = 5\* by IV Etoposide 100 mg/m\^2 by IV over 1 hour on days 1, 2, and 3 every cycle Maintenance: Following 4-6 cycles of combination chemotherapy, start sunitinib at 150 mg on day 1, then 37.5 daily until disease progression.
Arm II (Combination Chemotherapy + Placebo Maintenance)	Carboplatin	Participants will receive the following combination chemotherapy for 4-6 cycles (21 days): Cisplatin 80 mg/m\^2 by IV over 1 hour on day 1 every cycle OR Carboplatin AUC = 5\* by IV Etoposide 100 mg/m2 by IV over 1 hour on days 1, 2, and 3 every cycle Maintenance: Following 4-6 cycles of combination chemotherapy, start placebo at 150 mg on day 1, then 37.5 daily until disease progression.
Arm I (Combination Chemotherapy + Sunitinib Maintenance)	Sunitinib Malate	Participants will receive the following combination chemotherapy for 4-6 cycles (21 days): Cisplatin 80 mg/m\^2 by IV over 1 hour on day 1 every cycle OR Carboplatin AUC = 5\* by IV Etoposide 100 mg/m\^2 by IV over 1 hour on days 1, 2, and 3 every cycle Maintenance: Following 4-6 cycles of combination chemotherapy, start sunitinib at 150 mg on day 1, then 37.5 daily until disease progression.
Arm I (Combination Chemotherapy + Sunitinib Maintenance)	Etoposide	Participants will receive the following combination chemotherapy for 4-6 cycles (21 days): Cisplatin 80 mg/m\^2 by IV over 1 hour on day 1 every cycle OR Carboplatin AUC = 5\* by IV Etoposide 100 mg/m\^2 by IV over 1 hour on days 1, 2, and 3 every cycle Maintenance: Following 4-6 cycles of combination chemotherapy, start sunitinib at 150 mg on day 1, then 37.5 daily until disease progression.
Arm II (Combination Chemotherapy + Placebo Maintenance)	Etoposide	Participants will receive the following combination chemotherapy for 4-6 cycles (21 days): Cisplatin 80 mg/m\^2 by IV over 1 hour on day 1 every cycle OR Carboplatin AUC = 5\* by IV Etoposide 100 mg/m2 by IV over 1 hour on days 1, 2, and 3 every cycle Maintenance: Following 4-6 cycles of combination chemotherapy, start placebo at 150 mg on day 1, then 37.5 daily until disease progression.
Arm II (Combination Chemotherapy + Placebo Maintenance)	Cisplatin	Participants will receive the following combination chemotherapy for 4-6 cycles (21 days): Cisplatin 80 mg/m\^2 by IV over 1 hour on day 1 every cycle OR Carboplatin AUC = 5\* by IV Etoposide 100 mg/m2 by IV over 1 hour on days 1, 2, and 3 every cycle Maintenance: Following 4-6 cycles of combination chemotherapy, start placebo at 150 mg on day 1, then 37.5 daily until disease progression.

Primary Outcome Measures

Name	Time	Method
Maximum Tolerated of Sunitinib Combined With Cisplatin and Etoposide (Phase I)	21 days	The maximum tolerated dose is defined at the highest sunitinib dose at which less than one third of participants develop a dose limiting toxicity (DLT). A DLT is defined as: delay of beginning cycle 2 of chemotherapy by \> 7 days due to neutropenia, grade 4 hematologic toxicity lasting greater than 1 week (chemotherapy alone would be expected to cause significant grade 4 hematologic toxicity) or grade 3 or 4 nonhematologic toxicity (excluding grade 3 or 4 fatigue if the patient is found to be hypothyroid and responds to fatigue \< grade 3 with thyroid replacement therapy).
Progression-free Survival (Phase II)	Up to 3 years	Progression free survival (PFS) was defined as the time from maintenance randomization to progression or death of any cause. Progression free and alive patients were censored at the date of last follow-up. The median PFS with 95% CI was estimated using the Kaplan Meier method.

Secondary Outcome Measures

Name	Time	Method
Number of Participants With Overall Tumor Response	Up to 3 years	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; Progressive Disease (PD): 20% increase in sum of longest diameter of target lesions; Stable Disease (SD): small changes that do not meet above criteria. Overall tumor response is the total number of CR and PRs.
Overall Survival	Up to 3 years	Overall survival (OS) was defined as the time from randomization to death of any cause. Surviving patients were censored at the date of last follow-up. The median OS with 95% CI was estimated using the Kaplan Meier method.

Trial Locations

Locations (125): Ohio State University Comprehensive Cancer Center
🇺🇸
Columbus, Ohio, United States
Heartland Cancer Research NCORP
🇺🇸
Decatur, Illinois, United States
Illinois CancerCare-Princeton
🇺🇸
Princeton, Illinois, United States
Elkhart Clinic
🇺🇸
Elkhart, Indiana, United States
Nebraska Cancer Research Center
🇺🇸
Lincoln, Nebraska, United States
Michiana Hematology Oncology PC-South Bend
🇺🇸
South Bend, Indiana, United States
State University of New York Upstate Medical University
🇺🇸
Syracuse, New York, United States
University of Vermont and State Agricultural College
🇺🇸
Burlington, Vermont, United States
University of Minnesota/Masonic Cancer Center
🇺🇸
Minneapolis, Minnesota, United States
Minneapolis VA Medical Center
🇺🇸
Minneapolis, Minnesota, United States
Illinois CancerCare-Canton
🇺🇸
Canton, Illinois, United States
Illinois CancerCare-Eureka
🇺🇸
Eureka, Illinois, United States
Illinois CancerCare-Havana
🇺🇸
Havana, Illinois, United States
University of Chicago Comprehensive Cancer Center
🇺🇸
Chicago, Illinois, United States
Hopedale Medical Complex - Hospital
🇺🇸
Hopedale, Illinois, United States
Hematology and Oncology Associates-Oakland
🇺🇸
Oakland, California, United States
Doctors Medical Center- JC Robinson Regional Cancer Center
🇺🇸
San Pablo, California, United States
Tom K Lee Inc
🇺🇸
Oakland, California, United States
Illinois CancerCare-Bloomington
🇺🇸
Bloomington, Illinois, United States
Community Cancer Center Foundation
🇺🇸
Normal, Illinois, United States
Galesburg Cottage Hospital
🇺🇸
Galesburg, Illinois, United States
Illinois CancerCare-Galesburg
🇺🇸
Galesburg, Illinois, United States
Mason District Hospital
🇺🇸
Havana, Illinois, United States
South Bend Clinic
🇺🇸
South Bend, Indiana, United States
Alta Bates Summit Medical Center - Summit Campus
🇺🇸
Oakland, California, United States
Mount Sinai Medical Center
🇺🇸
Miami Beach, Florida, United States
Illinois CancerCare-Spring Valley
🇺🇸
Spring Valley, Illinois, United States
Michiana Hematology Oncology PC-Westville
🇺🇸
Westville, Indiana, United States
Christiana Care Health System-Christiana Hospital
🇺🇸
Newark, Delaware, United States
Holy Cross Hospital
🇺🇸
Fort Lauderdale, Florida, United States
Illinois CancerCare-Macomb
🇺🇸
Macomb, Illinois, United States
Perry Memorial Hospital
🇺🇸
Princeton, Illinois, United States
Memorial Health University Medical Center
🇺🇸
Savannah, Georgia, United States
Illinois CancerCare-Peoria
🇺🇸
Peoria, Illinois, United States
Saint Joseph Medical Center
🇺🇸
Bloomington, Illinois, United States
Illinois CancerCare-Monmouth
🇺🇸
Monmouth, Illinois, United States
Bromenn Regional Medical Center
🇺🇸
Normal, Illinois, United States
Illinois CancerCare-Peru
🇺🇸
Peru, Illinois, United States
Graham Hospital Association
🇺🇸
Canton, Illinois, United States
Ottawa Regional Hospital and Healthcare Center
🇺🇸
Ottawa, Illinois, United States
Saint Margaret's Hospital
🇺🇸
Spring Valley, Illinois, United States
AMITA Health Adventist Medical Center
🇺🇸
La Grange, Illinois, United States
Memorial Hospital
🇺🇸
Carthage, Illinois, United States
Pekin Hospital
🇺🇸
Pekin, Illinois, United States
Illinois Valley Hospital
🇺🇸
Peru, Illinois, United States
Fort Wayne Medical Oncology and Hematology Inc-Parkview
🇺🇸
Fort Wayne, Indiana, United States
Saint Joseph Regional Medical Center-Mishawaka
🇺🇸
Mishawaka, Indiana, United States
Hematology Oncology Associates of Central New York-East Syracuse
🇺🇸
East Syracuse, New York, United States
Roswell Park Cancer Institute
🇺🇸
Buffalo, New York, United States
Cooper Hospital University Medical Center
🇺🇸
Camden, New Jersey, United States
Duke University Medical Center
🇺🇸
Durham, North Carolina, United States
Glens Falls Hospital
🇺🇸
Glens Falls, New York, United States
Alegent Health Immanuel Medical Center
🇺🇸
Omaha, Nebraska, United States
Missouri Valley Cancer Consortium
🇺🇸
Omaha, Nebraska, United States
Nebraska Methodist Hospital
🇺🇸
Omaha, Nebraska, United States
Creighton University Medical Center
🇺🇸
Omaha, Nebraska, United States
University of Nebraska Medical Center
🇺🇸
Omaha, Nebraska, United States
Michiana Hematology Oncology PC-Plymouth
🇺🇸
Plymouth, Indiana, United States
Ralph Lauren Center for Cancer Care and Prevention
🇺🇸
New York, New York, United States
McLeod Regional Medical Center
🇺🇸
Florence, South Carolina, United States
OSF Saint Anthony Medical Center
🇺🇸
Rockford, Illinois, United States
Arroyo Grande Community
🇺🇸
Arroyo Grande, California, United States
PCR Oncology
🇺🇸
Arroyo Grande, California, United States
East Bay Radiation Oncology Center
🇺🇸
Castro Valley, California, United States
Contra Costa Regional Medical Center
🇺🇸
Martinez, California, United States
Valley Medical Oncology Consultants-Fremont
🇺🇸
Fremont, California, United States
MedStar Georgetown University Hospital
🇺🇸
Washington, District of Columbia, United States
Jupiter Medical Center
🇺🇸
Jupiter, Florida, United States
Eureka Hospital
🇺🇸
Eureka, Illinois, United States
Illinois CancerCare-Carthage
🇺🇸
Carthage, Illinois, United States
Illinois CancerCare-Kewanee Clinic
🇺🇸
Kewanee, Illinois, United States
Holy Family Medical Center
🇺🇸
Monmouth, Illinois, United States
Mcdonough District Hospital
🇺🇸
Macomb, Illinois, United States
Kewanee Hospital
🇺🇸
Kewanee, Illinois, United States
Illinois CancerCare-Community Cancer Center
🇺🇸
Normal, Illinois, United States
OSF Saint Francis Radiation Oncology at Pekin Cancer Treatment Center
🇺🇸
Pekin, Illinois, United States
IU Health La Porte Hospital
🇺🇸
La Porte, Indiana, United States
Community Howard Regional Health
🇺🇸
Kokomo, Indiana, United States
Northern Indiana Cancer Research Consortium
🇺🇸
South Bend, Indiana, United States
University of Iowa/Holden Comprehensive Cancer Center
🇺🇸
Iowa City, Iowa, United States
University of Maryland/Greenebaum Cancer Center
🇺🇸
Baltimore, Maryland, United States
Eastern Maine Medical Center
🇺🇸
Bangor, Maine, United States
Union Hospital of Cecil County
🇺🇸
Elkton, Maryland, United States
Peninsula Regional Medical Center
🇺🇸
Salisbury, Maryland, United States
Addison Gilbert Hospital
🇺🇸
Gloucester, Massachusetts, United States
Marie Yeager Cancer Center
🇺🇸
Saint Joseph, Michigan, United States
University of Missouri - Ellis Fischel
🇺🇸
Columbia, Missouri, United States
Washington University School of Medicine
🇺🇸
Saint Louis, Missouri, United States
CHI Health Saint Francis
🇺🇸
Grand Island, Nebraska, United States
Alegent Health Bergan Mercy Medical Center
🇺🇸
Omaha, Nebraska, United States
New Hampshire Oncology Hematology PA-Concord
🇺🇸
Concord, New Hampshire, United States
LRGHealthcare-Lakes Region General Hospital
🇺🇸
Laconia, New Hampshire, United States
Memorial Sloan Kettering Cancer Center
🇺🇸
New York, New York, United States
Wayne Memorial Hospital
🇺🇸
Goldsboro, North Carolina, United States
FirstHealth of the Carolinas-Moore Regional Hospital
🇺🇸
Pinehurst, North Carolina, United States
Iredell Memorial Hospital
🇺🇸
Statesville, North Carolina, United States
Beaufort Memorial Hospital
🇺🇸
Beaufort, South Carolina, United States
Miriam Hospital
🇺🇸
Providence, Rhode Island, United States
Central Vermont Medical Center/National Life Cancer Treatment
🇺🇸
Berlin, Vermont, United States
Elkhart General Hospital
🇺🇸
Elkhart, Indiana, United States
Memorial Hospital of South Bend
🇺🇸
South Bend, Indiana, United States
El Camino Hospital
🇺🇸
Mountain View, California, United States
Bay Area Tumor Institute
🇺🇸
Oakland, California, United States
Highland General Hospital
🇺🇸
Oakland, California, United States
UCSF Medical Center-Mount Zion
🇺🇸
San Francisco, California, United States
Beebe Medical Center
🇺🇸
Lewes, Delaware, United States
Proctor Hospital
🇺🇸
Peoria, Illinois, United States
Illinois CancerCare-Ottawa Clinic
🇺🇸
Ottawa, Illinois, United States
Lakeland Medical Center Saint Joseph
🇺🇸
Saint Joseph, Michigan, United States
Methodist Medical Center of Illinois
🇺🇸
Peoria, Illinois, United States
Illinois CancerCare-Pekin
🇺🇸
Pekin, Illinois, United States
OSF Saint Francis Medical Center
🇺🇸
Peoria, Illinois, United States
Michiana Hematology Oncology PC-Elkhart
🇺🇸
Elkhart, Indiana, United States
Great Plains Health Callahan Cancer Center
🇺🇸
North Platte, Nebraska, United States
Danville Regional Medical Center
🇺🇸
Danville, Virginia, United States
New Hampshire Oncology Hematology PA-Hooksett
🇺🇸
Hooksett, New Hampshire, United States
Michiana Hematology Oncology PC-Mishawaka
🇺🇸
Mishawaka, Indiana, United States
Valley Medical Oncology Consultants-Castro Valley
🇺🇸
Castro Valley, California, United States
Bay Area Breast Surgeons Inc
🇺🇸
Emeryville, California, United States
Margaret R Pardee Memorial Hospital
🇺🇸
Hendersonville, North Carolina, United States
Lakeland Hospital Niles
🇺🇸
Niles, Michigan, United States
Florida Cancer Specialists-Gainesville Cancer Center
🇺🇸
Gainesville, Florida, United States
Wake Forest University Health Sciences
🇺🇸
Winston-Salem, North Carolina, United States
Virginia Commonwealth University/Massey Cancer Center
🇺🇸
Richmond, Virginia, United States
Rhode Island Hospital
🇺🇸
Providence, Rhode Island, United States