Gemcitabine Hydrochloride and Docetaxel With or Without Bevacizumab in Treating Patients With Advanced or Recurrent Uterine Leiomyosarcoma
- Conditions
- Stage IIIB Uterine SarcomaStage IIIC Uterine SarcomaStage IVA Uterine SarcomaRecurrent Uterine Corpus SarcomaUterine Corpus LeiomyosarcomaStage IIIA Uterine SarcomaStage IVB Uterine Sarcoma
- Interventions
- Biological: BevacizumabDrug: DocetaxelDrug: Gemcitabine HydrochlorideBiological: FilgrastimBiological: PegfilgrastimOther: Placebo
- Registration Number
- NCT01012297
- Lead Sponsor
- National Cancer Institute (NCI)
- Brief Summary
This randomized phase III trial is studying gemcitabine hydrochloride, docetaxel, and bevacizumab to see how well they work compared with gemcitabine hydrochloride, docetaxel, and a placebo in treating patients with advanced or recurrent uterine leiomyosarcoma. Drugs used in chemotherapy, such as gemcitabine hydrochloride and docetaxel, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Monoclonal antibodies, such as bevacizumab, can block tumor growth in different ways. Some block the ability of tumor cells to grow and spread. Others find tumor cells and help kill them or carry tumor-killing substances to them. Bevacizumab may also stop the growth of tumor cells by blocking blood flow to the tumor. It is not yet known whether gemcitabine hydrochloride and docetaxel are more effective when given with or without bevacizumab in treating uterine leiomyosarcoma.
- Detailed Description
PRIMARY OBJECTIVES:
I. To determine whether the addition of bevacizumab to fixed-dose rate gemcitabine-docetaxel reduces the progression-free survival (PFS) event rate when compared to gemcitabine-docetaxel plus placebo in patients with advanced or recurrent uterine leiomyosarcoma (LMS).
SECONDARY OBJECTIVES:
I. To determine the objective response rate, as measured by RECIST, of patients treated with fixed-dose rate gemcitabine-docetaxel with bevacizumab, compared with the objective response rate of patients treated with fixed-dose rate gemcitabine-docetaxel with placebo.
II. To determine if the addition of bevacizumab to the combination of gemcitabine and docetaxel increases overall survival in patients with advanced or recurrent uterine LMS.
III. To determine the toxicity profile of fixed-dose rate gemcitabine-docetaxel with and without bevacizumab in this patient population.
IV. To bank formalin-fixed and paraffin-embedded (FFPE) tumor tissue for research.
OUTLINE: This is a multicenter study. Patients are stratified according to prior whole-pelvic radiotherapy (yes vs no). Patients are randomized to 1 of 2 treatment arms.
ARM I: Patients receive a placebo IV over 30-90 minutes on day 1, gemcitabine hydrochloride IV over 90 minutes on days 1 and 8, and docetaxel IV over 60 minutes on day 8. Patients also receive filgrastim subcutaneously (SC) on days 9-15 or pegfilgrastim SC on day 9 or 10.
ARM II: Patients receive bevacizumab IV over 30-90 minutes on day 1, gemcitabine hydrochloride IV over 90 minutes on days 1 and 8, and docetaxel IV over 60 minutes on day 8. Patients also receive filgrastim SC on days 9-15 or pegfilgrastim SC on day 9 or 10.
In both arms, courses repeat every 21 days in the absence of disease progression or unacceptable toxicity.
After completion of study treatment, patients are followed up every 3 months for 2 years and then every 6 months for 3 years.
Recruitment & Eligibility
- Status
- TERMINATED
- Sex
- Female
- Target Recruitment
- 107
- Patients must have advanced or recurrent uterine leiomyosarcoma with documented disease progression; histologic confirmation of the original primary tumor is required
- All patients must have measurable disease as defined by RECIST 1.1; measurable disease is defined as at least one lesion that can be accurately measured in at least one dimension (longest diameter to be recorded); each lesion must be >= 10 mm when measured by CT, MRI or caliper measurement by clinical exam; or >= 20 mm when measured by chest x-ray; lymph nodes must be >= 15 mm in short axis when measured by CT or MRI
- Patient must have at least one "target lesion" to be used to assess response on this protocol as defined by RECIST 1.1; tumors within a previously irradiated field will be designated as "non-target" lesions unless progression is documented or a biopsy is obtained to confirm persistence at least 90 days following completion of radiation therapy
- Patients must have a GOG Performance Status of 0, 1, or 2
- Patients must have recovered from effects of recent surgery, radiotherapy or other therapy
- Patients should be free of active infection requiring antibiotics (with the exception of an uncomplicated UTI)
- Any hormonal therapy directed at the malignant tumor must be discontinued at least one week prior to first day of study treatment; continuation of hormone replacement therapy is permitted
- Platelet count greater than or equal to 100,000/mm^3
- ANC count greater than or equal to 1,500/mm^3
- Creatinine less than or equal to 1.5 x institutional upper limit normal (ULN), per NCI CTCAE Version 4.0 Grade 1
- Bilirubin within normal range (CTCAE Version 4 Grade 0)
- SGOT and alkaline phosphatase less than or equal to 2.5 x ULN, per the CTCAE Version 4.0 Grade 1)
- SGOT less than or equal to 2.5 x ULN, per the CTCAE Version 4.0 Grade 1
- Alkaline phosphatase less than or equal to 2.5 x ULN, per the CTCAE Version 4.0 Grade 1
- Neuropathy (sensory and motor) less than or equal to Grade 1 per the CTCAE Version 4.0.
- No history of transient ischemic attack (TIA) or stroke or CNS hemorrhage within the past 6 months
- Urine protein creatinine (UPC) ratio must be < 1.0 gm; if UPC ratio >= 1, collection of 24-hour urine measurement of urine protein is recommended
- PT such that international normalized ratio (INR) is =< 1.5 and a PTT =< 1.5 times the institutional upper limit of normal (or an in-therapeutic-range INR, usually between 2 and 3, if a patient is on a stable dose of therapeutic warfarin)
- Patients must have signed an approved informed consent and authorization permitting release of personal health information
- Patients must meet pre-entry requirements
- Patients of childbearing potential must have a negative serum pregnancy test prior to the study entry and be practicing an effective form of contraception
-
Patients who have received prior cytotoxic chemotherapy for management of uterine sarcoma; patients who have received prior VEGF-pathway targeted agent such as bevacizumab, PTK787, VEGF-trap, or who have received prior treatment with a multi-kinase inhibitor such as sorafenib or sunitinib are not eligible
-
Patients who have had prior therapy with docetaxel or gemcitabine or bevacizumab
-
Patients with a history of other invasive malignancies, with the exceptions of non-melanoma skin cancer, carcinoma in situ of the cervix, and ductal carcinoma in situ of the breast, are excluded if there is any evidence of other malignancy being present within the last five years; patients are also excluded if their previous cancer treatment contraindicates this protocol therapy
-
Patients with active bleeding or pathologic conditions that carry high risk of bleeding, such as known bleeding disorder, coagulopathy, or tumor involving major vessels; (necessary use of warfarin or low molecular weight heparin is permitted, provided the INR is maintained in the therapeutic range of approximately 2-3)
-
Patients with major surgery or significant traumatic injury within 28 days prior to study entry
-
Patients with a history of abdominal fistula or perforation within the past 12 months
-
Patients with a current, serious, non-healing wound, ulcer, or bone fracture
-
Patients with history or evidence upon physical examination of CNS disease, including history of primary brain tumor, or any history of brain metastases, or seizures not controlled with standard medical therapy
-
Patients with known hypersensitivity to Chinese hamster ovary cell products or other recombinant human or humanized antibodies
-
Cardiovascular function; specifically, patient may not have:
- Uncontrolled hypertension, defined as systolic > 150 mm Hg or diastolic > 100 mm Hg in a patient with no history of hypertension; patients with a history of hypertension before enrollment on study are permitted, but such patients must have BP less than or equal to 140/90 mmHg; use of blood pressure medications to achieve and maintain blood pressure control is permitted
- Myocardial infarction or unstable angina within 6 months of the first date of bevacizumab/placebo therapy
- New York Heart Association (NYHA) Grade II or greater congestive heart failure or serious cardiac arrhythmia requiring medication; women who have received prior treatment with an anthracycline (including doxorubicin and/or liposomal doxorubicin) and have an ejection fraction < 50% will be excluded from the study
- Grade 1, Category 2 or greater, peripheral vascular disease; patient cannot have anything worse than mild, symptomatic claudication with exercise
- History of cerebrovascular accident (CVA, stroke), transient ischemic attack (TIA) or subarachnoid hemorrhage within six months of the first date of bevacizumab/placebo therapy
- History of pulmonary embolism or deep vein thrombosis in the past 6 months
-
Patients with, or with anticipation of, invasive procedures as defined below:
- Major surgical procedure, open biopsy or significant traumatic injury within 28 days prior to the first date of bevacizumab/placebo therapy
- Major surgical procedure anticipated during the course of the study.
- Minor surgical procedures (i.e., mediport insertion), fine needle aspirates, or core biopsies within 7 days prior to the first date of bevacizumab/placebo therapy
-
Patients who are pregnant or nursing
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Arm I Gem+Doce+Placebo Gemcitabine Hydrochloride Patients receive a placebo IV over 30-90 minutes on day 1, gemcitabine hydrochloride IV over 90 minutes on days 1 and 8, and docetaxel IV over 60 minutes on day 8. Patients also receive filgrastim subcutaneously (SC) on days 9-15 or pegfilgrastim SC on day 9 or 10. Arm II Gem+Doce+Bev Gemcitabine Hydrochloride Patients receive bevacizumab IV over 30-90 minutes on day 1, gemcitabine hydrochloride IV over 90 minutes on days 1 and 8, and docetaxel IV over 60 minutes on day 8. Patients also receive filgrastim SC on days 9-15 or pegfilgrastim SC on day 9 or 10. Arm II Gem+Doce+Bev Pegfilgrastim Patients receive bevacizumab IV over 30-90 minutes on day 1, gemcitabine hydrochloride IV over 90 minutes on days 1 and 8, and docetaxel IV over 60 minutes on day 8. Patients also receive filgrastim SC on days 9-15 or pegfilgrastim SC on day 9 or 10. Arm II Gem+Doce+Bev Filgrastim Patients receive bevacizumab IV over 30-90 minutes on day 1, gemcitabine hydrochloride IV over 90 minutes on days 1 and 8, and docetaxel IV over 60 minutes on day 8. Patients also receive filgrastim SC on days 9-15 or pegfilgrastim SC on day 9 or 10. Arm I Gem+Doce+Placebo Pegfilgrastim Patients receive a placebo IV over 30-90 minutes on day 1, gemcitabine hydrochloride IV over 90 minutes on days 1 and 8, and docetaxel IV over 60 minutes on day 8. Patients also receive filgrastim subcutaneously (SC) on days 9-15 or pegfilgrastim SC on day 9 or 10. Arm I Gem+Doce+Placebo Filgrastim Patients receive a placebo IV over 30-90 minutes on day 1, gemcitabine hydrochloride IV over 90 minutes on days 1 and 8, and docetaxel IV over 60 minutes on day 8. Patients also receive filgrastim subcutaneously (SC) on days 9-15 or pegfilgrastim SC on day 9 or 10. Arm I Gem+Doce+Placebo Placebo Patients receive a placebo IV over 30-90 minutes on day 1, gemcitabine hydrochloride IV over 90 minutes on days 1 and 8, and docetaxel IV over 60 minutes on day 8. Patients also receive filgrastim subcutaneously (SC) on days 9-15 or pegfilgrastim SC on day 9 or 10. Arm II Gem+Doce+Bev Bevacizumab Patients receive bevacizumab IV over 30-90 minutes on day 1, gemcitabine hydrochloride IV over 90 minutes on days 1 and 8, and docetaxel IV over 60 minutes on day 8. Patients also receive filgrastim SC on days 9-15 or pegfilgrastim SC on day 9 or 10. Arm I Gem+Doce+Placebo Docetaxel Patients receive a placebo IV over 30-90 minutes on day 1, gemcitabine hydrochloride IV over 90 minutes on days 1 and 8, and docetaxel IV over 60 minutes on day 8. Patients also receive filgrastim subcutaneously (SC) on days 9-15 or pegfilgrastim SC on day 9 or 10. Arm II Gem+Doce+Bev Docetaxel Patients receive bevacizumab IV over 30-90 minutes on day 1, gemcitabine hydrochloride IV over 90 minutes on days 1 and 8, and docetaxel IV over 60 minutes on day 8. Patients also receive filgrastim SC on days 9-15 or pegfilgrastim SC on day 9 or 10.
- Primary Outcome Measures
Name Time Method Progression-free Survival From date of randomization until the date of first documented progression or date of death from any cause, whichever came first, assessed up to 60 months Progression free survival (PFS) was defined as the number of months between study enrollment and documentation of disease progression (RECIST 1.1) or death from any cause. Patients still alive and disease free at the last followup were censored on the date of last CT Scan.
Assessed with a log-rank test stratified by whether the patient had whole pelvic radiotherapy prior to starting the study treatment. The product-limit method will be used to estimate the cumulative distribution of PFS for the patients assigned to each treatment group.
- Secondary Outcome Measures
Name Time Method Overall Survival Up to 5 years Overall survival (OS) was defined as the number of months between study enrollment and death from any cause. Patients still alive at the last followup were censored on the date of last CT Scan.
The product-limit method will be used to estimate the cumulative distribution of overall survival times for the patients assigned to each treatment group.Frequency and Severity of Adverse Effects as Assessed by the CTCAE Version 4.0 Up to 5 years Count of participants with Adverse events (AEs) that are CTCAE Grade 3 or worse.
Please refer to the adverse event reporting for more detail.Objective Response Rate as Measured by RECIST 1.1 Criteria Up to 5 years "Per Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.1) for target lesions and assessed by MRI: Complete Response (CR), Disappearance of all target lesions; Partial Response (PR), \>=30% decrease in the sum of the longest diameter of target lesions; Overall Response (OR) = CR + PR.
Trial Locations
- Locations (200)
USC / Norris Comprehensive Cancer Center
🇺🇸Los Angeles, California, United States
UCLA / Jonsson Comprehensive Cancer Center
🇺🇸Los Angeles, California, United States
Los Angeles County-USC Medical Center
🇺🇸Los Angeles, California, United States
Pennsylvania Hospital
🇺🇸Philadelphia, Pennsylvania, United States
Cancer Research for the Ozarks NCORP
🇺🇸Springfield, Missouri, United States
Avera Cancer Institute
🇺🇸Sioux Falls, South Dakota, United States
Case Western Reserve University
🇺🇸Cleveland, Ohio, United States
MetroHealth Medical Center
🇺🇸Cleveland, Ohio, United States
Cleveland Clinic Cancer Center/Fairview Hospital
🇺🇸Cleveland, Ohio, United States
Cleveland Clinic Foundation
🇺🇸Cleveland, Ohio, United States
Rush University Medical Center
🇺🇸Chicago, Illinois, United States
University of Chicago Comprehensive Cancer Center
🇺🇸Chicago, Illinois, United States
Ohio State University Comprehensive Cancer Center
🇺🇸Columbus, Ohio, United States
UPMC-Magee Womens Hospital
🇺🇸Pittsburgh, Pennsylvania, United States
University of Miami Miller School of Medicine-Sylvester Cancer Center
🇺🇸Miami, Florida, United States
Indiana University/Melvin and Bren Simon Cancer Center
🇺🇸Indianapolis, Indiana, United States
Franciscan Saint Francis Health-Indianapolis
🇺🇸Indianapolis, Indiana, United States
Gynecologic Oncology of Indiana
🇺🇸Indianapolis, Indiana, United States
Saint Vincent Oncology Center
🇺🇸Indianapolis, Indiana, United States
Women's Cancer Center of Nevada
🇺🇸Las Vegas, Nevada, United States
Hennepin County Medical Center
🇺🇸Minneapolis, Minnesota, United States
University of California San Diego
🇺🇸San Diego, California, United States
University of Cincinnati
🇺🇸Cincinnati, Ohio, United States
Duke University Medical Center
🇺🇸Durham, North Carolina, United States
Abington Memorial Hospital
🇺🇸Abington, Pennsylvania, United States
University of Kansas Cancer Center
🇺🇸Kansas City, Kansas, United States
University of Mississippi Medical Center
🇺🇸Jackson, Mississippi, United States
UCSF Medical Center-Mount Zion
🇺🇸San Francisco, California, United States
Virtua Memorial
🇺🇸Mount Holly, New Jersey, United States
Hartford Hospital
🇺🇸Hartford, Connecticut, United States
Medical University of South Carolina
🇺🇸Charleston, South Carolina, United States
Morristown Medical Center
🇺🇸Morristown, New Jersey, United States
Cooper Hospital University Medical Center
🇺🇸Camden, New Jersey, United States
Christiana Care Health System-Christiana Hospital
🇺🇸Newark, Delaware, United States
Center of Hope at Renown Medical Center
🇺🇸Reno, Nevada, United States
Fox Chase Cancer Center
🇺🇸Philadelphia, Pennsylvania, United States
Overlook Hospital
🇺🇸Summit, New Jersey, United States
Rutgers Cancer Institute of New Jersey
🇺🇸New Brunswick, New Jersey, United States
Saint Joseph's Hospital and Medical Center
🇺🇸Phoenix, Arizona, 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
Wayne State University/Karmanos Cancer Institute
🇺🇸Detroit, Michigan, United States
University of Oklahoma Health Sciences Center
🇺🇸Oklahoma City, Oklahoma, United States
The Medical Center of Aurora
🇺🇸Aurora, Colorado, United States
University of Colorado Cancer Center - Anschutz Cancer Pavilion
🇺🇸Aurora, Colorado, United States
Walter Reed National Military Medical Center
🇺🇸Bethesda, Maryland, United States
Mayo Clinic
🇺🇸Rochester, Minnesota, United States
Nebraska Methodist Hospital
🇺🇸Omaha, Nebraska, United States
Swedish Medical Center
🇺🇸Englewood, Colorado, United States
Wake Forest University Health Sciences
🇺🇸Winston-Salem, North Carolina, United States
Providence Saint Joseph Medical Center/Disney Family Cancer Center
🇺🇸Burbank, California, United States
UC San Diego Moores Cancer Center
🇺🇸La Jolla, California, United States
Kaiser Permanente Los Angeles Medical Center
🇺🇸Los Angeles, California, United States
Palo Alto Medical Foundation-Gynecologic Oncology
🇺🇸Mountain View, California, United States
UC Irvine Health/Chao Family Comprehensive Cancer Center
🇺🇸Orange, California, United States
John Muir Medical Center-Walnut Creek
🇺🇸Walnut Creek, California, United States
Olive View-University of California Los Angeles Medical Center
🇺🇸Sylmar, California, United States
Boulder Community Hospital
🇺🇸Boulder, Colorado, United States
Exempla Saint Joseph Hospital
🇺🇸Denver, Colorado, United States
Rocky Mountain Gynecologic Oncology PC
🇺🇸Englewood, Colorado, United States
Saint Mary's Hospital and Regional Medical Center
🇺🇸Grand Junction, Colorado, United States
Saint Anthony Hospital
🇺🇸Lakewood, Colorado, United States
North Colorado Medical Center
🇺🇸Greeley, Colorado, United States
Littleton Adventist Hospital
🇺🇸Littleton, Colorado, United States
Parker Adventist Hospital
🇺🇸Parker, Colorado, United States
McKee Medical Center
🇺🇸Loveland, Colorado, United States
Saint Mary Corwin Medical Center
🇺🇸Pueblo, Colorado, United States
Longmont United Hospital
🇺🇸Longmont, Colorado, United States
North Suburban Medical Center
🇺🇸Thornton, Colorado, United States
SCL Health Lutheran Medical Center
🇺🇸Wheat Ridge, Colorado, United States
Washington Hospital Center
🇺🇸Washington, District of Columbia, United States
The Hospital of Central Connecticut
🇺🇸New Britain, Connecticut, United States
Beebe Medical Center
🇺🇸Lewes, Delaware, United States
Florida Hospital Orlando
🇺🇸Orlando, Florida, United States
Mercy Hospital
🇺🇸Coon Rapids, Minnesota, United States
UF Cancer Center at Orlando Health
🇺🇸Orlando, Florida, United States
Mayo Clinic in Florida
🇺🇸Jacksonville, Florida, United States
Georgia Regents University Medical Center
🇺🇸Augusta, Georgia, United States
John B Amos Cancer Center
🇺🇸Columbus, Georgia, United States
Northwestern University
🇺🇸Chicago, Illinois, United States
Memorial University Medical Center
🇺🇸Savannah, Georgia, United States
Cadence Cancer Center in Warrenville
🇺🇸Warrenville, Illinois, United States
Memorial Medical Center
🇺🇸Springfield, Illinois, United States
Sudarshan K Sharma MD Limted-Gynecologic Oncology
🇺🇸Hinsdale, Illinois, United States
Elkhart General Hospital
🇺🇸Elkhart, Indiana, United States
Elkhart Clinic
🇺🇸Elkhart, Indiana, United States
Michiana Hematology Oncology PC-Elkhart
🇺🇸Elkhart, Indiana, United States
IU Health La Porte Hospital
🇺🇸La Porte, Indiana, United States
Community Howard Regional Health
🇺🇸Kokomo, Indiana, United States
Michiana Hematology Oncology PC-Mishawaka
🇺🇸Mishawaka, Indiana, United States
Michiana Hematology Oncology PC-Plymouth
🇺🇸Plymouth, Indiana, United States
Saint Joseph Regional Medical Center-Mishawaka
🇺🇸Mishawaka, Indiana, United States
Michiana Hematology Oncology PC-South Bend
🇺🇸South Bend, Indiana, United States
South Bend Clinic
🇺🇸South Bend, Indiana, United States
Northern Indiana Cancer Research Consortium CCOP
🇺🇸South Bend, Indiana, United States
Michiana Hematology Oncology PC-Westville
🇺🇸Westville, Indiana, United States
Iowa Methodist Medical Center
🇺🇸Des Moines, Iowa, United States
Iowa Oncology Research Association CCOP
🇺🇸Des Moines, Iowa, United States
Medical Oncology and Hematology Associates-Des Moines
🇺🇸Des Moines, Iowa, United States
Medical Oncology and Hematology Associates-West Des Moines
🇺🇸Clive, Iowa, United States
Mercy Cancer Center-West Lakes
🇺🇸Clive, Iowa, United States
Mercy Medical Center - Des Moines
🇺🇸Des Moines, Iowa, United States
Medical Oncology and Hematology Associates-Laurel
🇺🇸Des Moines, Iowa, United States
University of Iowa/Holden Comprehensive Cancer Center
🇺🇸Iowa City, Iowa, United States
Iowa Lutheran Hospital
🇺🇸Des Moines, Iowa, United States
Baptist Health Lexington
🇺🇸Lexington, Kentucky, United States
Methodist West Hospital
🇺🇸West Des Moines, Iowa, United States
Mercy Medical Center-West Lakes
🇺🇸West Des Moines, Iowa, United States
Norton Hospital Pavilion and Medical Campus
🇺🇸Louisville, Kentucky, United States
University of Maryland/Greenebaum Cancer Center
🇺🇸Baltimore, Maryland, United States
The James Graham Brown Cancer Center at University of Louisville
🇺🇸Louisville, Kentucky, United States
Johns Hopkins University/Sidney Kimmel Cancer Center
🇺🇸Baltimore, Maryland, United States
MedStar Franklin Square Medical Center/Weinberg Cancer Institute
🇺🇸Baltimore, Maryland, United States
Lahey Hospital and Medical Center
🇺🇸Burlington, Massachusetts, United States
Greater Baltimore Medical Center
🇺🇸Baltimore, Maryland, United States
Union Hospital of Cecil County
🇺🇸Elkton, Maryland, United States
Spectrum Health Big Rapids Hospital
🇺🇸Big Rapids, Michigan, United States
Bronson Battle Creek
🇺🇸Battle Creek, Michigan, United States
Grand Rapids Clinical Oncology Program
🇺🇸Grand Rapids, Michigan, United States
Spectrum Health at Butterworth Campus
🇺🇸Grand Rapids, Michigan, United States
Mercy Health Saint Mary's
🇺🇸Grand Rapids, Michigan, United States
Mercy Health Mercy Campus
🇺🇸Muskegon, Michigan, United States
West Michigan Cancer Center
🇺🇸Kalamazoo, Michigan, United States
Spectrum Health Reed City Hospital
🇺🇸Reed City, Michigan, United States
Michiana Hematology Oncology PC-Niles
🇺🇸Niles, Michigan, United States
Lakeland Hospital
🇺🇸Saint Joseph, Michigan, United States
Metro Health Hospital
🇺🇸Wyoming, Michigan, United States
Marie Yeager Cancer Center
🇺🇸Saint Joseph, Michigan, United States
Munson Medical Center
🇺🇸Traverse City, Michigan, United States
Unity Hospital
🇺🇸Fridley, Minnesota, United States
Fairview Ridges Hospital
🇺🇸Burnsville, Minnesota, United States
Fairview-Southdale Hospital
🇺🇸Edina, Minnesota, United States
Saint John's Hospital - Healtheast
🇺🇸Maplewood, Minnesota, United States
Abbott-Northwestern Hospital
🇺🇸Minneapolis, Minnesota, United States
New Ulm Medical Center
🇺🇸New Ulm, Minnesota, United States
Hutchinson Area Health Care
🇺🇸Hutchinson, Minnesota, United States
Minnesota Oncology Hematology PA-Maplewood
🇺🇸Maplewood, Minnesota, United States
North Memorial Medical Health Center
🇺🇸Robbinsdale, Minnesota, United States
Metro-Minnesota NCI Community Oncology Research Program
🇺🇸Saint Louis Park, Minnesota, United States
Park Nicollet Clinic - Saint Louis Park
🇺🇸Saint Louis Park, Minnesota, United States
United Hospital
🇺🇸Saint Paul, Minnesota, United States
Lakeview Hospital
🇺🇸Stillwater, Minnesota, United States
Saint Francis Regional Medical Center
🇺🇸Shakopee, Minnesota, United States
Ridgeview Medical Center
🇺🇸Waconia, Minnesota, United States
Mercy Hospital Springfield
🇺🇸Springfield, Missouri, United States
Dartmouth Hitchcock Medical Center
🇺🇸Lebanon, New Hampshire, United States
University of New Mexico
🇺🇸Albuquerque, New Mexico, United States
UMDNJ - Robert Wood Johnson University Hospital
🇺🇸New Brunswick, New Jersey, United States
Virtua West Jersey Hospital Voorhees
🇺🇸Voorhees, New Jersey, United States
Southwest Gynecologic Oncology Associates Inc
🇺🇸Albuquerque, New Mexico, United States
Memorial Medical Center - Las Cruces
🇺🇸Las Cruces, New Mexico, United States
University of New Mexico Cancer Center
🇺🇸Albuquerque, New Mexico, United States
State University of New York Downstate Medical Center
🇺🇸Brooklyn, New York, United States
Mount Sinai Medical Center
🇺🇸New York, New York, United States
Carolinas Medical Center/Levine Cancer Institute
🇺🇸Charlotte, North Carolina, United States
Stony Brook University Medical Center
🇺🇸Stony Brook, New York, United States
Novant Health Presbyterian Medical Center
🇺🇸Charlotte, North Carolina, United States
Carolinas HealthCare System NorthEast
🇺🇸Concord, North Carolina, United States
Kettering Medical Center
🇺🇸Kettering, Ohio, United States
Riverside Methodist Hospital
🇺🇸Columbus, Ohio, United States
Lake University Ireland Cancer Center
🇺🇸Mentor, Ohio, United States
Hillcrest Hospital Cancer Center
🇺🇸Mayfield Heights, Ohio, United States
Tulsa Cancer Institute
🇺🇸Tulsa, Oklahoma, United States
Geisinger Medical Center-Cancer Center Hazleton
🇺🇸Hazleton, Pennsylvania, United States
Penn State Milton S Hershey Medical Center
🇺🇸Hershey, Pennsylvania, United States
Geisinger Medical Group
🇺🇸State College, Pennsylvania, United States
Geisinger Wyoming Valley/Henry Cancer Center
🇺🇸Wilkes-Barre, Pennsylvania, United States
West Penn Hospital
🇺🇸Pittsburgh, Pennsylvania, United States
Women and Infants Hospital
🇺🇸Providence, Rhode Island, United States
Reading Hospital
🇺🇸West Reading, Pennsylvania, United States
Sanford Cancer Center-Oncology Clinic
🇺🇸Sioux Falls, South Dakota, United States
Zale Lipshy University Hospital
🇺🇸Dallas, Texas, United States
Clements University Hospital
🇺🇸Dallas, Texas, United States
UT Southwestern/Simmons Cancer Center-Dallas
🇺🇸Dallas, Texas, United States
M D Anderson Cancer Center
🇺🇸Houston, Texas, United States
Sanford USD Medical Center - Sioux Falls
🇺🇸Sioux Falls, South Dakota, United States
Parkland Memorial Hospital
🇺🇸Dallas, Texas, United States
Baylor All Saints Medical Center at Fort Worth
🇺🇸Fort Worth, Texas, United States
University of Vermont Medical Center
🇺🇸Burlington, Vermont, United States
Huntsman Cancer Institute/University of Utah
🇺🇸Salt Lake City, Utah, United States
Cancer Center of Western Wisconsin
🇺🇸New Richmond, Wisconsin, United States
Memorial Hospital of South Bend
🇺🇸South Bend, Indiana, United States
Borgess Medical Center
🇺🇸Kalamazoo, Michigan, United States
Summa Akron City Hospital/Cooper Cancer Center
🇺🇸Akron, Ohio, United States
Bronson Methodist Hospital
🇺🇸Kalamazoo, Michigan, United States
Memorial Sloan-Kettering Cancer Center
🇺🇸New York, New York, United States
Penrose-Saint Francis Healthcare
🇺🇸Colorado Springs, Colorado, United States
Minnesota Oncology and Hematology PA-Woodbury
🇺🇸Woodbury, Minnesota, United States
Geisinger Medical Center
🇺🇸Danville, Pennsylvania, United States
Lehigh Valley Hospital-Cedar Crest
🇺🇸Allentown, Pennsylvania, United States
John Muir Medical Center-Concord Campus
🇺🇸Concord, California, United States
Washington University School of Medicine
🇺🇸Saint Louis, Missouri, United States
Regions Hospital
🇺🇸Saint Paul, Minnesota, United States
CoxHealth South Hospital
🇺🇸Springfield, Missouri, United States
Women's Cancer Care Associates LLC
🇺🇸Albany, New York, United States
University of Wisconsin Hospital and Clinics
🇺🇸Madison, Wisconsin, United States
Sky Ridge Medical Center
🇺🇸Lone Tree, Colorado, United States
Rice Memorial Hospital
🇺🇸Willmar, Minnesota, United States