Paclitaxel, Polyglutamate Paclitaxel, or Observation in Treating Patients With Stage III or Stage IV Ovarian Epithelial, Peritoneal Cancer, or Fallopian Tube Cancer
- Conditions
- Fallopian Tube Endometrioid AdenocarcinomaOvarian Brenner TumorOvarian Clear Cell AdenocarcinomaFallopian Tube Mucinous AdenocarcinomaOvarian Seromucinous CarcinomaStage IIIB Primary Peritoneal Cancer AJCC v7Stage IIIC Fallopian Tube Cancer AJCC v7Stage IIIC Primary Peritoneal Cancer AJCC v7Fallopian Tube Clear Cell AdenocarcinomaFallopian Tube Undifferentiated Carcinoma
- Interventions
- Other: Clinical ObservationOther: Laboratory Biomarker AnalysisProcedure: Quality-of-Life Assessment
- Registration Number
- NCT00108745
- Lead Sponsor
- GOG Foundation
- Brief Summary
This randomized phase III trial studies paclitaxel to see how well it works compared to polyglutamate paclitaxel or observation only in treating patients with stage III or stage IV ovarian epithelial, peritoneal cancer, or fallopian tube cancer. Drugs used in chemotherapy, such as paclitaxel and polyglutamate paclitaxel, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Paclitaxel and polyglutamate paclitaxel may also stop the growth of ovarian epithelial or peritoneal cancer by blocking blood flow to the tumor. Sometimes, after treatment, the tumor may not need additional treatment until it progresses. In this case, observation may be sufficient. It is not yet known whether paclitaxel is more effective than polyglutamate paclitaxel or observation only in treating ovarian epithelial, peritoneal, or fallopian tube cancer.
- Detailed Description
PRIMARY OBJECTIVES:
I. To determine whether CT-2103 (polyglutamate paclitaxel) or paclitaxel, administered to women with advanced ovarian, primary peritoneal or fallopian tube cancer who have attained a clinically-defined complete response to primary platinum/taxane-based chemotherapy ("consolidation/maintenance therapy") will reduce the death rate, compared to re-treatment at the time of documented disease progression.
II. To determine if, in this clinical setting, CT-2103 produces a more favorable toxicity profile (with a particular focus on peripheral neuropathy as measured by the Gynecologic Oncology Group \[GOG\] NTX4) and superior quality-of-life (as measured by the Functional Assessment of Cancer Therapy-Ovarian \[FACT-O\]), compared to paclitaxel.
SECONDARY OBJECTIVES:
I. To explore the relationship between expression of several of the angiogenic markers and overall survival or progression-free survival in patients randomized to CT-2103, paclitaxel, or no treatment.
II. To assess the association among the various tissue and serum markers of angiogenesis, and compare the ability of different combinations of these markers to predict patient outcome including overall survival and progression-free survival in patients randomized to CT-2103, paclitaxel, or no treatment.
III. To bank deoxyribonucleic acid (DNA) from whole blood for research and evaluate the association between single nucleotide polymorphisms (SNPs) and measures of clinical outcome including overall survival, progression-free survival and adverse events.
OUTLINE: Patients are randomized to 1 of 3 treatment arms.
ARM I: Patients receive polyglutamate paclitaxel intravenously (IV) over 10-20 minutes on day 1.
ARM II: Patients receive paclitaxel IV over 3 hours on day 1.
ARM III: Patients receive no further anticancer treatment until evidence of disease progression.
In arms I and II, treatment repeats every 28 days for up to 12 courses in the absence of disease progression or unacceptable toxicity.
After completion of study treatment, patients are followed every 3 months for 2 years and then every 6 months for 10 years.
Recruitment & Eligibility
- Status
- UNKNOWN
- Sex
- Female
- Target Recruitment
- 1157
-
Patients with a histologic diagnosis of primary peritoneal carcinoma, or stage III or IV epithelial ovarian or fallopian tube carcinoma, with either optimal (=< 1 cm residual disease) or suboptimal residual disease following initial surgery; all patients must have had appropriate surgery for ovarian, primary peritoneal or fallopian tube carcinoma with appropriate tissue available for histologic evaluation to confirm diagnosis and stage
-
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 tumor
- Adenocarcinoma not otherwise specified (NOS)
-
Patients must have completed treatment within the past 12 weeks with at least 5 cycles and not more than 8 cycles of a platinum (IV or intraperitoneal [IP]) and paclitaxel or docetaxel-based combination chemotherapy and have no symptoms suggestive of persistent cancer, normal (no evidence of cancer) computed tomography (CT) scan of the abdomen/pelvis and normal cancer antigen 125 (CA-125) following this therapy
- Patients treated with neo-adjuvant platinum-taxane chemotherapy for a presumptive diagnosis of stage III or IV epithelial ovarian, primary peritoneal or, fallopian tube (by paracentesis, percutaneous biopsy or open biopsy) are eligible provided that they have undergone interval abdominal surgery after at least one but no more than six cycles of standard chemotherapy; such surgery must meet the same criteria as for those undergoing up front surgery, including tissue diagnosis for confirmation of primary tumor site and stage III or IV disease; also, patients must have received at least two cycles after interval abdominal surgery
-
Absolute neutrophil count >= 1,500/ul, equivalent to Common Toxicity Criteria (CTCAE version [v]3.0) grade 1
-
Platelet count >= 100,000/ul
-
Creatinine =< 1.5 times institutional upper limit of normal (ULN), CTCAE v3.0 grade 1
-
Bilirubin =< 1.5 times ULN, (CTCAE v3.0 grade 1)
-
Serum glutamic oxaloacetic transaminase (SGOT) =< 2.5 times ULN (CTCAE v3.0 grade 1)
-
Alkaline phosphatase =< 2.5 times ULN (CTCAE v3.0 grade 1)
-
Neuropathy (sensory and motor) less than or equal to CTCAE v3.0 grade 1
-
Gynecologic Oncology Group (GOG) performance status of 0, 1, or 2
-
Patients must have signed an approved informed consent and Health Insurance Portability and Accountability Act (HIPAA) authorization
-
Patients must complete pre-entry assessments
-
Patients with a current diagnosis of epithelial ovarian or fallopian tube tumor of low malignant potential (LMP) (Borderline carcinomas) are not eligible; patients with a prior diagnosis of a low malignant potential tumor that was surgically resected and who subsequently develop invasive adenocarcinoma are eligible, provided that they have not received prior chemotherapy for their ovarian LMP tumor
-
Germ cell tumors, sex cord-stromal tumors, carcinosarcomas, mixed mullerian tumors or carcinosarcomas, metastatic carcinomas from other sites to the ovary and low malignant potential tumors including so called micropapillary serous carcinomas are not eligible
-
Patients who have received prior radiotherapy to any portion of the abdominal cavity or pelvis are excluded; prior radiation for localized cancer of the breast, head and neck, or skin is permitted, provided that it was completed more than 3 years prior to registration, and the patient remains free of recurrent or metastatic disease
-
Patients who have received investigational therapies, and/or biological therapies (i.e. Bevacizumab or Erlotinib) for their epithelial ovarian, primary peritoneal or fallopian tube cancers or for any other abdominal or pelvic tumor, are not excluded; however, biologics cannot be continued concurrent with the GOG-012 maintenance treatment (or observation); patients who have received prior chemotherapy for any other abdominal or pelvic tumor (except as noted above) are excluded; patients may have received prior adjuvant chemotherapy for localized breast cancer, provided that it was completed more than 3 years prior to registration, and that the patient remains free of recurrent or metastatic disease
-
Patients with synchronous primary endometrial cancer, or a past history of primary endometrial cancer, are excluded, unless all of the following conditions are met:
- Stage not greater than I-B
- Less than 3 mm invasion without vascular or lymphatic invasion
- No poorly differentiated subtypes, including papillary serous, clear cell, or other Federation of Gynecology and Obstetrics (FIGO) Grade 3 lesions
-
With the exception of non-melanoma skin cancer and other specific malignancies as noted above, patients with other invasive malignancies who had (or have) any evidence of the other cancer present within the last 5 years or whose previous cancer treatment contraindicates this protocol therapy are excluded
-
Patients with acute hepatitis, or known chronic hepatitis
-
Patients with an active infection that requires antibiotics
-
Patients with ongoing gastrointestinal bleeding requiring blood product support
-
Patients whose circumstances at the time of entry onto the protocol would not permit completion of study or required follow up
-
Patients with unstable angina or those who have had a myocardial infarction within the past six months; patients with evidence of abnormal cardiac conduction (e.g. bundle branch block, heart block) are eligible if their disease has been stable for the past six months
-
Patients are excluded who have had prior therapy with CT-2103
-
Patients with active bleeding or an unexplained prothrombin time (PT) or partial thromboplastin time (PTT) > institutional upper limit normal (ULN)
-
Patients who are pregnant or nursing are excluded; patients who may become pregnant must practice an effective method of birth control
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Arm I (paclitaxel poliglumex) Quality-of-Life Assessment Patients receive polyglutamate paclitaxel IV over 10-20 minutes on day 1.Treatment repeats every 28 days for up to 12 courses in the absence of disease progression or unacceptable toxicity. Arm III (observation) Clinical Observation Patients receive no further anticancer treatment until evidence of disease progression. Arm I (paclitaxel poliglumex) Laboratory Biomarker Analysis Patients receive polyglutamate paclitaxel IV over 10-20 minutes on day 1.Treatment repeats every 28 days for up to 12 courses in the absence of disease progression or unacceptable toxicity. Arm III (observation) Quality-of-Life Assessment Patients receive no further anticancer treatment until evidence of disease progression. Arm II (paclitaxel) Laboratory Biomarker Analysis Patients receive paclitaxel IV over 3 hours on day 1. Treatment repeats every 28 days for up to 12 courses in the absence of disease progression or unacceptable toxicity. Arm III (observation) Laboratory Biomarker Analysis Patients receive no further anticancer treatment until evidence of disease progression. Arm II (paclitaxel) Quality-of-Life Assessment Patients receive paclitaxel IV over 3 hours on day 1. Treatment repeats every 28 days for up to 12 courses in the absence of disease progression or unacceptable toxicity. Arm II (paclitaxel) Paclitaxel Patients receive paclitaxel IV over 3 hours on day 1. Treatment repeats every 28 days for up to 12 courses in the absence of disease progression or unacceptable toxicity. Arm I (paclitaxel poliglumex) Paclitaxel Poliglumex Patients receive polyglutamate paclitaxel IV over 10-20 minutes on day 1.Treatment repeats every 28 days for up to 12 courses in the absence of disease progression or unacceptable toxicity.
- Primary Outcome Measures
Name Time Method Overall Survival All patients were followed (with physical exams and histories) every three months for the first two years, then every six months for the next three years and then annually for the next five years. Overall survival (OS) was defined as the number of months between study enrollment and death from any cause. Patients still alive at the last follow-up were censored on the date of last contact.
- Secondary Outcome Measures
Name Time Method Progression-free Survival Progression was assessed every 8 weeks for the first 15 months, then every 3 months, up to 14.2 years. Progression free survival (PFS) was defined as the number of months between study enrollment and the date of first clinical, biochemical, or radiological evidence of progression or death due to any cause. Patients who were alive without progression at the time of analysis were censored on the date of the last tumor assessment.
Patient-Reported Quality of Life (QOL) 1. Prior to treatment 2. Prior to cycle 3 3. Prior to cycle 5 4. Prior to cycle 7 5. Prior to cycle 12 6. 12 months post treatment Patient reported quality of life was measured with the Treatment Outcome Index (TOI) of the Functional Assessment of Cancer Therapy for ovarian cancer (FACT-O TOI). The FACT-En TOI is a scale for assessing general QOL of ovarian cancer patients. The FACT-O TOI score ranges 0-100 with a large score suggesting better QOL.
Frequency and Severity of Adverse Effects Assessed by CTCAE v3.0 Measured within 6 months of enrollment; through all cycles of chemotherapy and up to 30 days after the last cycle of chemotherapy. Up to 10 cycles of chemotherapy were allowed. Cycles were to be repeated every 3 weeks. Number of treated patients with Adverse Events (grade 3 or higher) observed while receiving randomized therapy among adverse event terms with at least 4 patients reporting.
Patient-Reported Peripheral Neuropathy Symptoms 1. Prior to treatment 2. Prior to cycle 3 3. Prior to cycle 5 4. Prior to cycle 7 5. Prior to cycle 12 6. 12 months post treatment Patient reported peripheral neuropathy symptoms was measured with the Functional Assessment of Cancer Therapy/ Gynecologic Oncology Group - neurotoxicity subscale (short version) (FACT/GOG-Ntx subscale). The Ntx score ranges 0-16 with a large score suggesting less peripheral neuropathy symptoms.
Trial Locations
- Locations (315)
University of Pennsylvania/Abramson Cancer Center
🇺🇸Philadelphia, Pennsylvania, United States
Mount Carmel Health Center West
🇺🇸Columbus, Ohio, United States
MetroHealth Medical Center
🇺🇸Cleveland, Ohio, United States
West Penn Hospital
🇺🇸Pittsburgh, Pennsylvania, United States
Swedish Medical Center-First Hill
🇺🇸Seattle, Washington, United States
University of Washington Medical Center - Northwest
🇺🇸Seattle, Washington, United States
Kaiser Permanente Los Angeles Medical Center
🇺🇸Los Angeles, California, United States
Mayo Clinic in Arizona
🇺🇸Scottsdale, Arizona, United States
Beebe Medical Center
🇺🇸Lewes, Delaware, United States
Highlands Oncology Group PA - Fayetteville
🇺🇸Fayetteville, Arkansas, United States
Providence Saint Joseph Medical Center/Disney Family Cancer Center
🇺🇸Burbank, California, United States
University of Arkansas for Medical Sciences
🇺🇸Little Rock, Arkansas, United States
Southeast Gynecologic Oncology Associates
🇺🇸Jacksonville, Florida, United States
Eastern Connecticut Hematology and Oncology Associates
🇺🇸Norwich, Connecticut, United States
Hartford Hospital
🇺🇸Hartford, Connecticut, United States
UC San Diego Moores Cancer Center
🇺🇸La Jolla, California, United States
MedStar Washington Hospital Center
🇺🇸Washington, District of Columbia, United States
The Hospital of Central Connecticut
🇺🇸New Britain, Connecticut, United States
Saint Alphonsus Cancer Care Center-Boise
🇺🇸Boise, Idaho, United States
Poudre Valley Hospital
🇺🇸Fort Collins, Colorado, United States
Greater Baltimore Medical Center
🇺🇸Baltimore, Maryland, United States
Mayo Clinic in Florida
🇺🇸Jacksonville, Florida, United States
University of Chicago Comprehensive Cancer Center
🇺🇸Chicago, Illinois, United States
Tufts Medical Center
🇺🇸Boston, Massachusetts, United States
Christiana Care - Union Hospital
🇺🇸Elkton, Maryland, United States
University of Kansas Cancer Center
🇺🇸Kansas City, Kansas, United States
LSU Health Sciences Center at Shreveport
🇺🇸Shreveport, Louisiana, United States
South Bend Clinic
🇺🇸South Bend, Indiana, United States
University of Maryland/Greenebaum Cancer Center
🇺🇸Baltimore, Maryland, United States
Allegiance Health
🇺🇸Jackson, Michigan, United States
Michiana Hematology Oncology PC-Plymouth
🇺🇸Plymouth, Indiana, United States
Woman's Hospital
🇺🇸Baton Rouge, Louisiana, United States
Bronson Battle Creek
🇺🇸Battle Creek, Michigan, United States
Memorial Hospital of South Bend
🇺🇸South Bend, Indiana, United States
CHRISTUS Highland Medical Center
🇺🇸Shreveport, Louisiana, United States
University of New Mexico Cancer Center
🇺🇸Albuquerque, New Mexico, United States
State University of New York Downstate Medical Center
🇺🇸Brooklyn, New York, United States
SSM Health Saint Louis University Hospital
🇺🇸Saint Louis, Missouri, United States
Bronson Methodist Hospital
🇺🇸Kalamazoo, Michigan, United States
Borgess Medical Center
🇺🇸Kalamazoo, Michigan, United States
Kettering Medical Center
🇺🇸Kettering, Ohio, United States
Novant Health Presbyterian Medical Center
🇺🇸Charlotte, North Carolina, United States
Roswell Park Cancer Institute
🇺🇸Buffalo, New York, United States
Saint Dominic-Jackson Memorial Hospital
🇺🇸Jackson, Mississippi, United States
Memorial Sloan Kettering Cancer Center
🇺🇸New York, New York, United States
Mercy Hospital Springfield
🇺🇸Springfield, Missouri, United States
Mercy Hospital Joplin
🇺🇸Joplin, Missouri, United States
Jefferson Abington Hospital
🇺🇸Abington, Pennsylvania, United States
Gynecologic Oncology Network
🇺🇸Greenville, North Carolina, United States
Rutherford Hospital
🇺🇸Rutherfordton, North Carolina, United States
Southwest Gynecologic Oncology Associates Inc
🇺🇸Albuquerque, New Mexico, United States
Northwell Health/Center for Advanced Medicine
🇺🇸Lake Success, New York, United States
Cleveland Clinic Foundation
🇺🇸Cleveland, Ohio, United States
Singing River Hospital
🇺🇸Pascagoula, Mississippi, United States
State University of New York Upstate Medical University
🇺🇸Syracuse, New York, United States
Summa Health System - Akron Campus
🇺🇸Akron, Ohio, United States
University of Missouri - Ellis Fischel
🇺🇸Columbia, Missouri, United States
Freeman Health System
🇺🇸Joplin, Missouri, United States
Long Island Jewish Medical Center
🇺🇸New Hyde Park, New York, United States
Memorial Medical Center - Las Cruces
🇺🇸Las Cruces, New Mexico, United States
Mount Sinai Hospital
🇺🇸New York, New York, United States
Island Gynecologic Oncology
🇺🇸Brightwaters, New York, United States
Stony Brook University Medical Center
🇺🇸Stony Brook, New York, United States
Cleveland Clinic Akron General
🇺🇸Akron, Ohio, United States
Jersey Shore Medical Center
🇺🇸Neptune, New Jersey, United States
Westchester Medical Center
🇺🇸Valhalla, New York, United States
Women's Cancer Care Associates LLC
🇺🇸Albany, New York, United States
Aultman Health Foundation
🇺🇸Canton, Ohio, United States
Chattanooga's Program in Women's Oncology
🇺🇸Chattanooga, Tennessee, United States
Ohio State University Comprehensive Cancer Center
🇺🇸Columbus, Ohio, United States
Riverside Methodist Hospital
🇺🇸Columbus, Ohio, United States
AnMed Health Cancer Center
🇺🇸Anderson, South Carolina, United States
Avera Cancer Institute
🇺🇸Sioux Falls, South Dakota, United States
Chattanooga Gynecological Oncology
🇺🇸Chattanooga, Tennessee, United States
Oklahoma Cancer Specialists and Research Institute-Tulsa
🇺🇸Tulsa, Oklahoma, United States
Cone Health Cancer Center
🇺🇸Greensboro, North Carolina, United States
Geisinger Medical Group
🇺🇸State College, Pennsylvania, United States
Sanford USD Medical Center - Sioux Falls
🇺🇸Sioux Falls, South Dakota, United States
Knoxville Gynecologic Cancer Specialists PC
🇺🇸Knoxville, Tennessee, United States
Geisinger Medical Center
🇺🇸Danville, Pennsylvania, United States
University of Texas Medical Branch
🇺🇸Galveston, Texas, United States
Brooke Army Medical Center
🇺🇸Fort Sam Houston, Texas, United States
Geisinger Wyoming Valley/Henry Cancer Center
🇺🇸Wilkes-Barre, Pennsylvania, United States
Bay Area Medical Center
🇺🇸Marinette, Wisconsin, United States
Virginia Oncology Associates - Lake Wright
🇺🇸Norfolk, Virginia, United States
Northern Virginia Pelvic Surgery Associates
🇺🇸Annandale, Virginia, United States
Lyndon Baines Johnson General Hospital
🇺🇸Houston, Texas, United States
Fred Hutchinson Cancer Research Center
🇺🇸Seattle, Washington, United States
University of Washington Medical Center - Montlake
🇺🇸Seattle, Washington, United States
Vince Lombardi Cancer Clinic - Slinger
🇺🇸Slinger, Wisconsin, United States
Franciscan Health Indianapolis
🇺🇸Indianapolis, Indiana, United States
Women's Cancer Center of Nevada
🇺🇸Las Vegas, Nevada, United States
University of Cincinnati Cancer Center-UC Medical Center
🇺🇸Cincinnati, Ohio, United States
University of California San Diego
🇺🇸San Diego, California, United States
University of Minnesota/Masonic Cancer Center
🇺🇸Minneapolis, Minnesota, United States
Vanderbilt University/Ingram Cancer Center
🇺🇸Nashville, Tennessee, United States
LDS Hospital
🇺🇸Salt Lake City, Utah, United States
Christiana Care Health System-Christiana Hospital
🇺🇸Newark, Delaware, United States
Associates In Womens Health
🇺🇸Wichita, Kansas, United States
Saint Mary's Hospital and Regional Medical Center
🇺🇸Grand Junction, Colorado, United States
Penrose-Saint Francis Healthcare
🇺🇸Colorado Springs, Colorado, United States
Mercy Hospital
🇺🇸Coon Rapids, Minnesota, United States
McKee Medical Center
🇺🇸Loveland, Colorado, United States
Parker Adventist Hospital
🇺🇸Parker, Colorado, United States
Cancer Center of Kansas - Chanute
🇺🇸Chanute, Kansas, United States
Cancer Center of Kansas - Parsons
🇺🇸Parsons, Kansas, United States
Unity Hospital
🇺🇸Fridley, Minnesota, United States
Cancer Center of Kansas-Independence
🇺🇸Independence, Kansas, United States
Cancer Center of Kansas-Wichita Medical Arts Tower
🇺🇸Wichita, Kansas, United States
SCL Health Lutheran Medical Center
🇺🇸Wheat Ridge, Colorado, United States
Cancer Center of Kansas - Salina
🇺🇸Salina, Kansas, United States
Wichita NCI Community Oncology Research Program
🇺🇸Wichita, Kansas, United States
Cancer Center of Kansas - Wichita
🇺🇸Wichita, Kansas, United States
United Hospital
🇺🇸Saint Paul, Minnesota, United States
Cancer Center of Kansas - Newton
🇺🇸Newton, Kansas, United States
Fairview Ridges Hospital
🇺🇸Burnsville, Minnesota, United States
North Memorial Medical Health Center
🇺🇸Robbinsdale, Minnesota, United States
Saint Luke's Hospital of Duluth
🇺🇸Duluth, Minnesota, United States
Metro Minnesota Community Oncology Research Consortium
🇺🇸Saint Louis Park, Minnesota, United States
Fairview Southdale Hospital
🇺🇸Edina, Minnesota, United States
Minnesota Oncology Hematology PA-Maplewood
🇺🇸Maplewood, Minnesota, United States
Littleton Adventist Hospital
🇺🇸Littleton, Colorado, United States
Cancer Center of Kansas - El Dorado
🇺🇸El Dorado, Kansas, United States
Cancer Center of Kansas - Pratt
🇺🇸Pratt, Kansas, United States
Cancer Center of Kansas - Wellington
🇺🇸Wellington, Kansas, United States
Regions Hospital
🇺🇸Saint Paul, Minnesota, United States
Ascension Via Christi Hospitals Wichita
🇺🇸Wichita, Kansas, United States
Minnesota Oncology Hematology PA-Woodbury
🇺🇸Woodbury, Minnesota, United States
Ridgeview Medical Center
🇺🇸Waconia, Minnesota, United States
Cancer Center of Kansas - Fort Scott
🇺🇸Fort Scott, Kansas, United States
Wayne State University/Karmanos Cancer Institute
🇺🇸Detroit, Michigan, United States
Henry Ford Hospital
🇺🇸Detroit, Michigan, United States
University of Oklahoma Health Sciences Center
🇺🇸Oklahoma City, Oklahoma, United States
University of Alabama at Birmingham Cancer Center
🇺🇸Birmingham, Alabama, United States
Rose Medical Center
🇺🇸Denver, Colorado, United States
Porter Adventist Hospital
🇺🇸Denver, Colorado, United States
Western States Cancer Research NCORP
🇺🇸Denver, Colorado, United States
SCL Health Saint Joseph Hospital
🇺🇸Denver, Colorado, United States
Presbyterian - Saint Lukes Medical Center - Health One
🇺🇸Denver, Colorado, United States
Providence Portland Medical Center
🇺🇸Portland, Oregon, United States
Oregon Health and Science University
🇺🇸Portland, Oregon, United States
Mayo Clinic in Rochester
🇺🇸Rochester, Minnesota, United States
Tennessee Valley Gynecologic Oncology
🇺🇸Huntsville, Alabama, United States
Saint Joseph's Hospital and Medical Center
🇺🇸Phoenix, Arizona, United States
Baptist Health Lexington
🇺🇸Lexington, Kentucky, United States
Palo Alto Medical Foundation-Gynecologic Oncology
🇺🇸Mountain View, California, United States
UC Irvine Health/Chao Family Comprehensive Cancer Center
🇺🇸Orange, California, United States
Rocky Mountain Gynecologic Oncology PC
🇺🇸Englewood, Colorado, United States
North Colorado Medical Center
🇺🇸Greeley, Colorado, United States
University of Connecticut
🇺🇸Farmington, Connecticut, United States
Smilow Cancer Hospital Care Center at Saint Francis
🇺🇸Hartford, Connecticut, United States
Holy Cross Hospital
🇺🇸Fort Lauderdale, Florida, United States
Florida Gynecologic Oncology
🇺🇸Fort Myers, Florida, United States
Women's Cancer Associates
🇺🇸Saint Petersburg, Florida, United States
Sarasota Memorial Hospital
🇺🇸Sarasota, Florida, United States
University of Illinois
🇺🇸Chicago, Illinois, United States
Advocate Lutheran General Hospital
🇺🇸Park Ridge, Illinois, United States
Memorial Medical Center
🇺🇸Springfield, Illinois, United States
Michiana Hematology Oncology PC-South Bend
🇺🇸South Bend, Indiana, United States
Northern Indiana Cancer Research Consortium
🇺🇸South Bend, Indiana, United States
Michiana Hematology Oncology PC-Westville
🇺🇸Westville, Indiana, United States
Cancer Center of Kansas - Dodge City
🇺🇸Dodge City, Kansas, United States
Cancer Center of Kansas-Kingman
🇺🇸Kingman, Kansas, United States
Saint Luke's South Hospital
🇺🇸Overland Park, Kansas, United States
Kansas City NCI Community Oncology Research Program
🇺🇸Prairie Village, Kansas, United States
Cancer Center of Kansas - Winfield
🇺🇸Winfield, Kansas, United States
Massachusetts General Hospital Cancer Center
🇺🇸Boston, Massachusetts, United States
UMass Memorial Medical Center - Memorial Division
🇺🇸Worcester, Massachusetts, United States
Ascension Saint John Hospital
🇺🇸Detroit, Michigan, United States
Mercy Health Saint Mary's
🇺🇸Grand Rapids, Michigan, United States
Spectrum Health at Butterworth Campus
🇺🇸Grand Rapids, Michigan, United States
Mercy Health Mercy Campus
🇺🇸Muskegon, Michigan, United States
Lakeland Hospital Niles
🇺🇸Niles, Michigan, United States
Lake Huron Medical Center
🇺🇸Port Huron, Michigan, United States
Abbott-Northwestern Hospital
🇺🇸Minneapolis, Minnesota, United States
Park Nicollet Clinic - Saint Louis Park
🇺🇸Saint Louis Park, Minnesota, United States
University of Mississippi Medical Center
🇺🇸Jackson, Mississippi, United States
Saint Luke's East - Lee's Summit
🇺🇸Lee's Summit, Missouri, United States
Mercy Hospital Saint Louis
🇺🇸Saint Louis, Missouri, United States
Center of Hope at Renown Medical Center
🇺🇸Reno, Nevada, United States
Cooper Hospital University Medical Center
🇺🇸Camden, New Jersey, United States
Virtua Memorial
🇺🇸Mount Holly, New Jersey, United States
Queens Hospital Center
🇺🇸Jamaica, New York, United States
North Shore University Hospital
🇺🇸Manhasset, New York, United States
Laura and Isaac Perlmutter Cancer Center at NYU Langone
🇺🇸New York, New York, United States
NYP/Columbia University Medical Center/Herbert Irving Comprehensive Cancer Center
🇺🇸New York, New York, United States
Cone Health Cancer Center at Alamance Regional
🇺🇸Burlington, North Carolina, United States
Duke University Medical Center
🇺🇸Durham, North Carolina, United States
New Hanover Regional Medical Center/Zimmer Cancer Center
🇺🇸Wilmington, North Carolina, United States
Cleveland Clinic Cancer Center/Fairview Hospital
🇺🇸Cleveland, Ohio, United States
Compass Oncology Rose Quarter
🇺🇸Portland, Oregon, United States
Saint Luke's University Hospital-Bethlehem Campus
🇺🇸Bethlehem, Pennsylvania, United States
Geisinger Medical Center-Cancer Center Hazleton
🇺🇸Hazleton, Pennsylvania, United States
Women and Infants Hospital
🇺🇸Providence, Rhode Island, United States
Baptist Memorial Hospital and Cancer Center-Memphis
🇺🇸Memphis, Tennessee, United States
M D Anderson Cancer Center
🇺🇸Houston, Texas, United States
Seattle Cancer Care Alliance
🇺🇸Seattle, Washington, United States
MultiCare Tacoma General Hospital
🇺🇸Tacoma, Washington, United States
Green Bay Oncology Limited at Saint Mary's Hospital
🇺🇸Green Bay, Wisconsin, United States
University of Colorado Hospital
🇺🇸Aurora, Colorado, United States
Moffitt Cancer Center
🇺🇸Tampa, Florida, United States
Walter Reed National Military Medical Center
🇺🇸Bethesda, Maryland, United States
Nebraska Methodist Hospital
🇺🇸Omaha, Nebraska, United States
University of Nebraska Medical Center
🇺🇸Omaha, Nebraska, United States
Aurora Saint Luke's Medical Center
🇺🇸Milwaukee, Wisconsin, United States
CoxHealth South Hospital
🇺🇸Springfield, Missouri, United States
Case Western Reserve University
🇺🇸Cleveland, Ohio, United States
Pennsylvania Hospital
🇺🇸Philadelphia, Pennsylvania, United States
Miami Valley Hospital
🇺🇸Dayton, Ohio, United States
UH Seidman Cancer Center at Lake Health Mentor Campus
🇺🇸Mentor, Ohio, United States
Penn State Milton S Hershey Medical Center
🇺🇸Hershey, Pennsylvania, United States
Reading Hospital
🇺🇸West Reading, Pennsylvania, United States
UT Southwestern/Simmons Cancer Center-Dallas
🇺🇸Dallas, Texas, United States
The Don and Sybil Harrington Cancer Center
🇺🇸Amarillo, Texas, United States
Houston Methodist Hospital
🇺🇸Houston, Texas, United States
Virginia Mason Medical Center
🇺🇸Seattle, Washington, United States
University of Virginia Cancer Center
🇺🇸Charlottesville, Virginia, United States
Skagit Valley Hospital Regional Cancer Care Center
🇺🇸Mount Vernon, Washington, United States
Bon Secours Mary Immaculate Hospital
🇺🇸Newport News, Virginia, United States
Carilion Clinic Gynecological Oncology
🇺🇸Roanoke, Virginia, United States
Harrison HealthPartners Hematology and Oncology-Bremerton
🇺🇸Bremerton, Washington, United States
Pacific Gynecology Specialists
🇺🇸Seattle, Washington, United States
Providence Saint Mary Regional Cancer Center
🇺🇸Walla Walla, Washington, United States
Long Beach Memorial Medical Center-Todd Cancer Institute
🇺🇸Long Beach, California, United States
Cedars Sinai Medical Center
🇺🇸Los Angeles, California, United States
UCLA / Jonsson Comprehensive Cancer Center
🇺🇸Los Angeles, California, United States
UCSF Medical Center-Mount Zion
🇺🇸San Francisco, California, United States
John B Amos Cancer Center
🇺🇸Columbus, Georgia, United States
Morton Plant Hospital
🇺🇸Clearwater, Florida, United States
Northwestern Medicine Cancer Center Warrenville
🇺🇸Warrenville, Illinois, United States
Sudarshan K Sharma MD Limited-Gynecologic Oncology
🇺🇸Hinsdale, Illinois, United States
Northeast Georgia Medical Center-Gainesville
🇺🇸Gainesville, Georgia, United States
Memorial Health University Medical Center
🇺🇸Savannah, Georgia, United States
Rush University Medical Center
🇺🇸Chicago, Illinois, United States
Central Georgia Gynecologic Oncology
🇺🇸Macon, Georgia, United States
Decatur Memorial Hospital
🇺🇸Decatur, Illinois, United States
Northwestern University
🇺🇸Chicago, Illinois, United States
Michiana Hematology Oncology PC-Elkhart
🇺🇸Elkhart, Indiana, United States
Indiana University/Melvin and Bren Simon Cancer Center
🇺🇸Indianapolis, Indiana, United States
Saint Vincent Hospital and Health Care Center
🇺🇸Indianapolis, Indiana, United States
Elkhart General Hospital
🇺🇸Elkhart, Indiana, United States
Community Howard Regional Health
🇺🇸Kokomo, Indiana, United States
IU Health La Porte Hospital
🇺🇸La Porte, Indiana, United States
Michiana Hematology Oncology PC-Mishawaka
🇺🇸Mishawaka, Indiana, United States
The Community Hospital
🇺🇸Munster, Indiana, United States
University of Iowa/Holden Comprehensive Cancer Center
🇺🇸Iowa City, Iowa, United States
New York Hospital Medical Center of Queens
🇺🇸Fresh Meadows, New York, United States
Hope Women's Cancer Centers-Asheville
🇺🇸Asheville, North Carolina, United States
Sutter Medical Center Sacramento
🇺🇸Sacramento, California, United States
University of California Davis Comprehensive Cancer Center
🇺🇸Sacramento, California, United States
Michigan Cancer Research Consortium NCORP
🇺🇸Ann Arbor, Michigan, United States
Saint Joseph Mercy Hospital
🇺🇸Ann Arbor, Michigan, United States
University of Michigan Comprehensive Cancer Center
🇺🇸Ann Arbor, Michigan, United States
Southeast Clinical Oncology Research Consortium NCORP
🇺🇸Winston-Salem, North Carolina, United States
Boulder Community Hospital
🇺🇸Boulder, Colorado, United States
Emory University Hospital/Winship Cancer Institute
🇺🇸Atlanta, Georgia, United States
Hillcrest Hospital Cancer Center
🇺🇸Mayfield Heights, Ohio, United States
Saint Joseph Regional Medical Center-Mishawaka
🇺🇸Mishawaka, Indiana, United States
University of Pittsburgh Cancer Institute (UPCI)
🇺🇸Pittsburgh, Pennsylvania, United States
UPMC-Magee Womens Hospital
🇺🇸Pittsburgh, Pennsylvania, United States
Cancer Care Northwest - Spokane South
🇺🇸Spokane, Washington, United States
Washington University School of Medicine
🇺🇸Saint Louis, Missouri, United States
Carle Cancer Center
🇺🇸Urbana, Illinois, United States
AdventHealth Orlando
🇺🇸Orlando, Florida, United States
Orlando Health Cancer Institute
🇺🇸Orlando, Florida, United States
Norton Hospital Pavilion and Medical Campus
🇺🇸Louisville, Kentucky, United States
The James Graham Brown Cancer Center at University of Louisville
🇺🇸Louisville, Kentucky, United States
Saint Luke's Hospital of Kansas City
🇺🇸Kansas City, Missouri, United States
Research Medical Center
🇺🇸Kansas City, Missouri, United States
UNC Lineberger Comprehensive Cancer Center
🇺🇸Chapel Hill, North Carolina, United States
Medical University of South Carolina
🇺🇸Charleston, South Carolina, United States
Yale University
🇺🇸New Haven, Connecticut, United States
Munson Medical Center
🇺🇸Traverse City, Michigan, United States
Aurora West Allis Medical Center
🇺🇸West Allis, Wisconsin, United States
William Beaumont Hospital-Royal Oak
🇺🇸Royal Oak, Michigan, United States
Sparrow Hospital
🇺🇸Lansing, Michigan, United States
ProHealth Waukesha Memorial Hospital
🇺🇸Waukesha, Wisconsin, United States
Ascension Saint Mary's Hospital
🇺🇸Saginaw, Michigan, United States
Morristown Medical Center
🇺🇸Morristown, New Jersey, United States
Vince Lombardi Cancer Clinic-Sheboygan
🇺🇸Sheboygan, Wisconsin, United States
West Michigan Cancer Center
🇺🇸Kalamazoo, Michigan, United States
Wake Forest University Health Sciences
🇺🇸Winston-Salem, North Carolina, United States
Cancer Research Consortium of West Michigan NCORP
🇺🇸Grand Rapids, Michigan, United States
Spectrum Health Big Rapids Hospital
🇺🇸Big Rapids, Michigan, United States
Lakeland Medical Center Saint Joseph
🇺🇸Saint Joseph, Michigan, United States
Metro Health Hospital
🇺🇸Wyoming, Michigan, United States
NYU Winthrop Hospital
🇺🇸Mineola, New York, United States
Sibley Memorial Hospital
🇺🇸Washington, District of Columbia, United States
MedStar Franklin Square Medical Center/Weinberg Cancer Institute
🇺🇸Baltimore, Maryland, United States
Saint Joseph Mercy Oakland
🇺🇸Pontiac, Michigan, United States
Dartmouth Hitchcock Medical Center
🇺🇸Lebanon, New Hampshire, United States
Hurley Medical Center
🇺🇸Flint, Michigan, United States
Black Hills Obstetrics and Gynecology
🇺🇸Rapid City, South Dakota, United States
University of Vermont Medical Center
🇺🇸Burlington, Vermont, United States
Aurora Cancer Care-Grafton
🇺🇸Grafton, Wisconsin, United States
Gundersen Lutheran Medical Center
🇺🇸La Crosse, Wisconsin, United States
Holy Family Memorial Hospital
🇺🇸Manitowoc, Wisconsin, United States
Green Bay Oncology at Saint Vincent Hospital
🇺🇸Green Bay, Wisconsin, United States
Saint Vincent Hospital Cancer Center Green Bay
🇺🇸Green Bay, Wisconsin, United States
Medical College of Wisconsin
🇺🇸Milwaukee, Wisconsin, United States
Iowa Methodist Medical Center
🇺🇸Des Moines, Iowa, United States
Iowa-Wide Oncology Research Coalition NCORP
🇺🇸Des Moines, Iowa, United States
Mercy Medical Center - Des Moines
🇺🇸Des Moines, Iowa, United States
Iowa Lutheran Hospital
🇺🇸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
University of Kentucky/Markey Cancer Center
🇺🇸Lexington, Kentucky, United States
Tulane University Health Sciences Center
🇺🇸New Orleans, Louisiana, United States
Ochsner Medical Center Jefferson
🇺🇸New Orleans, Louisiana, United States
Dell Seton Medical Center at The University of Texas
🇺🇸Austin, Texas, United States
Virginia Commonwealth University/Massey Cancer Center
🇺🇸Richmond, Virginia, United States
University of Wisconsin Hospital and Clinics
🇺🇸Madison, Wisconsin, United States
Baystate Medical Center
🇺🇸Springfield, Massachusetts, United States
Saint Mary Mercy Hospital
🇺🇸Livonia, Michigan, United States
Spectrum Health Reed City Hospital
🇺🇸Reed City, Michigan, United States