Dasatinib or Placebo, Radiation Therapy, and Temozolomide in Treating Patients With Newly Diagnosed Glioblastoma Multiforme

Phase 1

Completed

Conditions: Brain and Central Nervous System Tumors

Interventions: Drug: dasatinib
Other: placebo
Drug: temozolomide
Radiation: radiation therapy

Registration Number: NCT00869401

Lead Sponsor: Alliance for Clinical Trials in Oncology

Brief Summary: Dasatinib may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. It may also make tumor cells more sensitive to radiation therapy. Radiation therapy uses high-energy x-rays to kill tumor cells. Drugs used in chemotherapy, such as temozolomide, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. This randomized phase I/II trial is studying the best dose of dasatinib and to see how well it works compared with a placebo when given together with radiation therapy and temozolomide in treating patients with newly diagnosed glioblastoma multiforme.

Detailed Description: This trial includes a phase I dose-escalation study and a double-blind randomized phase II trial for patients with newly diagnosed glioblastoma multiforme (GBM). Phase I will be a cohort of 3 dose-escalation trial of dasatinib in combination with radiation and concomitant temozolomide. Patients receive concomitant chemotherapy and radiation therapy for cycle one. Patients receive adjuvant chemotherapy 28-42 days post cycle one treatment. Patients receive only dasatinib post cycle 8 treatment until progressive disease, unacceptable adverse events or refusal.

Phase II will be a randomized trial with two treatment arms. Patients will be randomized at the time of registration at a ratio of 1:2 respectively to either standard therapy arm (continuous daily placebo prior, during and after standard radiotherapy/temozolomide followed by temozolomide. For more information please see the Arms section. The primary objectives are listed below.

Primary Objectives:

1. To establish a maximum tolerated dose of dasatinib combined with radiation and temozolomide in this patient population (Phase I)

2. To determine the efficacy of dasatinib in combination with radiotherapy and concomitant and adjuvant temozolomide in patients with newly diagnosed glioblastoma, and compare it with the standard of care approach in the treatment of these patients consisting of radiotherapy and temozolomide, followed by adjuvant temozolomide (Phase II)

Patients are followed for 5 years post treatment. The study permanently closed to accrual on January 31, 2014.

Recruitment & Eligibility

Status: COMPLETED

Sex: All

Target Recruitment: 217

Inclusion Criteria

Central Pathology Review - Central pathology review submission. This review is mandatory prior to registration to confirm eligibility.

Registration Inclusion Criteria:

Age ≥ 18 years
Histological Confirmation of Glioblastoma - Histologically confirmed newly diagnosed glioblastoma (GBM) (grade 4 astrocytoma) as determined by pre-registration central pathology review. Note: GBM with oligodendroglial features are not permitted in this study if they are 1p19q codeleted. Sites submitting GBM with oligodendroglial features will be asked to provide results of 1p/19q codeletion status.
Measurable or Evaluable Disease - Measurable or evaluable disease by gadolinium MRI or contrast CT scan. Note: Patients who have had a gross total resection are eligible on the basis of evaluable disease.
ECOG Performance Status 0, 1 or 2.
Required Laboratory Values:

The following laboratory values obtained ≤ 14 days prior to registration.
- Absolute neutrophil count (ANC) ≥ 1500/mm3
- Platelet count ≥ 100,000/mm3
- Hemoglobin > 9.0 g/dL
- Total bilirubin ≤ 1.5 x institutional upper limit of normal (ULN)
- SGOT (AST) ≤ 2.5 x ULN
- Creatinine ≤ 1.5 x ULN
Required INR Value: The following INR value obtained ≤ 28 days prior to registration
- INR ≤ 1.5
Urine or Serum Pregnancy Test - Negative urine or serum pregnancy test done ≤ 7 days prior to registration, for women of childbearing potential only.
Written Informed Consent - Patient must provide written informed consent.
Return to Enrolling Institution - Patient must be willing to return to Alliance enrolling institution for follow-up.
Tissue Samples - Patient must be willing to provide tissue samples for research purposes.
Patient must be willing to provide tissue samples for research purposes.
Required Antibiotic Prophylaxis - Patient must be willing to comply with antibiotic prophylaxis with trimethoprim/sulfamethoxazole, pentamidine or dapsone.
Grapefruit and Grapefruit Juice - Patient must be willing to abstain from eating grapefruit or drinking grapefruit juice for the duration of the study treatment.
Ability to Swallow - Patient must have the ability to take oral medication (dasatinib must be swallowed whole).
Quality of Life (QOL) Questionnaires - Phase II patients only: Patients must be willing and able to complete QOL questionnaires independently or with the help of a caregiver.
Other Anti-Tumor Drug Therapies - Patient must be willing to forego other cytotoxic and non-cytotoxic drug therapy against the tumor while being treated with dasatinib and temozolomide.

Registration

Exclusion Criteria

Pregnancy, Nursing and Required Contraception - Any of the following because this study involves an investigational agent whose genotoxic, mutagenic and teratogenic effects on the developing fetus and newborn are unknown:
- Pregnant women
- Nursing women
- Men or women of childbearing potential who are unwilling to employ adequate contraception throughout study treatment and for at least 12 weeks after study drug is stopped.
Prior Radiotherapy or Chemotherapy for Any CNS Neoplasm - Received any prior radiotherapy or chemotherapy for any CNS neoplasm (hormones, vitamins and growth factors are not considered chemotherapy for the purposes of this study.
Prior Surgery for Any CNS Neoplasm - Prior surgeries for any CNS neoplasms, other than surgery related to the current GBM diagnosis. Note: If Gliadel wafers are placed at time of primary resection, this would be considered prior therapy and patient would be ineligible.
Concurrent Illness or Disease - Co-morbid systemic illnesses or other severe concurrent disease which, in the judgment of the investigator, would make the patient inappropriate for entry into this study or interfere significantly with the proper assessment of safety and toxicity of the prescribed regimens. Including but not limited to:
- History of bleeding diathesis
- Current use of chronic systemic anticoagulation therapy that cannot be discontinued (antiplatelet agents, Aspirin)
- Current chronic use of NSAIDs which cannot be discontinued
Pleural or Pericardial Effusions - Pleural or pericardial effusion of any grade.
Immunocompromised Status - Immunocompromised patients (other than that related to the use of corticosteroids) and patients known to be HIV positive and currently receiving antiretroviral therapy. Note: Patients known to be HIV positive, but without clinical evidence of an immunocompromised state, are eligible for this trial.
Uncontrolled Intercurrent Illness - Uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements.
Other Investigational Agents - Receiving any other investigational agent which would be considered as a treatment for the primary neoplasm.
Other Active Malignancies - Other active malignancy ≤ 5 years prior to registration.

Exceptions: Non-melanotic skin cancer or carcinoma-in-situ of the cervix. Note: If there is a history of prior malignancy, they must not be receiving other specific treatment other than hormonal therapy for their cancer.
History of Cardiac or Metabolic Conditions:
- Myocardial infarction ≤ 6 months, or congestive heart failure requiring use of ongoing maintenance therapy for life-threatening ventricular arrhythmias
- Diagnosed congenital long QT syndrome
- Any history of clinically significant ventricular arrhythmias (such as ventricular tachycardia, ventricular fibrillation, or Torsades de pointes)
- Prolonged QTc interval on pre-entry electrocardiogram (> 450 msec)
- Patients with hypokalemia or hypomagnesemia if it cannot be corrected prior to dasatinib administration.
Clinically Significant Cardiovascular Disease - Patients may not have any clinically significant cardiovascular disease including the following:
- Myocardial infarction or ventricular tachyarrhythmia within 6 months.
- Ejection fraction less than institutional normal
- Major conduction abnormality (unless a cardiac pacemaker is present)
Note: Patients with any cardiopulmonary symptoms of unknown cause (e.g., shortness of breath, chest pain, etc.) should be evaluated by a baseline echocardiogram with or without stress test as needed in addition to ECG to rule out QTc prolongation. The patient may be referred to a cardiologist at the discretion of the principal investigator.

Patients with underlying cardiopulmonary dysfunction should be excluded from the study.
Congestive Heart Failure - New York Heart Association classification ≥ Class II Congestive Heart Failure.
Prohibited or Restricted Concomitant Treatments - Currently taking one of the following medications:
- Enzyme inducing anti-convulsants (EIACs) Note: To be eligible, patient must be switched to non-EIAC medications ≥7 days prior to registration. See protocol for a list of EIAC and non-EIAC medications.
- Potent inhibitors of CYP3A4 which cannot be discontinued. See protocol for a list of medications known to inhibit CYP3A4.
- Medications known to prolong QT interval which cannot be discontinued or switched. See Appendix II for a list of medications which are known to prolong the QT interval.
- Medications that may possibly prolong QT interval and produce a QTc that is ≥ 60 msec or a QTcF that is ≥ 450 msec. See Appendix II for a list of medications that may possibly prolong QTc.
- St. John's Wort
- H2 blockers or proton pump inhibitors (PPIs), such as famotidine (Pepcid) and omeprazole (Prilosec) respectively, which cannot be discontinued or switched to locally acting agents, such as Maalox, Mylanta and TUMS.
Allergy to Antibiotic Prophylaxis Medications - Severe allergy to sulfa medications and dapsone and pentamidine.

Study & Design

Study Type: INTERVENTIONAL

Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Group 1 (Phase II) dasatinib + radiation + temozolomide	radiation therapy	Patients receive concomitant chemotherapy and radiation for cycle one for a total of 42 days, then patients receive adjuvant chemotherapy 28-42 days post cycle one treatment. Patients receive only dasatinib post cycle 8 until progressive disease, unacceptable adverse events or refusal.
Group 2 (Phase II) placebo + radiation + temozolomide	placebo	Patients receive concomitant chemotherapy and radiation for cycle one for a total of 42 days, then patients receive adjuvant chemotherapy 28-42 days post cycle one treatment. Patients receive only placebo post cycle 8 until progressive disease, unacceptable adverse events or refusal.
Group 2 (Phase II) placebo + radiation + temozolomide	radiation therapy	Patients receive concomitant chemotherapy and radiation for cycle one for a total of 42 days, then patients receive adjuvant chemotherapy 28-42 days post cycle one treatment. Patients receive only placebo post cycle 8 until progressive disease, unacceptable adverse events or refusal.
Group 1 (Phase II) dasatinib + radiation + temozolomide	dasatinib	Patients receive concomitant chemotherapy and radiation for cycle one for a total of 42 days, then patients receive adjuvant chemotherapy 28-42 days post cycle one treatment. Patients receive only dasatinib post cycle 8 until progressive disease, unacceptable adverse events or refusal.
Group 1 (Phase II) dasatinib + radiation + temozolomide	temozolomide	Patients receive concomitant chemotherapy and radiation for cycle one for a total of 42 days, then patients receive adjuvant chemotherapy 28-42 days post cycle one treatment. Patients receive only dasatinib post cycle 8 until progressive disease, unacceptable adverse events or refusal.
Group 2 (Phase II) placebo + radiation + temozolomide	temozolomide	Patients receive concomitant chemotherapy and radiation for cycle one for a total of 42 days, then patients receive adjuvant chemotherapy 28-42 days post cycle one treatment. Patients receive only placebo post cycle 8 until progressive disease, unacceptable adverse events or refusal.

Primary Outcome Measures

Name	Time	Method
Overall Survival	Up to 5 years post treatment	Overall survival (OS) is the primary endpoint and is defined as the time from study registration to time of death due to any cause. All patients who meet the eligibility criteria, have signed a consent form, and have received at least one dose of the regimens will be considered evaluable. Patients who are lost to follow-up will be censored at the date of their last follow-up. Patients still alive at the time of analysis will be censored. Only Phase II was evaluated for survival
The Number of Dose Limiting Toxicities(DLT) in Order to Determine Maximum Tolerable Dose(MTD) of Dasatinib Combined With Radiation and Temozolomide in This Patient Population.	Every cycle from first dose to end of rest period prior cycle 3	Doselimiting toxicity will be defined as: Adverse event at least possibly related to the study medication. All by CTCAE v3.0 criteria: Greater than or equal to grade 3: diarrhea or skin rash or desquamation or (other) clinically relevant non-hematological adverse event or non-hematologic adverse event at least possibly due to drug therapy. Or greater than or equal to grade 4: neutropenia or leukopenia or thrombocytopenia or radiation dermatitis or hematologic adverse event OR failure to administer greater than 75% of dasatinib TMZ or interruption of RT for more than 5 days due to adverse events.OR severe acute central nervous system deterioration attributable to TMZ, RT and or dasatinib which cannot be controlled with corticosteroid administration. The MTD for this study will be defined as the highest safely tolerated dose level where at most 1 out of 6 patients experience DLT with the next higher dose having at least 2 patients out of a maximum of 6 patients experience DLT.

Secondary Outcome Measures

Name	Time	Method
Progression-free Survival	Up to 5 years post treatment	Progression-free survival (PFS) is defined as the time from study registration to the date of first observation of disease progression or death due to any cause (whichever comes first). If a patient has not progressed or died, progression-free survival is censored at the time of last follow-up. Only Phase II patients were evaluated for Progression-free survival
Objective Response	Up to 5 years post treatment	Objective response to treatment will be determined by a combination of the results of neurological exam and the MRI and/or CT measurement of the tumor at each evaluation as is used for all NCCTG neuro-oncology trials. The proportion of patients in each response category will be summarized. Only phase II patients were evaluated for response.

Trial Locations

Locations (206): Helen and Harry Gray Cancer Center at Hartford Hospital
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Hartford, Connecticut, United States
Illinois CancerCare - Canton
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Canton, Illinois, United States
Licking Memorial Cancer Care Program at Licking Memorial Hospital
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Newark, Ohio, United States
Eureka Community Hospital
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Eureka, Illinois, United States
Marshfield Clinic - Marshfield Center
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Marshfield, Wisconsin, United States
CCOP - Northern Indiana CR Consortium
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South Bend, Indiana, United States
Park Nicollet Cancer Center
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Saint Louis Park, Minnesota, United States
Montana Cancer Center at St. Patrick Hospital and Health Sciences Center
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Missoula, Montana, United States
Mission Hospitals - Memorial Campus
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Asheville, North Carolina, United States
Resurrection Medical Center
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Chicago, Illinois, United States
Riverside Methodist Hospital Cancer Care
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Columbus, Ohio, United States
CCOP - Columbus
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Columbus, Ohio, United States
Grant Medical Center Cancer Care
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Columbus, Ohio, United States
Mount Carmel Health - West Hospital
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Columbus, Ohio, United States
Doctors Hospital at Ohio Health
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Columbus, Ohio, United States
Toledo Hospital
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Toledo, Ohio, United States
Memorial Hospital of South Bend
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South Bend, Indiana, United States
Valley Cancer Center
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Spring Valley, Illinois, United States
Reid Hospital & Health Care Services
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Richmond, Indiana, United States
Illinois CancerCare - Princeton
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Princeton, Illinois, United States
Elkhart Clinic, LLC
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Elkhart, Indiana, United States
Illinois CancerCare - Spring Valley
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Spring Valley, Illinois, United States
Mayo Clinic - Jacksonville
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Jacksonville, Florida, United States
Illinois Valley Community Hospital
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Peru, Illinois, United States
Mercy Regional Cancer Center at Mercy Medical Center
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Cedar Rapids, Iowa, United States
Saint Joseph Regional Medical Center
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Mishawaka, Indiana, United States
Medical Oncology and Hematology Associates - West Des Moines
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Clive, Iowa, United States
CCOP - Carle Cancer Center
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Urbana, Illinois, United States
Elkhart General Hospital
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Elkhart, Indiana, United States
CCOP - Iowa Oncology Research Association
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Des Moines, Iowa, United States
Medical Oncology and Hematology Associates at John Stoddard Cancer Center
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Des Moines, Iowa, United States
Fairview Ridges Hospital
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Burnsville, Minnesota, United States
Cancer Center of Kansas, PA - Dodge City
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Dodge City, Kansas, United States
Coborn Cancer Center
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Saint Cloud, Minnesota, United States
Mercy Memorial Hospital - Monroe
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Monroe, Michigan, United States
Hickman Cancer Center at Bixby Medical Center
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Adrian, Michigan, United States
Hutchinson Area Health Care
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Hutchinson, Minnesota, United States
CCOP - Wichita
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Wichita, Kansas, United States
Community Cancer Center of Monroe
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Monroe, Michigan, United States
Wayne Hospital
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Greenville, Ohio, United States
Strecker Cancer Center at Marietta Memorial Hospital
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Marietta, Ohio, United States
Lakeland Regional Cancer Care Center - St. Joseph
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Saint Joseph, Michigan, United States
St. Vincent Healthcare Cancer Care Services
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Billings, Montana, United States
Hematology-Oncology Centers of the Northern Rockies - Billings
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Billings, Montana, United States
Lakes Region General Hospital
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Laconia, New Hampshire, United States
Minnesota Oncology - Woodbury
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Woodbury, Minnesota, United States
Community Hospital of Springfield and Clark County
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Springfield, Ohio, United States
Genesis - Good Samaritan Hospital
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Zanesville, Ohio, United States
Fredericksburg Oncology, Incorporated
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Fredericksburg, Virginia, United States
St. Charles Mercy Hospital
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Oregon, Ohio, United States
Mercy Hospital of Tiffin
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Tiffin, Ohio, United States
Southern Ohio Medical Center Cancer Center
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Portsmouth, Ohio, United States
Cancer Centers of the Carolinas - Seneca
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Seneca, South Carolina, United States
St. Vincent Mercy Medical Center
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Toledo, Ohio, United States
Kalispell Regional Medical Center
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Kalispell, Montana, United States
Northwest Ohio Oncology Center
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Maumee, Ohio, United States
Bozeman Deaconess Cancer Center
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Bozeman, Montana, United States
New Hampshire Oncology - Hematology, PA - Hooksett
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Hooksett, New Hampshire, United States
Fulton County Health Center
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Wauseon, Ohio, United States
Cancer Centers of the Carolinas - Easley
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Easley, South Carolina, United States
Cancer Centers of the Carolinas - Eastside
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Greenville, South Carolina, United States
CCOP - Greenville
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Greenville, South Carolina, United States
St. Anne Mercy Hospital
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Toledo, Ohio, United States
Toledo Clinic, Incorporated - Main Clinic
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Toledo, Ohio, United States
Sanford Cancer Center at Sanford USD Medical Center
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Sioux Falls, South Dakota, United States
Cancer Centers of the Carolinas - Greer Radiation Oncology
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Greer, South Carolina, United States
Toledo Clinic - Oregon
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Oregon, Ohio, United States
Flower Hospital Cancer Center
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Sylvania, Ohio, United States
Central Wisconsin Cancer Program at Agnesian HealthCare
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Fond Du Lac, Wisconsin, United States
Precision Radiotherapy at University Pointe
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West Chester, Ohio, United States
Morgan Cancer Center at Lehigh Valley Hospital - Cedar Crest
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Allentown, Pennsylvania, United States
Cancer Centers of the Carolinas - Faris Road
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Greenville, South Carolina, United States
Saint Joseph's Hospital
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Marshfield, Wisconsin, United States
Greenville Hospital Cancer Center
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Greenville, South Carolina, United States
Marshfield Clinic Cancer Care at Regional Cancer Center
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Eau Claire, Wisconsin, United States
Knox Community Hospital
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Mount Vernon, Ohio, United States
Mount Carmel St. Ann's Cancer Center
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Westerville, Ohio, United States
Gundersen Lutheran Center for Cancer and Blood
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La Crosse, Wisconsin, United States
Medical University of Ohio Cancer Center
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Toledo, Ohio, United States
UVMC Cancer Care Center at Upper Valley Medical Center
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Troy, Ohio, United States
Saint Michael's Hospital Cancer Center
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Stevens Point, Wisconsin, United States
Rapid City Regional Hospital
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Rapid City, South Dakota, United States
Avera Cancer Institute
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Sioux Falls, South Dakota, United States
Marshfield Clinic - Weston Center
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Weston, Wisconsin, United States
Marshfield Clinic - Lakeland Center
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Minocqua, Wisconsin, United States
St. Francis Hospital Cancer Care Services
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Indianapolis, Indiana, United States
Virginia Piper Cancer Institute at Abbott - Northwestern Hospital
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Minneapolis, Minnesota, United States
Charles M. Barrett Cancer Center at University Hospital
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Cincinnati, Ohio, United States
Hennepin County Medical Center - Minneapolis
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Minneapolis, Minnesota, United States
Ridgeview Medical Center
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Waconia, Minnesota, United States
St. Alexius Medical Center Cancer Center
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Bismarck, North Dakota, United States
Altru Cancer Center at Altru Hospital
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Grand Forks, North Dakota, United States
Wesley Medical Center
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Wichita, Kansas, United States
Cancer Center of Kansas, PA - Liberal
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Liberal, Kansas, United States
Medical Oncology and Hematology Associates at Mercy Cancer Center
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Des Moines, Iowa, United States
Siouxland Hematology-Oncology Associates, LLP
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Sioux City, Iowa, United States
Mercy Medical Center - Sioux City
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Sioux City, Iowa, United States
St. Luke's Regional Medical Center
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Sioux City, Iowa, United States
John B. Amos Cancer Center
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Columbus, Georgia, United States
Illinois CancerCare - Bloomington
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Bloomington, Illinois, United States
Illinois CancerCare - Kewanee Clinic
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Kewanee, Illinois, United States
Illinois CancerCare - Monmouth
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Monmouth, Illinois, United States
Illinois CancerCare - Carthage
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Carthage, Illinois, United States
Galesburg Clinic, PC
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Galesburg, Illinois, United States
St. Joseph Medical Center
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Bloomington, Illinois, United States
Illinois CancerCare - Eureka
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Eureka, Illinois, United States
Illinois CancerCare - Havana
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Havana, Illinois, United States
OSF Holy Family Medical Center
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Monmouth, Illinois, United States
BroMenn Regional Medical Center
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Normal, Illinois, United States
Illinois CancerCare - Macomb
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Macomb, Illinois, United States
Illinois CancerCare - Community Cancer Center
🇺🇸
Normal, Illinois, United States
Oncology Hematology Associates of Central Illinois, PC - Ottawa
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Ottawa, Illinois, United States
Community Hospital of Ottawa
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Ottawa, Illinois, United States
Illinois CancerCare - Pekin
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Pekin, Illinois, United States
Community Cancer Center
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Elyria, Ohio, United States
Cancer Treatment Center at Pekin Hospital
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Pekin, Illinois, United States
Proctor Hospital
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Peoria, Illinois, United States
OSF St. Francis Medical Center
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Peoria, Illinois, United States
CCOP - Illinois Oncology Research Association
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Peoria, Illinois, United States
Methodist Medical Center of Illinois
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Peoria, Illinois, United States
Oncology Hematology Associates of Central Illinois, PC - Peoria
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Peoria, Illinois, United States
Illinois CancerCare - Peru
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Peru, Illinois, United States
Michiana Hematology-Oncology, PC - Elkhart
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Elkhart, Indiana, United States
Howard Community Hospital
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Kokomo, Indiana, United States
Michiana Hematology Oncology PC - Plymouth
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Plymouth, Indiana, United States
Michiana Hematology-Oncology, PC - South Bend
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Mishawaka, Indiana, United States
Cedar Rapids Oncology Associates
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Cedar Rapids, Iowa, United States
Michiana Hematology Oncology PC - La Porte
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Westville, Indiana, United States
Mercy Cancer Center - West Lakes
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Clive, Iowa, United States
John Stoddard Cancer Center at Iowa Methodist Medical Center
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Des Moines, Iowa, United States
John Stoddard Cancer Center at Iowa Lutheran Hospital
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Des Moines, Iowa, United States
Mercy Cancer Center at Mercy Medical Center - Des Moines
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Des Moines, Iowa, United States
Methodist West Hospital
🇺🇸
West Des Moines, Iowa, United States
Cancer Center of Kansas, PA - El Dorado
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El Dorado, Kansas, United States
Cancer Center of Kansas, PA - Chanute
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Chanute, Kansas, United States
Lawrence Memorial Hospital
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Lawrence, Kansas, United States
Cancer Center of Kansas - Fort Scott
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Fort Scott, Kansas, United States
Cancer Center of Kansas, PA - Kingman
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Kingman, Kansas, United States
Cancer Center of Kansas-Independence
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Independence, Kansas, United States
Cancer Center of Kansas, PA - Newton
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Newton, Kansas, United States
Cancer Center of Kansas, PA - Wellington
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Wellington, Kansas, United States
Cancer Center of Kansas, PA - Salina
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Salina, Kansas, United States
Cancer Center of Kansas, PA - Parsons
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Parsons, Kansas, United States
Cancer Center of Kansas, PA - Pratt
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Pratt, Kansas, United States
Associates in Womens Health, PA - North Review
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Wichita, Kansas, United States
Cancer Center of Kansas, PA - Medical Arts Tower
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Wichita, Kansas, United States
Cancer Center of Kansas, PA - Wichita
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Wichita, Kansas, United States
Via Christi Cancer Center at Via Christi Regional Medical Center
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Wichita, Kansas, United States
Miller - Dwan Medical Center
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Duluth, Minnesota, United States
MeritCare Bemidji
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Bemidji, Minnesota, United States
Lakeside Cancer Specialists, PLLC
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Saint Joseph, Michigan, United States
Mercy and Unity Cancer Center at Mercy Hospital
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Coon Rapids, Minnesota, United States
Essentia Health - Duluth Clinic
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Duluth, Minnesota, United States
CCOP - Duluth
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Duluth, Minnesota, United States
Fairview Southdale Hospital
🇺🇸
Edina, Minnesota, United States
HealthEast Cancer Care at St. John's Hospital
🇺🇸
Maplewood, Minnesota, United States
Minnesota Oncology - Maplewood
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Maplewood, Minnesota, United States
Mercy and Unity Cancer Center at Unity Hospital
🇺🇸
Fridley, Minnesota, United States
Humphrey Cancer Center at North Memorial Outpatient Center
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Robbinsdale, Minnesota, United States
CentraCare Clinic - River Campus
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Saint Cloud, Minnesota, United States
CCOP - Metro-Minnesota
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Saint Louis Park, Minnesota, United States
St. Francis Cancer Center at St. Francis Medical Center
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Shakopee, Minnesota, United States
Regions Hospital Cancer Care Center
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Saint Paul, Minnesota, United States
United Hospital
🇺🇸
Saint Paul, Minnesota, United States
Willmar Cancer Center at Rice Memorial Hospital
🇺🇸
Willmar, Minnesota, United States
Lakeview Hospital
🇺🇸
Stillwater, Minnesota, United States
Siteman Cancer Center at Barnes-Jewish Hospital - Saint Louis
🇺🇸
Saint Louis, Missouri, United States
CCOP - Montana Cancer Consortium
🇺🇸
Billings, Montana, United States
St. James Healthcare Cancer Care
🇺🇸
Butte, Montana, United States
Billings Clinic - Downtown
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Billings, Montana, United States
Benefis Sletten Cancer Institute
🇺🇸
Great Falls, Montana, United States
St. Peter's Hospital
🇺🇸
Helena, Montana, United States
Montana Cancer Specialists at Montana Cancer Center
🇺🇸
Missoula, Montana, United States
New Hampshire Oncology - Hematology, PA at Payson Center for Cancer Care
🇺🇸
Concord, New Hampshire, United States
CCOP - Hematology-Oncology Associates of Central New York
🇺🇸
East Syracuse, New York, United States
Wayne Memorial Hospital, Incorporated
🇺🇸
Goldsboro, North Carolina, United States
Medcenter One Hospital Cancer Care Center
🇺🇸
Bismarck, North Dakota, United States
Mid Dakota Clinic, PC
🇺🇸
Bismarck, North Dakota, United States
MeritCare Broadway
🇺🇸
Fargo, North Dakota, United States
Wood County Oncology Center
🇺🇸
Bowling Green, Ohio, United States
Adena Regional Medical Center
🇺🇸
Chillicothe, Ohio, United States
Grandview Hospital
🇺🇸
Dayton, Ohio, United States
David L. Rike Cancer Center at Miami Valley Hospital
🇺🇸
Dayton, Ohio, United States
Good Samaritan Hospital
🇺🇸
Dayton, Ohio, United States
Samaritan North Cancer Care Center
🇺🇸
Dayton, Ohio, United States
Grady Memorial Hospital
🇺🇸
Delaware, Ohio, United States
CCOP - Dayton
🇺🇸
Dayton, Ohio, United States
Hematology Oncology Center
🇺🇸
Elyria, Ohio, United States
Charles F. Kettering Memorial Hospital
🇺🇸
Kettering, Ohio, United States
Blanchard Valley Medical Associates
🇺🇸
Findlay, Ohio, United States
Middletown Regional Hospital
🇺🇸
Franklin, Ohio, United States
Fairfield Medical Center
🇺🇸
Lancaster, Ohio, United States
Lima Memorial Hospital
🇺🇸
Lima, Ohio, United States
Ruth G. McMillan Cancer Center at Greene Memorial Hospital
🇺🇸
Xenia, Ohio, United States
Natalie Warren Bryant Cancer Center at St. Francis Hospital
🇺🇸
Tulsa, Oklahoma, United States
Cancer Centers of the Carolinas - Greer Medical Oncology
🇺🇸
Greer, South Carolina, United States
Cancer Centers of the Carolinas - Grove Commons
🇺🇸
Greenville, South Carolina, United States
Cancer Centers of the Carolinas - Spartanburg
🇺🇸
Spartanburg, South Carolina, United States
Center for Cancer Treatment & Prevention at Sacred Heart Hospital
🇺🇸
Eau Claire, Wisconsin, United States
Ministry Medical Group at Saint Mary's Hospital
🇺🇸
Rhinelander, Wisconsin, United States
Marshfield Clinic - Indianhead Center
🇺🇸
Rice Lake, Wisconsin, United States
Marshfield Clinic at Saint Michael's Hospital
🇺🇸
Stevens Point, Wisconsin, United States
Mayo Clinic Cancer Center
🇺🇸
Rochester, Minnesota, United States
University of New Mexico Cancer Center
🇺🇸
Albuquerque, New Mexico, United States
Center for Cancer Therapy at LaPorte Hospital and Health Services
🇺🇸
La Porte, Indiana, United States
Cancer Center of Kansas, PA - Winfield
🇺🇸
Winfield, Kansas, United States