Prophylactic Antiviral Therapy in Patients With Current or Past Hepatitis B Virus Infection Receiving Anti-Cancer Therapy for Solid Tumors

Phase 3

Terminated

Conditions: Hepatitis B Infection
Malignant Solid Neoplasm

Interventions: Drug: Entecavir
Other: Best Practice
Drug: Tenofovir Alafenamide
Drug: Tenofovir Disoproxil Fumarate

Registration Number: NCT03887702

Lead Sponsor: SWOG Cancer Research Network

Brief Summary: This phase III trial studies the effect of hepatitis B antiviral (anti-HBV) therapy in preventing liver complications in patients with chronic or past hepatitis B virus (HBV) who are receiving anti-cancer therapy for solid tumors. People with chronic or past HBV who are undergoing therapy for cancer are at an increased risk for changes in the liver which could be minor or severe. Anti-HBV therapy acts against infections caused by HBV and may help reduce the chance that HBV gets worse or comes back in patients receiving anti-cancer therapy for solid tumors.

Detailed Description: Co-Primary Objectives

1. To compare the effect of prophylactic anti-HBV therapy versus upon indication anti-HBV therapy on time-to-adverse liver outcomes of liver failure or liver-related death in patients with chronic HBV infection (HBsAg+ and anti-HBc+) receiving anti-cancer therapy for solid tumors.

2. To compare the effect of upon indication anti-HBV therapy versus usual care on time-to-adverse liver outcomes of liver failure or liver-related death in patients with past HBV infection (HBsAg- and anti-HBc+) receiving anti-cancer therapy for solid tumors.

Secondary Objectives

1. Using time-to-event analysis, to compare the effect of anti-HBV therapy versus upon indication anti-HBV therapy on HBV reactivation, on the combined endpoint of adverse liver outcomes (liver failure or liver-related death) and HBV reactivation, and on HBV flare by arm in patients with chronic HBV infection receiving anticancer therapy for solid tumors.

2. Using time-to-event analysis, to compare the effect of upon indication anti-HBV therapy versus usual care on HBV reactivation, on the combined endpoint of adverse liver outcomes (liver failure or liver-related death) and HBV reactivation, and on HBV flare by arm in patients with past HBV infection receiving anti-cancer therapy for solid tumors.

Translational Objectives

1. To compare baseline and changes in overall immune status and HBV-specific immune response in patients with solid tumors and chronic or past HBV infection receiving anti-cancer therapy, and to compare the differences in these immune responses by HBV reactivation status.

2. To identify demographic and clinical predictors and correlative immunologic biomarkers of HBV reactivation after receipt of anti-cancer therapy in patients with solid tumors and chronic or past HBV infection.

OUTLINE: Patients are recruited in two cohorts (Cohort 1: chronic HBV infection, Cohort 2: past HBV infection), with each cohort randomized equally to one of two potential treatment arms.

Chronic HBV Infection (Cohort 1) Arms:

Arm 1: Patients receive tenofovir alafenamide (TAF) orally (PO) once daily (QD) or tenofovir disoproxil fumarate (TDF) PO QD or entecavir PO QD immediately or within 42 days after initial dose of chemotherapy. Treatment continues for up to 6 months after the last dose of chemotherapy or a maximum of 24 months in the absence of disease progression or unacceptable toxicity.

Arm 2: Patients receive TAF PO QD or TDF PO QD or entecavir PO QD after HBV reactivation during chemotherapy. Treatment continues for up to 6 months after the last dose of chemotherapy or a maximum of 24 months in the absence of disease progression or unacceptable toxicity.

Past HBV infection (Cohort 2) Arms:

Arm 3: Patients receive TAF PO QD or TDF PO QD or entecavir PO QD after HBV reactivation during chemotherapy. Treatment continues for up to 6 months after the last dose of chemotherapy or a maximum of 24 months in the absence of disease progression or unacceptable toxicity.

Arm 4: Patients receive anti-HBV therapy at the discretion of the physician. Any Food and Drug Administration (FDA) approved anti-viral medication for HBV may be used.

(Cohort 1: Arm 2 and Cohort 2: Arm 3 follow the same treatment plan, but are considered part of separate parallel studies and are therefore identified as separate arms.)

Patients are followed for 24 months: every 4 weeks from randomization to week 24, then every 8 weeks thereafter up to week 104.

Recruitment & Eligibility

Status: TERMINATED

Sex: All

Target Recruitment: 4

Inclusion Criteria

Patients must be diagnosed with stage I-III solid tumor malignancy; patients with only carcinoma in situ or with stage IV disease are excluded
Patients must not have lymphoma, leukemia, or myeloma
Patients must not have primary liver cancer, known cirrhosis, or evidence of any malignancy that involves the liver
Patients must be planning to receive systemic anti-cancer therapy (either single agent or some combination of systemic cytotoxic therapy, systemic immunotherapy or systemic targeted therapy) for this solid tumor
Patients must not have been previously treated with the same anti-cancer therapy regimen that is now anticipated; the anti-cancer therapy does not have to be first-line therapy; prior and/or concurrent radiotherapy is allowed
Patients must be registered <= 28 days prior to the planned start date of anti-cancer therapy; if the patient has started systemic anti-cancer therapy, patient must be registered <= 42 days after the initiation of first cycle of anti-cancer therapy
Patients who have received prior anti-cancer therapy must have discontinued all previous therapies (excluding planned anti-cancer therapy to occur in conjunction with this study) >= 1 day prior to registration to this study
Patients must not have had any cancer therapy regimen that includes anti-CD20
Patients must not be receiving antiviral medications active against HBV, including: adefovir, entecavir, lamivudine, telbivudine, tenofovir disoproxil fumarate, tenofovir alafenamide (TAF), or any other Food and Drug Administration (FDA) approved agents for the treatment of hepatitis B; patients who have previously received antiviral medication must not have required any antiviral medication active against HBV >= 90 days prior to registration to this study
Patients must not have had hematopoietic stem cell transplantation therapy
Patients must not be taking or planning to take warfarin
Patients who will be treated with TAF must not be taking or planning to take oxcarbazepine, phenobarbital, phenytoin, rifabutin, rifampin, rifapentine, or St. John's Wort
Patients who will be treated with TAF and are concomitantly taking or plan to take carbamazepine must be given an increased dose of TAF or alternatively be given ETV or TDF
Patients must have results for the following HBV tests done within 28 days prior to registration: HBsAg AND anti-HBc (total immunoglobulin [Ig] or IgG, but not IgM only) AND hepatitis B surface antibody (anti-HBs); for the anti-HBs test, quantitative or qualitative (including "indeterminate") results are allowable
Patients must have tested positive for HBsAg or anti-HBc (total Ig, IgG, but not IgM) and must have baseline HBV deoxyribonucleic acid (DNA) completed <= 42 days prior to registration
Complete blood count (CBC) must be completed <= 28 days prior to registration; results do not need to be in the institutional limits of normal
International normalized ratio (INR) must be completed <= 28 days prior to registration; results must <= 1.2 x institutional limits of normal
Alanine aminotransferase (ALT) must be obtained <= 28 days prior to registration; ALT must be < 1.5 x institutional ULN
Total bilirubin must be obtained <= 28 days prior to registration; total bilirubin must be < 1.5 x institutional ULN
Creatinine results must be obtained <= 28 days prior to registration
Patients must not have known current active hepatitis C infection (HCV); active HCV is defined by a detectable HCV ribonucleic acid (RNA) level; Note: HCV testing is not required for eligibility
Patients must not have a history of human immunodeficiency (HIV) infection; patients with unknown HIV status must have HIV testing completed <= 365 days prior to registration
Patients must have Zubrod performance status of 0-2
Patients must not be pregnant or nursing, as the safety of the study drug in pregnant and nursing women has not been established; women/men of reproductive potential must have agreed to use an effective contraceptive method; a woman is considered to be of "reproductive potential" if she has had menses at any time in the preceding 12 consecutive months; in addition to routine contraceptive methods, "effective contraception" also includes heterosexual celibacy and surgery intended to prevent pregnancy (or with a side-effect of pregnancy prevention) defined as a hysterectomy, bilateral oophorectomy or bilateral tubal ligation; however, if at any point a previously celibate patient chooses to become heterosexually active during the time period for use of contraceptive measures outlined in the protocol, he/she is responsible for beginning contraceptive measures
Patients must have specimens collected for submission as outlined
Patients must be offered the opportunity to participate in optional translational medicine studies as outlined
Patients with impaired decision-making capacity are eligible as long as their neurological or psychological condition does not preclude their safe participation in the study (e.g., tracking pill consumption and reporting adverse events to the investigator)
Patients may have concurrent participation in other clinical trials that entail cytotoxic, immunotherapy, targeted therapy; surgical treatment; radiotherapy treatment; or any combination thereof
Patients must be informed of the investigational nature of this study and must sign and give written informed consent in accordance with institutional and federal guidelines
As a part of the Oncology Patient Enrollment Network (OPEN) registration process the treating institution's identity is provided in order to ensure that the current (within 365 days) date of institutional review board approval for this study has been entered in the system

Exclusion Criteria

Not provided

Study & Design

Study Type: INTERVENTIONAL

Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Arm 1 (TAF, TDF, entecavir: prophylactic)	Entecavir	\[Cohort 1\] Patients receive TAF PO QD or TDF PO QD or entecavir PO QD immediately or within 42 days after initial dose of chemotherapy. Treatment continues for up to 6 months after the last dose of chemotherapy or a maximum of 24 months in the absence of disease progression or unacceptable toxicity.
Arm 1 (TAF, TDF, entecavir: prophylactic)	Tenofovir Disoproxil Fumarate	\[Cohort 1\] Patients receive TAF PO QD or TDF PO QD or entecavir PO QD immediately or within 42 days after initial dose of chemotherapy. Treatment continues for up to 6 months after the last dose of chemotherapy or a maximum of 24 months in the absence of disease progression or unacceptable toxicity.
Arm 2 (TAF, TDF, entecavir: upon indication)	Tenofovir Alafenamide	\[Cohort 1\] Patients receive TAF PO QD or TDF PO QD or entecavir PO QD after HBV reactivation during chemotherapy. Treatment continues for up to 6 months after the last dose of chemotherapy or a maximum of 24 months in the absence of disease progression or unacceptable toxicity.
Arm 4 (Anti-Viral therapy: usual care)	Best Practice	\[Cohort 2\] Patients receive anti-HBV therapy at the discretion of the physician. Any Food and Drug Administration (FDA) approved anti-viral medication for treatment of HBV may be utilized.
Arm 1 (TAF, TDF, entecavir: prophylactic)	Tenofovir Alafenamide	\[Cohort 1\] Patients receive TAF PO QD or TDF PO QD or entecavir PO QD immediately or within 42 days after initial dose of chemotherapy. Treatment continues for up to 6 months after the last dose of chemotherapy or a maximum of 24 months in the absence of disease progression or unacceptable toxicity.
Arm 2 (TAF, TDF, entecavir: upon indication)	Entecavir	\[Cohort 1\] Patients receive TAF PO QD or TDF PO QD or entecavir PO QD after HBV reactivation during chemotherapy. Treatment continues for up to 6 months after the last dose of chemotherapy or a maximum of 24 months in the absence of disease progression or unacceptable toxicity.
Arm 2 (TAF, TDF, entecavir: upon indication)	Tenofovir Disoproxil Fumarate	\[Cohort 1\] Patients receive TAF PO QD or TDF PO QD or entecavir PO QD after HBV reactivation during chemotherapy. Treatment continues for up to 6 months after the last dose of chemotherapy or a maximum of 24 months in the absence of disease progression or unacceptable toxicity.
Arm 3 (TAF, TDF, entecavir: upon indication)	Entecavir	\[Cohort 2\] Patients receive TAF PO QD or TDF PO QD or entecavir PO QD after HBV reactivation during chemotherapy. Treatment continues for up to 6 months after the last dose of chemotherapy or a maximum of 24 months in the absence of disease progression or unacceptable toxicity.
Arm 3 (TAF, TDF, entecavir: upon indication)	Tenofovir Alafenamide	\[Cohort 2\] Patients receive TAF PO QD or TDF PO QD or entecavir PO QD after HBV reactivation during chemotherapy. Treatment continues for up to 6 months after the last dose of chemotherapy or a maximum of 24 months in the absence of disease progression or unacceptable toxicity.
Arm 4 (Anti-Viral therapy: usual care)	Entecavir	\[Cohort 2\] Patients receive anti-HBV therapy at the discretion of the physician. Any Food and Drug Administration (FDA) approved anti-viral medication for treatment of HBV may be utilized.
Arm 3 (TAF, TDF, entecavir: upon indication)	Tenofovir Disoproxil Fumarate	\[Cohort 2\] Patients receive TAF PO QD or TDF PO QD or entecavir PO QD after HBV reactivation during chemotherapy. Treatment continues for up to 6 months after the last dose of chemotherapy or a maximum of 24 months in the absence of disease progression or unacceptable toxicity.
Arm 4 (Anti-Viral therapy: usual care)	Tenofovir Alafenamide	\[Cohort 2\] Patients receive anti-HBV therapy at the discretion of the physician. Any Food and Drug Administration (FDA) approved anti-viral medication for treatment of HBV may be utilized.
Arm 4 (Anti-Viral therapy: usual care)	Tenofovir Disoproxil Fumarate	\[Cohort 2\] Patients receive anti-HBV therapy at the discretion of the physician. Any Food and Drug Administration (FDA) approved anti-viral medication for treatment of HBV may be utilized.

Primary Outcome Measures

Name	Time	Method
Number of Participants With Adverse Liver Outcome	From randomization to 24 months	Adverse liver outcome: Defined as liver-related death or liver failure (ascites, hepatic encephalopathy or impaired hepatic synthetic function defined as total bilirubin ≥ 5 mg/dL or INR ≥ 2.0) not due to disease progression in the liver. Assessment of the primary endpoint will be made by sites and subsequently adjudicated by the research oversight team by blinded review.

Secondary Outcome Measures

Name	Time	Method
Number of Participants With Hepatitis B Virus (HBV) Flare	From randomization to 24 months	Hepatitis flare is defined as ALT \> 3 x baseline and \>100 U/L.
Combined Endpoint of Adverse Liver Outcomes and HBV Reactivation, Number of Participants	From randomization to 24 months	Adverse liver outcome: Defined as liver-related death or liver failure (ascites, hepatic encephalopathy or impaired hepatic synthetic function defined as total bilirubin ≥ 5 mg/dL or INR ≥ 2.0) not due to disease progression in the liver. Assessment of the primary endpoint will be made by sites and subsequently adjudicated by the research oversight team by blinded review. HBV reactivation is defined as one of the following: * ≥ 2 log (100-fold) increase in HBV DNA compared to baseline in patients with detectable HBV DNA at baseline, or * HBV DNA ≥ 3 log (1,000) IU/mL in a patient with previously undetectable HBV DNA, or * HBV DNA ≥ 4 log (10,000) IU/mL if baseline HBV DNA not available, or * HBsAg seroreversion (HBsAg- to HBsAg+) in a patient previously HBsAg-. The combined endpoint of adverse liver outcomes and HBV reactivation is the occurrence of either adverse liver outcome or HBV reactivation as defined above.
Number of Participants With Hepatitis B Virus (HBV) Reactivation	From randomization up to 24 months	HBV reactivation is is defined as one of the following: * ≥ 2 log (100-fold) increase in HBV DNA compared to baseline in patients with detectable HBV DNA at baseline, or * HBV DNA ≥ 3 log (1,000) IU/mL in a patient with previously undetectable HBV DNA, or * HBV DNA ≥ 4 log (10,000) IU/mL if baseline HBV DNA not available, or * HBsAg seroreversion (HBsAg- to HBsAg+) in a patient previously HBsAg-.

Trial Locations

Locations (193): Prisma Health Cancer Institute - Easley
🇺🇸
Easley, South Carolina, United States
M D Anderson Cancer Center
🇺🇸
Houston, Texas, United States
Health Partners Inc
🇺🇸
Minneapolis, Minnesota, United States
Lawrence Memorial Hospital
🇺🇸
Lawrence, Kansas, United States
Cancer Center of Kansas - El Dorado
🇺🇸
El Dorado, Kansas, United States
Cancer Center of Kansas-Liberal
🇺🇸
Liberal, Kansas, United States
Cancer Center of Kansas - McPherson
🇺🇸
McPherson, Kansas, United States
Menorah Medical Center
🇺🇸
Overland Park, Kansas, United States
Cancer Center of Kansas - Wichita
🇺🇸
Wichita, Kansas, United States
Cancer Center of Kansas - Salina
🇺🇸
Salina, Kansas, United States
Cancer Center of Kansas - Wellington
🇺🇸
Wellington, Kansas, United States
Cancer Center of Kansas - Winfield
🇺🇸
Winfield, Kansas, United States
Associates In Womens Health
🇺🇸
Wichita, Kansas, United States
Kansas Institute of Medicine Cancer and Blood Center
🇺🇸
Lenexa, Kansas, United States
Minimally Invasive Surgery Hospital
🇺🇸
Lenexa, Kansas, United States
Cancer Center of Kansas - Newton
🇺🇸
Newton, Kansas, United States
Cancer Center of Kansas - Dodge City
🇺🇸
Dodge City, Kansas, United States
Cancer Center of Kansas - Chanute
🇺🇸
Chanute, Kansas, United States
Cancer Center of Kansas-Kingman
🇺🇸
Kingman, Kansas, United States
Billings Clinic-Cody
🇺🇸
Cody, Wyoming, United States
Cancer Center of Kansas-Independence
🇺🇸
Independence, Kansas, United States
Welch Cancer Center
🇺🇸
Sheridan, Wyoming, United States
Cancer Center of Kansas-Manhattan
🇺🇸
Manhattan, Kansas, United States
Cancer Center of Kansas - Parsons
🇺🇸
Parsons, Kansas, United States
Central Care Cancer Center - Great Bend
🇺🇸
Great Bend, Kansas, United States
Kaiser Permanente-San Francisco
🇺🇸
San Francisco, California, United States
Central Care Cancer Center - Bolivar
🇺🇸
Bolivar, Missouri, United States
Mercy Hospital Springfield
🇺🇸
Springfield, Missouri, United States
Los Angeles County-USC Medical Center
🇺🇸
Los Angeles, California, United States
Kootenai Health - Coeur d'Alene
🇺🇸
Coeur d'Alene, Idaho, United States
Walter Knox Memorial Hospital
🇺🇸
Emmett, Idaho, United States
Minnesota Oncology Hematology PA-Maplewood
🇺🇸
Maplewood, Minnesota, United States
Saint John's Hospital - Healtheast
🇺🇸
Maplewood, Minnesota, United States
Monticello Cancer Center
🇺🇸
Monticello, Minnesota, United States
North Memorial Medical Health Center
🇺🇸
Robbinsdale, Minnesota, United States
New Ulm Medical Center
🇺🇸
New Ulm, Minnesota, United States
Park Nicollet Clinic - Saint Louis Park
🇺🇸
Saint Louis Park, Minnesota, United States
Ridgeview Medical Center
🇺🇸
Waconia, Minnesota, United States
Minnesota Oncology Hematology PA-Woodbury
🇺🇸
Woodbury, Minnesota, United States
Mercy Hospital South
🇺🇸
Saint Louis, Missouri, United States
Great Falls Clinic
🇺🇸
Great Falls, Montana, United States
Prisma Health Greenville Memorial Hospital
🇺🇸
Greenville, South Carolina, United States
Prisma Health Cancer Institute - Eastside
🇺🇸
Greenville, South Carolina, United States
Mercy Hospital Oklahoma City
🇺🇸
Oklahoma City, Oklahoma, United States
Abbott-Northwestern Hospital
🇺🇸
Minneapolis, Minnesota, United States
Prisma Health Cancer Institute - Greer
🇺🇸
Greer, South Carolina, United States
Kaiser Permanente-Woodland Hills
🇺🇸
Woodland Hills, California, United States
Lewis Cancer and Research Pavilion at Saint Joseph's/Candler
🇺🇸
Savannah, Georgia, United States
Kaiser Permanente-Anaheim
🇺🇸
Anaheim, California, United States
Kaiser Permanente-Deer Valley Medical Center
🇺🇸
Antioch, California, United States
Kaiser Permanente-Baldwin Park
🇺🇸
Baldwin Park, California, United States
Mercy Hospital Fort Smith
🇺🇸
Fort Smith, Arkansas, United States
Epic Care-Dublin
🇺🇸
Dublin, California, United States
Kaiser Permanente-Bellflower
🇺🇸
Bellflower, California, United States
Kaiser Permanente Dublin
🇺🇸
Dublin, California, United States
Epic Care Partners in Cancer Care
🇺🇸
Emeryville, California, United States
Kaiser Permanente-Fremont
🇺🇸
Fremont, California, United States
Bay Area Breast Surgeons Inc
🇺🇸
Emeryville, California, United States
Kaiser Permanente-Fontana
🇺🇸
Fontana, California, United States
Kaiser Permanente - Harbor City
🇺🇸
Harbor City, California, United States
Fresno Cancer Center
🇺🇸
Fresno, California, United States
Kaiser Permanente-Irvine
🇺🇸
Irvine, California, United States
Tibor Rubin VA Medical Center
🇺🇸
Long Beach, California, United States
Kaiser Permanente West Los Angeles
🇺🇸
Los Angeles, California, United States
Kaiser Permanente Los Angeles Medical Center
🇺🇸
Los Angeles, California, United States
USC / Norris Comprehensive Cancer Center
🇺🇸
Los Angeles, California, United States
Contra Costa Regional Medical Center
🇺🇸
Martinez, California, United States
USC Norris Oncology/Hematology-Newport Beach
🇺🇸
Newport Beach, California, United States
Kaiser Permanente-Modesto
🇺🇸
Modesto, California, United States
Alta Bates Summit Medical Center - Summit Campus
🇺🇸
Oakland, California, United States
Bay Area Tumor Institute
🇺🇸
Oakland, California, United States
Kaiser Permanente Oakland-Broadway
🇺🇸
Oakland, California, United States
Keck Medical Center of USC Pasadena
🇺🇸
Pasadena, California, United States
Kaiser Permanente-Oakland
🇺🇸
Oakland, California, United States
Kaiser Permanente-Ontario
🇺🇸
Ontario, California, United States
Kaiser Permanente - Panorama City
🇺🇸
Panorama City, California, United States
Kaiser Permanente-Rancho Cordova Cancer Center
🇺🇸
Rancho Cordova, California, United States
Kaiser Permanente-Redwood City
🇺🇸
Redwood City, California, United States
Kaiser Permanente-Richmond
🇺🇸
Richmond, California, United States
Kaiser Permanente-Riverside
🇺🇸
Riverside, California, United States
Kaiser Permanente-Roseville
🇺🇸
Roseville, California, United States
Rohnert Park Cancer Center
🇺🇸
Rohnert Park, California, United States
The Permanente Medical Group-Roseville Radiation Oncology
🇺🇸
Roseville, California, United States
Kaiser Permanente-San Diego Zion
🇺🇸
San Diego, California, United States
Kaiser Permanente-Santa Teresa-San Jose
🇺🇸
San Jose, California, United States
Kaiser Permanente San Leandro
🇺🇸
San Leandro, California, United States
Kaiser Permanente-San Rafael
🇺🇸
San Rafael, California, United States
Kaiser Permanente-San Marcos
🇺🇸
San Marcos, California, United States
Kaiser San Rafael-Gallinas
🇺🇸
San Rafael, California, United States
Kaiser Permanente-Santa Rosa
🇺🇸
Santa Rosa, California, United States
Kaiser Permanente Medical Center - Santa Clara
🇺🇸
Santa Clara, California, United States
Kaiser Permanente Cancer Treatment Center
🇺🇸
South San Francisco, California, United States
Kaiser Permanente-South San Francisco
🇺🇸
South San Francisco, California, United States
Kaiser Permanente Medical Center-Vacaville
🇺🇸
Vacaville, California, United States
Kaiser Permanente-Vallejo
🇺🇸
Vallejo, California, United States
Kaiser Permanente-Stockton
🇺🇸
Stockton, California, United States
Kaiser Permanente-Walnut Creek
🇺🇸
Walnut Creek, California, United States
Epic Care Cyberknife Center
🇺🇸
Walnut Creek, California, United States
Broward Health North
🇺🇸
Deerfield Beach, Florida, United States
Broward Health Medical Center
🇺🇸
Fort Lauderdale, Florida, United States
Hawaii Cancer Care - Savio
🇺🇸
'Aiea, Hawaii, United States
Pali Momi Medical Center
🇺🇸
'Aiea, Hawaii, United States
Queen's Cancer Center - Pearlridge
🇺🇸
'Aiea, Hawaii, United States
The Cancer Center of Hawaii-Pali Momi
🇺🇸
'Aiea, Hawaii, United States
The Queen's Medical Center - West Oahu
🇺🇸
'Ewa Beach, Hawaii, United States
Wilcox Memorial Hospital and Kauai Medical Clinic
🇺🇸
Lihue, Hawaii, United States
Castle Medical Center
🇺🇸
Kailua, Hawaii, United States
Saint Alphonsus Cancer Care Center-Boise
🇺🇸
Boise, Idaho, United States
Saint Alphonsus Cancer Care Center-Caldwell
🇺🇸
Caldwell, Idaho, United States
Saint Alphonsus Medical Center-Nampa
🇺🇸
Nampa, Idaho, United States
Idaho Urologic Institute-Meridian
🇺🇸
Meridian, Idaho, United States
Kootenai Cancer Clinic
🇺🇸
Sandpoint, Idaho, United States
Saint Anthony's Health
🇺🇸
Alton, Illinois, United States
Northwestern University
🇺🇸
Chicago, Illinois, United States
Carle on Vermilion
🇺🇸
Danville, Illinois, United States
Kootenai Clinic Cancer Services - Post Falls
🇺🇸
Post Falls, Idaho, United States
Rush - Copley Medical Center
🇺🇸
Aurora, Illinois, United States
Good Samaritan Regional Health Center
🇺🇸
Mount Vernon, Illinois, United States
Carle Physician Group-Mattoon/Charleston
🇺🇸
Mattoon, Illinois, United States
Carle Physician Group-Effingham
🇺🇸
Effingham, Illinois, United States
The Carle Foundation Hospital
🇺🇸
Urbana, Illinois, United States
Carle Cancer Center
🇺🇸
Urbana, Illinois, United States
Rush-Copley Healthcare Center
🇺🇸
Yorkville, Illinois, United States
Central Care Cancer Center - Garden City
🇺🇸
Garden City, Kansas, United States
Cancer Center of Kansas - Pratt
🇺🇸
Pratt, Kansas, United States
Cancer Center of Kansas-Wichita Medical Arts Tower
🇺🇸
Wichita, Kansas, United States
Ochsner LSU Health Monroe Medical Center
🇺🇸
Monroe, Louisiana, United States
LSU Health Sciences Center at Shreveport
🇺🇸
Shreveport, Louisiana, United States
Fairview Ridges Hospital
🇺🇸
Burnsville, Minnesota, United States
Cambridge Medical Center
🇺🇸
Cambridge, Minnesota, United States
Minnesota Oncology - Burnsville
🇺🇸
Burnsville, Minnesota, United States
Mercy Hospital
🇺🇸
Coon Rapids, Minnesota, United States
Fairview Southdale Hospital
🇺🇸
Edina, Minnesota, United States
Unity Hospital
🇺🇸
Fridley, Minnesota, United States
Fairview Clinics and Surgery Center Maple Grove
🇺🇸
Maple Grove, Minnesota, United States
Fairview Northland Medical Center
🇺🇸
Princeton, Minnesota, United States
Hennepin County Medical Center
🇺🇸
Minneapolis, Minnesota, United States
Regions 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
Cox Cancer Center Branson
🇺🇸
Branson, Missouri, United States
Mercy Hospital Joplin
🇺🇸
Joplin, Missouri, United States
Centerpoint Medical Center LLC
🇺🇸
Independence, 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
Saint Louis Cancer and Breast Institute-South City
🇺🇸
Saint Louis, Missouri, United States
Heartland Regional Medical Center
🇺🇸
Saint Joseph, Missouri, United States
Mercy Hospital Saint Louis
🇺🇸
Saint Louis, Missouri, United States
Mercy Hospital Washington
🇺🇸
Washington, Missouri, United States
CoxHealth South Hospital
🇺🇸
Springfield, Missouri, United States
Bozeman Deaconess Hospital
🇺🇸
Bozeman, Montana, United States
Billings Clinic Cancer Center
🇺🇸
Billings, Montana, United States
Community Medical Hospital
🇺🇸
Missoula, Montana, United States
NYP/Columbia University Medical Center/Herbert Irving Comprehensive Cancer Center
🇺🇸
New York, New York, United States
Saint Alphonsus Medical Center-Ontario
🇺🇸
Ontario, Oregon, United States
Kaiser Permanente Northwest
🇺🇸
Portland, Oregon, United States
Prisma Health Cancer Institute - Spartanburg
🇺🇸
Boiling Springs, South Carolina, United States
Saint Alphonsus Medical Center-Baker City
🇺🇸
Baker City, Oregon, United States
Prisma Health Cancer Institute - Butternut
🇺🇸
Greenville, South Carolina, United States
Prisma Health Cancer Institute - Faris
🇺🇸
Greenville, South Carolina, United States
Prisma Health Cancer Institute - Seneca
🇺🇸
Seneca, South Carolina, United States
Kaiser Permanente Washington
🇺🇸
Seattle, Washington, United States
Cancer Center of Western Wisconsin
🇺🇸
New Richmond, Wisconsin, United States
FHP Health Center-Guam
🇬🇺
Tamuning, Guam
Kaiser Permanente-Fresno
🇺🇸
Fresno, California, United States
Fairview Lakes Medical Center
🇺🇸
Wyoming, Minnesota, United States
United Hospital
🇺🇸
Saint Paul, Minnesota, United States
Saint Louis Cancer and Breast Institute-Ballwin
🇺🇸
Ballwin, Missouri, United States
University of Mississippi Medical Center
🇺🇸
Jackson, Mississippi, United States
Benefis Healthcare- Sletten Cancer Institute
🇺🇸
Great Falls, Montana, United States
Kalispell Regional Medical Center
🇺🇸
Kalispell, Montana, United States
Saint Peter's Community Hospital
🇺🇸
Helena, Montana, United States
Community Hospital of Anaconda
🇺🇸
Anaconda, Montana, United States
Kaiser Permanente Downtown Commons
🇺🇸
Sacramento, California, United States
Kaiser Permanente-South Sacramento
🇺🇸
Sacramento, California, United States
South Sacramento Cancer Center
🇺🇸
Sacramento, California, United States
Kaiser Permanente - Sacramento
🇺🇸
Sacramento, California, United States
Hawaii Cancer Care Inc - Waterfront Plaza
🇺🇸
Honolulu, Hawaii, United States
Island Urology
🇺🇸
Honolulu, Hawaii, United States
Queen's Cancer Cenrer - POB I
🇺🇸
Honolulu, Hawaii, United States
Queen's Medical Center
🇺🇸
Honolulu, Hawaii, United States
Straub Clinic and Hospital
🇺🇸
Honolulu, Hawaii, United States
University of Hawaii Cancer Center
🇺🇸
Honolulu, Hawaii, United States
Hawaii Cancer Care Inc-Liliha
🇺🇸
Honolulu, Hawaii, United States
Hawaii Diagnostic Radiology Services LLC
🇺🇸
Honolulu, Hawaii, United States
Kuakini Medical Center
🇺🇸
Honolulu, Hawaii, United States
Queen's Cancer Center - Kuakini
🇺🇸
Honolulu, Hawaii, United States
The Cancer Center of Hawaii-Liliha
🇺🇸
Honolulu, Hawaii, United States
Kaiser Permanente Moanalua Medical Center
🇺🇸
Honolulu, Hawaii, United States
Kapiolani Medical Center for Women and Children
🇺🇸
Honolulu, Hawaii, United States
Research Medical Center
🇺🇸
Kansas City, Missouri, United States