Assessing the Accuracy of Tumor Biopsies After Chemotherapy to Determine if Patients Can Avoid Breast Surgery
- Conditions
- Stage IIA Breast CancerStage IIIA Breast CancerInvasive Breast CarcinomaStage II Breast CancerStage IIB Breast Cancer
- Interventions
- Procedure: Biopsy of Breast
- Registration Number
- NCT03188393
- Lead Sponsor
- NRG Oncology
- Brief Summary
This phase II trial studies how well biopsy of breast after chemotherapy works in predicting pathologic response in patients with stage II-IIIA breast cancer undergoing breast conserving surgery. Tumor tissue collected from biopsy before surgery may help to check if chemotherapy destroyed the breast cancer cells and may be compared to the tumor removed during surgery to check if they are the same.
- Detailed Description
PRIMARY OBJECTIVES:
I. To assess the accuracy of post-neoadjuvant systemic therapy (NST) image-directed tumor bed biopsy for pathologic complete response (pCR), defined as resolution of both invasive disease and ductal carcinoma in situ (DCIS), in cases of clinical and radiologic complete response with trimodality imaging.
SECONDARY OBJECTIVES:
I. To collect axillary pathology results, surgical staging methods (sentinel lymph node biopsy and/or axillary lymph node dissection), and management (surgery and/or radiation) in order to determine axillary nodal response to neoadjuvant chemotherapy and its relationship to breast pCR.
II. To correlate imaging results with pathologic nodal status following neoadjuvant chemotherapy for future planning of axillary management in the next study.
III. To retrospectively assess the negative predictive value (NPV) of a trimodality imaging algorithm in combination with the tumor bed biopsy for predicting pCR.
IV. To collect all trimodality imaging data to determine which combination of the trimodality imaging best identifies the group achieving pCR.
V. To correlate the number of needle cores and tumor bed clip retrieval with the NPV of the tumor site biopsy.
VI. To determine the clinical, imaging, pathologic, and molecular tumor factors associated with the highest NPVs of post-NST tumor bed biopsies.
VII. To improve identification and selection of patients with breast and possible axillary pCR for future trial planning, routine biomarkers (estrogen receptor \[ER\], progesterone receptor \[PR\], HER2 neu, and Ki67) will be collected to allow comparison to image/clinical complete response (CR), and tumor bed biopsies.
OUTLINE:
After completion of neoadjuvant therapy, patients undergo stereotactic biopsy of breast tumor any time prior to breast conserving surgery. Patients then undergo breast conserving surgery as per standard of care. Patients may also undergo postoperative radiation therapy per standard of care or adjuvant therapy at the investigator's discretion.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 105
-
The patient must have signed and dated an Institutional Review Board (IRB)-approved consent form that conforms to federal and institutional guidelines
-
The patient must have an Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1
-
Patients must have had ER analysis performed on the primary breast tumor collected prior to neoadjuvant therapy according to current American Society of Clinical Oncology (ASCO)/College of American Pathologists (CAP) guideline recommendations for hormone receptor testing; if negative for ER, assessment of progesterone receptor (PgR) must also be performed according to current ASCO/CAP Guideline Recommendations for hormone receptor testing. Patients who have a primary tumor that is hormone receptor-positive or hormone receptor-negative are eligible.
-
Patients must have had HER2 testing performed on the primary breast tumor collected prior to neoadjuvant chemotherapy according to the current ASCO/CAP guideline recommendations for human epidermal growth factor receptor 2 testing in breast cancer; patients who have a primary tumor that is HER2-positive, HER2-equivocal, or HER2-negative are eligible
-
Patients must have had a biopsy marker placed within the tumor bed with imaging confirmation (preferably mammogram but ultrasound or magnetic resonance imaging [MRI] is acceptable) of marker placement prior to neoadjuvant chemotherapy
-
Patients with operable focal or multifocal (T1-T3, stage II or III invasive ductal carcinoma [all receptor phenotypes]), and who have completed neoadjuvant chemotherapy with a clinical complete response (by clinical examination)
-
Patients with synchronous bilateral breast cancer are eligible if at least one of the synchronous breast cancers has a cCR, and the side with a cCR meets criteria. (Patients with previous contralateral invasive breast cancer treated with anti-cancer therapy are eligible.)
-
Patients must have achieved a complete or near complete radiologic tumor response on breast imaging with mammogram, ultrasound, and MRI during or after completion of appropriate neoadjuvant chemotherapy defined as:
- Mammogram with malignant appearing calcification or mass ≤ 1 cm; or
- Ultrasound with a hypoechoic area ≤ 2 cm; or
- Breast MRI not demonstrating a residual mass with rapid rise and washout type III kinetics.
-
At the time of consent, the patient's intent must be to undergo breast conserving therapy.
-
Patient must be able to undergo stereotactic-vacuum-assisted breast biopsy with clip placement after completion of neoadjuvant chemotherapy. (The patient must be enrolled on the study before performing the post-neoadjuvant stereotactic-vacuum-assisted breast biopsy.)
-
Patient must have completed neoadjuvant chemotherapy.
-
Patients with HER2-positive tumors must have received neoadjuvant anti-HER2 therapy (either with all or with a portion of the neoadjuvant chemotherapy regimen), unless medically contraindicated.
-
Patients treated with PD-1 or PD-L1 inhibitors, CDK 4/6 inhibitors, or other immune-based therapy are eligible.
-
T4 tumors including inflammatory breast cancer
-
Patients with distant metastatic disease
-
Lumpectomy performed prior to study entry
-
Patients with any history of prior radiation therapy in the affected breast
-
Patients with a prior history of ipsilateral invasive breast cancer; (patients with previous ipsilateral/contralateral DCIS or previous contralateral invasive breast cancer treated with anti-cancer therapy are eligible)
-
Patients with invasive lobular carcinoma
-
Patients who have multicentric disease
-
Patients treated with neoadjuvant hormonal therapy only are not eligible
-
Patients who are medically unfit to undergo surgical resection
-
Patients without breast biopsy marker documented by imaging at tumor bed site prior to initiation of neoadjuvant therapy
-
Patients with one or more of the following imaging criteria from any of the 3 imaging modalities after completion of NCT demonstrating incomplete radiologic response are not eligible:
- Mammogram with malignant appearing calcifications or mass > 1 cm; or
- Ultrasound with a hypoechoic area > 2 cm; or
- Breast MRI demonstrating a residual mass with rapid rise and washout type III kinetics.
-
Psychiatric or addictive disorders or other conditions that, in the opinion of the investigator, would preclude the patient from meeting the study requirements or interfere with interpretation of study results
-
Pregnancy or lactation at the time of study registration; (Note: Pregnancy testing according to institutional standards for women of childbearing potential must be performed within 2 weeks prior to study registration.)
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- SINGLE_GROUP
- Arm && Interventions
Group Intervention Description Diagnostic (biopsy of breast) Biopsy of Breast After completion of neoadjuvant therapy, patients undergo stereotactic biopsy of breast tumor any time prior to breast conserving surgery. Patients then undergo breast conserving surgery as per standard of care. Patients may also undergo postoperative radiation therapy per standard of care or adjuvant therapy at the investigator's discretion.
- Primary Outcome Measures
Name Time Method Proportion of patients with pCR Up to 18 months The proportion of tumor bed biopsies that are negative among those who are shown to have pCR at surgery will be determined. The point estimate and 95% confidence interval will be calculated.
- Secondary Outcome Measures
Name Time Method Trimodality imaging algorithm +/- biopsy as a predictor of pCR Up to18 months Analysis will be performed to assess the improvement in the negative predictive value of the trimodality imaging algorithm when the results of tumor bed biopsy are added.
Incidence of adverse events associated with tumor bed biopsy Up to 18 months Descriptive analysis will be performed to determine the frequencies of adverse events associated with tumor bed biopsy.
Improvement of negative predictive value Up to 18 months Analysis will be performed to assess the improvement in the negative predictive value of the trimodality imaging algorithm when the results of tumor bed biopsy are added.
Residual cancer burden score Up to 18 months Descriptive analysis will be performed to determine the distribution of residual cancer burden score.
Number of needle cores performed Up to 18 months Descriptive analysis will be performed to determine the distribution of the number of needle cores performed and the proportion of clips retrieved.
Proportion of clips retrieved Up to 18 months Descriptive analysis will be performed.
Trial Locations
- Locations (381)
Anne Arundel Medical Center
🇺🇸Annapolis, Maryland, United States
Emory Saint Joseph's Hospital
🇺🇸Atlanta, Georgia, United States
Emory University Hospital/Winship Cancer Institute
🇺🇸Atlanta, Georgia, United States
Eden Hospital Medical Center
🇺🇸Castro Valley, California, United States
Bay Area Breast Surgeons Inc
🇺🇸Emeryville, California, United States
Palo Alto Medical Foundation-Fremont
🇺🇸Fremont, California, United States
Kaiser Permanente-Fresno
🇺🇸Fresno, California, United States
Kaiser Permanente-Fremont
🇺🇸Fremont, California, United States
Epic Care Partners in Cancer Care
🇺🇸Emeryville, California, United States
Alta Bates Summit Medical Center-Herrick Campus
🇺🇸Berkeley, California, United States
Sutter Auburn Faith Hospital
🇺🇸Auburn, California, United States
Kaiser Permanente-Deer Valley Medical Center
🇺🇸Antioch, California, United States
University of South Alabama Mitchell Cancer Institute
🇺🇸Mobile, Alabama, United States
Palo Alto Medical Foundation-Camino Division
🇺🇸Mountain View, California, United States
Sutter Cancer Centers Radiation Oncology Services-Cameron Park
🇺🇸Cameron Park, California, United States
Epic Care-Dublin
🇺🇸Dublin, California, United States
USC / Norris Comprehensive Cancer Center
🇺🇸Los Angeles, California, United States
Palo Alto Medical Foundation-Gynecologic Oncology
🇺🇸Mountain View, California, United States
Fresno Cancer Center
🇺🇸Fresno, California, United States
McKee Medical Center
🇺🇸Loveland, Colorado, United States
Rocky Mountain Cancer Centers-Sky Ridge
🇺🇸Lone Tree, Colorado, United States
Delaware Clinical and Laboratory Physicians PA
🇺🇸Newark, Delaware, United States
Beebe Medical Center
🇺🇸Lewes, Delaware, United States
John Fitzgerald Kennedy Medical Center
🇺🇸Atlantis, Florida, United States
National Jewish Health-Northern Hematology Oncology
🇺🇸Thornton, Colorado, United States
University of Iowa/Holden Comprehensive Cancer Center
🇺🇸Iowa City, Iowa, United States
Kootenai Health - Coeur d'Alene
🇺🇸Coeur d'Alene, Idaho, United States
Swedish Medical Center
🇺🇸Englewood, Colorado, United States
UC Comprehensive Cancer Center at Silver Cross
🇺🇸New Lenox, Illinois, United States
Medical Oncology Hematology Consultants PA
🇺🇸Newark, Delaware, United States
Carle Physician Group-Effingham
🇺🇸Effingham, Illinois, United States
Christiana Care Health System-Christiana Hospital
🇺🇸Newark, Delaware, United States
Saint Mary's Hospital and Regional Medical Center
🇺🇸Grand Junction, Colorado, United States
Marjorie Weinberg Cancer Center at Loyola-Gottlieb
🇺🇸Melrose Park, Illinois, United States
Saint Alphonsus Cancer Care Center-Boise
🇺🇸Boise, Idaho, United States
Carle Physician Group-Mattoon/Charleston
🇺🇸Mattoon, Illinois, United States
Trinity Medical Center
🇺🇸Moline, Illinois, United States
Henry Ford Macomb Hospital-Clinton Township
🇺🇸Clinton Township, Michigan, United States
Dekalb Medical Center
🇺🇸Decatur, Georgia, United States
Kootenai Clinic Cancer Services - Post Falls
🇺🇸Post Falls, Idaho, United States
Good Samaritan Regional Health Center
🇺🇸Mount Vernon, Illinois, United States
Rush - Copley Medical Center
🇺🇸Aurora, Illinois, United States
Saint Louis Cancer and Breast Institute-South City
🇺🇸Saint Louis, Missouri, United States
Carle at The Riverfront
🇺🇸Danville, Illinois, United States
Henry Ford West Bloomfield Hospital
🇺🇸West Bloomfield, Michigan, United States
Northwestern Medicine Lake Forest Hospital
🇺🇸Lake Forest, Illinois, United States
Carle Cancer Center
🇺🇸Urbana, Illinois, United States
Rush-Copley Healthcare Center
🇺🇸Yorkville, Illinois, United States
UM Upper Chesapeake Medical Center
🇺🇸Bel Air, Maryland, United States
The Carle Foundation Hospital
🇺🇸Urbana, Illinois, United States
Deaconess Clinic Downtown
🇺🇸Evansville, Indiana, United States
University of Kansas Cancer Center - Lee's Summit
🇺🇸Lee's Summit, Missouri, United States
Mercy Clinic-Rolla-Cancer and Hematology
🇺🇸Rolla, Missouri, United States
Parkview Hospital Randallia
🇺🇸Fort Wayne, Indiana, United States
Henry Ford Cancer Institute-Downriver
🇺🇸Brownstown, Michigan, United States
University of Chicago Medicine-Orland Park
🇺🇸Orland Park, Illinois, United States
Billings Clinic Cancer Center
🇺🇸Billings, Montana, United States
Unity Hospital
🇺🇸Fridley, Minnesota, United States
Siteman Cancer Center at Saint Peters Hospital
🇺🇸Saint Peters, Missouri, United States
Community Hospital of Anaconda
🇺🇸Anaconda, Montana, United States
Wake Forest University at Mount Airy
🇺🇸Mount Airy, North Carolina, United States
Delbert Day Cancer Institute at PCRMC
🇺🇸Rolla, Missouri, United States
Roswell Park Cancer Institute
🇺🇸Buffalo, New York, United States
Fairview Clinics and Surgery Center Maple Grove
🇺🇸Maple Grove, Minnesota, United States
Saint John's Hospital - Healtheast
🇺🇸Maplewood, Minnesota, United States
Saint Alphonsus Medical Center-Ontario
🇺🇸Ontario, Oregon, United States
Sechler Family Cancer Center
🇺🇸Lebanon, Pennsylvania, United States
Great Falls Clinic
🇺🇸Great Falls, Montana, United States
SUNY Upstate Medical Center-Community Campus
🇺🇸Syracuse, New York, United States
Carolinas Medical Center/Levine Cancer Institute
🇺🇸Charlotte, North Carolina, United States
Mount Sinai Hospital
🇺🇸New York, New York, United States
Heartland Regional Medical Center
🇺🇸Saint Joseph, Missouri, United States
Cherry Tree Cancer Center
🇺🇸Hanover, Pennsylvania, United States
Mount Sinai Union Square
🇺🇸New York, New York, United States
Mercy Hospital Springfield
🇺🇸Springfield, Missouri, United States
State University of New York Upstate Medical University
🇺🇸Syracuse, New York, United States
Siteman Cancer Center-South County
🇺🇸Saint Louis, Missouri, United States
The Cancer Institute of New Jersey Hamilton
🇺🇸Hamilton, New Jersey, United States
UHHS-Chagrin Highlands Medical Center
🇺🇸Beachwood, Ohio, United States
Mercy Hospital Saint Louis
🇺🇸Saint Louis, Missouri, United States
Community Medical Hospital
🇺🇸Missoula, Montana, United States
Mount Sinai West
🇺🇸New York, New York, United States
Atrium Health Pineville/LCI-Pineville
🇺🇸Charlotte, North Carolina, United States
Atrium Health Union/LCI-Union
🇺🇸Monroe, North Carolina, United States
UHHS-Westlake Medical Center
🇺🇸Westlake, Ohio, United States
Wake Forest University at Elkin
🇺🇸Elkin, North Carolina, United States
Ephrata Community Hospital
🇺🇸Ephrata, Pennsylvania, United States
UPMC Uniontown Hospital Radiation Oncology
🇺🇸Uniontown, Pennsylvania, United States
Saint James Community Hospital and Cancer Treatment Center
🇺🇸Butte, Montana, United States
Ephrata Cancer Center
🇺🇸Ephrata, Pennsylvania, United States
Aurora BayCare Medical Center
🇺🇸Green Bay, Wisconsin, United States
Scott and White Healthcare Round Rock
🇺🇸Round Rock, Texas, United States
Scott and White Memorial Hospital
🇺🇸Temple, Texas, United States
Sentara Norfolk General Hospital
🇺🇸Norfolk, Virginia, United States
Aurora Medical Center in Summit
🇺🇸Summit, Wisconsin, United States
Vanderbilt-Ingram Cancer Center Cool Springs
🇺🇸Franklin, Tennessee, United States
South Jordan Health Center
🇺🇸South Jordan, Utah, United States
Aurora Bay Area Medical Group-Marinette
🇺🇸Marinette, Wisconsin, United States
UPMC Hillman Cancer Center in Coraopolis
🇺🇸Moon, Pennsylvania, United States
UPMC Washington Hospital Radiation Oncology
🇺🇸Washington, Pennsylvania, United States
Prisma Health Cancer Institute - Spartanburg
🇺🇸Boiling Springs, South Carolina, United States
Aurora Cancer Care-Southern Lakes VLCC
🇺🇸Burlington, Wisconsin, United States
Sentara Virginia Beach General Hospital
🇺🇸Virginia Beach, Virginia, United States
University Health Network-Princess Margaret Hospital
🇨🇦Toronto, Ontario, Canada
Reading Hospital
🇺🇸West Reading, Pennsylvania, United States
Prisma Health Cancer Institute - Seneca
🇺🇸Seneca, South Carolina, United States
Aurora Health Care Germantown Health Center
🇺🇸Germantown, Wisconsin, United States
Houston Methodist Sugar Land Hospital
🇺🇸Sugar Land, Texas, United States
Prisma Health Greenville Memorial Hospital
🇺🇸Greenville, South Carolina, United States
Aurora Health Center-Fond du Lac
🇺🇸Fond Du Lac, Wisconsin, United States
West Virginia University Healthcare
🇺🇸Morgantown, West Virginia, United States
Aurora Cancer Care-Racine
🇺🇸Racine, Wisconsin, United States
WellSpan Health-York Cancer Center
🇺🇸York, Pennsylvania, United States
Vince Lombardi Cancer Clinic - Oshkosh
🇺🇸Oshkosh, Wisconsin, United States
Vince Lombardi Cancer Clinic-Sheboygan
🇺🇸Sheboygan, Wisconsin, United States
The Research Institute of the McGill University Health Centre (MUHC)
🇨🇦Montreal, Quebec, Canada
Jewish General Hospital
🇨🇦Montreal, Quebec, Canada
Aurora West Allis Medical Center
🇺🇸West Allis, Wisconsin, United States
Case Western Reserve University
🇺🇸Cleveland, Ohio, United States
John H Stroger Jr Hospital of Cook County
🇺🇸Chicago, Illinois, United States
Rush University Medical Center
🇺🇸Chicago, Illinois, United States
University of Chicago Comprehensive Cancer Center
🇺🇸Chicago, Illinois, United States
Northwestern University
🇺🇸Chicago, Illinois, United States
UPMC-Presbyterian Hospital
🇺🇸Pittsburgh, Pennsylvania, United States
University of Pittsburgh Cancer Institute (UPCI)
🇺🇸Pittsburgh, Pennsylvania, United States
UPMC-Shadyside Hospital
🇺🇸Pittsburgh, Pennsylvania, United States
UPMC-Saint Clair Hospital Cancer Center
🇺🇸Pittsburgh, Pennsylvania, United States
Sutter Cancer Centers Radiation Oncology Services-Auburn
🇺🇸Auburn, California, United States
Mills-Peninsula Medical Center
🇺🇸Burlingame, California, United States
Sutter Davis Hospital
🇺🇸Davis, California, United States
Los Angeles County-USC Medical Center
🇺🇸Los Angeles, California, United States
Contra Costa Regional Medical Center
🇺🇸Martinez, California, United States
Memorial Medical Center
🇺🇸Modesto, California, United States
Kaiser Permanente-Modesto
🇺🇸Modesto, California, United States
Sutter Cancer Research Consortium
🇺🇸Novato, California, United States
Alta Bates Summit Medical Center - Summit Campus
🇺🇸Oakland, California, United States
Bay Area Tumor Institute
🇺🇸Oakland, California, United States
Kaiser Permanente Oakland-Broadway
🇺🇸Oakland, California, United States
Palo Alto Medical Foundation Health Care
🇺🇸Palo Alto, California, United States
Kaiser Permanente-Oakland
🇺🇸Oakland, California, United States
Keck Medical Center of USC Pasadena
🇺🇸Pasadena, California, United States
Kaiser Permanente-Rancho Cordova Cancer Center
🇺🇸Rancho Cordova, California, United States
Stanford Cancer Institute Palo Alto
🇺🇸Palo Alto, California, United States
Kaiser Permanente-Richmond
🇺🇸Richmond, California, United States
Rohnert Park Cancer Center
🇺🇸Rohnert Park, California, United States
Kaiser Permanente-Redwood City
🇺🇸Redwood City, California, United States
Kaiser Permanente-Roseville
🇺🇸Roseville, California, United States
The Permanente Medical Group-Roseville Radiation Oncology
🇺🇸Roseville, California, United States
Sutter Cancer Centers Radiation Oncology Services-Roseville
🇺🇸Roseville, California, United States
Sutter Roseville Medical Center
🇺🇸Roseville, California, United States
Kaiser Permanente-Santa Teresa-San Jose
🇺🇸San Jose, California, United States
Kaiser Permanente-San Rafael
🇺🇸San Rafael, California, United States
Kaiser San Rafael-Gallinas
🇺🇸San Rafael, California, United States
Kaiser Permanente Medical Center - Santa Clara
🇺🇸Santa Clara, California, United States
Palo Alto Medical Foundation-Santa Cruz
🇺🇸Santa Cruz, California, United States
Kaiser Permanente-Santa Rosa
🇺🇸Santa Rosa, California, United States
Kaiser Permanente Cancer Treatment Center
🇺🇸South San Francisco, California, United States
Kaiser Permanente-South San Francisco
🇺🇸South San Francisco, California, United States
Kaiser Permanente-Stockton
🇺🇸Stockton, California, United States
Palo Alto Medical Foundation-Sunnyvale
🇺🇸Sunnyvale, California, United States
Sutter Cancer Centers Radiation Oncology Services-Vacaville
🇺🇸Vacaville, California, United States
Sutter Solano Medical Center/Cancer Center
🇺🇸Vallejo, California, United States
Kaiser Permanente Medical Center-Vacaville
🇺🇸Vacaville, California, United States
Kaiser Permanente-Vallejo
🇺🇸Vallejo, California, United States
Kaiser Permanente-Walnut Creek
🇺🇸Walnut Creek, California, United States
Epic Care Cyberknife Center
🇺🇸Walnut Creek, California, United States
Boulder Community Hospital
🇺🇸Boulder, Colorado, United States
Rocky Mountain Cancer Centers-Boulder
🇺🇸Boulder, Colorado, United States
Poudre Valley Hospital
🇺🇸Fort Collins, Colorado, United States
National Jewish Health-Western Hematology Oncology
🇺🇸Golden, Colorado, United States
Grand Valley Oncology
🇺🇸Grand Junction, Colorado, United States
North Colorado Medical Center
🇺🇸Greeley, Colorado, United States
Good Samaritan Medical Center
🇺🇸Lafayette, Colorado, United States
Rocky Mountain Cancer Centers-Littleton
🇺🇸Littleton, Colorado, United States
Helen F Graham Cancer Center
🇺🇸Newark, Delaware, United States
TidalHealth Nanticoke / Allen Cancer Center
🇺🇸Seaford, Delaware, United States
Christiana Care Health System-Wilmington Hospital
🇺🇸Wilmington, Delaware, United States
Memorial Regional Hospital/Joe DiMaggio Children's Hospital
🇺🇸Hollywood, Florida, United States
Memorial Hospital West
🇺🇸Pembroke Pines, Florida, United States
Emory University Hospital Midtown
🇺🇸Atlanta, Georgia, United States
Piedmont Hospital
🇺🇸Atlanta, Georgia, United States
Piedmont Fayette Hospital
🇺🇸Fayetteville, Georgia, United States
Medical Center of Central Georgia
🇺🇸Macon, Georgia, United States
Houston Methodist Hospital
🇺🇸Houston, Texas, United States
M D Anderson Cancer Center
🇺🇸Houston, Texas, United States
Walter Knox Memorial Hospital
🇺🇸Emmett, Idaho, United States
Loyola University Medical Center
🇺🇸Maywood, Illinois, United States
Parkview Regional Medical Center
🇺🇸Fort Wayne, Indiana, United States
Goshen Center for Cancer Care
🇺🇸Goshen, Indiana, United States
Greater Baltimore Medical Center
🇺🇸Baltimore, Maryland, United States
Lahey Hospital and Medical Center
🇺🇸Burlington, Massachusetts, United States
Winchester Hospital
🇺🇸Winchester, Massachusetts, United States
Henry Ford Medical Center-Fairlane
🇺🇸Dearborn, Michigan, United States
Allegiance Health
🇺🇸Jackson, Michigan, United States
Henry Ford Medical Center-Columbus
🇺🇸Novi, Michigan, United States
Sanford Joe Lueken Cancer Center
🇺🇸Bemidji, Minnesota, United States
Fairview Ridges Hospital
🇺🇸Burnsville, Minnesota, United States
Cambridge Medical Center
🇺🇸Cambridge, Minnesota, United States
Mercy Hospital
🇺🇸Coon Rapids, Minnesota, United States
Fairview Southdale Hospital
🇺🇸Edina, Minnesota, United States
Minnesota Oncology Hematology PA-Maplewood
🇺🇸Maplewood, Minnesota, United States
Monticello Cancer Center
🇺🇸Monticello, Minnesota, United States
New Ulm Medical Center
🇺🇸New Ulm, Minnesota, United States
North Memorial Medical Health Center
🇺🇸Robbinsdale, Minnesota, United States
Park Nicollet Clinic - Saint Louis Park
🇺🇸Saint Louis Park, Minnesota, United States
Regions Hospital
🇺🇸Saint Paul, Minnesota, United States
Saint Francis Regional Medical Center
🇺🇸Shakopee, Minnesota, United States
United Hospital
🇺🇸Saint Paul, Minnesota, United States
Lakeview Hospital
🇺🇸Stillwater, Minnesota, United States
Rice Memorial Hospital
🇺🇸Willmar, Minnesota, United States
Ridgeview Medical Center
🇺🇸Waconia, Minnesota, United States
Minnesota Oncology Hematology PA-Woodbury
🇺🇸Woodbury, Minnesota, United States
Fairview Lakes Medical Center
🇺🇸Wyoming, Minnesota, United States
Saint Louis Cancer and Breast Institute-Ballwin
🇺🇸Ballwin, Missouri, United States
Central Care Cancer Center - Bolivar
🇺🇸Bolivar, Missouri, United States
Cox Cancer Center Branson
🇺🇸Branson, Missouri, United States
Centerpoint Medical Center LLC
🇺🇸Independence, Missouri, United States
Siteman Cancer Center at West County Hospital
🇺🇸Creve Coeur, Missouri, United States
Freeman Health System
🇺🇸Joplin, Missouri, United States
Mercy Hospital Joplin
🇺🇸Joplin, Missouri, United States
Benefis Healthcare- Sletten Cancer Institute
🇺🇸Great Falls, Montana, United States
University of New Mexico Cancer Center
🇺🇸Albuquerque, New Mexico, United States
Wake Forest University at Lexington
🇺🇸Lexington, North Carolina, United States
Ohio State University Comprehensive Cancer Center
🇺🇸Columbus, Ohio, United States
UH Seidman Cancer Center at Saint John Medical Center
🇺🇸Westlake, Ohio, United States
Adams Cancer Center
🇺🇸Gettysburg, Pennsylvania, United States
Jefferson Abington Hospital
🇺🇸Abington, Pennsylvania, United States
UPMC Cancer Centers - Arnold Palmer Pavilion
🇺🇸Greensburg, Pennsylvania, United States
Christiana Care Health System-Concord Health Center
🇺🇸Chadds Ford, Pennsylvania, United States
UPMC-Johnstown/John P. Murtha Regional Cancer Center
🇺🇸Johnstown, Pennsylvania, United States
UPMC Cancer Center at UPMC McKeesport
🇺🇸McKeesport, Pennsylvania, United States
UPMC-Saint Margaret
🇺🇸Pittsburgh, Pennsylvania, United States
UPMC-Magee Womens Hospital
🇺🇸Pittsburgh, Pennsylvania, United States
Allegheny General Hospital
🇺🇸Pittsburgh, Pennsylvania, United States
UPMC-Passavant Hospital
🇺🇸Pittsburgh, Pennsylvania, United States
WellSpan Health-York Hospital
🇺🇸York, Pennsylvania, United States
Women and Infants Hospital
🇺🇸Providence, Rhode Island, United States
Wexford Health and Wellness Pavilion
🇺🇸Wexford, Pennsylvania, United States
Sanford USD Medical Center - Sioux Falls
🇺🇸Sioux Falls, South Dakota, United States
Prisma Health Cancer Institute - Greer
🇺🇸Greer, South Carolina, United States
Doctor's Hospital of Laredo
🇺🇸Laredo, Texas, United States
Farmington Health Center
🇺🇸Farmington, Utah, United States
Sentara Cancer Institute at Sentara CarePlex Hospital
🇺🇸Hampton, Virginia, United States
Sentara Leigh Hospital
🇺🇸Norfolk, Virginia, United States
Sentara Princess Anne Hospital
🇺🇸Virginia Beach, Virginia, United States
WVUH-Berkely Medical Center
🇺🇸Martinsburg, West Virginia, United States
Aurora Cancer Care-Grafton
🇺🇸Grafton, Wisconsin, United States
Cancer Center of Western Wisconsin
🇺🇸New Richmond, Wisconsin, United States
Aurora Cancer Care-Kenosha South
🇺🇸Kenosha, Wisconsin, United States
Vince Lombardi Cancer Clinic-Two Rivers
🇺🇸Two Rivers, Wisconsin, United States
Naval Medical Center -San Diego
🇺🇸San Diego, California, United States
Abbott-Northwestern Hospital
🇺🇸Minneapolis, Minnesota, United States
Hennepin County Medical Center
🇺🇸Minneapolis, Minnesota, United States
Health Partners Inc
🇺🇸Minneapolis, Minnesota, United States
Duke University Medical Center
🇺🇸Durham, North Carolina, United States
Pali Momi Medical Center
🇺🇸'Aiea, Hawaii, United States
Sanford Roger Maris Cancer Center
🇺🇸Fargo, North Dakota, United States
University of Kansas Hospital-Indian Creek Campus
🇺🇸Overland Park, Kansas, United States
Billings Clinic-Cody
🇺🇸Cody, Wyoming, United States
Hawaii Cancer Care - Westridge
🇺🇸'Aiea, Hawaii, United States
Queen's Cancer Center - Pearlridge
🇺🇸'Aiea, Hawaii, United States
The Cancer Center of Hawaii-Pali Momi
🇺🇸'Aiea, Hawaii, United States
Wilcox Memorial Hospital and Kauai Medical Clinic
🇺🇸Lihue, Hawaii, United States
Central Care Cancer Center - Garden City
🇺🇸Garden City, Kansas, United States
Central Care Cancer Center - Great Bend
🇺🇸Great Bend, Kansas, United States
Salina Regional Health Center
🇺🇸Salina, Kansas, United States
Menorah Medical Center
🇺🇸Overland Park, Kansas, United States
Sanford Broadway Medical Center
🇺🇸Fargo, North Dakota, United States
University of Kansas Health System Saint Francis Campus
🇺🇸Topeka, Kansas, United States
Coffeyville Regional Medical Center
🇺🇸Coffeyville, Kansas, United States
HaysMed University of Kansas Health System
🇺🇸Hays, Kansas, United States
Minimally Invasive Surgery Hospital
🇺🇸Lenexa, Kansas, United States
Olathe Health Cancer Center
🇺🇸Olathe, Kansas, United States
Ascension Via Christi - Pittsburg
🇺🇸Pittsburg, Kansas, United States
Cheyenne Regional Medical Center-West
🇺🇸Cheyenne, Wyoming, United States
University of Kansas Cancer Center-Overland Park
🇺🇸Overland Park, Kansas, United States
University of Kansas Hospital-Westwood Cancer Center
🇺🇸Westwood, Kansas, United States
Sanford Bismarck Medical Center
🇺🇸Bismarck, North Dakota, United States
University of Kansas Cancer Center
🇺🇸Kansas City, Kansas, United States
Kansas Institute of Medicine Cancer and Blood Center
🇺🇸Lenexa, Kansas, United States
Welch Cancer Center
🇺🇸Sheridan, Wyoming, United States
Cancer Center at Saint Joseph's
🇺🇸Phoenix, Arizona, United States
Kaiser Permanente San Leandro
🇺🇸San Leandro, California, United States
California Pacific Medical Center-Pacific Campus
🇺🇸San Francisco, California, United States
Kaiser Permanente-San Francisco
🇺🇸San Francisco, California, United States
Vanderbilt University/Ingram Cancer Center
🇺🇸Nashville, Tennessee, United States
Huntsman Cancer Institute/University of Utah
🇺🇸Salt Lake City, Utah, United States
University of Alabama at Birmingham Cancer Center
🇺🇸Birmingham, Alabama, United States
SCL Health Saint Joseph Hospital
🇺🇸Denver, Colorado, United States
Denver Health Medical Center
🇺🇸Denver, Colorado, United States
Colorado Blood Cancer Institute
🇺🇸Denver, Colorado, United States
National Jewish Health-Main Campus
🇺🇸Denver, Colorado, United States
The Women's Imaging Center
🇺🇸Denver, Colorado, United States
Presbyterian - Saint Lukes Medical Center - Health One
🇺🇸Denver, Colorado, United States
Rocky Mountain Cancer Centers-Midtown
🇺🇸Denver, Colorado, United States
Rocky Mountain Cancer Centers-Rose
🇺🇸Denver, Colorado, United States
Rose Medical Center
🇺🇸Denver, Colorado, United States
Western Surgical Care
🇺🇸Denver, Colorado, United States
Henry Ford Hospital
🇺🇸Detroit, Michigan, United States
Mayo Clinic in Rochester
🇺🇸Rochester, Minnesota, United States
University of Oklahoma Health Sciences Center
🇺🇸Oklahoma City, Oklahoma, United States
Mercy Hospital Oklahoma City
🇺🇸Oklahoma City, Oklahoma, United States
Aurora Cancer Care-Milwaukee
🇺🇸Milwaukee, Wisconsin, United States
Aurora Saint Luke's Medical Center
🇺🇸Milwaukee, Wisconsin, United States
Aurora Sinai Medical Center
🇺🇸Milwaukee, Wisconsin, United States
University of Arizona Cancer Center-North Campus
🇺🇸Tucson, Arizona, United States
Rocky Mountain Cancer Centers-Aurora
🇺🇸Aurora, Colorado, United States
Washington University School of Medicine
🇺🇸Saint Louis, Missouri, United States
Mercy Hospital South
🇺🇸Saint Louis, Missouri, United States
Mercy Hospital Washington
🇺🇸Washington, Missouri, United States
CoxHealth South Hospital
🇺🇸Springfield, Missouri, United States
University of Colorado Hospital
🇺🇸Aurora, Colorado, United States
Mountain Blue Cancer Care Center - Swedish
🇺🇸Englewood, Colorado, United States
SCL Health Lutheran Medical Center
🇺🇸Wheat Ridge, Colorado, United States
South Sacramento Cancer Center
🇺🇸Sacramento, California, United States
Kaiser Permanente Downtown Commons
🇺🇸Sacramento, California, United States
Kaiser Permanente-South Sacramento
🇺🇸Sacramento, California, United States
Sutter Medical Center Sacramento
🇺🇸Sacramento, California, United States
Kaiser Permanente - Sacramento
🇺🇸Sacramento, California, United States
Wake Forest University Health Sciences
🇺🇸Winston-Salem, North Carolina, United States
Bozeman Deaconess Hospital
🇺🇸Bozeman, Montana, United States
UPMC Pinnacle Cancer Center/Community Osteopathic Campus
🇺🇸Harrisburg, Pennsylvania, United States
Yale University
🇺🇸New Haven, Connecticut, United States
Orlando Health Cancer Institute
🇺🇸Orlando, Florida, United States
Rutgers Cancer Institute of New Jersey
🇺🇸New Brunswick, New Jersey, United States
Saint Vincent Healthcare
🇺🇸Billings, Montana, United States
Kootenai Cancer Clinic
🇺🇸Sandpoint, Idaho, United States
Prisma Health Cancer Institute - Easley
🇺🇸Easley, South Carolina, United States
CHUM - Centre Hospitalier de l'Universite de Montreal
🇨🇦Montreal, Quebec, Canada
Prisma Health Cancer Institute - Butternut
🇺🇸Greenville, South Carolina, United States
Vanderbilt Breast Center at One Hundred Oaks
🇺🇸Nashville, Tennessee, United States
Baptist Memorial Hospital and Cancer Center-Memphis
🇺🇸Memphis, Tennessee, United States
Rutgers Cancer Institute of New Jersey-Robert Wood Johnson University Hospital
🇺🇸New Brunswick, New Jersey, United States
Mercy Hospital Fort Smith
🇺🇸Fort Smith, Arkansas, United States
Kalispell Regional Medical Center
🇺🇸Kalispell, Montana, United States
Prisma Health Cancer Institute - Faris
🇺🇸Greenville, South Carolina, United States
Idaho Urologic Institute-Meridian
🇺🇸Meridian, Idaho, United States
Beebe Health Campus
🇺🇸Rehoboth Beach, Delaware, United States
Smilow Cancer Center/Yale-New Haven Hospital
🇺🇸New Haven, Connecticut, United States
Banner University Medical Center - Tucson
🇺🇸Tucson, Arizona, United States
Prisma Health Cancer Institute - Eastside
🇺🇸Greenville, South Carolina, United States
Avera Cancer Institute
🇺🇸Sioux Falls, South Dakota, United States
Saint Vincent Frontier Cancer Center
🇺🇸Billings, Montana, United States
Sanford Cancer Center Oncology Clinic
🇺🇸Sioux Falls, South Dakota, United States
Saint Alphonsus Cancer Care Center-Caldwell
🇺🇸Caldwell, Idaho, United States
Saint Peter's Community Hospital
🇺🇸Helena, Montana, United States
Saint Alphonsus Cancer Care Center-Nampa
🇺🇸Nampa, Idaho, United States
Camden Clark Medical Center
🇺🇸Parkersburg, West Virginia, United States
Truman Medical Centers
🇺🇸Kansas City, Missouri, United States
The University of Kansas Cancer Center-South
🇺🇸Kansas City, Missouri, United States
Research Medical Center
🇺🇸Kansas City, Missouri, United States
University of Kansas Cancer Center - North
🇺🇸Kansas City, Missouri, United States
UNC Lineberger Comprehensive Cancer Center
🇺🇸Chapel Hill, North Carolina, United States
Hawaii Cancer Care Inc-Liliha
🇺🇸Honolulu, Hawaii, United States
Kaiser Permanente Moanalua Medical Center
🇺🇸Honolulu, Hawaii, United States
Kapiolani Medical Center for Women and Children
🇺🇸Honolulu, Hawaii, United States
University of Florida Health Science Center - Gainesville
🇺🇸Gainesville, Florida, United States
Hawaii Cancer Care Inc - Waterfront Plaza
🇺🇸Honolulu, Hawaii, United States
Queen's Medical Center
🇺🇸Honolulu, Hawaii, United States
Louisiana State University Health Science Center
🇺🇸New Orleans, Louisiana, United States
University Medical Center New Orleans
🇺🇸New Orleans, Louisiana, United States
Island Urology
🇺🇸Honolulu, Hawaii, United States
Queen's Cancer Cenrer - POB I
🇺🇸Honolulu, Hawaii, United States
Straub Clinic and Hospital
🇺🇸Honolulu, Hawaii, United States
University of Hawaii Cancer Center
🇺🇸Honolulu, Hawaii, United States
Kuakini Medical Center
🇺🇸Honolulu, Hawaii, United States
Queen's Cancer Center - Kuakini
🇺🇸Honolulu, Hawaii, United States
The Cancer Center of Hawaii-Liliha
🇺🇸Honolulu, Hawaii, United States
Virginia Commonwealth University/Massey Cancer Center
🇺🇸Richmond, Virginia, United States
Montefiore Medical Center-Einstein Campus
🇺🇸Bronx, New York, United States
Montefiore Medical Center-Weiler Hospital
🇺🇸Bronx, New York, United States
Montefiore Medical Center - Moses Campus
🇺🇸Bronx, New York, United States
Sutter Pacific Medical Foundation
🇺🇸Santa Rosa, California, United States
United Hospital Center
🇺🇸Bridgeport, West Virginia, United States
UPMC Pinnacle Harrisburg
🇺🇸Harrisburg, Pennsylvania, United States
Aurora Cancer Care-Milwaukee West
🇺🇸Wauwatosa, Wisconsin, United States
Saint Alphonsus Medical Center-Baker City
🇺🇸Baker City, Oregon, United States
UPMC-Heritage Valley Health System Beaver
🇺🇸Beaver, Pennsylvania, United States
Chancellor Center for Oncology
🇺🇸Newburgh, Indiana, United States
UPMC Cancer Center at UPMC Northwest
🇺🇸Seneca, Pennsylvania, United States
Siteman Cancer Center at Christian Hospital
🇺🇸Saint Louis, Missouri, United States