MedPath

Testing Whether the Combination of Two Immunotherapy Drugs Have Activity in Recurrent or Persistent Clear Cell Ovarian Cancer

Phase 2
Completed
Conditions
Malignant Ovarian Clear Cell Tumor
Recurrent Ovarian Carcinoma
Interventions
Drug: Epacadostat
Biological: Pembrolizumab
Registration Number
NCT03602586
Lead Sponsor
National Cancer Institute (NCI)
Brief Summary

This phase II trial studies how well pembrolizumab and epacadostat work in treating patients with ovarian clear cell carcinoma that has come back (recurrent), remains despite treatment (persistent), or is growing, spreading, or getting worse (progressive). Immunotherapy with monoclonal antibodies, such as pembrolizumab, may help the body's immune system attack the cancer, and may interfere with the ability of tumor cells to grow and spread. Epacadostat may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Giving pembrolizumab and epacadostat may work better compared to usual treatment (surgery, radiation, or cytotoxic chemotherapy) in treating patients with ovarian clear cell carcinoma.

Detailed Description

PRIMARY OBJECTIVE:

I. To assess the objective tumor response (proportion of objective response by Response Evaluation Criteria in Solid Tumors \[RECIST\] 1.1 criteria) of the combination of pembrolizumab (MK-3475 \[pembrolizumab\]) and epacadostat in patients with recurrent or persistent clear cell carcinoma of the ovary.

SECONDARY OBJECTIVES:

I. To determine the nature and degree of toxicity of MK-3475 (pembrolizumab) + epacadostat as assessed by Common Terminology Criteria for Adverse Events (CTCAE) in patients with recurrent or persistent clear cell carcinoma of the ovary.

II. To estimate the progression-free survival (PFS) and overall survival (OS) in patients treated with combination of MK-3475 (pembrolizumab) and epacadostat.

EXPLORATORY TRANSLATIONAL OBJECTIVES:

I. Determine whether the ratio of plasma tryptophan to kynurenine (T:K) correlates with response to MK-3475 (pembrolizumab) + epacadostat, by evaluating plasma T:K pre-treatment, during treatment, and at disease progression.

II. Determine whether the presence of PD-L1, IDO-1, tumor-infiltrating regulatory T cells (Tregs), CD8 tumor-infiltrating lymphocytes (TILs), and human leukocyte antigen (HLA) class I in the tumor microenvironment at baseline correlates with objective response to MK-3475 (pembrolizumab) + epacadostat.

III. Determine whether soluble PD-L1 (sPD-L1) levels in plasma are correlated with response to MK-3475 (pembrolizumab) + epacadostat, by evaluating sPD-L1 concentrations pre-treatment, during treatment, and at disease progression.

OUTLINE:

Patients receive epacadostat orally (PO) twice daily (BID) and pembrolizumab intravenously (IV) over 30 minutes once every 3 weeks (Q3W). Cycles repeat every 21 days in the absence of disease progression or unacceptable toxicity.

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

Recruitment & Eligibility

Status
COMPLETED
Sex
Female
Target Recruitment
14
Inclusion Criteria
  • Primary tumors must be at least 50% clear cell histomorphology in order to be eligible or have a histologically documented recurrence with at least 50% clear cell histomorphology. Recurrence should be biopsy proven as per standard of care unless the tumor is located in an area deemed unsafe to biopsy. Histologic confirmation of the original primary tumor is required via the pathology report. The percentage of clear cell histomorphology must be documented in the pathology report or in an addendum to the original report. If slides of the primary tumor are not available for review due to disposal of slides by the histology laboratory (typically 10 years after diagnosis), a biopsy of the recurrent or persistent tumor is required to confirm at least 50% clear cell histomorphology, as long as tumor is located in an area deemed safe to biopsy. The percentage of clear cell involvement must be documented in the pathology report or in an addendum to the original report

  • All patents must have measurable disease, and at least one "target lesion" to be used to assess response as defined by RECIST 1.1. Measurable disease is defined as at least one lesion that can be accurately measured in at least one dimension (longest diameter to be recorded). Each lesion must be >= 10 mm when measured by computed tomography (CT), magnetic resonance imaging (MRI) or caliper measurement by clinical exam; or >= 20 mm when measured by chest x-ray. Lymph nodes must be >= 15 mm in short axis when measured by CT or MRI

  • Appropriate stage for study entry based on the following diagnostic workup:

    • History/physical examination within 28 days prior to registration

    • Imaging of target lesions within 28 days prior to registration

    • Further protocol-specific assessments

      • Recovery from adverse effects of recent surgery, radiotherapy or chemotherapy (residual grade 1 toxicity is considered recovered)
      • Any other prior therapy directed at the malignant tumor including chemotherapy, and biologic/targeted agents must be discontinued at least 4 weeks prior to registration. Any hormonal therapy directed at the malignant tumor must be discontinued at least 2 weeks prior to registration
      • Any prior radiation therapy must be completed at least 4 weeks prior to registration, and progression must be outside the radiation field
      • At least 4 weeks must have elapsed since any major surgery prior to registration
  • The trial is open only to women with recurrent or progressive clear cell carcinoma of the ovary

  • Patients must have an Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1 within 28 days prior to registration

  • Patients must have had one prior platinum-based chemotherapy for management of primary disease. Patients are allowed to receive, but are not required to receive, up to two additional cytotoxic regimens for management of recurrent or persistent disease

  • Absolute neutrophil count (ANC) >= 1,500/ul (within 14 days prior to registration)

  • Platelets >= 100,000/ul (within 14 days prior to registration)

  • Hemoglobin (Hgb) >= 8.0 g/dL within 14 days prior to registration (Note: the use of transfusion of other intervention to achieve a Hgb >= 8.0 g/dL is acceptable)

  • Creatinine =< 1.5 x institutional upper limit of normal (ULN) or creatinine clearance (CrCl) >= 60 mL/min using Cockcroft-Gault formula (within 14 days prior to registration)

  • Bilirubin =< 2.5 x ULN (within 14 days prior to registration)

  • Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) =< 2.5 x ULN (within 14 days prior to registration)

  • Normal thyroid function testing (thyroid-stimulating hormone [TSH]) (within 14 days prior to registration)

  • Negative pregnancy test in women of childbearing potential

  • Women of childbearing potential who are sexually active should be willing and able to use medically acceptable forms of contraception for the course of the study through 120 days after the last dose of MK-3475 (pembrolizumab). Women who are not of childbearing potential (i.e., who are postmenopausal or surgically sterile, who have had a hysterectomy and/or bilateral oophorectomy) do not require contraception

  • The patient or a legally authorized representative must provide study-specific informed consent prior to study entry

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Exclusion Criteria
  • Prior invasive malignancy (except non-melanomatous skin cancer) unless disease free for a minimum of 3 years
  • Patients who have had prior therapy with MK-3475 (pembrolizumab) or epacadostat or with an anti-PD-1, anti-PD-L1, anti-PD-L2, anti-CTLA-4 antibody, or any other antibody or drug specifically targeting T-cell co-stimulation or immune check point pathways
  • History of severe hypersensitivity reaction to any monoclonal antibody
  • Patients with active auto-immune disease or history of autoimmune disease that might recur, which may affect vital organ function or require immune suppressive treatment including systemic corticosteroids, should be excluded. These include but are not limited to patients with a history of immune related neurologic disease, multiple sclerosis, autoimmune (demyelinating) neuropathy, Guillain-Barre syndrome, myasthenia gravis; systemic autoimmune disease such as systemic lupus erythematosus (SLE), connective tissue diseases, scleroderma, inflammatory bowel disease, Crohn's, ulcerative colitis, hepatitis; and patients with a history of toxic epidermal necrolysis (TEN), Stevens-Johnson syndrome, or phospholipid syndrome should be excluded because of the risk of recurrence or exacerbation of disease. Patients with vitiligo, endocrine deficiencies including thyroiditis managed with replacement hormones including physiologic corticosteroids are eligible. Patients with rheumatoid arthritis and other arthropathies, Sjogren's syndrome and psoriasis controlled with topical medication and patients with positive serology, such as antinuclear antibodies (ANA), anti-thyroid antibodies should be evaluated for the presence of target organ involvement and potential need for systemic treatment but should otherwise be eligible
  • Patients with uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure and unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements
  • Patients with history or evidence upon physical examination of central nervous system (CNS) disease, including primary brain tumor, seizures which are not controlled with non-enzyme inducing anticonvulsants, and/or epidural disease, or history of cerebrovascular accident (CVA, stroke), transient ischemic attack (TIA) or subarachnoid hemorrhage within six months prior to the first date of study treatment. Those with brain metastases are permitted as long as they have been treated with brain radiation therapy and have been documented stability 4 weeks following completion of brain radiation therapy
  • In order for patients with human immunodeficiency virus (HIV) or known acquired immunodeficiency syndrome (AIDS) to be eligible, they must be on a stable highly active antiretroviral therapy (HAART) regimen with no drug-drug interaction with UGT1A9, have CD4+ counts > 350, with no detectable viral load on quantitative polymerase chain reaction (PCR), and no opportunistic infection
  • Patients with treated hepatitis viral infections (hepatitis B and C) are eligible if they have completed definitive treatment at least 6 months prior, have no detectable viral load on quantitative PCR, and liver function tests (LFTs) meet eligibility requirements
  • Patients with a condition requiring systemic treatment with either corticosteroids (> 10 mg daily prednisone equivalents) or other immunosuppressive medications within 14 days of study drug administration
  • Therapy with monoamine oxidase inhibitors (MAOIs) and selective serotonin reuptake inhibitor (SSRIs) within the last 4 weeks or history of serotonin syndrome. Concomitant use of monoamine oxidase inhibitors or SSRIs with epacadostat (INCB024360) is prohibited
  • Patients who have had evidence of active or acute diverticulitis, intra-abdominal abscess, abdominal/pelvic fistula, gastrointestinal perforation, gastrointestinal (GI) obstruction and/or who require parenteral hydration and/or nutrition
  • Epacadostat (INCB024360) is a substrate of CYP3A4, CYP1A2, CYP2C19, UGT1A9, P-gp, and BCRP. Use caution when administered with strong inhibitors/inducers of these isoenzymes and transporter proteins. Because the lists of these agents are constantly changing, it is important to regularly consult a frequently-updated medical reference
  • History or presence of an abnormal electrocardiography (ECG) that, in the investigator's opinion, is clinically meaningful. Screening QTc interval > 480 milliseconds is excluded (corrected by Fridericia). In the event that a single QTc is > 480 milliseconds, the subject may enroll if the average QTc for the 3 ECGs is < 480 milliseconds. For subjects with an intraventricular conduction delay (QRS interval > 120 msec), the JTc interval may be used in place of the QTc with sponsor approval. The JTc must be < 340 milliseconds if JTc is used in place of QTc. Subjects with left bundle branch block are excluded
  • Patients who are pregnant or nursing
Read More

Study & Design

Study Type
INTERVENTIONAL
Study Design
SINGLE_GROUP
Arm && Interventions
GroupInterventionDescription
Treatment (epacadostat, pembrolizumab)PembrolizumabPatients receive epacadostat PO BID and pembrolizumab IV over 30 minutes Q3W. Cycles repeat every 21 days in the absence of disease progression or unacceptable toxicity.
Treatment (epacadostat, pembrolizumab)EpacadostatPatients receive epacadostat PO BID and pembrolizumab IV over 30 minutes Q3W. Cycles repeat every 21 days in the absence of disease progression or unacceptable toxicity.
Primary Outcome Measures
NameTimeMethod
Complete or Partial Objective Tumor ResponseWithin 7 months of study entry

Assessed by Response Evaluation Criteria in Solid Tumors (RECIST) version (v.) 1.1 criteria. Exact 95% confidence limits, accounting for interim analysis, will be provided in the final report. Per Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.1) for target lesions and assessed by MRI: Complete Response (CR), Disappearance of all target lesions; Partial Response (PR), \>=20% decrease in the sum of the longest diameter of target lesions and a 5 mm absolute increase; Overall Response (OR) = CR + PR.

Secondary Outcome Measures
NameTimeMethod
Overall Survival (OS)Overall survival (OS) is defined as the duration of time from the start of study treatment to time of death or the date of last contact. The median follow-up time for OS was 34.9 months.

Assessment of deaths starting from the time of enrollment.

Number of Participants With Adverse Events of Grade 3 or HigherAdverse events were assessed from the start of treatment until 30 days after the end of the last treatment cycle. Adverse events were collected for a median time of 5.1 months and a maximum time of 23.8 months.

Assessed using Common Terminology Criteria for Adverse Events (CTCAE) version 5. Number of participants with an adverse event of grade 3 or higher.

Progression-free Survival (PFS)Radiographic tumor assessments were completed 12 weeks after the start of treatment, then every 6 weeks for 49 weeks, followed by every 12 weeks until disease progression or treatment discontinuation. The median follow-up time was 4.8 months.

Disease progression will be defined using RECIST v. 1.1 criteria. The distributions of PFS will be estimated and graphed using the Kaplan-Meier product limit method. Per Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.1) for target lesions and assessed by MRI: Complete Response (CR), Disappearance of all target lesions; Partial Response (PR), \>=20% decrease in the sum of the longest diameter of target lesions and a 5 mm absolute increase; Overall Response (OR) = CR + PR." Progression-free survival (PFS) is defined as the duration of time from the start of study treatment to time of progression or death, whichever occurs first.

Trial Locations

Locations (363)

Columbus Oncology and Hematology Associates Inc

🇺🇸

Columbus, Ohio, United States

Riverside Methodist Hospital

🇺🇸

Columbus, Ohio, United States

Grant Medical Center

🇺🇸

Columbus, Ohio, United States

The Mark H Zangmeister Center

🇺🇸

Columbus, Ohio, United States

Case Western Reserve University

🇺🇸

Cleveland, Ohio, United States

Anchorage Associates in Radiation Medicine

🇺🇸

Anchorage, Alaska, United States

Anchorage Radiation Therapy Center

🇺🇸

Anchorage, Alaska, United States

Alaska Oncology and Hematology LLC

🇺🇸

Anchorage, Alaska, United States

Saint Luke's Cancer Institute - Twin Falls

🇺🇸

Twin Falls, Idaho, United States

Walter Knox Memorial Hospital

🇺🇸

Emmett, Idaho, United States

Saint Luke's Cancer Institute - Boise

🇺🇸

Boise, Idaho, United States

Saint Luke's Cancer Institute - Fruitland

🇺🇸

Fruitland, Idaho, United States

Idaho Urologic Institute-Meridian

🇺🇸

Meridian, Idaho, United States

Saint Luke's Cancer Institute - Meridian

🇺🇸

Meridian, Idaho, United States

Renown Regional Medical Center

🇺🇸

Reno, Nevada, United States

CHI Health Good Samaritan

🇺🇸

Kearney, Nebraska, United States

Benefis Sletten Cancer Institute

🇺🇸

Great Falls, Montana, United States

Saint Charles Health System

🇺🇸

Bend, Oregon, United States

Saint Alphonsus Cancer Care Center-Ontario

🇺🇸

Ontario, Oregon, United States

Providence Newberg Medical Center

🇺🇸

Newberg, Oregon, United States

Pulmonary Medicine Center of Chattanooga-Hixson

🇺🇸

Hixson, Tennessee, United States

Memorial Hospital

🇺🇸

Chattanooga, Tennessee, United States

Saint Charles Health System-Redmond

🇺🇸

Redmond, Oregon, United States

Aurora Bay Area Medical Group-Marinette

🇺🇸

Marinette, Wisconsin, United States

ProHealth Oconomowoc Memorial Hospital

🇺🇸

Oconomowoc, Wisconsin, United States

Vince Lombardi Cancer Clinic-Sheboygan

🇺🇸

Sheboygan, Wisconsin, United States

Aurora Medical Center in Summit

🇺🇸

Summit, Wisconsin, United States

Aurora Cancer Care-Milwaukee West

🇺🇸

Wauwatosa, Wisconsin, United States

ProHealth Waukesha Memorial Hospital

🇺🇸

Waukesha, Wisconsin, United States

Advance Oncology Center

🇵🇷

Aguadilla, Puerto Rico

Doctor's Cancer Center-Arecibo

🇵🇷

Arecibo, Puerto Rico

Doctors Cancer Center

🇵🇷

Manati, Puerto Rico

Instituto Oncologia Moderna Ponce

🇵🇷

Ponce, Puerto Rico

San Juan Community Oncology Group

🇵🇷

San Juan, Puerto Rico

Centro de Hematologia y Oncologia del Sur

🇵🇷

Santa Isabel, Puerto Rico

UM Sylvester Comprehensive Cancer Center at Kendall

🇺🇸

Miami, Florida, United States

Desert West Surgery

🇺🇸

Las Vegas, Nevada, United States

OptumCare Cancer Care at Charleston

🇺🇸

Las Vegas, Nevada, United States

University Medical Center of Southern Nevada

🇺🇸

Las Vegas, Nevada, United States

Hope Cancer Care of Nevada

🇺🇸

Las Vegas, Nevada, United States

Radiation Oncology Centers of Nevada Central

🇺🇸

Las Vegas, Nevada, United States

Women's Cancer Center of Nevada

🇺🇸

Las Vegas, Nevada, United States

Ann M Wierman MD LTD

🇺🇸

Las Vegas, Nevada, United States

GenesisCare USA - Vegas Tenaya

🇺🇸

Las Vegas, Nevada, United States

HealthCare Partners Medical Group Oncology/Hematology-Tenaya

🇺🇸

Las Vegas, Nevada, United States

OptumCare Cancer Care at MountainView

🇺🇸

Las Vegas, Nevada, United States

Comprehensive Cancer Centers of Nevada - Town Center

🇺🇸

Las Vegas, Nevada, United States

Las Vegas Cancer Center-Medical Center

🇺🇸

Las Vegas, Nevada, United States

Comprehensive Cancer Centers of Nevada

🇺🇸

Las Vegas, Nevada, United States

GenesisCare USA - Fort Apache

🇺🇸

Las Vegas, Nevada, United States

OptumCare Cancer Care at Fort Apache

🇺🇸

Las Vegas, Nevada, United States

Comprehensive Cancer Centers of Nevada - Central Valley

🇺🇸

Las Vegas, Nevada, United States

University Cancer Center

🇺🇸

Las Vegas, Nevada, United States

TriHealth Cancer Institute-Westside

🇺🇸

Cincinnati, Ohio, United States

Anchorage Oncology Centre

🇺🇸

Anchorage, Alaska, United States

Katmai Oncology Group

🇺🇸

Anchorage, Alaska, United States

University of Arkansas for Medical Sciences

🇺🇸

Little Rock, Arkansas, United States

Providence Alaska Medical Center

🇺🇸

Anchorage, Alaska, United States

PCR Oncology

🇺🇸

Arroyo Grande, California, United States

CHI Saint Vincent Cancer Center Hot Springs

🇺🇸

Hot Springs, Arkansas, United States

Alaska Breast Care and Surgery LLC

🇺🇸

Anchorage, Alaska, United States

Alaska Women's Cancer Care

🇺🇸

Anchorage, Alaska, United States

Pali Momi Medical Center

🇺🇸

'Aiea, Hawaii, United States

Queen's Cancer Center - Pearlridge

🇺🇸

'Aiea, Hawaii, United States

UM Sylvester Comprehensive Cancer Center at Plantation

🇺🇸

Plantation, Florida, United States

Ascension Saint Vincent Indianapolis Hospital

🇺🇸

Indianapolis, Indiana, United States

UC Comprehensive Cancer Center at Silver Cross

🇺🇸

New Lenox, Illinois, United States

Rush-Copley Healthcare Center

🇺🇸

Yorkville, Illinois, United States

University of Chicago Medicine-Orland Park

🇺🇸

Orland Park, Illinois, United States

The Carle Foundation Hospital

🇺🇸

Urbana, Illinois, United States

Jewish Hospital Medical Center South

🇺🇸

Shepherdsville, Kentucky, United States

Trinity Regional Medical Center

🇺🇸

Fort Dodge, Iowa, United States

MetroHealth Medical Center

🇺🇸

Cleveland, Ohio, United States

Strecker Cancer Center-Belpre

🇺🇸

Belpre, Ohio, United States

Radiation Oncology Associates

🇺🇸

Reno, Nevada, United States

Geauga Hospital

🇺🇸

Chardon, Ohio, United States

Saint Alphonsus Cancer Care Center-Baker City

🇺🇸

Baker City, Oregon, United States

Presbyterian Rust Medical Center/Jorgensen Cancer Center

🇺🇸

Rio Rancho, New Mexico, United States

Providence Cancer Institute Clackamas Clinic

🇺🇸

Clackamas, Oregon, United States

Dickstein Cancer Treatment Center

🇺🇸

White Plains, New York, United States

Saint Mary's Regional Medical Center

🇺🇸

Reno, Nevada, United States

Delaware Health Center-Grady Cancer Center

🇺🇸

Delaware, Ohio, United States

Cleveland Clinic Foundation

🇺🇸

Cleveland, Ohio, United States

Bethesda North Hospital

🇺🇸

Cincinnati, Ohio, United States

TriHealth Cancer Institute-Anderson

🇺🇸

Cincinnati, Ohio, United States

Delaware Radiation Oncology

🇺🇸

Delaware, Ohio, United States

Adena Regional Medical Center

🇺🇸

Chillicothe, Ohio, United States

Dartmouth Hitchcock Medical Center/Dartmouth Cancer Center

🇺🇸

Lebanon, New Hampshire, United States

Ohio State University Comprehensive Cancer Center

🇺🇸

Columbus, Ohio, United States

Cleveland Clinic Cancer Center/Fairview Hospital

🇺🇸

Cleveland, Ohio, United States

Memorial GYN Plus

🇺🇸

Ooltewah, Tennessee, United States

Marietta Memorial Hospital

🇺🇸

Marietta, Ohio, United States

Knox Community Hospital

🇺🇸

Mount Vernon, Ohio, United States

UH Seidman Cancer Center at Lake Health Mentor Campus

🇺🇸

Mentor, Ohio, United States

Licking Memorial Hospital

🇺🇸

Newark, Ohio, United States

Clackamas Radiation Oncology Center

🇺🇸

Clackamas, Oregon, United States

Swedish Medical Center-Cherry Hill

🇺🇸

Seattle, Washington, United States

Harrison HealthPartners Hematology and Oncology-Poulsbo

🇺🇸

Poulsbo, Washington, United States

Bay Area Hospital

🇺🇸

Coos Bay, Oregon, United States

Aurora Cancer Care-Southern Lakes VLCC

🇺🇸

Burlington, Wisconsin, United States

University of Virginia Cancer Center

🇺🇸

Charlottesville, Virginia, United States

Avera Cancer Institute

🇺🇸

Sioux Falls, South Dakota, United States

Vince Lombardi Cancer Clinic - Oshkosh

🇺🇸

Oshkosh, Wisconsin, United States

Saint Francis Hospital

🇺🇸

Federal Way, Washington, United States

ProHealth D N Greenwald Center

🇺🇸

Mukwonago, Wisconsin, United States

Aurora Health Care Germantown Health Center

🇺🇸

Germantown, Wisconsin, United States

Aurora Cancer Care-Racine

🇺🇸

Racine, Wisconsin, United States

Cancer Center of Western Wisconsin

🇺🇸

New Richmond, Wisconsin, United States

Kadlec Clinic Hematology and Oncology

🇺🇸

Kennewick, Washington, United States

PeaceHealth United General Medical Center

🇺🇸

Sedro-Woolley, Washington, United States

Swedish Medical Center-Ballard Campus

🇺🇸

Seattle, Washington, United States

PeaceHealth Southwest Medical Center

🇺🇸

Vancouver, Washington, United States

Providence Saint Mary Regional Cancer Center

🇺🇸

Walla Walla, Washington, United States

Aurora Cancer Care-Grafton

🇺🇸

Grafton, Wisconsin, United States

Aurora BayCare Medical Center

🇺🇸

Green Bay, Wisconsin, United States

Swedish Cancer Institute-Edmonds

🇺🇸

Edmonds, Washington, United States

Providence Regional Cancer System-Yelm

🇺🇸

Yelm, Washington, United States

Pacific Gynecology Specialists

🇺🇸

Seattle, Washington, United States

Franciscan Research Center-Northwest Medical Plaza

🇺🇸

Tacoma, Washington, United States

Providence Regional Cancer System-Shelton

🇺🇸

Shelton, Washington, United States

Aurora Cancer Care-Kenosha South

🇺🇸

Kenosha, Wisconsin, United States

Vince Lombardi Cancer Clinic-Two Rivers

🇺🇸

Two Rivers, Wisconsin, United States

UW Cancer Center at ProHealth Care

🇺🇸

Waukesha, Wisconsin, United States

Hematologia Oncologia San Pablo

🇵🇷

Bayamon, Puerto Rico

HIMA San Pablo Oncologic Hospital

🇵🇷

Caguas, Puerto Rico

San Juan City Hospital

🇵🇷

San Juan, Puerto Rico

Methodist West Hospital

🇺🇸

West Des Moines, Iowa, United States

Mercy Cancer Center-West Lakes

🇺🇸

Clive, Iowa, United States

Alegent Health Mercy Hospital

🇺🇸

Council Bluffs, Iowa, United States

Greater Regional Medical Center

🇺🇸

Creston, Iowa, United States

Cox Cancer Center Branson

🇺🇸

Branson, Missouri, United States

UHHS-Chagrin Highlands Medical Center

🇺🇸

Beachwood, Ohio, United States

Good Samaritan Hospital - Cincinnati

🇺🇸

Cincinnati, Ohio, United States

Mount Carmel East Hospital

🇺🇸

Columbus, Ohio, United States

Mount Carmel Health Center West

🇺🇸

Columbus, Ohio, United States

Doctors Hospital

🇺🇸

Columbus, Ohio, United States

Grady Memorial Hospital

🇺🇸

Delaware, Ohio, United States

Fairfield Medical Center

🇺🇸

Lancaster, Ohio, United States

Hillcrest Hospital Cancer Center

🇺🇸

Mayfield Heights, Ohio, United States

OhioHealth Mansfield Hospital

🇺🇸

Mansfield, Ohio, United States

OhioHealth Marion General Hospital

🇺🇸

Marion, Ohio, United States

ProMedica Toledo Hospital/Russell J Ebeid Children's Hospital

🇺🇸

Toledo, Ohio, United States

ProMedica Flower Hospital

🇺🇸

Sylvania, Ohio, United States

Saint Ann's Hospital

🇺🇸

Westerville, Ohio, United States

Genesis Healthcare System Cancer Care Center

🇺🇸

Zanesville, Ohio, United States

Southern Ohio Medical Center

🇺🇸

Portsmouth, Ohio, United States

UHHS-Westlake Medical Center

🇺🇸

Westlake, Ohio, United States

University Hospitals Sharon Health Center

🇺🇸

Wadsworth, Ohio, United States

University Hospitals Portage Medical Center

🇺🇸

Ravenna, Ohio, United States

Newark Radiation Oncology

🇺🇸

Newark, Ohio, United States

Women and Infants Hospital

🇺🇸

Providence, Rhode Island, United States

Asplundh Cancer Pavilion

🇺🇸

Willow Grove, Pennsylvania, United States

Oklahoma Cancer Specialists and Research Institute-Tulsa

🇺🇸

Tulsa, Oklahoma, United States

M D Anderson Cancer Center

🇺🇸

Houston, Texas, United States

PeaceHealth Saint Joseph Medical Center

🇺🇸

Bellingham, Washington, United States

Harrison HealthPartners Hematology and Oncology-Bremerton

🇺🇸

Bremerton, Washington, United States

Saint Joseph Regional Cancer Center

🇺🇸

Bryan, Texas, United States

Providence Regional Cancer System-Aberdeen

🇺🇸

Aberdeen, Washington, United States

Providence Regional Cancer Partnership

🇺🇸

Everett, Washington, United States

Highline Medical Center-Main Campus

🇺🇸

Burien, Washington, United States

Saint Elizabeth Hospital

🇺🇸

Enumclaw, Washington, United States

Kaiser Permanente Washington

🇺🇸

Seattle, Washington, United States

Providence Regional Cancer System-Lacey

🇺🇸

Lacey, Washington, United States

Saint Clare Hospital

🇺🇸

Lakewood, Washington, United States

PeaceHealth Saint John Medical Center

🇺🇸

Longview, Washington, United States

Swedish Medical Center-First Hill

🇺🇸

Seattle, Washington, United States

Northwest Medical Specialties PLLC

🇺🇸

Tacoma, Washington, United States

Saint Michael Cancer Center

🇺🇸

Silverdale, Washington, United States

Mercy Hospital

🇺🇸

Coon Rapids, Minnesota, United States

Minnesota Oncology Hematology PA-Maplewood

🇺🇸

Maplewood, Minnesota, United States

Saint John's Hospital - Healtheast

🇺🇸

Maplewood, Minnesota, United States

Mountain Blue Cancer Care Center

🇺🇸

Golden, Colorado, United States

National Jewish Health-Western Hematology Oncology

🇺🇸

Golden, Colorado, United States

Rice Memorial Hospital

🇺🇸

Willmar, Minnesota, United States

Ascension Via Christi - Pittsburg

🇺🇸

Pittsburg, Kansas, United States

Penrose-Saint Francis Healthcare

🇺🇸

Colorado Springs, Colorado, United States

Boulder Community Hospital

🇺🇸

Boulder, Colorado, United States

Health Partners Inc

🇺🇸

Minneapolis, Minnesota, United States

Rocky Mountain Cancer Centers-Penrose

🇺🇸

Colorado Springs, Colorado, United States

Minnesota Oncology Hematology PA-Woodbury

🇺🇸

Woodbury, Minnesota, United States

Mercy Medical Center

🇺🇸

Durango, Colorado, United States

Rocky Mountain Cancer Centers-Sky Ridge

🇺🇸

Lone Tree, Colorado, United States

Banner North Colorado Medical Center

🇺🇸

Greeley, Colorado, United States

Welch Cancer Center

🇺🇸

Sheridan, Wyoming, United States

Billings Clinic-Cody

🇺🇸

Cody, Wyoming, United States

Good Samaritan Medical Center

🇺🇸

Lafayette, Colorado, United States

Monticello Cancer Center

🇺🇸

Monticello, Minnesota, United States

Coffeyville Regional Medical Center

🇺🇸

Coffeyville, Kansas, United States

Hennepin County Medical Center

🇺🇸

Minneapolis, Minnesota, United States

Regions Hospital

🇺🇸

Saint Paul, Minnesota, United States

Mountain Blue Cancer Care Center - Swedish

🇺🇸

Englewood, Colorado, United States

Longmont United Hospital

🇺🇸

Longmont, Colorado, United States

Park Nicollet Clinic - Saint Louis Park

🇺🇸

Saint Louis Park, Minnesota, United States

Saint Mary Corwin Medical Center

🇺🇸

Pueblo, Colorado, United States

Rocky Mountain Cancer Centers-Littleton

🇺🇸

Littleton, Colorado, United States

Littleton Adventist Hospital

🇺🇸

Littleton, Colorado, United States

Salina Regional Health Center

🇺🇸

Salina, Kansas, United States

Saint Mary's Hospital and Regional Medical Center

🇺🇸

Grand Junction, Colorado, United States

Banner McKee Medical Center

🇺🇸

Loveland, Colorado, United States

Parker Adventist Hospital

🇺🇸

Parker, Colorado, United States

Rocky Mountain Cancer Centers-Parker

🇺🇸

Parker, Colorado, United States

SCL Health Lutheran Medical Center

🇺🇸

Wheat Ridge, Colorado, United States

Lakeview Hospital

🇺🇸

Stillwater, Minnesota, United States

Southwest Oncology PC

🇺🇸

Durango, Colorado, United States

Sky Ridge Medical Center

🇺🇸

Lone Tree, Colorado, United States

Swedish Medical Center

🇺🇸

Englewood, Colorado, United States

University of Kansas Hospital-Westwood Cancer Center

🇺🇸

Westwood, Kansas, United States

Fairview Southdale Hospital

🇺🇸

Edina, Minnesota, United States

Rocky Mountain Cancer Centers-Lakewood

🇺🇸

Lakewood, Colorado, United States

Fairview Ridges Hospital

🇺🇸

Burnsville, Minnesota, United States

New Ulm Medical Center

🇺🇸

New Ulm, Minnesota, United States

Fairview Clinics and Surgery Center Maple Grove

🇺🇸

Maple Grove, Minnesota, United States

Olathe Health Cancer Center

🇺🇸

Olathe, Kansas, United States

Abbott-Northwestern Hospital

🇺🇸

Minneapolis, Minnesota, United States

Rocky Mountain Cancer Centers - Pueblo

🇺🇸

Pueblo, Colorado, United States

University of Kansas Health System Saint Francis Campus

🇺🇸

Topeka, Kansas, United States

Ridgeview Medical Center

🇺🇸

Waconia, Minnesota, United States

Saint Francis Regional Medical Center

🇺🇸

Shakopee, Minnesota, United States

HaysMed

🇺🇸

Hays, Kansas, United States

Cheyenne Regional Medical Center-West

🇺🇸

Cheyenne, Wyoming, United States

Hawaii Cancer Care - Westridge

🇺🇸

'Aiea, Hawaii, United States

The Cancer Center of Hawaii-Pali Momi

🇺🇸

'Aiea, Hawaii, United States

Wilcox Memorial Hospital and Kauai Medical Clinic

🇺🇸

Lihue, Hawaii, United States

Fairview Lakes Medical Center

🇺🇸

Wyoming, Minnesota, United States

United Hospital

🇺🇸

Saint Paul, Minnesota, United States

University of Oklahoma Health Sciences Center

🇺🇸

Oklahoma City, Oklahoma, United States

Mercy Hospital Oklahoma City

🇺🇸

Oklahoma City, Oklahoma, United States

Saint Patrick Hospital - Community Hospital

🇺🇸

Missoula, Montana, United States

CoxHealth South Hospital

🇺🇸

Springfield, Missouri, United States

Great Falls Clinic

🇺🇸

Great Falls, Montana, United States

National Jewish Health-Main Campus

🇺🇸

Denver, Colorado, United States

The Women's Imaging Center

🇺🇸

Denver, Colorado, United States

Presbyterian - Saint Lukes Medical Center - Health One

🇺🇸

Denver, Colorado, United States

Porter Adventist Hospital

🇺🇸

Denver, Colorado, United States

Rocky Mountain Cancer Centers-Midtown

🇺🇸

Denver, Colorado, United States

Colorado Blood Cancer Institute

🇺🇸

Denver, Colorado, United States

SCL Health Saint Joseph Hospital

🇺🇸

Denver, Colorado, United States

Rocky Mountain Cancer Centers-Rose

🇺🇸

Denver, Colorado, United States

Rose Medical Center

🇺🇸

Denver, Colorado, United States

Western Surgical Care

🇺🇸

Denver, Colorado, United States

Providence Portland Medical Center

🇺🇸

Portland, Oregon, United States

Providence Saint Vincent Medical Center

🇺🇸

Portland, Oregon, United States

Cancer and Blood Specialists-Henderson

🇺🇸

Henderson, Nevada, United States

Rocky Mountain Cancer Centers-Aurora

🇺🇸

Aurora, Colorado, United States

The Medical Center of Aurora

🇺🇸

Aurora, Colorado, United States

Mayo Clinic in Rochester

🇺🇸

Rochester, Minnesota, United States

Alegent Health Bergan Mercy Medical Center

🇺🇸

Omaha, Nebraska, United States

Creighton University Medical Center

🇺🇸

Omaha, Nebraska, 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

Rocky Mountain Cancer Centers-Longmont

🇺🇸

Longmont, Colorado, United States

National Jewish Health-Northern Hematology Oncology

🇺🇸

Thornton, Colorado, United States

Rocky Mountain Cancer Centers-Thornton

🇺🇸

Thornton, Colorado, United States

Providence Saint Joseph Medical Center/Disney Family Cancer Center

🇺🇸

Burbank, California, United States

Rocky Mountain Cancer Centers-Boulder

🇺🇸

Boulder, Colorado, United States

Saint Anthony Hospital

🇺🇸

Lakewood, Colorado, United States

UM Sylvester Comprehensive Cancer Center at Coral Gables

🇺🇸

Coral Gables, Florida, United States

Sacred Heart Hospital

🇺🇸

Pensacola, Florida, United States

Augusta University Medical Center

🇺🇸

Augusta, Georgia, United States

Saint Alphonsus Cancer Care Center-Caldwell

🇺🇸

Caldwell, Idaho, United States

Saint Alphonsus Cancer Care Center-Boise

🇺🇸

Boise, Idaho, United States

Kootenai Health - Coeur d'Alene

🇺🇸

Coeur d'Alene, Idaho, United States

Saint Luke's Cancer Institute - Nampa

🇺🇸

Nampa, Idaho, United States

Saint Alphonsus Cancer Care Center-Nampa

🇺🇸

Nampa, Idaho, United States

Kootenai Clinic Cancer Services - Post Falls

🇺🇸

Post Falls, Idaho, United States

Kootenai Clinic Cancer Services - Sandpoint

🇺🇸

Sandpoint, Idaho, United States

University of Chicago Comprehensive Cancer Center

🇺🇸

Chicago, Illinois, United States

Rush - Copley Medical Center

🇺🇸

Aurora, Illinois, United States

Carle Physician Group-Effingham

🇺🇸

Effingham, Illinois, United States

Carle Physician Group-Mattoon/Charleston

🇺🇸

Mattoon, Illinois, United States

Good Samaritan Regional Health Center

🇺🇸

Mount Vernon, Illinois, United States

Carle at The Riverfront

🇺🇸

Danville, Illinois, United States

Sudarshan K Sharma MD Limited-Gynecologic Oncology

🇺🇸

Hinsdale, Illinois, United States

Carle Cancer Center

🇺🇸

Urbana, Illinois, United States

Mission Cancer and Blood - West Des Moines

🇺🇸

Clive, Iowa, United States

University of Iowa/Holden Comprehensive Cancer Center

🇺🇸

Iowa City, Iowa, United States

Mercy Medical Center-West Lakes

🇺🇸

West Des Moines, Iowa, United States

Flaget Memorial Hospital

🇺🇸

Bardstown, Kentucky, United States

Commonwealth Cancer Center-Corbin

🇺🇸

Corbin, Kentucky, United States

Saint Joseph London

🇺🇸

London, Kentucky, United States

Johns Hopkins University/Sidney Kimmel Cancer Center

🇺🇸

Baltimore, Maryland, United States

Huron Medical Center PC

🇺🇸

Port Huron, Michigan, United States

Lake Huron Medical Center

🇺🇸

Port Huron, Michigan, United States

Saint Louis Cancer and Breast Institute-Ballwin

🇺🇸

Ballwin, Missouri, United States

Mercy Hospital Joplin

🇺🇸

Joplin, Missouri, United States

Freeman Health System

🇺🇸

Joplin, Missouri, United States

Delbert Day Cancer Institute at PCRMC

🇺🇸

Rolla, Missouri, United States

Mercy Clinic-Rolla-Cancer and Hematology

🇺🇸

Rolla, Missouri, United States

Heartland Regional Medical Center

🇺🇸

Saint Joseph, Missouri, United States

Saint Louis Cancer and Breast Institute-South City

🇺🇸

Saint Louis, Missouri, United States

Mercy Hospital South

🇺🇸

Saint Louis, Missouri, United States

Mercy Hospital Saint Louis

🇺🇸

Saint Louis, Missouri, United States

Community Hospital of Anaconda

🇺🇸

Anaconda, Montana, United States

Mercy Hospital Washington

🇺🇸

Washington, Missouri, United States

Mercy Hospital Springfield

🇺🇸

Springfield, Missouri, United States

Billings Clinic Cancer Center

🇺🇸

Billings, Montana, United States

Saint Vincent Healthcare

🇺🇸

Billings, Montana, United States

Saint Vincent Frontier Cancer Center

🇺🇸

Billings, Montana, United States

Bozeman Health Deaconess Hospital

🇺🇸

Bozeman, Montana, United States

Saint James Community Hospital and Cancer Treatment Center

🇺🇸

Butte, Montana, United States

Kalispell Regional Medical Center

🇺🇸

Kalispell, Montana, United States

Saint Peter's Community Hospital

🇺🇸

Helena, Montana, United States

Nebraska Cancer Specialists/Oncology Hematology West PC

🇺🇸

Grand Island, Nebraska, United States

Heartland Hematology and Oncology

🇺🇸

Kearney, Nebraska, United States

Community Medical Center

🇺🇸

Missoula, Montana, United States

Saint Elizabeth Regional Medical Center

🇺🇸

Lincoln, Nebraska, United States

Nebraska Methodist Hospital

🇺🇸

Omaha, Nebraska, United States

Alegent Health Immanuel Medical Center

🇺🇸

Omaha, Nebraska, United States

Alegent Health Lakeside Hospital

🇺🇸

Omaha, Nebraska, United States

Hematology and Oncology Consultants PC

🇺🇸

Omaha, Nebraska, United States

Midlands Community Hospital

🇺🇸

Papillion, Nebraska, United States

Carson Tahoe Regional Medical Center

🇺🇸

Carson City, Nevada, United States

Comprehensive Cancer Centers of Nevada-Horizon Ridge

🇺🇸

Henderson, Nevada, United States

Comprehensive Cancer Centers of Nevada - Henderson

🇺🇸

Henderson, Nevada, United States

Las Vegas Cancer Center-Henderson

🇺🇸

Henderson, Nevada, United States

OptumCare Cancer Care at Seven Hills

🇺🇸

Henderson, Nevada, United States

Comprehensive Cancer Centers of Nevada-Southeast Henderson

🇺🇸

Henderson, Nevada, United States

GenesisCare USA - Henderson

🇺🇸

Henderson, Nevada, United States

Cancer and Blood Specialists-Shadow

🇺🇸

Las Vegas, Nevada, United States

HealthCare Partners Medical Group Oncology/Hematology-Maryland Parkway

🇺🇸

Las Vegas, Nevada, United States

GenesisCare USA - Las Vegas

🇺🇸

Las Vegas, Nevada, United States

HealthCare Partners Medical Group Oncology/Hematology-San Martin

🇺🇸

Las Vegas, Nevada, United States

Cancer and Blood Specialists-Tenaya

🇺🇸

Las Vegas, Nevada, United States

Radiation Oncology Centers of Nevada Southeast

🇺🇸

Las Vegas, Nevada, United States

Comprehensive Cancer Centers of Nevada - Northwest

🇺🇸

Las Vegas, Nevada, United States

Comprehensive Cancer Centers of Nevada-Summerlin

🇺🇸

Las Vegas, Nevada, United States

Summerlin Hospital Medical Center

🇺🇸

Las Vegas, Nevada, United States

HealthCare Partners Medical Group Oncology/Hematology-Centennial Hills

🇺🇸

Las Vegas, Nevada, United States

Hope Cancer Care of Nevada-Pahrump

🇺🇸

Pahrump, Nevada, United States

Aurora West Allis Medical Center

🇺🇸

West Allis, Wisconsin, United States

Cancer Center-Metro Medical Center Bayamon

🇵🇷

Bayamon, Puerto Rico

Centro Comprensivo de Cancer de UPR

🇵🇷

San Juan, Puerto Rico

Primary Care Physician Group

🇵🇷

San Juan, Puerto Rico

Island Urology

🇺🇸

Honolulu, Hawaii, United States

Queen's Medical Center

🇺🇸

Honolulu, Hawaii, United States

UofL Health Medical Center Northeast

🇺🇸

Louisville, Kentucky, United States

Jewish Hospital

🇺🇸

Louisville, Kentucky, United States

Saints Mary and Elizabeth Hospital

🇺🇸

Louisville, Kentucky, United States

University Health Truman Medical Center

🇺🇸

Kansas City, Missouri, United States

University of Hawaii Cancer Center

🇺🇸

Honolulu, Hawaii, United States

Mercy Medical Center - Des Moines

🇺🇸

Des Moines, Iowa, United States

Queen's Cancer Cenrer - POB I

🇺🇸

Honolulu, Hawaii, United States

Kuakini Medical Center

🇺🇸

Honolulu, Hawaii, United States

Queen's Cancer Center - Kuakini

🇺🇸

Honolulu, Hawaii, United States

Iowa Methodist Medical Center

🇺🇸

Des Moines, Iowa, United States

Broadlawns Medical Center

🇺🇸

Des Moines, Iowa, United States

Mission Cancer and Blood - Laurel

🇺🇸

Des Moines, Iowa, United States

The Cancer Center of Hawaii-Liliha

🇺🇸

Honolulu, Hawaii, United States

Mission Cancer and Blood - Des Moines

🇺🇸

Des Moines, Iowa, United States

Iowa Lutheran Hospital

🇺🇸

Des Moines, Iowa, United States

Hawaii Cancer Care Inc - Waterfront Plaza

🇺🇸

Honolulu, Hawaii, United States

Straub Clinic and Hospital

🇺🇸

Honolulu, Hawaii, United States

Hawaii Cancer Care Inc-Liliha

🇺🇸

Honolulu, Hawaii, United States

Kapiolani Medical Center for Women and Children

🇺🇸

Honolulu, Hawaii, United States

Saint Joseph Radiation Oncology Resource Center

🇺🇸

Lexington, Kentucky, United States

Saint Joseph Hospital East

🇺🇸

Lexington, Kentucky, United States

Southwest Gynecologic Oncology Associates Inc

🇺🇸

Albuquerque, New Mexico, United States

University of New Mexico Cancer Center

🇺🇸

Albuquerque, New Mexico, United States

Unity Hospital

🇺🇸

Fridley, Minnesota, United States

Swedish Cancer Institute-Issaquah

🇺🇸

Issaquah, Washington, United States

Providence Regional Cancer System-Centralia

🇺🇸

Centralia, Washington, United States

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