Irinotecan and Cetuximab With or Without Bevacizumab in Treating Patients With Metastatic Colorectal Cancer That Progressed During First-Line Therapy
- Conditions
- Recurrent Rectal CancerStage IVB Colon CancerStage IVA Rectal CancerStage IVB Rectal CancerRecurrent Colon CancerStage IVA Colon Cancer
- Interventions
- Drug: irinotecan hydrochlorideDrug: leucovorin calciumDrug: fluorouracilBiological: cetuximabBiological: bevacizumab
- Registration Number
- NCT00499369
- Lead Sponsor
- National Cancer Institute (NCI)
- Brief Summary
This randomized phase III trial is studying giving irinotecan and cetuximab together with bevacizumab to see how well it works compared with giving irinotecan and cetuximab alone in treating patients with metastatic colorectal cancer that progressed during first-line therapy. Drugs used in chemotherapy, such as irinotecan, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Monoclonal antibodies, such as cetuximab and bevacizumab, can block tumor growth in different ways. Some block the ability of tumor cells to grow and spread. Others find tumor cells and help kill them or carry tumor-killing substances to them. Bevacizumab may also stop the growth of tumor cells by blocking blood flow to the tumor. It is not yet known whether irinotecan and cetuximab are more effective with or without bevacizumab in treating metastatic colorectal cancer.
- Detailed Description
PRIMARY OBJECTIVES:
I. Compare progression-free survival of patients with metastatic colorectal cancer that progressed on first-line therapy comprising bevacizumab and FOLFOX, OPTIMOX, or XELOX treated with irinotecan hydrochloride-based chemotherapy and cetuximab with vs without bevacizumab.
II. Compare overall survival of patients treated with these regimens. III. Compare objective tumor response (confirmed and unconfirmed, complete and partial response) in patients with measurable disease treated with these regimens.
IV. Compare the tolerability and safety profile of these regimens in these patients.
OUTLINE: This is a multicenter, randomized study. Patients are stratified according to Zubrod performance status (0 vs 1 or 2), discontinuation of oxaliplatin during first-line therapy (yes vs no), planned concurrent chemotherapy (FOLFIRI vs single-agent irinotecan hydrochloride), and time from last dose of bevacizumab (14-42 days vs \>= 43 days).
All patients receive 1 of the following chemotherapy regimens:
SINGLE AGENT IRINOTECAN HYDROCHLORIDE: Patients receive irinotecan hydrochloride intravenously (IV) over 90 minutes on day 1. Treatment repeats every 21 days in the absence of disease progression or unacceptable toxicity.
FOLFIRI: Patients receive irinotecan hydrochloride IV over 90 minutes and leucovorin calcium IV over 2 hours on day 1 and fluorouracil IV continuously over 46-48 hours on days 1 and 2. Treatment repeats every 14 days in the absence of disease progression or unacceptable toxicity.
Patients are then randomized to 1 of 3 treatment arms.
ARM I: Patients receive single-agent irinotecan hydrochloride or FOLFIRI as outlined above and cetuximab IV over 1-2 hours on day 1. Courses repeat every 14-21 days (depending upon chemotherapy regimen) in the absence of disease progression or unacceptable toxicity.
ARM II: Patients receive single-agent irinotecan hydrochloride or FOLFIRI as outlined above and cetuximab as in arm I. Patients also receive bevacizumab IV over 30 minutes on day 1. Courses repeat every 14-21 days (depending upon chemotherapy regimen) in the absence of disease progression or unacceptable toxicity.
ARM III (closed to accrual as of 4/20/2009): Patients receive single-agent irinotecan hydrochloride or FOLFIRI as outlined above and cetuximab as in arm I. Patients also receive a higher dose of bevacizumab (higher than in arm II) IV over 30 minutes on day 1. Courses repeat every 14-21 days (depending upon chemotherapy regimen) in the absence of disease progression or unacceptable toxicity.
After completion of study treatment, patients are followed every 6 months for 2 years and then once a year for 3 years.
Recruitment & Eligibility
- Status
- TERMINATED
- Sex
- All
- Target Recruitment
- 72
-
Patients must have metastatic colorectal cancer that has been histologically or cytologically confirmed; confirmation may be from either the primary tumor or a metastasis; patients must have wild type KRAS
-
Patients must be registered within 28 days of documented disease progression on first line chemotherapy with bevacizumab plus either FOLFOX, OPTIMOX, or XELOX; this progression must have occurred within 90 days after the last dose of bevacizumab; patients who discontinued oxaliplatin, continued with 5-FU/LV or capecitabine and bevacizumab and then had subsequent progression while on fluoropyrimidine and bevacizumab are eligible; patients who discontinued bevacizumab due to adverse events in the first-line setting are not eligible
-
Measurable or nonmeasurable disease
-
At least 14 days must have elapsed since the last dose of first line chemotherapy and bevacizumab
-
Patients must not have received prior treatment with irinotecan (either as adjuvant or metastatic treatment)
-
Patients must have no history of prior treatment with cetuximab or other agents targeting VEGF or EGFR (except for bevacizumab)
-
Prior radiotherapy is allowed, provided at least 28 days have elapsed since the last treatment; all adverse events related to radiation therapy must be resolved
-
Prior surgery is allowed, provided at least 28 days have elapsed since any major surgery and patient has recovered from all effects
-
Zubrod performance status 0-2
-
Absolute neutrophil count (ANC) >= 1,500/mm^3
-
Platelet count >= 100,000/mm^3
-
Hemoglobin >= 9 g/dL
-
Total bilirubin =< 1.5 times upper limit of normal (ULN)
-
Serum glutamic oxaloacetic transaminase (SGOT) or serum glutamic pyruvate transaminase (SGPT) =< 2.5 x IULN; if there are known liver metastases, SGOT or SGPT must be =< 5 x IULN; these results must be obtained within 28 days prior to registration
-
Serum creatinine =< IULN or measured or estimated creatinine clearance >= 60 mL/min
-
Patients must not have a history or known presence of brain metastasis
-
Patients may be on full dose anticoagulation with warfarin provided that the patient has an acceptable International Normalized Ratio (INR) (between 2 and 3), obtained within 28 days prior to registration
-
No clinically relevant bleeding diathesis or coagulopathy
-
Patients must not have experienced nephrotic range proteinuria from prior bevacizumab therapy; urine protein must be screened by urine analysis for Urine Protein Creatinine (UPC) ratio; for UPC ratio > 0.5, 24-hour urine protein must be obtained and the level must be < 1,000 mg for patient enrollment; urine protein and creatinine used in calculating the UPC ratio must be obtained within 28 days prior to registration
-
No uncontrolled high blood pressure (BP) (i.e., systolic BP > 150 mm Hg and diastolic BP > 90 mm Hg)
-
No cardiovascular event within the past 6 months, including any of the following:
- Arterial thrombosis
- Unstable angina
- Myocardial infarction
- Cerebrovascular accident
-
Patients must not have New York Heart Association (NYHA) >= Grade 2 congestive heart failure
-
Patients must not have unstable symptomatic arrhythmia requiring medication; (patients with chronic, controlled arrhythmias such as atrial fibrillation or paroxysmal supraventricular tachycardia [PSVT] are eligible)
-
No clinically significant peripheral vascular disease
-
No serious or nonhealing active wound, ulcer, or bone fracture
-
No history of gastrointestinal (GI) perforation while on prior bevacizumab
-
No significant bleeding episodes (e.g., hemoptysis or upper or lower GI bleeding) within the past 6 months unless the source of bleeding has been resected
-
No known hypersensitivity to bevacizumab or known potential hypersensitivity to cetuximab
-
No other concurrent chemotherapy, hormonal therapy, radiotherapy, immunotherapy, or any other type of anticancer treatment
-
Due to the possibility of harm to a fetus or nursing infant from this treatment regimen, patients must not be pregnant or nursing; women and men of reproductive potential must have agreed to use an effective contraceptive method
-
No other malignancy within the past 5 years except for adequately treated basal or squamous cell skin cancer or cervical cancer in situ
-
All patients must be informed of the investigational nature of this study and must sign and give written informed consent in accordance with institutional and federal guidelines
-
At the time of patient registration, the treating institution's name and identification (ID) number must be provided to the Data Operations Center in Seattle in order to ensure that the current (within 365 days) date of institutional review board approval for this study has been entered into the data base
Not provided
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Arm I (chemotherapy, cetuximab) leucovorin calcium Patients receive single-agent irinotecan hydrochloride IV or FOLFIRI IV. They also receive cetuximab IV over 1-2 hours on day 1. Courses repeat every 14-21 days (depending upon chemotherapy regimen) in the absence of disease progression or unacceptable toxicity. Arm II (chemotherapy, cetuximab, bevacizumab) leucovorin calcium Patients receive single-agent irinotecan hydrochloride or FOLFIRI AND cetuximab as in arm I. Patients also receive bevacizumab IV over 30 minutes on day 1. Courses repeat every 14-21 days (depending upon chemotherapy regimen) in the absence of disease progression or unacceptable toxicity. Arm III (closed to accrual as of 4/20/2009) irinotecan hydrochloride Patients receive single-agent irinotecan hydrochloride or FOLFIRI AND cetuximab as in arm I. Patients also receive a higher dose of bevacizumab (higher than in arm II) IV over 30 minutes on day 1. Courses repeat every 14-21 days (depending upon chemotherapy regimen) in the absence of disease progression or unacceptable toxicity. Arm I (chemotherapy, cetuximab) cetuximab Patients receive single-agent irinotecan hydrochloride IV or FOLFIRI IV. They also receive cetuximab IV over 1-2 hours on day 1. Courses repeat every 14-21 days (depending upon chemotherapy regimen) in the absence of disease progression or unacceptable toxicity. Arm II (chemotherapy, cetuximab, bevacizumab) fluorouracil Patients receive single-agent irinotecan hydrochloride or FOLFIRI AND cetuximab as in arm I. Patients also receive bevacizumab IV over 30 minutes on day 1. Courses repeat every 14-21 days (depending upon chemotherapy regimen) in the absence of disease progression or unacceptable toxicity. Arm II (chemotherapy, cetuximab, bevacizumab) cetuximab Patients receive single-agent irinotecan hydrochloride or FOLFIRI AND cetuximab as in arm I. Patients also receive bevacizumab IV over 30 minutes on day 1. Courses repeat every 14-21 days (depending upon chemotherapy regimen) in the absence of disease progression or unacceptable toxicity. Arm II (chemotherapy, cetuximab, bevacizumab) bevacizumab Patients receive single-agent irinotecan hydrochloride or FOLFIRI AND cetuximab as in arm I. Patients also receive bevacizumab IV over 30 minutes on day 1. Courses repeat every 14-21 days (depending upon chemotherapy regimen) in the absence of disease progression or unacceptable toxicity. Arm III (closed to accrual as of 4/20/2009) leucovorin calcium Patients receive single-agent irinotecan hydrochloride or FOLFIRI AND cetuximab as in arm I. Patients also receive a higher dose of bevacizumab (higher than in arm II) IV over 30 minutes on day 1. Courses repeat every 14-21 days (depending upon chemotherapy regimen) in the absence of disease progression or unacceptable toxicity. Arm III (closed to accrual as of 4/20/2009) cetuximab Patients receive single-agent irinotecan hydrochloride or FOLFIRI AND cetuximab as in arm I. Patients also receive a higher dose of bevacizumab (higher than in arm II) IV over 30 minutes on day 1. Courses repeat every 14-21 days (depending upon chemotherapy regimen) in the absence of disease progression or unacceptable toxicity. Arm III (closed to accrual as of 4/20/2009) bevacizumab Patients receive single-agent irinotecan hydrochloride or FOLFIRI AND cetuximab as in arm I. Patients also receive a higher dose of bevacizumab (higher than in arm II) IV over 30 minutes on day 1. Courses repeat every 14-21 days (depending upon chemotherapy regimen) in the absence of disease progression or unacceptable toxicity. Arm I (chemotherapy, cetuximab) fluorouracil Patients receive single-agent irinotecan hydrochloride IV or FOLFIRI IV. They also receive cetuximab IV over 1-2 hours on day 1. Courses repeat every 14-21 days (depending upon chemotherapy regimen) in the absence of disease progression or unacceptable toxicity. Arm I (chemotherapy, cetuximab) irinotecan hydrochloride Patients receive single-agent irinotecan hydrochloride IV or FOLFIRI IV. They also receive cetuximab IV over 1-2 hours on day 1. Courses repeat every 14-21 days (depending upon chemotherapy regimen) in the absence of disease progression or unacceptable toxicity. Arm II (chemotherapy, cetuximab, bevacizumab) irinotecan hydrochloride Patients receive single-agent irinotecan hydrochloride or FOLFIRI AND cetuximab as in arm I. Patients also receive bevacizumab IV over 30 minutes on day 1. Courses repeat every 14-21 days (depending upon chemotherapy regimen) in the absence of disease progression or unacceptable toxicity. Arm III (closed to accrual as of 4/20/2009) fluorouracil Patients receive single-agent irinotecan hydrochloride or FOLFIRI AND cetuximab as in arm I. Patients also receive a higher dose of bevacizumab (higher than in arm II) IV over 30 minutes on day 1. Courses repeat every 14-21 days (depending upon chemotherapy regimen) in the absence of disease progression or unacceptable toxicity.
- Primary Outcome Measures
Name Time Method Progression-free Survival (PFS) Up to 5 years PFS is measured from date of registration to first documentation of progression or symptomatic deterioration, or death due to any cause. Patients last known to be alive and progression free are censored at date of last contact.
- Secondary Outcome Measures
Name Time Method Overall Survival Up to 5 years Time to death is from date of registration to date of death due to any cause. Patients last known to be alive are censored at date of last contact.
Objective Tumor Response Up to 5 years Toxicity Up to 5 years Number of patients with Grade 3 through 5 adverse events that are related to study drug. Only adverse events that are possibly, probably or definitely related to study drug are reported.
Trial Locations
- Locations (381)
Graham Hospital Association
🇺🇸Canton, Illinois, United States
Elkhart General Hospital
🇺🇸Elkhart, Indiana, United States
Toledo Radiation Oncology at Northwest Ohio Onocolgy Center
🇺🇸Maumee, Ohio, United States
Saint Luke's Hospital
🇺🇸Maumee, Ohio, United States
Toledo Clinic Cancer Centers-Maumee
🇺🇸Maumee, Ohio, United States
Geisinger Medical Group
🇺🇸State College, Pennsylvania, United States
Riverside Methodist Hospital
🇺🇸Columbus, Ohio, United States
Mount Carmel Health Center West
🇺🇸Columbus, Ohio, United States
Boston Medical Center
🇺🇸Boston, Massachusetts, United States
Harborview Medical Center
🇺🇸Seattle, Washington, United States
Group Health Cooperative-Seattle
🇺🇸Seattle, Washington, United States
University of Washington Medical Center
🇺🇸Seattle, Washington, United States
Abbott-Northwestern Hospital
🇺🇸Minneapolis, Minnesota, United States
Virginia Piper Cancer Institute
🇺🇸Minneapolis, Minnesota, United States
Saint Edward Mercy Medical Center
🇺🇸Ft. Smith, Arkansas, United States
Valley Medical Oncology Consultants-Castro Valley
🇺🇸Castro Valley, California, United States
Providence Saint Joseph Medical Center/Disney Family Cancer Center
🇺🇸Burbank, California, United States
East Bay Radiation Oncology Center
🇺🇸Castro Valley, California, United States
Bay Area Breast Surgeons Inc
🇺🇸Oakland, California, United States
Bay Area Tumor Institute CCOP
🇺🇸Oakland, California, United States
Palchak David MD
🇺🇸Pismo Beach, California, United States
Boulder Community Hospital
🇺🇸Boulder, Colorado, United States
North Colorado Medical Center
🇺🇸Greeley, Colorado, United States
Saint Anthony Hospital
🇺🇸Lakewood, Colorado, United States
Sky Ridge Medical Center
🇺🇸Lone Tree, Colorado, United States
McKee Medical Center
🇺🇸Loveland, Colorado, United States
Longmont United Hospital
🇺🇸Longmont, Colorado, United States
North Suburban Medical Center
🇺🇸Thornton, Colorado, United States
The Hospital of Central Connecticut
🇺🇸New Britain, Connecticut, United States
Exempla Lutheran Medical Center
🇺🇸Wheat Ridge, Colorado, United States
Bayhealth Medical Center at Kent General
🇺🇸Dover, Delaware, United States
Lombardi Comprehensive Cancer Center at Georgetown University
🇺🇸Washington, District of Columbia, United States
Mayo Clinic in Florida
🇺🇸Jacksonville, Florida, United States
Edna Williams Cancer Center at the Baptist Cancer Institute
🇺🇸Jacksonville, Florida, United States
Northside Hospital
🇺🇸Atlanta, Georgia, United States
Atlanta Regional CCOP
🇺🇸Atlanta, Georgia, United States
Saint Joseph's Hospital of Atlanta
🇺🇸Atlanta, Georgia, United States
Well Star Cobb Hospital
🇺🇸Austell, Georgia, United States
Dekalb Medical Center
🇺🇸Decatur, Georgia, United States
Atlanta VA Medical Center
🇺🇸Decatur, Georgia, United States
John B Amos Cancer Center
🇺🇸Columbus, Georgia, United States
Wellstar Kennestone Hospital
🇺🇸Marietta, Georgia, United States
Gwinnett Medical Center
🇺🇸Lawrenceville, Georgia, United States
Southern Regional Medical Center
🇺🇸Riverdale, Georgia, United States
Harbin Clinic Medical Oncology and Clinical Research
🇺🇸Rome, Georgia, United States
South Georgia Medical Center
🇺🇸Valdosta, Georgia, United States
Rush - Copley Medical Center
🇺🇸Aurora, Illinois, United States
Saint Joseph Medical Center
🇺🇸Bloomington, Illinois, United States
Memorial Hospital
🇺🇸Carthage, Illinois, United States
Decatur Memorial Hospital
🇺🇸Decatur, Illinois, United States
John H Stroger Jr Hospital of Cook County
🇺🇸Chicago, Illinois, United States
Crossroads Cancer Center
🇺🇸Effingham, Illinois, United States
Resurrection Healthcare
🇺🇸Chicago, Illinois, United States
Saint Anthony Memorial Hospital
🇺🇸Effingham, Illinois, United States
Galesburg Cottage Hospital
🇺🇸Galesburg, Illinois, United States
Eureka Hospital
🇺🇸Eureka, Illinois, United States
Hopedale Medical Complex - Hospital
🇺🇸Hopedale, Illinois, United States
Illinois CancerCare Galesburg
🇺🇸Galesburg, Illinois, United States
Mason District Hospital
🇺🇸Havana, Illinois, United States
Joliet Oncology-Hematology Associates Limited
🇺🇸Joliet, Illinois, United States
Adventist La Grange Memorial Hospital
🇺🇸La Grange, Illinois, United States
Bromenn Regional Medical Center
🇺🇸Normal, Illinois, United States
Mcdonough District Hospital
🇺🇸Macomb, Illinois, United States
Community Cancer Center Foundation
🇺🇸Normal, Illinois, United States
Illinois CancerCare-Peoria
🇺🇸Peoria, Illinois, United States
Perry Memorial Hospital
🇺🇸Princeton, Illinois, United States
Saint Margaret's Hospital
🇺🇸Spring Valley, Illinois, United States
Michiana Hematology Oncology PC-Mishawaka
🇺🇸Mishawaka, Indiana, United States
Franciscan Saint Anthony Health-Michigan City
🇺🇸Michigan City, Indiana, United States
Michiana Hematology Oncology PC-Plymouth
🇺🇸Plymouth, Indiana, United States
Michiana Hematology Oncology PC-South Bend
🇺🇸South Bend, Indiana, United States
South Bend Clinic
🇺🇸South Bend, Indiana, United States
Northern Indiana Cancer Research Consortium
🇺🇸South Bend, Indiana, United States
McFarland Clinic PC-William R Bliss Cancer Center
🇺🇸Ames, Iowa, United States
Michiana Hematology Oncology-PC Westville
🇺🇸Westville, Indiana, United States
Hematology Oncology Associates-Quad Cities
🇺🇸Bettendorf, Iowa, 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
Iowa Oncology Research Association CCOP
🇺🇸Des Moines, Iowa, United States
Iowa Lutheran Hospital
🇺🇸Des Moines, Iowa, United States
Siouxland Hematology Oncology Associates
🇺🇸Sioux City, Iowa, United States
Saint Luke's Regional Medical Center
🇺🇸Sioux City, Iowa, United States
Covenant Medical Center
🇺🇸Waterloo, Iowa, United States
Mercy Medical Center-Sioux City
🇺🇸Sioux City, Iowa, United States
Hays Medical Center
🇺🇸Hays, Kansas, United States
Cancer Center of Kansas-Independence
🇺🇸Independence, Kansas, United States
Promise Regional Medical Center-Hutchinson
🇺🇸Hutchinson, Kansas, United States
Cancer Center of Kansas - Pratt
🇺🇸Pratt, Kansas, United States
Stormont-Vail Regional Health Center
🇺🇸Topeka, Kansas, United States
Saint Francis Hospital and Medical Center - Topeka
🇺🇸Topeka, Kansas, United States
Cancer Center of Kansas-Wichita Medical Arts Tower
🇺🇸Wichita, Kansas, United States
Regions Hospital
🇺🇸Saint Paul, Minnesota, United States
Ridgeview Medical Center
🇺🇸Waconia, Minnesota, United States
Saint Joseph's Hospital - Healtheast
🇺🇸Saint Paul, Minnesota, United States
Park Nicollet Clinic - Saint Louis Park
🇺🇸Saint Louis Park, Minnesota, United States
United Hospital
🇺🇸Saint Paul, Minnesota, United States
Singing River Hospital
🇺🇸Pascagoula, Mississippi, United States
Southeast Missouri Hospital
🇺🇸Cape Girardeau, Missouri, United States
Veterans Administration
🇺🇸Columbia, Missouri, United States
Saint Louis University Hospital
🇺🇸Saint Louis, Missouri, United States
Missouri Baptist Medical Center
🇺🇸Saint Louis, Missouri, United States
Mercy Hospital Springfield
🇺🇸Springfield, Missouri, United States
Center for Cancer Care and Research
🇺🇸Saint Louis, Missouri, United States
Northern Montana Hospital
🇺🇸Havre, Montana, United States
Great Falls Clinic
🇺🇸Great Falls, Montana, United States
Community Medical Hospital
🇺🇸Missoula, Montana, United States
Good Samaritan Hospital
🇺🇸Kearney, Nebraska, United States
Nebraska Cancer Research Center
🇺🇸Lincoln, Nebraska, United States
Virtua West Jersey Hospital Voorhees
🇺🇸Voorhees, New Jersey, United States
Fox Chase Cancer Center at Virtua Memorial Hospital of Burlington County
🇺🇸Mount Holly, New Jersey, United States
Adirondack Cancer Center
🇺🇸Glens Falls, New York, United States
Orange Regional Medical Center
🇺🇸Middletown, New York, United States
Southeastern Medical Oncology Center-Goldsboro
🇺🇸Goldsboro, North Carolina, United States
Margaret R Pardee Memorial Hospital
🇺🇸Hendersonville, North Carolina, United States
Rutherford Hospital
🇺🇸Rutherfordton, North Carolina, United States
Bismarck Cancer Center
🇺🇸Bismarck, North Dakota, United States
Altru Cancer Center
🇺🇸Grand Forks, North Dakota, United States
Aultman Health Foundation
🇺🇸Canton, Ohio, United States
Columbus CCOP
🇺🇸Columbus, Ohio, United States
North Coast Cancer Care-Clyde
🇺🇸Clyde, Ohio, United States
Grant Medical Center
🇺🇸Columbus, Ohio, United States
Knox Community Hospital
🇺🇸Mount Vernon, Ohio, United States
Licking Memorial Hospital
🇺🇸Newark, Ohio, United States
Fisher-Titus Medical Center
🇺🇸Norwalk, Ohio, United States
Saint Charles Hospital
🇺🇸Oregon, Ohio, United States
Flower Hospital
🇺🇸Sylvania, Ohio, United States
Saint Vincent Mercy Medical Center
🇺🇸Toledo, Ohio, United States
Fulton County Health Center
🇺🇸Wauseon, Ohio, United States
Genesis HealthCare System
🇺🇸Zanesville, Ohio, United States
Geisinger Medical Center-Cancer Center Hazelton
🇺🇸Hazleton, Pennsylvania, United States
Geisinger Medical Center
🇺🇸Danville, Pennsylvania, United States
Central PA Hematology-Medical Oncology Associates PC
🇺🇸Lemoyne, Pennsylvania, United States
Thomas Jefferson University Hospital
🇺🇸Philadelphia, Pennsylvania, United States
Hematology and Oncology Associates of North East Pennsylvania
🇺🇸Scranton, Pennsylvania, United States
Greenville Health System Cancer Institute-Faris
🇺🇸Greenville, South Carolina, United States
Greenville Health System Cancer Instutite/Greenville CCOP
🇺🇸Greenville, South Carolina, United States
Spartanburg Regional Medical Center
🇺🇸Spartanburg, South Carolina, United States
Rapid City Regional Hospital
🇺🇸Rapid City, South Dakota, United States
Harrison HealthPartners Hematology and Oncology-Bremerton
🇺🇸Bremerton, Washington, United States
West Virginia University Charleston
🇺🇸Charleston, West Virginia, United States
Green Bay Oncology - Oconto Falls
🇺🇸Oconto Falls, Wisconsin, United States
Green Bay Oncology - Sturgeon Bay
🇺🇸Sturgeon Bay, Wisconsin, United States
Rocky Mountain Oncology
🇺🇸Casper, Wyoming, United States
Northern Rockies Radiation Oncology Center
🇺🇸Billings, Montana, United States
Kalispell Medical Oncology
🇺🇸Kalispell, Montana, United States
Montana Cancer Specialists
🇺🇸Missoula, Montana, United States
Saint Patrick Hospital - Community Hospital
🇺🇸Missoula, Montana, United States
Saint Peter's Community Hospital
🇺🇸Helena, Montana, United States
Kalispell Regional Medical Center
🇺🇸Kalispell, Montana, United States
Swedish Medical Center
🇺🇸Englewood, Colorado, United States
Glacier Oncology PLLC
🇺🇸Kalispell, Montana, United States
Guardian Oncology and Center for Wellness
🇺🇸Missoula, Montana, United States
Bozeman Deaconess Cancer Center
🇺🇸Bozeman, Montana, United States
Benefis Healthcare- Sletten Cancer Institute
🇺🇸Great Falls, Montana, United States
Bozeman Deaconess Hospital
🇺🇸Bozeman, Montana, United States
Porter Adventist Hospital
🇺🇸Denver, Colorado, United States
Exempla Saint Joseph Hospital
🇺🇸Denver, Colorado, United States
Rose Medical Center
🇺🇸Denver, Colorado, United States
Colorado Cancer Research Program CCOP
🇺🇸Denver, Colorado, United States
Henry Ford Hospital
🇺🇸Detroit, Michigan, United States
Adventist Medical Center
🇺🇸Portland, Oregon, United States
Columbia Saint Mary's Water Tower Medical Commons
🇺🇸Milwaukee, Wisconsin, United States
University of Missouri - Ellis Fischel
🇺🇸Columbia, Missouri, United States
Highland General Hospital
🇺🇸Oakland, California, United States
Glendale Memorial Hospital and Health Center
🇺🇸Glendale, California, United States
University of Southern California
🇺🇸Los Angeles, California, United States
Saint Rose Hospital
🇺🇸Hayward, California, United States
Fremont - Rideout Cancer Center
🇺🇸Marysville, California, United States
Eden Hospital Medical Center
🇺🇸Castro Valley, California, United States
City of Hope Medical Center
🇺🇸Duarte, California, United States
Alta Bates Summit Medical Center - Summit Campus
🇺🇸Oakland, California, United States
Penrose-Saint Francis Healthcare
🇺🇸Colorado Springs, Colorado, United States
Valley Medical Oncology Consultants
🇺🇸Pleasanton, California, United States
Northbay Cancer Center
🇺🇸Fairfield, California, United States
Marin General Hospital
🇺🇸Greenbrae, California, United States
Valley Medical Oncology Consultants-Fremont
🇺🇸Fremont, California, United States
Valley Care Health System - Pleasanton
🇺🇸Pleasanton, California, United States
Sutter Roseville Medical Center
🇺🇸Roseville, California, United States
Doctors Medical Center- JC Robinson Regional Cancer Center
🇺🇸San Pablo, California, United States
Larry G Strieff MD Medical Corporation
🇺🇸Oakland, California, United States
Tom K Lee Inc
🇺🇸Oakland, California, United States
Tahoe Forest Cancer Center
🇺🇸Truckee, California, United States
Memorial Hospital Colorado Springs
🇺🇸Colorado Springs, Colorado, United States
Saint Joseph Mercy Oakland
🇺🇸Pontiac, Michigan, United States
Space Coast Cancer Centers-Titusville
🇺🇸Titusville, Florida, United States
University of Miami Miller School of Medicine-Sylvester Cancer Center
🇺🇸Miami, Florida, United States
Bixby Medical Center
🇺🇸Adrian, Michigan, United States
Holland Community Hospital
🇺🇸Holland, Michigan, United States
Illinois CancerCare-Ottawa Clinic
🇺🇸Ottawa, Illinois, United States
Piedmont Hospital
🇺🇸Atlanta, Georgia, United States
Ottawa Regional Hospital and Healthcare Center
🇺🇸Ottawa, Illinois, United States
Mercy Medical Center - Des Moines
🇺🇸Des Moines, Iowa, United States
Cedar Rapids Oncology Association
🇺🇸Cedar Rapids, Iowa, United States
Cancer Center of Kansas-Liberal
🇺🇸Liberal, Kansas, United States
Proctor Hospital
🇺🇸Peoria, Illinois, United States
OSF Saint Francis Medical Center
🇺🇸Peoria, Illinois, United States
Meeker County Memorial Hospital
🇺🇸Litchfield, Minnesota, United States
Unity Hospital
🇺🇸Fridley, Minnesota, United States
Michiana Hematology Oncology PC-Elkhart
🇺🇸Elkhart, Indiana, United States
Oncology Associates at Mercy Medical Center
🇺🇸Cedar Rapids, Iowa, United States
Fort Wayne Medical Oncology and Hematology Inc-Parkview
🇺🇸Fort Wayne, Indiana, United States
William Beaumont Hospital-Royal Oak
🇺🇸Royal Oak, Michigan, United States
Saint Mary Mercy Hospital
🇺🇸Livonia, Michigan, United States
Pekin Hospital
🇺🇸Pekin, Illinois, United States
Green Bay Oncology - Iron Mountain
🇺🇸Iron Mountain, Michigan, United States
Methodist Medical Center of Illinois
🇺🇸Peoria, Illinois, United States
Pekin Cancer Treatment Center
🇺🇸Pekin, Illinois, United States
Genesys Regional Medical Center-West Flint Campus
🇺🇸Flint, Michigan, United States
Saint John Hospital and Medical Center
🇺🇸Detroit, Michigan, United States
Saint Mary's Hospital and Regional Medical Center
🇺🇸Grand Junction, Colorado, United States
Green Bay Oncology - Escanaba
🇺🇸Escanaba, Michigan, United States
Elkhart Clinic
🇺🇸Elkhart, Indiana, United States
Carle Cancer Center
🇺🇸Urbana, Illinois, United States
Community Howard Regional Health
🇺🇸Kokomo, Indiana, United States
Saint Joseph Regional Medical Center-Mishawaka
🇺🇸Mishawaka, Indiana, United States
Illinois Oncology Research Association CCOP
🇺🇸Peoria, Illinois, United States
Indiana University Health La Porte Hospital
🇺🇸La Porte, Indiana, United States
Carle Clinic-Urbana Main
🇺🇸Urbana, Illinois, United States
Oakwood Hospital
🇺🇸Dearborn, Michigan, United States
Via Christi Regional Medical Center
🇺🇸Wichita, Kansas, United States
Wichita CCOP
🇺🇸Wichita, Kansas, United States
Memorial Medical Center
🇺🇸Springfield, Illinois, United States
Memorial Hospital of South Bend
🇺🇸South Bend, Indiana, United States
Memorial Hospital at Easton - Shore Regional Cancer Center
🇺🇸Easton, Maryland, United States
Frederick Memorial Hospital
🇺🇸Frederick, Maryland, United States
Sturdy Memorial Hospital
🇺🇸Attleboro, Massachusetts, United States
Hickman Cancer Center
🇺🇸Adrian, Michigan, United States
Saint Mary Corwin Medical Center
🇺🇸Pueblo, Colorado, United States
Doctors Carrol, Sheth, Raghavan
🇺🇸Louisville, Kentucky, United States
Essentia Health Duluth Clinic CCOP
🇺🇸Duluth, Minnesota, United States
Fairview-Southdale Hospital
🇺🇸Edina, Minnesota, United States
Essentia Health Saint Mary's Medical Center
🇺🇸Duluth, Minnesota, United States
Baton Rouge General Medical Center
🇺🇸Baton Rouge, Louisiana, United States
Miller-Dwan Hospital
🇺🇸Duluth, Minnesota, United States
Cancer Center of Kansas - Winfield
🇺🇸Winfield, Kansas, United States
Mercy Health Partners-Hackley Campus
🇺🇸Muskegon, Michigan, United States
Eastern Maine Medical Center
🇺🇸Bangor, Maine, United States
Cancer Center of Kansas - Chanute
🇺🇸Chanute, Kansas, United States
Hurley Medical Center
🇺🇸Flint, Michigan, United States
Sparrow Hospital
🇺🇸Lansing, Michigan, United States
Saint Vincent Healthcare
🇺🇸Billings, Montana, United States
Hematology-Oncology Centers of the Northern Rockies PC
🇺🇸Billings, Montana, United States
Rice Memorial Hospital
🇺🇸Willmar, Minnesota, United States
Minnesota Oncology and Hematology PA-Woodbury
🇺🇸Woodbury, Minnesota, United States
Woodwinds Health Campus
🇺🇸Woodbury, Minnesota, United States
Montana Cancer Consortium CCOP
🇺🇸Billings, Montana, United States
Billings Clinic
🇺🇸Billings, Montana, United States
Kinston Medical Specialists PA
🇺🇸Kinston, North Carolina, United States
Sparta Cancer Treatment Center
🇺🇸Sparta, New Jersey, United States
Glens Falls Hospital
🇺🇸Glens Falls, New York, United States
Mid Dakota Clinic
🇺🇸Bismarck, North Dakota, United States
FirstHealth of the Carolinas-Moore Regional Hosiptal
🇺🇸Pinehurst, North Carolina, United States
Akron General Medical Center
🇺🇸Akron, Ohio, United States
Mary Rutan Hospital
🇺🇸Bellefontaine, Ohio, United States
Toledo Clinic Cancer Centers-Bowling Green
🇺🇸Bowling Green, Ohio, United States
Doctors Hospital
🇺🇸Columbus, Ohio, United States
Grady Memorial Hospital
🇺🇸Delaware, Ohio, United States
Community Health Partners Regional Medical Center
🇺🇸Elyria, Ohio, United States
Lima Memorial Hospital
🇺🇸Lima, Ohio, United States
Fremont Memorial Hospital
🇺🇸Fremont, Ohio, United States
Fairfield Medical Center
🇺🇸Lancaster, Ohio, United States
Mansfield General Hospital-MedCentral Health System
🇺🇸Mansfield, Ohio, United States
Marietta Memorial Hospital
🇺🇸Marietta, Ohio, United States
North Coast Cancer Care
🇺🇸Sandusky, Ohio, United States
Mercy Hospital of Tiffin
🇺🇸Tiffin, Ohio, United States
Firelands Regional Medical Center
🇺🇸Sandusky, Ohio, United States
Springfield Regional Medical Center
🇺🇸Springfield, Ohio, United States
Toledo Clinic Cancer Centers-Oregon
🇺🇸Oregon, Ohio, United States
Saint Ann's Hospital
🇺🇸Westerville, Ohio, United States
Mercy Fitzgerald Hospital
🇺🇸Darby, Pennsylvania, United States
University of Toledo
🇺🇸Toledo, Ohio, United States
Bay Area Hospital
🇺🇸Coos Bay, Oregon, United States
Riddle Hospital
🇺🇸Media, Pennsylvania, United States
Allegheny Cancer Center at Allegheny General Hospital
🇺🇸Pittsburgh, Pennsylvania, United States
Associates In Hematology Oncology PC-Upland
🇺🇸Upland, Pennsylvania, United States
Greenville Health System Cancer Institute-Greer
🇺🇸Greer, South Carolina, United States
South Carolina Oncology Associates PA
🇺🇸Columbia, South Carolina, United States
Greenville Health System Cancer Institute-Easley
🇺🇸Easley, South Carolina, United States
Scott and White Memorial Hospital
🇺🇸Temple, Texas, United States
Greenville Health System Cancer Institute-Spartanburg
🇺🇸Spartanburg, South Carolina, United States
Medical Consultants Limited
🇺🇸Milwaukee, Wisconsin, United States
Mayo Clinic Health System Eau Claire Hospital - Luther Campus
🇺🇸Eau Claire, Wisconsin, United States
Green Bay Oncology at Saint Vincent Hospital
🇺🇸Green Bay, Wisconsin, United States
Camden-Clark Memorial Hospital
🇺🇸Parkersburg, West Virginia, United States
Skagit Valley Hospital
🇺🇸Mount Vernon, Washington, United States
Fredericksburg Oncology Inc
🇺🇸Fredericksburg, Virginia, United States
Wenatchee Valley Medical Center
🇺🇸Wenatchee, Washington, United States
Minor and James Medical PLLC
🇺🇸Seattle, Washington, United States
PeaceHealth Saint Joseph Medical Center
🇺🇸Bellingham, Washington, United States
Greenville Health System Cancer Institute-Seneca
🇺🇸Seneca, South Carolina, United States
Mercy Health System
🇺🇸Janesville, Wisconsin, United States
Saint Vincent Hospital
🇺🇸Green Bay, Wisconsin, United States
Upstate Carolina CCOP
🇺🇸Spartanburg, South Carolina, United States
The Don and Sybil Harrington Cancer Center
🇺🇸Amarillo, Texas, United States
Harrison HealthPartners Hematology and Oncology-Poulsbo
🇺🇸Poulsbo, Washington, United States
Bay Area Medical Center
🇺🇸Marinette, Wisconsin, United States
Welch Cancer Center
🇺🇸Sheridan, Wyoming, United States
Midelfort Clinic-Clairemont Campus
🇺🇸Eau Claire, Wisconsin, United States
Green Bay Oncology Limited at Saint Mary's Hospital
🇺🇸Green Bay, Wisconsin, United States
Saint Mary's Hospital
🇺🇸Green Bay, Wisconsin, United States
United General Hospital
🇺🇸Sedro-Woolley, Washington, United States
AnMed Health Hospital
🇺🇸Anderson, South Carolina, United States
Presbyterian - Saint Lukes Medical Center - Health One
🇺🇸Denver, Colorado, United States
Mercy Hospital
🇺🇸Coon Rapids, Minnesota, United States
Fairview Ridges Hospital
🇺🇸Burnsville, Minnesota, United States
Etzell, Paul S MD (UIA Investigator)
🇺🇸Fergus Falls, Minnesota, United States
Swenson, Wade II, MD (UIA Investigator)
🇺🇸Fergus Falls, Minnesota, United States
Hutchinson Area Health Care
🇺🇸Hutchinson, Minnesota, United States
Minnesota Oncology Hematology PA-Maplewood
🇺🇸Maplewood, Minnesota, United States
Mayo Clinic Health Systems-Mankato
🇺🇸Mankato, Minnesota, United States
Saint John's Hospital - Healtheast
🇺🇸Maplewood, Minnesota, United States
North Memorial Medical Health Center
🇺🇸Robbinsdale, Minnesota, United States
Hennepin County Medical Center
🇺🇸Minneapolis, Minnesota, United States
Mayo Clinic
🇺🇸Rochester, Minnesota, United States
Metro-Minnesota CCOP
🇺🇸Saint Louis Park, Minnesota, United States
Saint Alexius Medical Center
🇺🇸Bismarck, North Dakota, United States
Cancer Center of Kansas - El Dorado
🇺🇸El Dorado, Kansas, United States
Lawrence Memorial Hospital
🇺🇸Lawrence, Kansas, United States
Cancer Center of Kansas - Fort Scott
🇺🇸Fort Scott, Kansas, United States
Cancer Center of Kansas - Wellington
🇺🇸Wellington, Kansas, United States
Cancer Center of Kansas-Kingman
🇺🇸Kingman, Kansas, United States
Cancer Center of Kansas - Parsons
🇺🇸Parsons, Kansas, United States
Cancer Center of Kansas - Newton
🇺🇸Newton, Kansas, United States
Salina Regional Health Center
🇺🇸Salina, Kansas, United States
Olathe Cancer Center
🇺🇸Olathe, Kansas, United States
Cancer Center of Kansas - Salina
🇺🇸Salina, Kansas, United States
Associates In Womens Health
🇺🇸Wichita, Kansas, United States
Cancer Center of Kansas - Main Office
🇺🇸Wichita, Kansas, United States
Veterans Affairs Western New York Health Care System-Buffalo
🇺🇸Buffalo, New York, United States
Finger Lakes Hematology and Oncology
🇺🇸Clifton Springs, New York, United States
Greenville Health System Cancer Institute-Andrews
🇺🇸Greenville, South Carolina, United States
Greenville Health System Cancer Institute-Butternut
🇺🇸Greenville, South Carolina, United States
Saint James Community Hospital and Cancer Treatment Center
🇺🇸Butte, Montana, United States
Greenville Memorial Hospital
🇺🇸Greenville, South Carolina, United States
Self Regional Healthcare
🇺🇸Greenwood, South Carolina, United States
Cancer Centers of the Carolinas-Greer Medical Oncology
🇺🇸Greer, South Carolina, United States
The Medical Center of Aurora
🇺🇸Aurora, Colorado, United States
Fred Hutchinson Cancer Research Center/University of Washington Cancer Consortium
🇺🇸Seattle, Washington, United States
Swedish Medical Center-First Hill
🇺🇸Seattle, Washington, United States
Cancer Care Northwest - Spokane South
🇺🇸Spokane, Washington, United States
Hematology Oncology Center Incorporated
🇺🇸Elyria, Ohio, United States
Medical Oncology and Hematology Associates-West Des Moines
🇺🇸Clive, Iowa, United States
Grand Rapids Clinical Oncology Program
🇺🇸Grand Rapids, Michigan, United States
Allegiance Health
🇺🇸Jackson, Michigan, United States
Saint John Macomb-Oakland Hospital
🇺🇸Warren, Michigan, United States
Saint Mary's of Michigan
🇺🇸Saginaw, Michigan, United States
Michiana Hematology Oncology PC-Niles
🇺🇸Niles, Michigan, United States
Mercy Memorial Hospital
🇺🇸Monroe, Michigan, United States
Saint Joseph Mercy Port Huron
🇺🇸Port Huron, Michigan, United States
Marie Yeager Cancer Center
🇺🇸Saint Joseph, Michigan, United States
Lakeland Hospital
🇺🇸St. Joseph, Michigan, United States
Geisinger Wyoming Valley
🇺🇸Wilkes-Barre, Pennsylvania, United States
Columbia Saint Mary's Hospital - Ozaukee
🇺🇸Mequon, Wisconsin, United States
McLeod Regional Medical Center
🇺🇸Florence, South Carolina, United States
The Polyclinic
🇺🇸Seattle, Washington, United States
University of Tennessee - Memphis
🇺🇸Memphis, Tennessee, United States
The Toledo Hospital/Toledo Children's Hospital
🇺🇸Toledo, Ohio, United States
Community Cancer Center of Monroe
🇺🇸Monroe, Michigan, United States
Sanford Bismarck Medical Center
🇺🇸Bismarck, North Dakota, United States
Evergreen Hematology and Oncology PS
🇺🇸Spokane, Washington, United States
Via Christi Hospital-Pittsburg
🇺🇸Pittsburg, Kansas, United States
Michigan Cancer Research Consortium Community Clinical Oncology Program
🇺🇸Ann Arbor, Michigan, United States
UC Davis Comprehensive Cancer Center
🇺🇸Sacramento, California, United States
Saint Joseph Mercy Hospital
🇺🇸Ann Arbor, Michigan, United States
Berdeaux, Donald MD (UIA Investigator)
🇺🇸Great Falls, Montana, United States
Mercy Medical Center
🇺🇸Canton, Ohio, United States
Mercy Capitol
🇺🇸Des Moines, Iowa, United States
Illinois Valley Hospital
🇺🇸Peru, Illinois, United States
Toledo Community Hospital Oncology Program CCOP
🇺🇸Toledo, Ohio, United States
Mercy Saint Anne Hospital
🇺🇸Toledo, Ohio, United States
Toledo Clinic Cancer Centers-Toledo
🇺🇸Toledo, Ohio, United States
Columbia Basin Hematology and Oncology PLLC
🇺🇸Kennewick, Washington, United States
Saint Francis Regional Medical Center
🇺🇸Shakopee, Minnesota, United States
Cancer Center of Kansas - Dodge City
🇺🇸Dodge City, Kansas, United States
Aurora Cancer Care-Southern Lakes
🇺🇸Elkhorn, Wisconsin, United States
Holy Family Memorial Hospital
🇺🇸Manitowoc, Wisconsin, United States
Harold Alfond Center for Cancer Care
🇺🇸Augusta, Maine, United States
Adena Regional Medical Center
🇺🇸Chillicothe, Ohio, United States
Montefiore Medical Center
🇺🇸Bronx, New York, United States
University of Kansas Medical Center
🇺🇸Kansas City, Kansas, United States