Afatinib After Chemoradiation and Surgery in Treating Patients With Stage III-IV Squamous Cell Carcinoma of the Head and Neck at High-Risk of Recurrence
- Conditions
- Head and Neck Squamous Cell Carcinoma
- Interventions
- Other: placebo
- Registration Number
- NCT01824823
- Lead Sponsor
- ECOG-ACRIN Cancer Research Group
- Brief Summary
This randomized phase II trial studies how well giving afatinib after chemoradiation and surgery works in treating patients with stage III-IV squamous cell carcinoma of the head and neck at high-risk of recurrence. Afatinib may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth.
- Detailed Description
PRIMARY OBJECTIVES:
I. Examine disease-free survival (DFS) given afatinib/placebo adjuvant therapy in patients with viable tumors in lymph nodes after neck dissection for suspected residual disease after concurrent chemoradiation.
SECONDARY OBJECTIVES:
I. Evaluate the recurrence rate, recurrence patterns, development of second primary malignancies, overall survival (OS) and toxicity of afatinib/placebo.
II. Evaluate on-target inhibition by afatinib, and determine circulating deoxyribonucleic acid (DNA) as a biomarker of afatinib resistance.
OUTLINE: Patients are randomized to 1 of 2 treatment arms.
ARM A: Patients receive afatinib orally (PO) once daily (QD) on days 1-28.
ARM B: Patients receive placebo PO QD on days 1-28.
In both Arms, treatment repeats every 28 days for up to 12 courses in the absence of disease progression or unacceptable toxicity.
After completion of study treatment, patients are followed up every 3 months for 2 years, every 6 months for 1 year and then every 12 months for 2 years.
Recruitment & Eligibility
- Status
- TERMINATED
- Sex
- All
- Target Recruitment
- 3
- Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1
- Patients must have pathological evidence of persistent primary and/or lymph node disease with viable tumor cells following primary concurrent chemoradiotherapy of locoregionally advanced (stage III/IV) HNSCC of the oral cavity, oropharynx, larynx, hypopharynx or p16-positive unknown primary of the head and neck region; persistent primary and/or lymph node disease with viable tumor cells will be determined by the histological determination of tumor viability defined as tumor cells with intact cellular compartments (i.e. cytoplasm and nucleus) that do not exhibit karyolysis, pyknosis, or karyorrhexis on haematoxylin and eosin (H&E) staining
- Patients must have undergone a neck dissection following completion of chemoradiotherapy and must have involved at the minimum a compartment dissection of nodal levels with residual abnormalities on post-treatment imaging studies and/or received a complete resection of the residual primary lesion with negative margins
- Patients must have achieved a complete response at the primary disease site after chemoradiotherapy or complete resection of the residual primary site disease with negative margins
- All persistent lymph node disease must have received at least 66 Gy of radiotherapy and must have been completely surgically resected prior to registration, and surgical incisions should be adequately healed
- Patients with extracapsular lymph node extension, perineural or lymphovascular invasion will be eligible
- Patients must be at least 6 weeks (42 days) and no more than 36 weeks (252 days) from completion of chemoradiation at the time of registration
- Patients will be eligible regardless of ability to swallow; patients with dysphagia may have afatinib/placebo administered via gastrostomy tube
- Absolute neutrophil count >= 1,000/mm^3
- Platelets >= 100,000/mm^3
- Total bilirubin =< 1.5 x the upper limit of normal (ULN)
- Aspartate amino transferase (AST) =< 3 x the ULN
- Alanine amino transferase (ALT) =< 3 x the ULN
- Calculated creatinine clearance must be >= 50 ml/min using the Cockcroft-Gault formula
- Prior cetuximab or any epidermal growth factor receptor (EGFR) inhibitors will not be permitted including cetuximab administered with a chemoradiotherapy or radiotherapy regimen
- As all patients in this study will have received prior full dose, curative-intent external-beam radiotherapy to the involved neck, no additional external-beam radiotherapy will be permitted prior to or during study participation
- Women of childbearing potential and sexually active males must be strongly advised to use an accepted and effective method of contraception
- Patients must have electrocardiogram (ECG) within 8 weeks prior to randomization to the study
- Patients must be assessed for cardiac function by echocardiogram (ECHO) or multi-gated acquisition scan (MUGA) within 8 weeks prior to randomization
- Patients with known distant metastatic disease or with any gross residual disease following salvage primary tumor resection or neck dissection
- Known hypersensitivity to afatinib or any of the excipients of this product
- Prior adjuvant chemotherapy (aside from the initial induction chemotherapy followed by chemoradiotherapy or chemoradiotherapy regimen)
- History of acute myocardial infarction within 3 months prior to registration, and any history of uncontrolled angina, uncontrolled arrhythmia, or uncontrolled heart failure
- Pregnant or breast-feeding women
- Active infections, other cancers, or history of other cancers
- Participation in any other clinical trials or taking any other experimental medications
- Left ventricular dysfunction
- Evidence of interstitial lung disease
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Arm B (placebo) placebo Patients receive placebo PO QD on days 1-28. Arm A (afatinib) afatinib Patients receive afatinib PO QD on days 1-28.
- Primary Outcome Measures
Name Time Method Disease-free Survival (DFS) Assessed every 3 months for patients < 2 years from registration and every 6 months if patient is 2-3 years from registration and every 12 months if patient is 4-5 years from registration DFS is defined as the time from randomization to the earlier of disease recurrence, second primary cancer, or death without recurrence.
- Secondary Outcome Measures
Name Time Method
Trial Locations
- Locations (272)
John H Stroger Jr Hospital of Cook County
🇺🇸Chicago, Illinois, United States
University of Illinois
🇺🇸Chicago, Illinois, United States
Bozeman Deaconess Hospital
🇺🇸Bozeman, Montana, United States
Wayne Memorial Hospital
🇺🇸Goldsboro, North Carolina, United States
New York Oncology Hematology PC - Troy
🇺🇸Troy, New York, United States
Southeastern Medical Oncology Center-Wilson
🇺🇸Wilson, North Carolina, United States
New York Oncology Hematology PC -Albany Medical Center
🇺🇸Albany, New York, United States
Saint James Community Hospital and Cancer Treatment Center
🇺🇸Butte, Montana, United States
New York Oncology Hematology PC - Latham
🇺🇸Latham, New York, United States
Akron General Medical Center
🇺🇸Akron, Ohio, United States
Randolph Hospital
🇺🇸Asheboro, North Carolina, United States
New York Oncology Hematology PC-Hudson
🇺🇸Hudson, New York, United States
Benefis Healthcare- Sletten Cancer Institute
🇺🇸Great Falls, Montana, United States
Southeastern Medical Oncology Center-Jacksonville
🇺🇸Jacksonville, North Carolina, United States
Southeastern Medical Oncology Center-Goldsboro
🇺🇸Goldsboro, North Carolina, United States
Toledo Clinic Cancer Centers-Oregon
🇺🇸Oregon, Ohio, United States
Cone Health Cancer Center
🇺🇸Greensboro, North Carolina, United States
Providence Newberg Medical Center
🇺🇸Newberg, Oregon, United States
Greenville Health System Cancer Institute-Easley
🇺🇸Easley, South Carolina, United States
Tulsa Cancer Institute
🇺🇸Tulsa, Oklahoma, United States
Clackamas Radiation Oncology Center
🇺🇸Clackamas, Oregon, United States
Fredericksburg Oncology Inc
🇺🇸Fredericksburg, Virginia, United States
Geisinger Medical Oncology-Pottsville
🇺🇸Pottsville, Pennsylvania, United States
Greenville Health System Cancer Institute-Butternut
🇺🇸Greenville, South Carolina, United States
Providence Milwaukie Hospital
🇺🇸Milwaukie, Oregon, United States
Greenville Health System Cancer Institute-Spartanburg
🇺🇸Spartanburg, South Carolina, United States
Greenville Health System Cancer Institute-Eastside
🇺🇸Greenville, South Carolina, United States
Providence Regional Cancer System-Centralia
🇺🇸Centralia, Washington, United States
Saint Francis Hospital
🇺🇸Federal Way, Washington, United States
Saint Clare Hospital
🇺🇸Lakewood, Washington, United States
Thompson Cancer Survival Center
🇺🇸Knoxville, Tennessee, United States
Allenmore Hospital
🇺🇸Tacoma, Washington, United States
Saint John Medical Center
🇺🇸Longview, Washington, United States
Big Horn Basin Cancer Center
🇺🇸Cody, Wyoming, United States
Aspirus Regional Cancer Center
🇺🇸Wausau, Wisconsin, United States
Riverview Hospital
🇺🇸Wisconsin Rapids, Wisconsin, United States
Welch Cancer Center
🇺🇸Sheridan, Wyoming, United States
West Virginia University Healthcare
🇺🇸Morgantown, West Virginia, United States
Abbott-Northwestern Hospital
🇺🇸Minneapolis, Minnesota, United States
Health Partners Inc
🇺🇸Minneapolis, Minnesota, United States
Harold Alfond Center for Cancer Care
🇺🇸Augusta, Maine, United States
Meharry Medical College
🇺🇸Nashville, Tennessee, United States
Rocky Mountain Oncology
🇺🇸Casper, Wyoming, United States
Billings Clinic-Cody
🇺🇸Cody, Wyoming, United States
University of Mississippi Medical Center
🇺🇸Jackson, Mississippi, United States
Katmai Oncology Group
🇺🇸Anchorage, Alaska, United States
Providence Alaska Medical Center
🇺🇸Anchorage, Alaska, United States
Veteran's Administration Medical Center
🇺🇸Little Rock, Arkansas, United States
Poudre Valley Hospital
🇺🇸Fort Collins, Colorado, United States
Saint Francis Hospital and Medical Center
🇺🇸Hartford, Connecticut, United States
Christiana Gynecologic Oncology LLC
🇺🇸Newark, Delaware, United States
Beebe Medical Center
🇺🇸Lewes, Delaware, United States
Helen F Graham Cancer Center
🇺🇸Newark, Delaware, United States
Delaware Clinical and Laboratory Physicians PA
🇺🇸Newark, Delaware, United States
Regional Hematology and Oncology PA
🇺🇸Newark, Delaware, United States
Nanticoke Memorial Hospital
🇺🇸Seaford, Delaware, United States
Beebe Health Campus
🇺🇸Rehoboth Beach, Delaware, United States
Christiana Care Health System-Wilmington Hospital
🇺🇸Wilmington, Delaware, United States
Medical Center of Central Georgia
🇺🇸Macon, Georgia, United States
Emory University/Winship Cancer Institute
🇺🇸Atlanta, Georgia, United States
Saint Alphonsus Cancer Care Center-Boise
🇺🇸Boise, Idaho, United States
Saint Joseph Regional Medical Center
🇺🇸Lewiston, Idaho, United States
Kootenai Cancer Center
🇺🇸Post Falls, Idaho, United States
Centralia Oncology Clinic
🇺🇸Centralia, Illinois, United States
Kootenai Cancer
🇺🇸Sandpoint, Idaho, United States
Saint Joseph Hospital
🇺🇸Chicago, Illinois, United States
Cancer Care Center of Decatur
🇺🇸Decatur, Illinois, United States
Crossroads Cancer Center
🇺🇸Effingham, Illinois, United States
Decatur Memorial Hospital
🇺🇸Decatur, Illinois, United States
Porubcin, Michael MD (UIA Investigator)
🇺🇸Moline, Illinois, United States
Hinsdale Hematology Oncology Associates Incorporated
🇺🇸Hinsdale, Illinois, United States
Garneau, Stewart C MD (UIA Investigator)
🇺🇸Moline, Illinois, United States
Spector, David MD (UIA Investigator)
🇺🇸Moline, Illinois, United States
Trinity Medical Center
🇺🇸Moline, Illinois, United States
Good Samaritan Regional Health Center
🇺🇸Mount Vernon, Illinois, United States
Mary Greeley Medical Center
🇺🇸Ames, Iowa, United States
McFarland Clinic PC-William R Bliss Cancer Center
🇺🇸Ames, Iowa, United States
Constantinou, Costas L MD (UIA Investigator)
🇺🇸Bettendorf, Iowa, United States
McFarland Clinic PC-Boone
🇺🇸Boone, Iowa, United States
Medical Oncology and Hematology Associates-West Des Moines
🇺🇸Clive, Iowa, United States
Mercy Cancer Center-West Lakes
🇺🇸Clive, Iowa, United States
McFarland Clinic PC-Jefferson
🇺🇸Jefferson, Iowa, United States
McFarland Clinic PC-Trinity Cancer Center
🇺🇸Fort Dodge, Iowa, United States
McFarland Clinic PC-Marshalltown
🇺🇸Marshalltown, Iowa, United States
Siouxland Hematology Oncology Associates
🇺🇸Sioux City, Iowa, United States
Mercy Medical Center-Sioux City
🇺🇸Sioux City, Iowa, United States
Saint Luke's Regional Medical Center
🇺🇸Sioux City, Iowa, United States
Methodist West Hospital
🇺🇸West Des Moines, Iowa, 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 - El Dorado
🇺🇸El Dorado, Kansas, United States
Cancer Center of Kansas - Fort Scott
🇺🇸Fort Scott, Kansas, United States
Cancer Center of Kansas-Independence
🇺🇸Independence, Kansas, United States
Cancer Center of Kansas-Kingman
🇺🇸Kingman, Kansas, United States
Lawrence Memorial Hospital
🇺🇸Lawrence, Kansas, United States
Cancer Center of Kansas-Liberal
🇺🇸Liberal, Kansas, United States
Cancer Center of Kansas-Manhattan
🇺🇸Manhattan, Kansas, United States
Cancer Center of Kansas - McPherson
🇺🇸McPherson, Kansas, United States
Cancer Center of Kansas - Newton
🇺🇸Newton, Kansas, United States
Cancer Center of Kansas - Pratt
🇺🇸Pratt, Kansas, United States
Cancer Center of Kansas - Parsons
🇺🇸Parsons, Kansas, United States
Cancer Center of Kansas - Salina
🇺🇸Salina, Kansas, United States
Cancer Center of Kansas - Wellington
🇺🇸Wellington, Kansas, United States
Associates In Womens Health
🇺🇸Wichita, Kansas, United States
Cancer Center of Kansas-Wichita Medical Arts Tower
🇺🇸Wichita, Kansas, United States
Cancer Center of Kansas - Main Office
🇺🇸Wichita, Kansas, United States
Via Christi Regional Medical Center
🇺🇸Wichita, Kansas, United States
Cancer Center of Kansas - Winfield
🇺🇸Winfield, Kansas, United States
Eastern Maine Medical Center
🇺🇸Bangor, Maine, United States
Greater Baltimore Medical Center
🇺🇸Baltimore, Maryland, United States
Penobscot Bay Medical Center
🇺🇸Rockport, Maine, United States
Bixby Medical Center
🇺🇸Adrian, Michigan, United States
Hickman Cancer Center
🇺🇸Adrian, Michigan, United States
Bronson Battle Creek
🇺🇸Battle Creek, Michigan, United States
Oakwood Hospital and Medical Center
🇺🇸Dearborn, Michigan, United States
Spectrum Health Big Rapids Hospital
🇺🇸Big Rapids, Michigan, United States
Hurley Medical Center
🇺🇸Flint, Michigan, United States
Genesys Hurley Cancer Institute
🇺🇸Flint, Michigan, United States
Mercy Health Saint Mary's
🇺🇸Grand Rapids, Michigan, United States
Grand Rapids Clinical Oncology Program
🇺🇸Grand Rapids, Michigan, United States
Spectrum Health at Butterworth Campus
🇺🇸Grand Rapids, Michigan, United States
Allegiance Health
🇺🇸Jackson, Michigan, United States
Borgess Medical Center
🇺🇸Kalamazoo, Michigan, United States
Bronson Methodist Hospital
🇺🇸Kalamazoo, Michigan, United States
West Michigan Cancer Center
🇺🇸Kalamazoo, Michigan, United States
Saint Mary Mercy Hospital
🇺🇸Livonia, Michigan, United States
Sparrow Hospital
🇺🇸Lansing, Michigan, United States
Community Cancer Center of Monroe
🇺🇸Monroe, Michigan, United States
Mercy Memorial Hospital
🇺🇸Monroe, Michigan, United States
Mercy Health Mercy Campus
🇺🇸Muskegon, Michigan, United States
Lakeland Community Hospital
🇺🇸Niles, Michigan, United States
Saint Joseph Mercy Oakland
🇺🇸Pontiac, Michigan, United States
Saint Joseph Mercy Port Huron
🇺🇸Port Huron, Michigan, United States
Saint Mary's of Michigan
🇺🇸Saginaw, Michigan, United States
Spectrum Health Reed City Hospital
🇺🇸Reed City, Michigan, United States
Lakeland Hospital
🇺🇸Saint Joseph, 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
Fairview Ridges Hospital
🇺🇸Burnsville, Minnesota, United States
Fairview-Southdale Hospital
🇺🇸Edina, Minnesota, United States
Mercy Hospital
🇺🇸Coon Rapids, Minnesota, United States
Unity Hospital
🇺🇸Fridley, Minnesota, United States
Hutchinson Area Health Care
🇺🇸Hutchinson, Minnesota, United States
Hennepin County Medical Center
🇺🇸Minneapolis, Minnesota, United States
Saint John's Hospital - Healtheast
🇺🇸Maplewood, Minnesota, United States
New Ulm Medical Center
🇺🇸New Ulm, Minnesota, United States
North Memorial Medical Health Center
🇺🇸Robbinsdale, Minnesota, United States
Metro-Minnesota CCOP
🇺🇸Saint Louis Park, Minnesota, United States
Park Nicollet Clinic - Saint Louis Park
🇺🇸Saint Louis Park, Minnesota, United States
Regions Hospital
🇺🇸Saint Paul, Minnesota, United States
Saint Francis Regional Medical Center
🇺🇸Shakopee, Minnesota, United States
United Hospital
🇺🇸Saint Paul, Minnesota, United States
Ridgeview Medical Center
🇺🇸Waconia, Minnesota, United States
Lakeview Hospital
🇺🇸Stillwater, Minnesota, United States
Saint Francis Medical Center
🇺🇸Cape Girardeau, Missouri, United States
Rice Memorial Hospital
🇺🇸Willmar, Minnesota, United States
Minnesota Oncology and Hematology PA-Woodbury
🇺🇸Woodbury, Minnesota, United States
Phelps County Regional Medical Center
🇺🇸Rolla, Missouri, United States
Saint John's Clinic-Rolla-Cancer and Hematology
🇺🇸Rolla, Missouri, United States
Saint John's Mercy Medical Center
🇺🇸Saint Louis, Missouri, United States
Mercy Hospital Springfield
🇺🇸Springfield, Missouri, United States
Ozark Health Ventures LLC-Cancer Research for The Ozarks Springfield
🇺🇸Springfield, Missouri, United States
CoxHealth South Hospital
🇺🇸Springfield, Missouri, United States
Montana Cancer Consortium CCOP
🇺🇸Billings, Montana, United States
New York Oncology Hematology PC - Albany
🇺🇸Albany, New York, United States
Saint Vincent Healthcare
🇺🇸Billings, Montana, United States
Orange Regional Medical Center
🇺🇸Middletown, New York, United States
Southeastern Medical Oncology Center-Clinton
🇺🇸Clinton, North Carolina, United States
Margaret R Pardee Memorial Hospital
🇺🇸Hendersonville, North Carolina, United States
Kinston Medical Specialists PA
🇺🇸Kinston, North Carolina, United States
Annie Penn Memorial Hospital
🇺🇸Reidsville, North Carolina, United States
University of Cincinnati
🇺🇸Cincinnati, Ohio, United States
Cleveland Clinic Foundation
🇺🇸Cleveland, Ohio, United States
Saint Rita's Medical Center
🇺🇸Lima, Ohio, United States
Lima Memorial Hospital
🇺🇸Lima, Ohio, United States
Saint Charles Hospital
🇺🇸Oregon, Ohio, United States
Toledo Clinic Cancer Centers-Maumee
🇺🇸Maumee, Ohio, United States
Toledo Radiation Oncology at Northwest Ohio Onocolgy Center
🇺🇸Maumee, Ohio, United States
The Toledo Hospital/Toledo Children's Hospital
🇺🇸Toledo, Ohio, United States
Saint Vincent Mercy Medical Center
🇺🇸Toledo, Ohio, United States
Toledo Community Hospital Oncology Program CCOP
🇺🇸Toledo, Ohio, United States
University of Toledo
🇺🇸Toledo, Ohio, United States
Toledo Clinic Cancer Centers-Toledo
🇺🇸Toledo, Ohio, United States
Fulton County Health Center
🇺🇸Wauseon, Ohio, United States
University Pointe
🇺🇸West Chester, Ohio, United States
Providence Willamette Falls Medical Center
🇺🇸Oregon City, Oregon, United States
Adams Cancer Center
🇺🇸Gettysburg, Pennsylvania, United States
Pottstown Memorial Medical Center
🇺🇸Pottstown, Pennsylvania, United States
Geisinger Medical Center
🇺🇸Danville, Pennsylvania, United States
Lewistown Hospital
🇺🇸Lewistown, Pennsylvania, United States
Geisinger Medical Oncology at Evangelical Community Hospital
🇺🇸Lewisburg, Pennsylvania, United States
WellSpan Health-York Hospital
🇺🇸York, Pennsylvania, United States
Greenville Health System Cancer Institute-Andrews
🇺🇸Greenville, South Carolina, United States
Greenville Health System Cancer Institute-Faris
🇺🇸Greenville, South Carolina, United States
Greenville Health System Cancer Institute-Greer
🇺🇸Greer, South Carolina, United States
Greenville Memorial Hospital
🇺🇸Greenville, South Carolina, United States
Wellmont Bristol Regional Medical Center
🇺🇸Bristol, Tennessee, United States
Greenville Health System Cancer Institute-Seneca
🇺🇸Seneca, South Carolina, United States
Wellmont Medical Associates Oncology and Hematology-Kingsport
🇺🇸Kingsport, Tennessee, United States
Southwest VA Regional Cancer Center
🇺🇸Norton, Virginia, United States
Overlake Hospital Medical Center
🇺🇸Bellevue, Washington, United States
Providence - Saint Peter Hospital
🇺🇸Olympia, Washington, United States
Good Samaritan Community Hospital
🇺🇸Puyallup, Washington, United States
Northwest Medical Specialties PLLC
🇺🇸Tacoma, Washington, United States
Northwest CCOP
🇺🇸Tacoma, Washington, United States
Multicare Health System
🇺🇸Tacoma, Washington, United States
PeaceHealth Southwest Medical Center
🇺🇸Vancouver, Washington, United States
Langlade Hospital and Cancer Center
🇺🇸Antigo, Wisconsin, United States
Saint John Hospital and Medical Center
🇺🇸Detroit, Michigan, United States
University of Oklahoma Health Sciences Center
🇺🇸Oklahoma City, Oklahoma, United States
Western Oncology Research Consortium
🇺🇸Portland, Oregon, United States
Providence Saint Vincent Medical Center
🇺🇸Portland, Oregon, United States
Alegent Health Bergan Mercy Medical Center
🇺🇸Omaha, Nebraska, United States
Alegent Health Lakeside Hospital
🇺🇸Omaha, Nebraska, United States
Missouri Valley Cancer Consortium
🇺🇸Omaha, Nebraska, United States
Alegent Health Immanuel Medical Center
🇺🇸Omaha, Nebraska, United States
Urology Cancer Center PC
🇺🇸Omaha, Nebraska, United States
Oncology Hematology West PC
🇺🇸Omaha, Nebraska, United States
Memorial Medical Center
🇺🇸Springfield, Illinois, United States
Mercy Medical Center-West Lakes
🇺🇸West Des Moines, Iowa, United States
Toledo Clinic Cancer Centers-Bowling Green
🇺🇸Bowling Green, Ohio, United States
Mercy Saint Anne Hospital
🇺🇸Toledo, Ohio, United States
Flower Hospital
🇺🇸Sylvania, Ohio, United States
Providence Portland Medical Center
🇺🇸Portland, Oregon, United States
Mercy Hospital of Tiffin
🇺🇸Tiffin, Ohio, United States
Cherry Tree Cancer Center
🇺🇸Hanover, Pennsylvania, United States
Geisinger Medical Center-Cancer Center Hazleton
🇺🇸Hazleton, Pennsylvania, United States
Geisinger Medical Group
🇺🇸State College, Pennsylvania, United States
Geisinger Wyoming Valley
🇺🇸Wilkes-Barre, Pennsylvania, United States
Froedtert and the Medical College of Wisconsin
🇺🇸Milwaukee, Wisconsin, United States
Gundersen Lutheran Medical Center
🇺🇸La Crosse, Wisconsin, United States
Auburn Regional Medical Center
🇺🇸Auburn, Washington, United States
Providence Regional Cancer Partnership
🇺🇸Everett, Washington, United States
Providence Regional Cancer System-Lacey
🇺🇸Lacey, Washington, United States
Capital Medical Center
🇺🇸Olympia, Washington, United States
Cancer Center of Western Wisconsin
🇺🇸New Richmond, Wisconsin, United States
Minnesota Oncology Hematology PA-Maplewood
🇺🇸Maplewood, Minnesota, United States
Saint Joseph Mercy Hospital
🇺🇸Ann Arbor, Michigan, United States
Michigan Cancer Research Consortium Community Clinical Oncology Program
🇺🇸Ann Arbor, Michigan, United States
Kalispell Regional Medical Center
🇺🇸Kalispell, Montana, United States
Christiana Care Health System-Christiana Hospital
🇺🇸Newark, Delaware, United States
Alaska Breast Care and Surgery LLC
🇺🇸Anchorage, Alaska, United States
Alaska Women's Cancer Care
🇺🇸Anchorage, Alaska, United States
Billings Clinic
🇺🇸Billings, Montana, United States
Kootenai Medical Center
🇺🇸Coeur d'Alene, Idaho, United States
Anchorage Oncology Centre
🇺🇸Anchorage, Alaska, United States
Wellmont Holston Valley Hospital and Medical Center
🇺🇸Kingsport, Tennessee, United States
Medical Oncology Hematology Consultants PA
🇺🇸Newark, Delaware, United States
Nebraska Methodist Hospital
🇺🇸Omaha, Nebraska, United States
Oncology Hematology West
🇺🇸Omaha, Nebraska, United States
Community Medical Hospital
🇺🇸Missoula, Montana, United States
Nebraska Cancer Research Center
🇺🇸Lincoln, Nebraska, United States
West Virginia University Charleston
🇺🇸Charleston, West Virginia, United States
Creighton University Medical Center
🇺🇸Omaha, Nebraska, United States
Saint Peter's Community Hospital
🇺🇸Helena, Montana, United States
Saint Patrick Hospital - Community Hospital
🇺🇸Missoula, Montana, United States
Nebraska Hematology and Oncology
🇺🇸Lincoln, Nebraska, United States
University Medical Center Brackenridge
🇺🇸Austin, Texas, United States
Iowa Methodist Medical Center
🇺🇸Des Moines, Iowa, United States
Iowa Oncology Research Association CCOP
🇺🇸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
Mercy Medical Center - Des Moines
🇺🇸Des Moines, Iowa, United States
Iowa Lutheran Hospital
🇺🇸Des Moines, Iowa, United States
Albert Einstein College of Medicine
🇺🇸Bronx, New York, United States
Montefiore Medical Center-Einstein Campus
🇺🇸Bronx, New York, United States
Montefiore Medical Center - Moses Campus
🇺🇸Bronx, New York, United States
Wichita CCOP
🇺🇸Wichita, Kansas, United States
Saint Joseph Medical Center
🇺🇸Tacoma, Washington, United States
Wellmont Medical Associates Oncology and Hematology-Johnson City
🇺🇸Johnson City, Tennessee, United States
Memorial Hospital of Carbondale
🇺🇸Carbondale, Illinois, United States