Targeted Treatment for ALK Positive Patients Who Have Previously Been Treated for Non-squamous Non-small Cell Lung Cancer

Phase 2

Active, not recruiting

Conditions: Stage IV Lung Cancer AJCC v8
Stage IVA Lung Cancer AJCC v8
Stage IVB Lung Cancer AJCC v8
Lung Non-Squamous Non-Small Cell Carcinoma

Interventions: Drug: Crizotinib
Drug: Alectinib
Drug: Brigatinib
Drug: Ceritinib
Drug: Lorlatinib
Drug: Carboplatin
Drug: Ensartinib
Drug: Cisplatin
Drug: Pemetrexed

Registration Number: NCT03737994

Lead Sponsor: National Cancer Institute (NCI)

Brief Summary: This National Cancer Institute (NCI)-NRG ALK Protocol phase II trial studies how well a combination of different biomarker/ALK inhibitors work in treating patients with stage IV ALK positive non-squamous non-small cell lung cancer. Lorlatinib, ceritinib, alectinib, brigatinib, ensartinib, and crizotinib may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Drugs used in chemotherapy, such as pemetrexed, cisplatin, and carboplatin, 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. It is not yet known whether a combination of biomarker/ALK inhibitors or chemotherapy may work better in treating patients with ALK positive non-squamous non-small cell lung cancer.

Detailed Description: PRIMARY OBJECTIVES:

I. To assess whether ALK kinase domain mutations (G1202/C1156Y/I1171/L1196/ V1180/ F1174/compound mutation) associated with drug resistance are prognostic for objective response to subsequent ALK inhibitor therapy.

II. To assess whether subsequent pemetrexed based chemotherapy improves objective response comparing to ALK inhibitor therapy for no ALK mutation patients.

III. To evaluate objective responses of patients with specific genetic alterations (ALKL1198F/MET double mutation or high-level MET gene amplification) treated with crizotinib.

SECONDARY OBJECTIVES:

I. Progression-free survival (PFS). II. Duration of response (DOR). III. Overall survival (OS). IV. Intracranial objective response rate (ORR). V. Safety and tolerability.

CORRELATIVE SCIENCE OBJECTIVE:

I. Establish concordance between tumor and liquid biopsies.

OUTLINE:

Patients with a G1202R or G1202del mutation receive either lorlatinib orally (PO) once daily (QD) or brigatinib PO QD. Cycles repeat every 21 days in the absence of disease progression or unacceptable toxicity.

Patients with a C1156Y mutation receive either lorlatinib PO QD, brigatinib PO QD, or alectinib PO twice daily (BID). Cycles repeat every 21 days in the absence of disease progression or unacceptable toxicity.

Patients with a I1171 mutation receive either lorlatinib PO QD, ceritinib PO QD, or brigatinib PO QD. Cycles repeat every 21 days in the absence of disease progression or unacceptable toxicity.

Patients with a L1196 mutation receive either lorlatinib PO QD, brigatinib PO QD, ensartinib PO QD, alectinib PO BID, or ceritinib PO QD. Cycles repeat every 21 days in the absence of disease progression or unacceptable toxicity.

Patients with a V1180 mutation receive either lorlatinib PO QD, brigatinib PO QD, or ceritinib PO QD. Cycles repeat every 21 days in the absence of disease progression or unacceptable toxicity.

Patients with a F1174 mutation receive either alectinib PO BID, lorlatinib PO QD, or brigatinib PO QD. Cycles repeat every 21 days in the absence of disease progression or unacceptable toxicity.

Patients with a compound mutation receive lorlatinib PO QD. Cycles repeat every 21 days in the absence of disease progression or unacceptable toxicity.

Patients with an ALK L1198F mutation alone or with another mutation, and patients with high level MET amplification receive crizotinib PO BID. Cycles repeat every 21 days in the absence of disease progression or unacceptable toxicity.

Patients with no ALK-resistant mutations receive either lorlatinib PO QD, ceritinib PO QD, alectinib PO BID, brigatinib PO QD, or ensartinib PO QD, or pemetrexed intravenously (IV) over 10 minutes on day 1 and either cisplatin IV or carboplatin IV on day 1. ALK inhibitor cycles repeat every 21 days in the absence of disease progression or unacceptable toxicity. Pemetrexed-based treatment repeats every 21 days for up to 6 cycles in the absence of disease progression or unacceptable toxicity. Maintenance treatment of pemetrexed may continue until disease progression or unacceptable toxicity.

After completion of study treatment, patients are followed up for 30 days, every 3 months for 2 years, every 6 months for 3 years, and annually thereafter.

Recruitment & Eligibility

Status: ACTIVE_NOT_RECRUITING

Sex: All

Target Recruitment: 10

Inclusion Criteria

PRIOR TO STEP 1 REGISTRATION
Patients must have histologically or cytologically confirmed stage IV ALK-positive non-squamous non-small cell lung carcinoma (NSCLC) (includes M1a, M1b, M1c stage disease, American Joint Committee on Cancer [AJCC] 8th edition). ALK rearrangement must have been demonstrated by a Food and Drug Administration (FDA) approved assay (Vysis fluorescence in situ hybridization [FISH] or Ventana immunohistochemistry [IHC]) or by next generation sequencing (NGS)
Patient must be willing and able to undergo a fresh biopsy or if patient has a biopsy after progression on current tyrosine-kinase inhibitor (TKI) within 3 months of study enrollment (and has continued TKI for clinical benefit per treating physician) this tissue may be used. Must have sufficient tissue
Patient must have progressive disease as defined by Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 after one second generation ALK inhibitor, including LDK378 (ceritinib), alectinib, ensartinib, and brigatinib (may not have received more than one second-generation ALK inhibitor). Patient may have received prior crizotinib; however, the second generation ALK inhibitor received must be the last treatment given prior to study enrollment
- Prior lorlatinib (third-generation ALK inhibitor) is not allowed
Prior chemotherapy is not allowed except for one prior cycle received at the time of original diagnosis of metastatic NSCLC with no evidence of disease progression following the cycle. NOTE: prior adjuvant or neoadjuvant chemotherapy is allowed if last dose was received more than 12 months prior to enrollment
The patient or a legally authorized representative must provide study-specific informed consent prior to Step 1 Registration
PRIOR TO STEP 2 REGISTRATION
Absolute neutrophil count (ANC) >= 1500 cells/mm^3 (within 28 days prior to step 2 registration)
Platelets >= 100,000 cells/mm^3 (within 28 days prior to step 2 registration)
Estimated creatinine clearance >= 60 mL/min by the Cockcroft Gault formula (within 28 days prior to step 2 registration)
Total bilirubin =< 1.5 x upper limit of normal (ULN) (except for patients with documented Gilbert's syndrome) (within 28 days prior to step 2 registration)
Aspartate aminotransferase (AST) =< 2.5 x ULN; =< 5 x ULN if liver metastases are present (within 28 days prior to step 2 registration)
Alanine aminotransferase (ALT) =< 2.5 x ULN; =< 5 x ULN if liver metastases are present (within 28 days prior to step 2 registration)
Patients with asymptomatic treated or untreated brain metastases are eligible. Treated brain metastases are eligible as long as patients have measurable disease outside the brain according to RECIST 1.1. Patients must be on a stable or decreasing dose of steroids for at least 7 days prior to step 2 registration. Anticonvulsants are allowed as long as the patient is neurologically stable and not deteriorating
Patients enrolled with asymptomatic brain metastases (mets) must have at least one measurable target extracranial lesion according to RECIST 1.1
Eastern Cooperative Oncology Group (ECOG) performance status 0-2
Acute effects of any prior therapy resolved to baseline severity or to Common Terminology Criteria for Adverse Events (CTCAE) grade =< 1 (except for alopecia, hearing loss)
Not taking any medications that may interact with selected study medication based on stratification
Patients must be able to take oral medications (i.e. swallow whole tablets/capsules)
All females of childbearing potential must have a blood test or urine study within 14 days prior to Step 2 Registration to rule out pregnancy. A female of childbearing potential is any woman, regardless of sexual orientation or whether they have undergone tubal ligation, who meets the following criteria:
- Has not undergone a hysterectomy or bilateral oophorectomy; or
- Has not been naturally postmenopausal for at least 24 consecutive months (i.e., has had menses at any time in the preceding 24 consecutive months)
- Women must not be pregnant or breast-feeding due to potential harm to the fetus or infant from ALK inhibitors and the unknown risk. Women of childbearing potential and sexually active males must agree to use an accepted and effective method of contraception or to abstain from sexual intercourse for the duration of their participation in the study

Exclusion Criteria

Major surgery within 2 weeks of study entry. Minor surgical procedures (e.g., port insertion, pleurex catheter placement) are allowed and all wounds must not show signs of infection or draining
Palliative RT (< 10 fractions) must have been completed at least 48 hours prior to study entry. Stereotactic or small field brain irradiation must have completed at least 1 week prior to study entry. Whole brain RT or other palliative RT must have been completed at least 2 weeks prior to study entry
Prior dose of next generation ALK inhibitor (LDK378 [ceritinib], alectinib, ensartinib, lorlatinib) within 5 days prior to step 2 registration. Prior dose of brigatinib within 7 days prior to step 2 registration
History of interstitial lung disease or interstitial fibrosis, including a history of pneumonitis, obliterative bronchiolitis, pulmonary fibrosis. Patients with a history of prior radiation pneumonitis are not excluded
Active inflammatory gastrointestinal disease (such as Crohns, ulcerative colitis), chronic diarrhea, symptomatic diverticular disease, or any gastrointestinal disease that would affect the absorption of oral medications or increase the risk of toxicity
Clinically significant cardiovascular abnormalities, as determined by the treating/registering physician, such as uncontrolled hypertension, congestive heart failure New York Heart Association (NYHA) classification of 3, unstable angina or poorly controlled arrhythmia, or myocardial infarction within 6 months
Active and clinically significant bacterial, fungal, or viral infection
Patients with active or chronic pancreatitis based on lipase elevation, symptoms, and radiographic findings
Other concomitant serious illness or organ system dysfunction that in the opinion of the investigator would either compromise patient safety or interfere with the evaluation of the safety of the study drug
Patients must not plan to receive any other investigational agents during the course of therapy
Patients with active malignancy other than ALK-positive non-squamous NSCLC within the last 2 years are excluded (note: adequately treated basal cell or squamous cell skin cancer, in situ cervical cancer, papillary thyroid cancer treated with curative intent, adequately treated stage I or II cancer from which the patient is currently in complete remission, or any other cancer from which the patient has been disease free for 2 years are eligible)
No chemotherapy and/or immunotherapy allowed after step 1 registration

Study & Design

Study Type: INTERVENTIONAL

Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
ALK L1198F mutation (alone or combination with ALK inhibitor)	Crizotinib	Patients with ALK L1198F mutation (alone or in combination with another ALK mutation) receive crizotinib PO QD. Cycles repeat every 21 days in the absence of disease progression or unacceptable toxicity.
C1156Y	Alectinib	Patients with Cy1156Y mutation receive either lorlatinib PO QD, alectinib PO BID, or brigatinib PO QD. Cycles repeat every 21 days in the absence of disease progression or unacceptable toxicity.
C1156Y	Brigatinib	Patients with Cy1156Y mutation receive either lorlatinib PO QD, alectinib PO BID, or brigatinib PO QD. Cycles repeat every 21 days in the absence of disease progression or unacceptable toxicity.
C1156Y	Lorlatinib	Patients with Cy1156Y mutation receive either lorlatinib PO QD, alectinib PO BID, or brigatinib PO QD. Cycles repeat every 21 days in the absence of disease progression or unacceptable toxicity.
Compound mutation	Lorlatinib	Patients with a compound mutation receive lorlatinib PO QD. Cycles repeat every 21 days in the absence of disease progression or unacceptable toxicity.
F1174	Alectinib	Patients with F1174 receive either lorlatinib PO QD, alectinib PO BID, or brigatinib PO QD. Cycles repeat every 21 days in the absence of disease progression or unacceptable toxicity.
F1174	Brigatinib	Patients with F1174 receive either lorlatinib PO QD, alectinib PO BID, or brigatinib PO QD. Cycles repeat every 21 days in the absence of disease progression or unacceptable toxicity.
F1174	Lorlatinib	Patients with F1174 receive either lorlatinib PO QD, alectinib PO BID, or brigatinib PO QD. Cycles repeat every 21 days in the absence of disease progression or unacceptable toxicity.
G1202 (including G1202del and G1202R)	Brigatinib	Patients with G1202 (including G1202del and G1202R) receive either lorlatinib PO QD or brigatinib PO QD. Cycles repeat every 21 days in the absence of disease progression or unacceptable toxicity.
G1202 (including G1202del and G1202R)	Lorlatinib	Patients with G1202 (including G1202del and G1202R) receive either lorlatinib PO QD or brigatinib PO QD. Cycles repeat every 21 days in the absence of disease progression or unacceptable toxicity.
I1171	Brigatinib	Patients with I1171 mutation receive either lorlatinib PO QD, ceritinib PO QD, or brigatinib PO QD. Cycles repeat every 21 days in the absence of disease progression or unacceptable toxicity.
I1171	Ceritinib	Patients with I1171 mutation receive either lorlatinib PO QD, ceritinib PO QD, or brigatinib PO QD. Cycles repeat every 21 days in the absence of disease progression or unacceptable toxicity.
I1171	Lorlatinib	Patients with I1171 mutation receive either lorlatinib PO QD, ceritinib PO QD, or brigatinib PO QD. Cycles repeat every 21 days in the absence of disease progression or unacceptable toxicity.
L1196 (including L1196M)	Alectinib	Patients with L1196 (including L1196M) mutation receive either lorlatinib PO QD, ceritinib PO QD, alectinib PO BID, brigatinib PO QD, or ensartinib PO QD. Cycles repeat every 21 days in the absence of disease progression or unacceptable toxicity.
L1196 (including L1196M)	Brigatinib	Patients with L1196 (including L1196M) mutation receive either lorlatinib PO QD, ceritinib PO QD, alectinib PO BID, brigatinib PO QD, or ensartinib PO QD. Cycles repeat every 21 days in the absence of disease progression or unacceptable toxicity.
L1196 (including L1196M)	Ceritinib	Patients with L1196 (including L1196M) mutation receive either lorlatinib PO QD, ceritinib PO QD, alectinib PO BID, brigatinib PO QD, or ensartinib PO QD. Cycles repeat every 21 days in the absence of disease progression or unacceptable toxicity.
L1196 (including L1196M)	Crizotinib	Patients with L1196 (including L1196M) mutation receive either lorlatinib PO QD, ceritinib PO QD, alectinib PO BID, brigatinib PO QD, or ensartinib PO QD. Cycles repeat every 21 days in the absence of disease progression or unacceptable toxicity.
L1196 (including L1196M)	Ensartinib	Patients with L1196 (including L1196M) mutation receive either lorlatinib PO QD, ceritinib PO QD, alectinib PO BID, brigatinib PO QD, or ensartinib PO QD. Cycles repeat every 21 days in the absence of disease progression or unacceptable toxicity.
L1196 (including L1196M)	Lorlatinib	Patients with L1196 (including L1196M) mutation receive either lorlatinib PO QD, ceritinib PO QD, alectinib PO BID, brigatinib PO QD, or ensartinib PO QD. Cycles repeat every 21 days in the absence of disease progression or unacceptable toxicity.
MET amplification	Crizotinib	Patients with MET amplification receive crizotinib PO QD. Cycles repeat every 21 days in the absence of disease progression or unacceptable toxicity.
No ALK-resistance mutations	Alectinib	Patients with no ALK-resistant mutations receive either lorlatinib PO QD, ceritinib PO QD, alectinib PO BID, brigatinib PO QD, ensartinib PO QD, or pemetrexed IV over 10 minutes on day 1 with or without either cisplatin IV or carboplatin IV on day 1. ALK inhibitor cycles repeat every 21 days in the absence of disease progression or unacceptable toxicity. Pemetrexed-based treatment repeats every 21 days for up to 6 cycles in the absence of disease progression or unacceptable toxicity. Maintenance treatment of pemetrexed may continue until disease progression or unacceptable toxicity.
No ALK-resistance mutations	Brigatinib	Patients with no ALK-resistant mutations receive either lorlatinib PO QD, ceritinib PO QD, alectinib PO BID, brigatinib PO QD, ensartinib PO QD, or pemetrexed IV over 10 minutes on day 1 with or without either cisplatin IV or carboplatin IV on day 1. ALK inhibitor cycles repeat every 21 days in the absence of disease progression or unacceptable toxicity. Pemetrexed-based treatment repeats every 21 days for up to 6 cycles in the absence of disease progression or unacceptable toxicity. Maintenance treatment of pemetrexed may continue until disease progression or unacceptable toxicity.
No ALK-resistance mutations	Carboplatin	Patients with no ALK-resistant mutations receive either lorlatinib PO QD, ceritinib PO QD, alectinib PO BID, brigatinib PO QD, ensartinib PO QD, or pemetrexed IV over 10 minutes on day 1 with or without either cisplatin IV or carboplatin IV on day 1. ALK inhibitor cycles repeat every 21 days in the absence of disease progression or unacceptable toxicity. Pemetrexed-based treatment repeats every 21 days for up to 6 cycles in the absence of disease progression or unacceptable toxicity. Maintenance treatment of pemetrexed may continue until disease progression or unacceptable toxicity.
No ALK-resistance mutations	Ceritinib	Patients with no ALK-resistant mutations receive either lorlatinib PO QD, ceritinib PO QD, alectinib PO BID, brigatinib PO QD, ensartinib PO QD, or pemetrexed IV over 10 minutes on day 1 with or without either cisplatin IV or carboplatin IV on day 1. ALK inhibitor cycles repeat every 21 days in the absence of disease progression or unacceptable toxicity. Pemetrexed-based treatment repeats every 21 days for up to 6 cycles in the absence of disease progression or unacceptable toxicity. Maintenance treatment of pemetrexed may continue until disease progression or unacceptable toxicity.
No ALK-resistance mutations	Cisplatin	Patients with no ALK-resistant mutations receive either lorlatinib PO QD, ceritinib PO QD, alectinib PO BID, brigatinib PO QD, ensartinib PO QD, or pemetrexed IV over 10 minutes on day 1 with or without either cisplatin IV or carboplatin IV on day 1. ALK inhibitor cycles repeat every 21 days in the absence of disease progression or unacceptable toxicity. Pemetrexed-based treatment repeats every 21 days for up to 6 cycles in the absence of disease progression or unacceptable toxicity. Maintenance treatment of pemetrexed may continue until disease progression or unacceptable toxicity.
No ALK-resistance mutations	Ensartinib	Patients with no ALK-resistant mutations receive either lorlatinib PO QD, ceritinib PO QD, alectinib PO BID, brigatinib PO QD, ensartinib PO QD, or pemetrexed IV over 10 minutes on day 1 with or without either cisplatin IV or carboplatin IV on day 1. ALK inhibitor cycles repeat every 21 days in the absence of disease progression or unacceptable toxicity. Pemetrexed-based treatment repeats every 21 days for up to 6 cycles in the absence of disease progression or unacceptable toxicity. Maintenance treatment of pemetrexed may continue until disease progression or unacceptable toxicity.
No ALK-resistance mutations	Lorlatinib	Patients with no ALK-resistant mutations receive either lorlatinib PO QD, ceritinib PO QD, alectinib PO BID, brigatinib PO QD, ensartinib PO QD, or pemetrexed IV over 10 minutes on day 1 with or without either cisplatin IV or carboplatin IV on day 1. ALK inhibitor cycles repeat every 21 days in the absence of disease progression or unacceptable toxicity. Pemetrexed-based treatment repeats every 21 days for up to 6 cycles in the absence of disease progression or unacceptable toxicity. Maintenance treatment of pemetrexed may continue until disease progression or unacceptable toxicity.
No ALK-resistance mutations	Pemetrexed	Patients with no ALK-resistant mutations receive either lorlatinib PO QD, ceritinib PO QD, alectinib PO BID, brigatinib PO QD, ensartinib PO QD, or pemetrexed IV over 10 minutes on day 1 with or without either cisplatin IV or carboplatin IV on day 1. ALK inhibitor cycles repeat every 21 days in the absence of disease progression or unacceptable toxicity. Pemetrexed-based treatment repeats every 21 days for up to 6 cycles in the absence of disease progression or unacceptable toxicity. Maintenance treatment of pemetrexed may continue until disease progression or unacceptable toxicity.
V1180	Brigatinib	Patients with V1180 mutation receive either lorlatinib PO QD, ceritinib PO QD, or brigatinib PO QD. Cycles repeat every 21 days in the absence of disease progression or unacceptable toxicity.
V1180	Ceritinib	Patients with V1180 mutation receive either lorlatinib PO QD, ceritinib PO QD, or brigatinib PO QD. Cycles repeat every 21 days in the absence of disease progression or unacceptable toxicity.
V1180	Lorlatinib	Patients with V1180 mutation receive either lorlatinib PO QD, ceritinib PO QD, or brigatinib PO QD. Cycles repeat every 21 days in the absence of disease progression or unacceptable toxicity.

Primary Outcome Measures

Name	Time	Method
Objective Response Rate (ORR), Per Investigator Assessment Using the Response Evaluation Criteria in Solid Tumors (RECIST) v1.1 Criteria	Baseline to 24 weeks	ORR= number of subjects with best overall response (BOR) of complete or partial response (CR, PR) divided by number of evaluable subjects. BOR= best response recorded from start of treatment to first progression (PD)/new anticancer therapy, otherwise last follow-up. * CR: disappearance of target and non-target lesions; no new lesions; pathological lymph nodes \< 10mm. * PR: 30% decrease in target lesions; non-target lesions not progressed or not evaluated; no new lesions. * PD: 20% increase of target lesions and/or new lesion(s). ORR was to be compared using Fisher's exact test within each ALK inhibitor treatment arm (each mutation vs. no mutation) and also within the subset of subjects with no mutation comparing each experimental arm vs. pemetrexed. Due to early accrual closure (few subjects), only the number of subjects with BOR of CR or PR are provided, by mutation, no statistical testing. Analysis was to occur after each patient was potentially followed ≥ 24 weeks.

Secondary Outcome Measures

Name	Time	Method
Duration of Overall Response, Per Investigator Assessment Using RECIST v1.1	Baseline to the date of the first disease progression / progressive disease, death, or last known follow-up. Maximum follow-up time was 33.6 months, median 8.9 months.	Duration of overall response (DOR) is defined as the time from the first occurrence of a documented BOR of CR or PR to the first date of recorded disease progression (PD) or death from any cause (whichever occurs first). BOR is the best response recorded from the start of treatment to first progression (PD)/new anticancer therapy, otherwise last follow-up. * CR: disappearance of target and non-target lesions; no new lesions; pathological lymph nodes \< 10mm. * PR: 30% decrease in target lesions; non-target lesions not progressed or not evaluated; no new lesions. * PD: 20% increase of target lesions and/or new lesion(s). Median DOR was to be estimated, with 95% confidence intervals, for each mutation/regimen combination using the Kaplan-Meier method. Due to early accrual closure resulting in few subjects, only the mean and range DOR are provided, by mutation, and no statistical testing was done.
Intracranial Objective Response Rate, Per Investigator Assessment Using RECIST v1.1	Baseline to 24 weeks	Intracranial objective response rate (IORR) is defined as the number of participants with central nervous system (CNS) metastasis complete or partial response (CR, PR) divided by the number of evaluable participants with baseline CNS metastasis and no prior CNS radiation therapy. Participants who required additional treatment (for their non-cranial systemic disease) would be considered as non-responders (if they have not previously had an intracranial response). * CR: disappearance of target and non-target lesions; no new lesions; pathological lymph nodes \< 10mm. * PR: 30% decrease in target lesions; non-target lesions not progressed or not evaluated; no new lesions. IORR was to be estimated for each mutation/regimen combination, with the associated 95% confidence intervals (using Clapper-Pearson method). Due to early accrual closure resulting in few subjects, only the number of subjects with CR or PR are provided, by mutation, with no statistical testing.
Progression-free Survival (PFS), Per Investigator Assessment Using RECIST v1.1 Criteria	Baseline to the date of the first disease progression / progressive disease, death, or last known follow-up. Maximum follow-up time was 33.6 months, median 8.9 months.	Progression-free survival time is defined as the time from second step registration to the date of the first disease progression / progressive disease (PD), death, or last known follow-up (censored). Progressive disease is defined as a 20% increase of target lesions and/or new lesion(s). Percentage of participants progression-free at a given time (PFS) was to be estimated by the Kaplan-Meier method. Median PFS and PFS at specific time points was to be reported, with 95% confidence intervals, for each mutation (or no mutation)/regimen combination. Due to early accrual closure resulting in few participants, only the number of participants who progressed or died, by mutation, with no statistical testing.
Overall Survival (OS)	Baseline to the date of death or last known follow-up. Maximum follow-up time was 33.6 months, median 8.9 months.	Survival time is defined as the time from second step registration to the date of death, or last known follow-up (censored). Percentage of participants alive at a given time (OS) was to be estimated by the Kaplan-Meier method. Median OS and OS at specific time points was to be reported, with 95% confidence intervals, for each mutation/regimen combination. Due to early accrual closure resulting in few patients, only the number of participants who died are provided, by mutation, and no statistical testing was done.
Number of Participants by Highest Grade Adverse Event Reported	Baseline to the date of last known follow-up. Maximum follow-up time was 33.6 months, median 8.9 months.	Common Terminology Criteria for Adverse Events (version 4.0) grades adverse event severity from 1=mild to 5=death. Summary data is provided in this outcome measure; see Adverse Events Module for specific adverse event data.

Trial Locations

Locations (489): Macomb Hematology Oncology PC
🇺🇸
Warren, Michigan, United States
Kaiser Permanente-Richmond
🇺🇸
Richmond, California, United States
Carle Cancer Center
🇺🇸
Urbana, Illinois, United States
CTCA at Western Regional Medical Center
🇺🇸
Goodyear, Arizona, United States
Mayo Clinic Hospital in Arizona
🇺🇸
Phoenix, Arizona, United States
Mayo Clinic in Arizona
🇺🇸
Scottsdale, Arizona, United States
Mercy Hospital Fort Smith
🇺🇸
Fort Smith, Arkansas, United States
CHI Saint Vincent Cancer Center Hot Springs
🇺🇸
Hot Springs, Arkansas, United States
Kaiser Permanente-Anaheim
🇺🇸
Anaheim, California, United States
Kaiser Permanente-Deer Valley Medical Center
🇺🇸
Antioch, California, United States
Mission Hope Medical Oncology - Arroyo Grande
🇺🇸
Arroyo Grande, California, United States
Kaiser Permanente-Baldwin Park
🇺🇸
Baldwin Park, California, United States
The Carle Foundation Hospital
🇺🇸
Urbana, Illinois, United States
Kaiser Permanente-Bellflower
🇺🇸
Bellflower, California, United States
Kaiser Permanente Dublin
🇺🇸
Dublin, California, United States
21st Century Oncology - El Segundo
🇺🇸
El Segundo, California, United States
Kaiser Permanente-Fontana
🇺🇸
Fontana, California, United States
Kaiser Permanente-Fremont
🇺🇸
Fremont, California, United States
Fresno Cancer Center
🇺🇸
Fresno, California, United States
Kaiser Permanente-Fresno
🇺🇸
Fresno, California, United States
Kaiser Permanente South Bay
🇺🇸
Harbor City, California, United States
Kaiser Permanente-Irvine
🇺🇸
Irvine, California, United States
UC San Diego Moores Cancer Center
🇺🇸
La Jolla, California, United States
Loma Linda University Medical Center
🇺🇸
Loma Linda, California, United States
Kaiser Permanente Los Angeles Medical Center
🇺🇸
Los Angeles, California, United States
Kaiser Permanente West Los Angeles
🇺🇸
Los Angeles, California, United States
Kaiser Permanente-Modesto
🇺🇸
Modesto, California, United States
Kaiser Permanente Oakland-Broadway
🇺🇸
Oakland, California, United States
Kaiser Permanente-Oakland
🇺🇸
Oakland, California, United States
Kaiser Permanente-Ontario
🇺🇸
Ontario, California, United States
Kaiser Permanente - Panorama City
🇺🇸
Panorama City, California, United States
Kaiser Permanente-Rancho Cordova Cancer Center
🇺🇸
Rancho Cordova, California, United States
Kaiser Permanente-Redwood City
🇺🇸
Redwood City, California, United States
Kaiser Permanente-Riverside
🇺🇸
Riverside, California, United States
Rohnert Park Cancer Center
🇺🇸
Rohnert Park, California, United States
Kaiser Permanente-Roseville
🇺🇸
Roseville, California, United States
The Permanente Medical Group-Roseville Radiation Oncology
🇺🇸
Roseville, California, United States
Kaiser Permanente Downtown Commons
🇺🇸
Sacramento, California, United States
Kaiser Permanente-South Sacramento
🇺🇸
Sacramento, California, United States
South Sacramento Cancer Center
🇺🇸
Sacramento, California, United States
Kaiser Permanente Sacramento Medical Center
🇺🇸
Sacramento, California, United States
Kaiser Permanente-San Diego Mission
🇺🇸
San Diego, California, United States
Kaiser Permanente-San Diego Zion
🇺🇸
San Diego, California, United States
Kaiser Permanente-San Francisco
🇺🇸
San Francisco, California, United States
Kaiser Permanente-Santa Teresa-San Jose
🇺🇸
San Jose, California, United States
Kaiser Permanente San Leandro
🇺🇸
San Leandro, California, United States
Pacific Central Coast Health Center-San Luis Obispo
🇺🇸
San Luis Obispo, California, United States
Kaiser Permanente-San Marcos
🇺🇸
San Marcos, California, United States
Kaiser Permanente-San Rafael
🇺🇸
San Rafael, California, United States
Kaiser San Rafael-Gallinas
🇺🇸
San Rafael, California, United States
Kaiser Permanente Medical Center - Santa Clara
🇺🇸
Santa Clara, California, United States
Mission Hope Medical Oncology - Santa Maria
🇺🇸
Santa Maria, California, United States
Kaiser Permanente-Santa Rosa
🇺🇸
Santa Rosa, California, United States
Kaiser Permanente Cancer Treatment Center
🇺🇸
South San Francisco, California, United States
Kaiser Permanente-South San Francisco
🇺🇸
South San Francisco, California, United States
Kaiser Permanente-Stockton
🇺🇸
Stockton, California, United States
Kaiser Permanente Medical Center-Vacaville
🇺🇸
Vacaville, California, United States
Kaiser Permanente-Vallejo
🇺🇸
Vallejo, California, United States
Kaiser Permanente-Walnut Creek
🇺🇸
Walnut Creek, California, United States
Kaiser Permanente-Woodland Hills
🇺🇸
Woodland Hills, California, United States
UCHealth University of Colorado Hospital
🇺🇸
Aurora, Colorado, United States
Penrose-Saint Francis Healthcare
🇺🇸
Colorado Springs, Colorado, United States
Rocky Mountain Cancer Centers-Penrose
🇺🇸
Colorado Springs, Colorado, United States
UCHealth Memorial Hospital Central
🇺🇸
Colorado Springs, Colorado, United States
Saint Agnes Hospital
🇺🇸
Baltimore, Maryland, United States
Memorial Hospital North
🇺🇸
Colorado Springs, Colorado, United States
AdventHealth Porter
🇺🇸
Denver, Colorado, United States
Mercy Medical Center
🇺🇸
Springfield, Massachusetts, United States
Southwest Oncology PC
🇺🇸
Durango, Colorado, United States
Mountain Blue Cancer Care Center
🇺🇸
Golden, Colorado, United States
Rocky Mountain Cancer Centers-Lakewood
🇺🇸
Lakewood, Colorado, United States
Saint Anthony Hospital
🇺🇸
Lakewood, Colorado, United States
AdventHealth Littleton
🇺🇸
Littleton, Colorado, United States
Longmont United Hospital
🇺🇸
Longmont, Colorado, United States
Rocky Mountain Cancer Centers-Longmont
🇺🇸
Longmont, Colorado, United States
AdventHealth Parker
🇺🇸
Parker, Colorado, United States
Rocky Mountain Cancer Centers-Parker
🇺🇸
Parker, Colorado, United States
Saint Mary Corwin Medical Center
🇺🇸
Pueblo, Colorado, United States
Rocky Mountain Cancer Centers - Pueblo
🇺🇸
Pueblo, Colorado, United States
Rocky Mountain Cancer Centers-Thornton
🇺🇸
Thornton, Colorado, United States
Beebe Medical Center
🇺🇸
Lewes, Delaware, United States
Beebe South Coastal Health Campus
🇺🇸
Millville, Delaware, United States
Delaware Clinical and Laboratory Physicians PA
🇺🇸
Newark, Delaware, United States
Helen F Graham Cancer Center
🇺🇸
Newark, Delaware, United States
Medical Oncology Hematology Consultants PA
🇺🇸
Newark, Delaware, United States
Christiana Care Health System-Christiana Hospital
🇺🇸
Newark, Delaware, United States
Beebe Health Campus
🇺🇸
Rehoboth Beach, Delaware, United States
TidalHealth Nanticoke / Allen Cancer Center
🇺🇸
Seaford, Delaware, United States
Christiana Care Health System-Wilmington Hospital
🇺🇸
Wilmington, Delaware, United States
Sibley Memorial Hospital
🇺🇸
Washington, District of Columbia, United States
GenesisCare USA - Aventura FP
🇺🇸
Aventura, Florida, United States
GenesisCare USA - Boca Raton FP02
🇺🇸
Boca Raton, Florida, United States
GenesisCare USA - Boca Ration FP06
🇺🇸
Boca Raton, Florida, United States
Holy Cross Hospital
🇺🇸
Fort Lauderdale, Florida, United States
Mayo Clinic in Florida
🇺🇸
Jacksonville, Florida, United States
GenesisCare USA - Key West
🇺🇸
Key West, Florida, United States
GenesisCare USA - Lakewood Ranch
🇺🇸
Lakewood Ranch, Florida, United States
GenesisCare USA - Palm Beach Gardens
🇺🇸
Palm Beach Gardens, Florida, United States
GenesisCare USA - Plantation
🇺🇸
Plantation, Florida, United States
Good Samaritan Medical Center
🇺🇸
West Palm Beach, Florida, United States
Grady Health System
🇺🇸
Atlanta, Georgia, United States
Emory University Hospital Midtown
🇺🇸
Atlanta, Georgia, United States
Emory University Hospital/Winship Cancer Institute
🇺🇸
Atlanta, Georgia, United States
Emory Saint Joseph's Hospital
🇺🇸
Atlanta, Georgia, United States
Northside Hospital
🇺🇸
Atlanta, Georgia, United States
Northside Hospital - Duluth
🇺🇸
Duluth, Georgia, United States
Emory Johns Creek Hospital
🇺🇸
Johns Creek, Georgia, United States
Northside Hospital - Gwinnett
🇺🇸
Lawrenceville, Georgia, United States
CTCA at Southeastern Regional Medical Center
🇺🇸
Newnan, Georgia, United States
Suburban Hematology Oncology Associates - Snellville
🇺🇸
Snellville, Georgia, United States
Hawaii Cancer Care - Westridge
🇺🇸
'Aiea, Hawaii, United States
Pali Momi Medical Center
🇺🇸
'Aiea, Hawaii, United States
Queen's Cancer Center - Pearlridge
🇺🇸
'Aiea, Hawaii, United States
The Cancer Center of Hawaii-Pali Momi
🇺🇸
'Aiea, Hawaii, United States
Hawaii Cancer Care Inc - Waterfront Plaza
🇺🇸
Honolulu, Hawaii, United States
Island Urology
🇺🇸
Honolulu, Hawaii, United States
Queen's Cancer Cenrer - POB I
🇺🇸
Honolulu, Hawaii, United States
Queen's Medical Center
🇺🇸
Honolulu, Hawaii, United States
Straub Clinic and Hospital
🇺🇸
Honolulu, Hawaii, United States
University of Hawaii Cancer Center
🇺🇸
Honolulu, Hawaii, United States
Hawaii Cancer Care Inc-Liliha
🇺🇸
Honolulu, Hawaii, United States
Kuakini Medical Center
🇺🇸
Honolulu, Hawaii, United States
Queen's Cancer Center - Kuakini
🇺🇸
Honolulu, Hawaii, United States
The Cancer Center of Hawaii-Liliha
🇺🇸
Honolulu, Hawaii, United States
Kaiser Permanente Moanalua Medical Center
🇺🇸
Honolulu, Hawaii, United States
Kapiolani Medical Center for Women and Children
🇺🇸
Honolulu, Hawaii, United States
Wilcox Memorial Hospital and Kauai Medical Clinic
🇺🇸
Lihue, Hawaii, United States
Saint Alphonsus Cancer Care Center-Boise
🇺🇸
Boise, Idaho, United States
Saint Alphonsus Cancer Care Center-Caldwell
🇺🇸
Caldwell, Idaho, United States
Kootenai Health - Coeur d'Alene
🇺🇸
Coeur d'Alene, Idaho, United States
Walter Knox Memorial Hospital
🇺🇸
Emmett, Idaho, United States
Idaho Urologic Institute-Meridian
🇺🇸
Meridian, Idaho, United States
Saint Alphonsus Cancer Care Center-Nampa
🇺🇸
Nampa, Idaho, United States
Kootenai Clinic Cancer Services - Post Falls
🇺🇸
Post Falls, Idaho, United States
Kootenai Clinic Cancer Services - Sandpoint
🇺🇸
Sandpoint, Idaho, United States
Rush - Copley Medical Center
🇺🇸
Aurora, Illinois, United States
Illinois CancerCare-Bloomington
🇺🇸
Bloomington, Illinois, United States
Illinois CancerCare-Canton
🇺🇸
Canton, Illinois, United States
Memorial Hospital of Carbondale
🇺🇸
Carbondale, Illinois, United States
SIH Cancer Institute
🇺🇸
Carterville, Illinois, United States
Illinois CancerCare-Carthage
🇺🇸
Carthage, Illinois, United States
Centralia Oncology Clinic
🇺🇸
Centralia, Illinois, United States
University of Illinois
🇺🇸
Chicago, Illinois, United States
Carle at The Riverfront
🇺🇸
Danville, Illinois, United States
Cancer Care Specialists of Illinois - Decatur
🇺🇸
Decatur, Illinois, United States
Decatur Memorial Hospital
🇺🇸
Decatur, Illinois, United States
Illinois CancerCare-Dixon
🇺🇸
Dixon, Illinois, United States
Carle Physician Group-Effingham
🇺🇸
Effingham, Illinois, United States
Crossroads Cancer Center
🇺🇸
Effingham, Illinois, United States
Illinois CancerCare-Eureka
🇺🇸
Eureka, Illinois, United States
NorthShore University HealthSystem-Evanston Hospital
🇺🇸
Evanston, Illinois, United States
Illinois CancerCare-Galesburg
🇺🇸
Galesburg, Illinois, United States
Western Illinois Cancer Treatment Center
🇺🇸
Galesburg, Illinois, United States
NorthShore University HealthSystem-Glenbrook Hospital
🇺🇸
Glenview, Illinois, United States
NorthShore University HealthSystem-Highland Park Hospital
🇺🇸
Highland Park, Illinois, United States
Illinois CancerCare-Kewanee Clinic
🇺🇸
Kewanee, Illinois, United States
Illinois CancerCare-Macomb
🇺🇸
Macomb, Illinois, United States
Carle Physician Group-Mattoon/Charleston
🇺🇸
Mattoon, Illinois, United States
SSM Health Good Samaritan
🇺🇸
Mount Vernon, Illinois, United States
Cancer Care Center of O'Fallon
🇺🇸
O'Fallon, Illinois, United States
Illinois CancerCare-Ottawa Clinic
🇺🇸
Ottawa, Illinois, United States
Illinois CancerCare-Pekin
🇺🇸
Pekin, Illinois, United States
Illinois CancerCare-Peoria
🇺🇸
Peoria, Illinois, United States
Methodist Medical Center of Illinois
🇺🇸
Peoria, Illinois, United States
Illinois CancerCare-Peru
🇺🇸
Peru, Illinois, United States
Valley Radiation Oncology
🇺🇸
Peru, Illinois, United States
Illinois CancerCare-Princeton
🇺🇸
Princeton, Illinois, United States
Southern Illinois University School of Medicine
🇺🇸
Springfield, Illinois, United States
Springfield Clinic
🇺🇸
Springfield, Illinois, United States
Springfield Memorial Hospital
🇺🇸
Springfield, Illinois, United States
Southwest Illinois Health Services LLP
🇺🇸
Swansea, Illinois, United States
Rush-Copley Healthcare Center
🇺🇸
Yorkville, Illinois, United States
Indiana University/Melvin and Bren Simon Cancer Center
🇺🇸
Indianapolis, Indiana, United States
Reid Health
🇺🇸
Richmond, Indiana, United States
Mary Greeley Medical Center
🇺🇸
Ames, Iowa, United States
McFarland Clinic - Ames
🇺🇸
Ames, Iowa, United States
McFarland Clinic - Boone
🇺🇸
Boone, Iowa, United States
Mercy Cancer Center-West Lakes
🇺🇸
Clive, Iowa, United States
UI Health Care Mission Cancer and Blood - West Des Moines Clinic
🇺🇸
Clive, Iowa, United States
Alegent Health Mercy Hospital
🇺🇸
Council Bluffs, Iowa, United States
Greater Regional Medical Center
🇺🇸
Creston, Iowa, United States
Mercy Medical Center - Des Moines
🇺🇸
Des Moines, Iowa, United States
UI Health Care Mission Cancer and Blood - Laurel Clinic
🇺🇸
Des Moines, Iowa, United States
McFarland Clinic - Trinity Cancer Center
🇺🇸
Fort Dodge, Iowa, United States
McFarland Clinic - Jefferson
🇺🇸
Jefferson, Iowa, United States
McFarland Clinic - Marshalltown
🇺🇸
Marshalltown, Iowa, United States
Mercy Medical Center-West Lakes
🇺🇸
West Des Moines, Iowa, United States
Flaget Memorial Hospital
🇺🇸
Bardstown, Kentucky, United States
Commonwealth Cancer Center-Corbin
🇺🇸
Corbin, Kentucky, United States
Saint Joseph Radiation Oncology Resource Center
🇺🇸
Lexington, Kentucky, United States
Saint Joseph Hospital East
🇺🇸
Lexington, Kentucky, United States
Saint Joseph London
🇺🇸
London, Kentucky, 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
Jewish Hospital Medical Center South
🇺🇸
Shepherdsville, Kentucky, United States
Eastern Maine Medical Center
🇺🇸
Bangor, Maine, United States
Lafayette Family Cancer Center-EMMC
🇺🇸
Brewer, Maine, United States
Johns Hopkins University/Sidney Kimmel Cancer Center
🇺🇸
Baltimore, Maryland, United States
Massachusetts General Hospital Cancer Center
🇺🇸
Boston, Massachusetts, United States
Trinity Health Saint Joseph Mercy Hospital Ann Arbor
🇺🇸
Ann Arbor, Michigan, United States
Trinity Health IHA Medical Group Hematology Oncology - Brighton
🇺🇸
Brighton, Michigan, United States
Trinity Health Medical Center - Brighton
🇺🇸
Brighton, Michigan, United States
Henry Ford Cancer Institute-Downriver
🇺🇸
Brownstown, Michigan, United States
Trinity Health IHA Medical Group Hematology Oncology - Canton
🇺🇸
Canton, Michigan, United States
Trinity Health Medical Center - Canton
🇺🇸
Canton, Michigan, United States
Caro Cancer Center
🇺🇸
Caro, Michigan, United States
Chelsea Hospital
🇺🇸
Chelsea, Michigan, United States
Trinity Health IHA Medical Group Hematology Oncology - Chelsea Hospital
🇺🇸
Chelsea, Michigan, United States
Hematology Oncology Consultants-Clarkston
🇺🇸
Clarkston, Michigan, United States
Michigan Healthcare Professionals Clarkston
🇺🇸
Clarkston, Michigan, United States
Newland Medical Associates-Clarkston
🇺🇸
Clarkston, Michigan, United States
Henry Ford Macomb Hospital-Clinton Township
🇺🇸
Clinton Township, Michigan, United States
Henry Ford Medical Center-Fairlane
🇺🇸
Dearborn, Michigan, United States
Henry Ford Hospital
🇺🇸
Detroit, Michigan, United States
Henry Ford Health Saint John Hospital
🇺🇸
Detroit, Michigan, United States
Henry Ford River District Hospital
🇺🇸
East China Township, Michigan, United States
Michigan Healthcare Professionals Farmington
🇺🇸
Farmington Hills, Michigan, United States
Cancer Hematology Centers - Flint
🇺🇸
Flint, Michigan, United States
Genesee Hematology Oncology PC
🇺🇸
Flint, Michigan, United States
Genesys Hurley Cancer Institute
🇺🇸
Flint, Michigan, United States
Hurley Medical Center
🇺🇸
Flint, Michigan, United States
Henry Ford Saint John Hospital - Academic
🇺🇸
Grosse Pointe Woods, Michigan, United States
Henry Ford Saint John Hospital - Breast
🇺🇸
Grosse Pointe Woods, Michigan, United States
Henry Ford Saint John Hospital - Van Elslander
🇺🇸
Grosse Pointe Woods, Michigan, United States
Allegiance Health
🇺🇸
Jackson, Michigan, United States
University of Michigan Health - Sparrow Lansing
🇺🇸
Lansing, Michigan, United States
Hope Cancer Clinic
🇺🇸
Livonia, Michigan, United States
Trinity Health Saint Mary Mercy Livonia Hospital
🇺🇸
Livonia, Michigan, United States
Henry Ford Saint John Hospital - Macomb Medical
🇺🇸
Macomb, Michigan, United States
Henry Ford Warren Hospital - Breast Macomb
🇺🇸
Macomb, Michigan, United States
Michigan Healthcare Professionals Macomb
🇺🇸
Macomb, Michigan, United States
Michigan Healthcare Professionals Madison Heights
🇺🇸
Madison Heights, Michigan, United States
Saint Mary's Oncology/Hematology Associates of Marlette
🇺🇸
Marlette, Michigan, United States
Henry Ford Medical Center-Columbus
🇺🇸
Novi, Michigan, United States
Hope Cancer Center
🇺🇸
Pontiac, Michigan, United States
Michigan Healthcare Professionals Pontiac
🇺🇸
Pontiac, Michigan, United States
Newland Medical Associates-Pontiac
🇺🇸
Pontiac, Michigan, United States
Trinity Health Saint Joseph Mercy Oakland Hospital
🇺🇸
Pontiac, Michigan, United States
Henry Ford Rochester Hospital
🇺🇸
Rochester Hills, Michigan, United States
MyMichigan Medical Center Saginaw
🇺🇸
Saginaw, Michigan, United States
Oncology Hematology Associates of Saginaw Valley PC
🇺🇸
Saginaw, Michigan, United States
Henry Ford Macomb Health Center - Shelby Township
🇺🇸
Shelby, Michigan, United States
Bhadresh Nayak MD PC-Sterling Heights
🇺🇸
Sterling Heights, Michigan, United States
MyMichigan Medical Center Tawas
🇺🇸
Tawas City, Michigan, United States
Michigan Healthcare Professionals Troy
🇺🇸
Troy, Michigan, United States
Advanced Breast Care Center PLLC
🇺🇸
Warren, Michigan, United States
Henry Ford Health Warren Hospital
🇺🇸
Warren, Michigan, United States
Henry Ford Madison Heights Hospital - Breast
🇺🇸
Warren, Michigan, United States
Henry Ford Warren Hospital - GLCMS
🇺🇸
Warren, Michigan, United States
Henry Ford West Bloomfield Hospital
🇺🇸
West Bloomfield, Michigan, United States
Saint Mary's Oncology/Hematology Associates of West Branch
🇺🇸
West Branch, Michigan, United States
Huron Gastroenterology PC
🇺🇸
Ypsilanti, Michigan, United States
Trinity Health IHA Medical Group Hematology Oncology Ann Arbor Campus
🇺🇸
Ypsilanti, Michigan, United States
Riverwood Healthcare Center
🇺🇸
Aitkin, Minnesota, United States
Sanford Joe Lueken Cancer Center
🇺🇸
Bemidji, Minnesota, United States
Essentia Health Saint Joseph's Medical Center
🇺🇸
Brainerd, Minnesota, United States
Fairview Ridges Hospital
🇺🇸
Burnsville, Minnesota, United States
Minnesota Oncology - Burnsville
🇺🇸
Burnsville, Minnesota, United States
Cambridge Medical Center
🇺🇸
Cambridge, Minnesota, United States
Mercy Hospital
🇺🇸
Coon Rapids, Minnesota, United States
Essentia Health - Deer River Clinic
🇺🇸
Deer River, Minnesota, United States
Essentia Health Saint Mary's - Detroit Lakes Clinic
🇺🇸
Detroit Lakes, Minnesota, United States
Essentia Health Cancer Center
🇺🇸
Duluth, Minnesota, United States
Essentia Health Saint Mary's Medical Center
🇺🇸
Duluth, Minnesota, United States
Miller-Dwan Hospital
🇺🇸
Duluth, Minnesota, United States
Fairview Southdale Hospital
🇺🇸
Edina, Minnesota, United States
Lake Region Healthcare Corporation-Cancer Care
🇺🇸
Fergus Falls, Minnesota, United States
Essentia Health - Fosston
🇺🇸
Fosston, Minnesota, United States
Unity Hospital
🇺🇸
Fridley, Minnesota, United States
Essentia Health Hibbing Clinic
🇺🇸
Hibbing, Minnesota, United States
Fairview Clinics and Surgery Center Maple Grove
🇺🇸
Maple Grove, Minnesota, United States
Minnesota Oncology Hematology PA-Maplewood
🇺🇸
Maplewood, Minnesota, United States
Saint John's Hospital - Healtheast
🇺🇸
Maplewood, Minnesota, United States
Abbott-Northwestern Hospital
🇺🇸
Minneapolis, Minnesota, United States
Hennepin County Medical Center
🇺🇸
Minneapolis, Minnesota, United States
Health Partners Inc
🇺🇸
Minneapolis, Minnesota, United States
Monticello Cancer Center
🇺🇸
Monticello, Minnesota, United States
New Ulm Medical Center
🇺🇸
New Ulm, Minnesota, United States
Essentia Health - Park Rapids
🇺🇸
Park Rapids, Minnesota, United States
Fairview Northland Medical Center
🇺🇸
Princeton, Minnesota, United States
North Memorial Medical Health Center
🇺🇸
Robbinsdale, Minnesota, United States
Mayo Clinic in Rochester
🇺🇸
Rochester, Minnesota, United States
Park Nicollet Clinic - Saint Louis Park
🇺🇸
Saint Louis Park, Minnesota, United States
Regions Hospital
🇺🇸
Saint Paul, Minnesota, United States
United Hospital
🇺🇸
Saint Paul, Minnesota, United States
Essentia Health Sandstone
🇺🇸
Sandstone, Minnesota, United States
Saint Francis Regional Medical Center
🇺🇸
Shakopee, Minnesota, United States
Lakeview Hospital
🇺🇸
Stillwater, Minnesota, United States
Sanford Thief River Falls Medical Center
🇺🇸
Thief River Falls, Minnesota, United States
Essentia Health Virginia Clinic
🇺🇸
Virginia, Minnesota, United States
Ridgeview Medical Center
🇺🇸
Waconia, Minnesota, United States
Rice Memorial Hospital
🇺🇸
Willmar, Minnesota, United States
Minnesota Oncology Hematology PA-Woodbury
🇺🇸
Woodbury, Minnesota, United States
Sanford Cancer Center Worthington
🇺🇸
Worthington, Minnesota, United States
Fairview Lakes Medical Center
🇺🇸
Wyoming, Minnesota, United States
Grant Medical Center
🇺🇸
Columbus, Ohio, United States
Baptist Memorial Hospital and Cancer Center-Desoto
🇺🇸
Southhaven, Mississippi, United States
Saint Louis Cancer and Breast Institute-Ballwin
🇺🇸
Ballwin, Missouri, United States
Parkland Health Center-Bonne Terre
🇺🇸
Bonne Terre, Missouri, United States
Cox Cancer Center Branson
🇺🇸
Branson, Missouri, United States
Mercy Cancer Center - Cape Girardeau
🇺🇸
Cape Girardeau, Missouri, United States
Saint Francis Medical Center
🇺🇸
Cape Girardeau, Missouri, United States
Siteman Cancer Center at West County Hospital
🇺🇸
Creve Coeur, Missouri, United States
Parkland Health Center - Farmington
🇺🇸
Farmington, Missouri, United States
MU Health Care Goldschmidt Cancer Center
🇺🇸
Jefferson City, Missouri, United States
Freeman Health System
🇺🇸
Joplin, Missouri, United States
Mercy Hospital Joplin
🇺🇸
Joplin, Missouri, United States
Mercy Clinic-Rolla-Cancer and Hematology
🇺🇸
Rolla, Missouri, United States
Phelps Health Delbert Day Cancer Institute
🇺🇸
Rolla, Missouri, United States
Heartland Regional Medical Center
🇺🇸
Saint Joseph, Missouri, United States
Saint Louis Cancer and Breast Institute-South City
🇺🇸
Saint Louis, Missouri, United States
Washington University School of Medicine
🇺🇸
Saint Louis, Missouri, United States
Mercy Hospital South
🇺🇸
Saint Louis, Missouri, United States
Siteman Cancer Center-South County
🇺🇸
Saint Louis, Missouri, United States
Missouri Baptist Medical Center
🇺🇸
Saint Louis, Missouri, United States
Siteman Cancer Center at Christian Hospital
🇺🇸
Saint Louis, Missouri, United States
Mercy Hospital Saint Louis
🇺🇸
Saint Louis, Missouri, United States
Siteman Cancer Center at Saint Peters Hospital
🇺🇸
Saint Peters, Missouri, United States
Sainte Genevieve County Memorial Hospital
🇺🇸
Sainte Genevieve, Missouri, United States
Mercy Hospital Springfield
🇺🇸
Springfield, Missouri, United States
CoxHealth South Hospital
🇺🇸
Springfield, Missouri, United States
Missouri Baptist Sullivan Hospital
🇺🇸
Sullivan, Missouri, United States
BJC Outpatient Center at Sunset Hills
🇺🇸
Sunset Hills, Missouri, United States
Mercy Hospital Washington
🇺🇸
Washington, Missouri, United States
Community Hospital of Anaconda
🇺🇸
Anaconda, Montana, United States
Billings Clinic Cancer Center
🇺🇸
Billings, Montana, United States
Bozeman Health Deaconess Hospital
🇺🇸
Bozeman, Montana, United States
Benefis Sletten Cancer Institute
🇺🇸
Great Falls, Montana, United States
Great Falls Clinic
🇺🇸
Great Falls, Montana, United States
Saint Peter's Community Hospital
🇺🇸
Helena, Montana, United States
Logan Health Medical Center
🇺🇸
Kalispell, Montana, United States
Community Medical Center
🇺🇸
Scranton, Pennsylvania, United States
Nebraska Cancer Specialists/Oncology Hematology West PC
🇺🇸
Grand Island, Nebraska, United States
Fred and Pamela Buffett Cancer Center - Kearney
🇺🇸
Kearney, Nebraska, United States
CHI Health Good Samaritan
🇺🇸
Kearney, Nebraska, United States
Saint Elizabeth Regional Medical Center
🇺🇸
Lincoln, Nebraska, United States
Nebraska Methodist Hospital
🇺🇸
Omaha, Nebraska, United States
Alegent Health Immanuel Medical Center
🇺🇸
Omaha, Nebraska, United States
Hematology and Oncology Consultants PC
🇺🇸
Omaha, Nebraska, 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
Midlands Community Hospital
🇺🇸
Papillion, Nebraska, United States
Mount Sinai Chelsea
🇺🇸
New York, New York, United States
Mount Sinai Hospital
🇺🇸
New York, New York, United States
University of Rochester
🇺🇸
Rochester, New York, United States
ECU Health Oncology Kenansville
🇺🇸
Kenansville, North Carolina, United States
ECU Health Oncology Kinston
🇺🇸
Kinston, North Carolina, United States
ECU Health Oncology Richlands
🇺🇸
Richlands, North Carolina, United States
Sanford Bismarck Medical Center
🇺🇸
Bismarck, North Dakota, United States
Essentia Health Cancer Center-South University Clinic
🇺🇸
Fargo, North Dakota, United States
Sanford South University Medical Center
🇺🇸
Fargo, North Dakota, United States
Southpointe-Sanford Medical Center Fargo
🇺🇸
Fargo, North Dakota, United States
Sanford Medical Center Fargo
🇺🇸
Fargo, North Dakota, United States
Sanford Broadway Medical Center
🇺🇸
Fargo, North Dakota, United States
Sanford Roger Maris Cancer Center
🇺🇸
Fargo, North Dakota, United States
Essentia Health - Jamestown Clinic
🇺🇸
Jamestown, North Dakota, United States
Indu and Raj Soin Medical Center
🇺🇸
Beavercreek, Ohio, United States
Strecker Cancer Center-Belpre
🇺🇸
Belpre, Ohio, United States
Saint Elizabeth Boardman Hospital
🇺🇸
Boardman, Ohio, United States
Dayton Physicians LLC-Miami Valley South
🇺🇸
Centerville, Ohio, United States
Miami Valley Hospital South
🇺🇸
Centerville, Ohio, United States
Adena Regional Medical Center
🇺🇸
Chillicothe, Ohio, United States
University of Cincinnati Cancer Center-UC Medical Center
🇺🇸
Cincinnati, Ohio, United States
Good Samaritan Hospital - Cincinnati
🇺🇸
Cincinnati, Ohio, United States
Oncology Hematology Care Inc-Kenwood
🇺🇸
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
Cleveland Clinic Foundation
🇺🇸
Cleveland, Ohio, United States
Ohio State University Comprehensive Cancer Center
🇺🇸
Columbus, Ohio, United States
Mount Carmel East Hospital
🇺🇸
Columbus, Ohio, United States
Columbus Oncology and Hematology Associates Inc
🇺🇸
Columbus, Ohio, United States
Riverside Methodist Hospital
🇺🇸
Columbus, Ohio, United States
The Mark H Zangmeister Center
🇺🇸
Columbus, Ohio, United States
Mount Carmel Health Center West
🇺🇸
Columbus, Ohio, United States
Doctors Hospital
🇺🇸
Columbus, Ohio, United States
Good Samaritan Hospital - Dayton
🇺🇸
Dayton, Ohio, United States
Miami Valley Hospital
🇺🇸
Dayton, Ohio, United States
Dayton Physician LLC - Englewood
🇺🇸
Dayton, Ohio, United States
Miami Valley Hospital North
🇺🇸
Dayton, Ohio, United States
Delaware Health Center-Grady Cancer Center
🇺🇸
Delaware, Ohio, United States
Grady Memorial Hospital
🇺🇸
Delaware, Ohio, United States
Dublin Methodist Hospital
🇺🇸
Dublin, Ohio, United States
Armes Family Cancer Center
🇺🇸
Findlay, Ohio, United States
Blanchard Valley Hospital
🇺🇸
Findlay, Ohio, United States
Orion Cancer Care
🇺🇸
Findlay, Ohio, United States
Atrium Medical Center-Middletown Regional Hospital
🇺🇸
Franklin, Ohio, United States
Dayton Physicians LLC-Atrium
🇺🇸
Franklin, Ohio, United States
Central Ohio Breast and Endocrine Surgery
🇺🇸
Gahanna, Ohio, United States
Dayton Physicians LLC-Wayne
🇺🇸
Greenville, Ohio, United States
Wayne Hospital
🇺🇸
Greenville, Ohio, United States
Mount Carmel Grove City Hospital
🇺🇸
Grove City, Ohio, United States
Greater Dayton Cancer Center
🇺🇸
Kettering, Ohio, United States
First Dayton Cancer Care
🇺🇸
Kettering, Ohio, United States
Kettering Medical Center
🇺🇸
Kettering, Ohio, United States
Fairfield Medical Center
🇺🇸
Lancaster, Ohio, United States
OhioHealth Mansfield Hospital
🇺🇸
Mansfield, Ohio, United States
Marietta Memorial Hospital
🇺🇸
Marietta, Ohio, United States
OhioHealth Marion General Hospital
🇺🇸
Marion, Ohio, United States
Knox Community Hospital
🇺🇸
Mount Vernon, Ohio, United States
Licking Memorial Hospital
🇺🇸
Newark, Ohio, United States
Newark Radiation Oncology
🇺🇸
Newark, Ohio, United States
Southern Ohio Medical Center
🇺🇸
Portsmouth, Ohio, United States
Springfield Regional Cancer Center
🇺🇸
Springfield, Ohio, United States
Springfield Regional Medical Center
🇺🇸
Springfield, Ohio, United States
Dayton Physicians LLC - Troy
🇺🇸
Troy, Ohio, United States
Upper Valley Medical Center
🇺🇸
Troy, Ohio, United States
Saint Joseph Warren Hospital
🇺🇸
Warren, Ohio, United States
University of Cincinnati Cancer Center-West Chester
🇺🇸
West Chester, Ohio, United States
Saint Ann's Hospital
🇺🇸
Westerville, Ohio, United States
Saint Elizabeth Youngstown Hospital
🇺🇸
Youngstown, Ohio, United States
Genesis Healthcare System Cancer Care Center
🇺🇸
Zanesville, Ohio, United States
University of Oklahoma Health Sciences Center
🇺🇸
Oklahoma City, Oklahoma, United States
Mercy Hospital Oklahoma City
🇺🇸
Oklahoma City, Oklahoma, United States
Cancer Treatment Centers of America
🇺🇸
Tulsa, Oklahoma, United States
Oklahoma Cancer Specialists and Research Institute-Tulsa
🇺🇸
Tulsa, Oklahoma, United States
Saint Alphonsus Cancer Care Center-Baker City
🇺🇸
Baker City, Oregon, United States
Legacy Mount Hood Medical Center
🇺🇸
Gresham, Oregon, United States
Saint Alphonsus Cancer Care Center-Ontario
🇺🇸
Ontario, Oregon, United States
Legacy Good Samaritan Hospital and Medical Center
🇺🇸
Portland, Oregon, United States
Lehigh Valley Hospital-Cedar Crest
🇺🇸
Allentown, Pennsylvania, United States
UPMC Altoona
🇺🇸
Altoona, Pennsylvania, United States
UPMC Cancer Center-Bethel Park
🇺🇸
Bethel Park, Pennsylvania, United States
Lehigh Valley Hospital - Muhlenberg
🇺🇸
Bethlehem, Pennsylvania, United States
Bryn Mawr Hospital
🇺🇸
Bryn Mawr, Pennsylvania, United States
Christiana Care Health System-Concord Health Center
🇺🇸
Chadds Ford, Pennsylvania, United States
Geisinger Medical Center
🇺🇸
Danville, Pennsylvania, United States
Pocono Medical Center
🇺🇸
East Stroudsburg, Pennsylvania, United States
UPMC Pinnacle Cancer Center/Community Osteopathic Campus
🇺🇸
Harrisburg, Pennsylvania, United States
Geisinger Medical Center-Cancer Center Hazleton
🇺🇸
Hazleton, Pennsylvania, United States
Lehigh Valley Hospital-Hazleton
🇺🇸
Hazleton, Pennsylvania, United States
Geisinger Medical Oncology-Lewisburg
🇺🇸
Lewisburg, Pennsylvania, United States
Lewistown Hospital
🇺🇸
Lewistown, Pennsylvania, United States
UPMC Cancer Center at UPMC McKeesport
🇺🇸
McKeesport, Pennsylvania, United States
Riddle Memorial Hospital
🇺🇸
Media, Pennsylvania, United States
Arnold Palmer Cancer Center Medical Oncology Norwin
🇺🇸
N. Huntingdon, Pennsylvania, United States
Paoli Memorial Hospital
🇺🇸
Paoli, Pennsylvania, United States
Fox Chase Cancer Center
🇺🇸
Philadelphia, Pennsylvania, United States
Eastern Regional Medical Center
🇺🇸
Philadelphia, Pennsylvania, United States
Oncology Hematology Association
🇺🇸
Pittsburgh, Pennsylvania, United States
UPMC-Mercy Hospital
🇺🇸
Pittsburgh, Pennsylvania, United States
University of Pittsburgh Cancer Institute (UPCI)
🇺🇸
Pittsburgh, Pennsylvania, United States
UPMC-Passavant Hospital
🇺🇸
Pittsburgh, Pennsylvania, United States
Saint Clair Hospital
🇺🇸
Pittsburgh, Pennsylvania, United States
Geisinger Cancer Services-Pottsville
🇺🇸
Pottsville, Pennsylvania, United States
Geisinger Medical Oncology-Selinsgrove
🇺🇸
Selinsgrove, Pennsylvania, United States
Geisinger Medical Group
🇺🇸
State College, Pennsylvania, United States
UPMC Cancer Center-Washington
🇺🇸
Washington, Pennsylvania, United States
Geisinger Wyoming Valley/Henry Cancer Center
🇺🇸
Wilkes-Barre, Pennsylvania, United States
Lankenau Medical Center
🇺🇸
Wynnewood, Pennsylvania, United States
Sanford Cancer Center Oncology Clinic
🇺🇸
Sioux Falls, South Dakota, United States
Sanford USD Medical Center - Sioux Falls
🇺🇸
Sioux Falls, South Dakota, United States
Memorial Hospital
🇺🇸
Chattanooga, Tennessee, United States
Pulmonary Medicine Center of Chattanooga-Hixson
🇺🇸
Hixson, Tennessee, United States
Baptist Memorial Hospital and Cancer Center-Memphis
🇺🇸
Memphis, Tennessee, United States
Memorial GYN Plus
🇺🇸
Ooltewah, Tennessee, United States
Saint Joseph Regional Cancer Center
🇺🇸
Bryan, Texas, United States
Parkland Memorial Hospital
🇺🇸
Dallas, Texas, United States
UT Southwestern/Simmons Cancer Center-Dallas
🇺🇸
Dallas, Texas, United States
M D Anderson Cancer Center
🇺🇸
Houston, Texas, United States
Huntsman Cancer Institute/University of Utah
🇺🇸
Salt Lake City, Utah, United States
University of Virginia Cancer Center
🇺🇸
Charlottesville, Virginia, United States
Highline Medical Center-Main Campus
🇺🇸
Burien, Washington, United States
Saint Elizabeth Hospital
🇺🇸
Enumclaw, Washington, United States
Saint Francis Hospital
🇺🇸
Federal Way, Washington, United States
Saint Clare Hospital
🇺🇸
Lakewood, Washington, United States
Harrison HealthPartners Hematology and Oncology-Poulsbo
🇺🇸
Poulsbo, Washington, United States
Saint Michael Cancer Center
🇺🇸
Silverdale, Washington, United States
Franciscan Research Center-Northwest Medical Plaza
🇺🇸
Tacoma, Washington, United States
Northwest Medical Specialties PLLC
🇺🇸
Tacoma, Washington, United States
Legacy Salmon Creek Hospital
🇺🇸
Vancouver, Washington, United States
Duluth Clinic Ashland
🇺🇸
Ashland, Wisconsin, United States
Northwest Wisconsin Cancer Center
🇺🇸
Ashland, Wisconsin, United States
Marshfield Medical Center-EC Cancer Center
🇺🇸
Eau Claire, Wisconsin, United States
Marshfield Medical Center-Marshfield
🇺🇸
Marshfield, Wisconsin, United States
Medical College of Wisconsin
🇺🇸
Milwaukee, Wisconsin, United States
Marshfield Medical Center - Minocqua
🇺🇸
Minocqua, Wisconsin, United States
ProHealth D N Greenwald Center
🇺🇸
Mukwonago, Wisconsin, United States
Cancer Center of Western Wisconsin
🇺🇸
New Richmond, Wisconsin, United States
ProHealth Oconomowoc Memorial Hospital
🇺🇸
Oconomowoc, Wisconsin, United States
Marshfield Medical Center-Rice Lake
🇺🇸
Rice Lake, Wisconsin, United States
Marshfield Medical Center-River Region at Stevens Point
🇺🇸
Stevens Point, Wisconsin, United States
ProHealth Waukesha Memorial Hospital
🇺🇸
Waukesha, Wisconsin, United States
UW Cancer Center at ProHealth Care
🇺🇸
Waukesha, Wisconsin, United States
Marshfield Medical Center - Weston
🇺🇸
Weston, Wisconsin, United States
Billings Clinic-Cody
🇺🇸
Cody, Wyoming, United States
Welch Cancer Center
🇺🇸
Sheridan, Wyoming, United States