Targeted Treatment for RET Fusion-Positive Advanced Non-Small Cell Lung Cancer (A LUNG-MAP Treatment Trial)
- Conditions
- Recurrent Lung Non-Small Cell CarcinomaStage IV Lung Cancer AJCC v8Stage IVA Lung Cancer AJCC v8Stage IVB Lung Cancer AJCC v8
- Interventions
- Registration Number
- NCT04268550
- Lead Sponsor
- SWOG Cancer Research Network
- Brief Summary
This phase II LUNG-MAP treatment trial studies how well selpercatinib works in treating patients with RET fusion-positive non-small cell lung cancer that is stage IV or has come back (recurrent). Selpercatinib may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth.
- Detailed Description
PRIMARY OBJECTIVE:
I. To evaluate the objective response rate (ORR) (confirmed complete or partial response) by blinded independent centralized review (BICR) associated with selpercatinib (LOXO-292) in patients with previously-treated stage IV or recurrent RET fusion-positive non-small cell lung cancer (NSCLC).
SECONDARY OBJECTIVES:
I. To evaluate the duration of BICR-assessed response among BICR responders. II. To evaluate the frequency and severity of toxicities. III. To evaluate the investigator-assessed objective response rate (confirmed complete or partial response).
IV. To evaluate duration of investigator-assessed response among patients with a response as determined by the local investigator.
V. To evaluate investigator-assessed progression-free survival (IA-PFS). VI. To evaluate BICR-assessed PFS. VII. To evaluate overall survival (OS).
VIII. Among patients with brain metastases at baseline:
VIIIa. To evaluate the central nervous system (CNS) response rate (confirmed complete response \[CR\]).
VIIIb. To evaluate the duration of intracranial response among patients with a CNS response.
TRANSLATIONAL MEDICINE OBJECTIVES:
I. To collect, process, and bank cell-free deoxyribonucleic acid (cfDNA) at baseline, progression, and end of treatment for future development of a proposal to evaluate comprehensive next-generation sequencing of circulating tumor deoxyribonucleic acid (ctDNA).
II. To establish a tissue/blood repository from patients with refractory non-small cell lung cancer (NSCLC).
OUTLINE:
Patients receive selpercatinib orally (PO) twice daily (BID) on days 1-28. Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity.
After completion of study treatment, patients are followed up every 6 months for 2 years and then at the end of 3 years from date of sub-study registration.
Recruitment & Eligibility
- Status
- ACTIVE_NOT_RECRUITING
- Sex
- All
- Target Recruitment
- 124
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Patients must have been assigned to S1900B based on biomarker analysis of tissue and/or blood and determined to have RET fusion-positive NSCLC as defined here:
- Patients must have RET fusion-positive NSCLC as determined by the Foundation Medicine (FMI) tissue-assay, other tumor-based assays such as next-generation sequencing (NGS), polymerase chain reaction (PCR), or follicular in situ hybridization (FISH), or by cfDNA blood assay. Patients with RET fusions detected by immunohistochemistry (IHC) alone are not eligible. The testing must be done within a laboratory with Clinical Laboratory Improvement Act (CLIA), International Organization for Standardization (ISO/International Electrotechnical Commission (IEC), College of American Pathologists (CAP), or similar certification. Presence of RET fusions detected on tests performed outside of LUNGMAP must have been confirmed by the study biomarker review panel
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For patients whose prior therapy was for stage IV or recurrent disease, the patient must have received at least one line of a platinum-based chemotherapy regimen. For patients whose prior systemic therapy was for stage I-III disease only (i.e. patient has not received any treatment for stage IV or recurrent disease), disease progression on platinum-based chemotherapy must have occurred within one year from the last date that the patient received that therapy. Prior anti-PD-1/PD-L1 therapy, alone or in combination (e.g. nivolumab, pembrolizumab, or durvalumab) is allowed
-
Patients must be negative for all additional validated oncogenic drivers that could cause resistance to LOXO-292 treatment. This includes EGFR sensitizing mutations, EGFR T790M, ALK gene fusion, ROS1 gene fusion, KRAS activating mutation, BRAF V600E mutation and MET exon 14 skipping mutation or high-level amplification and expression
- Note: EGFR, ALK, ROS, KRAS, and BRAF testing is performed as part of the LUNGMAP screening/pre-screening FoundationOne test. If prior data is not available, results from the FMI testing must be obtained prior to sub-study registration
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Patients must have measurable disease documented by computed tomography (CT) or magnetic resonance imaging (MRI). The CT from a combined positron emission tomography (PET)/CT may be used to document only non-measurable disease unless it is of diagnostic quality. Measurable disease must be assessed within 28 days prior to sub-study registration. Pleural effusions, ascites and laboratory parameters are not acceptable as the only evidence of disease. Non-measurable disease must be assessed within 42 days prior to sub-study registration. All disease must be assessed and documented on the Baseline Tumor Assessment Form. Patients whose only measurable disease is within a previous radiation therapy port must demonstrate clearly progressive disease (in the opinion of the treating investigator) prior to registration. CT and MRI scans must be submitted for central review via transfer of images and data (TRIAD)
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Patients must have a CT or MRI scan of the brain to evaluate for CNS disease within 42 days prior to sub-study registration
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Patients with evidence of chronic hepatitis B virus (HBV) infection must have undetectable HBV viral load on suppressive therapy within 28 days prior to registration
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Patients with a history of hepatitis C virus (HCV) infection must have been treated and cured. Patients with HCV infection who are currently on treatment must have an undetectable HCV viral load within 28 days prior to registration
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Patients with known human immunodeficiency virus (HIV) infection are eligible, provided they are on effective anti-retroviral therapy and have undetectable viral load at their most recent viral load test and within 6 months prior to registration
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Patients must be able to swallow capsules
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Patients must have progressed (in the opinion of the treating physician) following the most recent line of therapy
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Patients must have recovered (=< grade 1) from any side effects of prior therapy. Patients must not have received any radiation therapy within 14 days prior to sub-study registration
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Absolute neutrophil count (ANC) >= 1,500/mcl (obtained within 28 days prior to sub-study registration)
-
Platelet count >= 100,000 mcl (obtained within 28 days prior to sub-study registration)
-
Serum bilirubin =< institutional upper limit of normal (IULN) (within 28 days prior to sub-study registration). For patients with liver metastases, bilirubin must be =< 5 x IULN
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Either alanine aminotransferase (ALT) or aspartate aminotransferase (AST) =< 2 x IULN (within 28 days prior to sub-study registration) (if both ALT and AST are done, both must be =< 2 IULN). For patients with liver metastases, bilirubin and either ALT or AST must be =< 5 x IULN (if both ALT and AST are done, both must be =< 5 x IULN)
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Serum creatinine =< the IULN or calculated creatinine clearance >= 50 mL/min using the following Cockcroft-Gault formula (within 28 days prior to sub-study registration)
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Patients must have Zubrod performance status 0-1 documented within 28 days prior to sub-study registration
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Pre-study history and physical exam must be obtained within 28 days prior to sub-study registration
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No other prior malignancy is allowed except for the following: adequately treated basal cell or squamous cell skin cancer, in situ cervical 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 five years
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Patients must have electrolytes and blood urea nitrogen (BUN) performed within 14 days prior to sub-study registration
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Patients must agree to have blood specimens submitted for circulating tumor DNA (ctDNA)
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Patients must also be offered participation in banking and in the correlative studies for collection and future use of specimens
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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 a part of the Oncology Patient Enrollment Network (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
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Patients with impaired decision-making capacity are eligible as long as their neurological or psychological condition does not preclude their safe participation in the study (e.g., tracking pill consumption and reporting adverse events to the investigator)
-
Patients must not have received any prior treatment with selective anti-RET inhibitors (anti-RET multikinase inhibitors are permitted)
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Patient must not have leptomeningeal disease, spinal cord compression or brain metastases unless: (1) metastases have been locally treated and have remained clinically controlled and asymptomatic for at least 14 days following treatment, and prior to registration, AND (2) patient has no residual neurological dysfunction and has been off corticosteroids for at least 24 hours prior to sub-study registration
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Patients must not have received any prior systemic therapy (systemic chemotherapy, immunotherapy or investigational drug) within 14 days prior to sub-study registration
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Patients must not be planning to receive any concurrent chemotherapy, immunotherapy, biologic or hormonal therapy for cancer treatment while receiving treatment on this study. Concurrent use of hormones for non-cancer-related conditions (e.g., insulin for diabetes and hormone replacement therapy) is acceptable
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Patient must not have had a major surgery within 14 days prior to sub-study registration. Patient must have fully recovered from the effects of prior surgery in the opinion of the treating investigator
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Patients must not have any grade III/IV cardiac disease as defined by the New York Heart Association Criteria (i.e., patients with cardiac disease resulting in marked limitation of physical activity or resulting in inability to carry on any physical activity without discomfort), unstable angina pectoris, and myocardial infarction within 6 months, or serious uncontrolled cardiac arrhythmia
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Patients must not have a QT interval by Fridericia (QTcF) > 470 msec based on the electrocardiogram (ECG) within 28 days prior to registration. It is suggested that a local cardiologist review the QTcF intervals
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Patients must not have any clinically significant uncontrolled systemic illness, including but not limited to uncontrolled infection, requiring intravenous antibiotics, unstable angina pectoris, myocardial infarction within the past 6 months, uncontrolled cardiac arrhythmias, uncontrolled hypertension, or uncontrolled diabetes mellitus
- Uncontrolled diabetes: Patients who have a diagnosis of diabetes must have an hemoglobin (Hb) A1C < 7% within 28 days prior to registration. The same criterion will be used in patients with confirmed diagnosis of diabetes mellitus who have been on a stable dietary or therapeutic regimen for this condition in the last three months
- Uncontrolled blood pressure and hypertension: All blood pressure measurements within the 28 days prior to registration must be systolic blood pressure (SBP) =< 180 and diastolic blood pressure (DBP) =< 100. An exception can be made by a healthcare provider for a patient with a single blood pressure elevation who upon rechecking has a blood pressure within the parameters above
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Patients must not have any impairment of gastrointestinal function or gastrointestinal disease that may significantly alter the absorption of LOXO-292 (e.g., ulcerative disease, uncontrolled nausea, vomiting, diarrhea, malabsorption syndrome, small bowel resection, or active peptic ulcer disease)
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Patients must not be planning to receive any strong inhibitors or inducers of CYP3A4 at least 14 days prior to sub-study registration and throughout protocol treatment
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Patients must not be planning to use proton pump inhibitors (PPIs) at least one week prior to sub-study registration and throughout protocol treatment
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Patients must not be pregnant or nursing. Women study patients of reproductive potential and fertile men study patients and their partners must abstain or use effective contraception (including barrier method) while receiving study treatment and for at least 3 months after the last dose of LOXO-292. Male study patients must agree not to donate sperm for 6 months after the last dose of LOXO-292. A woman is considered to be of "reproductive potential" if she has had menses at any time in the preceding 12 consecutive months. In addition to routine contraceptive methods, "effective contraception" also includes heterosexual celibacy and surgery intended to prevent pregnancy (or with a side-effect of pregnancy prevention) defined as a hysterectomy, bilateral oophorectomy or bilateral tubal ligation. However, if at any point a previously celibate patient chooses to become heterosexually active during the time period for use of contraceptive measures outlined in the protocol, he/she is responsible for beginning contraceptive measures
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- SINGLE_GROUP
- Arm && Interventions
Group Intervention Description Treatment (selpercatinib) Selpercatinib Patients receive selpercatinib orally PO BID on days 1-28. Cycles repeat every 28 days in the absence of disease progression or unacceptable toxicity.
- Primary Outcome Measures
Name Time Method Response rate by blinded independent centralized review (BICR) Up to 3 years from date of sub-study registration A response will be confirmed by a complete response (CR) or partial response (PR). Proportions and associated confidence intervals will be calculated.
- Secondary Outcome Measures
Name Time Method Incidence of adverse events Up to 3 years from date of sub-study registration Will be assessed using Common Terminology Criteria for Adverse Event version 5.0.
BICR-progression-free survival (PFS) From date of sub-study registration to date of first documentation of progression assessed by BICR or symptomatic deterioration, or death due to any cause, assessed up to 3 years from date of sub-study registration Will be estimated using the method of Kaplan-Meier. The Brookmeyer-Crowley method will be used to estimate confidence intervals for the median using Greenwood's formula and based on a log-log transformation applied on the survival function for landmark times
Investigator-assessed (IA) PFS From date of sub-study registration to date of first documentation of progression assessed by local review or symptomatic deterioration, or death due to any cause, assessed up to 3 years from date of sub-study registration Will be estimated using the method of Kaplan-Meier. The Brookmeyer-Crowley method will be used to estimate confidence intervals for the median using Greenwood's formula and based on a log-log transformation applied on the survival function for landmark times
Overall survival Up to 3 years from date of sub-study registration Will be estimated using the method of Kaplan-Meier. The Brookmeyer-Crowley method will be used to estimate confidence intervals for the median using Greenwood's formula and based on a log-log transformation applied on the survival function for landmark times
BICR-duration of response (DOR) From date of first documentation of confirmed response (CR or PR) to date of first documentation of progression assessed by BICR or symptomatic deterioration, or death due to any cause among patients who achieve, assessed at 6 and 12 months Will be evaluated among patients who achieve a confirmed response. Will be estimated using the method of Kaplan-Meier. The Brookmeyer-Crowley method will be used to estimate confidence intervals for the median using Greenwood's formula and based on a log-log transformation applied on the survival function for landmark times. The median DOR and percentage with DOR at landmark times at 6 and 12 months after documentation of confirmed response will be estimated.
Central nervous system (CNS) response rate Baseline Will be assessed among patients with brain metastases. Will be estimated using the method of Kaplan-Meier. The Brookmeyer-Crowley method will be used to estimate confidence intervals for the median using Greenwood's formula and based on a log-log transformation applied on the survival function for landmark times
Duration of intracranial response among patients with a CNS response Baseline Will be assessed among patients with brain metastases. Will be estimated using the method of Kaplan-Meier. The Brookmeyer-Crowley method will be used to estimate confidence intervals for the median using Greenwood's formula and based on a log-log transformation applied on the survival function for landmark times
Trial Locations
- Locations (306)
Columbus Oncology and Hematology Associates Inc
🇺🇸Columbus, Ohio, United States
The Mark H Zangmeister Center
🇺🇸Columbus, Ohio, United States
Doctors Hospital
🇺🇸Columbus, Ohio, United States
McFarland Clinic PC-Marshalltown
🇺🇸Marshalltown, Iowa, United States
Maine Medical Partners - South Portland
🇺🇸South Portland, Maine, United States
Marie Yeager Cancer Center
🇺🇸Saint Joseph, Michigan, United States
University of Kansas Cancer Center
🇺🇸Kansas City, Kansas, United States
Saint Joseph Mercy Brighton
🇺🇸Brighton, Michigan, United States
Allegiance Health
🇺🇸Jackson, Michigan, United States
Mercy Medical Center-West Lakes
🇺🇸West Des Moines, Iowa, United States
HaysMed University of Kansas Health System
🇺🇸Hays, Kansas, United States
Saint Mary Mercy Hospital
🇺🇸Livonia, Michigan, United States
Spectrum Health Reed City Hospital
🇺🇸Reed City, Michigan, United States
Palo Alto Medical Foundation-Camino Division
🇺🇸Mountain View, California, United States
Kaiser Permanente-Cadillac
🇺🇸Los Angeles, California, United States
Kaiser Permanente-Fontana
🇺🇸Fontana, California, United States
Kaiser Permanente - Panorama City
🇺🇸Panorama City, California, United States
UCHealth Memorial Hospital Central
🇺🇸Colorado Springs, Colorado, United States
Palo Alto Medical Foundation Health Care
🇺🇸Palo Alto, California, United States
Kaiser Permanente Los Angeles Medical Center
🇺🇸Los Angeles, California, United States
Fairbanks Memorial Hospital
🇺🇸Fairbanks, Alaska, United States
Kaiser Permanente-Baldwin Park
🇺🇸Baldwin Park, California, United States
Kaiser Permanente - Harbor City
🇺🇸Harbor City, California, United States
Sutter Solano Medical Center/Cancer Center
🇺🇸Vallejo, California, United States
Kaiser Permanente-Woodland Hills
🇺🇸Woodland Hills, California, United States
Palo Alto Medical Foundation-Fremont
🇺🇸Fremont, California, United States
McKee Medical Center
🇺🇸Loveland, Colorado, United States
Northeast Georgia Medical Center Braselton
🇺🇸Braselton, Georgia, United States
Kaiser Permanente-Anaheim
🇺🇸Anaheim, California, United States
Sutter Roseville Medical Center
🇺🇸Roseville, California, United States
Poudre Valley Hospital
🇺🇸Fort Collins, Colorado, United States
Kaiser Permanente-Bellflower
🇺🇸Bellflower, California, United States
Rocky Mountain Cancer Centers-Littleton
🇺🇸Littleton, Colorado, United States
Presbyterian Intercommunity Hospital
🇺🇸Whittier, California, United States
North Colorado Medical Center
🇺🇸Greeley, Colorado, United States
Kaiser Permanente-Ontario
🇺🇸Ontario, California, United States
Memorial Hospital North
🇺🇸Colorado Springs, Colorado, United States
Cancer Care and Hematology-Fort Collins
🇺🇸Fort Collins, Colorado, United States
Kaiser Permanente-Riverside
🇺🇸Riverside, California, United States
Northside Hospital
🇺🇸Atlanta, Georgia, United States
Saint Luke's Cancer Institute - Meridian
🇺🇸Meridian, Idaho, United States
Northeast Georgia Medical Center-Gainesville
🇺🇸Gainesville, Georgia, United States
Rocky Mountain Cancer Centers-Sky Ridge
🇺🇸Lone Tree, Colorado, United States
Mount Sinai Medical Center
🇺🇸Miami Beach, Florida, United States
Medical Center of the Rockies
🇺🇸Loveland, Colorado, United States
Kaiser Permanente-San Marcos
🇺🇸San Marcos, California, United States
Bayhealth Hospital Sussex Campus
🇺🇸Milford, Delaware, United States
Cancer Care Specialists of Illinois - Decatur
🇺🇸Decatur, Illinois, United States
Illinois CancerCare-Ottawa Clinic
🇺🇸Ottawa, Illinois, United States
Saint Luke's Mountain States Tumor Institute
🇺🇸Boise, Idaho, United States
Genesis Cancer Care Institute
🇺🇸Davenport, Iowa, United States
Illinois CancerCare-Carthage
🇺🇸Carthage, Illinois, United States
Saint Luke's Cancer Institute - Twin Falls
🇺🇸Twin Falls, Idaho, United States
Franciscan Health Mooresville
🇺🇸Mooresville, Indiana, United States
NorthShore University HealthSystem-Evanston Hospital
🇺🇸Evanston, Illinois, United States
Illinois CancerCare-Peru
🇺🇸Peru, Illinois, United States
NorthShore University HealthSystem-Glenbrook Hospital
🇺🇸Glenview, Illinois, United States
UCHealth Greeley Hospital
🇺🇸Greeley, Colorado, United States
UCHealth Lone Tree Health Center
🇺🇸Lone Tree, Colorado, United States
Northside Hospital - Gwinnett
🇺🇸Lawrenceville, Georgia, United States
Genesis Medical Center - East Campus
🇺🇸Davenport, Iowa, United States
Saint Luke's Cancer Institute - Fruitland
🇺🇸Fruitland, Idaho, United States
Memorial Hospital of South Bend
🇺🇸South Bend, Indiana, United States
Northside Hospital - Duluth
🇺🇸Duluth, Georgia, United States
Hawaii Cancer Care - Savio
🇺🇸'Aiea, Hawaii, United States
Mount Sinai Comprehensive Cancer Center at Aventura
🇺🇸Aventura, Florida, United States
Pali Momi Medical Center
🇺🇸'Aiea, Hawaii, United States
Illinois CancerCare-Pekin
🇺🇸Pekin, Illinois, United States
Hartford Hospital
🇺🇸Hartford, Connecticut, United States
Iowa Cancer Specialists
🇺🇸Davenport, Iowa, United States
Atlanta VA Medical Center
🇺🇸Decatur, Georgia, United States
Saint Luke's Cancer Institute - Nampa
🇺🇸Nampa, Idaho, United States
Crossroads Cancer Center
🇺🇸Effingham, Illinois, United States
Mercy Cancer Center-West Lakes
🇺🇸Clive, Iowa, United States
Genesis Cancer Center - Silvis
🇺🇸Silvis, Illinois, United States
Goshen Center for Cancer Care
🇺🇸Goshen, Indiana, United States
Lewis Cancer and Research Pavilion at Saint Joseph's/Candler
🇺🇸Savannah, Georgia, United States
Salina Regional Health Center
🇺🇸Salina, Kansas, United States
Saint Joseph Mercy Chelsea
🇺🇸Chelsea, Michigan, United States
MaineHealth/SMHC Cancer Care and Blood Disorders-Biddeford
🇺🇸Biddeford, Maine, United States
McFarland Clinic PC - Ames
🇺🇸Ames, Iowa, United States
McFarland Clinic PC-Boone
🇺🇸Boone, Iowa, United States
Illinois CancerCare-Peoria
🇺🇸Peoria, Illinois, United States
Illinois CancerCare-Dixon
🇺🇸Dixon, Illinois, United States
West Michigan Cancer Center
🇺🇸Kalamazoo, Michigan, United States
Medical Center of Baton Rouge
🇺🇸Baton Rouge, Louisiana, United States
Ochsner High Grove
🇺🇸Baton Rouge, Louisiana, United States
University of Kansas Health System Saint Francis Campus
🇺🇸Topeka, Kansas, United States
University of Kansas Hospital-Westwood Cancer Center
🇺🇸Westwood, Kansas, United States
Saint Joseph Mercy Canton
🇺🇸Canton, Michigan, United States
UMass Memorial Medical Center - University Campus
🇺🇸Worcester, Massachusetts, United States
Genesee Cancer and Blood Disease Treatment Center
🇺🇸Flint, Michigan, United States
Penobscot Bay Medical Center
🇺🇸Rockport, Maine, United States
Genesee Hematology Oncology PC
🇺🇸Flint, Michigan, United States
Ochsner Medical Center Kenner
🇺🇸Kenner, Louisiana, United States
Waldo County General Hospital
🇺🇸Belfast, Maine, United States
MaineHealth/SMHC Cancer Care and Blood Disorders-Sanford
🇺🇸Sanford, Maine, United States
Metro Health Hospital
🇺🇸Wyoming, Michigan, United States
Oncology Hematology Associates of Saginaw Valley PC
🇺🇸Saginaw, Michigan, United States
Rex Hematology Oncology Associates-Blue Ridge
🇺🇸Raleigh, North Carolina, United States
New Hampshire Oncology Hematology PA-Concord
🇺🇸Concord, New Hampshire, United States
Randolph Hospital
🇺🇸Asheboro, North Carolina, United States
Virtua Samson Cancer Center
🇺🇸Moorestown, New Jersey, United States
Saint Francis Medical Center
🇺🇸Cape Girardeau, Missouri, United States
Essentia Health Sandstone
🇺🇸Sandstone, Minnesota, United States
Virtua Voorhees
🇺🇸Voorhees, New Jersey, United States
Renown Regional Medical Center
🇺🇸Reno, Nevada, United States
Sanford Joe Lueken Cancer Center
🇺🇸Bemidji, Minnesota, United States
Margaret R Pardee Memorial Hospital
🇺🇸Hendersonville, North Carolina, United States
Essentia Health Virginia Clinic
🇺🇸Virginia, Minnesota, United States
Siteman Cancer Center at West County Hospital
🇺🇸Creve Coeur, Missouri, United States
Presbyterian Rust Medical Center/Jorgensen Cancer Center
🇺🇸Rio Rancho, New Mexico, United States
United Hospital
🇺🇸Saint Paul, Minnesota, United States
Mercy Hospital Springfield
🇺🇸Springfield, Missouri, United States
University of Rochester
🇺🇸Rochester, New York, United States
Rex Hematology Oncology Associates-Cary
🇺🇸Cary, North Carolina, United States
Community Hospital of Anaconda
🇺🇸Anaconda, Montana, United States
Essentia Health Cancer Center
🇺🇸Duluth, Minnesota, United States
Mercy Hospital Saint Louis
🇺🇸Saint Louis, Missouri, United States
Missouri Baptist Sullivan Hospital
🇺🇸Sullivan, Missouri, United States
Arnot Ogden Medical Center/Falck Cancer Center
🇺🇸Elmira, New York, United States
Washington University School of Medicine
🇺🇸Saint Louis, Missouri, United States
Rex Cancer Center of Wakefield
🇺🇸Raleigh, North Carolina, United States
Delaware Health Center-Grady Cancer Center
🇺🇸Delaware, Ohio, United States
Grant Medical Center
🇺🇸Columbus, Ohio, United States
Southern Ohio Medical Center
🇺🇸Portsmouth, Ohio, United States
UHHS-Westlake Medical Center
🇺🇸Westlake, Ohio, United States
Vince Lombardi Cancer Clinic-Sheboygan
🇺🇸Sheboygan, Wisconsin, United States
Adams Cancer Center
🇺🇸Gettysburg, Pennsylvania, United States
Langlade Hospital and Cancer Center
🇺🇸Antigo, Wisconsin, United States
Aspirus Medford Hospital
🇺🇸Medford, Wisconsin, United States
Prisma Health Cancer Institute - Butternut
🇺🇸Greenville, South Carolina, United States
Sanford Bismarck Medical Center
🇺🇸Bismarck, North Dakota, United States
Aurora Bay Area Medical Group-Marinette
🇺🇸Marinette, Wisconsin, United States
UH Seidman Cancer Center at Landerbrook Health Center
🇺🇸Mayfield Heights, Ohio, United States
Geauga Hospital
🇺🇸Chardon, Ohio, United States
Sechler Family Cancer Center
🇺🇸Lebanon, Pennsylvania, United States
Bon Secours Memorial Regional Medical Center
🇺🇸Mechanicsville, Virginia, United States
Aurora Cancer Care-Southern Lakes VLCC
🇺🇸Burlington, Wisconsin, United States
Licking Memorial Hospital
🇺🇸Newark, Ohio, United States
Fox Chase Cancer Center
🇺🇸Philadelphia, Pennsylvania, United States
Salem Hospital
🇺🇸Salem, Oregon, United States
The Don and Sybil Harrington Cancer Center
🇺🇸Amarillo, Texas, United States
Genesis Healthcare System Cancer Care Center
🇺🇸Zanesville, Ohio, United States
UPMC Pinnacle Cancer Center/Community Osteopathic Campus
🇺🇸Harrisburg, Pennsylvania, United States
Prisma Health Cancer Institute - Seneca
🇺🇸Seneca, South Carolina, United States
Duluth Clinic Ashland
🇺🇸Ashland, Wisconsin, United States
University Hospitals Sharon Health Center
🇺🇸Wadsworth, Ohio, United States
Prisma Health Cancer Institute - Eastside
🇺🇸Greenville, South Carolina, United States
UH Seidman Cancer Center at Firelands Regional Medical Center
🇺🇸Sandusky, Ohio, United States
Edwards Comprehensive Cancer Center
🇺🇸Huntington, West Virginia, United States
Jefferson Healthcare
🇺🇸Port Townsend, Washington, United States
Vince Lombardi Cancer Clinic-Two Rivers
🇺🇸Two Rivers, Wisconsin, United States
Aurora Cancer Care-Milwaukee West
🇺🇸Wauwatosa, Wisconsin, United States
Aspirus UW Cancer Center
🇺🇸Wisconsin Rapids, Wisconsin, United States
Aurora West Allis Medical Center
🇺🇸West Allis, Wisconsin, United States
Prisma Health Cancer Institute - Faris
🇺🇸Greenville, South Carolina, United States
Aurora Health Care Germantown Health Center
🇺🇸Germantown, Wisconsin, United States
Aurora Medical Center in Summit
🇺🇸Summit, Wisconsin, United States
Illinois CancerCare-Macomb
🇺🇸Macomb, Illinois, United States
Illinois CancerCare-Eureka
🇺🇸Eureka, Illinois, United States
Illinois CancerCare-Princeton
🇺🇸Princeton, Illinois, United States
Parkview Regional Medical Center
🇺🇸Fort Wayne, Indiana, United States
McFarland Clinic PC-Trinity Cancer Center
🇺🇸Fort Dodge, Iowa, United States
Cone Health Cancer Center
🇺🇸Greensboro, North Carolina, United States
Temple University Hospital
🇺🇸Philadelphia, Pennsylvania, United States
Aspirus Regional Cancer Center
🇺🇸Wausau, Wisconsin, United States
WellSpan Health-York Cancer Center
🇺🇸York, Pennsylvania, United States
Aurora Cancer Care-Kenosha South
🇺🇸Kenosha, Wisconsin, United States
Vince Lombardi Cancer Clinic - Oshkosh
🇺🇸Oshkosh, Wisconsin, United States
Parkland Memorial Hospital
🇺🇸Dallas, Texas, United States
University of Pittsburgh Cancer Institute (UPCI)
🇺🇸Pittsburgh, Pennsylvania, United States
Northwestern University
🇺🇸Chicago, Illinois, United States
Case Western Reserve University
🇺🇸Cleveland, Ohio, United States
Western Maryland Regional Medical Center
🇺🇸Cumberland, Maryland, United States
Franciscan Health Indianapolis
🇺🇸Indianapolis, Indiana, United States
OptumCare Cancer Care at Oakey
🇺🇸Las Vegas, Nevada, United States
OptumCare Cancer Care at Fort Apache
🇺🇸Las Vegas, Nevada, United States
Kaiser Permanente-San Diego Zion
🇺🇸San Diego, California, United States
Minneapolis VA Medical Center
🇺🇸Minneapolis, Minnesota, United States
Durham VA Medical Center
🇺🇸Durham, North Carolina, United States
California Pacific Medical Center-Pacific Campus
🇺🇸San Francisco, California, United States
Henry Ford Hospital
🇺🇸Detroit, Michigan, United States
University of Oklahoma Health Sciences Center
🇺🇸Oklahoma City, Oklahoma, United States
Mercy Hospital Oklahoma City
🇺🇸Oklahoma City, Oklahoma, United States
Kaiser Permanente Northwest
🇺🇸Portland, Oregon, United States
Oregon Health and Science University
🇺🇸Portland, Oregon, United States
Aurora Cancer Care-Milwaukee
🇺🇸Milwaukee, Wisconsin, United States
Aurora Saint Luke's Medical Center
🇺🇸Milwaukee, Wisconsin, United States
Medical College of Wisconsin
🇺🇸Milwaukee, Wisconsin, United States
Aurora Sinai Medical Center
🇺🇸Milwaukee, Wisconsin, United States
University of Kansas Cancer Center - Lee's Summit
🇺🇸Lee's Summit, Missouri, United States
Mercy Hospital South
🇺🇸Saint Louis, Missouri, United States
Siteman Cancer Center-South County
🇺🇸Saint Louis, Missouri, United States
Missouri Baptist Outpatient Center-Sunset Hills
🇺🇸Sunset Hills, Missouri, United States
Medical Oncology and Hematology Associates-West Des Moines
🇺🇸Clive, Iowa, United States
Sparrow Hospital
🇺🇸Lansing, Michigan, United States
Spectrum Health at Butterworth Campus
🇺🇸Grand Rapids, Michigan, United States
Ascension Saint Mary's Hospital
🇺🇸Saginaw, Michigan, United States
Illinois CancerCare-Galesburg
🇺🇸Galesburg, Illinois, United States
University Hospitals Parma Medical Center
🇺🇸Parma, Ohio, United States
NorthShore University HealthSystem-Highland Park Hospital
🇺🇸Highland Park, Illinois, United States
Cancer Care Center of O'Fallon
🇺🇸O'Fallon, Illinois, United States
Henry Ford Macomb Hospital-Clinton Township
🇺🇸Clinton Township, Michigan, United States
Mary Greeley Medical Center
🇺🇸Ames, Iowa, United States
Illinois CancerCare-Bloomington
🇺🇸Bloomington, Illinois, United States
Illinois CancerCare-Kewanee Clinic
🇺🇸Kewanee, Illinois, United States
Sanford Cancer Center Oncology Clinic
🇺🇸Sioux Falls, South Dakota, United States
Hawaii Cancer Care Inc-POB II
🇺🇸Honolulu, Hawaii, United States
Queen's Cancer Cenrer - POB I
🇺🇸Honolulu, Hawaii, United States
Queen's Medical Center
🇺🇸Honolulu, Hawaii, United States
Straub Clinic and Hospital
🇺🇸Honolulu, Hawaii, United States
Queen's Cancer Center - Kuakini
🇺🇸Honolulu, Hawaii, United States
James J Peters VA Medical Center
🇺🇸Bronx, New York, United States
Missouri Baptist Medical Center
🇺🇸Saint Louis, Missouri, United States
UT Southwestern/Simmons Cancer Center-Dallas
🇺🇸Dallas, Texas, United States
University of Arkansas for Medical Sciences
🇺🇸Little Rock, Arkansas, United States
Alta Bates Summit Medical Center-Herrick Campus
🇺🇸Berkeley, California, United States
Loma Linda University Medical Center
🇺🇸Loma Linda, California, United States
Sutter Auburn Faith Hospital
🇺🇸Auburn, California, United States
Kaiser Permanente-Irvine
🇺🇸Irvine, California, United States
Stanford Cancer Institute Palo Alto
🇺🇸Palo Alto, California, United States
Palo Alto Medical Foundation-Sunnyvale
🇺🇸Sunnyvale, California, United States
Palo Alto Medical Foundation-Santa Cruz
🇺🇸Santa Cruz, California, United States
Rocky Mountain Cancer Centers-Midtown
🇺🇸Denver, Colorado, United States
Rocky Mountain Cancer Centers-Boulder
🇺🇸Boulder, Colorado, United States
UCHealth Highlands Ranch Hospital
🇺🇸Highlands Ranch, Colorado, United States
Bayhealth Hospital Kent Campus
🇺🇸Dover, Delaware, United States
Suburban Hematology Oncology Associates - Snellville
🇺🇸Snellville, Georgia, United States
Illinois CancerCare-Canton
🇺🇸Canton, Illinois, United States
Loyola University Medical Center
🇺🇸Maywood, Illinois, United States
Greater Regional Medical Center
🇺🇸Creston, Iowa, United States
McFarland Clinic PC-Jefferson
🇺🇸Jefferson, Iowa, United States
Olathe Health Cancer Center
🇺🇸Olathe, Kansas, United States
University of Kansas Cancer Center-Overland Park
🇺🇸Overland Park, Kansas, United States
Harold Alfond Center for Cancer Care
🇺🇸Augusta, Maine, United States
Bronson Battle Creek
🇺🇸Battle Creek, Michigan, United States
IHA Hematology Oncology Consultants-Brighton
🇺🇸Brighton, Michigan, United States
IHA Hematology Oncology Consultants-Canton
🇺🇸Canton, Michigan, United States
IHA Hematology Oncology Consultants-Chelsea
🇺🇸Chelsea, Michigan, United States
Genesys Hurley Cancer Institute
🇺🇸Flint, Michigan, United States
Hope Cancer Clinic
🇺🇸Livonia, Michigan, United States
Ascension Saint Joseph Hospital
🇺🇸Tawas City, Michigan, United States
IHA Hematology Oncology Consultants-Ann Arbor
🇺🇸Ypsilanti, Michigan, United States
Munson Medical Center
🇺🇸Traverse City, Michigan, United States
Essentia Health - Deer River Clinic
🇺🇸Deer River, Minnesota, United States
University of Mississippi Medical Center
🇺🇸Jackson, Mississippi, United States
Essentia Health Hibbing Clinic
🇺🇸Hibbing, Minnesota, United States
Parkland Health Center - Farmington
🇺🇸Farmington, Missouri, United States
University of Kansas Cancer Center at North Kansas City Hospital
🇺🇸North Kansas City, Missouri, United States
Siteman Cancer Center at Saint Peters Hospital
🇺🇸Saint Peters, Missouri, United States
Sainte Genevieve County Memorial Hospital
🇺🇸Sainte Genevieve, Missouri, United States
Benefis Healthcare- Sletten Cancer Institute
🇺🇸Great Falls, Montana, United States
Bozeman Deaconess Hospital
🇺🇸Bozeman, Montana, United States
Solinsky Center for Cancer Care
🇺🇸Manchester, New Hampshire, United States
Mary Imogene Bassett Hospital
🇺🇸Cooperstown, New York, United States
Cone Health Cancer Center at Alamance Regional
🇺🇸Burlington, North Carolina, United States
Rex Hematology Oncology Associates-Garner
🇺🇸Garner, North Carolina, United States
Rex Cancer Center
🇺🇸Raleigh, North Carolina, United States
Adena Regional Medical Center
🇺🇸Chillicothe, Ohio, United States
Sanford Broadway Medical Center
🇺🇸Fargo, North Dakota, United States
Sanford Roger Maris Cancer Center
🇺🇸Fargo, North Dakota, United States
Strecker Cancer Center-Belpre
🇺🇸Belpre, Ohio, United States
UHHS-Chagrin Highlands Medical Center
🇺🇸Beachwood, Ohio, United States
UH Seidman Cancer Center at Southwest General Hospital
🇺🇸Middleburg Heights, Ohio, United States
Marietta Memorial Hospital
🇺🇸Marietta, Ohio, United States
UH Seidman Cancer Center at Lake Health Mentor Campus
🇺🇸Mentor, Ohio, United States
OhioHealth Marion General Hospital
🇺🇸Marion, Ohio, United States
University Hospitals Portage Medical Center
🇺🇸Ravenna, Ohio, United States
UH Seidman Cancer Center at Saint John Medical Center
🇺🇸Westlake, Ohio, United States
ProMedica Flower Hospital
🇺🇸Sylvania, Ohio, United States
Fox Chase Cancer Center - East Norriton Hospital Outpatient Center
🇺🇸East Norriton, Pennsylvania, United States
Ephrata Cancer Center
🇺🇸Ephrata, Pennsylvania, United States
Cherry Tree Cancer Center
🇺🇸Hanover, Pennsylvania, United States
Thomas Jefferson University Hospital
🇺🇸Philadelphia, Pennsylvania, United States
Prisma Health Cancer Institute - Easley
🇺🇸Easley, South Carolina, United States
Pottstown Hospital
🇺🇸Pottstown, Pennsylvania, United States
UPMC Susquehanna
🇺🇸Williamsport, Pennsylvania, United States
Bon Secours Saint Francis Medical Center
🇺🇸Midlothian, Virginia, United States
Prisma Health Cancer Institute - Greer
🇺🇸Greer, South Carolina, United States
Sanford USD Medical Center - Sioux Falls
🇺🇸Sioux Falls, South Dakota, United States
Prisma Health Cancer Institute - Spartanburg
🇺🇸Spartanburg, South Carolina, United States
Aurora Cancer Care-Grafton
🇺🇸Grafton, Wisconsin, United States
Gundersen Lutheran Medical Center
🇺🇸La Crosse, Wisconsin, United States
Aurora BayCare Medical Center
🇺🇸Green Bay, Wisconsin, United States
Aurora Cancer Care-Racine
🇺🇸Racine, Wisconsin, United States
Froedtert Menomonee Falls Hospital
🇺🇸Menomonee Falls, Wisconsin, United States
Marshfield Clinic - Weston Center
🇺🇸Weston, Wisconsin, United States
Froedtert West Bend Hospital/Kraemer Cancer Center
🇺🇸West Bend, Wisconsin, United States
Sutter Medical Center Sacramento
🇺🇸Sacramento, California, United States
University of California Davis Comprehensive Cancer Center
🇺🇸Sacramento, California, United States
University of Colorado Hospital
🇺🇸Aurora, Colorado, United States
Moffitt Cancer Center
🇺🇸Tampa, Florida, United States
Saint Joseph Mercy Hospital
🇺🇸Ann Arbor, Michigan, United States
University of Kansas Cancer Center - North
🇺🇸Kansas City, Missouri, United States
Ochsner Medical Center Jefferson
🇺🇸New Orleans, Louisiana, United States
Truman Medical Centers
🇺🇸Kansas City, Missouri, United States
Bon Secours Saint Mary's Hospital
🇺🇸Richmond, Virginia, United States
Medical University of South Carolina
🇺🇸Charleston, South Carolina, United States
Medical Oncology and Hematology Associates-Laurel
🇺🇸Des Moines, Iowa, United States
Mercy Medical Center - Des Moines
🇺🇸Des Moines, Iowa, United States
University of Kentucky/Markey Cancer Center
🇺🇸Lexington, Kentucky, United States
University of New Mexico Cancer Center
🇺🇸Albuquerque, New Mexico, United States
New Mexico Oncology Hematology Consultants
🇺🇸Albuquerque, New Mexico, United States
Presbyterian Kaseman Hospital
🇺🇸Albuquerque, New Mexico, United States
Veterans Affairs Connecticut Healthcare System-West Haven Campus
🇺🇸West Haven, Connecticut, United States