Vorinostat and Bortezomib in Treating Patients With Progressive, Recurrent Glioblastoma Multiforme

Phase 2

Completed

Conditions: Adult Giant Cell Glioblastoma
Adult Glioblastoma
Adult Gliosarcoma
Recurrent Adult Brain Tumor

Interventions: Drug: vorinostat
Procedure: therapeutic conventional surgery
Drug: bortezomib

Registration Number: NCT00641706

Lead Sponsor: National Cancer Institute (NCI)

Brief Summary: This phase II trial is studying how well giving vorinostat together with bortezomib works in treating patients with progressive, recurrent glioblastoma multiforme. Vorinostat and bortezomib may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Giving vorinostat together with bortezomib may kill more tumor cells.

Detailed Description: PRIMARY OBJECTIVES:

I. To determine the clinical efficacy of vorinostat (SAHA) and bortezomib, in terms of progression-free survival (PFS) at 6 months, in patients with progressive, recurrent glioblastoma multiforme.

SECONDARY OBJECTIVES:

I. To determine the clinical efficacy of this regimen, in terms of overall survival, PFS at 12 months, time to progression, and objective response rate, in these patients.

II. To identify molecular predictors of response in baseline tumor specimens from these patients.

III. To determine molecular changes in response to this regimen in tumor specimens from patients undergoing surgery.

OUTLINE: This is a multicenter study. Patients are stratified according to planned surgery (no \[stratum 1\] vs yes \[stratum 2\]).

STRATUM 1 (NOT UNDERGOING SURGERY): Patients receive oral vorinostat (SAHA) once daily on days 1-14 and bortezomib intravenously (IV) on days 1, 4, 8, and 11. Courses repeat every 21 days in the absence of disease progression or unacceptable toxicity.

STRATUM 2 (UNDERGOING SURGERY): Patients receive oral SAHA once daily for 2 days prior to surgery and then on the day of surgery. Patients also receive bortezomib IV on the day of surgery. After receiving the 3rd dose of SAHA, patients undergo surgery to remove the tumor. Beginning at least 7 days after surgery, patients receive SAHA and bortezomib as in stratum 1.

Tumor tissue samples are collected at baseline and during surgery (stratum 2) for correlative laboratory studies. Tissue samples are analyzed for baseline total and phosphorylated AKT and p27\^KIp1 expression by IHC. Tissue samples from patients in stratum 2 are also analyzed for histone acetylation status; markers of proteasome inhibition; total and phosphorylated Bax expression by IHC; and gene expression profiles.

After completion of study therapy, patients are followed every 3 months for 2 years and then every 6 months thereafter.

Recruitment & Eligibility

Status: COMPLETED

Sex: All

Target Recruitment: 44

Inclusion Criteria

Histologically confirmed glioblastoma multiforme
- Gliosarcoma or other grade 4 astrocytoma variant (e.g., giant cell glioblastoma) allowed
- Recurrent disease
Must have evidence of tumor progression by MRI or CT scan after radiotherapy or after the most recent antitumor therapy
Bidimensionally measurable or evaluable disease by MRI or CT scan
- Patients receiving corticosteroids must be on a fixed dose for at least 1 week prior to baseline scan
ECOG performance status 0-2
WBC ≥ 3,000/mm³
ANC ≥ 1,500/mm³
Platelet count ≥ 100,000/mm³
Hemoglobin ≥ 9 g/dL
Total bilirubin ≤ 1.5 times upper limit of normal (ULN)
AST ≤ 3 times ULN
Creatinine normal
Not pregnant or nursing
Negative pregnancy test
Fertile patients must use effective contraception during and for 6 months after the last dose of vorinostat
Willing to provide mandatory correlative laboratory tissue samples
Able to take oral medications
No uncontrolled infection
No known hypersensitivity to any of the components of vorinostat or bortezomib
No myocardial infarction or unstable angina within the past 6 months
No congestive heart failure requiring use of ongoing maintenance therapy or history of life-threatening ventricular arrhythmias
No concurrent uncontrolled illness including, but not limited to, any of the following:
- Ongoing or active infection
- Psychiatric illness or social situation that would limit compliance with study requirements
No other active malignancy within the past 3 years except nonmelanoma skin cancer or carcinoma in situ of the cervix
No comorbid systemic illness or other severe concurrent disease that, in the judgment of the investigator, would preclude study entry or significantly interfere with proper assessment of safety and toxicity of the prescribed study regimens
Not immunocompromised
- Patients known to be HIV positive are eligible provided there is no clinical evidence of an immunocompromised state
No peripheral neuropathy ≥ grade 2
No peripheral neuropathy with pain ≥ grade 1
No congenital long QT syndrome
No prolonged OTC interval (> 450 msec)
No other concurrent anticancer therapy (other than hormonal therapy)
At least 8 weeks since prior radiotherapy
More than 6 weeks since prior stereotactic radiosurgery or interstitial brachytherapy, unless there is a separate lesion on MRI that is not part of the prior treatment field
More than 4 weeks since prior chemotherapy (6 weeks for nitrosoureas)
No more than 1 prior chemotherapy regimen* for progressive/recurrent disease (stratum 1)
- Patients in stratum 2 may have received any number of prior chemotherapy regimens* for progressive/recurrent disease
More than 2 weeks since prior small molecule cell cycle inhibitors
More than 7 days since prior valproic acid
More than 7 days since prior category I drugs that are generally accepted to have a risk of causing Torsades de Pointes including:
- Quinidine, procainamide, disopyramide
- Amiodarone, sotalol, ibutilide, dofetilide
- Erythromycin, clarithromycin
- Chlorpromazine, haloperidol, mesoridazine, thioridazine, pimozide
- Cisapride, bepridil, droperidol, methadone, arsenic, chloroquine, domperidone, halofantrine, levomethadyl, pentamidine, sparfloxacin,lidoflazine
More than 4 weeks since prior bevacizumab
No prior treatment with vorinostat or bortezomib
No concurrent enzyme-inducing antiepileptic drugs (e.g., phenytoin,fosphenytoin, carbamazepine, phenobarbital, or primidone)
No other concurrent potent CYP3A4 inducer (e.g., rifampin or St. John's wort)
No other concurrent investigational therapy for the primary neoplasm

Exclusion Criteria

Not provided

Study & Design

Study Type: INTERVENTIONAL

Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Stratum 2 (undergoing surgery)	therapeutic conventional surgery	Patients receive oral SAHA once daily for 2 days prior to surgery and then on the day of surgery. Patients also receive bortezomib IV on the day of surgery. After receiving the 3rd dose of SAHA, patients undergo surgery to remove the tumor. Beginning at least 7 days after surgery, patients receive SAHA and bortezomib as in stratum 1.
Stratum 1 (not undergoing surgery)	vorinostat	Patients receive oral vorinostat (SAHA) once daily on days 1-14 and bortezomib IV on days 1, 4, 8, and 11. Courses repeat every 21 days in the absence of disease progression or unacceptable toxicity.
Stratum 1 (not undergoing surgery)	bortezomib	Patients receive oral vorinostat (SAHA) once daily on days 1-14 and bortezomib IV on days 1, 4, 8, and 11. Courses repeat every 21 days in the absence of disease progression or unacceptable toxicity.
Stratum 2 (undergoing surgery)	vorinostat	Patients receive oral SAHA once daily for 2 days prior to surgery and then on the day of surgery. Patients also receive bortezomib IV on the day of surgery. After receiving the 3rd dose of SAHA, patients undergo surgery to remove the tumor. Beginning at least 7 days after surgery, patients receive SAHA and bortezomib as in stratum 1.
Stratum 2 (undergoing surgery)	bortezomib	Patients receive oral SAHA once daily for 2 days prior to surgery and then on the day of surgery. Patients also receive bortezomib IV on the day of surgery. After receiving the 3rd dose of SAHA, patients undergo surgery to remove the tumor. Beginning at least 7 days after surgery, patients receive SAHA and bortezomib as in stratum 1.

Primary Outcome Measures

Name	Time	Method
Progression-free Survival at 6 Months	At 6 months	Estimated using the Binomial point estimator (number of successes divided by the total number of evaluable patients). A patient is classified as a success if alive and progression-free at 6 months. For patients with bidimensionally measurable disease (measurable disease), progression is defined as \> 25% increase in product of perpendicular diameters of contrast enhancement or mass or appearance of new lesions. For patients without bidimensionally measurable disease (evaluable disease), progression is defined as unequivocal increase in size of contrast enhancement or increase in mass effect as agreed upon independently by primary physician and quality control physicians or appearance of new lesions.

Secondary Outcome Measures

Name	Time	Method
Overall Survival	From study registration to date of death due to any cause or last follow-up (up to 5 years)	Estimated using Kaplan-Meier survival curve.
Time to Progression	From study registration to date of progression (up to 5 years)	Estimated using Kaplan-Meier survival curve. Patients who died were considered to have disease progression at the time of death unless there was documented evidence that no progression occurred before death. For patients with bidimensionally measurable disease (measurable disease), progression is defined as \> 25% increase in product of perpendicular diameters of contrast enhancement or mass or appearance of new lesions. For patients without bidimensionally measurable disease (evaluable disease), progression is defined as unequivocal increase in size of contrast enhancement or increase in mass effect as agreed upon independently by primary physician and quality control physicians or appearance of new lesions.
Proportion of Confirmed Tumor Response Defined as an Objective Status of Confirmed Response (CR), Partial Response (PR), or Regression (REGR) on Two Consecutive Evaluations	Assessed up to 5 years	Confidence intervals for the true proportion will be calculated using the exact binomial method. Measurable patients must achieve at least a 50% reduction in the product of perpendicular diameters of contrast enhancement or mass with no new lesions with the patient being on stable or decreased steroid dose. Evaluable patients must achieve unequivocal reduction in size of contrast-enhancement or decrease in mass effect as agreed upon independently by primary physician and quality control physicians; no new lesions. Patient should be on stable or decreased steroid dose.

Trial Locations

Locations (213): Rush - Copley Medical Center
🇺🇸
Aurora, Illinois, United States
Galesburg Cottage Hospital
🇺🇸
Galesburg, Illinois, United States
Illinois CancerCare Galesburg
🇺🇸
Galesburg, Illinois, United States
South Bend Clinic
🇺🇸
South Bend, Indiana, United States
Northern Indiana Cancer Research Consortium
🇺🇸
South Bend, Indiana, United States
Mercy Hospital
🇺🇸
Coon Rapids, Minnesota, United States
Essentia Health Saint Mary's Medical Center
🇺🇸
Duluth, Minnesota, United States
Metro-Minnesota CCOP
🇺🇸
Saint Louis Park, Minnesota, United States
Glacier Oncology PLLC
🇺🇸
Kalispell, Montana, United States
Upper Valley Medical Center
🇺🇸
Troy, Ohio, United States
Geisinger Medical Group
🇺🇸
State College, Pennsylvania, United States
AnMed Health Hospital
🇺🇸
Anderson, South Carolina, United States
Fredericksburg Oncology Inc
🇺🇸
Fredericksburg, Virginia, United States
Berdeaux, Donald MD (UIA Investigator)
🇺🇸
Great Falls, Montana, United States
Saint Patrick Hospital - Community Hospital
🇺🇸
Missoula, Montana, United States
Guardian Oncology and Center for Wellness
🇺🇸
Missoula, Montana, United States
Toledo Radiation Oncology at Northwest Ohio Onocolgy Center
🇺🇸
Maumee, Ohio, United States
Geisinger Medical Center
🇺🇸
Danville, Pennsylvania, United States
Upstate Carolina CCOP
🇺🇸
Spartanburg, South Carolina, United States
Virginia Piper Cancer Institute
🇺🇸
Minneapolis, Minnesota, United States
Hennepin County Medical Center
🇺🇸
Minneapolis, Minnesota, United States
Graham Hospital Association
🇺🇸
Canton, Illinois, United States
Saint Vincent Healthcare
🇺🇸
Billings, Montana, United States
Bozeman Deaconess Hospital
🇺🇸
Bozeman, Montana, United States
Swedish Medical Center
🇺🇸
Englewood, Colorado, United States
Saint James Community Hospital and Cancer Treatment Center
🇺🇸
Butte, Montana, United States
Montana Cancer Specialists
🇺🇸
Missoula, Montana, United States
Northern Montana Hospital
🇺🇸
Havre, Montana, United States
Kalispell Medical Oncology
🇺🇸
Kalispell, Montana, United States
Kalispell Regional Medical Center
🇺🇸
Kalispell, Montana, United States
Community Medical Hospital
🇺🇸
Missoula, Montana, United States
Billings Clinic
🇺🇸
Billings, Montana, United States
Saint Peter's Community Hospital
🇺🇸
Helena, Montana, United States
Mayo Clinic in Arizona
🇺🇸
Scottsdale, Arizona, United States
Illinois CancerCare-Bloomington
🇺🇸
Bloomington, Illinois, United States
Saint Mary's Hospital and Regional Medical Center
🇺🇸
Grand Junction, Colorado, United States
Longmont United Hospital
🇺🇸
Longmont, Colorado, United States
Saint Anthony Hospital
🇺🇸
Lakewood, Colorado, United States
Mason District Hospital
🇺🇸
Havana, Illinois, United States
Elkhart General Hospital
🇺🇸
Elkhart, Indiana, United States
Saint Joseph Regional Medical Center-Mishawaka
🇺🇸
Mishawaka, Indiana, United States
Porubcin, Michael MD (UIA Investigator)
🇺🇸
Moline, Illinois, United States
Oncology Associates at Mercy Medical Center
🇺🇸
Cedar Rapids, Iowa, United States
Franciscan Saint Anthony Health-Michigan City
🇺🇸
Michigan City, Indiana, United States
Mcdonough District Hospital
🇺🇸
Macomb, Illinois, United States
Illinois CancerCare-Kewanee Clinic
🇺🇸
Kewanee, Illinois, United States
Garneau, Stewart C MD (UIA Investigator)
🇺🇸
Moline, Illinois, United States
Illinois CancerCare-Macomb
🇺🇸
Macomb, Illinois, United States
Illinois CancerCare-Princeton
🇺🇸
Princeton, Illinois, United States
Illinois CancerCare-Spring Valley
🇺🇸
Spring Valley, Illinois, United States
Bromenn Regional Medical Center
🇺🇸
Normal, Illinois, United States
Sharis, Christine M MD (UIA Investigator)
🇺🇸
Moline, Illinois, United States
Perry Memorial Hospital
🇺🇸
Princeton, Illinois, United States
Mercy Capitol
🇺🇸
Des Moines, Iowa, United States
Illinois Valley Hospital
🇺🇸
Peru, Illinois, United States
Carle Cancer Center
🇺🇸
Urbana, Illinois, United States
Medical Oncology and Hematology Associates-West Des Moines
🇺🇸
Clive, Iowa, United States
Community Howard Regional Health
🇺🇸
Kokomo, Indiana, United States
Constantinou, Costas L MD (UIA Investigator)
🇺🇸
Bettendorf, Iowa, United States
Carle Clinic-Urbana Main
🇺🇸
Urbana, Illinois, United States
Iowa Methodist Medical Center
🇺🇸
Des Moines, Iowa, United States
Reid Hospital and Health Care Services
🇺🇸
Richmond, Indiana, United States
Medical Oncology and Hematology Associates-Laurel
🇺🇸
Des Moines, Iowa, United States
Bixby Medical Center
🇺🇸
Adrian, Michigan, United States
Hickman Cancer Center
🇺🇸
Adrian, Michigan, United States
Spectrum Health Big Rapids Hospital
🇺🇸
Big Rapids, Michigan, United States
Mercy Memorial Hospital
🇺🇸
Monroe, Michigan, United States
Spectrum Health at Butterworth Campus
🇺🇸
Grand Rapids, Michigan, United States
Community Cancer Center of Monroe
🇺🇸
Monroe, Michigan, United States
Minnesota Oncology Hematology PA-Maplewood
🇺🇸
Maplewood, Minnesota, United States
Sanford Medical Center-Fargo
🇺🇸
Fargo, North Dakota, United States
Rutherford Hospital
🇺🇸
Rutherfordton, North Carolina, United States
Great Falls Clinic
🇺🇸
Great Falls, Montana, United States
Saint Alexius Medical Center
🇺🇸
Bismarck, North Dakota, United States
Sanford Bismarck Medical Center
🇺🇸
Bismarck, North Dakota, United States
Miami Valley Hospital
🇺🇸
Dayton, Ohio, United States
Rapid City Regional Hospital
🇺🇸
Rapid City, South Dakota, United States
The Toledo Hospital/Toledo Children's Hospital
🇺🇸
Toledo, Ohio, United States
University of Toledo
🇺🇸
Toledo, Ohio, United States
Agnesian Cancer Center
🇺🇸
Fond Du Lac, Wisconsin, United States
Clinton Memorial Hospital
🇺🇸
Wilmington, Ohio, United States
Fulton County Health Center
🇺🇸
Wauseon, Ohio, United States
Grant Medical Center
🇺🇸
Columbus, Ohio, United States
Good Samaritan Hospital - Dayton
🇺🇸
Dayton, Ohio, United States
Saint Vincent Mercy Medical Center
🇺🇸
Toledo, Ohio, United States
Saint Ann's Hospital
🇺🇸
Westerville, Ohio, United States
Mercy Saint Anne Hospital
🇺🇸
Toledo, Ohio, United States
Doctors Hospital
🇺🇸
Columbus, Ohio, United States
Grandview Hospital
🇺🇸
Dayton, Ohio, United States
North Coast Cancer Care-Clyde
🇺🇸
Clyde, Ohio, United States
Marietta Memorial Hospital
🇺🇸
Marietta, Ohio, United States
Mercy Hospital of Tiffin
🇺🇸
Tiffin, Ohio, United States
Saint Charles Hospital
🇺🇸
Oregon, Ohio, United States
Greene Memorial Hospital
🇺🇸
Xenia, Ohio, United States
Rocky Mountain Oncology
🇺🇸
Casper, Wyoming, United States
Geisinger Medical Center-Cancer Center Hazleton
🇺🇸
Hazleton, Pennsylvania, United States
Saint Luke's Hospital
🇺🇸
Maumee, Ohio, United States
Licking Memorial Hospital
🇺🇸
Newark, Ohio, United States
Welch Cancer Center
🇺🇸
Sheridan, Wyoming, United States
Altru Cancer Center
🇺🇸
Grand Forks, North Dakota, United States
Hospital District Sixth of Harper County
🇺🇸
Anthony, Kansas, United States
Blanchard Valley Hospital
🇺🇸
Findlay, Ohio, United States
Dayton CCOP
🇺🇸
Dayton, Ohio, United States
Hematology Oncology Center Incorporated
🇺🇸
Elyria, Ohio, United States
Siouxland Hematology Oncology Associates
🇺🇸
Sioux City, Iowa, United States
Mercy Medical Center-Sioux City
🇺🇸
Sioux City, Iowa, United States
Saint Luke's Regional Medical Center
🇺🇸
Sioux City, Iowa, United States
Medical Oncology and Hematology Associates-Des Moines
🇺🇸
Des Moines, Iowa, United States
Mercy Medical Center - Des Moines
🇺🇸
Des Moines, Iowa, United States
Iowa Lutheran Hospital
🇺🇸
Des Moines, Iowa, United States
Saint Francis Hospital and Health Centers
🇺🇸
Beech Grove, Indiana, United States
Joliet Oncology-Hematology Associates Limited
🇺🇸
Joliet, Illinois, United States
Holy Family Medical Center
🇺🇸
Monmouth, Illinois, United States
Community Cancer Center Foundation
🇺🇸
Normal, Illinois, United States
Illinois CancerCare-Community Cancer Center
🇺🇸
Normal, Illinois, United States
Illinois CancerCare-Ottawa Clinic
🇺🇸
Ottawa, Illinois, United States
Pekin Cancer Treatment Center
🇺🇸
Pekin, Illinois, United States
Pekin Hospital
🇺🇸
Pekin, Illinois, United States
Illinois CancerCare-Monmouth
🇺🇸
Monmouth, Illinois, United States
Proctor Hospital
🇺🇸
Peoria, Illinois, United States
Illinois CancerCare-Peoria
🇺🇸
Peoria, Illinois, United States
Illinois Oncology Research Association CCOP
🇺🇸
Peoria, Illinois, United States
OSF Saint Francis Medical Center
🇺🇸
Peoria, Illinois, United States
Exempla Saint Joseph Hospital
🇺🇸
Denver, Colorado, United States
North Colorado Medical Center
🇺🇸
Greeley, Colorado, United States
Sky Ridge Medical Center
🇺🇸
Lone Tree, Colorado, United States
McKee Medical Center
🇺🇸
Loveland, Colorado, United States
Mayo Clinic in Florida
🇺🇸
Jacksonville, Florida, United States
Saint Joseph Medical Center
🇺🇸
Bloomington, Illinois, United States
Memorial Hospital
🇺🇸
Carthage, Illinois, United States
Eureka Hospital
🇺🇸
Eureka, Illinois, United States
Illinois CancerCare-Havana
🇺🇸
Havana, Illinois, United States
Illinois CancerCare-Cottage
🇺🇸
Galesburg, Illinois, United States
Hopedale Medical Complex - Hospital
🇺🇸
Hopedale, Illinois, United States
Stoffel, Thomas J MD (UIA Investigator)
🇺🇸
Moline, Illinois, United States
Illinois CancerCare-Peru
🇺🇸
Peru, Illinois, United States
Saint Margaret's Hospital
🇺🇸
Spring Valley, Illinois, United States
IU Health La Porte Hospital
🇺🇸
La Porte, Indiana, United States
Cedar Rapids Oncology Association
🇺🇸
Cedar Rapids, Iowa, United States
Iowa Oncology Research Association CCOP
🇺🇸
Des Moines, Iowa, United States
Lakeland Hospital
🇺🇸
St. Joseph, Michigan, United States
Mercy Health Partners-Hackley Campus
🇺🇸
Muskegon, Michigan, United States
Mercy Health Mercy Campus
🇺🇸
Muskegon, Michigan, United States
Sanford Clinic North-Bemidgi
🇺🇸
Bemidji, Minnesota, United States
Metro Health Hospital
🇺🇸
Wyoming, Michigan, United States
Fairview Ridges Hospital
🇺🇸
Burnsville, Minnesota, United States
Unity Hospital
🇺🇸
Fridley, Minnesota, United States
Saint John's Hospital - Healtheast
🇺🇸
Maplewood, Minnesota, United States
North Memorial Medical Health Center
🇺🇸
Robbinsdale, Minnesota, United States
Park Nicollet Clinic - Saint Louis Park
🇺🇸
Saint Louis Park, Minnesota, United States
Saint Francis Regional Medical Center
🇺🇸
Shakopee, Minnesota, United States
Montana Cancer Consortium CCOP
🇺🇸
Billings, Montana, United States
Ridgeview Medical Center
🇺🇸
Waconia, Minnesota, United States
Hematology-Oncology Centers of the Northern Rockies PC
🇺🇸
Billings, Montana, United States
Northern Rockies Radiation Oncology Center
🇺🇸
Billings, Montana, United States
Bozeman Deaconess Cancer Center
🇺🇸
Bozeman, Montana, United States
Bismarck Cancer Center
🇺🇸
Bismarck, North Dakota, United States
Sanford Clinic North-Fargo
🇺🇸
Fargo, North Dakota, United States
Mary Rutan Hospital
🇺🇸
Bellefontaine, Ohio, United States
Toledo Clinic Cancer Centers-Bowling Green
🇺🇸
Bowling Green, Ohio, United States
Samaritan North Health Center
🇺🇸
Dayton, Ohio, United States
Atrium Medical Center-Middletown Regional Hospital
🇺🇸
Franklin, Ohio, United States
Wayne Hospital
🇺🇸
Greenville, Ohio, United States
Toledo Clinic Cancer Centers-Maumee
🇺🇸
Maumee, Ohio, United States
North Coast Cancer Care
🇺🇸
Sandusky, Ohio, United States
Flower Hospital
🇺🇸
Sylvania, Ohio, United States
Toledo Clinic Cancer Centers-Oregon
🇺🇸
Oregon, Ohio, United States
Toledo Clinic Cancer Centers-Toledo
🇺🇸
Toledo, Ohio, United States
Genesis HealthCare System
🇺🇸
Zanesville, Ohio, United States
Geisinger Wyoming Valley
🇺🇸
Wilkes-Barre, Pennsylvania, United States
Spartanburg Regional Medical Center
🇺🇸
Spartanburg, South Carolina, United States
Midelfort Clinic-Clairemont Campus
🇺🇸
Eau Claire, Wisconsin, United States
Ottawa Regional Hospital and Healthcare Center
🇺🇸
Ottawa, Illinois, United States
North Suburban Medical Center
🇺🇸
Thornton, Colorado, United States
Boulder Community Hospital
🇺🇸
Boulder, Colorado, United States
Penrose-Saint Francis Healthcare
🇺🇸
Colorado Springs, Colorado, United States
Saint Mary Corwin Medical Center
🇺🇸
Pueblo, Colorado, United States
Illinois CancerCare-Canton
🇺🇸
Canton, Illinois, United States
Illinois CancerCare-Carthage
🇺🇸
Carthage, Illinois, United States
Exempla Lutheran Medical Center
🇺🇸
Wheat Ridge, Colorado, United States
Illinois CancerCare-Eureka
🇺🇸
Eureka, Illinois, United States
Essentia Health Duluth Clinic CCOP
🇺🇸
Duluth, Minnesota, United States
Miller-Dwan Hospital
🇺🇸
Duluth, Minnesota, United States
Mercy Health Saint Mary's
🇺🇸
Grand Rapids, Michigan, United States
Illinois CancerCare-Pekin
🇺🇸
Pekin, Illinois, United States
Memorial Hospital of South Bend
🇺🇸
South Bend, Indiana, United States
Methodist Medical Center of Illinois
🇺🇸
Peoria, Illinois, United States
Mid Dakota Clinic
🇺🇸
Bismarck, North Dakota, United States
Kettering Medical Center
🇺🇸
Kettering, Ohio, United States
Mount Carmel Health Center West
🇺🇸
Columbus, Ohio, United States
Grand Rapids Clinical Oncology Program
🇺🇸
Grand Rapids, Michigan, United States
Munson Medical Center
🇺🇸
Traverse City, Michigan, United States
Fairfield Medical Center
🇺🇸
Lancaster, Ohio, United States
Fairview-Southdale Hospital
🇺🇸
Edina, Minnesota, United States
Hutchinson Area Health Care
🇺🇸
Hutchinson, Minnesota, United States
Lake Region Healthcare Corporation-Cancer Care
🇺🇸
Fergus Falls, Minnesota, United States
Meeker County Memorial Hospital
🇺🇸
Litchfield, Minnesota, United States
Minnesota Oncology and Hematology PA-Woodbury
🇺🇸
Woodbury, Minnesota, United States
Abbott-Northwestern Hospital
🇺🇸
Minneapolis, Minnesota, United States
Regions Hospital
🇺🇸
Saint Paul, Minnesota, United States
United Hospital
🇺🇸
Saint Paul, Minnesota, United States
Riverside Methodist Hospital
🇺🇸
Columbus, Ohio, United States
Grady Memorial Hospital
🇺🇸
Delaware, Ohio, United States
Lima Memorial Hospital
🇺🇸
Lima, Ohio, United States
Toledo Community Hospital Oncology Program CCOP
🇺🇸
Toledo, Ohio, United States
Mayo Clinic Health System Eau Claire Hospital - Luther Campus
🇺🇸
Eau Claire, Wisconsin, United States
The Medical Center of Aurora
🇺🇸
Aurora, Colorado, United States
Porter Adventist Hospital
🇺🇸
Denver, Colorado, United States
Presbyterian - Saint Lukes Medical Center - Health One
🇺🇸
Denver, Colorado, United States
Rose Medical Center
🇺🇸
Denver, Colorado, United States
Colorado Cancer Research Program CCOP
🇺🇸
Denver, Colorado, United States
Mayo Clinic
🇺🇸
Rochester, Minnesota, United States
Bronson Battle Creek
🇺🇸
Battle Creek, Michigan, United States