Melphalan, Prednisone, and Thalidomide or Lenalidomide in Treating Patients With Newly Diagnosed Multiple Myeloma

Phase 3

Active, not recruiting

Conditions: Multiple Myeloma

Interventions: Other: Laboratory Biomarker Analysis
Drug: Melphalan
Drug: Lenalidomide
Drug: Prednisone
Other: Quality-of-Life Assessment
Drug: Thalidomide

Registration Number: NCT00602641

Lead Sponsor: National Cancer Institute (NCI)

Brief Summary: This randomized phase III trial studies melphalan and prednisone with thalidomide to see how well it works compared to melphalan and prednisone together with lenalidomide in treating patients with newly diagnosed multiple myeloma. Drugs used in chemotherapy, such as melphalan and prednisone, 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. Thalidomide and lenalidomide may stop the growth of multiple myeloma by blocking blood flow to the cancer. It is not yet known whether melphalan and prednisone are more effective when given together with thalidomide or lenalidomide in treating multiple myeloma.

Detailed Description: PRIMARY OBJECTIVES:

I. To compare progression-free survival between patients receiving melphalan, prednisone, and thalidomide versus melphalan, prednisone, and lenalidomide in newly diagnosed multiple myeloma patients who are not candidates for high-dose therapy.

SECONDARY OBJECTIVES:

I. To compare overall survival between the arms. II. To compare response rates and depth of response. III. To compare the incidence of toxicities. IV. To validate the translocation classification (TC) of myeloma as a prognostic tool using gene expression profiling at diagnosis.

TERTIARY OBJECTIVES:

I. To compare quality-of-life (QOL) change between arms based on the Functional Assessment of Cancer Therapy/Gynecologic Oncology Group-Neurotoxicity (FACT-Ntx) Trial Outcome Index (TOI) from registration (prior to initiation of treatment) to the end of cycle 24 (maintenance therapy).

II. To examine the impact of differential treatment response (PFS), if observed, on QOL based on the FACT-Ntx TOI up to cycle 38 (maintenance therapy).

III. To obtain prospective data on myeloma specific QOL attributes.

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

ARM I:

INDUCTION THERAPY: Patients receive melphalan orally (PO) and prednisone PO once daily (QD) on days 1-4, and thalidomide PO QD on days 1-28. Treatment repeats every 28 days for up to 12 courses in the absence of disease progression or unacceptable toxicity.

MAINTENANCE THERAPY: Patients receive thalidomide PO QD and continue in the absence of disease progression.

ARM II:

INDUCTION THERAPY: Patients receive melphalan PO and prednisone PO QD on days 1-4, and lenalidomide PO on days 1-21. Treatment repeats every 28 days for up to 12 courses in the absence of disease progression or unacceptable toxicity.

MAINTENANCE THERAPY: Patients receive lenalidomide PO QD on days 1-21. Courses repeat every 28 days in the absence of disease progression.

After completion of study treatment, patients are followed up periodically for 10 years.

Recruitment & Eligibility

Status: ACTIVE_NOT_RECRUITING

Sex: All

Target Recruitment: 306

Inclusion Criteria

Patients must have a confirmed diagnosis of symptomatic myeloma; for the original diagnosis of myeloma patients should have met the following criteria at one point in their disease course:
- Bone marrow plasmacytosis with >= 10% plasma cells or sheets of plasma cells or biopsy proven plasmacytoma
- Patient must have had symptomatic disease at initial diagnosis that prompted the initiation of therapy as well as evidence of end-organ damage at the time of diagnosis namely; at least one of the following: anemia, hypercalcemia, bone disease (lytic bone lesions or pathologic fracture), or renal dysfunction
  - NOTE: Patients with asymptomatic smoldering myeloma (serum m protein >= 3 gm/dL or bone marrow plasma cells >= 10% or greater plus no evidence of anemia, hypercalcemia, lytic bone lesions or renal dysfunction) and monoclonal gammopathy of undetermined significance (serum m protein < 3 gm/dL and bone marrow plasma cells < 10% plus no evidence of anemia, hypercalcemia, lytic bone lesions or renal dysfunction) are not eligible
Patients must be > 65 and have declined alternative treatment OR patients who are >= 18 < 65 are eligible if they:
- Are not a candidate for autologous stem cell transplantation in the opinion of the treating physician OR
- Have declined transplant or other alternative treatment
Eastern Cooperative Oncology Group (ECOG) performance status =< 2
All tests below must be performed within 28 days prior to randomization:
- Serum free light chain assay
- Kappa free light chain
- Lambda free light chain
  - NOTE: The serum free light chain test is required to be done if the patient does not have measurable disease in the serum or urine; measurable disease in the serum is defined as having a serum M-spike >= 1 g/dL; measurable disease in the urine is defined as having a urine M-spike >= 200 mg/24 hr
  - NOTE: urine protein electrophoresis (UPEP) (on a 24 hour collection) is required, no substitute method is acceptable; urine must be followed monthly if the baseline urine M-spike is >= 200 mg/24 hr; please note that if both serum and urine m-components are present, both must be followed in order to evaluate response
Hemoglobin > 7 g/dL
Platelet count > 75,000 cells/mm^3
Absolute neutrophil count > 1000 cells/mm^3
Creatinine < 2.5 mg/dL and creatinine clearance (measured or calculated) > 60 mL/min
Total bilirubin =< 1.5 mg/dL
Serum glutamate pyruvate transaminase (SGPT) [alanine aminotransferase (ALT)] and serum glutamic oxaloacetic transaminase (SGOT) [aspartate aminotransferase (AST)] =< 2.5 times the upper limit of normal
Patients must be previously untreated for myeloma, although prior treatment for myeloma with prednisone or dexamethasone for less than 4 weeks total dosing alone or in combination with thalidomide or lenalidomide for less than 2 weeks total dosing is allowable
Patients may be receiving bisphosphonates or growth factors (erythropoietin) for multiple myeloma; although erythropoietin is allowed, it is strongly discouraged due to increased risk of thrombosis when employed alongside thalidomide and/or lenalidomide therapy
Patients must be willing and able to take prophylaxis with either aspirin at 325 mg/day or alternative prophylaxis with either low molecular weight heparin or Coumadin
Females of childbearing potential (FCBP) must have a negative serum or urine pregnancy test with a sensitivity of at least 25 mIU/mL within 10 - 14 days and again within 24 hours prior to starting cycle 1 of lenalidomide; further, they must either commit to continued abstinence from heterosexual intercourse or begin TWO acceptable methods of birth control: one highly effective method and one additional effective method AT THE SAME TIME, at least 28 days before starting lenalidomide; FCBP must also agree to ongoing pregnancy testing; men must agree to use a latex condom during sexual contact with a FCBP, even if they have had a successful vasectomy; a FCBP is a sexually mature woman who: 1) has not undergone a hysterectomy or bilateral oophorectomy; or 2) 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); all patients must be counseled by a trained counselor every 28 days about pregnancy precautions and risks of fetal exposure
Patients must not have uncontrolled inter-current illness that would limit compliance with the study including:
- Uncontrolled hypertension
- Symptomatic congestive heart failure
- Unstable angina
- Uncontrolled cardiac arrhythmia
- Uncontrolled psychiatric illness or social situation
- Prior history of Stevens Johnson syndrome
Patients must not have grade 2 or higher peripheral neuropathy
Patients must not have an active, uncontrolled infection
Female patients MUST NOT be pregnant or breastfeeding; the use of these drugs in this patient population is ABSOLUTELY CONTRAINDICATED; for women of childbearing potential, a negative serum pregnancy test is required within 10-14 days prior to randomization; for female patients of childbearing potential a negative serum pregnancy test must be repeated within 24 hours prior to initiation of treatment, weekly for the first 4 weeks of treatment and then every 4 weeks if the patient's periods are regular or every 2 weeks if they are not; women of childbearing potential must be willing to refrain from sexual intercourse or must be willing to employ a dual method of contraception, one of which is highly effective [intrauterine device (IUD), birth control pills, tubal ligation or partner's vasectomy] and another additional method (condom, diaphragm or cervical cap) starting 4 weeks prior to and while taking lenalidomide and thalidomide and for four weeks after discontinuing this therapy; the male partner of a female using a single form of birth control should use a condom regardless of his vasectomy status
Sexually active males must be willing to use a condom (even if they have undergone a prior vasectomy) while having intercourse with any woman, while taking lenalidomide and thalidomide and for 4 weeks after stopping treatment
Patients must not have had a second active malignancy requiring treatment within the last 2 years, with the exceptions of basal or squamous cell carcinoma of the skin, in situ carcinoma of the cervix

Exclusion Criteria

Not provided

Study & Design

Study Type: INTERVENTIONAL

Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Arm I (thalidomide)	Laboratory Biomarker Analysis	INDUCTION THERAPY: Patients receive melphalan PO and prednisone PO QD on days 1-4, and thalidomide PO QD on days 1-28. Treatment repeats every 28 days for up to 12 courses in the absence of disease progression or unacceptable toxicity. MAINTENANCE THERAPY: Patients receive thalidomide PO QD and continue in the absence of disease progression.
Arm I (thalidomide)	Quality-of-Life Assessment	INDUCTION THERAPY: Patients receive melphalan PO and prednisone PO QD on days 1-4, and thalidomide PO QD on days 1-28. Treatment repeats every 28 days for up to 12 courses in the absence of disease progression or unacceptable toxicity. MAINTENANCE THERAPY: Patients receive thalidomide PO QD and continue in the absence of disease progression.
Arm II (lenalidomide)	Laboratory Biomarker Analysis	INDUCTION THERAPY: Patients receive melphalan PO and prednisone PO QD on days 1-4, and lenalidomide PO on days 1-21. Treatment repeats every 28 days for up to 12 courses in the absence of disease progression or unacceptable toxicity. MAINTENANCE THERAPY: Patients receive lenalidomide PO QD on days 1-21. Courses repeat every 28 days in the absence of disease progression.
Arm I (thalidomide)	Melphalan	INDUCTION THERAPY: Patients receive melphalan PO and prednisone PO QD on days 1-4, and thalidomide PO QD on days 1-28. Treatment repeats every 28 days for up to 12 courses in the absence of disease progression or unacceptable toxicity. MAINTENANCE THERAPY: Patients receive thalidomide PO QD and continue in the absence of disease progression.
Arm I (thalidomide)	Prednisone	INDUCTION THERAPY: Patients receive melphalan PO and prednisone PO QD on days 1-4, and thalidomide PO QD on days 1-28. Treatment repeats every 28 days for up to 12 courses in the absence of disease progression or unacceptable toxicity. MAINTENANCE THERAPY: Patients receive thalidomide PO QD and continue in the absence of disease progression.
Arm II (lenalidomide)	Lenalidomide	INDUCTION THERAPY: Patients receive melphalan PO and prednisone PO QD on days 1-4, and lenalidomide PO on days 1-21. Treatment repeats every 28 days for up to 12 courses in the absence of disease progression or unacceptable toxicity. MAINTENANCE THERAPY: Patients receive lenalidomide PO QD on days 1-21. Courses repeat every 28 days in the absence of disease progression.
Arm I (thalidomide)	Thalidomide	INDUCTION THERAPY: Patients receive melphalan PO and prednisone PO QD on days 1-4, and thalidomide PO QD on days 1-28. Treatment repeats every 28 days for up to 12 courses in the absence of disease progression or unacceptable toxicity. MAINTENANCE THERAPY: Patients receive thalidomide PO QD and continue in the absence of disease progression.
Arm II (lenalidomide)	Melphalan	INDUCTION THERAPY: Patients receive melphalan PO and prednisone PO QD on days 1-4, and lenalidomide PO on days 1-21. Treatment repeats every 28 days for up to 12 courses in the absence of disease progression or unacceptable toxicity. MAINTENANCE THERAPY: Patients receive lenalidomide PO QD on days 1-21. Courses repeat every 28 days in the absence of disease progression.
Arm II (lenalidomide)	Prednisone	INDUCTION THERAPY: Patients receive melphalan PO and prednisone PO QD on days 1-4, and lenalidomide PO on days 1-21. Treatment repeats every 28 days for up to 12 courses in the absence of disease progression or unacceptable toxicity. MAINTENANCE THERAPY: Patients receive lenalidomide PO QD on days 1-21. Courses repeat every 28 days in the absence of disease progression.

Primary Outcome Measures

Name	Time	Method
Progression-Free Survival (PFS)	Assessed every 3 months for 2 years, then every 6 months for 3 years, then annually for 10 years from the date of randomization.	PFS is defined as the time from randomization to the earlier of progression or death of any cause.

Secondary Outcome Measures

Name	Time	Method
Very Good Partial Response (VGPR) Rate	Assessed every cycle (1 cycle=28 days) for the first 12 cycles, and then every 2 cycles while on treatment. Post treatment assessed every 3 months < 2 years from study entry, every 6 months if 2-5 years, every 12 months if 6-10 years from study entry.	Response evaluation was based on the International Myeloma Working Group (IMWG) response criteria. VGPR rate was defined as patients achieving at least VGPR which include patients who achieving complete response (CR) and VGPR. CR refers to patients who have complete disappearance of an M-protein and no evidence of myeloma in the bone marrow. VGPR refers to patients who meet the following criteria: Serum and urine M-component detectable by immunofixation but not on electrophoresis; Or 90% or greater reduction in serum M-component plus urine M-component \<100 mg per 24 hours; If the serum and urine M protein are unmeasurable and the immunoglobulin free light chain parameter is being used to measure response, a ≥ 90% decrease in the difference between involved and uninvolved free light chain (FLC) levels is required in place of the M protein criteria.
Overall Survival	Assessed every 3 months for 2 years, then every 6 months for 3 years, then annually for 10 years from the date of randomization.	Overall survival was defined as time from randomization to death from any cause.
Change in Functional Assessment of Cancer Therapy-Neurotoxicity Trial Outcome Index (FACT-Ntx TOI) Score From Baseline to Cycle 12	Administered at registration, the beginning of cycle 7 d1, the end of cycle 12 d28, then at the end of cycle 18, 24, and 38 d28. For patients who discontinue treatment early, assessed at time of discontinuation and at the next quarterly follow-up visit.	A combined scale was used to assess the quality of life (QOL) comprising of the well established and validated functional well-being (FWB) and physical well-being (PWB) components of FACT-G version 4 (14 questions), which will address the physical and functional well-being of multiple myeloma patients plus the FACT-neurotoxicity (NTX, 11 questions), which will evaluate symptoms of neurotoxicity. This pooled scale is referred to as the FACT Ntx TOI. The FACT-Ntx TOI has 25 items and the score ranges from 0 (worst possible outcome) to 100 (best possible outcome).

Trial Locations

Locations (390): Saint Anthony Hospital
🇺🇸
Lakewood, Colorado, United States
Memorial Hospital
🇺🇸
Carthage, Illinois, United States
Swedish Covenant Hospital
🇺🇸
Chicago, Illinois, United States
Illinois CancerCare-Carthage
🇺🇸
Carthage, Illinois, United States
IU Health Arnett Cancer Care
🇺🇸
Lafayette, Indiana, United States
Franciscan Saint Anthony Health-Michigan City
🇺🇸
Michigan City, Indiana, United States
The Community Hospital
🇺🇸
Munster, Indiana, United States
Reid Health
🇺🇸
Richmond, Indiana, United States
McFarland Clinic - Ames
🇺🇸
Ames, Iowa, United States
Upper Valley Medical Center
🇺🇸
Troy, Ohio, United States
Providence Hospital
🇺🇸
Mobile, Alabama, United States
Poudre Valley Hospital
🇺🇸
Fort Collins, Colorado, United States
Saint Ann's Hospital
🇺🇸
Westerville, Ohio, United States
Saint Mary's Hospital and Regional Medical Center
🇺🇸
Grand Junction, Colorado, United States
Mayo Clinic in Arizona
🇺🇸
Scottsdale, Arizona, United States
Sparks Regional Medical Center
🇺🇸
Fort Smith, Arkansas, United States
UC San Diego Moores Cancer Center
🇺🇸
La Jolla, California, United States
Fremont - Rideout Cancer Center
🇺🇸
Marysville, California, United States
Banner North Colorado Medical Center
🇺🇸
Greeley, Colorado, United States
Memorial Medical Center
🇺🇸
Modesto, California, United States
University of California Davis Comprehensive Cancer Center
🇺🇸
Sacramento, California, United States
UC San Diego Medical Center - Hillcrest
🇺🇸
San Diego, California, United States
Kaiser Permanente-San Diego Mission
🇺🇸
San Diego, California, United States
San Diego VA Medical Center
🇺🇸
San Diego, California, United States
Gene Upshaw Memorial Tahoe Forest Cancer Center
🇺🇸
Truckee, California, United States
The Medical Center of Aurora
🇺🇸
Aurora, Colorado, United States
Boulder Community Hospital
🇺🇸
Boulder, Colorado, United States
Penrose-Saint Francis Healthcare
🇺🇸
Colorado Springs, Colorado, United States
AdventHealth Porter
🇺🇸
Denver, Colorado, United States
Presbyterian - Saint Lukes Medical Center - Health One
🇺🇸
Denver, Colorado, United States
Saint Joseph Hospital - Cancer Centers of Colorado
🇺🇸
Denver, Colorado, United States
Rose Medical Center
🇺🇸
Denver, Colorado, United States
Western States Cancer Research NCORP
🇺🇸
Denver, Colorado, United States
Swedish Medical Center
🇺🇸
Englewood, Colorado, United States
Sky Ridge Medical Center
🇺🇸
Lone Tree, Colorado, United States
Longmont United Hospital
🇺🇸
Longmont, Colorado, United States
Banner McKee Medical Center
🇺🇸
Loveland, Colorado, United States
Saint Mary Corwin Medical Center
🇺🇸
Pueblo, Colorado, United States
North Suburban Medical Center
🇺🇸
Thornton, Colorado, United States
Intermountain Health Lutheran Hospital
🇺🇸
Wheat Ridge, Colorado, United States
Hartford Hospital
🇺🇸
Hartford, Connecticut, United States
MedStar Georgetown University Hospital
🇺🇸
Washington, District of Columbia, United States
Holy Cross Hospital
🇺🇸
Fort Lauderdale, Florida, United States
Broward Health Medical Center
🇺🇸
Fort Lauderdale, Florida, United States
Mayo Clinic in Florida
🇺🇸
Jacksonville, Florida, United States
Jupiter Medical Center
🇺🇸
Jupiter, Florida, United States
Mount Sinai Medical Center
🇺🇸
Miami Beach, Florida, United States
Phoebe Putney Memorial Hospital
🇺🇸
Albany, Georgia, United States
Piedmont Hospital
🇺🇸
Atlanta, Georgia, United States
Emory University Hospital/Winship Cancer Institute
🇺🇸
Atlanta, Georgia, United States
Atlanta Regional CCOP
🇺🇸
Atlanta, Georgia, United States
Emory Saint Joseph's Hospital
🇺🇸
Atlanta, Georgia, United States
Northside Hospital
🇺🇸
Atlanta, Georgia, United States
Augusta University Medical Center
🇺🇸
Augusta, Georgia, United States
WellStar Cobb Hospital
🇺🇸
Austell, Georgia, United States
John B Amos Cancer Center
🇺🇸
Columbus, Georgia, United States
Emory Decatur Hospital
🇺🇸
Decatur, Georgia, United States
Dublin Hematology Oncology Care PC
🇺🇸
Dublin, Georgia, United States
Piedmont Fayette Hospital
🇺🇸
Fayetteville, Georgia, United States
Northside Hospital - Gwinnett
🇺🇸
Lawrenceville, Georgia, United States
Wellstar Kennestone Hospital
🇺🇸
Marietta, Georgia, United States
Southern Regional Medical Center
🇺🇸
Riverdale, Georgia, United States
Rush - Copley Medical Center
🇺🇸
Aurora, Illinois, United States
Illinois CancerCare-Bloomington
🇺🇸
Bloomington, Illinois, United States
Mount Sinai Hospital Medical Center
🇺🇸
Chicago, Illinois, United States
Harbin Clinic Medical Oncology and Clinical Research
🇺🇸
Rome, Georgia, United States
OSF Saint Joseph Medical Center
🇺🇸
Bloomington, Illinois, United States
OSF Saint Anthony's Health Center
🇺🇸
Alton, Illinois, United States
Graham Hospital Association
🇺🇸
Canton, Illinois, United States
Heartland Cancer Research NCORP
🇺🇸
Decatur, Illinois, United States
NorthShore University HealthSystem-Evanston Hospital
🇺🇸
Evanston, Illinois, United States
Saint Francis Hospital
🇺🇸
Federal Way, Washington, United States
Galesburg Cottage Hospital
🇺🇸
Galesburg, Illinois, United States
Illinois CancerCare-Canton
🇺🇸
Canton, Illinois, United States
University of Illinois
🇺🇸
Chicago, Illinois, United States
University of Chicago Comprehensive Cancer Center
🇺🇸
Chicago, Illinois, United States
Eureka Hospital
🇺🇸
Eureka, Illinois, United States
Illinois CancerCare-Eureka
🇺🇸
Eureka, Illinois, United States
Illinois CancerCare-Cottage
🇺🇸
Galesburg, Illinois, United States
Illinois CancerCare-Galesburg
🇺🇸
Galesburg, Illinois, United States
Western Illinois Cancer Treatment Center
🇺🇸
Galesburg, Illinois, United States
Illinois CancerCare-Havana
🇺🇸
Havana, Illinois, United States
Mason District Hospital
🇺🇸
Havana, Illinois, United States
Hinsdale Hematology Oncology Associates Incorporated
🇺🇸
Hinsdale, Illinois, United States
Hopedale Medical Complex - Hospital
🇺🇸
Hopedale, Illinois, United States
Duly Health and Care Joliet
🇺🇸
Joliet, Illinois, United States
Illinois CancerCare-Kewanee Clinic
🇺🇸
Kewanee, Illinois, United States
Kewanee Hospital
🇺🇸
Kewanee, Illinois, United States
AMITA Health Adventist Medical Center
🇺🇸
La Grange, Illinois, United States
Illinois CancerCare-Macomb
🇺🇸
Macomb, Illinois, United States
Mcdonough District Hospital
🇺🇸
Macomb, Illinois, United States
Garneau, Stewart C MD (UIA Investigator)
🇺🇸
Moline, Illinois, United States
Porubcin, Michael MD (UIA Investigator)
🇺🇸
Moline, Illinois, United States
Sharis, Christine M MD (UIA Investigator)
🇺🇸
Moline, Illinois, United States
Spector, David MD (UIA Investigator)
🇺🇸
Moline, Illinois, United States
Stoffel, Thomas J MD (UIA Investigator)
🇺🇸
Moline, Illinois, United States
Trinity Medical Center
🇺🇸
Moline, Illinois, United States
Holy Family Medical Center
🇺🇸
Monmouth, Illinois, United States
Illinois CancerCare-Monmouth
🇺🇸
Monmouth, Illinois, United States
SSM Health Good Samaritan
🇺🇸
Mount Vernon, Illinois, United States
Carle BroMenn Medical Center
🇺🇸
Normal, Illinois, United States
Carle Cancer Institute Normal
🇺🇸
Normal, Illinois, United States
Illinois CancerCare-Community Cancer Center
🇺🇸
Normal, Illinois, United States
Illinois CancerCare-Ottawa Clinic
🇺🇸
Ottawa, Illinois, United States
Ottawa Regional Hospital and Healthcare Center
🇺🇸
Ottawa, Illinois, United States
Illinois CancerCare-Pekin
🇺🇸
Pekin, Illinois, United States
OSF Saint Francis Radiation Oncology at Pekin
🇺🇸
Pekin, Illinois, United States
Pekin Hospital
🇺🇸
Pekin, Illinois, United States
Proctor Hospital
🇺🇸
Peoria, Illinois, United States
Illinois CancerCare-Peoria
🇺🇸
Peoria, Illinois, United States
Methodist Medical Center of Illinois
🇺🇸
Peoria, Illinois, United States
OSF Saint Francis Medical Center
🇺🇸
Peoria, Illinois, United States
Illinois CancerCare-Peru
🇺🇸
Peru, Illinois, United States
Illinois Valley Hospital
🇺🇸
Peru, Illinois, United States
Valley Radiation Oncology
🇺🇸
Peru, Illinois, United States
Illinois CancerCare-Princeton
🇺🇸
Princeton, Illinois, United States
Perry Memorial Hospital
🇺🇸
Princeton, Illinois, United States
Swedish American Hospital
🇺🇸
Rockford, Illinois, United States
Illinois CancerCare-Spring Valley
🇺🇸
Spring Valley, Illinois, United States
Saint Margaret's Hospital
🇺🇸
Spring Valley, Illinois, United States
Springfield Memorial Hospital
🇺🇸
Springfield, Illinois, United States
Carle Cancer Center
🇺🇸
Urbana, Illinois, United States
Franciscan Saint Francis Health-Beech Grove
🇺🇸
Beech Grove, Indiana, United States
Constantinou, Costas L MD (UIA Investigator)
🇺🇸
Bettendorf, Iowa, United States
University of Iowa Healthcare Cancer Services Quad Cities
🇺🇸
Bettendorf, Iowa, United States
UI Health Care Mission Cancer and Blood - West Des Moines Clinic
🇺🇸
Clive, Iowa, United States
MercyOne Genesis Davenport Medical Center
🇺🇸
Davenport, Iowa, United States
MercyOne Genesis Davenport Cancer Center
🇺🇸
Davenport, Iowa, United States
Mercy Capitol
🇺🇸
Des Moines, Iowa, United States
Iowa Methodist Medical Center
🇺🇸
Des Moines, Iowa, United States
Iowa-Wide Oncology Research Coalition NCORP
🇺🇸
Des Moines, Iowa, United States
UI Health Care Mission Cancer and Blood - Des Moines Clinic
🇺🇸
Des Moines, Iowa, United States
Mercy Medical Center - Des Moines
🇺🇸
Des Moines, Iowa, United States
UI Health Care Mission Cancer and Blood - Laurel Clinic
🇺🇸
Des Moines, Iowa, United States
Iowa Lutheran Hospital
🇺🇸
Des Moines, Iowa, United States
University of Iowa/Holden Comprehensive Cancer Center
🇺🇸
Iowa City, Iowa, United States
Iowa City VA Healthcare System
🇺🇸
Iowa City, Iowa, United States
Mercy Medical Center - North Iowa
🇺🇸
Mason City, Iowa, United States
Ottumwa Regional Health Center
🇺🇸
Ottumwa, Iowa, United States
Siouxland Regional Cancer Center
🇺🇸
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
Cotton O'Neil Cancer Center / Stormont Vail Health
🇺🇸
Topeka, Kansas, United States
Cedar Valley Medical Specialists
🇺🇸
Waterloo, Iowa, United States
Lawrence Memorial Hospital
🇺🇸
Lawrence, Kansas, United States
Doctors Carrol, Sheth, Raghavan
🇺🇸
Louisville, Kentucky, United States
Owensboro Health Mitchell Memorial Cancer Center
🇺🇸
Owensboro, Kentucky, United States
MercyOne Waterloo Cancer Center
🇺🇸
Waterloo, Iowa, United States
Wesley Medical Center
🇺🇸
Wichita, Kansas, United States
Ochsner Health Center-Summa
🇺🇸
Baton Rouge, Louisiana, United States
Ochsner Health Center-Covington
🇺🇸
Covington, Louisiana, United States
Ochsner Medical Center Jefferson
🇺🇸
New Orleans, Louisiana, United States
Mercy Hospital
🇺🇸
Coon Rapids, Minnesota, United States
Greater Baltimore Medical Center
🇺🇸
Baltimore, Maryland, United States
Walter Reed National Military Medical Center
🇺🇸
Bethesda, Maryland, United States
Lahey Hospital and Medical Center
🇺🇸
Burlington, Massachusetts, United States
Addison Gilbert Hospital
🇺🇸
Gloucester, Massachusetts, United States
Michigan Cancer Research Consortium NCORP
🇺🇸
Ann Arbor, Michigan, United States
Trinity Health Saint Joseph Mercy Hospital Ann Arbor
🇺🇸
Ann Arbor, Michigan, United States
Corewell Health Dearborn Hospital
🇺🇸
Dearborn, Michigan, United States
Henry Ford Health Saint John Hospital
🇺🇸
Detroit, Michigan, United States
Hurley Medical Center
🇺🇸
Flint, Michigan, United States
Genesys Regional Medical Center-West Flint Campus
🇺🇸
Flint, Michigan, United States
Allegiance Health
🇺🇸
Jackson, Michigan, United States
Bronson Methodist Hospital
🇺🇸
Kalamazoo, Michigan, United States
West Michigan Cancer Center
🇺🇸
Kalamazoo, Michigan, United States
Ascension Borgess Hospital
🇺🇸
Kalamazoo, Michigan, United States
University of Michigan Health - Sparrow Lansing
🇺🇸
Lansing, Michigan, United States
Trinity Health Saint Mary Mercy Livonia Hospital
🇺🇸
Livonia, Michigan, United States
Trinity Health Saint Joseph Mercy Oakland Hospital
🇺🇸
Pontiac, Michigan, United States
Lake Huron Medical Center
🇺🇸
Port Huron, Michigan, United States
MyMichigan Medical Center Saginaw
🇺🇸
Saginaw, Michigan, United States
Henry Ford Health Warren Hospital
🇺🇸
Warren, Michigan, United States
Sanford Joe Lueken Cancer Center
🇺🇸
Bemidji, Minnesota, United States
Essentia Health Saint Joseph's Medical Center
🇺🇸
Brainerd, Minnesota, United States
Fairview Ridges Hospital
🇺🇸
Burnsville, Minnesota, United States
Essentia Health Cancer Center
🇺🇸
Duluth, Minnesota, United States
Essentia Health Saint Mary's Medical Center
🇺🇸
Duluth, Minnesota, United States
Miller-Dwan Hospital
🇺🇸
Duluth, Minnesota, United States
Fairview Southdale Hospital
🇺🇸
Edina, Minnesota, United States
Lake Region Healthcare Corporation-Cancer Care
🇺🇸
Fergus Falls, Minnesota, United States
Unity Hospital
🇺🇸
Fridley, Minnesota, United States
Hutchinson Area Health Care
🇺🇸
Hutchinson, Minnesota, United States
Meeker County Memorial Hospital
🇺🇸
Litchfield, Minnesota, United States
Minnesota Oncology Hematology PA-Maplewood
🇺🇸
Maplewood, Minnesota, United States
Saint John's Hospital - Healtheast
🇺🇸
Maplewood, Minnesota, United States
Abbott-Northwestern Hospital
🇺🇸
Minneapolis, Minnesota, United States
Virginia Piper Cancer Institute
🇺🇸
Minneapolis, Minnesota, United States
Hennepin County Medical Center
🇺🇸
Minneapolis, Minnesota, United States
Minneapolis VA Medical Center
🇺🇸
Minneapolis, Minnesota, United States
North Memorial Medical Health Center
🇺🇸
Robbinsdale, Minnesota, United States
Mayo Clinic in Rochester
🇺🇸
Rochester, Minnesota, United States
Metro Minnesota Community Oncology Research Consortium
🇺🇸
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 Joseph's Hospital - Healtheast
🇺🇸
Saint Paul, Minnesota, United States
United Hospital
🇺🇸
Saint Paul, Minnesota, United States
Saint Francis Regional Medical Center
🇺🇸
Shakopee, Minnesota, United States
Lakeview Hospital
🇺🇸
Stillwater, Minnesota, United States
Ridgeview Medical Center
🇺🇸
Waconia, Minnesota, United States
Rice Memorial Hospital
🇺🇸
Willmar, Minnesota, United States
Minnesota Oncology Hematology PA-Woodbury
🇺🇸
Woodbury, Minnesota, United States
Woodwinds Health Campus
🇺🇸
Woodbury, Minnesota, United States
Singing River Hospital
🇺🇸
Pascagoula, Mississippi, United States
Central Care Cancer Center - Bolivar
🇺🇸
Bolivar, Missouri, United States
Cox Cancer Center Branson
🇺🇸
Branson, Missouri, United States
Southeast Missouri Hospital
🇺🇸
Cape Girardeau, Missouri, United States
Mercy Cancer Center - Cape Girardeau
🇺🇸
Cape Girardeau, Missouri, United States
Saint Francis Medical Center
🇺🇸
Cape Girardeau, Missouri, United States
Saint Luke's Hospital
🇺🇸
Chesterfield, Missouri, United States
MU Health Care Goldschmidt Cancer Center
🇺🇸
Jefferson City, Missouri, United States
Saint Louis Cancer and Breast Institute-South City
🇺🇸
Saint Louis, Missouri, United States
Missouri Baptist Medical Center
🇺🇸
Saint Louis, Missouri, United States
Center for Cancer Care and Research
🇺🇸
Saint Louis, Missouri, United States
Comprehensive Cancer Care PC
🇺🇸
Saint Louis, Missouri, United States
Mercy Hospital Saint Louis
🇺🇸
Saint Louis, Missouri, United States
Saint Louis-Cape Girardeau CCOP
🇺🇸
Saint Louis, Missouri, United States
Cancer Research for the Ozarks NCORP
🇺🇸
Springfield, Missouri, United States
Mercy Hospital Springfield
🇺🇸
Springfield, Missouri, United States
CoxHealth South Hospital
🇺🇸
Springfield, Missouri, United States
Billings Clinic Cancer Center
🇺🇸
Billings, Montana, United States
Northern Rockies Radiation Oncology Center
🇺🇸
Billings, Montana, United States
Saint Vincent Healthcare
🇺🇸
Billings, Montana, United States
Montana Cancer Consortium NCORP
🇺🇸
Billings, Montana, United States
Saint Vincent Frontier Cancer Center
🇺🇸
Billings, Montana, United States
Bozeman Health Deaconess Hospital
🇺🇸
Bozeman, Montana, United States
Saint James Community Hospital and Cancer Treatment Center
🇺🇸
Butte, Montana, United States
Benefis Sletten Cancer Institute
🇺🇸
Great Falls, Montana, United States
Berdeaux, Donald MD (UIA Investigator)
🇺🇸
Great Falls, Montana, United States
Great Falls Clinic
🇺🇸
Great Falls, Montana, United States
Northern Montana Hospital
🇺🇸
Havre, Montana, United States
Saint Peter's Community Hospital
🇺🇸
Helena, Montana, United States
Glacier Oncology PLLC
🇺🇸
Kalispell, Montana, United States
Kalispell Medical Oncology
🇺🇸
Kalispell, Montana, United States
Logan Health Medical Center
🇺🇸
Kalispell, Montana, United States
Montana Cancer Specialists
🇺🇸
Missoula, Montana, United States
Saint Patrick Hospital - Community Hospital
🇺🇸
Missoula, Montana, United States
Community Medical Center
🇺🇸
Missoula, Montana, United States
Guardian Oncology and Center for Wellness
🇺🇸
Missoula, Montana, United States
CHI Health Good Samaritan
🇺🇸
Kearney, Nebraska, United States
Nebraska Cancer Research Center
🇺🇸
Lincoln, Nebraska, United States
Missouri Valley Cancer Consortium
🇺🇸
Omaha, Nebraska, United States
Alegent Health Immanuel Medical Center
🇺🇸
Omaha, Nebraska, United States
Alegent Health Bergan Mercy Medical Center
🇺🇸
Omaha, Nebraska, United States
Creighton University Medical Center
🇺🇸
Omaha, Nebraska, United States
Roswell Park Cancer Institute
🇺🇸
Buffalo, New York, United States
University of Nebraska Medical Center
🇺🇸
Omaha, Nebraska, United States
University Medical Center of Southern Nevada
🇺🇸
Las Vegas, Nevada, United States
Nevada Cancer Institute-Summerlin Campus
🇺🇸
Las Vegas, Nevada, United States
Nevada Cancer Research Foundation NCORP
🇺🇸
Las Vegas, Nevada, United States
Veterans Adminstration New Jersey Health Care System
🇺🇸
East Orange, New Jersey, United States
Virtua Memorial
🇺🇸
Mount Holly, New Jersey, United States
Rutgers Cancer Institute of New Jersey
🇺🇸
New Brunswick, New Jersey, United States
Rutgers Cancer Institute of New Jersey-Robert Wood Johnson University Hospital
🇺🇸
New Brunswick, New Jersey, United States
Rutgers New Jersey Medical School
🇺🇸
Newark, New Jersey, United States
University of Rochester
🇺🇸
Rochester, New York, United States
Virtua Voorhees
🇺🇸
Voorhees, New Jersey, United States
Montefiore Medical Center-Wakefield Campus
🇺🇸
Bronx, New York, United States
Kings County Hospital
🇺🇸
Brooklyn, New York, United States
Hematology Oncology Associates of Central New York-East Syracuse
🇺🇸
East Syracuse, New York, United States
State University of New York Downstate Medical Center
🇺🇸
Brooklyn, New York, United States
Veterans Affairs New York Harbor Healthcare System-Manhattan Campus
🇺🇸
New York, New York, United States
Stony Brook University Medical Center
🇺🇸
Stony Brook, New York, United States
Syracuse Veterans Administration Medical Center
🇺🇸
Syracuse, New York, United States
Novant Health Presbyterian Medical Center
🇺🇸
Charlotte, North Carolina, United States
Southeastern Medical Oncology Center-Goldsboro
🇺🇸
Goldsboro, North Carolina, United States
Margaret R Pardee Memorial Hospital
🇺🇸
Hendersonville, North Carolina, United States
ECU Health Oncology Kinston
🇺🇸
Kinston, North Carolina, United States
Wayne Memorial Hospital
🇺🇸
Goldsboro, North Carolina, United States
UNC Rex Healthcare
🇺🇸
Raleigh, North Carolina, United States
Mid Dakota Clinic
🇺🇸
Bismarck, North Dakota, United States
Saint Alexius Medical Center
🇺🇸
Bismarck, North Dakota, United States
Sanford Bismarck Medical Center
🇺🇸
Bismarck, North Dakota, United States
Sanford Broadway Medical Center
🇺🇸
Fargo, North Dakota, United States
Summa Health System - Akron Campus
🇺🇸
Akron, Ohio, United States
Summa Health System - Barberton Campus
🇺🇸
Barberton, Ohio, United States
Mary Rutan Hospital
🇺🇸
Bellefontaine, Ohio, United States
Cleveland Clinic Mercy Hospital
🇺🇸
Canton, Ohio, United States
Aultman Health Foundation
🇺🇸
Canton, Ohio, United States
Adena Regional Medical Center
🇺🇸
Chillicothe, Ohio, United States
Case Western Reserve University
🇺🇸
Cleveland, Ohio, United States
MetroHealth Medical Center
🇺🇸
Cleveland, Ohio, United States
Riverside Methodist Hospital
🇺🇸
Columbus, Ohio, United States
Columbus NCI Community Oncology Research Program
🇺🇸
Columbus, Ohio, United States
Grant Medical Center
🇺🇸
Columbus, Ohio, United States
Mount Carmel Health Center West
🇺🇸
Columbus, Ohio, United States
Doctors Hospital
🇺🇸
Columbus, Ohio, United States
Grandview Hospital
🇺🇸
Dayton, Ohio, United States
Good Samaritan Hospital - Dayton
🇺🇸
Dayton, Ohio, United States
Miami Valley Hospital
🇺🇸
Dayton, Ohio, United States
Miami Valley Hospital North
🇺🇸
Dayton, Ohio, United States
Dayton Veterans Affairs Medical Center
🇺🇸
Dayton, 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
Atrium Medical Center-Middletown Regional Hospital
🇺🇸
Franklin, Ohio, United States
Wayne Hospital
🇺🇸
Greenville, Ohio, United States
Kettering Medical Center
🇺🇸
Kettering, 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
Knox Community Hospital
🇺🇸
Mount Vernon, Ohio, United States
Licking Memorial Hospital
🇺🇸
Newark, Ohio, United States
Springfield Regional Medical Center
🇺🇸
Springfield, Ohio, United States
Clinton Memorial Hospital/Foster J Boyd Regional Cancer Center
🇺🇸
Wilmington, Ohio, United States
Greene Memorial Hospital
🇺🇸
Xenia, Ohio, United States
Genesis Healthcare System Cancer Care Center
🇺🇸
Zanesville, Ohio, United States
Cancer Centers of Southwest Oklahoma Research
🇺🇸
Lawton, Oklahoma, United States
Clackamas Radiation Oncology Center
🇺🇸
Clackamas, Oregon, United States
Legacy Mount Hood Medical Center
🇺🇸
Gresham, Oregon, United States
Providence Milwaukie Hospital
🇺🇸
Milwaukie, Oregon, United States
Providence Newberg Medical Center
🇺🇸
Newberg, Oregon, United States
Providence Willamette Falls Medical Center
🇺🇸
Oregon City, Oregon, United States
Legacy Good Samaritan Hospital and Medical Center
🇺🇸
Portland, Oregon, United States
Providence Portland Medical Center
🇺🇸
Portland, Oregon, United States
Adventist Medical Center
🇺🇸
Portland, Oregon, United States
Providence Saint Vincent Medical Center
🇺🇸
Portland, Oregon, United States
Compass Oncology Rose Quarter
🇺🇸
Portland, Oregon, United States
Legacy Emanuel Hospital and Health Center
🇺🇸
Portland, Oregon, United States
Legacy Meridian Park Hospital
🇺🇸
Tualatin, Oregon, United States
Bryn Mawr Hospital
🇺🇸
Bryn Mawr, Pennsylvania, United States
Adams Cancer Center
🇺🇸
Gettysburg, Pennsylvania, United States
WellSpan Medical Oncology and Hematology
🇺🇸
Hanover, Pennsylvania, United States
Penn State Milton S Hershey Medical Center
🇺🇸
Hershey, Pennsylvania, United States
Central PA Hematology-Medical Oncology Associates PC
🇺🇸
Lemoyne, Pennsylvania, United States
Lewistown Hospital
🇺🇸
Lewistown, Pennsylvania, United States
Paoli Memorial Hospital
🇺🇸
Paoli, Pennsylvania, United States
Einstein Medical Center Philadelphia
🇺🇸
Philadelphia, Pennsylvania, United States
Phoenixville Hospital
🇺🇸
Phoenixville, Pennsylvania, United States
Guthrie Medical Group PC-Robert Packer Hospital
🇺🇸
Sayre, Pennsylvania, United States
Mount Nittany Medical Center
🇺🇸
State College, Pennsylvania, United States
UPMC Susquehanna
🇺🇸
Williamsport, Pennsylvania, United States
Lankenau Medical Center
🇺🇸
Wynnewood, Pennsylvania, United States
Main Line Health NCORP
🇺🇸
Wynnewood, Pennsylvania, United States
WellSpan Health-York Cancer Center
🇺🇸
York, Pennsylvania, United States
WellSpan Health-York Hospital
🇺🇸
York, Pennsylvania, United States
Rapid City Regional Hospital
🇺🇸
Rapid City, South Dakota, United States
Sanford Cancer Center Oncology Clinic
🇺🇸
Sioux Falls, South Dakota, United States
Avera Cancer Institute
🇺🇸
Sioux Falls, South Dakota, United States
Medical X-Ray Center
🇺🇸
Sioux Falls, South Dakota, United States
Avera McKennan Hospital and University Health Center
🇺🇸
Sioux Falls, South Dakota, United States
Sanford USD Medical Center - Sioux Falls
🇺🇸
Sioux Falls, South Dakota, United States
Cookeville Regional Medical Center
🇺🇸
Cookeville, Tennessee, United States
Jackson-Madison County General Hospital
🇺🇸
Jackson, Tennessee, United States
The Jackson Clinic PA
🇺🇸
Jackson, Tennessee, United States
Vanderbilt University/Ingram Cancer Center
🇺🇸
Nashville, Tennessee, United States
Scott and White Memorial Hospital
🇺🇸
Temple, Texas, United States
University of Virginia Cancer Center
🇺🇸
Charlottesville, Virginia, United States
Danville Regional Medical Center
🇺🇸
Danville, Virginia, United States
Sovah Health Martinsville
🇺🇸
Martinsville, Virginia, United States
MultiCare Auburn Medical Center
🇺🇸
Auburn, Washington, United States
Providence Regional Cancer System-Centralia
🇺🇸
Centralia, Washington, United States
Saint Clare Hospital
🇺🇸
Lakewood, Washington, United States
Providence - Saint Peter Hospital
🇺🇸
Olympia, Washington, United States
MultiCare Good Samaritan Hospital
🇺🇸
Puyallup, Washington, United States
Swedish Medical Center-First Hill
🇺🇸
Seattle, Washington, United States
MultiCare Allenmore Hospital
🇺🇸
Tacoma, Washington, United States
MultiCare Tacoma General Hospital
🇺🇸
Tacoma, Washington, United States
Northwest NCI Community Oncology Research Program
🇺🇸
Tacoma, Washington, United States
Saint Joseph Medical Center
🇺🇸
Tacoma, Washington, United States
PeaceHealth Southwest Medical Center
🇺🇸
Vancouver, Washington, United States
Legacy Salmon Creek Hospital
🇺🇸
Vancouver, Washington, United States
West Virginia University Charleston Division
🇺🇸
Charleston, West Virginia, United States
Camden Clark Medical Center
🇺🇸
Parkersburg, West Virginia, United States
Princeton Community Hospital
🇺🇸
Princeton, West Virginia, United States
ThedaCare Regional Cancer Center
🇺🇸
Appleton, Wisconsin, United States
HSHS Sacred Heart Hospital
🇺🇸
Eau Claire, Wisconsin, United States
Marshfield Clinic Cancer Center at Sacred Heart
🇺🇸
Eau Claire, Wisconsin, United States
Saint Agnes Hospital/Agnesian Cancer Center
🇺🇸
Fond Du Lac, Wisconsin, United States
University of Wisconsin Carbone Cancer Center - Johnson Creek
🇺🇸
Johnson Creek, Wisconsin, United States
Gundersen Lutheran Medical Center
🇺🇸
La Crosse, Wisconsin, United States
SSM Health Dean Medical Group - South Madison Campus
🇺🇸
Madison, Wisconsin, United States
University of Wisconsin Carbone Cancer Center - University Hospital
🇺🇸
Madison, Wisconsin, United States
Marshfield Medical Center-Marshfield
🇺🇸
Marshfield, Wisconsin, United States
Marshfield Medical Center
🇺🇸
Marshfield, Wisconsin, United States
Marshfield Medical Center - Minocqua
🇺🇸
Minocqua, Wisconsin, United States
ProHealth Oconomowoc Memorial Hospital
🇺🇸
Oconomowoc, Wisconsin, United States
Aspirus Cancer Care - James Beck Cancer Center
🇺🇸
Rhinelander, Wisconsin, United States
Marshfield Medical Center-Rice Lake
🇺🇸
Rice Lake, Wisconsin, United States
Aspirus Cancer Care - Stevens Point
🇺🇸
Stevens Point, Wisconsin, United States
ProHealth Waukesha Memorial Hospital
🇺🇸
Waukesha, Wisconsin, United States
Aspirus Regional Cancer Center
🇺🇸
Wausau, Wisconsin, United States
Marshfield Clinic-Wausau Center
🇺🇸
Wausau, Wisconsin, United States
Marshfield Medical Center - Weston
🇺🇸
Weston, Wisconsin, United States
Aspirus Cancer Care - Wisconsin Rapids
🇺🇸
Wisconsin Rapids, Wisconsin, United States
Marshfield Clinic - Wisconsin Rapids Center
🇺🇸
Wisconsin Rapids, Wisconsin, United States
Rocky Mountain Oncology
🇺🇸
Casper, Wyoming, United States
Welch Cancer Center
🇺🇸
Sheridan, Wyoming, United States
Rambam Medical Center
🇮🇱
Haifa, Israel
Shaare Zedek Medical Center
🇮🇱
Jerusalem, Israel