MedPath

Tivantinib With or Without Erlotinib Hydrochloride in Treating Patients With Metastatic or Locally Advanced Kidney Cancer That Cannot Be Removed by Surgery

Phase 2
Completed
Conditions
Type 1 Papillary Renal Cell Carcinoma
Type 2 Papillary Renal Cell Carcinoma
Stage III Renal Cell Cancer
Recurrent Renal Cell Carcinoma
Stage IV Renal Cell Cancer
Interventions
Other: Laboratory Biomarker Analysis
Registration Number
NCT01688973
Lead Sponsor
National Cancer Institute (NCI)
Brief Summary

This randomized phase II trial studies how well tivantinib with or without erlotinib hydrochloride works in treating patients with metastatic or locally advanced kidney cancer that cannot be removed by surgery. Tivantinib and erlotinib hydrochloride may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth.

Detailed Description

PRIMARY OBJECTIVES:

I. To assess the response rate (confirmed complete and partial response) of patients with locally advanced or metastatic papillary renal cell carcinoma treated with either ARQ 197 (tivantinib) or ARQ 197 combined with erlotinib (erlotinib hydrochloride).

SECONDARY OBJECTIVES:

I. To assess the progression free survival (PFS) of patients with locally advanced or metastatic papillary renal cell carcinoma treated with either ARQ 197 or ARQ 197 combined with erlotinib.

II. To assess the safety and tolerability of ARQ 197 therapy and ARQ 197 combined with erlotinib.

III. To descriptively assess the role of prior treatment on outcome.

TERTIARY OBJECTIVES:

I. To bank tissue specimens for future use and once funding is obtained to evaluate the expression of tissue correlative biomarkers such as hepatocyte growth factor receptor (c-MET) and epidermal growth factor receptor (EGFR), and to perform exploratory correlation with clinical outcomes.

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

ARM I: Patients receive tivantinib orally (PO) twice daily (BID) on days 1-28.

ARM II: Patients receive tivantinib PO BID and erlotinib hydrochloride PO once daily (QD) on days 1-28.

In both arms, courses repeat every 28 days in the absence of disease progression or unacceptable toxicity.

After completion of study treatment, patients are followed up every 3 months for 1 year and then every 6 months for up to 2 years.

Recruitment & Eligibility

Status
COMPLETED
Sex
All
Target Recruitment
55
Inclusion Criteria
  • Patients must have histologically or cytologically confirmed papillary histology renal cell carcinoma which is metastatic, or locally advanced and unresectable; mixed histologies will be allowed provided that they contain >= 50% of the papillary component
  • Patients must have measurable disease, defined as at least one lesion that can be accurately measured in at least one dimension; x-rays, scans or physical examinations used for tumor measurement must have been completed within 28 days prior to registration; x-rays, scans or physical examinations for non-measurable disease must have been completed within 42 days prior to registration; all disease must be assessed and documented on the Baseline Tumor Assessment form
  • Patients with metastatic disease who have a resectable primary tumor and are deemed a surgical candidate may have undergone resection; at least 28 days must have elapsed since surgery and patient must have recovered from any adverse effects of surgery
  • Patients with a history of brain metastases who are asymptomatic and have not received steroid therapy in the 14 days prior to registration are eligible; anti-seizure medications are allowed provided they are non-enzyme inducing (e.g. topiramate, levetiracetam, gabapentin)
  • Patients may have received up to one prior systemic therapy for advanced or metastatic renal cell carcinoma; patients must not have received a MET inhibitor or erlotinib as prior therapy; at least 21 days must have elapsed since completion of prior systemic therapy, 42 days for nitrosoureas or mitomycin C; patients must have recovered from all associated toxicities at the time of registration
  • Patients may have received prior radiation therapy, but must have measurable disease outside the radiation port; at least 21 days must have elapsed since completion of prior radiation therapy; patients must have recovered from all associated toxicities at the time of registration
  • Patients must not be receiving or planning to receive any other investigational agents
  • Patients must have a complete physical examination and medical history within 28 days prior to registration
  • Patients must have a Zubrod performance status of 0-2
  • White blood cell (WBC) >= 2,000/mcL
  • Absolute neutrophil count (ANC) >= 1,000/mcL
  • Platelet count >= 75,000/mcL
  • Serum bilirubin =< 1.5 x institutional upper limits of normal (ULN)
  • Serum glutamic oxaloacetic transaminase (SGOT)/aspartate aminotransferase (AST) and serum glutamic pyruvate transaminase (SGPT)/alanine aminotransferase (ALT) must be =< 1.5 x the institutional ULN unless the liver is involved with the tumor, in which case serum transaminase (SGOT/SGPT) must be =< 5 x the institutional ULN
  • Serum creatinine must be =< 2 x the institutional ULN
  • Sodium, potassium and calcium must be obtained within 14 days prior to registration
  • Patients with a known history of the following corneal diseases are not eligible: dry eye syndrome, Sjogren's syndrome, keratoconjunctivitis sicca, exposure keratopathy, Fuchs' dystrophy or other active disorders of cornea
  • Patients known to be human immunodeficiency virus (HIV)-positive and receiving combination anti-retroviral therapy are not eligible
  • Patients must be able to take oral medications; patients must not have gastrointestinal tract disease resulting in an inability to take oral medication or a requirement for intravenous (IV) alimentation, prior surgical procedures affecting absorption, or active peptic ulcer disease; patients with intractable nausea or vomiting are not eligible
  • Patients must not be pregnant or nursing; 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
  • No other prior malignancy is allowed except for the following: adequately treated basal cell or squamous cell skin cancer, in situ cervical cancer, adequately treated stage I or II cancer from which the patient is currently in complete remission, or any other cancer from which the patient has been disease-free for 5 years
  • Patients must be offered the opportunity to participate in specimen banking for future translational medicine studies
  • All patients must be informed of the investigational nature of this study and must sign and give written informed consent
  • 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
GroupInterventionDescription
Arm I (tivantinib)TivantinibPatients receive tivantinib PO BID on days 1-28.
Arm II (tivantinib and erlotinib hydrochloride)Erlotinib HydrochloridePatients receive tivantinib PO BID and erlotinib hydrochloride PO QD on days 1-28.
Arm I (tivantinib)Laboratory Biomarker AnalysisPatients receive tivantinib PO BID on days 1-28.
Arm II (tivantinib and erlotinib hydrochloride)Laboratory Biomarker AnalysisPatients receive tivantinib PO BID and erlotinib hydrochloride PO QD on days 1-28.
Arm II (tivantinib and erlotinib hydrochloride)TivantinibPatients receive tivantinib PO BID and erlotinib hydrochloride PO QD on days 1-28.
Primary Outcome Measures
NameTimeMethod
Response Rate (Confirmed Complete Response or Partial Response), Determined According to Response Evaluation Criteria in Solid TumorsUp to 3 years

Best Response is calculated from the sequence of objective statuses. CR: Two or more objective statuses of CR a minimum of four weeks apart documented before progression or symptomatic deterioration.

PR: Two or more objective statuses of PR or better a minimum of four weeks apart documented before progression or symptomatic deterioration, but not qualifying as CR.

Stable/no response: At least one objective status of stable/no response documented at least 6 weeks after registration and before progression or symptomatic deterioration, but not qualifying as anything else above.

Increasing disease: Objective status of progression within 12 weeks of registration, not qualifying as anything else above.

Symptomatic deterioration: Objective status of symptomatic deterioration within 12 weeks of registration, not qualifying as anything else above.

Secondary Outcome Measures
NameTimeMethod
Progression-free Survival (PFS)30 months

From date of registration to date of first documentation of progression or symptomatic deterioration, or death due to any cause. Patients last known to be alive without report of progression are censored at date of last contact.

Frequency and Severity of Toxicities, Graded by the National Cancer Institute Common Terminology Criteria for Adverse Events Version 4.0Up to 3 years

This study utilized the CTCAE (NCI Common Terminology Criteria for Adverse Events) Version 4.0 for toxicity and Serious Adverse Event reporting. Patients were evaluated every two weeks for the first eight weeks and then once every four weeks. If all protocol treatment is delayed more than three weeks, patients were removed from protocol treatment

Trial Locations

Locations (214)

Riverside Methodist Hospital

🇺🇸

Columbus, Ohio, United States

Columbus NCI Community Oncology Research Program

🇺🇸

Columbus, Ohio, United States

The Mark H Zangmeister Center

🇺🇸

Columbus, Ohio, United States

Alta Bates Summit Medical Center-Herrick Campus

🇺🇸

Berkeley, California, United States

Kaiser Permanente Los Angeles Medical Center

🇺🇸

Los Angeles, California, United States

Los Angeles County-USC Medical Center

🇺🇸

Los Angeles, California, United States

Cedars Sinai Medical Center

🇺🇸

Los Angeles, California, United States

Kaiser Permanente-Riverside

🇺🇸

Riverside, California, United States

Smilow Cancer Hospital Care Center at Saint Francis

🇺🇸

Hartford, Connecticut, United States

Saint Alphonsus Cancer Care Center-Boise

🇺🇸

Boise, Idaho, United States

Loyola University Medical Center

🇺🇸

Maywood, Illinois, United States

Hematology Oncology Associates of Illinois - Skokie

🇺🇸

Skokie, Illinois, United States

Mercy Medical Center-Sioux City

🇺🇸

Sioux City, Iowa, United States

Cancer Center of Kansas-Independence

🇺🇸

Independence, Kansas, United States

Saint John Macomb-Oakland Hospital

🇺🇸

Warren, Michigan, United States

Park Nicollet Clinic - Saint Louis Park

🇺🇸

Saint Louis Park, Minnesota, United States

Regions Hospital

🇺🇸

Saint Paul, Minnesota, United States

Heartland Regional Medical Center

🇺🇸

Saint Joseph, Missouri, United States

Kettering Medical Center

🇺🇸

Kettering, Ohio, United States

Geisinger Medical Center

🇺🇸

Danville, Pennsylvania, United States

Geisinger Wyoming Valley/Henry Cancer Center

🇺🇸

Wilkes-Barre, Pennsylvania, United States

Wenatchee Valley Hospital and Clinics

🇺🇸

Wenatchee, Washington, United States

University of Mississippi Medical Center

🇺🇸

Jackson, Mississippi, United States

Hematology and Oncology Associates

🇺🇸

Chicago, Illinois, United States

Kaiser Permanente-Bellflower

🇺🇸

Bellflower, California, United States

Kaiser Permanente-Irvine

🇺🇸

Irvine, California, United States

Kaiser Permanente-Cadillac

🇺🇸

Los Angeles, California, United States

City of Hope Comprehensive Cancer Center

🇺🇸

Duarte, California, United States

Menorah Medical Center

🇺🇸

Overland Park, Kansas, United States

Saint Luke's South Hospital

🇺🇸

Overland Park, Kansas, United States

Hematology Oncology Associates of Illinois-Highland Park

🇺🇸

Highland Park, Illinois, United States

Kaiser Permanente Hospital

🇺🇸

Fontana, California, United States

Hines Veterans Administration Hospital

🇺🇸

Hines, Illinois, United States

Saint Francis Hospital and Medical Center - Topeka

🇺🇸

Topeka, Kansas, United States

Unity Hospital

🇺🇸

Fridley, Minnesota, United States

Saint Luke's East - Lee's Summit

🇺🇸

Lee's Summit, Missouri, United States

Genesys Regional Medical Center-West Flint Campus

🇺🇸

Flint, Michigan, United States

West Michigan Cancer Center

🇺🇸

Kalamazoo, Michigan, United States

Sutter Cancer Research Consortium

🇺🇸

Novato, California, United States

Sutter Solano Medical Center/Cancer Center

🇺🇸

Vallejo, California, United States

United Hospital

🇺🇸

Saint Paul, Minnesota, United States

Kansas City NCI Community Oncology Research Program

🇺🇸

Prairie Village, Kansas, United States

Beaumont Hospital-Dearborn

🇺🇸

Dearborn, Michigan, United States

Kaiser Permanente

🇺🇸

Woodland Hills, California, United States

Cancer Center of Kansas - McPherson

🇺🇸

McPherson, Kansas, United States

Lake Huron Medical Center

🇺🇸

Port Huron, Michigan, United States

Via Christi Hospital-Pittsburg

🇺🇸

Pittsburg, Kansas, United States

Lakeview Hospital

🇺🇸

Stillwater, Minnesota, United States

Cancer Center of Kansas - Winfield

🇺🇸

Winfield, Kansas, United States

Hurley Medical Center

🇺🇸

Flint, Michigan, United States

Cancer Center of Kansas - Newton

🇺🇸

Newton, Kansas, United States

Cancer Center of Kansas - Parsons

🇺🇸

Parsons, Kansas, United States

Genesys Regional Medical Center

🇺🇸

Grand Blanc, Michigan, United States

Evergreen Hematology and Oncology PS

🇺🇸

Spokane, Washington, United States

Genesys Hurley Cancer Institute

🇺🇸

Flint, Michigan, United States

Allegiance Health

🇺🇸

Jackson, Michigan, United States

Saint John's Hospital - Healtheast

🇺🇸

Maplewood, Minnesota, United States

Hutchinson Area Health Care

🇺🇸

Hutchinson, Minnesota, United States

Cancer Center of Kansas-Wichita Medical Arts Tower

🇺🇸

Wichita, Kansas, United States

Borgess Medical Center

🇺🇸

Kalamazoo, Michigan, United States

Grandview Hospital

🇺🇸

Dayton, Ohio, United States

Ridgeview Medical Center

🇺🇸

Waconia, Minnesota, United States

New Ulm Medical Center

🇺🇸

New Ulm, Minnesota, United States

Veterans Adminstration New Jersey Health Care System

🇺🇸

East Orange, New Jersey, United States

Bronson Methodist Hospital

🇺🇸

Kalamazoo, Michigan, United States

Glens Falls Hospital

🇺🇸

Glens Falls, New York, United States

Metro Minnesota Community Oncology Research Consortium

🇺🇸

Saint Louis Park, Minnesota, United States

North Memorial Medical Health Center

🇺🇸

Robbinsdale, Minnesota, United States

Iredell Memorial Hospital

🇺🇸

Statesville, North Carolina, United States

Minnesota Oncology Hematology PA-Maplewood

🇺🇸

Maplewood, Minnesota, United States

Saint Francis Medical Center

🇺🇸

Cape Girardeau, Missouri, United States

Saint Rita's Medical Center

🇺🇸

Lima, Ohio, United States

Kadlec Clinic Hematology and Oncology

🇺🇸

Kennewick, Washington, United States

Cancer Care Northwest - Spokane South

🇺🇸

Spokane, Washington, United States

Cancer Center of Western Wisconsin

🇺🇸

New Richmond, Wisconsin, United States

Orange Regional Medical Center

🇺🇸

Middletown, New York, United States

Genesis Healthcare System Cancer Care Center

🇺🇸

Zanesville, Ohio, United States

Minnesota Oncology Hematology PA-Woodbury

🇺🇸

Woodbury, Minnesota, United States

Upper Valley Medical Center

🇺🇸

Troy, Ohio, United States

Swedish Medical Center-Edmonds

🇺🇸

Edmonds, Washington, United States

Geisinger Medical Center-Cancer Center Hazleton

🇺🇸

Hazleton, Pennsylvania, United States

Highline Medical Center-Main Campus

🇺🇸

Burien, Washington, United States

Liberty Radiation Oncology Center

🇺🇸

Liberty, Missouri, United States

Geisinger Medical Group

🇺🇸

State College, Pennsylvania, United States

Mount Carmel Health Center West

🇺🇸

Columbus, Ohio, United States

Marietta Memorial Hospital

🇺🇸

Marietta, Ohio, United States

Knox Community Hospital

🇺🇸

Mount Vernon, Ohio, United States

Harrison HealthPartners Hematology and Oncology-Poulsbo

🇺🇸

Poulsbo, Washington, United States

Saint Joseph Oncology Inc

🇺🇸

Saint Joseph, Missouri, United States

Saint Ann's Hospital

🇺🇸

Westerville, Ohio, United States

Gundersen Lutheran Medical Center

🇺🇸

La Crosse, Wisconsin, United States

Grant Medical Center

🇺🇸

Columbus, Ohio, United States

Licking Memorial Hospital

🇺🇸

Newark, Ohio, United States

Miami Valley Hospital

🇺🇸

Dayton, Ohio, United States

Southern Ohio Medical Center

🇺🇸

Portsmouth, Ohio, United States

Skagit Valley Hospital

🇺🇸

Mount Vernon, Washington, United States

Samaritan North Health Center

🇺🇸

Dayton, Ohio, United States

Springfield Regional Medical Center

🇺🇸

Springfield, Ohio, United States

Johns Hopkins University/Sidney Kimmel Cancer Center

🇺🇸

Baltimore, Maryland, United States

Kaiser Permanente-San Diego Mission

🇺🇸

San Diego, California, United States

Kaiser Permanente-San Diego Zion

🇺🇸

San Diego, California, United States

Franciscan Health Indianapolis

🇺🇸

Indianapolis, Indiana, United States

University Medical Center of Southern Nevada

🇺🇸

Las Vegas, Nevada, United States

Nevada Cancer Research Foundation CCOP

🇺🇸

Las Vegas, Nevada, United States

Harborview Medical Center

🇺🇸

Seattle, Washington, United States

Minor and James Medical PLLC

🇺🇸

Seattle, Washington, United States

Group Health Cooperative-Seattle

🇺🇸

Seattle, Washington, United States

Swedish Medical Center-First Hill

🇺🇸

Seattle, Washington, United States

University of Washington Medical Center

🇺🇸

Seattle, Washington, United States

California Pacific Medical Center-Pacific Campus

🇺🇸

San Francisco, California, United States

Abbott-Northwestern Hospital

🇺🇸

Minneapolis, Minnesota, United States

Hennepin County Medical Center

🇺🇸

Minneapolis, Minnesota, United States

Vanderbilt University/Ingram Cancer Center

🇺🇸

Nashville, Tennessee, United States

Cancer Therapy and Research Center at The UT Health Science Center at San Antonio

🇺🇸

San Antonio, Texas, United States

University Hospital

🇺🇸

San Antonio, Texas, United States

University of Texas Health Science Center at San Antonio

🇺🇸

San Antonio, Texas, United States

Huntsman Cancer Institute/University of Utah

🇺🇸

Salt Lake City, Utah, United States

Wayne State University/Karmanos Cancer Institute

🇺🇸

Detroit, Michigan, United States

Saint John Hospital and Medical Center

🇺🇸

Detroit, Michigan, United States

University of Oklahoma Health Sciences Center

🇺🇸

Oklahoma City, Oklahoma, United States

Associates In Womens Health

🇺🇸

Wichita, Kansas, United States

Cancer Center of Kansas - Wellington

🇺🇸

Wellington, Kansas, United States

Swedish Cancer Institute-Issaquah

🇺🇸

Issaquah, Washington, United States

Fred Hutchinson Cancer Research Center

🇺🇸

Seattle, Washington, United States

United General Hospital

🇺🇸

Sedro-Woolley, Washington, United States

Sparrow Hospital

🇺🇸

Lansing, Michigan, United States

Saint Mary Mercy Hospital

🇺🇸

Livonia, Michigan, United States

Saint Mary's of Michigan

🇺🇸

Saginaw, Michigan, United States

University of Arizona Cancer Center-Orange Grove Campus

🇺🇸

Tucson, Arizona, United States

University of Arizona Cancer Center-North Campus

🇺🇸

Tucson, Arizona, United States

The University of Arizona Medical Center-University Campus

🇺🇸

Tucson, Arizona, United States

Kaiser Permanente-Anaheim

🇺🇸

Anaheim, California, United States

Kaiser Permanente-Baldwin Park

🇺🇸

Baldwin Park, California, United States

Mills-Peninsula Medical Center

🇺🇸

Burlingame, California, United States

Kaiser Permanente - Harbor City

🇺🇸

Harbor City, California, United States

USC / Norris Comprehensive Cancer Center

🇺🇸

Los Angeles, California, United States

Fremont - Rideout Cancer Center

🇺🇸

Marysville, California, United States

Kaiser Permanente - Panorama City

🇺🇸

Panorama City, California, United States

Stanford Cancer Institute

🇺🇸

Palo Alto, California, United States

Kaiser Permanente-San Marcos

🇺🇸

San Marcos, California, United States

Sutter Pacific Medical Foundation

🇺🇸

Santa Rosa, California, United States

Gene Upshaw Memorial Tahoe Forest Cancer Center

🇺🇸

Truckee, California, United States

MedStar Georgetown University Hospital

🇺🇸

Washington, District of Columbia, United States

Sibley Memorial Hospital

🇺🇸

Washington, District of Columbia, United States

Idaho Urologic Institute-Meridian

🇺🇸

Meridian, Idaho, United States

George Washington University Medical Center

🇺🇸

Washington, District of Columbia, United States

Northwestern University

🇺🇸

Chicago, Illinois, United States

NorthShore Hematology Oncology-Libertyville

🇺🇸

Libertyville, Illinois, United States

Presence Saint Mary's Hospital

🇺🇸

Kankakee, Illinois, United States

Illinois Cancer Specialists-Niles

🇺🇸

Niles, Illinois, United States

Siouxland Regional Cancer Center

🇺🇸

Sioux City, Iowa, United States

Reid Health

🇺🇸

Richmond, Indiana, United States

University of Iowa/Holden Comprehensive Cancer Center

🇺🇸

Iowa City, Iowa, United States

Franciscan Saint Francis Health-Beech Grove

🇺🇸

Beech Grove, Indiana, United States

Saint Luke's Regional Medical Center

🇺🇸

Sioux City, Iowa, United States

Cancer Center of Kansas - Chanute

🇺🇸

Chanute, Kansas, United States

Cancer Center of Kansas - Dodge City

🇺🇸

Dodge City, Kansas, United States

Cancer Center of Kansas - El Dorado

🇺🇸

El Dorado, Kansas, United States

Saint Rose Ambulatory and Surgery Center

🇺🇸

Great Bend, Kansas, United States

Hutchinson Regional Medical Center

🇺🇸

Hutchinson, Kansas, United States

Cancer Center of Kansas - Fort Scott

🇺🇸

Fort Scott, Kansas, United States

Hays Medical Center

🇺🇸

Hays, Kansas, United States

Providence Medical Center

🇺🇸

Kansas City, Kansas, United States

University of Kansas Cancer Center

🇺🇸

Kansas City, Kansas, United States

Lawrence Memorial Hospital

🇺🇸

Lawrence, Kansas, United States

Cancer Center of Kansas-Kingman

🇺🇸

Kingman, Kansas, United States

Cancer Center of Kansas-Liberal

🇺🇸

Liberal, Kansas, United States

Cancer Center of Kansas - Pratt

🇺🇸

Pratt, Kansas, United States

Cancer Center of Kansas - Salina

🇺🇸

Salina, Kansas, United States

Salina Regional Health Center

🇺🇸

Salina, Kansas, United States

Via Christi Regional Medical Center

🇺🇸

Wichita, Kansas, United States

Cancer Center of Kansas - Wichita

🇺🇸

Wichita, Kansas, United States

Wichita NCI Community Oncology Research Program

🇺🇸

Wichita, Kansas, United States

Saint Joseph Mercy Oakland

🇺🇸

Pontiac, Michigan, United States

Fairview-Southdale Hospital

🇺🇸

Edina, Minnesota, United States

Mercy Hospital

🇺🇸

Coon Rapids, Minnesota, United States

Fairview Ridges Hospital

🇺🇸

Burnsville, Minnesota, United States

Saint Francis Regional Medical Center

🇺🇸

Shakopee, Minnesota, United States

Saint Louis Cancer and Breast Institute-South City

🇺🇸

Saint Louis, Missouri, United States

Saint Louis-Cape Girardeau CCOP

🇺🇸

Saint Louis, Missouri, United States

Mercy Hospital Saint Louis

🇺🇸

Saint Louis, Missouri, United States

University of Rochester

🇺🇸

Rochester, New York, United States

Columbia University/Herbert Irving Cancer Center

🇺🇸

New York, New York, United States

Kinston Medical Specialists PA

🇺🇸

Kinston, North Carolina, United States

Adena Regional Medical Center

🇺🇸

Chillicothe, Ohio, United States

Doctors Hospital

🇺🇸

Columbus, Ohio, United States

Wayne Hospital

🇺🇸

Greenville, Ohio, United States

Good Samaritan Hospital - Dayton

🇺🇸

Dayton, Ohio, United States

Atrium Medical Center-Middletown Regional Hospital

🇺🇸

Franklin, Ohio, United States

Dayton NCI Community Oncology Research Program

🇺🇸

Dayton, Ohio, United States

Grady Memorial Hospital

🇺🇸

Delaware, Ohio, United States

Blanchard Valley Hospital

🇺🇸

Findlay, Ohio, United States

Fairfield Medical Center

🇺🇸

Lancaster, Ohio, United States

Greene Memorial Hospital

🇺🇸

Xenia, Ohio, United States

University of Pennsylvania/Abramson Cancer Center

🇺🇸

Philadelphia, Pennsylvania, United States

Fox Chase Cancer Center

🇺🇸

Philadelphia, Pennsylvania, United States

Rapid City Regional Hospital

🇺🇸

Rapid City, South Dakota, United States

Baylor University Medical Center

🇺🇸

Dallas, Texas, United States

Cancer Care Center at Island Hospital

🇺🇸

Anacortes, Washington, United States

Audie L Murphy Veterans Affairs Hospital

🇺🇸

San Antonio, Texas, United States

Harrison HealthPartners Hematology and Oncology-Bremerton

🇺🇸

Bremerton, Washington, United States

PeaceHealth Saint Joseph Medical Center

🇺🇸

Bellingham, Washington, United States

University of California Davis Comprehensive Cancer Center

🇺🇸

Sacramento, California, United States

University of Colorado Cancer Center - Anschutz Cancer Pavilion

🇺🇸

Aurora, Colorado, United States

Saint Joseph Mercy Hospital

🇺🇸

Ann Arbor, Michigan, United States

Michigan Cancer Research Consortium NCORP

🇺🇸

Ann Arbor, Michigan, United States

University of Michigan Comprehensive Cancer Center

🇺🇸

Ann Arbor, Michigan, United States

Nebraska Methodist Hospital

🇺🇸

Omaha, Nebraska, United States

North Kansas City Hospital

🇺🇸

Kansas City, Missouri, United States

Research Medical Center

🇺🇸

Kansas City, Missouri, United States

Heartland Hematology and Oncology Associates Incorporated

🇺🇸

Kansas City, Missouri, United States

Truman Medical Center

🇺🇸

Kansas City, Missouri, United States

Saint Luke's Hospital of Kansas City

🇺🇸

Kansas City, Missouri, United States

Rice Memorial Hospital

🇺🇸

Willmar, Minnesota, United States

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