Elesclomol Sodium and Paclitaxel in Treating Patients With Recurrent or Persistent Ovarian Epithelial Cancer, Fallopian Tube Cancer, or Primary Peritoneal Cancer
- Conditions
- Ovarian Transitional Cell TumorFallopian Tube Transitional Cell CarcinomaOvarian Seromucinous CarcinomaOvarian Serous AdenocarcinomaOvarian Brenner TumorOvarian Mucinous AdenocarcinomaFallopian Tube Serous AdenocarcinomaFallopian Tube Undifferentiated CarcinomaOvarian Clear Cell AdenocarcinomaOvarian Endometrioid Adenocarcinoma
- Interventions
- Registration Number
- NCT00888615
- Lead Sponsor
- GOG Foundation
- Brief Summary
This phase II trial studies how well elesclomol sodium and paclitaxel work in treating patients with ovarian epithelial cancer, fallopian tube cancer, or primary peritoneal cancer that has returned after a period of improvement (recurrent) or is persistent. Drugs used in chemotherapy, such as elesclomol sodium and paclitaxel, work in different ways to stop the growth of tumor cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Elesclomol sodium may also help paclitaxel work better by making tumor cells more sensitive to the drug.
- Detailed Description
PRIMARY OBJECTIVES:
I. To estimate the antitumor activity of elesclomol (elesclomol sodium) and paclitaxel in patients with persistent or recurrent ovarian, fallopian tube, or primary peritoneal cancer primarily through the frequency of objective tumor responses.
II. To determine the nature and degree of toxicity of elesclomol and paclitaxel in this cohort of patients.
SECONDARY OBJECTIVES:
I. To estimate the progression-free survival and overall survival of patients treated with elesclomol and paclitaxel.
OUTLINE:
Patients receive paclitaxel intravenously (IV) over 1 hour and elesclomol sodium IV over 1 hour on days 1, 8, and 15. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity.
NOTE: Patients who are currently on treatment must not be dosed with elesclomol sodium after 12/31/2015. All other study procedures, with the exception of elesclomol sodium administration and paclitaxel administration, should continue in accordance with protocol requirements. Any treatment given after 12/31/2015, including continuation of paclitaxel, will be considered off study.
After completion of study treatment, patients are followed up every 3 months for 2 years and then every 6 months for 3 years.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- Female
- Target Recruitment
- 58
-
Patients must have recurrent or persistent epithelial ovarian, fallopian tube or primary peritoneal carcinoma; histologic documentation of the original primary tumor is required via the pathology report
- Patients with the following histologic epithelial cell types are eligible: serous adenocarcinoma, endometrioid adenocarcinoma, mucinous adenocarcinoma, undifferentiated carcinoma, clear cell adenocarcinoma, mixed epithelial carcinoma, transitional cell carcinoma, malignant Brenner's tumor, or adenocarcinoma not otherwise specified (N.O.S.)
-
All patients must have measurable disease as defined by Response Evaluation Criteria in Solid Tumors (RECIST) 1.1; measurable disease is defined as at least one lesion that can be accurately measured in at least one dimension (longest diameter to be recorded); each lesion must be >= 10 mm when measured by computed tomography (CT), magnetic resonance imaging (MRI) or caliper measurement by clinical exam; or >= 20 mm when measured by chest x-ray; lymph nodes must be >= 15 mm in short axis when measured by CT or MRI
-
Patients must have at least one "target lesion" to be used to assess response on this protocol as defined by RECIST 1.1; tumors within a previously irradiated field will be designated as "non-target" lesions unless progression is documented or a biopsy is obtained to confirm persistence at least 90 days following completion of radiation therapy
-
Patients must not be eligible for a higher priority Gynecologic Oncology Group (GOG) protocol, if one exists; in general, this would refer to any active GOG phase III protocol for the same patient population
-
Patients must have a GOG performance status of 0, 1, or 2
-
Patients must have baseline lactate dehydrogenase (LDH) levels =< 0.8 x upper limit of normal (ULN)
-
Recovery from effects of recent surgery, radiotherapy, or chemotherapy
- Patients should be free of active infection requiring antibiotics (with the exception of uncomplicated urinary tract infection [UTI])
- Any hormonal therapy directed at the malignant tumor must be discontinued at least one week prior to registration
- Any other prior therapy directed at the malignant tumor, including biological and immunologic agents, must be discontinued at least three weeks prior to registration
-
Prior therapy
- Patients must have had one prior platinum-based chemotherapeutic regimen for management of primary disease containing carboplatin, cisplatin, or another organoplatinum compound; this initial treatment may have included intraperitoneal therapy, high-dose therapy, consolidation, non-cytotoxic agents or extended therapy administered after surgical or non-surgical assessment
- Patients must have NOT received any additional cytotoxic chemotherapy for management of recurrent or persistent disease, including retreatment with initial chemotherapy regimens; (Note: optimal evaluation of the safety and efficacy of new chemotherapy regimens is best performed in patients with minimal prior therapy; non-investigational therapy, such as retreatment with platinum and/or paclitaxel, is non-curative in the setting of recurrent disease, and can generally be safely administered to patients following participation in a phase II trial)
- Patients are allowed to receive, but are not required to receive, one additional non-cytotoxic regimen for management of recurrent or persistent disease according to the following definition:
- Non-cytotoxic (biologic or cytostatic) agents include (but are not limited to) hormones, monoclonal antibodies, cytokines, and small-molecule inhibitors of signal transduction
- Patients must be considered platinum resistant or refractory according to standard GOG criteria, i.e., have had a treatment-free interval following platinum of less than 6 months, or have progressed during platinum-based therapy
-
Absolute neutrophil count (ANC) greater than or equal to 1,500/mcl
-
Platelets greater than or equal to 100,000/mcl
-
Creatinine less than or equal to 1.5 x institutional upper limit normal (ULN)
-
Bilirubin less than or equal to 1.5 x ULN
-
Serum glutamic oxaloacetic transaminase (SGOT) (aspartate aminotransferase [AST]) less than or equal to 3 x ULN
-
Alkaline phosphatase less than or equal to 2.5 x ULN
-
Neurologic function: neuropathy (sensory and motor) less than or equal to Common Terminology Criteria for Adverse Events (CTCAE) grade 1
-
Patients must have signed an approved informed consent and authorization permitting release of personal health information
-
Patients must meet pre-entry requirements
-
Patients of childbearing potential must have a negative serum pregnancy test prior to study entry and be practicing an effective form of contraception
-
Cautions and prohibited medications/treatments
- Since elesclomol is a substrate for cytochrome P450 family 2, subfamily C, polypeptide 9 (CYP2C9), cytochrome P450 family 2, subfamily D, polypeptide 6 (CYP2D6), cytochrome P450 family 2, subfamily C, polypeptide 19 (CYP2C19), and cytochrome P450 family 3, subfamily A, polypeptide 4 (CYP3A4) and an inducer of CYP3A4, cytochrome P450 family 1, subfamily A, polypeptide 2 (CYP1A2), cytochrome P450 family 2, subfamily A, polypeptide 6 (CYP2A6), and cytochrome P450 family 2, subfamily E, polypeptide 1 (CY2E1), it is recommended that the following be used with caution: sensitive substrates of CYP3A4, CYP1A2, and CY2E1, and strong inhibitors and inducers of CYP2C9, CYP2D6, CYP2C19, and CYP3A4
- Patients who have had prior therapy with elesclomol or prior second-line cytotoxic chemotherapy
- Patients who have received radiation to more than 25% of marrow-bearing areas
- Patients with a history of other invasive malignancies, with the exception of non-melanoma skin cancer and other specific malignancies are excluded if there is any evidence of other malignancy being present within the last three years; patients are also excluded if their previous cancer treatment contraindicates this protocol therapy
- Patients who have received prior radiotherapy to any portion of the abdominal cavity or pelvis OTHER THAN for the treatment of ovarian, fallopian tube, or primary peritoneal cancer are excluded; prior radiation for localized cancer of the breast, head and neck, or skin is permitted, provided that it was completed more than three years prior to registration, and the patient remains free of recurrent or metastatic disease
- Patients who have received prior chemotherapy for any abdominal or pelvic tumor OTHER THAN for the treatment of ovarian, fallopian tube, or primary peritoneal cancer are excluded; patients may have received prior adjuvant chemotherapy for localized breast cancer, provided that it was completed more than three years prior to registration, and that the patient remains free of recurrent or metastatic disease
- Patients who are pregnant or breastfeeding
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- SINGLE_GROUP
- Arm && Interventions
Group Intervention Description Treatment (paclitaxel, elesclomol sodium) Elesclomol Sodium Patients receive paclitaxel IV over 1 hour and elesclomol sodium IV over 1 hour on days 1, 8, and 15. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity. NOTE: Patients who are currently on treatment must not be dosed with elesclomol sodium after 12/31/2015. All other study procedures, with the exception of elesclomol sodium administration and paclitaxel administration, should continue in accordance with protocol requirements. Any treatment given after 12/31/2015, including continuation of paclitaxel, will be considered off study. Treatment (paclitaxel, elesclomol sodium) Paclitaxel Patients receive paclitaxel IV over 1 hour and elesclomol sodium IV over 1 hour on days 1, 8, and 15. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity. NOTE: Patients who are currently on treatment must not be dosed with elesclomol sodium after 12/31/2015. All other study procedures, with the exception of elesclomol sodium administration and paclitaxel administration, should continue in accordance with protocol requirements. Any treatment given after 12/31/2015, including continuation of paclitaxel, will be considered off study.
- Primary Outcome Measures
Name Time Method Duration of Objective Response Up to 5 years Duration of objective response (months)
Proportion of Participants With Objective Response Up to 5 years Proportion of Participants with Object Response (per response evaluation criteria in solid tumors criteria (RECIST V1.1) for target lesions as assessed by MRI: Complete Response (CR), disappearance of all target lesions, Partial Response (PR), \>= 30% decrease in the sum of the longest diameter of target lesions; Overall Response (OR) = CR + PR.
Number of Participants Who Experienced at Least One Adverse Event Up to 5 years The frequency of patients who experienced at least one adverse effect (with a grade of 1 or higher). Adverse effects are defined as any unfavorable and unintended sign, symptom, or disease that occurs in a patient administered a medical treatment, whether the event is considered related or unrelated to the medical treatment.
The Number of Participants Who Experienced at Least One Grade 3 Adverse Event Up to 5 years The number of participants who experienced at least one grade three (or higher) adverse effect. The severity of observed adverse effects is graded using the NCI CTCAE version 4.0.
- Secondary Outcome Measures
Name Time Method Progression-free Survival (Median) From start of treatment to time of progression or death, whichever occurs first, assessed up to 5 years Progression-free survival (median, in months) will be analyzed by Kaplan-Meier analysis (progression is defined using Response Evaluation Criteria in Solid Tumors Criteria (RECIST v1.1), as a 20% increase in the sum of the longest diameter of target lesions (also a 5 mm absolute increase is also required), or a measurable increase in a non-target lesion, or the appearance of new lesions.
Overall Survival (Median) From start of treatment to time of death or the date of last contact, assessed up to 5 years Overall survival (median, in months) will be analyzed by Kaplan-Meier analysis.
Trial Locations
- Locations (163)
Avera Cancer Institute
🇺🇸Sioux Falls, South Dakota, United States
Regional Cancer Center at Indian Path Community Hospital
🇺🇸Kingsport, Tennessee, United States
Wellmont Holston Valley Hospital and Medical Center
🇺🇸Kingsport, Tennessee, United States
MetroHealth Medical Center
🇺🇸Cleveland, Ohio, United States
Columbus Oncology and Hematology Associates Inc
🇺🇸Columbus, Ohio, United States
Riverside Methodist Hospital
🇺🇸Columbus, Ohio, United States
Columbus NCI Community Oncology Research Program
🇺🇸Columbus, Ohio, United States
The Mark H Zangmeister Center
🇺🇸Columbus, Ohio, United States
Mount Carmel Health Center West
🇺🇸Columbus, Ohio, United States
Hillcrest Hospital Cancer Center
🇺🇸Mayfield Heights, Ohio, United States
Saint Francis Medical Center
🇺🇸Cape Girardeau, Missouri, United States
West Michigan Cancer Center
🇺🇸Kalamazoo, Michigan, United States
Sparrow Hospital
🇺🇸Lansing, Michigan, United States
MD Anderson Cancer Center at Cooper-Voorhees
🇺🇸Voorhees, New Jersey, United States
Novant Health Presbyterian Medical Center
🇺🇸Charlotte, North Carolina, United States
CoxHealth South Hospital
🇺🇸Springfield, Missouri, United States
Randolph Hospital
🇺🇸Asheboro, North Carolina, United States
Genesys Hurley Cancer Institute
🇺🇸Flint, Michigan, United States
Bronson Methodist Hospital
🇺🇸Kalamazoo, Michigan, United States
Allegiance Health
🇺🇸Jackson, Michigan, United States
Saint Joseph Mercy Oakland
🇺🇸Pontiac, Michigan, United States
Hurley Medical Center
🇺🇸Flint, Michigan, United States
Saint Mary Mercy Hospital
🇺🇸Livonia, Michigan, United States
Christiana Care - Union Hospital
🇺🇸Elkton, Maryland, United States
Lake Huron Medical Center
🇺🇸Port Huron, Michigan, United States
Cone Health Cancer Center at Alamance Regional
🇺🇸Burlington, North Carolina, United States
Woman's Hospital
🇺🇸Baton Rouge, Louisiana, United States
Stony Brook University Medical Center
🇺🇸Stony Brook, New York, United States
Beaumont Hospital - Dearborn
🇺🇸Dearborn, Michigan, United States
Borgess Medical Center
🇺🇸Kalamazoo, Michigan, United States
Cone Health Cancer Center
🇺🇸Greensboro, North Carolina, United States
Cooper Hospital University Medical Center
🇺🇸Camden, New Jersey, United States
Margaret R Pardee Memorial Hospital
🇺🇸Hendersonville, North Carolina, United States
Hendersonville Hematology and Oncology at Pardee
🇺🇸Hendersonville, North Carolina, United States
Adena Regional Medical Center
🇺🇸Chillicothe, Ohio, United States
Fairfield Medical Center
🇺🇸Lancaster, Ohio, United States
Greater Baltimore Medical Center
🇺🇸Baltimore, Maryland, United States
Grant Medical Center
🇺🇸Columbus, Ohio, United States
Doctors Hospital
🇺🇸Columbus, Ohio, United States
Strecker Cancer Center-Belpre
🇺🇸Belpre, Ohio, United States
Mercy Hospital Springfield
🇺🇸Springfield, Missouri, United States
Cleveland Clinic Akron General
🇺🇸Akron, Ohio, United States
Providence Saint Mary Regional Cancer Center
🇺🇸Walla Walla, Washington, United States
Cleveland Clinic Foundation
🇺🇸Cleveland, Ohio, United States
Lancaster Radiation Oncology
🇺🇸Lancaster, Ohio, United States
Carilion Clinic Gynecological Oncology
🇺🇸Roanoke, Virginia, United States
Paoli Memorial Hospital
🇺🇸Paoli, Pennsylvania, United States
Annie Penn Memorial Hospital
🇺🇸Reidsville, North Carolina, United States
Summa Health System - Akron Campus
🇺🇸Akron, Ohio, United States
Lankenau Medical Center
🇺🇸Wynnewood, Pennsylvania, United States
Cone Heath Cancer Center at Mebane
🇺🇸Mebane, North Carolina, United States
Case Western Reserve University
🇺🇸Cleveland, Ohio, United States
Marietta Memorial Hospital
🇺🇸Marietta, Ohio, United States
Genesis Healthcare System Cancer Care Center
🇺🇸Zanesville, Ohio, United States
Bryn Mawr Hospital
🇺🇸Bryn Mawr, Pennsylvania, United States
Newark Radiation Oncology
🇺🇸Newark, Ohio, United States
University of Virginia Cancer Center
🇺🇸Charlottesville, Virginia, United States
Novant Health Cancer Institute - Thomasville
🇺🇸Thomasville, North Carolina, United States
Southwest VA Regional Cancer Center
🇺🇸Norton, Virginia, United States
Oklahoma Cancer Specialists and Research Institute-Tulsa
🇺🇸Tulsa, Oklahoma, United States
Cleveland Clinic Cancer Center/Fairview Hospital
🇺🇸Cleveland, Ohio, United States
University of Toledo
🇺🇸Toledo, Ohio, United States
Women and Infants Hospital
🇺🇸Providence, Rhode Island, United States
Cancer Care Northwest - Spokane South
🇺🇸Spokane, Washington, United States
Southern Ohio Medical Center
🇺🇸Portsmouth, Ohio, United States
Novant Health Cancer Institute - Mount Airy
🇺🇸Mount Airy, North Carolina, United States
Licking Memorial Hospital
🇺🇸Newark, Ohio, United States
Jefferson Abington Hospital
🇺🇸Abington, Pennsylvania, United States
Wellmont Medical Associates Oncology and Hematology-Johnson City
🇺🇸Johnson City, Tennessee, United States
UH Seidman Cancer Center at Lake Health Mentor Campus
🇺🇸Mentor, Ohio, United States
Rapid City Regional Hospital
🇺🇸Rapid City, South Dakota, United States
Wellmont Bristol Regional Medical Center
🇺🇸Bristol, Tennessee, United States
Green Bay Oncology at Saint Vincent Hospital
🇺🇸Green Bay, Wisconsin, United States
Knox Community Hospital
🇺🇸Mount Vernon, Ohio, United States
Bay Area Medical Center
🇺🇸Marinette, Wisconsin, United States
Springfield Regional Medical Center
🇺🇸Springfield, Ohio, United States
Black Hills Obstetrics and Gynecology
🇺🇸Rapid City, South Dakota, United States
Saint Vincent Hospital Cancer Center Green Bay
🇺🇸Green Bay, Wisconsin, United States
Holy Family Memorial Hospital
🇺🇸Manitowoc, Wisconsin, United States
M D Anderson Cancer Center
🇺🇸Houston, Texas, United States
Lyndon Baines Johnson General Hospital
🇺🇸Houston, Texas, United States
Pacific Gynecology Specialists
🇺🇸Seattle, Washington, United States
Fred Hutchinson Cancer Research Center
🇺🇸Seattle, Washington, United States
Seattle Cancer Care Alliance
🇺🇸Seattle, Washington, United States
Swedish Medical Center-First Hill
🇺🇸Seattle, Washington, United States
University of Washington Medical Center - Northwest
🇺🇸Seattle, Washington, United States
University of Washington Medical Center - Montlake
🇺🇸Seattle, Washington, United States
Women's Cancer Center of Nevada
🇺🇸Las Vegas, Nevada, United States
Saint Vincent Hospital and Health Care Center
🇺🇸Indianapolis, Indiana, United States
University of Cincinnati Cancer Center-UC Medical Center
🇺🇸Cincinnati, Ohio, United States
Duke University Medical Center
🇺🇸Durham, North Carolina, United States
University of Mississippi Medical Center
🇺🇸Jackson, Mississippi, United States
Washington University School of Medicine
🇺🇸Saint Louis, Missouri, United States
Saint Joseph's Hospital and Medical Center
🇺🇸Phoenix, Arizona, United States
Ascension Saint John Hospital
🇺🇸Detroit, Michigan, United States
University of Oklahoma Health Sciences Center
🇺🇸Oklahoma City, Oklahoma, United States
Sudarshan K Sharma MD Limited-Gynecologic Oncology
🇺🇸Hinsdale, Illinois, United States
Cancer Care Specialists of Illinois - Decatur
🇺🇸Decatur, Illinois, United States
Decatur Memorial Hospital
🇺🇸Decatur, Illinois, United States
Crossroads Cancer Center
🇺🇸Effingham, Illinois, United States
John Muir Medical Center-Concord Campus
🇺🇸Concord, California, United States
UC San Diego Moores Cancer Center
🇺🇸La Jolla, California, United States
University of California San Diego
🇺🇸San Diego, California, United States
John Muir Medical Center-Walnut Creek
🇺🇸Walnut Creek, California, United States
University of Connecticut
🇺🇸Farmington, Connecticut, United States
Hartford Hospital
🇺🇸Hartford, Connecticut, United States
Smilow Cancer Hospital Care Center at Saint Francis
🇺🇸Hartford, Connecticut, United States
The Hospital of Central Connecticut
🇺🇸New Britain, Connecticut, United States
Beebe Medical Center
🇺🇸Lewes, Delaware, United States
Christiana Care Health System-Christiana Hospital
🇺🇸Newark, Delaware, United States
Piedmont Hospital
🇺🇸Atlanta, Georgia, United States
Lewis Cancer and Research Pavilion at Saint Joseph's/Candler
🇺🇸Savannah, Georgia, United States
Saint Alphonsus Cancer Care Center-Boise
🇺🇸Boise, Idaho, United States
Rush University Medical Center
🇺🇸Chicago, Illinois, United States
University of Chicago Comprehensive Cancer Center
🇺🇸Chicago, Illinois, United States
UC Comprehensive Cancer Center at Silver Cross
🇺🇸New Lenox, Illinois, United States
Indiana University/Melvin and Bren Simon Cancer Center
🇺🇸Indianapolis, Indiana, United States
McFarland Clinic PC - Ames
🇺🇸Ames, Iowa, United States
Cancer Center of Kansas - Chanute
🇺🇸Chanute, Kansas, United States
Cancer Center of Kansas - Dodge City
🇺🇸Dodge City, Kansas, United States
Cancer Center of Kansas - El Dorado
🇺🇸El Dorado, Kansas, United States
Cancer Center of Kansas - Fort Scott
🇺🇸Fort Scott, Kansas, United States
Cancer Center of Kansas-Independence
🇺🇸Independence, Kansas, United States
Cancer Center of Kansas-Kingman
🇺🇸Kingman, Kansas, United States
Cancer Center of Kansas-Liberal
🇺🇸Liberal, Kansas, United States
Cancer Center of Kansas - Newton
🇺🇸Newton, Kansas, United States
Cancer Center of Kansas - Parsons
🇺🇸Parsons, Kansas, United States
Cancer Center of Kansas - Pratt
🇺🇸Pratt, Kansas, United States
Cancer Center of Kansas - Salina
🇺🇸Salina, Kansas, United States
Cancer Center of Kansas - Wellington
🇺🇸Wellington, Kansas, United States
Associates In Womens Health
🇺🇸Wichita, Kansas, United States
Cancer Center of Kansas-Wichita Medical Arts Tower
🇺🇸Wichita, Kansas, United States
Ascension Via Christi Hospitals Wichita
🇺🇸Wichita, Kansas, United States
Cancer Center of Kansas - Wichita
🇺🇸Wichita, Kansas, United States
Cancer Center of Kansas - Winfield
🇺🇸Winfield, Kansas, United States
Wichita NCI Community Oncology Research Program
🇺🇸Wichita, Kansas, United States
University of Vermont Medical Center
🇺🇸Burlington, Vermont, United States
Novant Health Cancer Institute - Wilkesboro
🇺🇸Wilkesboro, North Carolina, United States
Grandview Hospital
🇺🇸Dayton, Ohio, United States
Delaware Health Center-Grady Cancer Center
🇺🇸Delaware, Ohio, United States
Delaware Radiation Oncology
🇺🇸Delaware, Ohio, United States
Grady Memorial Hospital
🇺🇸Delaware, Ohio, United States
Saint Ann's Hospital
🇺🇸Westerville, Ohio, United States
Green Bay Oncology Limited at Saint Mary's Hospital
🇺🇸Green Bay, Wisconsin, United States
Ascension Saint Mary's Hospital
🇺🇸Saginaw, Michigan, United States
Saint John Macomb-Oakland Hospital
🇺🇸Warren, Michigan, United States
Novant Health Cancer Institute - Kernersville
🇺🇸Kernersville, North Carolina, United States
Kettering Medical Center
🇺🇸Kettering, Ohio, United States
University of Colorado Hospital
🇺🇸Aurora, Colorado, United States
Iowa Methodist Medical Center
🇺🇸Des Moines, Iowa, United States
Medical Oncology and Hematology Associates-Des Moines
🇺🇸Des Moines, Iowa, United States
Michigan Cancer Research Consortium NCORP
🇺🇸Ann Arbor, Michigan, United States
Novant Health Oncology Specialists
🇺🇸Winston-Salem, North Carolina, United States
Medical Oncology and Hematology Associates-Laurel
🇺🇸Des Moines, Iowa, United States
Mercy Medical Center - Des Moines
🇺🇸Des Moines, Iowa, United States
Iowa Lutheran Hospital
🇺🇸Des Moines, Iowa, United States
University of Kentucky/Markey Cancer Center
🇺🇸Lexington, Kentucky, United States
Saint Joseph Mercy Hospital
🇺🇸Ann Arbor, Michigan, United States
Novant Health Forsyth Medical Center
🇺🇸Winston-Salem, North Carolina, United States
Winston-Salem Health Care
🇺🇸Winston-Salem, North Carolina, United States
Wake Forest University Health Sciences
🇺🇸Winston-Salem, North Carolina, United States
Virginia Commonwealth University/Massey Cancer Center
🇺🇸Richmond, Virginia, United States
University of Wisconsin Hospital and Clinics
🇺🇸Madison, Wisconsin, United States