S1222 Trial (Everolimus, Anastrozole and Fulvestrant) in Post-Menopausal Stage IV Breast Cancer
- Conditions
- Breast Cancer
- Interventions
- Drug: Placebo - Everolimus
- Registration Number
- NCT02137837
- Lead Sponsor
- SWOG Cancer Research Network
- Brief Summary
This randomized Phase III trial studies how well the combination of fulvestrant and everolimus together or the combination of anastrozole, fulvestrant and everolimus together, improve progression-free survival (PFS) versus fulvestrant alone.
- Detailed Description
OBJECTIVES:
Primary
* To test the benefit of interfering with the function of the estrogen receptor (ER) and providing downstream target inhibition (PI3K/AKT/mTOR) with a combination of optimal dose fulvestrant and everolimus (Arm 2) to improve progression-free survival compared to the optimal dose fulvestrant alone (Arm 1).
* To test the benefit of adding the non-steroidal aromatase inhibitor anastrozole to optimal dose fulvestrant and everolimus (Arm 3) in order to improve progression free survival over optimal dose fulvestrant (Arm 1).
Secondary
* To compare progression-free survival among those receiving fulvestrant + everolimus + anastrozole (Arm 3) versus fulvestrant + everolimus (Arm 2).
* To compare overall survival among the treatment arms in post-menopausal patients with hormone-receptor positive (HR+) Stage IV breast cancer.
* To assess and compare toxicities, feasibility and compliance among the study regimens.
* To compare response rates and clinical benefit rates among the study regimens.
* To test molecular determinants of response to endocrine therapy and everolimus in circulating tumor cells:
1. CTC-Endocrine Therapy Index (CTC ETI) on the CellSearch® platform.
2. CTC-Next Generation Sequencing Analysis (CTC-NGS) of single cells captured on the HD-CTC® platform.
OUTLINE:
This is a multicenter study. Patients will be stratified according to the following factors:
* Measurable versus evaluable non-measurable disease
* Prior adjuvant hormonal therapy completed more than 5 years ago vs. prior adjuvant hormonal therapy completed 1-5 years ago vs. de novo presentation of metastatic disease or no prior adjuvant hormonal therapy.
ARMS:
* Arm 1: fulvestrant + placebo (everolimus) + placebo (anastrozole)
* Arm 2: fulvestrant + everolimus + placebo (anastrozole)
* Arm 3: fulvestrant + everolimus + anastrozole
Blood and tissue samples are collected for correlative science studies.
After completion of study treatment, patients are followed up every 6 months for 2 years and then yearly thereafter for 5 years.
Recruitment & Eligibility
- Status
- TERMINATED
- Sex
- Female
- Target Recruitment
- 37
Not provided
Not provided
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Arm 1: fulvestrant + everolimus placebo + anastrozole placebo Placebo - Everolimus Patients receive an injection of fulvestrant in each buttock on Days 1 \&15 for Cycle 1 and then Day 1 only for subsequent cycles. Patients also receive an oral placebo daily for both everolimus and anastrozole. This treatment regimen will continue until disease progression or toxicity. Arm 1: fulvestrant + everolimus placebo + anastrozole placebo Placebo - Anastrozole Patients receive an injection of fulvestrant in each buttock on Days 1 \&15 for Cycle 1 and then Day 1 only for subsequent cycles. Patients also receive an oral placebo daily for both everolimus and anastrozole. This treatment regimen will continue until disease progression or toxicity. Arm 2: fulvestrant + everolimus + anastrozole placebo Placebo - Anastrozole Patients receive an injection of fulvestrant in each buttock on Days 1 \&15 for Cycle 1 and then Day 1 only for subsequent cycles. Patients also receive an oral everolimus and an oral placebo for anastrozole daily. This treatment regimen will continue until disease progression or toxicity. Arm 1: fulvestrant + everolimus placebo + anastrozole placebo Fulvestrant Patients receive an injection of fulvestrant in each buttock on Days 1 \&15 for Cycle 1 and then Day 1 only for subsequent cycles. Patients also receive an oral placebo daily for both everolimus and anastrozole. This treatment regimen will continue until disease progression or toxicity. Arm 2: fulvestrant + everolimus + anastrozole placebo Fulvestrant Patients receive an injection of fulvestrant in each buttock on Days 1 \&15 for Cycle 1 and then Day 1 only for subsequent cycles. Patients also receive an oral everolimus and an oral placebo for anastrozole daily. This treatment regimen will continue until disease progression or toxicity. Arm 2: fulvestrant + everolimus + anastrozole placebo Everolimus Patients receive an injection of fulvestrant in each buttock on Days 1 \&15 for Cycle 1 and then Day 1 only for subsequent cycles. Patients also receive an oral everolimus and an oral placebo for anastrozole daily. This treatment regimen will continue until disease progression or toxicity. Arm 3: fulvestrant + everolimus + anastrozole Fulvestrant Patients receive an injection of fulvestrant in each buttock on Days 1 \&15 for Cycle 1 and then Day 1 only for subsequent cycles. Patients also receive everolimus and anastrozole by mouth daily. This treatment regimen will continue until disease progression or toxicity. Arm 3: fulvestrant + everolimus + anastrozole Anastrozole Patients receive an injection of fulvestrant in each buttock on Days 1 \&15 for Cycle 1 and then Day 1 only for subsequent cycles. Patients also receive everolimus and anastrozole by mouth daily. This treatment regimen will continue until disease progression or toxicity. Arm 3: fulvestrant + everolimus + anastrozole Everolimus Patients receive an injection of fulvestrant in each buttock on Days 1 \&15 for Cycle 1 and then Day 1 only for subsequent cycles. Patients also receive everolimus and anastrozole by mouth daily. This treatment regimen will continue until disease progression or toxicity.
- Primary Outcome Measures
Name Time Method Progression-Free Survival (Fulvestrant vs Fulvestrant + Everolimus ) up to 5 years From date of registration to date of first documentation of progression or death due to any cause. Participants last known to be alive are censored at date of last contact.
Progression-free Survival (Fulvestrant Versus Fulvestrant + Everolimus + Anastrozole) up to 5 years From date of registration to date of first documentation of progression or death due to any cause. Participants last known to be alive without report of progression are censored at date of last contact.
- Secondary Outcome Measures
Name Time Method Progression Free Survival (Fulvestrant + Everolimus vs Fulvestrant + Everolimus + Anastrozole) up to 5 years From date of registration to date of first documentation of progression or death due to any cause. Participants last known to be alive without report of progression are censored at date of last contact.
Overall Survival up to 5 years From date of registration to date of death due to any cause. Participants last known to be alive without report of progression are censored at date of last contact.
Number of Patients With Gr 3 Through 5 Adverse Events That Are Related to Study Drugs Duration of treatment and follow up until death or 5 years post registration Adverse Events (AEs) are reported by CTCAE Version 4.0. Only adverse events that are possibly, probably or definitely related to study drug are reported.
Response Rate assessed every 12 weeks, up to 5 years Proportion of participants who have confirmed or unconfirmed partial or complete response to therapy
Clinical Benefit Rate assessed every 12 weeks, up to 5 years Proportion of participants who have confirmed and unconfirmed partial response, complete response or stable disease.
Molecular Determinants of Response in Circulating Tumor Cells: CTC-ETI Day 1, Day 29, time of progression (Day 29 to be collected only if Day 1 CTC was elevated.) CTC-Endocrine Therapy Index (CTC-ETI) on the CellSearch® platform. Based on enumeration of CTC/7.5 mL of whole blood, with \>= 5 being elevated. (Due to limited samples collected, full analysis was not able to be performed as planned, so outcome measure reported here is number with elevated Day 1 CTC.)
Trial Locations
- Locations (223)
St. Patrick Hospital
🇺🇸Missoula, Montana, United States
Southeastern Medical Oncology Center-Jacksonville
🇺🇸Jacksonville, North Carolina, United States
Clackamas Radiation Oncology Center
🇺🇸Clackamas, Oregon, United States
Holston Valley Hospital and Medical Center
🇺🇸Kingsport, Tennessee, United States
Wellmont Medical Assoc Onc and Hem-Kingsport
🇺🇸Kingsport, Tennessee, United States
Sinai Hospital of Baltimore
🇺🇸Baltimore, Maryland, United States
Mount Carmel Health Center West
🇺🇸Columbus, Ohio, United States
Bozeman Deaconess Hospital
🇺🇸Bozeman, Montana, United States
Minor and James Medical, PLLC
🇺🇸Seattle, Washington, United States
Pacific Medical Center - First Hill
🇺🇸Seattle, Washington, United States
Swedish Medical Center - Ballard Campus
🇺🇸Seattle, Washington, United States
Group Health Cooperative-Seattle
🇺🇸Seattle, Washington, United States
VA Medical Center - Cincinnati
🇺🇸Cincinnati, Ohio, United States
University of Cincinnati Medical Center
🇺🇸Cincinnati, Ohio, United States
Southern Arizona VA Health Care System
🇺🇸Tucson, Arizona, United States
Katmai Oncology Group
🇺🇸Anchorage, Alaska, United States
Alaska Breast Care and Surgery LLC
🇺🇸Anchorage, Alaska, United States
Anchorage Oncology Centre
🇺🇸Anchorage, Alaska, United States
Cancer Center of Kansas - Newton
🇺🇸Newton, Kansas, United States
Springfield Clinic
🇺🇸Springfield, Illinois, United States
Addison Gilbert Hospital
🇺🇸Gloucester, Massachusetts, United States
Lahey Hospital and Medical Center
🇺🇸Burlington, Massachusetts, United States
Via Christi Regional Medical Center
🇺🇸Wichita, Kansas, United States
University Health Conway
🇺🇸Monroe, Louisiana, United States
Cancer Care Specialists of Illinois-Swansea
🇺🇸Swansea, Illinois, United States
Cancer Center of Kansas - Wellington
🇺🇸Wellington, Kansas, United States
Beverly Hospital
🇺🇸Beverly, Massachusetts, United States
Cancer Center of Kansas - El Dorado
🇺🇸El Dorado, Kansas, United States
Memorial Medical Center
🇺🇸Springfield, Illinois, United States
Reid Hospital and Health Care Services
🇺🇸Richmond, Indiana, United States
Cancer Center of Kansas - Dodge City
🇺🇸Dodge City, Kansas, United States
Loyola University Stritch School of Medicine
🇺🇸Maywood, Illinois, United States
Highland Clinic
🇺🇸Shreveport, Louisiana, United States
Associates in Women's Health
🇺🇸Wichita, Kansas, United States
Cancer Center of Kansas - Wichita
🇺🇸Wichita, Kansas, United States
Central Illinois Hematology Oncology Center
🇺🇸Springfield, Illinois, United States
Kishwaukee Community Hospital
🇺🇸DeKalb, Illinois, United States
Cancer Center of Kansas - Chanute
🇺🇸Chanute, Kansas, United States
Lawrence Memorial Hospital
🇺🇸Lawrence, Kansas, United States
Louisiana State University Health Sciences Center
🇺🇸Shreveport, Louisiana, United States
Winchester Hospital
🇺🇸Winchester, Massachusetts, United States
Allegiance Health
🇺🇸Jackson, Michigan, United States
Cancer Research for the Ozarks NCORP
🇺🇸Springfield, Missouri, United States
Benefis Healthcare West Campus
🇺🇸Great Falls, Montana, United States
Community Medical Center
🇺🇸Missoula, Montana, United States
Margaret R. Pardee Memorial Hospital
🇺🇸Hendersonville, North Carolina, United States
St. Louis Cancer and Breast Institute-South City
🇺🇸Saint Louis, Missouri, United States
Pacific Cancer Research Consortium NCORP
🇺🇸Seattle, Washington, United States
Fred Hutchinson Cancer Research Center
🇺🇸Seattle, Washington, United States
Adena Regional Medical Center
🇺🇸Chillicothe, Ohio, United States
Strecker Cancer Center-Belpre
🇺🇸Belpre, Ohio, United States
Dayton NCI Community Oncology Research Program
🇺🇸Dayton, Ohio, United States
Cleveland Clinic Cancer Center - Independence
🇺🇸Independence, Ohio, United States
Wayne Hospital
🇺🇸Greenville, Ohio, United States
St. Charles Health System
🇺🇸Bend, Oregon, United States
Providence Newberg Medical Center
🇺🇸Newberg, Oregon, United States
South Pointe Hospital
🇺🇸Warrensville Heights, Ohio, United States
Tacoma/Valley Radiation Oncology Ctrs-Puyallup
🇺🇸Puyallup, Washington, United States
Billings Clinic-Cody
🇺🇸Cody, Wyoming, United States
Welch Cancer Center - Sheridan Memorial Hospital
🇺🇸Sheridan, Wyoming, United States
University of Utah Medical Center
🇺🇸Salt Lake City, Utah, United States
Cancer Center of Kansas - Fort Scott
🇺🇸Fort Scott, Kansas, United States
Cancer Center of Kansas - Independence
🇺🇸Independence, Kansas, United States
Cancer Center of Kansas - Kingman
🇺🇸Kingman, Kansas, United States
Cancer Center of Kansas - Liberal
🇺🇸Liberal, Kansas, United States
Cancer Center of Kansas - Medical Arts Tower
🇺🇸Wichita, Kansas, United States
Cancer Center of Kansas - Parsons
🇺🇸Parsons, Kansas, United States
Cancer Center of Kansas - Pratt
🇺🇸Pratt, Kansas, United States
Cancer Center of Kansas - Winfield
🇺🇸Winfield, Kansas, United States
Southeastern Medical Oncology Center-Goldsboro
🇺🇸Goldsboro, North Carolina, United States
Wilcox Memorial Hospital and Kauai Medical Clinic
🇺🇸Lihue, Hawaii, United States
Licking Memorial Hospital
🇺🇸Newark, Ohio, United States
Providence Oncology and Hematology Care Southeast
🇺🇸Clackamas, Oregon, United States
Wichita NCI Community Oncology Research Program
🇺🇸Wichita, Kansas, United States
Alaska Women's Cancer Care
🇺🇸Anchorage, Alaska, United States
Providence Alaska Medical Center
🇺🇸Anchorage, Alaska, United States
University of Arizona Cancer Center - North Campus
🇺🇸Tucson, Arizona, United States
University of Arizona Cancer Center - Orange Grove
🇺🇸Tucson, Arizona, United States
Virginia G. Piper Cancer Center
🇺🇸Scottsdale, Arizona, United States
University of Arkansas for Medical Sciences
🇺🇸Little Rock, Arkansas, United States
University of Arizona Medical Center - Univ Campus
🇺🇸Tucson, Arizona, United States
Providence St. Joseph Medical Ctr/Disney Family CC
🇺🇸Burbank, California, United States
Bay Area Tumor Institute
🇺🇸Oakland, California, United States
City of Hope Antelope Valley
🇺🇸Lancaster, California, United States
City of Hope National Medical Center
🇺🇸Duarte, California, United States
City of Hope-Corona
🇺🇸Corona, California, United States
Summit Medical Center
🇺🇸Oakland, California, United States
Epic Care - Oakland
🇺🇸Oakland, California, United States
City of Hope South Pasadena
🇺🇸South Pasadena, California, United States
Bridgeport Hospital
🇺🇸Bridgeport, Connecticut, United States
St. Francis Hospital and Medical Center
🇺🇸Hartford, Connecticut, United States
Yale-New Haven Hospital North Haven Medical Center
🇺🇸North Haven, Connecticut, United States
Sacred Heart Hospital
🇺🇸Pensacola, Florida, United States
Cleveland Clinic - Weston
🇺🇸Weston, Florida, United States
South Georgia Medical Center - Pearlman Cancer Ctr
🇺🇸Valdosta, Georgia, United States
Oncare Hawaii, Inc - Pali Momi
🇺🇸'Aiea, Hawaii, United States
Pali Momi Medical Center
🇺🇸'Aiea, Hawaii, United States
St. Alphonsus Regional Medical Center
🇺🇸Boise, Idaho, United States
Kootenai Cancer Clinic
🇺🇸Sandpoint, Idaho, United States
Kootenai Cancer Center
🇺🇸Post Falls, Idaho, United States
Kootenai Medical Center
🇺🇸Coeur d'Alene, Idaho, United States
Cancer Care Specialists of Central Illinois
🇺🇸Decatur, Illinois, United States
Heartland Cancer Research NCORP
🇺🇸Decatur, Illinois, United States
Centralia Oncology Clinic
🇺🇸Centralia, Illinois, United States
Crossroads Cancer Center
🇺🇸Effingham, Illinois, United States
Decatur Memorial Hospital
🇺🇸Decatur, Illinois, United States
Marjorie Weinberg Cancer Center
🇺🇸Melrose Park, Illinois, United States
Good Samaritan Regional Health Center
🇺🇸Mount Vernon, Illinois, United States
De Soto Regional Medical Center
🇺🇸Mansfield, Louisiana, United States
Oakwood Healthcare, Inc.
🇺🇸Dearborn, Michigan, United States
Genesys Hurley Cancer Institute
🇺🇸Flint, Michigan, United States
William Beaumont Hospital-Grosse Pointe
🇺🇸Grosse Pointe, Michigan, United States
Hurley Medical Center
🇺🇸Flint, Michigan, United States
Sparrow Health System
🇺🇸Lansing, Michigan, United States
St. Joseph Mercy Port Huron
🇺🇸Port Huron, Michigan, United States
St. Mary Mercy Hospital
🇺🇸Livonia, Michigan, United States
MidMichigan Medical Center - Midland
🇺🇸Midland, Michigan, United States
Beaumont NCI Community Oncology Research Program
🇺🇸Royal Oak, Michigan, United States
Beaumont Children's Hospital-Royal Oak
🇺🇸Royal Oak, Michigan, United States
St Joseph Mercy Hospital - Oakland
🇺🇸Pontiac, Michigan, United States
Beaumont Hospital, Troy Campus
🇺🇸Troy, Michigan, United States
St. John Macomb Hospital
🇺🇸Warren, Michigan, United States
University of Mississippi Medical Center
🇺🇸Jackson, Mississippi, United States
St. Mary's Health System
🇺🇸Saginaw, Michigan, United States
Central Care Cancer Ctr-Carrie J. Babb Cancer Ctr
🇺🇸Bolivar, Missouri, United States
Cox Cancer Center Branson
🇺🇸Branson, Missouri, United States
St. Francis Medical Center
🇺🇸Cape Girardeau, Missouri, United States
Mercy Clinic Care and Hematology - Rolla
🇺🇸Rolla, Missouri, United States
Mercy Hospital - Joplin
🇺🇸Joplin, Missouri, United States
Mercy Hospital St. Louis
🇺🇸Saint Louis, Missouri, United States
Christian Hospital
🇺🇸Saint Louis, Missouri, United States
PCRMC Bond Clinic
🇺🇸Rolla, Missouri, United States
Phelps County Regional Medical Center
🇺🇸Rolla, Missouri, United States
Mercy Hospital Springfield
🇺🇸Springfield, Missouri, United States
CoxHealth South Hospital
🇺🇸Springfield, Missouri, United States
Billings Clinic Cancer Center
🇺🇸Billings, Montana, United States
Montana Cancer Consortium NCORP
🇺🇸Billings, Montana, United States
Mercy Hospital Washington
🇺🇸Washington, Missouri, United States
St. James Community Hosp and Cancer Treatment Center
🇺🇸Butte, Montana, United States
St. Peter's Community Hospital
🇺🇸Helena, Montana, United States
Kalispell Regional Medical Center
🇺🇸Kalispell, Montana, United States
CHI Health Good Samaritan Hospital
🇺🇸Kearney, Nebraska, United States
Southeastern Medical Oncology Center-Clinton
🇺🇸Clinton, North Carolina, United States
Wayne Memorial Hospital
🇺🇸Goldsboro, North Carolina, United States
Hendersonville Hematology and Oncology at Pardee
🇺🇸Hendersonville, North Carolina, United States
Park Ridge Health
🇺🇸Hendersonville, North Carolina, United States
Southeastern Medical Oncology Center-Wilson
🇺🇸Wilson, North Carolina, United States
Cleveland Clinic Cancer Center - Beachwood
🇺🇸Beachwood, Ohio, United States
Wilson Medical Center
🇺🇸Wilson, North Carolina, United States
Cleveland Clinic Foundation
🇺🇸Cleveland, Ohio, United States
Mount Carmel East Hospital
🇺🇸Columbus, Ohio, United States
Cleveland Clinic Cancer Center - Fairview Hospital
🇺🇸Cleveland, Ohio, United States
Columbus NCI Community Oncology Research Program
🇺🇸Columbus, Ohio, United States
Good Samaritan Hospital and Health Center
🇺🇸Dayton, Ohio, United States
The Mark H. Zangmeister Center
🇺🇸Columbus, Ohio, United States
Samaritan North Health Center
🇺🇸Dayton, Ohio, United States
VA Medical Center - Dayton
🇺🇸Dayton, Ohio, United States
Kettering Medical Center
🇺🇸Kettering, Ohio, United States
Fairfield Medical Center
🇺🇸Lancaster, Ohio, United States
Cleveland Clinic Cancer Center - Mansfield
🇺🇸Mansfield, Ohio, United States
Marietta Memorial Hospital
🇺🇸Marietta, Ohio, United States
Southern Ohio Medical Center
🇺🇸Portsmouth, Ohio, United States
Hillcrest Hospital Cancer Center
🇺🇸Mayfield Heights, Ohio, United States
Knox Community Hospital
🇺🇸Mount Vernon, Ohio, United States
North Coast Cancer Care, Inc.
🇺🇸Sandusky, Ohio, United States
Springfield Regional Medical Center
🇺🇸Springfield, Ohio, United States
Springfield Regional Cancer Center
🇺🇸Springfield, Ohio, United States
Cleveland Clinic Strongsville Family Health Center
🇺🇸Strongsville, Ohio, United States
St. Ann's Hospital
🇺🇸Westerville, Ohio, United States
Upper Valley Medical Centers
🇺🇸Troy, Ohio, United States
Cleveland Clinic Cancer Center - Wooster
🇺🇸Wooster, Ohio, United States
Genesis Healthcare System Cancer Care Center
🇺🇸Zanesville, Ohio, United States
Providence Willamette Falls Medical Center
🇺🇸Oregon City, Oregon, United States
McLeod Regional Medical Center
🇺🇸Florence, South Carolina, United States
Gibbs Cancer Center-Gaffney
🇺🇸Gaffney, South Carolina, United States
MGC Hematology Oncology-Union
🇺🇸Union, South Carolina, United States
Spartanburg Medical Cancer
🇺🇸Spartanburg, South Carolina, United States
Gibbs Cancer Center-Pelham
🇺🇸Greer, South Carolina, United States
Wellmont Medical Associates Oncology and Hematology
🇺🇸Bristol, Tennessee, United States
Wellmont Bristol Regional Medical Center
🇺🇸Bristol, Tennessee, United States
Wellmont Medical Assoc Onc and Hem-Johnson City
🇺🇸Johnson City, Tennessee, United States
Thompson Cancer Survival Center
🇺🇸Knoxville, Tennessee, United States
Don and Sybil Harrington Cancer Center
🇺🇸Amarillo, Texas, United States
Virginia Mason Bainbridge Island Medical Center
🇺🇸Bainbridge Island, Washington, United States
Island Hospital
🇺🇸Anacortes, Washington, United States
Auburn Regional Medical Center
🇺🇸Auburn, Washington, United States
Southwest Virginia Cancer Center
🇺🇸Norton, Virginia, United States
Swedish Cancer Inst-Eastside Oncology Hematoly
🇺🇸Bellevue, Washington, United States
Overlake Hospital Medical Center
🇺🇸Bellevue, Washington, United States
Swedish Medical Center - Edmonds
🇺🇸Edmonds, Washington, United States
Tacoma/Valley Radiation Oncology Ctrs-Gig Harbor
🇺🇸Gig Harbor, Washington, United States
PeaceHealth St. Joseph Medical Center
🇺🇸Bellingham, Washington, United States
MultiCare Gig Harbor Medical Park
🇺🇸Gig Harbor, Washington, United States
Virginia Mason Federal Way Medical Center
🇺🇸Federal Way, Washington, United States
Swedish Cancer Institute-Issaquah
🇺🇸Issaquah, Washington, United States
MultiCare Good Samaritan Hospital
🇺🇸Puyallup, Washington, United States
PeaceHealth St. John Medical Center
🇺🇸Longview, Washington, United States
Virginia Mason Lynnwood Medical Center
🇺🇸Lynnwood, Washington, United States
Virginia Mason Medical Center
🇺🇸Seattle, Washington, United States
Swedish Medical Center
🇺🇸Seattle, Washington, United States
Tacoma/Valley Radiation Oncology Ctrs-Jackson Hill
🇺🇸Tacoma, Washington, United States
MultiCare Tacoma General Hospital
🇺🇸Tacoma, Washington, United States
Mary Bridge Children's Hospital and Health Center
🇺🇸Tacoma, Washington, United States
Northwest NCI Community Oncology Research Program
🇺🇸Tacoma, Washington, United States
Tacoma/Valley Radiation Oncology Ctrs-Saint Joe's
🇺🇸Tacoma, Washington, United States
PeaceHealth Southwest Medical Center
🇺🇸Vancouver, Washington, United States
Multicare Health System
🇺🇸Tacoma, Washington, United States
Michigan Cancer Research Consortium NCORP
🇺🇸Ann Arbor, Michigan, United States
St. Joseph Mercy Hospital
🇺🇸Ann Arbor, Michigan, United States
University of Michigan Medical Center
🇺🇸Ann Arbor, Michigan, United States
Wayne State University Medical Center
🇺🇸Detroit, Michigan, United States
St. John Hospital and Medical Center
🇺🇸Detroit, Michigan, United States
Providence Portland Medical Center
🇺🇸Portland, Oregon, United States
Providence St. Vincent Medical Center
🇺🇸Portland, Oregon, United States
Yale University
🇺🇸New Haven, Connecticut, United States
Oncare Hawaii Inc-POB I
🇺🇸Honolulu, Hawaii, United States
Oncare Hawaii, Inc - POB II
🇺🇸Honolulu, Hawaii, United States
Straub Clinic and Hospital
🇺🇸Honolulu, Hawaii, United States
University of Hawaii Cancer Center
🇺🇸Honolulu, Hawaii, United States
Oncare Hawaii, Inc - Kuakini
🇺🇸Honolulu, Hawaii, United States
Oncare Hawaii, Inc - Liliha
🇺🇸Honolulu, Hawaii, United States
Kapiolani Medical Center for Women and Children
🇺🇸Honolulu, Hawaii, United States
Cancer Center of Kansas - Salina
🇺🇸Salina, Kansas, United States