Velcade,Thalidomide, and Dexamethasone Versus Velcade and Dexamethasone Versus Velcade, Melphalan, and Prednisone
- Conditions
- Multiple Myeloma
- Interventions
- Registration Number
- NCT00507416
- Lead Sponsor
- Millennium Pharmaceuticals, Inc.
- Brief Summary
This is a randomized, open label, multicenter clinical trial to compare the efficacy and safety of Velcade (bortezomib) and dexamethasone versus Velcade, thalidomide, and dexamethasone versus Velcade, melphalan, and prednisone in patients with previously untreated multiple myeloma not considered candidates for high-dose chemotherapy and autologous stem cell transplantation.
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 502
-
Male or female 18 years of age or older
-
Not a candidate for high-dose chemotherapy and stem cell transplantation (HDT/SCT) due to age, presence of important comorbid condition(s) likely to have a negative impact on tolerability of HDT-SCT, or subject preference.
-
A Karnofsky Performance Status score of ≥50%
-
Symptomatic multiple myeloma or asymptomatic multiple myeloma with related organ or tissue damage.
-
Asymptomatic multiple myeloma-related organ or tissue damage can include presence of an asymptomatic lytic bone lesion or plasmacytoma, the presence of anemia (hemoglobin <10 g/dL), renal function impairment (serum creatinine > upper limit of normal [ULN]) or hypercalcemia (serum calcium >ULN).
-
Must have measurable disease requiring systemic therapy. Measurable disease is defined by at least 1 of the following criteria:
- Quantifiable serum M-protein value (>1 g/dL of immunoglobulin (Ig)G or IgM M-protein, >0.5g/dL of IgA M-protein, >0.5 g/dL of IgD M-protein)
- Urine light-chain excretion ≥200 mg/24 hours
-
Voluntary written informed consent must be given before performance of any study related procedure not part of normal medical care, with the understanding that consent may be withdrawn by the participant at any time without prejudice to future medical care.
-
Diagnosis of smoldering multiple myeloma or monoclonal gammopathy of undetermined significance (MGUS). Smoldering multiple myeloma is defined as asymptomatic multiple myeloma with absence of lytic bone lesions. MGUS is defined by presence of serum monoclonal protein <3 g/dL; absence of lytic bone lesions, anemia, hypercalcemia, and renal insufficiency related to the monoclonal protein; and (if determined) proportion of plasma cells in the bone marrow of 10% or less.
-
Diagnosis of Waldenström's disease or other conditions in which immunoglobulin M (IgM) M-protein is present in the absence of a clonal plasma cell infiltration or lytic bone lesions.
-
Previously or currently treated with any systemic therapy for multiple myeloma. Prior treatment of hypercalcemia or spinal cord compression with corticosteroids or radiation therapy, respectively, does not disqualify the subject (the dose of corticosteroids should not exceed the equivalent of 160 mg of dexamethasone in 2-week period).
-
Radiation therapy within 2 weeks before randomization. Enrollment of patients who require concurrent radiotherapy (which must be localized in its field size) should be deferred until the radiotherapy is completed and 2 weeks have elapsed since the last date of therapy.
-
Major surgery within 30 days before randomization (Kyphoplasty is not considered major surgery)
-
History of allergy to any of the study medications, their analogues, or excipients in the various formulations
-
≥Grade 2 peripheral neuropathy on clinical examination within 21 days before enrollment.
-
Any of the following clinical laboratory values within 21 days prior to enrollment:
- Absolute neutrophil count (ANC) <1000 cells/mm^3
- Platelets <100,000 × 10^9/L, or <70 × 10^9/L if thrombocytopenia is considered by the investigator to be due to myeloma infiltration of bone marrow
- Aspartate aminotransferase [serum glutamic oxaloacetic transaminase] (AST [SGOT]) or alanine aminotransferase [serum glutamic-pyruvic transaminase] (ALT [SGPT]) >2× the upper limit of normal (ULN)
- Serum creatinine >2 mg/dL (>176.8 µmol/L); if the rise in creatinine is related to myeloma and there has been demonstrated a response to hydration, the subject may be enrolled.
-
Myocardial infarction within 6 months prior to enrollment or New York Hospital Association Class III or IV heart failure, uncontrolled angina, severe uncontrolled ventricular arrhythmias, or electrocardiographic evidence of acute ischemia or significant conduction system abnormalities in the opinion of the investigator. Prior to study entry, any abnormality on electrocardiogram at screening must be determined and documented by the investigator as not medically relevant.
-
Any condition, including laboratory abnormalities, that in the opinion of the Investigator places the patient at unacceptable risk if he/she were to participate in the study. This includes but is not limited to serious medical conditions or psychiatric illness likely to interfere with participation in this clinical study.
-
Prior malignancy except for adequately treated basal cell or squamous cell skin cancer, in situ cervical cancer, in situ breast cancer, in situ prostate cancer, or other cancer for which the patient has been disease-free for at least 3 years.
-
Female who is pregnant or breastfeeding. Female participants of childbearing potential must have a negative pregnancy test with a sensitivity of at least 50 mIU/mL during Screening.
-
Use of any investigational drugs within 30 days before randomization.
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Bortezomib and Dexamethasone (VD) Bortezomib Participants received bortezomib (Velcade) 1.3 mg/m\^2 administered as a bolus intravenous (IV) injection on Days 1, 4, 8, and 11, and dexamethasone 20 mg orally on Days 1, 2, 4, 5, 8, 9, 11 and 12 for eight 21-day treatment cycles (Induction). Participants then received bortezomib 1.6 mg/\^2 IV on Days 1, 8, 15 and 22 for five 35-day cycles (Maintenance). Bortezomib and Dexamethasone (VD) Dexamethasone Participants received bortezomib (Velcade) 1.3 mg/m\^2 administered as a bolus intravenous (IV) injection on Days 1, 4, 8, and 11, and dexamethasone 20 mg orally on Days 1, 2, 4, 5, 8, 9, 11 and 12 for eight 21-day treatment cycles (Induction). Participants then received bortezomib 1.6 mg/\^2 IV on Days 1, 8, 15 and 22 for five 35-day cycles (Maintenance). Bortezomib, Thalidomide, and Dexamethasone (VTD) Bortezomib Participants received bortezomib (Velcade) 1.3 mg/m\^2 administered as a bolus IV injection on Days 1, 4, 8, and 11, and dexamethasone 20 mg orally on Days 1, 2, 4, 5, 8, 9, 11 and 12, and thalidomide 100 mg orally on Days 1-21 for eight 21-day treatment cycles (Induction). Participants then received bortezomib 1.6 mg/\^2 IV on Days 1, 8, 15 and 22 for five 35-day cycles (Maintenance) . Bortezomib, Thalidomide, and Dexamethasone (VTD) Dexamethasone Participants received bortezomib (Velcade) 1.3 mg/m\^2 administered as a bolus IV injection on Days 1, 4, 8, and 11, and dexamethasone 20 mg orally on Days 1, 2, 4, 5, 8, 9, 11 and 12, and thalidomide 100 mg orally on Days 1-21 for eight 21-day treatment cycles (Induction). Participants then received bortezomib 1.6 mg/\^2 IV on Days 1, 8, 15 and 22 for five 35-day cycles (Maintenance) . Bortezomib, Melphalan and Prednisone (VMP) Bortezomib Participants received bortezomib (Velcade) 1.3 mg/m\^2 administered as a bolus IV injection on Days 1, 4, 8, and 11, and melphalan 9 mg/m\^2 orally on Days 1-4 every other cycle and prednisone 60 mg/m\^2 orally on Days 1-4 every other cycle for eight 21-day treatment cycles (Induction). Participants then received bortezomib 1.6 mg/\^2 IV on Days 1, 8, 15 and 22 for five 35-day cycles (Maintenance). Bortezomib, Thalidomide, and Dexamethasone (VTD) Thalidomide Participants received bortezomib (Velcade) 1.3 mg/m\^2 administered as a bolus IV injection on Days 1, 4, 8, and 11, and dexamethasone 20 mg orally on Days 1, 2, 4, 5, 8, 9, 11 and 12, and thalidomide 100 mg orally on Days 1-21 for eight 21-day treatment cycles (Induction). Participants then received bortezomib 1.6 mg/\^2 IV on Days 1, 8, 15 and 22 for five 35-day cycles (Maintenance) . Bortezomib, Melphalan and Prednisone (VMP) Prednisone Participants received bortezomib (Velcade) 1.3 mg/m\^2 administered as a bolus IV injection on Days 1, 4, 8, and 11, and melphalan 9 mg/m\^2 orally on Days 1-4 every other cycle and prednisone 60 mg/m\^2 orally on Days 1-4 every other cycle for eight 21-day treatment cycles (Induction). Participants then received bortezomib 1.6 mg/\^2 IV on Days 1, 8, 15 and 22 for five 35-day cycles (Maintenance). Bortezomib, Melphalan and Prednisone (VMP) Melphalan Participants received bortezomib (Velcade) 1.3 mg/m\^2 administered as a bolus IV injection on Days 1, 4, 8, and 11, and melphalan 9 mg/m\^2 orally on Days 1-4 every other cycle and prednisone 60 mg/m\^2 orally on Days 1-4 every other cycle for eight 21-day treatment cycles (Induction). Participants then received bortezomib 1.6 mg/\^2 IV on Days 1, 8, 15 and 22 for five 35-day cycles (Maintenance).
- Primary Outcome Measures
Name Time Method Progression Free Survival (PFS) From randomization until disease progression. Median follow-up time was 43 months. PFS is defined as the time from randomization to disease progression or death, whichever occurs first. Participants who did not progress and were still alive at the cut-off date were censored at the date of last contact. Response was assessed by the Investigator using the International Myeloma Working Group (IMWG) uniform response criteria.
Progressive disease requires 1 of the following:
* Increase of ≥ 25% from nadir in:
* Serum M-component (absolute increase ≥ 0.5 g/dl)
* Urine M-component (absolute increase ≥ 200 mg/24 hours)
* In patients without measurable serum and urine M-protein levels the difference between involved and uninvolved free light chain (FLC) levels (absolute increase \> 100 mg/dl)
* Bone marrow plasma cell percentage (absolute % ≥ 10%)
* Development of new or increase in the size of existing bone lesions or soft tissue plasmacytomas.
* Development of hypercalcemia (corrected serum calcium \> 11.5 mg/dl) attributed solely to plasma cell proliferative disease
- Secondary Outcome Measures
Name Time Method Percentage of Participants With an Overall Response Response assessed every other cycle for up to 13 cycles (49 weeks). Overall response defined as a best overall response of complete response (CR), very good partial response (VGPR) or partial response (PR), assessed by the Investigator using the IMWG uniform response criteria.
CR: Negative immunofixation on the serum and urine, disappearance of any soft tissue plasmacytomas, and \<5% plasma cells in bone marrow.
VGPR: Serum and urine M-protein detectable by immunofixation but not on electrophoresis or ≥ 90% reduction in serum M-protein plus urine M-protein level \<100 mg per 24 hours (h).
PR requires 1 of the following:
* ≥50% reduction of serum M-protein and 24-h urinary M-protein by ≥ 90% or to \<200 mg/24 h, or
* If M-protein not measurable, a ≥50% decrease in the difference between involved and uninvolved FLC levels, or
* If FLC not measurable, a ≥ 50% reduction in plasma cells, provided baseline bone marrow plasma cell percentage was ≥30%.
If present at baseline, a ≥50% reduction in the size of soft tissue plasmacytomas is also required.Percentage of Participants With a Complete Response Response assessed every other cycle, for up to 13 cycles (49 weeks). Participants with a best overall response of complete response, defined as negative immunofixation on the serum and urine, disappearance of any soft tissue plasmacytomas, and \<5% plasma cells in bone marrow. Response was assessed by the Investigator using the IMWG uniform response criteria.
Percentage of Participants With a Complete Response or a Very Good Partial Response Response assessed every other cycle for up to 13 cycles (49 weeks). Complete response is defined by negative immunofixation on the serum and urine, disappearance of any soft tissue plasmacytomas, and \<5% plasma cells in bone marrow.
Very good partial response is defined by serum and urine M-protein detectable by immunofixation but not on electrophoresis or 90% or greater reduction in serum M-protein plus urine M-protein level \<100 mg per 24 hours.
Response was assessed by the Investigator using the IMWG uniform response criteria.Duration of Response From first documented response until disease progression. Median follow-up time was 43 months. Duration of response is defined in participants with an overall response as the time between first documentation of response and disease progression. Responders without disease progression were censored at the last clinical assessment of response.
Overall Survival From randomization until death. Median follow-up time was 43 months. Overall survival is defined as the time between randomization and death. Participants still alive at the cutoff date or lost to follow-up were censored at the date of last contact.
Time to Alternative Therapy From randomization until alternative therapy. Median follow-up time was 43 months. Time to alternative therapy is defined as the time between randomization and alternative therapy. Participants who did not receive alternative therapy were censored at the time of last contact.
Change From Baseline in EORTC QLQ-C30 - Global Health Status Baseline and Day 1 of Cycles 3, 5, 7, 9, 11 and 13 The European Organisation for Research and Treatment of Cancer (EORTC) Core Quality of Life (QOL) questionnaire (EORTC QLQ-C30) is a 30-question tool used to assess the overall quality of life in cancer patients. It consists of 15 domains: 1 global health status (GHS) scale, 5 functional scales (Physical, Role, Cognitive, Emotional, Social), and 9 symptom scales/items (Fatigue, Nausea and Vomiting, Pain, Dyspnea, Sleep Disturbance, Appetite Loss, Constipation, Diarrhea, Financial Impact).
The EORTC QLQ-C30 Global Health Status/QOL Scale is scored between 0 and 100, where higher scores indicate better Global Health Status/QOL. Negative changes from baseline indicate deterioration in QOL or functioning and positive changes indicate improvement.
Trial Locations
- Locations (222)
Hematology Oncology Consultants Inc.
🇺🇸Columbus, Ohio, United States
S. Florida Oncology/ Hematology
🇺🇸West Palm Beach, Florida, United States
Hematology-Oncology Clinic
🇺🇸Baton Rouge, Louisiana, United States
Kalamazoo Hematology and Oncology
🇺🇸Kalamazoo, Michigan, United States
Breslin Cancer Center / Great Lakes Cancer Institute
🇺🇸Lansing, Michigan, United States
St. Barnabas Medical Center
🇺🇸Livingston, New Jersey, United States
The Cancer Center of Cookeville Regional Medical Center
🇺🇸Cookeville, Tennessee, United States
Wenatchee Valley Medical Center
🇺🇸Wenatchee, Washington, United States
John H. Stroger, Jr. Hospital of Cook County
🇺🇸Chicago, Illinois, United States
University of Chicago
🇺🇸Chicago, Illinois, United States
University Hospitals of Cleveland
🇺🇸Cleveland, Ohio, United States
Boston Medical Center
🇺🇸Boston, Massachusetts, United States
Investigative Clinical Research of Indiana, LLC
🇺🇸Indianapolis, Indiana, United States
Houston Cancer Institute
🇺🇸Houston, Texas, United States
Medicus Alliance Clinical Research Organization, LLC
🇺🇸Houston, Texas, United States
Auerbach Hematology Oncology Associates
🇺🇸Baltimore, Maryland, United States
Annapolis Oncology Center
🇺🇸Annapolis, Maryland, United States
Oncology Hematology Care, Inc.
🇺🇸Cincinnati, Ohio, United States
Metro MN CCOP
🇺🇸Minneapolis, Minnesota, United States
Cancer Care Center of South Texas
🇺🇸San Antonio, Texas, United States
Utah Cancer Specialists
🇺🇸Salt Lake City, Utah, United States
Cancer Care Associates
🇺🇸Oklahoma City, Oklahoma, United States
Henry Ford Health System
🇺🇸Detroit, Michigan, United States
Desert Oasis Cancer Center
🇺🇸Casa Grande, Arizona, United States
Compassionate Cancer Care Medical Group, Inc.
🇺🇸Riverside, California, United States
Cancer Center of Central Connecticut
🇺🇸Southington, Connecticut, United States
Glendale Memorial Hospital & Health Center
🇺🇸Glendale, California, United States
Clinical Trials and Research Associates, Inc.
🇺🇸Montebello, California, United States
Medical Oncology Care Associates
🇺🇸Orange, California, United States
Northern Arizona Hematology & Oncology Associates - AOA
🇺🇸Sedona, Arizona, United States
Heritage Physician Group Oncology
🇺🇸Hot Springs, Arkansas, United States
Robert A. Moss, MD, FACP, Inc.
🇺🇸Fountain Valley, California, United States
Edward A. Wagner, MD
🇺🇸Laguna Beach, California, United States
Southwest Cancer Care
🇺🇸Poway, California, United States
Northwest Oncology & Hematology Associates
🇺🇸Coral Springs, Florida, United States
Horizon Institute for Clinical Research
🇺🇸Hollywood, Florida, United States
Medical Oncology Associates of Augusta
🇺🇸Augusta, Georgia, United States
Northwest Georgia Oncology Centers, P.C.
🇺🇸Marietta, Georgia, United States
Summit Cancer Care
🇺🇸Savannah, Georgia, United States
Lakeland Regional Cancer Center
🇺🇸Lakeland, Florida, United States
Hematology Oncology Associates of Illinois
🇺🇸Chicago, Illinois, United States
Midwest Center for Hematology / Oncology
🇺🇸Joliet, Illinois, United States
Deaconess Clinic Incorporated
🇺🇸Evansville, Indiana, United States
Oncology Hematology Associates of North Illinois Ltd.
🇺🇸Gurnee, Illinois, United States
Cancer Care and Hematology Specialists of Chicagoland
🇺🇸Niles, Illinois, United States
Central Indiana Cancer Centers
🇺🇸Indianapolis, Indiana, United States
McFarland Clinic, P.C.
🇺🇸Ames, Iowa, United States
Clarian Arnett Cancer Center
🇺🇸Lafayette, Indiana, United States
Cancer Care Center
🇺🇸New Albany, Indiana, United States
Medical Consultants, PC
🇺🇸Muncie, Indiana, United States
Siouxland Hematology/Oncology Assoc., LLP
🇺🇸Sioux City, Iowa, United States
Quincy Medical Group
🇺🇸Quincy, Illinois, United States
Maryland Oncology Hematology, PA
🇺🇸Columbia, Maryland, United States
Greater Baltimore Medical Center
🇺🇸Baltimore, Maryland, United States
Maryland Hematology Oncology Association
🇺🇸Baltimore, Maryland, United States
St. Agnes Health Care
🇺🇸Baltimore, Maryland, United States
Oncology-Hematology Associates, P.A.
🇺🇸Clinton, Maryland, United States
Fallon Clinic at Worcester Medical Center
🇺🇸Worcester, Massachusetts, United States
Hematology Oncology Associates of Ohio & Michigan, PC
🇺🇸Lambertville, Michigan, United States
St. Louis Cancer Center
🇺🇸Chesterfield, Missouri, United States
Great Falls Clinic, LLP
🇺🇸Great Falls, Montana, United States
Buffalo Institute for Medical Research, Inc.
🇺🇸Buffalo, New York, United States
Veterans Affairs New Jersey Healthcare System
🇺🇸East Orange, New Jersey, United States
Drs. Forte, Schleider, Attas and Condemi, PA
🇺🇸Englewood, New Jersey, United States
Newark Beth Israel Hospital
🇺🇸Newark, New Jersey, United States
Somerset Hematology Oncology Associates
🇺🇸Somerville, New Jersey, United States
SUNY Upstate Medical University
🇺🇸Syracuse, New York, United States
Interlakes Foundation, Inc.
🇺🇸Rochester, New York, United States
Carolina Oncology Specialist, PA
🇺🇸Hickory, North Carolina, United States
New York Medical College
🇺🇸Valhalla, New York, United States
Cancer Care of WNC
🇺🇸Asheville, North Carolina, United States
Alamance Regional Medical Center
🇺🇸Burlington, North Carolina, United States
Greater Philadelphia Cancer and Hematology Specialists, PC
🇺🇸Philadelphia, Pennsylvania, United States
UPMC Cancer Pavillioin
🇺🇸Pittsburgh, Pennsylvania, United States
Scranton Hematology Oncology
🇺🇸Scranton, Pennsylvania, United States
Regional Hematology Oncology Associates
🇺🇸Langhorne, Pennsylvania, United States
Santee Hematology/Oncology
🇺🇸Sumter, South Carolina, United States
Texas Cancer Center
🇺🇸Fort Worth, Texas, United States
Sarah Cannon Research Institute
🇺🇸Nashville, Tennessee, United States
Virginia Oncology Associates
🇺🇸Norfolk, Virginia, United States
Northern Utah Associates
🇺🇸Ogden, Utah, United States
University of Tennesee Medical Center
🇺🇸Knoxville, Tennessee, United States
Texas Oncology, PA
🇺🇸Tyler, Texas, United States
Paris Regional Cancer Center
🇺🇸Paris, Texas, United States
Cancer Care Network of South Texas
🇺🇸San Antonio, Texas, United States
Texas Cancer Center - Sherman
🇺🇸Sherman, Texas, United States
The University of Vermont
🇺🇸Burlington, Vermont, United States
CTRC Institute for Drug Development
🇺🇸San Antonio, Texas, United States
Cancer Specialists of Tidewater
🇺🇸Chesapeake, Virginia, United States
Fairfax/Northern Virginia Hematology/Oncology
🇺🇸Fairfax, Virginia, United States
Masoom Kandahari, MD, PC
🇺🇸Woodbridge, Virginia, United States
Oncology and Hematology Associates of Southwest Virginia, Inc.
🇺🇸Salem, Virginia, United States
Puget Sound Cancer Center - Edmonds
🇺🇸Edmonds, Washington, United States
Lynchburg Hematology Oncology Clinic, Inc.
🇺🇸Lynchburg, Virginia, United States
Yakima Valley Memorial Hospital / North Star Lodge
🇺🇸Yakima, Washington, United States
Rocky Mountain Cancer Center
🇺🇸Denver, Colorado, United States
Birmingham Hematology Oncology Assciates, LLC
🇺🇸Birmingham, Alabama, United States
Hubert H. Humphrey Cancer Center
🇺🇸Robbinsdale, Minnesota, United States
Cancer Center of Kansas
🇺🇸Wichita, Kansas, United States
Northwest Medical Specialties, PLLC
🇺🇸Tacoma, Washington, United States
Puget Sound Cancer Center, Inc
🇺🇸Seattle, Washington, United States
Arizona Oncology Associates
🇺🇸Tucson, Arizona, United States
Sparta Cancer Center
🇺🇸Sparta, New Jersey, United States
Oncology Care Associates, P.L.L.C.
🇺🇸St. Joseph, Michigan, United States
Florida Cancer Institute
🇺🇸New Port Richey, Florida, United States
Ocala Oncology Center
🇺🇸Ocala, Florida, United States
Gulfcoast Oncology Associates
🇺🇸St. Petersburg, Florida, United States
Hematology Oncology Associates of the Treasure Coast, PA
🇺🇸Port St. Lucie, Florida, United States
White River Junction VAMC
🇺🇸White River Junction, Vermont, United States
Low Country Hematology & Oncology
🇺🇸Mt. Pleasant, South Carolina, United States
Elmhurst Memorial Hospital
🇺🇸Elmhurst, Illinois, United States
Joliet Oncology-Hematology Associates, Ltd.
🇺🇸Joliet, Illinois, United States
Coastal Bend Cancer Center
🇺🇸Corpus Christi, Texas, United States
Texas Oncology - Odessa
🇺🇸Odessa, Texas, United States
Texas Cancer Center of Mesquite
🇺🇸Mesquite, Texas, United States
Sutter Cancer Center
🇺🇸Sacramento, California, United States
Center for Cancer and Blood Disorders
🇺🇸Bethesda, Maryland, United States
Creighton Cancer Center
🇺🇸Omaha, Nebraska, United States
Christus St. Francis Cabrini Cancer Center
🇺🇸Alexandria, Louisiana, United States
Goshen Medical Associates
🇺🇸Goshen, New York, United States
Central Georgia Cancer Care
🇺🇸Macon, Georgia, United States
Cancer & Blood Disease Center
🇺🇸Lecanto, Florida, United States
Cancer Research & Prevention Center
🇺🇸Soquel, California, United States
Desert Cancer Care, Incorporated
🇺🇸Rancho Mirage, California, United States
Trivalley Oncology Hematology
🇺🇸Westlake Village, California, United States
Christiana Care Health Services
🇺🇸Newark, Delaware, United States
The Center for Hematology-Oncology
🇺🇸Boca Raton, Florida, United States
Avera Research Institute
🇺🇸Sioux Falls, South Dakota, United States
Pasco Hernando Oncology
🇺🇸New Port Richey, Florida, United States
Kansas City Cancer Centers - Southwest
🇺🇸Overland Park, Kansas, United States
Innovative Medical Research of South Florida Inc.
🇺🇸North Miami Beach, Florida, United States
Commonwealth Cancer Center
🇺🇸Danville, Kentucky, United States
Western Kentucky Hematology and Oncology Group
🇺🇸Paducah, Kentucky, United States
Cancer & Hematology Centers of Western Michigan
🇺🇸Grand Rapids, Michigan, United States
Erie County Medical Center
🇺🇸Buffalo, New York, United States
Pacific Cancer Medical Centre
🇺🇸Anaheim, California, United States
Hematology Oncology Services of Arkansas
🇺🇸Little Rock, Arkansas, United States
Ventura County Hematology Oncology Specialists
🇺🇸Oxnard, California, United States
Compassionate Cancer Care Medical Group
🇺🇸Corona, California, United States
California Cancer Care
🇺🇸Greenbrae, California, United States
Tower Cancer Research Foundation
🇺🇸Beverly Hills, California, United States
Beaver Medical Group
🇺🇸Highland, California, United States
Stockton Hematology/Oncology
🇺🇸Stockton, California, United States
Florida Cancer Specialists
🇺🇸Fort Myers, Florida, United States
Baptist Cancer Institute
🇺🇸Jacksonville, Florida, United States
University of Florida- Jacksonville
🇺🇸Jacksonville, Florida, United States
Cancer Care of North Florida
🇺🇸Lake City, Florida, United States
Cancer Centers of Florida, P.A.
🇺🇸Ocoee, Florida, United States
Snake River Oncology of Eastern Idaho, PLLC.
🇺🇸Idaho Falls, Idaho, United States
Cancer Care & Hematology Specialists of Chicagoland
🇺🇸Arlington Heights, Illinois, United States
St. Lukes Mountain States Tumor Institute
🇺🇸Boise, Idaho, United States
Mid-Illinois Hem & Onc
🇺🇸Normal, Illinois, United States
Hematology Oncology Consultants, Inc.
🇺🇸Naperville, Illinois, United States
Memorial Hospital of South Bend
🇺🇸South Bend, Indiana, United States
Hope Center
🇺🇸Terre Haute, Indiana, United States
Kentucky Cancer Clinic
🇺🇸Hazard, Kentucky, United States
Carroll County Cancer Center
🇺🇸Westminster, Maryland, United States
Providence Cancer Center
🇺🇸Southfield, Michigan, United States
Capital Region Medical Center/Cancer Center
🇺🇸Jefferson City, Missouri, United States
Osteopathic Medical Hematology & Oncology
🇺🇸Woodhaven, Michigan, United States
St. Luke's Hospital
🇺🇸Duluth, Minnesota, United States
St. Joseph Oncology
🇺🇸St. Joseph, Missouri, United States
Great Plains Regional Medical Center
🇺🇸North Platte, Nebraska, United States
Las Vegas Cancer Center
🇺🇸Henderson, Nevada, United States
Comprehensive Cancer Centers of Nevada
🇺🇸Las Vegas, Nevada, United States
New Mexico Cancer Care Associates
🇺🇸Santa Fe, New Mexico, United States
Stratton VA Medical Center IRB
🇺🇸Albany, New York, United States
Huntington Medical Group
🇺🇸Huntington Station, New York, United States
North Shore-Long Island Jewish Health System
🇺🇸Lake Success, New York, United States
Memorial Sloan Kettering Cancer Center
🇺🇸New York, New York, United States
Arena Oncology Associates
🇺🇸New Hyde Park, New York, United States
New York Presbyterian Hospital-Cornell Campus
🇺🇸New York, New York, United States
Richmond University Medical Center
🇺🇸Staten Island, New York, United States
Blood and Cancer Clinic
🇺🇸Fayetteville, North Carolina, United States
Gaston Hematology & Oncology
🇺🇸Gastonia, North Carolina, United States
Raleigh Hematology Oncology / Associates, P.C.
🇺🇸Raleigh, North Carolina, United States
Emerywood Hematology/Oncology
🇺🇸High Point, North Carolina, United States
Hanover Medical Specialists, P.A.
🇺🇸Wilmington, North Carolina, United States
St. Alexius Clinical Research Services
🇺🇸Bismark, North Dakota, United States
Gabrail Cancer Center
🇺🇸Canton, Ohio, United States
Oncology Partners Network
🇺🇸Cincinnati, Ohio, United States
Dayton Clinical Oncology Program
🇺🇸Dayton, Ohio, United States
Dayton Oncology & Hematology
🇺🇸Kettering, Ohio, United States
Toledo Community Hospital Oncology Program
🇺🇸Toledo, Ohio, United States
Willamette Valley Cancer Center
🇺🇸Eugene, Oregon, United States
Trilogy Cancer Center
🇺🇸Wooster, Ohio, United States
Oklahoma Oncology and Hematology
🇺🇸Tulsa, Oklahoma, United States
Hematology & Oncology Associates of NEPA
🇺🇸Dunmore, Pennsylvania, United States
Onc-Hem of Lehigh Valley, PC
🇺🇸Bethlehem, Pennsylvania, United States
Medical Oncology Associates
🇺🇸Kingston, Pennsylvania, United States
Roger Williams Medical Center
🇺🇸Providence, Rhode Island, United States
Guthrie Research Institute
🇺🇸Sayre, Pennsylvania, United States
Cancer Center of the Carolinas
🇺🇸Greenville, South Carolina, United States
The Family Cancer Center, PLLC
🇺🇸Collierville, Tennessee, United States
Chattanooga Oncology Hematology Associates
🇺🇸Chattanooga, Tennessee, United States
The Jones Clinic
🇺🇸Germantown, Tennessee, United States
East Tennessee Oncology/Hematology
🇺🇸Knoxville, Tennessee, United States
Texas Oncology, P.A.
🇺🇸Midland, Texas, United States
South Texas Institute of Cancer and Blood Disorders
🇺🇸Corpus Christi, Texas, United States
Dallas Oncology Consultants
🇺🇸Dallas, Texas, United States
Texas Oncology
🇺🇸Waco, Texas, United States
Texas Oncology, PA / Methodist Charlton Cancer Center
🇺🇸Dallas, Texas, United States
El Paso Cancer Treatment Center
🇺🇸El Paso, Texas, United States
Lee C. Drinkard, MD
🇺🇸Grapevine, Texas, United States
Texas Oncology PA
🇺🇸Dallas, Texas, United States
Lake Vista Cancer Center
🇺🇸Lewisville, Texas, United States
Longview Cancer Center
🇺🇸Longview, Texas, United States
Blood and Cancer Center of East Texas
🇺🇸Tyler, Texas, United States
Tyler Hematology/Oncology, PA
🇺🇸Tyler, Texas, United States
Peninsula Cancer Institute Riverside Cancer Center
🇺🇸Newport News, Virginia, United States
Gundersen Clinic, Ltd.
🇺🇸La Crosse, Wisconsin, United States
Alyce & Elmore Kraemer Cancer Center
🇺🇸West Bend, Wisconsin, United States
Providence Everett Medical Center
🇺🇸Everett, Washington, United States
Hospital Auxillo Mutuo, Auxilio Mutuo Cancer Center
🇵🇷San Juan, Puerto Rico
MD Anderson Cancer Center Orlando
🇺🇸Orlando, Florida, United States
Heartland Hematology-Oncology Associates, Inc.
🇺🇸Kansas City, Missouri, United States
Kansas City Veterans Administration Medical Center
🇺🇸Kansas City, Missouri, United States
MUSC Hollings Cancer Center
🇺🇸Charleston, South Carolina, United States
Virginia Cancer Institute
🇺🇸Richmond, Virginia, United States
Southwest Regional Cancer Center
🇺🇸Austin, Texas, United States
Eastchester Center for Cancer Care
🇺🇸Bronx, New York, United States
Cancer Care Northwest, US Oncology
🇺🇸Spokane, Washington, United States