Testing Sacituzumab Govitecan Therapy in Patients With HER2-Negative Breast Cancer and Brain Metastases
- Conditions
- Anatomic Stage IV Breast Cancer AJCC v8Invasive Breast CarcinomaPrognostic Stage IV Breast Cancer AJCC v8Metastatic HER2 Negative Breast CarcinomaMetastatic Malignant Neoplasm in the Brain
- Interventions
- Biological: Sacituzumab Govitecan
- Registration Number
- NCT04647916
- Lead Sponsor
- SWOG Cancer Research Network
- Brief Summary
This phase II trial studies the effect of sacituzumab govitecan in treating patients with HER2-negative breast cancer that has spread to the brain (brain metastases). Sacituzumab govitecan is a monoclonal antibody, called sacituzumab, linked to a chemotherapy drug, called govitecan. Sacituzumab is a form of targeted therapy because it attaches to specific molecules on the surface of cancer cells, known as Trop-2 receptors, and delivers govitecan to kill them. Giving sacituzumab govitecan may shrink the cancer in the brain and/or extend the time until the cancer gets worse.
- Detailed Description
PRIMARY OBJECTIVE:
I. To evaluate the intracranial objective response rate (ORR) (complete response \[CR\] or partial response \[PR\] by Response Assessment in Neuro-Oncology Brain Metastases \[RANO-BM\]) with sacituzumab govitecan (IMMU-132) in patients with HER2-negative metastatic breast cancer with brain involvement.
SECONDARY OBJECTIVES:
I. To evaluate bi-compartmental progression-free survival in this population. II. To evaluate overall survival in this population. III. To assess safety and tolerability of sacituzumab govitecan (IMMU-132) treatment in this population.
IV. To evaluate ORR by hormone-receptor (HR) subgroup (HR+, HR-).
BANKING OBJECTIVE:
I. To bank specimens for future correlative studies.
OUTLINE:
Patients receive sacituzumab govitecan intravenously (IV) over 1-3 hours on days 1 and 8. Cycles repeat every 21 days for up to 2 years in the absence of disease progression or unacceptable toxicity.
After completion of study registration, patients are followed up every 3 months for 1 year and then every 6 months for 1 year.
Recruitment & Eligibility
- Status
- RECRUITING
- Sex
- All
- Target Recruitment
- 44
- Participants must have histologically confirmed HER2-negative (per 2018 American Society of Clinical Oncology [ASCO]/College of American Pathologists [CAP] joint guideline) invasive breast cancer that has metastasized to the brain. NOTE: Pathology report must confirm HER2-negative invasive breast cancer. Brain metastases must be confirmed by radiology report
- Participants must have an magnetic resonance imaging (MRI) of the brain within 28 days prior to registration and must have central nervous system metastases with at least one measurable brain metastasis >= 1.0 cm in size (per RANO-BM) that has not been irradiated, or has progressed despite prior radiation therapy (in the opinion of the treating physician). In the rare case that a previously irradiated brain metastasis is the sole target lesion and if there is concern about possible radiation necrosis, patient is eligible only if there is clear progression in the previously radiated lesion. Computed tomography (CT) of the head cannot substitute for brain MRI. All central nervous system (CNS) disease must be assessed and documented on the S2007 Brain Metastases Baseline Tumor Assessment Form
- Participants may have measurable or non-measurable extracranial disease. All measurable disease must be assessed within 28 days prior to registration; all non-measurable disease must be assessed within 42 days prior to registration. Participants are NOT required to have extracranial disease, but must have scans done to document disease status at baseline. All extracranial disease must be assessed and documented on the Baseline Tumor Assessment Form (Response Evaluation Criteria in Solid Tumors [RECIST] 1.1). NOTE: Brain lesions should not be included on the Baseline Tumor Assessment Form (RECIST 1.1) for this study
- Participants must have had CNS progression after previous CNS-directed therapy (radiation therapy, surgery, or any combination of therapy)
- Participants must have resolution of adverse event(s) of the most recent prior systemic anti-cancer therapy to < grade 2, with the exception of alopecia and =< grade 2 neuropathy, which are allowed
- Participants with a prior or concurrent malignancy whose natural history or treatment (in the opinion of the treating physician) does not have the potential to interfere with the safety or efficacy assessment of the investigational regimen are eligible for this trial
- Participants must have Zubrod performance status 0 or 1
- Participants must have history and physical exam obtained within 21 days prior to registration
- Absolute neutrophil count (ANC) >= 1,500/mcL (obtained within 21 days prior to registration)
- Platelet count >= 100,000/mcL (obtained within 21 days prior to registration)
- Hemoglobin >= 9.0 g/dL (obtained within 21 days prior to registration)
- Total bilirubin =< 1.5 times institutional upper limit of normal (ULN) (obtained within 21 days prior to registration)
- Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) =< 3 x institutional ULN (obtained within 21 days prior to registration)
- Participants must have a serum creatinine =< 1.5 times the institutional upper limit of normal (IULN) OR measured OR calculated creatinine clearance >= 30 mL/min using the following Cockcroft-Gault Formula. This specimen must have been drawn and processed within 21 days prior to registration
- Participants must have adequate cardiac function. Participants with known history or current symptoms of cardiac disease, or history of treatment with cardiotoxic agents, must have a clinical risk assessment of cardiac function using the New York Heart Association Functional Classification, and must be class 2B or better
- Participants must be offered the opportunity to participate in specimen banking. With participant consent, specimens must be collected and submitted via the Southwest Oncology Group (SWOG) Specimen Tracking System
- Participants must be informed of the investigational nature of this study and must sign and give informed consent in accordance with institutional and federal guidelines
- Participants must not have had more than 2 seizures within 28 days prior to registration
- Participants must not have received systemic therapy (including small-molecule kinase inhibitors) or non-cytotoxic hormonal therapy (e.g., tamoxifen) within 7 days prior to registration
- Participants must not have received anti-cancer biologic agents (antibodies, immune modulators, vaccines, cytokines) within 21 days prior to registration
- Participants must not have received nitrosoureas or mitomycin C within 42 days, metronomic/protracted low-dose chemotherapy within 14 days, or other cytotoxic chemotherapy within 28 days prior to registration
- Human immunodeficiency virus (HIV)-positive patients on combination antiretroviral agents that are strong CYP3A4 inhibitors or inducers and who are unwilling or unable to change to antiretroviral therapies without such interactions are ineligible because of the potential for pharmacokinetic interactions with sacituzumab govitecan (IMMU-132)
- Due to potential drug interactions of anti-retroviral drugs with sacituzumab govitecan (IMMU-132), participants must not have known active or chronic hepatitis B virus (HBV) infection, requiring suppressive therapy or known active hepatitis C virus (HCV) infection. Participants with a known history of HCV infection must have been treated and cured
- Participants must not have received enzyme-inducing anti-epileptic agents (e.g., carbamazepine, phenytoin, phenobarbital, primidone) within 7 days prior to registration or within 14 days of planned start of cycle 1, day 1 treatment, and participants must not be planning to receive enzyme-inducing anti-epileptic agents (e.g., carbamazepine, phenytoin, phenobarbital, primidone) for the duration of protocol treatment
- Participants must not be receiving warfarin (or other coumarin derivatives) at time of registration or be planning to receive warfarin (or other coumarin derivatives) for the duration of protocol treatment. Participants who are able to switch to low molecular weight heparin (LMWH) or direct oral anticoagulants (DOACs) prior to date of registration (and plan to remain off of warfarin or other coumarin derivatives) for the duration of protocol treatment) are eligible
- Patients must not be receiving or be planning to receive concomitantly any other anti-cancer therapy, including endocrine therapy. Note: Concomitant hormone replacement therapy is allowed
- Participants must not have a condition requiring ongoing systemic treatment with corticosteroids (> 4 mg daily dexamethasone [or bioequivalent]) or other immunosuppressive medications within 7 days prior to the baseline MRI. Corticosteroids administration must be stable and planned to remain =< 4 mg daily for the duration of protocol treatment. However, use of corticosteroids for clinical symptoms is allowed based upon treating physician discretion
- Participants must not have uncontrolled diabetes in the opinion of the treating investigator 21 days prior to registration
- Participants must not be pregnant or nursing. Women of reproductive potential must have a negative serum or urine pregnancy test within 7 days prior to registration. Women and men of reproductive potential must have agreed to use an effective contraceptive method for the duration of protocol treatment and for at least 6 months after the last dose of sacituzumab govitecan (IMMU-132). A woman is considered to be of "reproductive potential" if she has had menses at any time in the preceding 12 consecutive months. In addition to routine contraceptive methods, "effective contraception" also includes heterosexual celibacy and surgery intended to prevent pregnancy (or with a side-effect of pregnancy prevention) defined as a hysterectomy, bilateral oophorectomy or bilateral tubal ligation. However, if at any point a previously celibate participant chooses to become heterosexually active during the time period for use of contraceptive measures outlined, he/she is responsible for beginning contraceptive measures
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- SINGLE_GROUP
- Arm && Interventions
Group Intervention Description Treatment (sacituzumab govitecan) Sacituzumab Govitecan Patients receive sacituzumab govitecan IV over 1-3 hours on days 1 and 8. Cycles repeat every 21 days for up to 2 years in the absence of disease progression or unacceptable toxicity.
- Primary Outcome Measures
Name Time Method Objective response rate (ORR) Up to 2 years ORR will be evaluated using use a Simon two-stage minimax design.
- Secondary Outcome Measures
Name Time Method Overall survival From date of registration to date of death due to any cause, assessed up to 2 years Will use the Kaplan-Meier curves to estimate the respective survival curves.
Progression-free survival From date of registration to date of first documentation of progression or symptomatic deterioration or death due to any cause, assessed up to 2 years Will use the Kaplan-Meier curves to estimate the respective survival curves.
Incidence of adverse events Up to 2 years Adverse events will be graded using the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. The incidence of adverse events will be reported. Toxicity will be by grade and attribution to treatment.
Trial Locations
- Locations (296)
Walter Knox Memorial Hospital
🇺🇸Emmett, Idaho, United States
Saint Alphonsus Cancer Care Center-Boise
🇺🇸Boise, Idaho, United States
SIH Cancer Institute
🇺🇸Carterville, Illinois, United States
Illinois CancerCare-Canton
🇺🇸Canton, Illinois, United States
Cancer Care Specialists of Illinois - Decatur
🇺🇸Decatur, Illinois, United States
Rush - Copley Medical Center
🇺🇸Aurora, Illinois, United States
Illinois CancerCare-Carthage
🇺🇸Carthage, Illinois, United States
Illinois CancerCare-Bloomington
🇺🇸Bloomington, Illinois, United States
Saint Alphonsus Cancer Care Center-Caldwell
🇺🇸Caldwell, Idaho, United States
Saint Anthony's Health
🇺🇸Alton, Illinois, United States
Memorial Hospital of Carbondale
🇺🇸Carbondale, Illinois, United States
Northwestern University
🇺🇸Chicago, Illinois, United States
Centralia Oncology Clinic
🇺🇸Centralia, Illinois, United States
Carle on Vermilion
🇺🇸Danville, Illinois, United States
Truman Medical Centers
🇺🇸Kansas City, Missouri, United States
Saint Patrick Hospital - Community Hospital
🇺🇸Missoula, Montana, United States
Crossroads Cancer Center
🇺🇸Effingham, Illinois, United States
Illinois CancerCare-Kewanee Clinic
🇺🇸Kewanee, Illinois, United States
Memorial Medical Center
🇺🇸Springfield, Illinois, United States
McFarland Clinic PC-Trinity Cancer Center
🇺🇸Fort Dodge, Iowa, United States
Ascension Providence Hospitals - Novi
🇺🇸Novi, Michigan, United States
Illinois CancerCare-Peru
🇺🇸Peru, Illinois, United States
Alegent Health Mercy Hospital
🇺🇸Council Bluffs, Iowa, United States
Saint Joseph London
🇺🇸London, Kentucky, United States
Baptist Memorial Hospital and Cancer Center-Desoto
🇺🇸Southhaven, Mississippi, United States
Ascension Providence Hospitals - Southfield
🇺🇸Southfield, Michigan, United States
Reid Health
🇺🇸Richmond, Indiana, United States
McFarland Clinic PC - Ames
🇺🇸Ames, Iowa, United States
Southeast Cancer Center
🇺🇸Cape Girardeau, Missouri, United States
Flaget Memorial Hospital
🇺🇸Bardstown, Kentucky, United States
Central Care Cancer Center - Bolivar
🇺🇸Bolivar, Missouri, United States
Bozeman Deaconess Hospital
🇺🇸Bozeman, Montana, United States
Saint Joseph Hospital East
🇺🇸Lexington, Kentucky, United States
University of New Mexico Cancer Center
🇺🇸Albuquerque, New Mexico, United States
Methodist West Hospital
🇺🇸West Des Moines, Iowa, United States
Saint Francis Medical Center
🇺🇸Cape Girardeau, Missouri, United States
Hickman Cancer Center
🇺🇸Adrian, Michigan, United States
University of Kansas Cancer Center - North
🇺🇸Kansas City, Missouri, United States
Northwell Health/Center for Advanced Medicine
🇺🇸Lake Success, New York, United States
Missouri Baptist Sullivan Hospital
🇺🇸Sullivan, Missouri, United States
Southeastern Medical Oncology Center-Clinton
🇺🇸Clinton, North Carolina, United States
CoxHealth South Hospital
🇺🇸Springfield, Missouri, United States
Billings Clinic Cancer Center
🇺🇸Billings, Montana, United States
Southeastern Medical Oncology Center-Goldsboro
🇺🇸Goldsboro, North Carolina, United States
Harrison HealthPartners Hematology and Oncology-Poulsbo
🇺🇸Poulsbo, Washington, United States
Vanderbilt-Ingram Cancer Center Cool Springs
🇺🇸Franklin, Tennessee, United States
Highline Medical Center-Main Campus
🇺🇸Burien, Washington, United States
Providence Regional Cancer System-Centralia
🇺🇸Centralia, Washington, United States
Miami Valley Hospital North
🇺🇸Dayton, Ohio, United States
Saint Alphonsus Medical Center-Ontario
🇺🇸Ontario, Oregon, United States
Spartanburg Medical Center
🇺🇸Spartanburg, South Carolina, United States
Springfield Regional Cancer Center
🇺🇸Springfield, Ohio, United States
Harrison HealthPartners Hematology and Oncology-Bremerton
🇺🇸Bremerton, Washington, United States
Saint Alphonsus Medical Center-Baker City
🇺🇸Baker City, Oregon, United States
Saint Francis Hospital
🇺🇸Federal Way, Washington, United States
Armes Family Cancer Center
🇺🇸Findlay, Ohio, United States
Harrison Medical Center
🇺🇸Bremerton, Washington, United States
Cleveland Clinic Cancer Center Mansfield
🇺🇸Mansfield, Ohio, United States
Saint Charles Health System
🇺🇸Bend, Oregon, United States
UPMC Susquehanna
🇺🇸Williamsport, Pennsylvania, United States
Bay Area Hospital
🇺🇸Coos Bay, Oregon, United States
Saint Charles Health System-Redmond
🇺🇸Redmond, Oregon, United States
Providence Regional Cancer System-Lacey
🇺🇸Lacey, Washington, United States
Saint Joseph Regional Cancer Center
🇺🇸Bryan, Texas, United States
Cheyenne Regional Medical Center-West
🇺🇸Cheyenne, Wyoming, United States
Welch Cancer Center
🇺🇸Sheridan, Wyoming, United States
Mercy Hospital Fort Smith
🇺🇸Fort Smith, Arkansas, United States
UC Irvine Health Cancer Center-Newport
🇺🇸Costa Mesa, California, United States
Saint Alphonsus Medical Center-Nampa
🇺🇸Nampa, Idaho, United States
Carle Physician Group-Mattoon/Charleston
🇺🇸Mattoon, Illinois, United States
Heartland Regional Medical Center
🇺🇸Saint Joseph, Missouri, United States
Illinois CancerCare-Princeton
🇺🇸Princeton, Illinois, United States
Dayton Physicians LLC-Atrium
🇺🇸Franklin, Ohio, United States
Greater Dayton Cancer Center
🇺🇸Kettering, Ohio, United States
Clackamas Radiation Oncology Center
🇺🇸Clackamas, Oregon, United States
Providence Cancer Institute Clackamas Clinic
🇺🇸Clackamas, Oregon, United States
Swedish Cancer Institute-Edmonds
🇺🇸Edmonds, Washington, United States
Anchorage Associates in Radiation Medicine
🇺🇸Anchorage, Alaska, United States
Anchorage Radiation Therapy Center
🇺🇸Anchorage, Alaska, United States
Alaska Breast Care and Surgery LLC
🇺🇸Anchorage, Alaska, United States
Alaska Oncology and Hematology LLC
🇺🇸Anchorage, Alaska, United States
Anchorage Oncology Centre
🇺🇸Anchorage, Alaska, United States
Katmai Oncology Group
🇺🇸Anchorage, Alaska, United States
Providence Alaska Medical Center
🇺🇸Anchorage, Alaska, United States
Fairbanks Memorial Hospital
🇺🇸Fairbanks, Alaska, United States
University of Arizona Cancer Center-Orange Grove Campus
🇺🇸Tucson, Arizona, United States
Banner University Medical Center - Tucson
🇺🇸Tucson, Arizona, United States
University of Arizona Cancer Center-North Campus
🇺🇸Tucson, Arizona, United States
CHI Saint Vincent Cancer Center Hot Springs
🇺🇸Hot Springs, Arkansas, United States
Epic Care-Dublin
🇺🇸Dublin, California, United States
Bay Area Breast Surgeons Inc
🇺🇸Emeryville, California, United States
Epic Care Partners in Cancer Care
🇺🇸Emeryville, California, United States
Contra Costa Regional Medical Center
🇺🇸Martinez, California, United States
Alta Bates Summit Medical Center - Summit Campus
🇺🇸Oakland, California, United States
Bay Area Tumor Institute
🇺🇸Oakland, California, United States
UC Irvine Health/Chao Family Comprehensive Cancer Center
🇺🇸Orange, California, United States
Pacific Central Coast Health Center-San Luis Obispo
🇺🇸San Luis Obispo, California, United States
Mission Hope Medical Oncology - Santa Maria
🇺🇸Santa Maria, California, United States
Saint John's Cancer Institute
🇺🇸Santa Monica, California, United States
Epic Care Cyberknife Center
🇺🇸Walnut Creek, California, United States
Longmont United Hospital
🇺🇸Longmont, Colorado, United States
Rocky Mountain Cancer Centers-Longmont
🇺🇸Longmont, Colorado, United States
Lewis Cancer and Research Pavilion at Saint Joseph's/Candler
🇺🇸Savannah, Georgia, United States
Illinois CancerCare-Peoria
🇺🇸Peoria, Illinois, United States
Methodist Medical Center of Illinois
🇺🇸Peoria, Illinois, United States
Dana-Farber Cancer Institute
🇺🇸Boston, Massachusetts, United States
Cleveland Clinic Foundation
🇺🇸Cleveland, Ohio, United States
Baptist Memorial Hospital and Cancer Center-Golden Triangle
🇺🇸Columbus, Mississippi, United States
Freeman Health System
🇺🇸Joplin, Missouri, United States
Delbert Day Cancer Institute at PCRMC
🇺🇸Rolla, Missouri, United States
Mercy Hospital Springfield
🇺🇸Springfield, Missouri, United States
Missouri Baptist Outpatient Center-Sunset Hills
🇺🇸Sunset Hills, Missouri, United States
Mercy Hospital Washington
🇺🇸Washington, Missouri, United States
UPMC Pinnacle Cancer Center/Community Osteopathic Campus
🇺🇸Harrisburg, Pennsylvania, United States
UPMC-Mercy Hospital
🇺🇸Pittsburgh, Pennsylvania, United States
UPMC Memorial
🇺🇸York, Pennsylvania, United States
Baptist Memorial Hospital and Cancer Center-Collierville
🇺🇸Collierville, Tennessee, United States
Providence Regional Cancer System-Aberdeen
🇺🇸Aberdeen, Washington, United States
PeaceHealth Saint Joseph Medical Center
🇺🇸Bellingham, Washington, United States
Providence Regional Cancer Partnership
🇺🇸Everett, Washington, United States
Kadlec Clinic Hematology and Oncology
🇺🇸Kennewick, Washington, United States
PeaceHealth Saint John Medical Center
🇺🇸Longview, Washington, United States
Jefferson Healthcare
🇺🇸Port Townsend, Washington, United States
PeaceHealth United General Medical Center
🇺🇸Sedro-Woolley, Washington, United States
Providence Regional Cancer System-Shelton
🇺🇸Shelton, Washington, United States
PeaceHealth Southwest Medical Center
🇺🇸Vancouver, Washington, United States
Providence Saint Mary Regional Cancer Center
🇺🇸Walla Walla, Washington, United States
Providence Regional Cancer System-Yelm
🇺🇸Yelm, Washington, United States
Swedish Medical Center-First Hill
🇺🇸Seattle, Washington, United States
Swedish Medical Center-Cherry Hill
🇺🇸Seattle, Washington, United States
Good Samaritan Hospital - Cincinnati
🇺🇸Cincinnati, Ohio, United States
Bethesda North Hospital
🇺🇸Cincinnati, Ohio, United States
TriHealth Cancer Institute-Westside
🇺🇸Cincinnati, Ohio, United States
TriHealth Cancer Institute-Anderson
🇺🇸Cincinnati, Ohio, United States
Boulder Community Foothills Hospital
🇺🇸Boulder, Colorado, United States
Penrose-Saint Francis Healthcare
🇺🇸Colorado Springs, Colorado, United States
Rocky Mountain Cancer Centers-Penrose
🇺🇸Colorado Springs, Colorado, United States
Rocky Mountain Cancer Centers - Swedish
🇺🇸Englewood, Colorado, United States
North Colorado Medical Center
🇺🇸Greeley, Colorado, United States
Rocky Mountain Cancer Centers-Lakewood
🇺🇸Lakewood, Colorado, United States
Parker Adventist Hospital
🇺🇸Parker, Colorado, United States
Rocky Mountain Cancer Centers - Centennial
🇺🇸Centennial, Colorado, United States
Mercy Medical Center
🇺🇸Durango, Colorado, United States
Mountain Blue Cancer Care Center - Swedish
🇺🇸Englewood, Colorado, United States
Rocky Mountain Cancer Centers-Boulder
🇺🇸Boulder, Colorado, United States
Southwest Oncology PC
🇺🇸Durango, Colorado, United States
University of Kansas Cancer Center-Overland Park
🇺🇸Overland Park, Kansas, United States
Saint Mary Corwin Medical Center
🇺🇸Pueblo, Colorado, United States
Saint Anthony Hospital
🇺🇸Lakewood, Colorado, United States
Sky Ridge Medical Center
🇺🇸Lone Tree, Colorado, United States
Rocky Mountain Cancer Centers-Thornton
🇺🇸Thornton, Colorado, United States
Lawrence Memorial Hospital
🇺🇸Lawrence, Kansas, United States
University of Kansas Health System Saint Francis Campus
🇺🇸Topeka, Kansas, United States
Olathe Health Cancer Center
🇺🇸Olathe, Kansas, United States
University of Kansas Hospital-Westwood Cancer Center
🇺🇸Westwood, Kansas, United States
Rocky Mountain Cancer Centers-Littleton
🇺🇸Littleton, Colorado, United States
Littleton Adventist Hospital
🇺🇸Littleton, Colorado, United States
Central Care Cancer Center - Garden City
🇺🇸Garden City, Kansas, United States
Ascension Via Christi - Pittsburg
🇺🇸Pittsburg, Kansas, United States
Billings Clinic-Cody
🇺🇸Cody, Wyoming, United States
The Melanoma and Skin Cancer Institute
🇺🇸Englewood, Colorado, United States
Rocky Mountain Cancer Centers-Sky Ridge
🇺🇸Lone Tree, Colorado, United States
McKee Medical Center
🇺🇸Loveland, Colorado, United States
Salina Regional Health Center
🇺🇸Salina, Kansas, United States
Central Care Cancer Center - Great Bend
🇺🇸Great Bend, Kansas, United States
HaysMed University of Kansas Health System
🇺🇸Hays, Kansas, United States
Cancer Center at Saint Joseph's
🇺🇸Phoenix, Arizona, United States
The Women's Imaging Center
🇺🇸Denver, Colorado, United States
Porter Adventist Hospital
🇺🇸Denver, Colorado, United States
Colorado Blood Cancer Institute
🇺🇸Denver, Colorado, United States
Rose Medical 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
Western Surgical Care
🇺🇸Denver, Colorado, United States
Vanderbilt Breast Center at One Hundred Oaks
🇺🇸Nashville, Tennessee, United States
Mercy Hospital Oklahoma City
🇺🇸Oklahoma City, Oklahoma, United States
Providence Portland Medical Center
🇺🇸Portland, Oregon, United States
Providence Saint Vincent Medical Center
🇺🇸Portland, Oregon, United States
Vanderbilt University/Ingram Cancer Center
🇺🇸Nashville, Tennessee, United States
University of Texas Health Science Center at San Antonio
🇺🇸San Antonio, Texas, United States
Mayo Clinic in Rochester
🇺🇸Rochester, Minnesota, United States
Alegent Health Bergan Mercy Medical Center
🇺🇸Omaha, Nebraska, United States
Alegent Health Lakeside Hospital
🇺🇸Omaha, Nebraska, United States
Creighton University Medical Center
🇺🇸Omaha, Nebraska, United States
Parkland Health Center - Farmington
🇺🇸Farmington, Missouri, United States
Mercy Hospital Joplin
🇺🇸Joplin, Missouri, United States
Mercy Clinic-Rolla-Cancer and Hematology
🇺🇸Rolla, Missouri, United States
University of Kansas Cancer Center at North Kansas City Hospital
🇺🇸North Kansas City, Missouri, United States
Saint Louis Cancer and Breast Institute-South City
🇺🇸Saint Louis, Missouri, United States
Rocky Mountain Cancer Centers-Aurora
🇺🇸Aurora, Colorado, United States
The Medical Center of Aurora
🇺🇸Aurora, Colorado, United States
Walter Reed National Military Medical Center
🇺🇸Bethesda, Maryland, United States
Providence Saint Joseph Medical Center/Disney Family Cancer Center
🇺🇸Burbank, California, United States
Carle Physician Group-Effingham
🇺🇸Effingham, Illinois, United States
Illinois CancerCare-Dixon
🇺🇸Dixon, Illinois, United States
Decatur Memorial Hospital
🇺🇸Decatur, Illinois, United States
Illinois CancerCare-Eureka
🇺🇸Eureka, Illinois, United States
Illinois CancerCare-Galesburg
🇺🇸Galesburg, Illinois, United States
Illinois CancerCare-Macomb
🇺🇸Macomb, Illinois, United States
Cancer Care Center of O'Fallon
🇺🇸O'Fallon, Illinois, United States
Illinois CancerCare-Ottawa Clinic
🇺🇸Ottawa, Illinois, United States
Valley Radiation Oncology
🇺🇸Peru, Illinois, United States
Southern Illinois University School of Medicine
🇺🇸Springfield, Illinois, United States
Carle Cancer Center
🇺🇸Urbana, Illinois, United States
Illinois CancerCare - Washington
🇺🇸Washington, Illinois, United States
Mary Greeley Medical Center
🇺🇸Ames, Iowa, United States
Rush-Copley Healthcare Center
🇺🇸Yorkville, Illinois, United States
Mercy Cancer Center-West Lakes
🇺🇸Clive, Iowa, United States
Greater Regional Medical Center
🇺🇸Creston, Iowa, United States
Iowa Methodist Medical Center
🇺🇸Des Moines, Iowa, United States
Saint Anthony Regional Hospital
🇺🇸Carroll, Iowa, United States
Medical Oncology and Hematology Associates-West Des Moines
🇺🇸Clive, Iowa, United States
Medical Oncology and Hematology Associates-Des Moines
🇺🇸Des Moines, Iowa, United States
Broadlawns Medical Center
🇺🇸Des Moines, Iowa, United States
Medical Oncology and Hematology Associates-Laurel
🇺🇸Des Moines, Iowa, United States
Mercy Medical Center - Des Moines
🇺🇸Des Moines, Iowa, United States
McFarland Clinic PC-Marshalltown
🇺🇸Marshalltown, Iowa, United States
Trinity Regional Medical Center
🇺🇸Fort Dodge, Iowa, United States
McFarland Clinic PC-Jefferson
🇺🇸Jefferson, Iowa, United States
Iowa Lutheran Hospital
🇺🇸Des Moines, Iowa, United States
Mercy Medical Center-West Lakes
🇺🇸West Des Moines, Iowa, United States
Saint Joseph Radiation Oncology Resource Center
🇺🇸Lexington, Kentucky, United States
Commonwealth Cancer Center-Corbin
🇺🇸Corbin, Kentucky, United States
Southeastern Medical Oncology Center-Jacksonville
🇺🇸Jacksonville, North Carolina, United States
Miami Valley Hospital South
🇺🇸Centerville, Ohio, United States
Good Samaritan Hospital Medical Center
🇺🇸West Islip, New York, United States
Dayton Physicians LLC-Miami Valley South
🇺🇸Centerville, Ohio, United States
Miami Valley Hospital
🇺🇸Dayton, Ohio, United States
Cleveland Clinic Cancer Center/Fairview Hospital
🇺🇸Cleveland, Ohio, United States
Kettering Medical Center
🇺🇸Kettering, Ohio, United States
Dayton Physician LLC-Miami Valley Hospital North
🇺🇸Dayton, Ohio, United States
Mercy Health - Saint Anne Hospital
🇺🇸Toledo, Ohio, United States
North Coast Cancer Care
🇺🇸Sandusky, Ohio, United States
South Pointe Hospital
🇺🇸Warrensville Heights, Ohio, United States
UPMC Camp Hill
🇺🇸Camp Hill, Pennsylvania, United States
University of Pittsburgh Cancer Institute (UPCI)
🇺🇸Pittsburgh, Pennsylvania, United States
Saint Elizabeth Hospital
🇺🇸Enumclaw, Washington, United States
M D Anderson Cancer Center
🇺🇸Houston, Texas, United States
Swedish Cancer Institute-Issaquah
🇺🇸Issaquah, Washington, United States
Pacific Gynecology Specialists
🇺🇸Seattle, Washington, United States
Swedish Medical Center-Ballard Campus
🇺🇸Seattle, Washington, United States
Saint Clare Hospital
🇺🇸Lakewood, Washington, United States
Franciscan Research Center-Northwest Medical Plaza
🇺🇸Tacoma, Washington, United States
Toledo Clinic Cancer Centers-Toledo
🇺🇸Toledo, Ohio, United States
Illinois CancerCare-Pekin
🇺🇸Pekin, Illinois, United States
The Carle Foundation Hospital
🇺🇸Urbana, Illinois, United States
Western Illinois Cancer Treatment Center
🇺🇸Galesburg, Illinois, United States
Mission Hope Medical Oncology - Arroyo Grande
🇺🇸Arroyo Grande, California, United States
Good Samaritan Regional Health Center
🇺🇸Mount Vernon, Illinois, United States
Hillcrest Hospital Cancer Center
🇺🇸Mayfield Heights, Ohio, United States
Capital Region Southwest Campus
🇺🇸Jefferson City, Missouri, United States
Sainte Genevieve County Memorial Hospital
🇺🇸Sainte Genevieve, Missouri, United States
Mercy Hospital South
🇺🇸Saint Louis, Missouri, United States
Missouri Baptist Medical Center
🇺🇸Saint Louis, Missouri, United States
Mercy Hospital Saint Louis
🇺🇸Saint Louis, Missouri, United States
Jewish Hospital
🇺🇸Louisville, Kentucky, United States
Saints Mary and Elizabeth Hospital
🇺🇸Louisville, Kentucky, United States
UofL Health Medical Center Northeast
🇺🇸Louisville, Kentucky, United States
University of Michigan Comprehensive Cancer Center
🇺🇸Ann Arbor, Michigan, United States
Saint Luke's Cancer Institute - Boise
🇺🇸Boise, Idaho, United States
Benefis Healthcare- Sletten Cancer Institute
🇺🇸Great Falls, Montana, United States
Community Medical Hospital
🇺🇸Missoula, Montana, United States
Idaho Urologic Institute-Meridian
🇺🇸Meridian, Idaho, United States
Alaska Women's Cancer Care
🇺🇸Anchorage, Alaska, United States
Saint Luke's Cancer Institute - Meridian
🇺🇸Meridian, Idaho, United States
CHI Health Good Samaritan
🇺🇸Kearney, Nebraska, United States
Saint Luke's Cancer Institute - Fruitland
🇺🇸Fruitland, Idaho, United States
Saint Luke's Cancer Institute - Twin Falls
🇺🇸Twin Falls, Idaho, United States
Saint Luke's Cancer Institute - Nampa
🇺🇸Nampa, Idaho, United States
Kootenai Clinic Cancer Services - Post Falls
🇺🇸Post Falls, Idaho, United States
Kootenai Cancer Clinic
🇺🇸Sandpoint, Idaho, United States
Baptist Cancer Center-Grenada
🇺🇸Grenada, Mississippi, United States
Kalispell Regional Medical Center
🇺🇸Kalispell, Montana, United States
Swedish Medical Center
🇺🇸Englewood, Colorado, United States
Baptist Memorial Hospital and Cancer Center-Oxford
🇺🇸Oxford, Mississippi, United States
Community Hospital of Anaconda
🇺🇸Anaconda, Montana, United States
Saint Elizabeth Regional Medical Center
🇺🇸Lincoln, Nebraska, United States
Toledo Clinic Cancer Centers-Monroe
🇺🇸Monroe, Michigan, United States
Gibbs Cancer Center-Pelham
🇺🇸Greer, South Carolina, United States
Gibbs Cancer Center-Gaffney
🇺🇸Gaffney, South Carolina, United States
Kootenai Health - Coeur d'Alene
🇺🇸Coeur d'Alene, Idaho, United States
Midlands Community Hospital
🇺🇸Papillion, Nebraska, United States
MGC Hematology Oncology-Union
🇺🇸Union, South Carolina, United States
Alegent Health Immanuel Medical Center
🇺🇸Omaha, Nebraska, United States
Great Falls Clinic
🇺🇸Great Falls, Montana, United States
Providence Newberg Medical Center
🇺🇸Newberg, Oregon, United States
Baptist Memorial Hospital and Cancer Center-Memphis
🇺🇸Memphis, Tennessee, United States
Northwest Medical Specialties PLLC
🇺🇸Tacoma, Washington, United States
Springfield Clinic
🇺🇸Springfield, Illinois, United States
University of Kansas Cancer Center - Lee's Summit
🇺🇸Lee's Summit, Missouri, United States
McFarland Clinic PC-Boone
🇺🇸Boone, Iowa, United States
Saint Louis Cancer and Breast Institute-Ballwin
🇺🇸Ballwin, Missouri, United States
CHI Health Saint Francis
🇺🇸Grand Island, Nebraska, United States
Jewish Hospital Medical Center South
🇺🇸Shepherdsville, Kentucky, United States
Solinsky Center for Cancer Care
🇺🇸Manchester, New Hampshire, United States
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