Temozolomide With or Without Capecitabine in Treating Patients With Advanced Pancreatic Neuroendocrine Tumors
- Conditions
- GastrinomaSomatostatinomaGlucagonomaRecurrent Islet Cell CarcinomaInsulinomaIslet Cell CarcinomaPancreatic Polypeptide Tumor
- Interventions
- Registration Number
- NCT01824875
- Lead Sponsor
- ECOG-ACRIN Cancer Research Group
- Brief Summary
This randomized phase II trial studies how well giving temozolomide with or without capecitabine works in treating patients with advanced pancreatic neuroendocrine tumors. Drugs used in chemotherapy, such as temozolomide and capecitabine, work in different ways to stop the growth of tumor cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. It is not yet known whether temozolomide is more effective with or without capecitabine in treating patients with advanced pancreatic neuroendocrine tumors.
- Detailed Description
PRIMARY OBJECTIVES:
I. To evaluate progression-free survival (PFS) associated with temozolomide alone or temozolomide and capecitabine in patients with advanced pancreatic neuroendocrine tumors.
SECONDARY OBJECTIVES:
I. To evaluate response rates (RR) associated with temozolomide alone or temozolomide and capecitabine treatment in patients with advanced pancreatic neuroendocrine tumors.
II. To evaluate overall survival (OS) associated with temozolomide alone or temozolomide and capecitabine in patients with advanced pancreatic neuroendocrine tumors.
III. To evaluate the toxicity associated with temozolomide alone or temozolomide and capecitabine treatment in patients with advanced pancreatic neuroendocrine tumors.
IV. To evaluate the usefulness of methyl guanine methyltransferase (MGMT) status (by immunohistochemistry \[IHC\] and promoter methylation) for predicting response in pancreatic neuroendocrine tumor patients treated with either temozolomide or temozolomide and capecitabine.
V. To bank radiology images for evaluation of quality, reproducibility, and compliance with computed tomography (CT) methodology.
OUTLINE: Patients are randomized to 1 of 2 treatment arms.
ARM A: Patients receive temozolomide orally (PO) once daily (QD) on days 1-5. Treatment repeats every 28 days for up to 13 courses in the absence of disease progression or unacceptable toxicity.
ARM B: Patients receive capecitabine PO twice daily (BID) on days 1-14 and temozolomide PO QD on days 10-14. Treatment repeats every 28 days for up to 13 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, and then every 6 months for 3 years.
Recruitment & Eligibility
- Status
- ACTIVE_NOT_RECRUITING
- Sex
- All
- Target Recruitment
- 144
-
Patient must have histologically or pathologically confirmed locally unresectable or metastatic low or intermediate grade pancreatic neuroendocrine tumor
-
Patient must have measurable disease by Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 criteria; baseline measurements and evaluations of all sites of disease must be obtained <= 4 weeks prior to randomization and must be acquired by multiphasic CT or contrast magnetic resonance imaging (MRI)
-
Date of last documented disease progression must be within 12 months from date of randomization
-
Prior everolimus and/or sunitinib therapy is allowed, so long as it was discontinued >= 4 weeks prior to randomization
-
Concurrent somatostatin analogues are allowed provided that patients
- Have been on a stable dose for 8 weeks and
- Have documented disease progression on that dose
-
Chemoembolization is allowed if ≥ 4 weeks from study entry. There are 2 possible scenarios:
- If patient has hepatic disease only: they need to have progressed in the liver since chemoembolization and have measurable disease by RECIST 1.1 in order to be eligible.
- If patient has hepatic and extrahepatic disease: they will need to have progressed inside OR outside the liver and have measureable disease by RECIST 1.1 in order to be eligible.
-
Leukocytes >= 3,000/mm^3
-
Absolute neutrophil count >= 1,500/mm^3
-
Hemoglobin >= 9 g/dL
-
Platelets >= 100,000/mm^3
-
Total bilirubin <= institutional upper limit of normal (ULN) or <= 1.5 X institutional ULN (if the patient has liver metastases)
-
Aspartate aminotransferase (AST) (serum glutamic oxaloacetic transaminase [SGOT])/alanine aminotransferase (ALT) (serum glutamate pyruvate transaminase [SGPT]) <= 3 X institutional ULN or (<= 5 X institutional ULN if the patient has liver metastases)
-
Serum creatinine <= 1.5 X institutional ULN
-
Patient must have Eastern Cooperative Oncology Group (ECOG) performance status 0-1
-
Patient must have life expectancy >= 12 weeks all females of childbearing potential must have a blood test or urine study within =< 2 weeks prior to randomization to rule out pregnancy; a female of childbearing potential is any woman, regardless of sexual orientation or whether they have undergone tubal ligation, who meets the following criteria:
- Has not undergone a hysterectomy or bilateral oophorectomy; or
- Has not been naturally postmenopausal for at least 24 consecutive months (i.e., has had menses at any time in the preceding 24 consecutive months)
-
Women of childbearing potential and sexually active males must be strongly advised to use an accepted and effective method of contraception or to abstain from sexual intercourse for the duration of their participation in the study; should a woman become pregnant while participating in this study, she should inform her treating physician immediately; if a man impregnates a woman while participating in this study, he should inform his treating physician immediately
-
Patient must be able to swallow pills
-
Patient must be able to tolerate CT or magnetic resonance (MR) imaging including contrast agents as required for their treatment and the protocol
-
Small cell carcinoma
-
Prior temozolomide, dacarbazine (DTIC), or capecitabine, or 5-FU (fluorouracil) therapy
-
Receiving any other investigational agents while on study treatment
-
Receiving Coumadin while on treatment; other anticoagulants are allowed
-
Patients with either clinically apparent central nervous system metastases or carcinomatous meningitis are ineligible
-
Active or uncontrolled infection or serious medical or psychiatric illness
-
History of allergic reactions attributed to compounds of similar chemical or biologic composition to temozolomide or capecitabine
-
Absorption issues that would limit the ability to absorb study agents
-
Patients with a history of the following within 12 months of study entry:
- Arterial thromboembolic events
- Unstable angina
- Myocardial Infarction
-
Symptomatic peripheral vascular disease
-
Patients with previous or concurrent malignancy; exceptions are made for patients who meet any of the following conditions:
- Non-melanoma skin cancer, in situ cervical cancer, or breast cancer in situ OR
- Prior malignancy completely excised or removed and patient has been continuously disease free for > 5 years OR
- Prior malignancy cured by non-surgical modalities and patient has been continuously disease free for > 5 years
-
Pregnant or breast-feeding
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Arm A (temozolomide) temozolomide Patients receive temozolomide PO QD on days 1-5. Treatment repeats every 28 days for up to 13 courses in the absence of disease progression or unacceptable toxicity. Arm B (temozolomide and capecitabine) temozolomide Patients receive capecitabine PO BID on days 1-14 and temozolomide PO QD on days 10-14. Treatment repeats every 28 days for up to 13 courses in the absence of disease progression or unacceptable toxicity. Arm B (temozolomide and capecitabine) capecitabine Patients receive capecitabine PO BID on days 1-14 and temozolomide PO QD on days 10-14. Treatment repeats every 28 days for up to 13 courses in the absence of disease progression or unacceptable toxicity.
- Primary Outcome Measures
Name Time Method Progression-free Survival Assessed every 3 months for 3 years and then every 6 months for years 3-5 Progression-free survival (PFS) is defined as the time from randomization to progression or death without evidence of progression. Progression was evaluated using the revised Response Evaluation Criteria in Solid Tumors (RECIST) guideline (version 1.1) and defined as at least a 20% increase in the sum of the diameters of target lesions, taking as reference the smallest sum on study (this includes the baseline sum if that is the smallest on study). In addition to the relative increase of 20%, the sum must also demonstrate an absolute increase of at least 5 mm. Kaplan-Meier method was used to estimate PFS.
- Secondary Outcome Measures
Name Time Method Overall Survival Assessed every 3 months for 3 years and then every 6 months for years 3-5 Overall survival is defined as time from randomization to death or date last known alive.
Proportion of Patients With Response Assessed every 3 months for 3 years and then every 6 months for years 3-5 Response was evaluated using the revised Response Evaluation Criteria in Solid Tumors (RECIST) guideline (version 1.1) and defined as either complete response (CR) or partial response (PR).
CR is defined as disappearance of all target lesions. Any pathological lymph nodes (whether target or non-target) must have reduction in short axis to \< 10 mm.
PR is defined as at least a 30% decrease in the sum of the diameters of target lesions, taking as reference the baseline sum diameters.Association Between Methyl Guanine Methyltransferase (MGMT) Status by Immunohistochemistry (IHC) and Response Assessed every 3 months for 3 years and then every 6 months for years 3-5 Response was evaluated using the revised Response Evaluation Criteria in Solid Tumors (RECIST) guideline (version 1.1) and defined as either complete response (CR) or partial response (PR). CR is defined as disappearance of all target lesions. PR is defined as at least a 30% decrease in the sum of the diameters of target lesions, taking as reference the baseline sum diameters.
MGMT status was determined by IHC using paraffin-embedded sections of 4µm. A score (H-score) was generated based on the findings and scoring was performed by two pathologists. This H-score ranges from 0 (no staining in the tumor) to 300 (diffuse intense staining of the tumor). The highest score was used if there was disagreement. H-scores were grouped into 3 standard categories for MGMT status:
Category 1 - \<=50 Category 2 - 51-100 Category 3 - \>100Association Between Methyl Guanine Methyltransferase (MGMT) Status by Promoter Methylation and Response Assessed every 3 months for 3 years and then every 6 months for years 3-5 Response was evaluated using the revised Response Evaluation Criteria in Solid Tumors (RECIST) guideline (version 1.1) and defined as either complete response (CR) or partial response (PR).
CR is defined as disappearance of all target lesions. Any pathological lymph nodes (whether target or non-target) must have reduction in short axis to \< 10 mm.
PR is defined as at least a 30% decrease in the sum of the diameters of target lesions, taking as reference the baseline sum diameters.
MGMT status is determined by promoter methylation, a clinically validated methylation-specific polymerase chain reaction (PCR) analysis. A tumor sample is considered positive for MGMT promoter methylation if an 80bp band is detected in the methylated PCR reaction. It would be considered MGMT negative if an 80bp band is not detected in the methylated PCR reaction.
Trial Locations
- Locations (321)
University of Miami Miller School of Medicine-Sylvester Cancer Center
🇺🇸Miami, Florida, United States
Nevada Cancer Research Foundation CCOP
🇺🇸Las Vegas, Nevada, United States
Oncology Hematology Care Inc - Western Hills
🇺🇸Cincinnati, Ohio, United States
University of Cincinnati
🇺🇸Cincinnati, Ohio, United States
Kaiser Permanente-San Francisco
🇺🇸San Francisco, California, United States
UCSF-Mount Zion
🇺🇸San Francisco, California, United States
California Pacific Medical Center
🇺🇸San Francisco, California, United States
Vanderbilt Cancer Center
🇺🇸Nashville, Tennessee, United States
Cancer Center of Kansas - Salina
🇺🇸Salina, Kansas, United States
Cancer Center of Kansas - Winfield
🇺🇸Winfield, Kansas, United States
Castle Medical Center
🇺🇸Kailua, Hawaii, United States
Cancer Center of Kansas - Wellington
🇺🇸Wellington, Kansas, United States
Cancer Center of Kansas-Kingman
🇺🇸Kingman, Kansas, United States
Cancer Center of Kansas - Newton
🇺🇸Newton, Kansas, United States
Wilcox Memorial Hospital and Kauai Medical Clinic
🇺🇸Lihue, Hawaii, United States
Cancer Center of Kansas-Manhattan
🇺🇸Manhattan, Kansas, United States
Cancer Center of Kansas - Pratt
🇺🇸Pratt, Kansas, United States
Saint John Hospital and Medical Center
🇺🇸Detroit, Michigan, United States
Kaiser Anaheim Medical Center
🇺🇸Anaheim, California, United States
University of Southern California/Norris Cancer Center
🇺🇸Los Angeles, California, United States
Kaiser Foundation Hospital
🇺🇸Bellflower, California, United States
Cedars-Sinai Medical Center
🇺🇸Los Angeles, California, United States
Kaiser Permanente-Deer Valley Medical Center
🇺🇸Antioch, California, United States
Kaiser Permanente Los Angeles Medical Center
🇺🇸Los Angeles, California, United States
Southern California Permanente Medical Group
🇺🇸Irvine, California, United States
Kaiser Permanente, Hayward
🇺🇸Hayward, California, United States
Kaiser Permanente-Redwood City
🇺🇸Redwood City, California, United States
Kaiser Permanente-Stockton
🇺🇸Stockton, California, United States
Kaiser Permanente-South San Francisco
🇺🇸South San Francisco, California, United States
Sutter Pacific Medical Foundation
🇺🇸Santa Rosa, California, United States
Kaiser Permanente-Santa Teresa-San Jose
🇺🇸San Jose, California, United States
Kaiser Permanente at San Diego
🇺🇸San Diego, California, United States
Kaiser Permanente Health Care
🇺🇸San Marcos, California, United States
Kaiser Permanente-San Rafael
🇺🇸San Rafael, California, United States
Pali Momi Medical Center
🇺🇸'Aiea, Hawaii, United States
Stanford University Hospitals and Clinics
🇺🇸Stanford, California, United States
Oncare Hawaii Inc-Pali Momi
🇺🇸'Aiea, Hawaii, United States
Crossroads Cancer Center
🇺🇸Effingham, Illinois, United States
Kaiser Permanente Medical Center-Vacaville
🇺🇸Vacaville, California, United States
Illinois CancerCare-Canton
🇺🇸Canton, Illinois, United States
Beebe Medical Center
🇺🇸Lewes, Delaware, United States
Beebe Health Campus
🇺🇸Rehoboth Beach, Delaware, United States
Oncare Hawaii Inc-POB II
🇺🇸Honolulu, Hawaii, United States
Memorial Hospital of Carbondale
🇺🇸Carbondale, Illinois, United States
Good Samaritan Regional Health Center
🇺🇸Mount Vernon, Illinois, United States
Edna Williams Cancer Center at the Baptist Cancer Institute
🇺🇸Jacksonville, Florida, United States
Saint Joseph Medical Center
🇺🇸Bloomington, Illinois, United States
Presence Saint Mary's Hospital
🇺🇸Kankakee, Illinois, United States
Illinois CancerCare-Bloomington
🇺🇸Bloomington, Illinois, United States
Centralia Oncology Clinic
🇺🇸Centralia, Illinois, United States
Illinois CancerCare-Galesburg Cottage Plaza Office
🇺🇸Galesburg, Illinois, United States
Illinois CancerCare-Macomb
🇺🇸Macomb, Illinois, United States
Illinois CancerCare-Princeton
🇺🇸Princeton, Illinois, United States
Illinois CancerCare-Pekin
🇺🇸Pekin, Illinois, United States
Trinity Medical Center
🇺🇸Moline, Illinois, United States
Franciscan Saint Francis Health-Indianapolis
🇺🇸Indianapolis, Indiana, United States
Methodist Medical Center of Illinois
🇺🇸Peoria, Illinois, United States
Ottawa Regional Hospital and Healthcare Center
🇺🇸Ottawa, Illinois, United States
OSF Saint Francis Medical Center
🇺🇸Peoria, Illinois, United States
Illinois CancerCare-Ottawa Clinic
🇺🇸Ottawa, Illinois, United States
Memorial Medical Center
🇺🇸Springfield, Illinois, United States
Mary Greeley Medical Center
🇺🇸Ames, Iowa, United States
McFarland Clinic PC-William R Bliss Cancer Center
🇺🇸Ames, Iowa, United States
SwedishAmerican Regional Cancer Center/ACT
🇺🇸Rockford, Illinois, United States
Reid Hospital and Health Care Services
🇺🇸Richmond, Indiana, United States
Pekin Cancer Treatment Center
🇺🇸Pekin, Illinois, United States
Proctor Hospital
🇺🇸Peoria, Illinois, United States
Illinois CancerCare-Peoria
🇺🇸Peoria, Illinois, United States
Illinois CancerCare-Peru
🇺🇸Peru, Illinois, United States
Hematology Oncology Associates of Illinois - Skokie
🇺🇸Skokie, Illinois, United States
Illinois Oncology Research Association CCOP
🇺🇸Peoria, Illinois, United States
Lawrence Memorial Hospital
🇺🇸Lawrence, Kansas, United States
Cancer Center of Kansas-Independence
🇺🇸Independence, Kansas, United States
Mercy Cancer Center-West Lakes
🇺🇸Clive, Iowa, United States
Oncology Hematology Care Incorporated
🇺🇸Crestview Hills, Kentucky, United States
Cancer Center of Kansas - Chanute
🇺🇸Chanute, Kansas, United States
Allegiance Health
🇺🇸Jackson, Michigan, United States
Hickman Cancer Center
🇺🇸Adrian, Michigan, United States
McFarland Clinic PC-Marshalltown
🇺🇸Marshalltown, Iowa, United States
Mercy Medical Center-West Lakes
🇺🇸West Des Moines, Iowa, United States
Cancer Center of Kansas - El Dorado
🇺🇸El Dorado, Kansas, United States
Cancer Center of Kansas - Parsons
🇺🇸Parsons, Kansas, United States
Cancer Center of Kansas - McPherson
🇺🇸McPherson, Kansas, United States
Cancer Center of Kansas-Liberal
🇺🇸Liberal, Kansas, United States
Saint Mary's of Michigan
🇺🇸Saginaw, Michigan, United States
Fairview-Southdale Hospital
🇺🇸Edina, Minnesota, United States
Lahey Hospital and Medical Center
🇺🇸Burlington, Massachusetts, United States
Hurley Medical Center
🇺🇸Flint, Michigan, United States
Boston Medical Center
🇺🇸Boston, Massachusetts, United States
Oakwood Hospital
🇺🇸Dearborn, Michigan, United States
Bixby Medical Center
🇺🇸Adrian, Michigan, United States
Wichita CCOP
🇺🇸Wichita, Kansas, United States
Bronson Methodist Hospital
🇺🇸Kalamazoo, Michigan, United States
Saint Mary Mercy Hospital
🇺🇸Livonia, Michigan, United States
Hutchinson Area Health Care
🇺🇸Hutchinson, Minnesota, United States
Columbus Oncology and Hematology Associates Inc
🇺🇸Columbus, Ohio, United States
Columbus CCOP
🇺🇸Columbus, Ohio, United States
Oncology and Hematology Care Inc - Blue Ash
🇺🇸Cincinnati, Ohio, United States
Community Cancer Center of Monroe
🇺🇸Monroe, Michigan, United States
Mercy Hospital
🇺🇸Coon Rapids, Minnesota, United States
CoxHealth Cancer Center
🇺🇸Branson, Missouri, United States
New York Oncology Hematology PC - Amsterdam
🇺🇸Amsterdam, New York, United States
Strecker Cancer Center-Belpre
🇺🇸Belpre, Ohio, United States
New York Oncology Hematology PC-Hudson
🇺🇸Hudson, New York, United States
Atrium Medical Center-Middletown Regional Hospital
🇺🇸Franklin, Ohio, United States
West Michigan Cancer Center
🇺🇸Kalamazoo, Michigan, United States
Sparrow Hospital
🇺🇸Lansing, Michigan, United States
Abbott-Northwestern Hospital
🇺🇸Minneapolis, Minnesota, United States
Fairview Ridges Hospital
🇺🇸Burnsville, Minnesota, United States
Saint Joseph Mercy Port Huron
🇺🇸Port Huron, Michigan, United States
Lakeview Hospital
🇺🇸Stillwater, Minnesota, United States
Rice Memorial Hospital
🇺🇸Willmar, Minnesota, United States
Metro-Minnesota CCOP
🇺🇸Saint Louis Park, Minnesota, United States
Minnesota Oncology and Hematology PA-Woodbury
🇺🇸Woodbury, Minnesota, United States
Phelps County Regional Medical Center
🇺🇸Rolla, Missouri, United States
Central Care Cancer Center-Carrie J Babb Cancer Center
🇺🇸Bolivar, Missouri, United States
Saint Francis Regional Medical Center
🇺🇸Shakopee, Minnesota, United States
United Hospital
🇺🇸Saint Paul, Minnesota, United States
Saint John's Clinic-Rolla-Cancer and Hematology
🇺🇸Rolla, Missouri, United States
New York Oncology Hematology PC - Albany
🇺🇸Albany, New York, United States
Southeast Cancer Center
🇺🇸Cape Girardeau, Missouri, United States
Missouri Baptist Medical Center
🇺🇸Saint Louis, Missouri, United States
Oncology Hematology Care Inc - Kenwood
🇺🇸Cincinnati, Ohio, United States
New York Oncology Hematology PC -Albany Medical Center
🇺🇸Albany, New York, United States
Kinston Medical Specialists PA
🇺🇸Kinston, North Carolina, United States
Akron General Medical Center
🇺🇸Akron, Ohio, United States
Iredell Memorial Hospital
🇺🇸Statesville, North Carolina, United States
CoxHealth South Hospital
🇺🇸Springfield, Missouri, United States
Riverside Methodist Hospital
🇺🇸Columbus, Ohio, United States
The Mark H Zangmeister Center
🇺🇸Columbus, Ohio, United States
Mount Carmel Health Center West
🇺🇸Columbus, Ohio, United States
Cleveland Clinic Foundation
🇺🇸Cleveland, Ohio, United States
University of Toledo
🇺🇸Toledo, Ohio, United States
Cleveland Clinic Cancer Center-Strongsville
🇺🇸Strongsville, Ohio, United States
Toledo Community Hospital Oncology Program CCOP
🇺🇸Toledo, Ohio, United States
Saint Charles Hospital
🇺🇸Oregon, Ohio, United States
Cleveland Clinic Cancer Center Beachwood
🇺🇸Beachwood, Ohio, United States
Ohio State University Medical Center
🇺🇸Columbus, Ohio, United States
Doctors Hospital
🇺🇸Columbus, Ohio, United States
Case Western Reserve University
🇺🇸Cleveland, Ohio, United States
Oncology and Hematology Care Incorporated
🇺🇸Cincinnati, Ohio, United States
Toledo Radiation Oncology at Northwest Ohio Onocolgy Center
🇺🇸Maumee, Ohio, United States
Fairfield Medical Center
🇺🇸Lancaster, Ohio, United States
Saint Rita's Medical Center
🇺🇸Lima, Ohio, United States
Marietta Memorial Hospital
🇺🇸Marietta, Ohio, United States
Cleveland Clinic Cancer Center Independence
🇺🇸Independence, Ohio, United States
Upper Valley Medical Center
🇺🇸Troy, Ohio, United States
Mercy Cancer Center-Elyria
🇺🇸Elyria, Ohio, United States
Blanchard Valley Hospital
🇺🇸Findlay, Ohio, United States
Lancaster Radiation Oncology
🇺🇸Lancaster, Ohio, United States
Wayne Hospital
🇺🇸Greenville, Ohio, United States
Delaware Radiation Oncology
🇺🇸Delaware, Ohio, United States
Lima Memorial Hospital
🇺🇸Lima, Ohio, United States
Knox Community Hospital
🇺🇸Mount Vernon, Ohio, United States
Oncology Hematology Care Inc
🇺🇸Fairfield, Ohio, United States
Southern Ohio Medical Center
🇺🇸Portsmouth, Ohio, United States
Springfield Regional Medical Center
🇺🇸Springfield, Ohio, United States
University of Oklahoma Health Sciences Center
🇺🇸Oklahoma City, Oklahoma, United States
Mercy Hospital of Tiffin
🇺🇸Tiffin, Ohio, United States
Greenville Health System Cancer Institute-Greer
🇺🇸Greer, South Carolina, United States
Genesis HealthCare System
🇺🇸Zanesville, Ohio, United States
Penn State Milton S Hershey Medical Center
🇺🇸Hershey, Pennsylvania, United States
Tulsa Cancer Institute
🇺🇸Tulsa, Oklahoma, United States
Geisinger Medical Center-Cancer Center Hazleton
🇺🇸Hazleton, Pennsylvania, United States
Thomas Jefferson University Hospital
🇺🇸Philadelphia, Pennsylvania, United States
Geisinger Medical Group
🇺🇸State College, Pennsylvania, United States
Geisinger Medical Oncology-Pottsville
🇺🇸Pottsville, Pennsylvania, United States
Ozark Health Ventures LLC dba Cancer Research for The Ozarks Springfield
🇺🇸Springfield, Missouri, United States
Saint Louis Cancer and Breast Institute-South City
🇺🇸Saint Louis, Missouri, United States
Saint John's Mercy Medical Center
🇺🇸Saint Louis, Missouri, United States
New York Oncology Hematology PC - Latham
🇺🇸Latham, New York, United States
New York Oncology Hematology PC - Troy
🇺🇸Troy, New York, United States
Hennepin County Medical Center
🇺🇸Minneapolis, Minnesota, United States
Minnesota Oncology Hematology PA-Maplewood
🇺🇸Maplewood, Minnesota, United States
Unity Hospital
🇺🇸Fridley, Minnesota, United States
Saint John's Hospital - Healtheast
🇺🇸Maplewood, 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
Regions Hospital
🇺🇸Saint Paul, Minnesota, United States
Genesys Hurley Cancer Institute
🇺🇸Flint, Michigan, United States
Borgess Medical Center
🇺🇸Kalamazoo, Michigan, United States
Saint Joseph Mercy Oakland
🇺🇸Pontiac, Michigan, United States
Saint John Macomb-Oakland Hospital
🇺🇸Warren, Michigan, United States
McFarland Clinic PC-Boone
🇺🇸Boone, Iowa, United States
Methodist West Hospital
🇺🇸West Des Moines, Iowa, United States
Kaiser Permanente-West Los Angeles
🇺🇸Los Angeles, California, United States
Sutter Cancer Research Consortium
🇺🇸Novato, California, United States
Kaiser Permanente - Panorama City
🇺🇸Panorama City, California, United States
Kaiser Permanente-Vallejo
🇺🇸Vallejo, California, United States
Kaiser Permanente-Walnut Creek
🇺🇸Walnut Creek, California, United States
Sutter Solano Medical Center
🇺🇸Vallejo, California, United States
Illinois CancerCare-Carthage
🇺🇸Carthage, Illinois, United States
University of Illinois
🇺🇸Chicago, Illinois, United States
Illinois CancerCare-Eureka
🇺🇸Eureka, Illinois, United States
Hematology Oncology Associates of Illinois-Highland Park
🇺🇸Highland Park, Illinois, United States
Illinois CancerCare-Kewanee Clinic
🇺🇸Kewanee, Illinois, United States
North Shore Hematology Oncology
🇺🇸Libertyville, Illinois, United States
Loyola University Medical Center
🇺🇸Maywood, Illinois, United States
Garneau, Stewart C MD (UIA Investigator)
🇺🇸Moline, Illinois, United States
Porubcin, Michael MD (UIA Investigator)
🇺🇸Moline, Illinois, United States
Spector, David MD (UIA Investigator)
🇺🇸Moline, Illinois, United States
Adena Regional Medical Center
🇺🇸Chillicothe, Ohio, United States
Toledo Clinic Cancer Centers-Bowling Green
🇺🇸Bowling Green, Ohio, United States
Grant Medical Center
🇺🇸Columbus, Ohio, United States
Oncology Hematology Care Inc - Anderson
🇺🇸Cincinnati, Ohio, United States
Licking Memorial Hospital
🇺🇸Newark, Ohio, United States
The Toledo Hospital/Toledo Children's Hospital
🇺🇸Toledo, Ohio, United States
Flower Hospital
🇺🇸Sylvania, Ohio, United States
Mercy Saint Anne Hospital
🇺🇸Toledo, Ohio, United States
Cancer Center of Western Wisconsin
🇺🇸New Richmond, Wisconsin, United States
Fox Chase Cancer Center
🇺🇸Philadelphia, Pennsylvania, United States
Fredericksburg Oncology Inc
🇺🇸Fredericksburg, Virginia, United States
Mercy Memorial Hospital
🇺🇸Monroe, Michigan, United States
Saint Luke's Regional Medical Center
🇺🇸Sioux City, Iowa, United States
Mercy Medical Center-Sioux City
🇺🇸Sioux City, Iowa, United States
Siouxland Hematology Oncology Associates
🇺🇸Sioux City, Iowa, United States
Kaiser Permanente-South Sacramento
🇺🇸Sacramento, California, United States
Kaiser Permanente - Sacramento
🇺🇸Sacramento, California, United States
H. Lee Moffitt Cancer Center and Research Institute
🇺🇸Tampa, Florida, United States
Saint Joseph Mercy Hospital
🇺🇸Ann Arbor, Michigan, United States
Michigan Cancer Research Consortium Community Clinical Oncology Program
🇺🇸Ann Arbor, Michigan, United States
Nebraska Methodist Hospital
🇺🇸Omaha, Nebraska, United States
University of Michigan University Hospital
🇺🇸Ann Arbor, Michigan, United States
Froedtert and the Medical College of Wisconsin
🇺🇸Milwaukee, Wisconsin, United States
Kaiser Permanente-Richmond
🇺🇸Richmond, California, United States
Grady Memorial Hospital
🇺🇸Delaware, Ohio, United States
Hinsdale Hematology Oncology Associates Incorporated
🇺🇸Hinsdale, Illinois, United States
Gundersen Lutheran
🇺🇸La Crosse, Wisconsin, United States
Constantinou, Costas L MD (UIA Investigator)
🇺🇸Bettendorf, Iowa, United States
Florida Hospital
🇺🇸Orlando, Florida, United States
Delaware Clinical and Laboratory Physicians PA
🇺🇸Newark, Delaware, United States
Helen F Graham Cancer Center
🇺🇸Newark, Delaware, United States
Medical Oncology Hematology Consultants PA
🇺🇸Newark, Delaware, United States
Kaiser Permanente Medical Group - Baldwin Park
🇺🇸Baldwin Park, California, United States
Alta Bates Summit Medical Center-Herrick Campus
🇺🇸Berkeley, California, United States
Kaiser Permanente - Harbor City
🇺🇸Harbor City, California, United States
Kaiser Permanente, Fremont
🇺🇸Fremont, California, United States
Kaiser Permanente
🇺🇸Woodland Hills, California, United States
Kaiser Permanente-Modesto
🇺🇸Modesto, California, United States
University of California Medical Center At Irvine-Orange Campus
🇺🇸Orange, California, United States
Kaiser Permanente-Oakland
🇺🇸Oakland, California, United States
Kaiser Permanente-Roseville
🇺🇸Roseville, California, United States
Kaiser Permanente Medical Center
🇺🇸Riverside, California, United States
Kaiser Permanente Medical Center - Santa Clara
🇺🇸Santa Clara, California, United States
Kaiser Permanente-Santa Rosa
🇺🇸Santa Rosa, California, United States
Northwestern University
🇺🇸Chicago, Illinois, United States
Illinois CancerCare Galesburg
🇺🇸Galesburg, Illinois, United States
Cancer Care Center of Decatur
🇺🇸Decatur, Illinois, United States
Decatur Memorial Hospital
🇺🇸Decatur, Illinois, United States
Community Cancer Center Foundation
🇺🇸Normal, Illinois, United States
Illinois CancerCare-Monmouth
🇺🇸Monmouth, Illinois, United States
McFarland Clinic PC-Jefferson
🇺🇸Jefferson, Iowa, United States
Cancer Center of Kansas - Dodge City
🇺🇸Dodge City, Kansas, United States
Cancer Center of Kansas - Fort Scott
🇺🇸Fort Scott, Kansas, United States
Mercy Hospital Springfield
🇺🇸Springfield, Missouri, United States
Ridgeview Medical Center
🇺🇸Waconia, Minnesota, United States
Saint Francis Medical Center
🇺🇸Cape Girardeau, Missouri, United States
Capital Region Medical Center-Goldschmidt Cancer Center
🇺🇸Jefferson City, Missouri, United States
New York Oncology Hematology PC - Rexford
🇺🇸Rexford, New York, United States
Delaware Health Center-Grady Cancer Center
🇺🇸Delaware, Ohio, United States
Toledo Clinic Cancer Centers-Maumee
🇺🇸Maumee, Ohio, United States
Hematology Oncology Center Incorporated
🇺🇸Elyria, Ohio, United States
Kettering Medical Center
🇺🇸Kettering, Ohio, United States
Toledo Clinic Cancer Centers-Toledo
🇺🇸Toledo, Ohio, United States
Newark Radiation Oncology
🇺🇸Newark, Ohio, United States
Geisinger Medical Center
🇺🇸Danville, Pennsylvania, United States
Saint Ann's Hospital
🇺🇸Westerville, Ohio, United States
Fulton County Health Center
🇺🇸Wauseon, Ohio, United States
Greene Memorial Hospital
🇺🇸Xenia, Ohio, United States
Geisinger Medical Oncology at Evangelical Community Hospital
🇺🇸Lewisburg, Pennsylvania, United States
Geisinger Wyoming Valley
🇺🇸Wilkes-Barre, Pennsylvania, United States
Greenville Health System Cancer Institute-Butternut
🇺🇸Greenville, South Carolina, United States
Reading Hospital
🇺🇸West Reading, Pennsylvania, United States
Ochsner Medical Center Jefferson
🇺🇸New Orleans, Louisiana, United States
Christiana Gynecologic Oncology LLC
🇺🇸Newark, Delaware, United States
Regional Hematology and Oncology PA
🇺🇸Newark, Delaware, United States
Christiana Care Health System-Christiana Hospital
🇺🇸Newark, Delaware, United States
Saint Francis Hospital and Medical Center
🇺🇸Hartford, Connecticut, United States
Middlesex Hospital
🇺🇸Middletown, Connecticut, United States
Nanticoke Memorial Hospital
🇺🇸Seaford, Delaware, United States
Saint Alphonsus Regional Medical Center
🇺🇸Boise, Idaho, United States
Ochsner Health Center-Summa
🇺🇸Baton Rouge, Louisiana, United States
Cooper Hospital University Medical Center
🇺🇸Camden, New Jersey, United States
Fox Chase Cancer Center at Virtua Memorial Hospital of Burlington County
🇺🇸Mount Holly, New Jersey, United States
Virtua West Jersey Hospital Voorhees
🇺🇸Voorhees, New Jersey, United States
Iowa Methodist Medical Center
🇺🇸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
Queen's Medical Center
🇺🇸Honolulu, Hawaii, United States
Straub Clinic and Hospital
🇺🇸Honolulu, Hawaii, United States
University of Hawaii
🇺🇸Honolulu, Hawaii, United States
OnCare Hawaii-Liliha
🇺🇸Honolulu, Hawaii, United States
Oncare Hawaii Inc-Kuakini
🇺🇸Honolulu, Hawaii, United States
Kaiser Permanente Moanalua Medical Center
🇺🇸Honolulu, Hawaii, United States
Iowa Oncology Research Association CCOP
🇺🇸Des Moines, Iowa, United States
Mercy Medical Center - Des Moines
🇺🇸Des Moines, Iowa, United States
Iowa Lutheran Hospital
🇺🇸Des Moines, Iowa, United States
Montefiore Medical Center-Weiler Division
🇺🇸Bronx, New York, United States
University of Wisconsin Hospital and Clinics
🇺🇸Madison, Wisconsin, 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
University of Rochester
🇺🇸Rochester, New York, United States
Grandview Hospital
🇺🇸Dayton, Ohio, United States
Good Samaritan Hospital - Dayton
🇺🇸Dayton, Ohio, United States
Miami Valley Hospital
🇺🇸Dayton, Ohio, United States
Samaritan North Health Center
🇺🇸Dayton, Ohio, United States
Dayton CCOP
🇺🇸Dayton, Ohio, United States
Greenville Health System Cancer Institute/Greenville CCOP
🇺🇸Greenville, South Carolina, United States
Christiana Care Health System-Wilmington Hospital
🇺🇸Wilmington, Delaware, United States
Saint Vincent Mercy Medical Center
🇺🇸Toledo, Ohio, United States
Medical Oncology and Hematology Associates-West Des Moines
🇺🇸Clive, Iowa, United States
Hillcrest Hospital Cancer Center
🇺🇸Mayfield Heights, Ohio, United States
Toledo Clinic Cancer Centers-Oregon
🇺🇸Oregon, Ohio, United States
North Coast Cancer Care
🇺🇸Sandusky, Ohio, United States
Mills - Peninsula Hospitals
🇺🇸Burlingame, California, United States
Kaiser Permanente Hospital
🇺🇸Fontana, California, United States
Illinois Cancer Specialists-Niles
🇺🇸Niles, Illinois, United States
Montefiore Medical Center
🇺🇸Bronx, New York, United States