Azacitidine With or Without Entinostat in Treating Patients With Myelodysplastic Syndromes, Chronic Myelomonocytic Leukemia, or Acute Myeloid Leukemia

Phase 2

Completed

Conditions: Acute Myeloid Leukemia Arising From Previous Myelodysplastic Syndrome
Adult Acute Myeloid Leukemia in Remission
Adult Acute Myeloid Leukemia With Inv(16)(p13.1q22); CBFB-MYH11
Adult Acute Myeloid Leukemia With t(16;16)(p13.1;q22); CBFB-MYH11
Adult Acute Myeloid Leukemia With t(8;21)(q22;q22); RUNX1-RUNX1T1
Adult Acute Myeloid Leukemia With t(9;11)(p22;q23); MLLT3-MLL
Adult Acute Promyelocytic Leukemia With t(15;17)(q22;q12); PML-RARA
Alkylating Agent-Related Acute Myeloid Leukemia
Recurrent Adult Acute Myeloid Leukemia
Chronic Myelomonocytic Leukemia

Interventions: Drug: Azacitidine
Other: Laboratory Biomarker Analysis
Drug: Entinostat

Registration Number: NCT00313586

Lead Sponsor: National Cancer Institute (NCI)

Brief Summary: This randomized phase II trial studies azacitidine with or without entinostat to see how well they work compared to azacitidine alone in treating patients with myelodysplastic syndromes, chronic myelomonocytic leukemia, or acute myeloid leukemia. Drugs used in chemotherapy, such as azacitidine, work in different ways to stop the growth of cancer cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Entinostat may stop the growth of cancer cells by blocking some of the enzymes needed for cell growth. Giving azacitidine together with entinostat may work better in treating patients with myelodysplastic syndromes, chronic myelomonocytic leukemia, or acute myeloid leukemia.

Detailed Description: PRIMARY OBJECTIVES:

I. To estimate the overall response rate (complete, partial, and hematologic improvement-major by International Working Group \[IWG\] criteria) in response to azacitidine and entinostat.

II. To estimate the major response rate (complete and partial responses by the IWG response criteria) to a 10-day regimen of azacitidine and to the same regimen of azacitidine in combination with entinostat administered orally on days 3 and 10 of each cycle in patients with de novo myelodysplastic syndromes (MDS), chronic myelomonocytic leukemia (CMMoL) (dysplastic) and acute myeloid leukemia with trilineage dysplasia (AML-TLD), as well as in patients with treatment-induced MDS, CMMoL (dysplastic) and AML-TLD.

SECONDARY OBJECTIVES:

I. To evaluate the toxicity of azacitidine and entinostat in this patient population.

II. To identify changes in gene promoter methylation and gene expression which may be associated with response to azacitidine and entinostat.

III. To identify other molecular mechanisms (such as deoxyribonucleic acid \[DNA\] damage) which may be associated with response to azacitidine and entinostat.

OUTLINE: Patients are randomized to 1 of 2 treatment arms.

ARM A: Patients receive azacitidine subcutaneously (SC) once daily (QD) on days 1-10.

ARM B: Patients receive azacitidine as in Arm A and entinostat orally (PO) on days 3 and 10.

In both arms, treatment repeats every 28 days for 6-24 courses in the absence of disease progression or unacceptable toxicity.

After completion of study treatment, patients are followed up for 5 years.

Recruitment & Eligibility

Status: COMPLETED

Sex: All

Target Recruitment: 197

Inclusion Criteria

The following diagnoses will be eligible for this study:
Myelodysplastic syndromes: the diagnosis of MDS must be confirmed by a bone marrow aspirate and/or biopsy within two weeks prior to registration; NOTE: blast count must be < 20%; patients with any International Prognostic Score (IPSS) are eligible; patients with low or intermediate (INT)-1 IPSS must have a platelet count < 50,000/mm^3 and/or absolute neutrophil count (ANC) < 500/mm^3 within seven days prior to registration
Chronic myelomonocytic leukemia (dysplastic subtype): the diagnosis of CMMoL must be confirmed by a bone marrow aspirate and/or biopsy within two weeks prior to registration; patients with CMMoL must have a WBC < 12,000/mm^3, documented within 4 weeks prior to study entry (two sets of counts that are 2 weeks apart will be taken)
Acute myeloid leukemia with multilineage dysplasia: the diagnosis of AML-TLD must be confirmed by a bone marrow aspirate and/or biopsy within two weeks prior to registration; NOTE: there must be evidence of >= 20% blasts on the review of the bone marrow aspirate and/or biopsy; AML-TLD will be interpreted to include patients formerly diagnosed by French-American-British (FAB) criteria as refractory anemia with excess blasts in transformation (RAEB-t), as well as patients with no history of antecedent hematologic disorder who have AML which meets criteria for AML-TLD by World Health Organization (WHO) criteria; patients with AML-TLD must have a white blood cell (WBC) =< 30,000/mm^3 documented within 4 weeks prior to study entry (two sets of counts that are 2 weeks apart will be taken); patients whose WBC has doubled within this period of time and is greater than 20,000/mm^3 at the time of screening will not be eligible
Women must not be pregnant or breast-feeding; all females of childbearing potential must have a blood test or urine study within two weeks prior to registration to rule out pregnancy
Women of childbearing potential and sexually active males must be strongly advised to use an accepted and effective method of contraception
Patient must have Eastern Cooperative Oncology Group (ECOG) performance status between 0-2
Patient must have no prior treatment with azacitidine, decitabine or entinostat
Patients must not have active infections at the time of registration
Serum creatinine < 2.0 mg/dL; test must be done within seven days prior to registration
Total serum bilirubin within institutional limits unless due to intra- or extramedullary hemolysis or Gilbert's syndrome; test must be done within seven days prior to registration
Aspartate transaminase (AST) (serum glutamic oxaloacetic transaminase [SGOT]) and alanine transaminase (ALT) (serum glutamate pyruvate transaminase [SGPT]) =< 2.5 x institutional upper limit of normal (ULN); tests must be done within seven days prior to registration
Patients must not have received any AML induction chemotherapy or stem cell transplantation; any other treatment for their disease, including hematopoietic growth factors may not be given, within three weeks prior to registration, and should have recovered from all toxicities of prior therapy (to grade 0 or 1)
Patients must have no clinical evidence of central nervous system (CNS) or pulmonary leukostasis, disseminated intravascular coagulation, or CNS leukemia
Patients must have no serious or uncontrolled medical conditions
Patients who have therapy-induced MDS, CMMoL (dysplastic) and AML-TLD are eligible and will be treated as separate cohorts from the patients with de novo MDS, CMMoL (dysplastic) and AML-TLD
Patients should have a life expectancy of at least six months
Patients must not have advanced malignant hepatic tumors
Patients must not have a known hypersensitivity to azacitidine or mannitol
Southwest Oncology Group (SWOG) ONLY: all SWOG patients must be registered on SWOG-9007 ("Cytogenetic Studies in Leukemia Patients"); collection of the pretreatment bone marrow specimen (or of peripheral blood if the marrow is not aspirable) must be completed within 28 days before registration; the pretreatment specimen must be submitted to a SWOG-approved cytogenetics laboratory as described in protocol SWOG-9007; note that submission of bone marrow cytogenetic studies are required to calculate the IPSS score (stratification issue); in addition, cytogenetic response will be measured at follow-up requiring a second cytogenetic study at the end of protocol treatment; NOTE: In addition to SWOG-9007, SWOG patients must be offered participation in S9910, the leukemia centralized reference laboratories and tissue repositories ancillary study; If consent is given, collection of pretreatment blood and/or marrow specimens must be completed within 14 days prior to registration. If the patient consents to participate in S9910, pretreatment specimens of marrow and/or peripheral blood must be submitted to the Southwest Oncology Group Myeloid Repository at the University of New Mexico for cellular and molecular studies; S9910 also requests submission of remission and relapse specimens

Exclusion Criteria

Not provided

Study & Design

Study Type: INTERVENTIONAL

Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Arm A (azacitidine)	Laboratory Biomarker Analysis	Patients receive azacitidine SC QD on days 1-10. Treatment repeats every 28 days for 6-24 courses in the absence of disease progression or unacceptable toxicity.
Arm B (azacitidine, entinostat)	Laboratory Biomarker Analysis	Patients receive azacitidine as in Arm A and entinostat PO on days 3 and 10. Treatment repeats every 28 days for 6-24 courses in the absence of disease progression or unacceptable toxicity.
Arm A (azacitidine)	Azacitidine	Patients receive azacitidine SC QD on days 1-10. Treatment repeats every 28 days for 6-24 courses in the absence of disease progression or unacceptable toxicity.
Arm B (azacitidine, entinostat)	Azacitidine	Patients receive azacitidine as in Arm A and entinostat PO on days 3 and 10. Treatment repeats every 28 days for 6-24 courses in the absence of disease progression or unacceptable toxicity.
Arm B (azacitidine, entinostat)	Entinostat	Patients receive azacitidine as in Arm A and entinostat PO on days 3 and 10. Treatment repeats every 28 days for 6-24 courses in the absence of disease progression or unacceptable toxicity.

Primary Outcome Measures

Name	Time	Method
Proportion of Patients With Clinical Response	Assessed every 3 months if patient is < 2 years from study entry, every 6 months if patient is 2 - 5 years from study entry.	Clinical response is defined as a complete response (CR), partial response (PR) or trilineage response (TR) graded according to the following criteria: 1. World Health Organization classification of the acute leukemias and myelodysplastic syndrome (by Bennett) 2. Myelodysplastic syndromes standardized response criteria: further definition (by Cheson et al.) 3. Report of an international working group to standardize response criteria for myelodysplastic syndromes (by Cheson et al.)

Secondary Outcome Measures

Name	Time	Method

Trial Locations

Locations (234): Clements University Hospital
🇺🇸
Dallas, Texas, United States
Union Hospital of Cecil County
🇺🇸
Elkton, Maryland, United States
Hematology and Oncology Associates
🇺🇸
Chicago, Illinois, United States
John H Stroger Jr Hospital of Cook County
🇺🇸
Chicago, Illinois, United States
University of Chicago Comprehensive Cancer Center
🇺🇸
Chicago, Illinois, United States
Presence Saint Joseph Hospital-Chicago
🇺🇸
Chicago, Illinois, United States
Menorah Medical Center
🇺🇸
Overland Park, Kansas, United States
Cancer Center of Kansas - Salina
🇺🇸
Salina, Kansas, United States
Cancer Center of Kansas - Chanute
🇺🇸
Chanute, Kansas, United States
Cancer Center of Kansas-Kingman
🇺🇸
Kingman, Kansas, United States
Kansas City NCI Community Oncology Research Program
🇺🇸
Prairie Village, Kansas, United States
Rocky Mountain Oncology
🇺🇸
Casper, Wyoming, United States
Saint Luke's South Hospital
🇺🇸
Overland Park, Kansas, United States
Lawrence Memorial Hospital
🇺🇸
Lawrence, Kansas, United States
Cancer Center of Kansas-Liberal
🇺🇸
Liberal, Kansas, United States
Cancer Center of Kansas - Newton
🇺🇸
Newton, Kansas, United States
Cancer Center of Kansas-Independence
🇺🇸
Independence, Kansas, United States
Providence Medical Center
🇺🇸
Kansas City, Kansas, United States
Cancer Center of Kansas - El Dorado
🇺🇸
El Dorado, Kansas, United States
Cancer Center of Kansas - Winfield
🇺🇸
Winfield, Kansas, United States
Hospital District Sixth of Harper County
🇺🇸
Anthony, Kansas, United States
Cancer Center of Kansas - Fort Scott
🇺🇸
Fort Scott, Kansas, United States
Radiation Oncology Practice Corporation Southwest
🇺🇸
Overland Park, Kansas, United States
Saint Francis Hospital and Medical Center - Topeka
🇺🇸
Topeka, Kansas, United States
Cancer Center of Kansas - Dodge City
🇺🇸
Dodge City, Kansas, United States
Cancer Center of Kansas - Parsons
🇺🇸
Parsons, Kansas, United States
Cancer Center of Kansas - Wichita
🇺🇸
Wichita, Kansas, United States
Salina Regional Health Center
🇺🇸
Salina, Kansas, United States
Graham Hospital Association
🇺🇸
Canton, Illinois, United States
Stanford Cancer Institute
🇺🇸
Palo Alto, California, United States
North Colorado Medical Center
🇺🇸
Greeley, Colorado, United States
Poudre Valley Hospital
🇺🇸
Fort Collins, Colorado, United States
Saint Mary Corwin Medical Center
🇺🇸
Pueblo, Colorado, United States
Sky Ridge Medical Center
🇺🇸
Lone Tree, Colorado, United States
SCL Health Lutheran Medical Center
🇺🇸
Wheat Ridge, Colorado, United States
Illinois CancerCare-Bloomington
🇺🇸
Bloomington, Illinois, United States
MacNeal Hospital and Cancer Center
🇺🇸
Berwyn, Illinois, United States
Illinois CancerCare-Carthage
🇺🇸
Carthage, Illinois, United States
Jesse Brown Veterans Affairs Medical Center
🇺🇸
Chicago, Illinois, United States
Bromenn Regional Medical Center
🇺🇸
Normal, Illinois, United States
Community Cancer Center Foundation
🇺🇸
Normal, Illinois, United States
OSF Saint Francis Radiation Oncology at Pekin Cancer Treatment Center
🇺🇸
Pekin, Illinois, United States
Illinois CancerCare-Monmouth
🇺🇸
Monmouth, Illinois, United States
Pekin Hospital
🇺🇸
Pekin, Illinois, United States
Mcdonough District Hospital
🇺🇸
Macomb, Illinois, United States
Illinois CancerCare-Pekin
🇺🇸
Pekin, Illinois, United States
Proctor Hospital
🇺🇸
Peoria, Illinois, United States
Centerpoint Medical Center LLC
🇺🇸
Independence, Missouri, United States
Lake Region Healthcare Corporation-Cancer Care
🇺🇸
Fergus Falls, Minnesota, United States
Southeast Missouri Hospital
🇺🇸
Cape Girardeau, Missouri, United States
University of Minnesota/Masonic Cancer Center
🇺🇸
Minneapolis, Minnesota, United States
Benefis Healthcare- Sletten Cancer Institute
🇺🇸
Great Falls, Montana, United States
Bozeman Deaconess Hospital
🇺🇸
Bozeman, Montana, United States
Presbyterian Kaseman Hospital
🇺🇸
Albuquerque, New Mexico, United States
Montefiore Medical Center-Weiler Hospital
🇺🇸
Bronx, New York, United States
Montefiore Medical Center - Moses Campus
🇺🇸
Bronx, New York, United States
Case Western Reserve University
🇺🇸
Cleveland, Ohio, United States
Orange Regional Medical Center
🇺🇸
Middletown, New York, United States
Carolinas Medical Center/Levine Cancer Institute
🇺🇸
Charlotte, North Carolina, United States
Adirondack Cancer Center
🇺🇸
Glens Falls, New York, United States
Sanford Medical Center-Fargo
🇺🇸
Fargo, North Dakota, United States
Kinston Medical Specialists PA
🇺🇸
Kinston, North Carolina, United States
WellSpan Health-York Hospital
🇺🇸
York, Pennsylvania, United States
Medical X-Ray Center
🇺🇸
Sioux Falls, South Dakota, United States
Lankenau Medical Center
🇺🇸
Wynnewood, Pennsylvania, United States
Porter Adventist Hospital
🇺🇸
Denver, Colorado, United States
Presbyterian - Saint Lukes Medical Center - Health One
🇺🇸
Denver, Colorado, United States
SCL Health Saint Joseph Hospital
🇺🇸
Denver, Colorado, United States
Rose Medical Center
🇺🇸
Denver, Colorado, United States
Colorado Cancer Research Program NCORP
🇺🇸
Denver, Colorado, United States
Henry Ford Hospital
🇺🇸
Detroit, Michigan, United States
Mayo Clinic
🇺🇸
Rochester, Minnesota, United States
Medical Consultants Limited
🇺🇸
Milwaukee, Wisconsin, United States
Mount Sinai Medical Center
🇺🇸
New York, New York, United States
Saint Anthony Hospital
🇺🇸
Lakewood, Colorado, United States
Boston Medical Center
🇺🇸
Boston, Massachusetts, United States
Los Angeles Oncology Institute
🇺🇸
Los Angeles, California, United States
Providence Saint Joseph Medical Center/Disney Family Cancer Center
🇺🇸
Burbank, California, United States
Penrose-Saint Francis Healthcare
🇺🇸
Colorado Springs, Colorado, United States
Saint Mary's Hospital and Regional Medical Center
🇺🇸
Grand Junction, Colorado, United States
Longmont United Hospital
🇺🇸
Longmont, Colorado, United States
McKee Medical Center
🇺🇸
Loveland, Colorado, United States
North Suburban Medical Center
🇺🇸
Thornton, Colorado, United States
Sibley Memorial Hospital
🇺🇸
Washington, District of Columbia, United States
Beebe Medical Center
🇺🇸
Lewes, Delaware, United States
Christiana Care Health System-Christiana Hospital
🇺🇸
Newark, Delaware, United States
Emory University/Winship Cancer Institute
🇺🇸
Atlanta, Georgia, United States
Rush - Copley Medical Center
🇺🇸
Aurora, Illinois, United States
Saint Joseph Medical Center
🇺🇸
Bloomington, Illinois, United States
Illinois CancerCare-Canton
🇺🇸
Canton, Illinois, United States
University of Illinois
🇺🇸
Chicago, Illinois, United States
Mercy Hospital and Medical Center
🇺🇸
Chicago, Illinois, United States
Decatur Memorial Hospital
🇺🇸
Decatur, Illinois, United States
Heartland Cancer Research NCORP
🇺🇸
Decatur, Illinois, United States
Illinois CancerCare-Galesburg
🇺🇸
Galesburg, Illinois, United States
NorthShore University HealthSystem-Evanston Hospital
🇺🇸
Evanston, Illinois, United States
Illinois CancerCare-Eureka
🇺🇸
Eureka, Illinois, United States
Eureka Hospital
🇺🇸
Eureka, Illinois, United States
Galesburg Cottage Hospital
🇺🇸
Galesburg, Illinois, United States
Mason District Hospital
🇺🇸
Havana, Illinois, United States
Illinois CancerCare-Havana
🇺🇸
Havana, Illinois, United States
Hopedale Medical Complex - Hospital
🇺🇸
Hopedale, Illinois, United States
Joliet Oncology-Hematology Associates Limited
🇺🇸
Joliet, Illinois, United States
NorthShore Hematology Oncology-Libertyville
🇺🇸
Libertyville, Illinois, United States
Illinois CancerCare-Macomb
🇺🇸
Macomb, Illinois, United States
Illinois Cancer Specialists-Niles
🇺🇸
Niles, Illinois, United States
Illinois CancerCare-Community Cancer Center
🇺🇸
Normal, Illinois, United States
Holy Family Medical Center
🇺🇸
Monmouth, Illinois, United States
Ottawa Regional Hospital and Healthcare Center
🇺🇸
Ottawa, Illinois, United States
Illinois CancerCare-Ottawa Clinic
🇺🇸
Ottawa, Illinois, United States
Methodist Medical Center of Illinois
🇺🇸
Peoria, Illinois, United States
OSF Saint Francis Medical Center
🇺🇸
Peoria, Illinois, United States
Illinois CancerCare-Peoria
🇺🇸
Peoria, Illinois, United States
Illinois CancerCare-Peru
🇺🇸
Peru, Illinois, United States
Illinois CancerCare-Princeton
🇺🇸
Princeton, Illinois, United States
Perry Memorial Hospital
🇺🇸
Princeton, Illinois, United States
SwedishAmerican Regional Cancer Center/ACT
🇺🇸
Rockford, Illinois, United States
Swedish American Hospital
🇺🇸
Rockford, Illinois, United States
Edward H Kaplan MD and Associates
🇺🇸
Skokie, Illinois, United States
Illinois CancerCare-Spring Valley
🇺🇸
Spring Valley, Illinois, United States
Memorial Medical Center
🇺🇸
Springfield, Illinois, United States
Fort Wayne Medical Oncology and Hematology Inc-Parkview
🇺🇸
Fort Wayne, Indiana, United States
Saint Margaret's Hospital
🇺🇸
Spring Valley, Illinois, United States
Franciscan Saint Anthony Health-Michigan City
🇺🇸
Michigan City, Indiana, United States
McFarland Clinic PC-William R Bliss Cancer Center
🇺🇸
Ames, Iowa, United States
Medical Oncology and Hematology Associates-West Des Moines
🇺🇸
Clive, Iowa, United States
Iowa Methodist Medical Center
🇺🇸
Des Moines, Iowa, United States
Iowa-Wide Oncology Research Coalition NCORP
🇺🇸
Des Moines, Iowa, United States
Mercy Medical Center - Des Moines
🇺🇸
Des Moines, Iowa, United States
Medical Oncology and Hematology Associates-Des Moines
🇺🇸
Des Moines, Iowa, United States
Saint Luke's Regional Medical Center
🇺🇸
Sioux City, Iowa, United States
Siouxland Regional Cancer Center
🇺🇸
Sioux City, Iowa, United States
Medical Oncology and Hematology Associates-Laurel
🇺🇸
Des Moines, Iowa, United States
Iowa Lutheran Hospital
🇺🇸
Des Moines, Iowa, United States
Mercy Medical Center-Sioux City
🇺🇸
Sioux City, Iowa, United States
University of Iowa/Holden Comprehensive Cancer Center
🇺🇸
Iowa City, Iowa, United States
Memorial Hospital
🇺🇸
Carthage, Illinois, United States
Loyola University Medical Center
🇺🇸
Maywood, Illinois, United States
Carle Clinic-Urbana Main
🇺🇸
Urbana, Illinois, United States
Sutter Roseville Medical Center
🇺🇸
Roseville, California, United States
Cancer Center of Kansas - Wellington
🇺🇸
Wellington, Kansas, United States
Shawnee Mission Medical Center-KCCC
🇺🇸
Shawnee Mission, Kansas, United States
Mayo Clinic in Arizona
🇺🇸
Scottsdale, Arizona, United States
Boulder Community Hospital
🇺🇸
Boulder, Colorado, United States
Swedish Medical Center
🇺🇸
Englewood, Colorado, United States
Mercy Capitol
🇺🇸
Des Moines, Iowa, United States
Front Range Cancer Specialists
🇺🇸
Fort Collins, Colorado, United States
Illinois Valley Hospital
🇺🇸
Peru, Illinois, United States
Cancer Center of Kansas-Wichita Medical Arts Tower
🇺🇸
Wichita, Kansas, United States
University of Maryland/Greenebaum Cancer Center
🇺🇸
Baltimore, Maryland, United States
Eastern Maine Medical Center
🇺🇸
Bangor, Maine, United States
Johns Hopkins University/Sidney Kimmel Cancer Center
🇺🇸
Baltimore, Maryland, United States
Sanford Clinic North-Bemidgi
🇺🇸
Bemidji, Minnesota, United States
Veterans Administration
🇺🇸
Columbia, Missouri, United States
Saint Luke's East - Lee's Summit
🇺🇸
Lee's Summit, Missouri, United States
Liberty Hospital
🇺🇸
Liberty, Missouri, United States
Liberty Radiation Oncology Center
🇺🇸
Liberty, Missouri, United States
Saint Louis University Hospital
🇺🇸
Saint Louis, Missouri, United States
Northern Rockies Radiation Oncology Center
🇺🇸
Billings, Montana, United States
Bozeman Deaconess Cancer Center
🇺🇸
Bozeman, Montana, United States
Saint Vincent Healthcare
🇺🇸
Billings, Montana, United States
Berdeaux, Donald MD (UIA Investigator)
🇺🇸
Great Falls, Montana, United States
Saint Peter's Community Hospital
🇺🇸
Helena, Montana, United States
Kalispell Medical Oncology
🇺🇸
Kalispell, Montana, United States
Northern Montana Hospital
🇺🇸
Havre, Montana, United States
Glacier Oncology PLLC
🇺🇸
Kalispell, Montana, United States
Montana Cancer Specialists
🇺🇸
Missoula, Montana, United States
Great Falls Clinic
🇺🇸
Great Falls, Montana, United States
Kalispell Regional Medical Center
🇺🇸
Kalispell, Montana, United States
Guardian Oncology and Center for Wellness
🇺🇸
Missoula, Montana, United States
Ocean Medical Center
🇺🇸
Brick, New Jersey, United States
Roswell Park Cancer Institute
🇺🇸
Buffalo, New York, United States
Community Medical Hospital
🇺🇸
Missoula, Montana, United States
Northwell Health NCORP
🇺🇸
Lake Success, New York, United States
Laura and Isaac Perlmutter Cancer Center at NYU Langone
🇺🇸
New York, New York, United States
Sanford Clinic North-Fargo
🇺🇸
Fargo, North Dakota, United States
Geisinger Medical Center
🇺🇸
Danville, Pennsylvania, United States
Akron General Medical Center
🇺🇸
Akron, Ohio, United States
Geisinger Medical Center-Cancer Center Hazleton
🇺🇸
Hazleton, Pennsylvania, United States
Fox Chase Cancer Center
🇺🇸
Philadelphia, Pennsylvania, United States
Paoli Memorial Hospital
🇺🇸
Paoli, Pennsylvania, United States
Scranton Hematology Oncology
🇺🇸
Scranton, Pennsylvania, United States
Main Line Health NCORP
🇺🇸
Wynnewood, Pennsylvania, United States
Sanford Cancer Center-Oncology Clinic
🇺🇸
Sioux Falls, South Dakota, United States
Geisinger Medical Group
🇺🇸
State College, Pennsylvania, United States
Jackson-Madison County General Hospital
🇺🇸
Jackson, Tennessee, United States
Zale Lipshy University Hospital
🇺🇸
Dallas, Texas, United States
Danville Regional Medical Center
🇺🇸
Danville, Virginia, United States
UT Southwestern/Simmons Cancer Center-Dallas
🇺🇸
Dallas, Texas, United States
Cottonwood Hospital Medical Center
🇺🇸
Murray, Utah, United States
Scott and White Memorial Hospital
🇺🇸
Temple, Texas, United States
University of Wisconsin Hospital and Clinics
🇺🇸
Madison, Wisconsin, United States
Midwest Center for Hematology Oncology
🇺🇸
Joliet, Illinois, United States
Hematology Oncology Associates of Illinois - Skokie
🇺🇸
Skokie, Illinois, United States
Saint Joseph Oncology Inc
🇺🇸
Saint Joseph, Missouri, United States
Northwestern University
🇺🇸
Chicago, Illinois, United States
Weiss Memorial Hospital
🇺🇸
Chicago, Illinois, United States
Cooper Hospital University Medical Center
🇺🇸
Camden, New Jersey, United States
Illinois CancerCare-Kewanee Clinic
🇺🇸
Kewanee, Illinois, United States
University of Missouri - Ellis Fischel
🇺🇸
Columbia, Missouri, United States
Bryn Mawr Hospital
🇺🇸
Bryn Mawr, Pennsylvania, United States
Heartland Regional Medical Center
🇺🇸
Saint Joseph, Missouri, United States
Long Island Jewish Medical Center
🇺🇸
New Hyde Park, New York, United States
University of Tennessee - Knoxville
🇺🇸
Knoxville, Tennessee, United States
Sanford USD Medical Center - Sioux Falls
🇺🇸
Sioux Falls, South Dakota, United States
Geisinger Wyoming Valley/Henry Cancer Center
🇺🇸
Wilkes-Barre, Pennsylvania, United States
University of Pittsburgh Cancer Institute (UPCI)
🇺🇸
Pittsburgh, Pennsylvania, United States
DuPage Medical Group-Ogden
🇺🇸
Naperville, Illinois, United States
Mercy Hospital
🇺🇸
Scranton, Pennsylvania, United States
Sutter General Hospital
🇺🇸
Sacramento, California, United States
The Medical Center of Aurora
🇺🇸
Aurora, Colorado, United States
Wake Forest University Health Sciences
🇺🇸
Winston-Salem, North Carolina, United States
Truman Medical Center
🇺🇸
Kansas City, Missouri, United States
Saint Luke's Cancer Institute
🇺🇸
Kansas City, Missouri, United States
Heartland Hematology and Oncology Associates Incorporated
🇺🇸
Kansas City, Missouri, United States
Saint Luke's Hospital of Kansas City
🇺🇸
Kansas City, Missouri, United States
Radiation Oncology Practice Corporation South
🇺🇸
Kansas City, Missouri, United States
Saint Joseph Health Center
🇺🇸
Kansas City, Missouri, United States
North Kansas City Hospital
🇺🇸
Kansas City, Missouri, United States
Research Medical Center
🇺🇸
Kansas City, Missouri, United States
Radiation Oncology Practice Corporation - North
🇺🇸
Kansas City, Missouri, United States
Big Sky Oncology
🇺🇸
Great Falls, Montana, United States
Saint James Community Hospital and Cancer Treatment Center
🇺🇸
Butte, Montana, United States
Billings Clinic Cancer Center
🇺🇸
Billings, Montana, United States
Montana Cancer Consortium NCORP
🇺🇸
Billings, Montana, United States
Frontier Cancer Center and Blood Institute-Billings
🇺🇸
Billings, Montana, United States
East Carolina University
🇺🇸
Greenville, North Carolina, United States
Saint Patrick Hospital - Community Hospital
🇺🇸
Missoula, Montana, United States
North Shore University Hospital
🇺🇸
Manhasset, New York, United States
Associates In Womens Health
🇺🇸
Wichita, Kansas, United States
Via Christi Regional Medical Center
🇺🇸
Wichita, Kansas, United States
Wichita NCI Community Oncology Research Program
🇺🇸
Wichita, Kansas, United States
Cancer Center of Kansas - Pratt
🇺🇸
Pratt, Kansas, United States
Welch Cancer Center
🇺🇸
Sheridan, Wyoming, United States