Bevacizumab and Intravenous or Intraperitoneal Chemotherapy in Treating Patients With Stage II-III Ovarian Epithelial Cancer, Fallopian Tube Cancer, or Primary Peritoneal Cancer

Phase 3

Completed

• Conditions: Fallopian Tube Serous Adenocarcinoma; Fallopian Tube Clear Cell Adenocarcinoma; Ovarian Clear Cell Adenocarcinoma; Primary Peritoneal Endometrioid Adenocarcinoma; Stage III Ovarian Cancer AJCC v6 and v7; Stage IIIB Ovarian Cancer AJCC v6 and v7; Fallopian Tube Mucinous Adenocarcinoma; Fallopian Tube Undifferentiated Carcinoma; Malignant Ovarian Brenner Tumor; Ovarian Seromucinous Carcinoma
• Interventions: Biological: Bevacizumab; Drug: Carboplatin; Drug: Cisplatin; Other: Laboratory Biomarker Analysis; Drug: Paclitaxel; Other: Quality-of-Life Assessment

• Registration Number: NCT00951496
• Lead Sponsor: National Cancer Institute (NCI)

Brief Summary

This randomized phase III trial studies bevacizumab and intravenous (given into a vein) chemotherapy to see how well they work compared with bevacizumab and intraperitoneal (given into the abdominal cavity) chemotherapy in treating patients with stage II-III ovarian epithelial cancer, fallopian tube cancer, or primary peritoneal cancer. Monoclonal antibodies, such as bevacizumab, can block the ability of tumor cells to grow and spread by blocking the growth of new blood vessels necessary for tumor growth. Drugs used in chemotherapy, such as paclitaxel, carboplatin, and cisplatin, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. It is not yet known whether giving bevacizumab together with intravenous chemotherapy is more effective than giving bevacizumab together with intraperitoneal chemotherapy in treating patients with ovarian epithelial cancer, fallopian tube cancer, or primary peritoneal cancer.

Detailed Description

PRIMARY OBJECTIVES:

I. To determine if one or both of the proposed intraperitoneal chemotherapy regimens improves the progression-free survival (PFS) event rate compared to standard intravenous chemotherapy for first-line treatment of patients diagnosed with advanced stage ovarian, peritoneal or fallopian tube cancer.

II. If both intraperitoneal (IP) regimens significantly improve the PFS event rate compared to the standard regimen, then a second study objective is to determine whether IP cisplatin and intravenous (IV) paclitaxel on day one plus IP paclitaxel on day eight improves the PFS event rate when compared to the IP carboplatin and IV paclitaxel.

SECONDARY OBJECTIVES:

I. To determine if intraperitoneal chemotherapy reduces the overall death rate compared to standard intravenous chemotherapy.

II. To assess the frequency and severity of adverse events as defined by Common Terminology Criteria for Adverse Events (CTCAE) version 3.0.

III. To compare the patient-reported outcomes on: Quality of Life (Function Assessment of Cancer Therapy-Ovarian-Trial Outcome Index \[FACT-O-TOI\]), Neuropathy (FACT-Gynecologic Oncology Group/Neurotoxicity \[GOG/NTX4\] scale), Abdominal discomfort (FACT-GOG/AD scale), Fatigue (FACIT-Fatigue scale), and Nausea (item from FACT-O-TOI).

IV. To assess the frequency and the reasons for early discontinuation of the study treatments.

TERTIARY OBJECTIVES:

I. To bank deoxyribonucleic acid (DNA) from whole blood for research and examine the association between single nucleotide polymorphisms (SNPs) and measures of clinical outcome including overall survival, progression-free survival and adverse events.

II. To bank archival tumor for research and examine the association between tumor markers and measures of clinical outcome including overall survival, progression-free survival and adverse events.

III. Patients will be encouraged to enroll on the companion translational research protocol (CEM0703 under development).

OUTLINE: Patients are randomized to 1 of 3 treatment arms.

ARM I: Patients receive paclitaxel IV over 1 hour on days 1, 8, and 15 and carboplatin IV over 30 minutes on day 1. Patients also receive bevacizumab IV over 30-90 minutes on day 1 in courses 2-6. Treatment repeats every 21 days for 6 courses in the absence of disease progression or unacceptable toxicity. Patients then receive bevacizumab alone in courses 7-22 in the absence of disease progression or unacceptable toxicity.

ARM II: Patients receive paclitaxel as in Arm I and carboplatin IP on day 1. Patients also receive bevacizumab as in Arm I. Treatment repeats every 21 days for 6 courses in the absence of disease progression or unacceptable toxicity. Patients then receive bevacizumab alone as in Arm I.

ARM III: Patients receive paclitaxel IV over 3 hours on day 1, cisplatin IP on day 2, and paclitaxel IP on day 8. Patients also receive bevacizumab as in Arm I. Treatment repeats every 21 days for 6 courses in the absence of disease progression or unacceptable toxicity. Patients then receive bevacizumab alone as in Arm I.

After completion of study treatment, patients are followed up every 3 months for 2 years, every 6 months for 3 years, and then annually for 5 years.

Study Timeline

• Study First Submitted: 2009-08-01
• Study First Submitted QC: 2009-08-01
• Study First Posted: 2009-08-04
• Study Start: 2009-08-11
• Primary Completion: 2016-01-11
• Study Completion: 2016-01-11
• Results First Submitted: 2017-10-04
• Results First Submitted QC: 2018-04-19
• Results First Posted: 2018-05-18
• Status Verified: 2021-03
• Last Update Submitted: 2021-04-13
• Last Update Posted: 2021-05-04

Recruitment & Eligibility

• Status: COMPLETED
• Sex: Female
• Target Recruitment: 1560

Inclusion Criteria

• Patients with a histologic diagnosis of epithelial ovarian, fallopian tube, or primary peritoneal carcinoma, stage II, III, or IV with either optimal (=< 1 cm residual disease) or suboptimal residual disease; in the event of a higher priority Phase III Gynecologic Oncology Group (GOG) protocol becoming available for suboptimal and/or stage IV patients, the eligibility of this study will narrow and exclude those patients at those participating institutions (11/02/2009)

  • Note: patients with suboptimal disease/and or stage IV will not be eligible as of April 1, 2011; they should be enrolled on GOG-0262 (03/14/11)
  • All patients must have a procedure for determining diagnosis of epithelial ovarian, fallopian tube, primary peritoneal, with appropriate tissue for histologic evaluation; the minimum surgery required is an abdominal surgery providing tissue for histologic evaluation and establishing and documenting the primary site and stage, as well as a maximal effort at tumor debulking; if additional surgery was performed, it should have been in accordance with appropriate surgery for ovarian or peritoneal carcinoma described in the GOG Surgical Procedures Manual (https://www.gog.fccc.edu/manuals/pdf/surgman.pdf) (11/02/2009)(08/16/2010)

• Patients with the following histologic epithelial cell types are eligible: serous adenocarcinoma, endometrioid adenocarcinoma, mucinous adenocarcinoma, undifferentiated carcinoma, clear cell adenocarcinoma, mixed epithelial carcinoma, transitional cell carcinoma, malignant Brenner's Tumor, or adenocarcinoma not otherwise specified (N.O.S.); however, the histologic features of the tumor must be compatible with a primary Müllerian epithelial adenocarcinoma; if doubt exists, it is recommended that the investigator should have the slides reviewed by an independent pathologist prior to entry; patients may have co-existing endometrial cancer so long as the primary origin of invasive tumor is ovarian or peritoneal; Note: patients with mucinous, low grade and clear cell disease are eligible unless there is a higher priority GOG trial open (11/02/2009) (08/16/2010)

• Absolute neutrophil count (ANC) greater than or equal to 1,500/mcl, equivalent to Common Terminology Criteria for Adverse Events v3.0 (CTCAE) grade 1; this ANC cannot have been induced or supported by granulocyte colony stimulating factors

• Platelets greater than or equal to 100,000/mcl

• Creatinine no greater than institutional upper limits of normal (03/29/10)

• Bilirubin less than or equal to 1.5 x upper limit of normal (ULN) (CTCAE grade 1)

• Alanine aminotransferase (ALT), aspartate aminotransferase (AST) less than or equal to 2.5 x ULN (CTCAE grade 1)

• Alkaline phosphatase less than or equal to 2.5 x ULN (CTCAE grade 1)

• Neuropathy (sensory and motor) less than or equal to CTCAE grade 1

• Prothrombin time (PT) such that international normalized ratio (INR) is =< 1.5 x ULN (or an in-range INR, usually between 2 and 3, if a patient is on a stable dose of therapeutic warfarin) and a partial thromboplastin time (PTT) =< 1.5 times the upper limit of normal (heparin, Lovenox or alternative anticoagulants are acceptable); this corresponds to CTCAE version 3.0 grade 1 one or less (11/02/2009) (03/29/10)

• Patients with a GOG performance status of 0, 1, or 2

• Patients must be entered and treated within 12 weeks of their most recent surgery performed for the combined purpose of diagnosis, staging and/or cytoreduction; the first cycle of chemotherapy should not be given until at least seven days after the most recent major surgery, which allows 4 weeks to have elapsed prior to the first bevacizumab dose; (placement of venous or peritoneal access devices will be considered minor surgery) (03/29/10)

• Patients who have met the pre-entry requirements specified

• An approved informed consent and authorization permitting release of personal health information must be signed by the patient or guardian

• Patients in this trial may receive ovarian estrogen +/- progestin replacement therapy as indicated at the lowest effective dose(s) for control of menopausal symptoms at any time, but high dose progestin as an appetite stimulant should be avoided (03/29/10)

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Exclusion Criteria

• Patients with a current diagnosis of borderline epithelial ovarian tumor (formerly "tumors of low malignant potential") or recurrent invasive epithelial ovarian cancer treated with surgery only (such as those with stage IA or IB low grade lesions) are not eligible; patients with a prior diagnosis of a borderline tumor that was surgically resected and who subsequently develop an unrelated, new invasive epithelial ovarian or peritoneal primary cancer are eligible, provided that they have not received prior chemotherapy for any ovarian tumor

• Patients with a history of other invasive malignancies, with the exception of non-melanoma skin cancer and other specific malignancies are excluded if there is any evidence of the other malignancy being present within the last five years; patients are also excluded if their previous cancer treatment contraindicates this protocol therapy (11/02/2009)

• Patients who have received prior radiotherapy to any portion of the abdominal cavity or pelvis are excluded; prior radiation for localized cancer of the breast, head and neck, or skin is permitted, provided that it was completed more than three years prior to registration, and the patient remains free of recurrent or metastatic disease

• Patients who have received prior chemotherapy for any abdominal or pelvic tumor including neo-adjuvant chemotherapy for their ovarian or primary peritoneal cancer are excluded; patients may have received prior adjuvant chemotherapy for localized breast cancer, provided that it was completed more than three years prior to registration, and that the patient remains free of recurrent or metastatic disease

• Patients who have received any targeted therapy (including but not limited to vaccines, antibodies, tyrosine kinase inhibitors) or hormonal therapy for management of their epithelial ovarian or peritoneal primary cancer

• Patients with synchronous primary endometrial cancer, or a past history of primary endometrial cancer, are excluded, unless all of the following conditions are met: stage not greater than IB; no more than superficial myometrial invasion, without vascular or lymphatic invasion; no poorly differentiated subtypes, including papillary serous, clear cell or other FIGO grade 3 lesions

• Patients with acute hepatitis or active infection that requires parenteral antibiotics

• Patients with serious non-healing wound, ulcer, or bone fracture; this includes history of abdominal fistula, gastrointestinal perforation or intra-abdominal abscess within 28 days; patients with granulating incisions healing by secondary intention with no evidence of fascial dehiscence or infection are eligible but require weekly wound examinations

• Patients with active bleeding or pathologic conditions that carry high risk of bleeding, such as known bleeding disorder, coagulopathy, or tumor involving major vessels

• Patients with history or evidence upon physical examination of major central nervous system (CNS) disease (for example: primary brain tumor, metastatic cancer in the brain, seizures not controlled with standard medical therapy, any brain metastases, or history of cerebrovascular accident [CVA, stroke], transient ischemic attack [TIA] or subarachnoid hemorrhage within six months of the first date of treatment on this study) (11/02/2009) (03/29/10)

• Patients with clinically significant cardiovascular disease; this includes:

  • Uncontrolled hypertension, defined as systolic > 150 mm Hg or diastolic > 90 mmHg
  • Myocardial infarction or unstable angina < 6 months prior to registration
  • New York Heart Association (NYHA) grade II or greater congestive heart failure
  • Serious cardiac arrhythmia requiring medication; this does not include asymptomatic atrial fibrillation with controlled ventricular rate, or past history of supraventricular tachycardia controlled with medications and that is asymptomatic (03/29/10)
  • CTCAE grade 2 or greater peripheral vascular disease (at least brief (< 24 hrs) episodes of ischemia managed non-surgically and without permanent deficit)

• Patients with known hypersensitivity to Chinese hamster ovary cell products or other recombinant human or humanized antibodies; patients with known allergy to Cremophor or polysorbate 80

• Patients with clinically significant proteinuria; urine protein should be screened by urine protein-creatinine ratio (UPCR); patients must have a UPCR < 1.0 to allow participation in the study

• Patients with or with anticipation of invasive procedures as defined below:

  • Major surgical procedure, open biopsy or significant traumatic injury within 28 days prior to the first date of bevacizumab therapy (cycle 2)
  • Major surgical procedure anticipated during the course of the study; this includes, but is not limited to abdominal surgery (laparotomy or laparoscopy) prior to disease progression, such as colostomy or enterostomy reversal, interval or secondary cytoreductive surgery, or second look surgery
  • Core biopsy, within 7 days prior to the first date of bevacizumab therapy (cycle 2)

• Patients with GOG performance grade of 3 or 4

• Patients who are pregnant or nursing; patients of childbearing potential must agree to use contraceptive measures during study therapy and for at least six months after completion of bevacizumab therapy

• Patients who have received prior therapy with any anti-vascular endothelial growth factor (VEGF) drug, including bevacizumab

• Patients with clinical symptoms or signs of gastrointestinal obstruction and/ or those who require parenteral hydration and/or nutrition; patients with history or current diagnosis of inflammatory bowel disease are not eligible (12/20/10)

• Patients with medical history or conditions not otherwise previously specified which in the opinion of the investigator should exclude participation in this study; examples of this would be: persistent gastrointestinal symptoms resulting from clostridia difficile enterocolitis or bowel surgery which may increase gastrointestinal toxicity from bevacizumab; or hearing loss or neuropathy which would prevent tolerance to cisplatin, and paclitaxel administration; the investigator should feel free to consult the Study Chair or Study Co-Chairs for uncertainty in this regard (12/20/10)

• Patients with metastatic tumor in the parenchyma of the liver or lungs with proximity to large vessels which could make the patient as high risk of lethal hemorrhage during treatment with bevacizumab (i.e. hemoptysis, liver rupture) (11/02/2009)

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Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Arm III (paclitaxel IP, bevacizumab, cisplatin IP)	Laboratory Biomarker Analysis	Patients receive paclitaxel IV over 3 hours on day 1, cisplatin IP on day 2, and paclitaxel IP on day 8. Patients also receive bevacizumab as in Arm I. Treatment repeats every 21 days for 6 courses in the absence of disease progression or unacceptable toxicity. Patients then receive bevacizumab alone as in Arm I.
Arm I (paclitaxel, carboplatin, bevacizumab)	Laboratory Biomarker Analysis	Patients receive paclitaxel IV over 1 hour on days 1, 8, and 15 and carboplatin IV over 30 minutes on day 1. Patients also receive bevacizumab IV over 30-90 minutes on day 1 in courses 2-6. Treatment repeats every 21 days for 6 courses in the absence of disease progression or unacceptable toxicity. Patients then receive bevacizumab alone in courses 7-22 in the absence of disease progression or unacceptable toxicity.
Arm II (paclitaxel, bevacizumab, carboplatin IP)	Quality-of-Life Assessment	Patients receive paclitaxel as in Arm I and carboplatin IP on day 1. Patients also receive bevacizumab as in Arm I. Treatment repeats every 21 days for 6 courses in the absence of disease progression or unacceptable toxicity. Patients then receive bevacizumab alone as in Arm I.
Arm I (paclitaxel, carboplatin, bevacizumab)	Bevacizumab	Patients receive paclitaxel IV over 1 hour on days 1, 8, and 15 and carboplatin IV over 30 minutes on day 1. Patients also receive bevacizumab IV over 30-90 minutes on day 1 in courses 2-6. Treatment repeats every 21 days for 6 courses in the absence of disease progression or unacceptable toxicity. Patients then receive bevacizumab alone in courses 7-22 in the absence of disease progression or unacceptable toxicity.
Arm I (paclitaxel, carboplatin, bevacizumab)	Quality-of-Life Assessment	Patients receive paclitaxel IV over 1 hour on days 1, 8, and 15 and carboplatin IV over 30 minutes on day 1. Patients also receive bevacizumab IV over 30-90 minutes on day 1 in courses 2-6. Treatment repeats every 21 days for 6 courses in the absence of disease progression or unacceptable toxicity. Patients then receive bevacizumab alone in courses 7-22 in the absence of disease progression or unacceptable toxicity.
Arm II (paclitaxel, bevacizumab, carboplatin IP)	Bevacizumab	Patients receive paclitaxel as in Arm I and carboplatin IP on day 1. Patients also receive bevacizumab as in Arm I. Treatment repeats every 21 days for 6 courses in the absence of disease progression or unacceptable toxicity. Patients then receive bevacizumab alone as in Arm I.
Arm II (paclitaxel, bevacizumab, carboplatin IP)	Laboratory Biomarker Analysis	Patients receive paclitaxel as in Arm I and carboplatin IP on day 1. Patients also receive bevacizumab as in Arm I. Treatment repeats every 21 days for 6 courses in the absence of disease progression or unacceptable toxicity. Patients then receive bevacizumab alone as in Arm I.
Arm III (paclitaxel IP, bevacizumab, cisplatin IP)	Bevacizumab	Patients receive paclitaxel IV over 3 hours on day 1, cisplatin IP on day 2, and paclitaxel IP on day 8. Patients also receive bevacizumab as in Arm I. Treatment repeats every 21 days for 6 courses in the absence of disease progression or unacceptable toxicity. Patients then receive bevacizumab alone as in Arm I.
Arm III (paclitaxel IP, bevacizumab, cisplatin IP)	Quality-of-Life Assessment	Patients receive paclitaxel IV over 3 hours on day 1, cisplatin IP on day 2, and paclitaxel IP on day 8. Patients also receive bevacizumab as in Arm I. Treatment repeats every 21 days for 6 courses in the absence of disease progression or unacceptable toxicity. Patients then receive bevacizumab alone as in Arm I.
Arm I (paclitaxel, carboplatin, bevacizumab)	Carboplatin	Patients receive paclitaxel IV over 1 hour on days 1, 8, and 15 and carboplatin IV over 30 minutes on day 1. Patients also receive bevacizumab IV over 30-90 minutes on day 1 in courses 2-6. Treatment repeats every 21 days for 6 courses in the absence of disease progression or unacceptable toxicity. Patients then receive bevacizumab alone in courses 7-22 in the absence of disease progression or unacceptable toxicity.
Arm I (paclitaxel, carboplatin, bevacizumab)	Paclitaxel	Patients receive paclitaxel IV over 1 hour on days 1, 8, and 15 and carboplatin IV over 30 minutes on day 1. Patients also receive bevacizumab IV over 30-90 minutes on day 1 in courses 2-6. Treatment repeats every 21 days for 6 courses in the absence of disease progression or unacceptable toxicity. Patients then receive bevacizumab alone in courses 7-22 in the absence of disease progression or unacceptable toxicity.
Arm II (paclitaxel, bevacizumab, carboplatin IP)	Carboplatin	Patients receive paclitaxel as in Arm I and carboplatin IP on day 1. Patients also receive bevacizumab as in Arm I. Treatment repeats every 21 days for 6 courses in the absence of disease progression or unacceptable toxicity. Patients then receive bevacizumab alone as in Arm I.
Arm II (paclitaxel, bevacizumab, carboplatin IP)	Paclitaxel	Patients receive paclitaxel as in Arm I and carboplatin IP on day 1. Patients also receive bevacizumab as in Arm I. Treatment repeats every 21 days for 6 courses in the absence of disease progression or unacceptable toxicity. Patients then receive bevacizumab alone as in Arm I.
Arm III (paclitaxel IP, bevacizumab, cisplatin IP)	Cisplatin	Patients receive paclitaxel IV over 3 hours on day 1, cisplatin IP on day 2, and paclitaxel IP on day 8. Patients also receive bevacizumab as in Arm I. Treatment repeats every 21 days for 6 courses in the absence of disease progression or unacceptable toxicity. Patients then receive bevacizumab alone as in Arm I.
Arm III (paclitaxel IP, bevacizumab, cisplatin IP)	Paclitaxel	Patients receive paclitaxel IV over 3 hours on day 1, cisplatin IP on day 2, and paclitaxel IP on day 8. Patients also receive bevacizumab as in Arm I. Treatment repeats every 21 days for 6 courses in the absence of disease progression or unacceptable toxicity. Patients then receive bevacizumab alone as in Arm I.

Primary Outcome Measures

Name	Time	Method
Median Progression-free Survival	Progression-free survival is measured from date of randomization until first indication of progression based on RECIST criteria or death from any cause, or if progression-free at last contact, the date of last disease assessment up to 10 years.	Estimate the median duration of progression-free survival in months. Progression is defined using Response Evaluation Criteria in Solid Tumors criteria (RECIST v1.0) as a 20% increase in the sum of the longest diameter of target lesions, or a measurable increase in a non-target lesion, or the appearance of new lesions.

Secondary Outcome Measures

Name	Time	Method
Patient Reported Neurotoxicity (Ntx)	Time points: Baseline, prior to cycle 4, prior to cycle 7, prior to cycle 13, prior to cycle 21, 84 weeks post starting treatment	The FACT/GOG-NTX subscale (short version) contains 4 items measuring sensory neuropathy. Each item is scored using a 5 point Likert scale (0=not at all; 1=a little bit;2=somewhat;3=quite a bit; 4=very much). For each item, reversal was performed prior to score calculation so that a large score suggests less symptoms. According to the FACIT measurement system, the subscale score was calculated as the summation of the individual item scores if more than 50% of a subscale items were answered. When unanswered items existed, a subscale score was prorated by multiplying the mean of the answered item scores by the number of items in the subscale. The Ntx subscale score ranges from 0-16 with a large subscale score suggesting less symptom or better QOL.
Patient Reported Nausea	Time points: Baseline, prior to cycle 4, prior to cycle 7, prior to cycle 13, prior to cycle 21, 84 weeks post starting treatment	Nausea was measured with the a single item ,' I have nausea' from the FACT-O TOI, and was scored using a 5 point scale (0=not at all; 1=a little bit; 2=somewhat;3=quite a bit;4=very much)
Patient Reported Quality of Life (QOL)	Time points: Baseline, prior to cycle 4, prior to cycle 7, prior to cycle 13, prior to cycle 21, up to 84 weeks post starting treatment	QOL was measured with the FACT-O TOI score. Means at baseline are raw means. Scores are reported at all time points in the outcome measure table. FACT-O TOI is Trial outcome index (TOI) of the Functional assessment of cancer therapy (FACT) for ovarian cancer (FACT-O). The FACT-O TOI is composed of three subscales; Physical Well Being (PWB) ( 7 items), and Ovarian Cancer subscale (OCS) (12 items). Each item in the FACT-O TOI are scored using a 5 point scale (0=not at all; 1=a little bit; 2=somewhat;3=quite a bit;4=very much). A subscale score is computed as long as more thatn 50% of subscale items have been answered. A total score of the FACT-O items provide valid responses and all three subscales have valid scores. A score of the FACT-) TOI is ranged 0-104 with a larger score indicating a more preferred state of health-related quality of life (HRQOL).
Overall Survival	Up to 10 years	Estimate the median duration of overall survival in months.
Patients With Adverse Events by Treatment Group, as Defined by NCI CTCAE (Common Terminology Criteria for Adverse Events Version 3.0) Version 3.0	During treatment and up to 30 days after end of treatment	Eligible and treated patients. CTCAE includes grades 1-5. Grade refers to the severity of the adverse event. Grades 0 listed should be interpreted to mean there were no subjects in the arm with a toxicity to report. Grade 1 toxicities are mild; asymptomatic or mild symptoms. Grade 2 toxicities are moderate; minimal, local or noninvasive intervention indicated. Grade 3 toxicities are severe or medically significant but not immediately life-threatening. Grade 4 toxicities are life threatening. Grade 5 is death related to adverse event.
Patient Reported Fatigue	Time points: Baseline, prior to cycle 4, prior to cycle 7, prior to cycle 13, prior to cycle 21, 84 weeks post starting treatment	Patient reported fatigue as measured with the Functional Assessment of Chronic Illness Therapy- Fatigue scale (FACIT-Fatigue). The FACIT-Fatigue contains 13 items. Each item was scored using a 5-point scale (0=not at all; 1=a little bit; 2=somewhat; 3=quite a bit; 4=very much). For the negative items, reversal was performed prior to score calculation. According to the FACIT measurement system, the Fatigue score was the summation of the individual item scores if more than 50% of subscale items were answered. When unanswered items existed, a subscale score was prorated by multiplying the mean of the answered item scores by the number of items in the scale. The FACIT-Fatigue score ranges 0-52 with a large score suggesting less fatigue.

Trial Locations

Locations (500)

Mayo Clinic in Arizona; 🇺🇸 Scottsdale, Arizona, United States

Providence Alaska Medical Center; 🇺🇸 Anchorage, Alaska, United States

The Hospital of Central Connecticut; 🇺🇸 New Britain, Connecticut, United States

Eastern Connecticut Hematology and Oncology Associates; 🇺🇸 Norwich, Connecticut, United States

Christiana Care Health System-Christiana Hospital; 🇺🇸 Newark, Delaware, United States

Smilow Cancer Hospital Care Center at Saint Francis; 🇺🇸 Hartford, Connecticut, United States

Danbury Hospital; 🇺🇸 Danbury, Connecticut, United States

Beebe Medical Center; 🇺🇸 Lewes, Delaware, United States

University of Mississippi Medical Center; 🇺🇸 Jackson, Mississippi, United States

Washington University School of Medicine; 🇺🇸 Saint Louis, Missouri, United States

Jersey Shore Medical Center; 🇺🇸 Neptune, New Jersey, United States

Benefis Healthcare- Sletten Cancer Institute; 🇺🇸 Great Falls, Montana, United States

Edwards Comprehensive Cancer Center; 🇺🇸 Huntington, West Virginia, United States

Mount Carmel Health Center West; 🇺🇸 Columbus, Ohio, United States

Doctors Hospital; 🇺🇸 Columbus, Ohio, United States

Illinois CancerCare-Havana; 🇺🇸 Havana, Illinois, United States

Fox Chase Cancer Center; 🇺🇸 Philadelphia, Pennsylvania, United States

Case Western Reserve University; 🇺🇸 Cleveland, Ohio, United States

West Penn Hospital; 🇺🇸 Pittsburgh, Pennsylvania, United States

Beth Israel Deaconess Medical Center; 🇺🇸 Boston, Massachusetts, United States

M D Anderson Cancer Center; 🇺🇸 Houston, Texas, United States

Swedish Medical Center-First Hill; 🇺🇸 Seattle, Washington, United States

University of Washington Medical Center - Northwest; 🇺🇸 Seattle, Washington, United States

The Watson Clinic; 🇺🇸 Lakeland, Florida, United States

Hartford Hospital; 🇺🇸 Hartford, Connecticut, United States

Morton Plant Hospital; 🇺🇸 Clearwater, Florida, United States

University of South Alabama Mitchell Cancer Institute; 🇺🇸 Mobile, Alabama, United States

City of Hope Comprehensive Cancer Center; 🇺🇸 Duarte, California, United States

Providence Saint Joseph Medical Center/Disney Family Cancer Center; 🇺🇸 Burbank, California, United States

PCR Oncology; 🇺🇸 Arroyo Grande, California, United States

John Muir Medical Center-Concord Campus; 🇺🇸 Concord, California, United States

Kaiser Permanente Los Angeles Medical Center; 🇺🇸 Los Angeles, California, United States

Alta Bates Summit Medical Center-Herrick Campus; 🇺🇸 Berkeley, California, United States

UCLA / Jonsson Comprehensive Cancer Center; 🇺🇸 Los Angeles, California, United States

Rocky Mountain Gynecologic Oncology PC; 🇺🇸 Englewood, Colorado, United States

UC Irvine Health/Chao Family Comprehensive Cancer Center; 🇺🇸 Orange, California, United States

Sutter Cancer Research Consortium; 🇺🇸 Novato, California, United States

Palo Alto Medical Foundation-Gynecologic Oncology; 🇺🇸 Mountain View, California, United States

Saint Vincent's Medical Center; 🇺🇸 Jacksonville, Florida, United States

Sutter Solano Medical Center/Cancer Center; 🇺🇸 Vallejo, California, United States

Stanford Cancer Institute Palo Alto; 🇺🇸 Palo Alto, California, United States

John Muir Medical Center-Walnut Creek; 🇺🇸 Walnut Creek, California, United States

Saint Joseph Hospital - Orange; 🇺🇸 Orange, California, United States

Wilcox Memorial Hospital and Kauai Medical Clinic; 🇺🇸 Lihue, Hawaii, United States

Sibley Memorial Hospital; 🇺🇸 Washington, District of Columbia, United States

Stamford Hospital/Bennett Cancer Center; 🇺🇸 Stamford, Connecticut, United States

Florida Gynecologic Oncology; 🇺🇸 Fort Myers, Florida, United States

Southeast Gynecologic Oncology Associates; 🇺🇸 Jacksonville, Florida, United States

Illinois CancerCare-Bloomington; 🇺🇸 Bloomington, Illinois, United States

Kootenai Cancer Center; 🇺🇸 Post Falls, Idaho, United States

Northside Hospital; 🇺🇸 Atlanta, Georgia, United States

IU Health La Porte Hospital; 🇺🇸 La Porte, Indiana, United States

Northeast Georgia Medical Center-Gainesville; 🇺🇸 Gainesville, Georgia, United States

MedStar Washington Hospital Center; 🇺🇸 Washington, District of Columbia, United States

Bayfront Outpatient Health Clinic; 🇺🇸 Saint Petersburg, Florida, United States

John B Amos Cancer Center; 🇺🇸 Columbus, Georgia, United States

Cancer Center of Kansas - Dodge City; 🇺🇸 Dodge City, Kansas, United States

Cancer Center of Kansas-Liberal; 🇺🇸 Liberal, Kansas, United States

Memorial Health University Medical Center; 🇺🇸 Savannah, Georgia, United States

Illinois CancerCare-Kewanee Clinic; 🇺🇸 Kewanee, Illinois, United States

Memorial Hospital of South Bend; 🇺🇸 South Bend, Indiana, United States

University of Kansas Cancer Center; 🇺🇸 Kansas City, Kansas, United States

Cancer Center of Kansas - Wellington; 🇺🇸 Wellington, Kansas, United States

Ascension Via Christi Hospitals Wichita; 🇺🇸 Wichita, Kansas, United States

Illinois CancerCare-Peoria; 🇺🇸 Peoria, Illinois, United States

Illinois CancerCare-Pekin; 🇺🇸 Pekin, Illinois, United States

Community Howard Regional Health; 🇺🇸 Kokomo, Indiana, United States

Cotton O'Neil Cancer Center / Stormont Vail Health; 🇺🇸 Topeka, Kansas, United States

Reid Health; 🇺🇸 Richmond, Indiana, United States

Maine Medical Center-Bramhall Campus; 🇺🇸 Portland, Maine, United States

MedStar Franklin Square Medical Center/Weinberg Cancer Institute; 🇺🇸 Baltimore, Maryland, United States

Dana-Farber Cancer Institute; 🇺🇸 Boston, Massachusetts, United States

Saint Elizabeth Medical Center South; 🇺🇸 Edgewood, Kentucky, United States

McFarland Clinic PC - Ames; 🇺🇸 Ames, Iowa, United States

Southwest Medical Center; 🇺🇸 Liberal, Kansas, United States

Cancer Center of Kansas - Pratt; 🇺🇸 Pratt, Kansas, United States

Cancer Center of Kansas - Winfield; 🇺🇸 Winfield, Kansas, United States

Bronson Battle Creek; 🇺🇸 Battle Creek, Michigan, United States

Tufts Medical Center; 🇺🇸 Boston, Massachusetts, United States

Massachusetts General Hospital Cancer Center; 🇺🇸 Boston, Massachusetts, United States

Woman's Hospital; 🇺🇸 Baton Rouge, Louisiana, United States

Harold Alfond Center for Cancer Care; 🇺🇸 Augusta, Maine, United States

UMass Memorial Medical Center - Memorial Division; 🇺🇸 Worcester, Massachusetts, United States

Christiana Care - Union Hospital; 🇺🇸 Elkton, Maryland, United States

Lahey Hospital and Medical Center; 🇺🇸 Burlington, Massachusetts, United States

Brigham and Women's Hospital; 🇺🇸 Boston, Massachusetts, United States

Associates in Oncology Hematology PC -Kensington; 🇺🇸 Kensington, Maryland, United States

Medini, Eitan MD (UIA Investigator); 🇺🇸 Alexandria, Minnesota, United States

Essentia Health Cancer Center; 🇺🇸 Duluth, Minnesota, United States

Saint John's Hospital - Healtheast; 🇺🇸 Maplewood, Minnesota, United States

Metro Minnesota Community Oncology Research Consortium; 🇺🇸 Saint Louis Park, Minnesota, United States

Saint Vincent Frontier Cancer Center; 🇺🇸 Billings, Montana, United States

Queens Hospital Center; 🇺🇸 Jamaica, New York, United States

Adena Regional Medical Center; 🇺🇸 Chillicothe, Ohio, United States

Cone Health Cancer Center at Alamance Regional; 🇺🇸 Burlington, North Carolina, United States

Upper Valley Medical Center; 🇺🇸 Troy, Ohio, United States

Greene Memorial Hospital; 🇺🇸 Xenia, Ohio, United States

Clements University Hospital; 🇺🇸 Dallas, Texas, United States

Harrison Medical Center; 🇺🇸 Bremerton, Washington, United States

Providence Regional Cancer Partnership; 🇺🇸 Everett, Washington, United States

Northern Virginia Pelvic Surgery Associates; 🇺🇸 Annandale, Virginia, United States

University of Pennsylvania/Abramson Cancer Center; 🇺🇸 Philadelphia, Pennsylvania, United States

University of Virginia Cancer Center; 🇺🇸 Charlottesville, Virginia, United States

Peninsula Cancer Institute-Newport News; 🇺🇸 Newport News, Virginia, United States

Utah Valley Regional Medical Center; 🇺🇸 Provo, Utah, United States

Danville Regional Medical Center; 🇺🇸 Danville, Virginia, United States

Women and Infants Hospital; 🇺🇸 Providence, Rhode Island, United States

Cancer Care Northwest - Spokane South; 🇺🇸 Spokane, Washington, United States

Dixie Medical Center Regional Cancer Center; 🇺🇸 Saint George, Utah, United States

University of Vermont Medical Center; 🇺🇸 Burlington, Vermont, United States

Vince Lombardi Cancer Clinic - Oshkosh; 🇺🇸 Oshkosh, Wisconsin, United States

Kaiser Permanente Washington; 🇺🇸 Seattle, Washington, United States

Sanford Cancer Center Oncology Clinic; 🇺🇸 Sioux Falls, South Dakota, United States

Black Hills Obstetrics and Gynecology; 🇺🇸 Rapid City, South Dakota, United States

Carilion Clinic Gynecological Oncology; 🇺🇸 Roanoke, Virginia, United States

Fred Hutchinson Cancer Research Center; 🇺🇸 Seattle, Washington, United States

Seattle Cancer Care Alliance; 🇺🇸 Seattle, Washington, United States

Wenatchee Valley Hospital and Clinics; 🇺🇸 Wenatchee, Washington, United States

University of Washington Medical Center - Montlake; 🇺🇸 Seattle, Washington, United States

Aurora BayCare Medical Center; 🇺🇸 Green Bay, Wisconsin, United States

Gundersen Lutheran Medical Center; 🇺🇸 La Crosse, Wisconsin, United States

Saint Vincent Hospital Cancer Center at Saint Mary's; 🇺🇸 Green Bay, Wisconsin, United States

Indiana University/Melvin and Bren Simon Cancer Center; 🇺🇸 Indianapolis, Indiana, United States

University of California San Diego; 🇺🇸 San Diego, California, United States

Abbott-Northwestern Hospital; 🇺🇸 Minneapolis, Minnesota, United States

Hennepin County Medical Center; 🇺🇸 Minneapolis, Minnesota, United States

University of Minnesota/Masonic Cancer Center; 🇺🇸 Minneapolis, Minnesota, United States

Good Samaritan Hospital - Cincinnati; 🇺🇸 Cincinnati, Ohio, United States

California Pacific Medical Center-Pacific Campus; 🇺🇸 San Francisco, California, United States

UCSF Medical Center-Mount Zion; 🇺🇸 San Francisco, California, United States

Intermountain Health Care; 🇺🇸 Salt Lake City, Utah, United States

Huntsman Cancer Institute/University of Utah; 🇺🇸 Salt Lake City, Utah, United States

LDS Hospital; 🇺🇸 Salt Lake City, Utah, United States

Pacific Cancer Institute of Maui; 🇺🇸 Wailuku, Hawaii, United States

Cancer Center of Kansas-Independence; 🇺🇸 Independence, Kansas, United States

Cancer Center of Kansas-Wichita Medical Arts Tower; 🇺🇸 Wichita, Kansas, United States

Rocky Mountain Oncology; 🇺🇸 Casper, Wyoming, United States

Associates In Womens Health; 🇺🇸 Wichita, Kansas, United States

Wichita NCI Community Oncology Research Program; 🇺🇸 Wichita, Kansas, United States

Cancer Center of Kansas - Chanute; 🇺🇸 Chanute, Kansas, United States

Lawrence Memorial Hospital; 🇺🇸 Lawrence, Kansas, United States

Cancer Center of Kansas - Wichita; 🇺🇸 Wichita, Kansas, United States

Welch Cancer Center; 🇺🇸 Sheridan, Wyoming, United States

Baystate Medical Center; 🇺🇸 Springfield, Massachusetts, United States

Saint Joseph's Hospital and Medical Center; 🇺🇸 Phoenix, Arizona, United States

University of Colorado; 🇺🇸 Denver, Colorado, United States

Compass Oncology Rose Quarter; 🇺🇸 Portland, Oregon, United States

Eastern Maine Medical Center; 🇺🇸 Bangor, Maine, United States

University of Alabama at Birmingham Cancer Center; 🇺🇸 Birmingham, Alabama, United States

University of Arizona Cancer Center-North Campus; 🇺🇸 Tucson, Arizona, United States

University of Arkansas for Medical Sciences; 🇺🇸 Little Rock, Arkansas, United States

Mills-Peninsula Medical Center; 🇺🇸 Burlingame, California, United States

Marin General Hospital; 🇺🇸 Greenbrae, California, United States

Long Beach Memorial Medical Center-Todd Cancer Institute; 🇺🇸 Long Beach, California, United States

Sutter Roseville Medical Center; 🇺🇸 Roseville, California, United States

Mayo Clinic in Florida; 🇺🇸 Jacksonville, Florida, United States

University of Miami Miller School of Medicine-Sylvester Cancer Center; 🇺🇸 Miami, Florida, United States

Pali Momi Medical Center; 🇺🇸 'Aiea, Hawaii, United States

Maui Memorial Medical Center; 🇺🇸 Wailuku, Hawaii, United States

Graham Hospital Association; 🇺🇸 Canton, Illinois, United States

Illinois CancerCare-Canton; 🇺🇸 Canton, Illinois, United States

Illinois CancerCare-Carthage; 🇺🇸 Carthage, Illinois, United States

Northwestern University; 🇺🇸 Chicago, Illinois, United States

Rush University Medical Center; 🇺🇸 Chicago, Illinois, United States

Presence Resurrection Medical Center; 🇺🇸 Chicago, Illinois, United States

University of Chicago Comprehensive Cancer Center; 🇺🇸 Chicago, Illinois, United States

Decatur Memorial Hospital; 🇺🇸 Decatur, Illinois, United States

Heartland Cancer Research NCORP; 🇺🇸 Decatur, Illinois, United States

Eureka Hospital; 🇺🇸 Eureka, Illinois, United States

Illinois CancerCare-Eureka; 🇺🇸 Eureka, Illinois, United States

NorthShore University HealthSystem-Evanston Hospital; 🇺🇸 Evanston, Illinois, United States

Galesburg Cottage Hospital; 🇺🇸 Galesburg, Illinois, United States

Illinois CancerCare-Cottage; 🇺🇸 Galesburg, Illinois, United States

Illinois CancerCare-Galesburg; 🇺🇸 Galesburg, Illinois, United States

Mason District Hospital; 🇺🇸 Havana, Illinois, United States

Hinsdale Hematology Oncology Associates Incorporated; 🇺🇸 Hinsdale, Illinois, United States

Sudarshan K Sharma MD Limited-Gynecologic Oncology; 🇺🇸 Hinsdale, Illinois, United States

Illinois CancerCare-Macomb; 🇺🇸 Macomb, Illinois, United States

Mcdonough District Hospital; 🇺🇸 Macomb, Illinois, United States

Loyola University Medical Center; 🇺🇸 Maywood, Illinois, United States

Holy Family Medical Center; 🇺🇸 Monmouth, Illinois, United States

Illinois CancerCare-Monmouth; 🇺🇸 Monmouth, Illinois, United States

Bromenn Regional Medical Center; 🇺🇸 Normal, Illinois, United States

Community Cancer Center Foundation; 🇺🇸 Normal, Illinois, United States

Illinois CancerCare-Community Cancer Center; 🇺🇸 Normal, Illinois, United States

Illinois CancerCare-Ottawa Clinic; 🇺🇸 Ottawa, Illinois, United States

Advocate Lutheran General Hospital; 🇺🇸 Park Ridge, Illinois, United States

Ottawa Regional Hospital and Healthcare Center; 🇺🇸 Ottawa, Illinois, United States

OSF Saint Francis Radiation Oncology at Pekin Cancer Treatment Center; 🇺🇸 Pekin, Illinois, United States

Pekin Hospital; 🇺🇸 Pekin, Illinois, United States

Proctor Hospital; 🇺🇸 Peoria, Illinois, United States

Methodist Medical Center of Illinois; 🇺🇸 Peoria, Illinois, United States

OSF Saint Francis Medical Center; 🇺🇸 Peoria, Illinois, United States

Illinois CancerCare-Peru; 🇺🇸 Peru, Illinois, United States

Illinois Valley Hospital; 🇺🇸 Peru, Illinois, United States

Illinois CancerCare-Princeton; 🇺🇸 Princeton, Illinois, United States

Perry Memorial Hospital; 🇺🇸 Princeton, Illinois, United States

Illinois CancerCare-Spring Valley; 🇺🇸 Spring Valley, Illinois, United States

Memorial Medical Center; 🇺🇸 Springfield, Illinois, United States

Northwestern Medicine Cancer Center Warrenville; 🇺🇸 Warrenville, Illinois, United States

Northwestern Medicine Central DuPage Hospital; 🇺🇸 Winfield, Illinois, United States

Elkhart Clinic; 🇺🇸 Elkhart, Indiana, United States

Elkhart General Hospital; 🇺🇸 Elkhart, Indiana, United States

Michiana Hematology Oncology PC-Elkhart; 🇺🇸 Elkhart, Indiana, United States

Medical Oncology and Hematology Associates-West Des Moines; 🇺🇸 Clive, Iowa, United States

Michiana Hematology Oncology PC-Westville; 🇺🇸 Westville, Indiana, United States

University of Iowa/Holden Comprehensive Cancer Center; 🇺🇸 Iowa City, Iowa, United States

Cancer Center of Kansas - El Dorado; 🇺🇸 El Dorado, Kansas, United States

Cancer Center of Kansas - Fort Scott; 🇺🇸 Fort Scott, Kansas, United States

Hematology/Oncology Clinic PLLC; 🇺🇸 Baton Rouge, Louisiana, United States

Cancer Center of Kansas - Salina; 🇺🇸 Salina, Kansas, United States

Greater Baltimore Medical Center; 🇺🇸 Baltimore, Maryland, United States

Sinai Hospital of Baltimore; 🇺🇸 Baltimore, Maryland, United States

Johns Hopkins University/Sidney Kimmel Cancer Center; 🇺🇸 Baltimore, Maryland, United States

Holy Cross Hospital; 🇺🇸 Silver Spring, Maryland, United States

Maryland Oncology Hematology PA-Aquilino Cancer Center; 🇺🇸 Rockville, Maryland, United States

Mercy Health Saint Mary's; 🇺🇸 Grand Rapids, Michigan, United States

Allegiance Health; 🇺🇸 Jackson, Michigan, United States

West Michigan Cancer Center; 🇺🇸 Kalamazoo, Michigan, United States

Sparrow Hospital; 🇺🇸 Lansing, Michigan, United States

Mercy Health Mercy Campus; 🇺🇸 Muskegon, Michigan, United States

Lakeland Hospital Niles; 🇺🇸 Niles, Michigan, United States

Lake Huron Medical Center; 🇺🇸 Port Huron, Michigan, United States

Saint Joseph Mercy Oakland; 🇺🇸 Pontiac, Michigan, United States

William Beaumont Hospital-Royal Oak; 🇺🇸 Royal Oak, Michigan, United States

Ascension Saint Mary's Hospital; 🇺🇸 Rhinelander, Wisconsin, United States

Lakeland Medical Center Saint Joseph; 🇺🇸 Saint Joseph, Michigan, United States

Ascension Providence Hospitals - Southfield; 🇺🇸 Southfield, Michigan, United States

Marie Yeager Cancer Center; 🇺🇸 Saint Joseph, Michigan, United States

Munson Medical Center; 🇺🇸 Traverse City, Michigan, United States

Saint John Macomb-Oakland Hospital; 🇺🇸 Warren, Michigan, United States

Metro Health Hospital; 🇺🇸 Wyoming, Michigan, United States

Essentia Health Saint Joseph's Medical Center; 🇺🇸 Brainerd, Minnesota, United States

Mercy Hospital; 🇺🇸 Scranton, Pennsylvania, United States

Miller-Dwan Hospital; 🇺🇸 Duluth, Minnesota, United States

Fairview Southdale Hospital; 🇺🇸 Edina, Minnesota, United States

Unity Hospital; 🇺🇸 Fridley, Minnesota, United States

Hutchinson Area Health Care; 🇺🇸 Hutchinson, Minnesota, United States

Minnesota Oncology Hematology PA-Maplewood; 🇺🇸 Maplewood, Minnesota, United States

North Memorial Medical Health Center; 🇺🇸 Robbinsdale, Minnesota, United States

Saint Cloud Hospital; 🇺🇸 Saint Cloud, Minnesota, United States

Park Nicollet Frauenshuh Cancer Center; 🇺🇸 Saint Louis Park, Minnesota, United States

Regions Hospital; 🇺🇸 Saint Paul, Minnesota, United States

United Hospital; 🇺🇸 Saint Paul, Minnesota, United States

Saint Francis Regional Medical Center; 🇺🇸 Shakopee, Minnesota, United States

Lakeview Hospital; 🇺🇸 Stillwater, Minnesota, United States

Rice Memorial Hospital; 🇺🇸 Willmar, Minnesota, United States

Minnesota Oncology Hematology PA-Woodbury; 🇺🇸 Woodbury, Minnesota, United States

University of Missouri - Ellis Fischel; 🇺🇸 Columbia, Missouri, United States

Saint Louis University Hospital; 🇺🇸 Saint Louis, Missouri, United States

Cancer Research for the Ozarks NCORP; 🇺🇸 Springfield, Missouri, United States

Billings Clinic Cancer Center; 🇺🇸 Billings, Montana, United States

Northern Rockies Radiation Oncology Center; 🇺🇸 Billings, Montana, United States

Saint Vincent Healthcare; 🇺🇸 Billings, Montana, United States

Montana Cancer Consortium NCORP; 🇺🇸 Billings, Montana, United States

Bozeman Deaconess Hospital; 🇺🇸 Bozeman, Montana, United States

Saint James Community Hospital and Cancer Treatment Center; 🇺🇸 Butte, Montana, United States

Great Falls Clinic; 🇺🇸 Great Falls, Montana, United States

Berdeaux, Donald MD (UIA Investigator); 🇺🇸 Great Falls, Montana, United States

Northern Montana Hospital; 🇺🇸 Havre, Montana, United States

Saint Peter's Community Hospital; 🇺🇸 Helena, Montana, United States

Glacier Oncology PLLC; 🇺🇸 Kalispell, Montana, United States

Kalispell Medical Oncology; 🇺🇸 Kalispell, Montana, United States

Saint Patrick Hospital - Community Hospital; 🇺🇸 Missoula, Montana, United States

Kalispell Regional Medical Center; 🇺🇸 Kalispell, Montana, United States

Montana Cancer Specialists; 🇺🇸 Missoula, Montana, United States

Community Medical Hospital; 🇺🇸 Missoula, Montana, United States

Walter Reed National Military Medical Center; 🇺🇸 Bethesda, Maryland, United States

Guardian Oncology and Center for Wellness; 🇺🇸 Missoula, Montana, United States

Mayo Clinic in Rochester; 🇺🇸 Rochester, Minnesota, United States

Nebraska Methodist Hospital; 🇺🇸 Omaha, Nebraska, United States

CHI Health Good Samaritan; 🇺🇸 Kearney, Nebraska, United States

Women's Cancer Center of Nevada; 🇺🇸 Las Vegas, Nevada, United States

Dartmouth Hitchcock Medical Center; 🇺🇸 Lebanon, New Hampshire, United States

Center of Hope at Renown Medical Center; 🇺🇸 Reno, Nevada, United States

Norris Cotton Cancer Center-Manchester; 🇺🇸 Manchester, New Hampshire, United States

Renown Regional Medical Center; 🇺🇸 Reno, Nevada, United States

Cooper Hospital University Medical Center; 🇺🇸 Camden, New Jersey, United States

Hunterdon Medical Center; 🇺🇸 Flemington, New Jersey, United States

Hackensack University Medical Center; 🇺🇸 Hackensack, New Jersey, United States

Aurora Saint Luke's Medical Center; 🇺🇸 Milwaukee, Wisconsin, United States

Medical College of Wisconsin; 🇺🇸 Milwaukee, Wisconsin, United States

Morristown Medical Center; 🇺🇸 Morristown, New Jersey, United States

Virtua Memorial; 🇺🇸 Mount Holly, New Jersey, United States

Valley Hospital; 🇺🇸 Ridgewood, New Jersey, United States

Overlook Hospital; 🇺🇸 Summit, New Jersey, United States

Virtua Voorhees; 🇺🇸 Voorhees, New Jersey, United States

University of New Mexico Cancer Center; 🇺🇸 Albuquerque, New Mexico, United States

Southwest Gynecologic Oncology Associates Inc; 🇺🇸 Albuquerque, New Mexico, United States

Women's Cancer Care Associates LLC; 🇺🇸 Albany, New York, United States

Island Gynecologic Oncology; 🇺🇸 Brightwaters, New York, United States

New York Hospital Medical Center of Queens; 🇺🇸 Fresh Meadows, New York, United States

Northwell Health NCORP; 🇺🇸 Lake Success, New York, United States

North Shore University Hospital; 🇺🇸 Manhasset, New York, United States

Long Island Jewish Medical Center; 🇺🇸 New Hyde Park, New York, United States

Mount Kisco Medical Group; 🇺🇸 Mount Kisco, New York, United States

Northern Westchester Hospital; 🇺🇸 Mount Kisco, New York, United States

Laura and Isaac Perlmutter Cancer Center at NYU Langone; 🇺🇸 New York, New York, United States

Mount Sinai Hospital; 🇺🇸 New York, New York, United States

Memorial Sloan Kettering Cancer Center; 🇺🇸 New York, New York, United States

NYP/Weill Cornell Medical Center; 🇺🇸 New York, New York, United States

State University of New York Upstate Medical University; 🇺🇸 Syracuse, New York, United States

Randolph Hospital; 🇺🇸 Asheboro, North Carolina, United States

Stony Brook University Medical Center; 🇺🇸 Stony Brook, New York, United States

Hope Women's Cancer Centers-Asheville; 🇺🇸 Asheville, North Carolina, United States

Carolinas Medical Center/Levine Cancer Institute; 🇺🇸 Charlotte, North Carolina, United States

Cone Health Cancer Center; 🇺🇸 Greensboro, North Carolina, United States

Duke University Medical Center; 🇺🇸 Durham, North Carolina, United States

Duke Raleigh Hospital; 🇺🇸 Raleigh, North Carolina, United States

Annie Penn Memorial Hospital; 🇺🇸 Reidsville, North Carolina, United States

Summa Health System - Akron Campus; 🇺🇸 Akron, Ohio, United States

Cleveland Clinic Akron General; 🇺🇸 Akron, Ohio, United States

Summa Health System - Barberton Campus; 🇺🇸 Barberton, Ohio, United States

Cleveland Clinic Mercy Hospital; 🇺🇸 Canton, Ohio, United States

Aultman Health Foundation; 🇺🇸 Canton, Ohio, United States

University of Cincinnati/Barrett Cancer Center; 🇺🇸 Cincinnati, Ohio, United States

MetroHealth Medical Center; 🇺🇸 Cleveland, Ohio, United States

Cleveland Clinic Cancer Center/Fairview Hospital; 🇺🇸 Cleveland, Ohio, United States

Cleveland Clinic Foundation; 🇺🇸 Cleveland, Ohio, United States

Ohio State University Comprehensive Cancer Center; 🇺🇸 Columbus, Ohio, United States

Riverside Methodist Hospital; 🇺🇸 Columbus, Ohio, United States

Columbus NCI Community Oncology Research Program; 🇺🇸 Columbus, Ohio, United States

Grant Medical Center; 🇺🇸 Columbus, Ohio, United States

Grandview Hospital; 🇺🇸 Dayton, Ohio, United States

Good Samaritan Hospital - Dayton; 🇺🇸 Dayton, Ohio, United States

Miami Valley Hospital; 🇺🇸 Dayton, Ohio, United States

Dayton NCI Community Oncology Research Program; 🇺🇸 Dayton, Ohio, United States

Grady Memorial Hospital; 🇺🇸 Delaware, Ohio, United States

Miami Valley Hospital North; 🇺🇸 Dayton, Ohio, United States

Blanchard Valley Hospital; 🇺🇸 Findlay, Ohio, United States

Wayne Hospital; 🇺🇸 Greenville, Ohio, United States

Atrium Medical Center-Middletown Regional Hospital; 🇺🇸 Franklin, Ohio, United States

Fairfield Medical Center; 🇺🇸 Lancaster, Ohio, United States

Hillcrest Hospital Cancer Center; 🇺🇸 Mayfield Heights, Ohio, United States

UH Seidman Cancer Center at Lake Health Mentor Campus; 🇺🇸 Mentor, Ohio, United States

Knox Community Hospital; 🇺🇸 Mount Vernon, Ohio, United States

Licking Memorial Hospital; 🇺🇸 Newark, Ohio, United States

Springfield Regional Medical Center; 🇺🇸 Springfield, Ohio, United States

Southern Ohio Medical Center; 🇺🇸 Portsmouth, Ohio, United States

University of Toledo; 🇺🇸 Toledo, Ohio, United States

Saint Ann's Hospital; 🇺🇸 Westerville, Ohio, United States

Wright-Patterson Medical Center; 🇺🇸 Wright-Patterson Air Force Base, Ohio, United States

Genesis Healthcare System Cancer Care Center; 🇺🇸 Zanesville, Ohio, United States

Oklahoma Cancer Specialists and Research Institute-Tulsa; 🇺🇸 Tulsa, Oklahoma, United States

University of Oklahoma Health Sciences Center; 🇺🇸 Oklahoma City, Oklahoma, United States

Legacy Good Samaritan Hospital and Medical Center; 🇺🇸 Portland, Oregon, United States

Abington Memorial Hospital; 🇺🇸 Abington, Pennsylvania, United States

Saint Luke's University Hospital-Bethlehem Campus; 🇺🇸 Bethlehem, Pennsylvania, United States

Lehigh Valley Hospital-Cedar Crest; 🇺🇸 Allentown, Pennsylvania, United States

Geisinger Medical Center; 🇺🇸 Danville, Pennsylvania, United States

Geisinger Medical Center-Cancer Center Hazleton; 🇺🇸 Hazleton, Pennsylvania, United States

Penn State Milton S Hershey Medical Center; 🇺🇸 Hershey, Pennsylvania, United States

Pennsylvania Hospital; 🇺🇸 Philadelphia, Pennsylvania, United States

Thomas Jefferson University Hospital; 🇺🇸 Philadelphia, Pennsylvania, United States

Temple University Hospital; 🇺🇸 Philadelphia, Pennsylvania, United States

UPMC-Magee Womens Hospital; 🇺🇸 Pittsburgh, Pennsylvania, United States

Phoenixville Hospital; 🇺🇸 Phoenixville, Pennsylvania, United States

Geisinger Medical Group; 🇺🇸 State College, Pennsylvania, United States

Scranton Hematology Oncology; 🇺🇸 Scranton, Pennsylvania, United States

WellSpan Health-York Hospital; 🇺🇸 York, Pennsylvania, United States

AnMed Health Hospital; 🇺🇸 Anderson, South Carolina, United States

AnMed Health Cancer Center; 🇺🇸 Anderson, South Carolina, United States

Prisma Health Cancer Institute - Spartanburg; 🇺🇸 Boiling Springs, South Carolina, United States

Prisma Health Cancer Institute - Easley; 🇺🇸 Easley, South Carolina, United States

Greenville Health System Cancer Institute-Andrews; 🇺🇸 Greenville, South Carolina, United States

Saint Francis Hospital; 🇺🇸 Greenville, South Carolina, United States

Prisma Health Cancer Institute - Butternut; 🇺🇸 Greenville, South Carolina, United States

Prisma Health Cancer Institute - Faris; 🇺🇸 Greenville, South Carolina, United States

Prisma Health Greenville Memorial Hospital; 🇺🇸 Greenville, South Carolina, United States

Prisma Health Cancer Institute - Eastside; 🇺🇸 Greenville, South Carolina, United States

Self Regional Healthcare; 🇺🇸 Greenwood, South Carolina, United States

Prisma Health Cancer Institute - Greer; 🇺🇸 Greer, South Carolina, United States

Prisma Health Cancer Institute - Seneca; 🇺🇸 Seneca, South Carolina, United States

Spartanburg Medical Center; 🇺🇸 Spartanburg, South Carolina, United States

Avera Cancer Institute; 🇺🇸 Sioux Falls, South Dakota, United States

Sanford USD Medical Center - Sioux Falls; 🇺🇸 Sioux Falls, South Dakota, United States

University of Tennessee - Knoxville; 🇺🇸 Knoxville, Tennessee, United States

Vanderbilt University/Ingram Cancer Center; 🇺🇸 Nashville, Tennessee, United States

Parkland Memorial Hospital; 🇺🇸 Dallas, Texas, United States

UT Southwestern/Simmons Cancer Center-Dallas; 🇺🇸 Dallas, Texas, United States

Brooke Army Medical Center; 🇺🇸 Fort Sam Houston, Texas, United States

Baylor All Saints Medical Center at Fort Worth; 🇺🇸 Fort Worth, Texas, United States

Lyndon Baines Johnson General Hospital; 🇺🇸 Houston, Texas, United States

Houston Methodist Hospital; 🇺🇸 Houston, Texas, United States

Colorado Gynecologic Oncology Group; 🇺🇸 Aurora, Colorado, United States

University of Colorado Hospital; 🇺🇸 Aurora, Colorado, United States

Scott and White Memorial Hospital; 🇺🇸 Temple, Texas, United States

Wilford Hall Medical Center; 🇺🇸 Lackland Air Force Base, Texas, United States

McKay-Dee Hospital Center; 🇺🇸 Ogden, Utah, United States

Delbert Day Cancer Institute at PCRMC; 🇺🇸 Rolla, Missouri, United States

Saint Luke's Hospital; 🇺🇸 Chesterfield, Missouri, United States

Mercy Hospital Springfield; 🇺🇸 Springfield, Missouri, United States

CoxHealth South Hospital; 🇺🇸 Springfield, Missouri, United States

Marshfield Medical Center-Rice Lake; 🇺🇸 Rice Lake, Wisconsin, United States

Aurora West Allis Medical Center; 🇺🇸 West Allis, Wisconsin, United States

Marshfield Clinic - Wisconsin Rapids Center; 🇺🇸 Wisconsin Rapids, Wisconsin, United States

Fairview Ridges Hospital; 🇺🇸 Burnsville, Minnesota, United States

Essentia Health Saint Mary's Medical Center; 🇺🇸 Duluth, Minnesota, United States

Coborn Cancer Center at Saint Cloud Hospital; 🇺🇸 Saint Cloud, Minnesota, United States

Ridgeview Medical Center; 🇺🇸 Waconia, Minnesota, United States

Park Nicollet Clinic - Saint Louis Park; 🇺🇸 Saint Louis Park, Minnesota, United States

Roswell Park Cancer Institute; 🇺🇸 Buffalo, New York, United States

Northwell Health/Center for Advanced Medicine; 🇺🇸 Lake Success, New York, United States

Harrison HealthPartners Hematology and Oncology-Bremerton; 🇺🇸 Bremerton, Washington, United States

New Hanover Regional Medical Center/Zimmer Cancer Center; 🇺🇸 Wilmington, North Carolina, United States

Saint Joseph Medical Center; 🇺🇸 Tacoma, Washington, United States

Memorial Hospital; 🇺🇸 Carthage, Illinois, United States

Women's Cancer Associates; 🇺🇸 Saint Petersburg, Florida, United States

Advocate Sherman Hospital; 🇺🇸 Elgin, Illinois, United States

Saint Vincent Hospital and Health Care Center; 🇺🇸 Indianapolis, Indiana, United States

Michiana Hematology Oncology PC-Mishawaka; 🇺🇸 Mishawaka, Indiana, United States

Michiana Hematology Oncology PC-South Bend; 🇺🇸 South Bend, Indiana, United States

The Community Hospital; 🇺🇸 Munster, Indiana, United States

Saint Joseph Regional Medical Center-Mishawaka; 🇺🇸 Mishawaka, Indiana, United States

South Bend Clinic; 🇺🇸 South Bend, Indiana, United States

Commonwealth Hematology Oncology PC-Worcester; 🇺🇸 Worcester, Massachusetts, United States

Spectrum Health Big Rapids Hospital; 🇺🇸 Big Rapids, Michigan, United States

Wayne State University/Karmanos Cancer Institute; 🇺🇸 Detroit, Michigan, United States

Hurley Medical Center; 🇺🇸 Flint, Michigan, United States

Cancer Research Consortium of West Michigan NCORP; 🇺🇸 Grand Rapids, Michigan, United States

Genesys Regional Medical Center-West Flint Campus; 🇺🇸 Flint, Michigan, United States

Saint Mary Mercy Hospital; 🇺🇸 Livonia, Michigan, United States

Bronson Methodist Hospital; 🇺🇸 Kalamazoo, Michigan, United States

Borgess Medical Center; 🇺🇸 Kalamazoo, Michigan, United States

Mary Rutan Hospital; 🇺🇸 Bellefontaine, Ohio, United States

Marietta Memorial Hospital; 🇺🇸 Marietta, Ohio, United States

Clinton Memorial Hospital; 🇺🇸 Wilmington, Ohio, United States

Geisinger Wyoming Valley/Henry Cancer Center; 🇺🇸 Wilkes-Barre, Pennsylvania, United States

PeaceHealth Medical Group PC; 🇺🇸 Bellingham, Washington, United States

Skagit Valley Hospital Regional Cancer Care Center; 🇺🇸 Mount Vernon, Washington, United States

Harrison HealthPartners Hematology and Oncology-Poulsbo; 🇺🇸 Poulsbo, Washington, United States

MultiCare Deaconess Cancer and Blood Specialty Center - Downtown; 🇺🇸 Spokane, Washington, United States

Olympic Medical Cancer Care Center; 🇺🇸 Sequim, Washington, United States

Providence Saint Mary Regional Cancer Center; 🇺🇸 Walla Walla, Washington, United States

North Star Lodge Cancer Center at Yakima Valley Memorial Hospital; 🇺🇸 Yakima, Washington, United States

Marshfield Clinic Cancer Center at Sacred Heart; 🇺🇸 Eau Claire, Wisconsin, United States

Marshfield Clinic-Chippewa Center; 🇺🇸 Chippewa Falls, Wisconsin, United States

Green Bay Oncology at Saint Vincent Hospital; 🇺🇸 Green Bay, Wisconsin, United States

Saint Vincent Hospital Cancer Center Green Bay; 🇺🇸 Green Bay, Wisconsin, United States

Green Bay Oncology Limited at Saint Mary's Hospital; 🇺🇸 Green Bay, Wisconsin, United States

Marshfield Medical Center-Marshfield; 🇺🇸 Marshfield, Wisconsin, United States

Ascension Columbia Saint Mary's Hospital - Milwaukee; 🇺🇸 Milwaukee, Wisconsin, United States

Aurora Sinai Medical Center; 🇺🇸 Milwaukee, Wisconsin, United States

Ascension Columbia Saint Mary's Hospital Ozaukee; 🇺🇸 Mequon, Wisconsin, United States

Marshfield Clinic-Minocqua Center; 🇺🇸 Minocqua, Wisconsin, United States

Aurora Medical Center in Summit; 🇺🇸 Summit, Wisconsin, United States

Ascension Saint Michael's Hospital; 🇺🇸 Stevens Point, Wisconsin, United States

Marshfield Medical Center - Weston; 🇺🇸 Weston, Wisconsin, United States

University of California Davis Comprehensive Cancer Center; 🇺🇸 Sacramento, California, United States

Sutter Medical Center Sacramento; 🇺🇸 Sacramento, California, United States

Saint Joseph Mercy Hospital; 🇺🇸 Ann Arbor, Michigan, United States

Michigan Cancer Research Consortium NCORP; 🇺🇸 Ann Arbor, Michigan, United States

Southeast Clinical Oncology Research Consortium NCORP; 🇺🇸 Winston-Salem, North Carolina, United States

Wake Forest University Health Sciences; 🇺🇸 Winston-Salem, North Carolina, United States

Pacific Gynecology Specialists; 🇺🇸 Seattle, Washington, United States

Northern Indiana Cancer Research Consortium; 🇺🇸 South Bend, Indiana, United States

Marshfield Medical Center; 🇺🇸 Marshfield, Wisconsin, United States

Michiana Hematology Oncology PC-Plymouth; 🇺🇸 Plymouth, Indiana, United States

Beaumont Hospital - Dearborn; 🇺🇸 Dearborn, Michigan, United States

Cancer Institutes of Washington PLLC; 🇺🇸 Yakima, Washington, United States

Vince Lombardi Cancer Clinic-Two Rivers; 🇺🇸 Two Rivers, Wisconsin, United States

Henry Ford Hospital; 🇺🇸 Detroit, Michigan, United States

Ascension Saint John Hospital; 🇺🇸 Detroit, Michigan, United States

Kettering Medical Center; 🇺🇸 Kettering, Ohio, United States

MultiCare Tacoma General Hospital; 🇺🇸 Tacoma, Washington, United States

The Women's Oncology Center; 🇺🇸 Saint Louis, Missouri, United States

UMass Memorial Medical Center - University Campus; 🇺🇸 Worcester, Massachusetts, United States

AdventHealth Orlando; 🇺🇸 Orlando, Florida, United States

Orlando Health Cancer Institute; 🇺🇸 Orlando, Florida, United States

Norton Hospital Pavilion and Medical Campus; 🇺🇸 Louisville, Kentucky, United States

Tulane University Health Sciences Center; 🇺🇸 New Orleans, Louisiana, United States

Ochsner Medical Center Jefferson; 🇺🇸 New Orleans, Louisiana, United States

UNC Lineberger Comprehensive Cancer Center; 🇺🇸 Chapel Hill, North Carolina, United States

Medical University of South Carolina; 🇺🇸 Charleston, South Carolina, United States

Virginia Commonwealth University/Massey Cancer Center; 🇺🇸 Richmond, Virginia, United States

University of Hawaii Cancer Center; 🇺🇸 Honolulu, Hawaii, United States

The Cancer Center of Hawaii-Liliha; 🇺🇸 Honolulu, Hawaii, United States

Kapiolani Medical Center for Women and Children; 🇺🇸 Honolulu, Hawaii, United States

Mercy Capitol; 🇺🇸 Des Moines, Iowa, United States

Iowa-Wide Oncology Research Coalition NCORP; 🇺🇸 Des Moines, Iowa, United States

Hawaii Cancer Care Inc - Waterfront Plaza; 🇺🇸 Honolulu, Hawaii, United States

Queen's Cancer Center - Kuakini; 🇺🇸 Honolulu, Hawaii, United States

Iowa Methodist Medical Center; 🇺🇸 Des Moines, Iowa, United States

Queen's Medical Center; 🇺🇸 Honolulu, Hawaii, United States

Straub Clinic and Hospital; 🇺🇸 Honolulu, Hawaii, United States

Mercy Medical Center - Des Moines; 🇺🇸 Des Moines, Iowa, United States

Medical Oncology and Hematology Associates-Des Moines; 🇺🇸 Des Moines, Iowa, United States

Medical Oncology and Hematology Associates-Laurel; 🇺🇸 Des Moines, Iowa, United States

Iowa Lutheran Hospital; 🇺🇸 Des Moines, Iowa, United States

Baptist Health Lexington; 🇺🇸 Lexington, Kentucky, United States

University of Kentucky/Markey Cancer Center; 🇺🇸 Lexington, Kentucky, United States

Montefiore Medical Center-Einstein Campus; 🇺🇸 Bronx, New York, United States

University of Wisconsin Hospital and Clinics; 🇺🇸 Madison, Wisconsin, United States

Spectrum Health at Butterworth Campus; 🇺🇸 Grand Rapids, Michigan, United States

Cancer Center of Kansas-Kingman; 🇺🇸 Kingman, Kansas, United States

Cancer Center of Kansas - Newton; 🇺🇸 Newton, Kansas, United States

NYU Winthrop Hospital; 🇺🇸 Mineola, New York, United States

Cancer Center of Kansas - Parsons; 🇺🇸 Parsons, Kansas, United States

Saint Margaret's Hospital; 🇺🇸 Spring Valley, Illinois, United States

Chester County Hospital; 🇺🇸 West Chester, Pennsylvania, United States