Dasatinib in Treating Patients With Recurrent Glioblastoma Multiforme or Gliosarcoma
- Conditions
- Adult Giant Cell GlioblastomaAdult GlioblastomaAdult GliosarcomaRecurrent Adult Brain Neoplasm
- Interventions
- Drug: DasatinibOther: Pharmacological Study
- Registration Number
- NCT00423735
- Lead Sponsor
- National Cancer Institute (NCI)
- Brief Summary
This phase II trial studies how well dasatinib works in treating patients with glioblastoma multiforme or gliosarcoma that has come back. Dasatinib may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth.
- Detailed Description
PRIMARY OBJECTIVES:
I. To determine the therapeutic efficacy of dasatinib in all patients (i.e., stages 1B and 2 combined) with recurrent/progressive glioblastoma (GBM) as measured by 6-month progression-free survival.
SECONDARY OBJECTIVES:
I. To determine the therapeutic efficacy of dasatinib for stage 1B patients with recurrent/progressive GBM as measured by a hybrid endpoint of 6-month progression-free survival OR objective response of (complete response \[CR\] or partial response \[PR\]) rate.
II. To determine patient overall survival. III. To determine the toxicity of dasatinib in the treatment of patients with GBM.
IV. To determine radiographic response rate to treatment. V. To determine patient progression-free survival. VI. To explore molecular correlates of clinical outcome. VII. To explore pharmacokinetic correlates of dosing, toxicity, and efficacy.
OUTLINE:
Patients receive dasatinib orally (PO) twice daily (BID) on days 1-28. Courses repeat every 28 days in the absence of disease progression and unacceptable toxicity.
After the completion of study treatment, patients are followed up periodically.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 64
-
Histologically proven diagnosis of GBM; gliosarcoma is also an eligible diagnosis
-
The patient must consent to submission of tissue for central pathology review
-
Patients who have already undergone central pathology review through their enrollment on another Radiation Therapy Oncology Group (RTOG) GBM trial do not need to consent to having their material re-reviewed by the central pathologist for this study
-
All patients must consent to molecular analysis of pre-dasatinib tumor tissue
-
Patients accrued to stage I (closed to accrual) or stage IB (opened to accrual May 5, 2009) must have tumors overexpressing at least 2 known dasatinib targets (i.e., SRC proto-oncogene, non-receptor tyrosine kinase [SRC], v-kit Hardy-Zuckerman 4 feline sarcoma viral oncogene homolog [KIT], platelet-derived growth factor receptor [PDGFR], or ephrin type-A receptor 2 [EPHA2])
-
Patients accrued to stage II (cohort closed; not currently applicable) do not require overexpression of SRC, KIT, PDGFR, or EPHA2
-
History and physical examination, including height and weight, within 10 days prior to registration on study
-
Brain magnetic resonance imaging (MRI) with and without gadolinium within 10 days prior to registration on study
-
Contrast-enhanced computed tomography (CT) scans are allowed for patients who cannot undergo MRI scanning
-
Karnofsky performance status >= 60
-
Absolute neutrophil count (ANC) >= 1,000 cells/mm^3
-
Platelets >= 75,000 cells/mm^3
-
Hemoglobin (Hgb) >= 8.0 g/dl; (note: the use of transfusion or other intervention to achieve Hgb >= 8.0 g/dl is acceptable)
-
Leukocytes >= 3,000 cells/mm^3
-
Absolute lymphocyte count (ALC) >= 500 cells/mm^3
-
Total bilirubin =< 1.5 X institutional upper limit of normal (ULN)
-
Aspartate aminotransferase (AST) (serum glutamic oxaloacetic transaminase [SGOT])/alanine aminotransferase (ALT) (serum glutamate pyruvate transaminase [SGPT]) =< 2.5 institutional upper limit of normal
-
Creatinine =< 3 X institutional upper limit of normal or creatinine clearance >= 60 mL/min/1.73 m^2 for patients with creatinine levels above institutional normal
-
All patients must have undergone prior treatment with radiotherapy and temozolomide; no other prior treatments are allowed
-
There must be unequivocal radiographic evidence for tumor progression by MRI or CT scan, and the same type of scan (i.e., MRI or CT) must be used throughout the period of protocol treatment for tumor measurement; patients must be on a stable or decreasing dose of corticosteroids for at least 5 days before the baseline MRI/CT is performed
-
Patients having undergone recent surgery for recurrent/progressive disease are eligible as long as they have recovered from the effects of surgery; patients who recently underwent resection without measurable disease post-operatively are also eligible
-
Measurable disease is not required for eligibility in patients who recently underwent resection as long as the following conditions are met as applicable:
- Progression of disease led to the surgery
- Gliadel wafers were not placed during the most recent surgery
- Neither convection enhanced delivery nor catheters for infusion of chemotherapy were used during the most recent surgery
- Radioactive seeds were not placed during the most recent surgery
- The histology of the most recent surgery documented recurrent/persistent/progressive malignant glioma
-
Women of childbearing potential must have a negative beta human chorionic gonadotropin (B HCG) pregnancy test =< 3 days prior to registration
-
Patient must sign study-specific informed consent prior to study entry
-
Prior invasive malignancy (except non-melanomatous skin cancer) unless disease free for a minimum of 3 years; (for example, carcinoma in situ of the breast, oral cavity, or cervix are all permissible)
-
Radiotherapy within 4 weeks or temozolomide within 14 days prior to registration or failure to recover from adverse events of either radiotherapy or temozolomide
-
Patients may not be receiving any other investigational agents
-
Severe, active comorbidity, defined as follows:
-
Any clinically significant cardiovascular disease including the following:
- Unstable angina and/or congestive heart failure requiring hospitalization within the past 6 months
- Transmural myocardial infarction or ventricular tachyarrhythmia within the past 6 months
- Prolonged corrected QT interval (QTc) > 480 msec (Fridericia correction)
- Ejection fraction less than institutional normal
- Major conduction abnormality (unless a cardiac pacemaker is present)
-
Acute bacterial or fungal infection requiring intravenous antibiotics at the time of registration
-
Chronic obstructive pulmonary disease exacerbation or other respiratory illness requiring hospitalization or precluding study therapy at the time of registration
-
Acquired immune deficiency syndrome (AIDS) based upon current Centers for Disease Control and Prevention (CDC) definition; note, however, that human immunodeficiency virus (HIV) testing is not required for entry into this protocol
-
-
Pregnancy or women of childbearing potential and men who are sexually active and not willing/able to use medically acceptable forms of contraception; breastfeeding should be discontinued if the mother is treated with dasatinib
-
History of allergic reactions attributed to compounds of similar chemical or biologic composition to dasatinib
-
Patients who require concurrent treatment with any medications or substances that are potent inhibitors or inducers of cytochrome P450, family 3, subfamily A, polypeptide 4 (CYP3A4) are ineligible
-
Patients must not be taking hepatic enzyme inducing antiepileptic drugs (EIAEDs); if patients were previously on EIAEDs that have been discontinued, patients must have been off EIAEDs for >= 2 weeks prior to initiation of dasatinib
-
Patients who require antacids should use short-acting, locally active agents (e.g., Maalox, Mylanta etc.); however, these agents should not be taken within either 2 hours before or 2 hours after the dasatinib dose
-
Use of antithrombotic and/or antiplatelet agents (e.g., warfarin, heparin, low molecular weight heparin, aspirin, clopidogrel, ticlopidine, Aggrenox)
-
Use of ibuprofen or non-steroidal anti-inflammatory drugs (NSAIDs)
-
Patients with any condition (e.g., gastrointestinal tract disease resulting in an inability to take oral medication or a requirement for intravenous [IV] alimentation, prior surgical procedures affecting absorption, or active peptic ulcer disease) that impairs their ability to swallow and retain dasatinib tablets are excluded
-
Prior treatment with stereotactic radiosurgery (including Gamma-Knife, Cyberknife, or other variants) or brachytherapy
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- SINGLE_GROUP
- Arm && Interventions
Group Intervention Description Treatment (dasatinib) Pharmacological Study Patients receive dasatinib PO BID on days 1-28. Courses repeat every 28 days in the absence of disease progression and unacceptable toxicity. Treatment (dasatinib) Dasatinib Patients receive dasatinib PO BID on days 1-28. Courses repeat every 28 days in the absence of disease progression and unacceptable toxicity.
- Primary Outcome Measures
Name Time Method Number of Patients Achieving 6-month Progression-free Survival (6mPFS) Registration to 6 months This study utilized a two-stage phase II design (Stage 1B and 2). The primary endpoint of 6-month progression-free survival (6mPFS) would be assessed based on the patients combined from 1B and 2 if the study continued to Stage 2. Null hypothesis = 11%; alternative hypothesis = 25%. Simon's minmax 2-stage design was used with type I and type II error both set at 10%. If the first stage met its criteria (see secondary outcome measure), then accrual would continue, otherwise there would be no further accrual and the alternative hypothesis would be rejected. Following Stage 2 accrual completion and 6 months of follow-up, if 9 or more patients were alive without progression by 6 months, the null hypothesis would be rejected in favor of the alternative.
- Secondary Outcome Measures
Name Time Method Number of Patients Achieving Objective Response (Partial or Complete Response) OR 6-month Progression-free Survival (6mPFS) Registration to 6 months Study design and efficacy determination uses the hybrid endpoint of 6mPFS or complete/partial response of any duration prior to or at 6 months. Null hypothesis = 11%; alternative hypothesis = 25%. Simon's minmax 2-stage design was used with type I and type II error both set at 10%. Stage 1 and 1B: If 2 or fewer patients were alive and progression-free at 6 months or achieved complete/partial response, then there would be no further accrual and the alternative hypothesis would be rejected. Otherwise accrual would continue to a total of 50 analyzable patients to address the primary endpoint. Complete Response: Complete disappearance of all enhancing tumor on consecutive CT or MRI scans at least 1 month apart; off corticosteroids; neurologically stable/improved. Partial Response: ≥ 50% decrease in size of enhancing tumor on consecutive CT or MRI scans at least 1 month apart; corticosteroids stable/reduced; neurologically stable/improved.
Overall Survival Analysis occurs after all patients have been on study for at least 6 months. (Patients are followed from registration to death or study termination whichever occurs first.) Survival time is defined as time from randomization to date of death from any cause and is estimated by the Kaplan-Meier method. Patients last known to be alive are censored at the date of last contact. The study is not designed for a comparison of the treatment arms to each other.
Treatment Response Rates at Six Months From registration to 6 months Best response is assessed using standard criteria for patients with malignant gliomas (Macdonald 1990) as reported by the site. Complete response (CR): Complete disappearance of all enhancing tumor on consecutive CT or MRI scans at least 1 month apart; off corticosteroids; neurologically stable/improved. Partial response (PR): ≥ 50% decrease in size of enhancing tumor on consecutive CT or MRI scans at least 1 month apart; corticosteroids stable/reduced; neurologically stable/improved. Stable disease (SD): Does not qualify for CR, PR, or PD. Progressive disease (PD): ≥ 25% increase in the size of enhancing tumor or any new tumor; neurologically worse; steroids stable/increased. The best tumor response is defined as the best radiographic response for patients evaluable for radiographic response prior to progression, up to six months. The study is not designed for a comparison of the treatment arms to each other.
Rate of Adverse Events Analysis occurs after all patients have been on study for at least 6 months. (Patients are followed from registration to death or study termination whichever occurs first.) The rate of patients' worst overall grade of adverse event is reported. Adverse events are graded using CTCAE v3.0. Grade refers to the severity of the AE. The CTCAE v3.0 assigns Grades 1 through 5 with unique clinical descriptions of severity for each AE based on this general guideline: Grade 1 Mild AE, Grade 2 Moderate AE, Grade 3 Severe AE, Grade 4 Life-threatening or disabling AE, Grade 5 Death related to AE. The study is not designed for a comparison of the treatment arms to each other.
Progression-free Survival Analysis occurs after all patients have been on study for at least 6 months. (Patients are followed from registration to death or study termination whichever occurs first.) Progression-free survival time is measured from randomization to the date of first progression or death, else the last follow-up date on which the patient was reported alive, and is estimated by the Kaplan-Meier method. Progression is defined as ≥ 25% increase in the size of enhancing tumor or any new tumor, neurologically worse, or steroids stable/increased. The study is not designed for a comparison of the treatment arms to each other.
Correlation of Molecular Markers and Tumor Response From registration to 6 months The following markers were examined: p-SRC, PDGFR, EPHA2, c-KIT. Patients were categorized based on the number of positive molecular markers they had: 2 vs. 3 and 4. Correlation of marker category and best tumor response was tested using Fisher's exact test. The best tumor response is defined as the best radiographic response for patients evaluable for radiographic response prior to progression up to six months. Patients are combined from the two treatment arms.
Correlation of Pharmacokinetic Data With Dosing, Toxicity, and Efficacy Analysis occurs after all patients have been on study for at least 6 months. (Patients are followed from registration to death or study termination whichever occurs first.) Sufficient pharmacokinetic data was not obtained.
Trial Locations
- Locations (188)
Boca Raton Regional Hospital
🇺🇸Boca Raton, Florida, United States
Boston Medical Center
🇺🇸Boston, Massachusetts, United States
M D Anderson Cancer Center
🇺🇸Houston, Texas, United States
University of Cincinnati/Barrett Cancer Center
🇺🇸Cincinnati, Ohio, United States
Hennepin County Medical Center
🇺🇸Minneapolis, Minnesota, United States
Sutter Cancer Centers Radiation Oncology Services-Auburn
🇺🇸Auburn, California, United States
The University of Arizona Medical Center-University Campus
🇺🇸Tucson, Arizona, United States
Sutter Cancer Centers Radiation Oncology Services-Cameron Park
🇺🇸Cameron Park, California, United States
Mobile Infirmary Medical Center
🇺🇸Mobile, Alabama, United States
Regions Hospital
🇺🇸Saint Paul, Minnesota, United States
Arizona Oncology Services Foundation
🇺🇸Scottsdale, Arizona, United States
Mercy San Juan Medical Center
🇺🇸Carmichael, California, United States
University of Rochester
🇺🇸Rochester, New York, United States
North Memorial Medical Health Center
🇺🇸Robbinsdale, Minnesota, United States
Novant Health Presbyterian Medical Center
🇺🇸Charlotte, North Carolina, United States
Sparta Cancer Treatment Center
🇺🇸Sparta, New Jersey, United States
Good Samaritan Hospital - Dayton
🇺🇸Dayton, Ohio, United States
Cheshire Medical Center-Dartmouth-Hitchcock Keene
🇺🇸Keene, New Hampshire, United States
Delaware County Memorial Hospital
🇺🇸Drexel Hill, Pennsylvania, United States
Centerpoint Medical Center LLC
🇺🇸Independence, Missouri, United States
Metro Minnesota Community Oncology Research Consortium
🇺🇸Saint Louis Park, Minnesota, United States
Integrated Community Oncology Network-Florida Cancer Center Beaches
🇺🇸Jacksonville Beach, Florida, United States
Abbott-Northwestern Hospital
🇺🇸Minneapolis, Minnesota, United States
Saint Francis Regional Medical Center
🇺🇸Shakopee, Minnesota, United States
Memorial Sloan Kettering Cancer Center
🇺🇸New York, New York, United States
Rutherford Hospital
🇺🇸Rutherfordton, North Carolina, United States
Dartmouth Hitchcock Medical Center
🇺🇸Lebanon, New Hampshire, United States
Integrated Community Oncology Network-Southside Cancer Center
🇺🇸Jacksonville, Florida, United States
Highland Hospital
🇺🇸Rochester, New York, United States
Park Nicollet Clinic - Saint Louis Park
🇺🇸Saint Louis Park, Minnesota, United States
University of Florida Health Science Center - Jacksonville
🇺🇸Jacksonville, Florida, United States
United Hospital
🇺🇸Saint Paul, Minnesota, United States
Atrium Medical Center-Middletown Regional Hospital
🇺🇸Franklin, Ohio, United States
Miami Valley Hospital
🇺🇸Dayton, Ohio, United States
Blanchard Valley Hospital
🇺🇸Findlay, Ohio, United States
West Michigan Cancer Center
🇺🇸Kalamazoo, Michigan, United States
Spartanburg Medical Center
🇺🇸Spartanburg, South Carolina, United States
Singing River Hospital
🇺🇸Pascagoula, Mississippi, United States
Northeast Radiation Oncology Center
🇺🇸Dunmore, Pennsylvania, United States
Sandra L Maxwell Cancer Center
🇺🇸Cedar City, Utah, United States
Thompson Cancer Survival Center - West
🇺🇸Knoxville, Tennessee, United States
Aultman Health Foundation
🇺🇸Canton, Ohio, United States
Minnesota Oncology Hematology PA-Woodbury
🇺🇸Woodbury, Minnesota, United States
Upper Valley Medical Center
🇺🇸Troy, Ohio, United States
Veteran Affairs Medical Center
🇺🇸Dayton, Ohio, United States
Covenant Medical Center-Lakeside
🇺🇸Lubbock, Texas, United States
Summa Akron City Hospital/Cooper Cancer Center
🇺🇸Akron, Ohio, United States
Saint Francis Hospital
🇺🇸Greenville, South Carolina, United States
Greenville Health System Cancer Institute-Eastside
🇺🇸Greenville, South Carolina, United States
Cottonwood Hospital Medical Center
🇺🇸Murray, Utah, United States
Summa Barberton Hospital
🇺🇸Barberton, Ohio, United States
Logan Regional Hospital
🇺🇸Logan, Utah, United States
Cape Radiation Oncology
🇺🇸Cape Girardeau, Missouri, United States
Utah Valley Regional Medical Center
🇺🇸Provo, Utah, United States
Upper Delaware Valley Cancer Center
🇺🇸Milford, Pennsylvania, United States
University Pointe
🇺🇸West Chester, Ohio, United States
Thompson Cancer Survival Center at Methodist
🇺🇸Oak Ridge, Tennessee, United States
Dixie Medical Center Regional Cancer Center
🇺🇸Saint George, Utah, United States
Wellmont Holston Valley Hospital and Medical Center
🇺🇸Kingsport, Tennessee, United States
Adams Cancer Center
🇺🇸Gettysburg, Pennsylvania, United States
Cherry Tree Cancer Center
🇺🇸Hanover, Pennsylvania, United States
Cleveland Clinic Akron General
🇺🇸Akron, Ohio, United States
American Fork Hospital / Huntsman Intermountain Cancer Center
🇺🇸American Fork, Utah, United States
AnMed Health Hospital
🇺🇸Anderson, South Carolina, United States
University of Vermont College of Medicine
🇺🇸Burlington, Vermont, United States
Saint Vincent Hospital Cancer Center Green Bay
🇺🇸Green Bay, Wisconsin, United States
WellSpan Health-York Hospital
🇺🇸York, Pennsylvania, United States
McKay-Dee Hospital Center
🇺🇸Ogden, Utah, United States
Penn State Milton S Hershey Medical Center
🇺🇸Hershey, Pennsylvania, United States
Rapid City Regional Hospital
🇺🇸Rapid City, South Dakota, United States
Thompson Cancer Survival Center
🇺🇸Knoxville, Tennessee, United States
Intermountain Medical Center
🇺🇸Murray, Utah, United States
Intermountain Health Care
🇺🇸Salt Lake City, Utah, United States
Utah Cancer Specialists-Salt Lake City
🇺🇸Salt Lake City, Utah, United States
Huntsman Cancer Institute/University of Utah
🇺🇸Salt Lake City, Utah, United States
LDS Hospital
🇺🇸Salt Lake City, Utah, United States
Ascension Saint John Hospital
🇺🇸Detroit, Michigan, United States
University of Oklahoma Health Sciences Center
🇺🇸Oklahoma City, Oklahoma, United States
Saint Luke's East - Lee's Summit
🇺🇸Lee's Summit, Missouri, United States
Kansas City NCI Community Oncology Research Program
🇺🇸Prairie Village, Kansas, United States
Hutchinson Area Health Care
🇺🇸Hutchinson, Minnesota, United States
City of Hope Comprehensive Cancer Center
🇺🇸Duarte, California, United States
Glendale Adventist Medical Center
🇺🇸Glendale, California, United States
UC Irvine Health/Chao Family Comprehensive Cancer Center
🇺🇸Orange, California, United States
Sutter Cancer Centers Radiation Oncology Services-Roseville
🇺🇸Roseville, California, United States
Smilow Cancer Hospital Care Center at Saint Francis
🇺🇸Hartford, Connecticut, United States
Sutter Cancer Centers Radiation Oncology Services-Vacaville
🇺🇸Vacaville, California, United States
Beebe Medical Center
🇺🇸Lewes, Delaware, United States
Christiana Care Health System-Christiana Hospital
🇺🇸Newark, Delaware, United States
Holy Cross Hospital
🇺🇸Fort Lauderdale, Florida, United States
Baptist MD Anderson Cancer Center
🇺🇸Jacksonville, Florida, United States
Jupiter Medical Center
🇺🇸Jupiter, Florida, United States
Baptist Medical Center South
🇺🇸Jacksonville, Florida, United States
Mount Sinai Medical Center
🇺🇸Miami Beach, Florida, United States
21st Century Oncology-Orange Park
🇺🇸Orange Park, Florida, United States
Saint John's Hospital
🇺🇸Springfield, Illinois, United States
Bay Medical Center
🇺🇸Panama City, Florida, United States
21st Century Oncology-Palatka
🇺🇸Palatka, Florida, United States
Integrated Community Oncology Network-Flager Cancer Center
🇺🇸Saint Augustine, Florida, United States
John B Amos Cancer Center
🇺🇸Columbus, Georgia, United States
Memorial Health University Medical Center
🇺🇸Savannah, Georgia, United States
Ingalls Memorial Hospital
🇺🇸Harvey, Illinois, United States
Saint Vincent Anderson Regional Hospital/Cancer Center
🇺🇸Anderson, Indiana, United States
Franciscan Saint Francis Health-Beech Grove
🇺🇸Beech Grove, Indiana, United States
Reid Health
🇺🇸Richmond, Indiana, United States
Saint Luke's South Hospital
🇺🇸Overland Park, Kansas, United States
IU Health Methodist Hospital
🇺🇸Indianapolis, Indiana, United States
Shawnee Mission Medical Center-KCCC
🇺🇸Shawnee Mission, Kansas, United States
Union Hospital of Cecil County
🇺🇸Elkton, Maryland, United States
Menorah Medical Center
🇺🇸Overland Park, Kansas, United States
Beaumont Hospital-Dearborn
🇺🇸Dearborn, Michigan, United States
Hurley Medical Center
🇺🇸Flint, Michigan, United States
Green Bay Oncology - Escanaba
🇺🇸Escanaba, Michigan, United States
Genesys Regional Medical Center-West Flint Campus
🇺🇸Flint, Michigan, United States
Green Bay Oncology - Iron Mountain
🇺🇸Iron Mountain, Michigan, United States
Bronson Methodist Hospital
🇺🇸Kalamazoo, Michigan, United States
Allegiance Health
🇺🇸Jackson, Michigan, United States
Borgess Medical Center
🇺🇸Kalamazoo, Michigan, United States
Sparrow Hospital
🇺🇸Lansing, Michigan, United States
Saint Joseph Mercy Oakland
🇺🇸Pontiac, Michigan, United States
Saint Mary Mercy Hospital
🇺🇸Livonia, Michigan, United States
Saint John Macomb-Oakland Hospital
🇺🇸Warren, Michigan, United States
Lake Huron Medical Center
🇺🇸Port Huron, Michigan, United States
Saint Mary's of Michigan
🇺🇸Saginaw, Michigan, United States
Fairview Ridges Hospital
🇺🇸Burnsville, Minnesota, United States
Mercy Hospital
🇺🇸Coon Rapids, Minnesota, United States
Fairview-Southdale Hospital
🇺🇸Edina, Minnesota, United States
Minnesota Oncology Hematology PA-Maplewood
🇺🇸Maplewood, Minnesota, United States
Unity Hospital
🇺🇸Fridley, Minnesota, United States
Saint John's Hospital - Healtheast
🇺🇸Maplewood, Minnesota, United States
Heartland Regional Medical Center
🇺🇸Saint Joseph, Missouri, United States
Liberty Radiation Oncology Center
🇺🇸Liberty, Missouri, United States
Washington University School of Medicine
🇺🇸Saint Louis, Missouri, United States
Siteman Cancer Center at Saint Peters Hospital
🇺🇸Saint Peters, Missouri, United States
Mercy Hospital Springfield
🇺🇸Springfield, Missouri, United States
CoxHealth South Hospital
🇺🇸Springfield, Missouri, United States
Cancer Research for the Ozarks NCORP
🇺🇸Springfield, Missouri, United States
Virtua Memorial
🇺🇸Mount Holly, New Jersey, United States
Renown Regional Medical Center
🇺🇸Reno, Nevada, United States
Cooper Hospital University Medical Center
🇺🇸Camden, New Jersey, United States
Virtua Voorhees
🇺🇸Voorhees, New Jersey, United States
Grandview Hospital
🇺🇸Dayton, Ohio, United States
Samaritan North Health Center
🇺🇸Dayton, Ohio, United States
Kettering Medical Center
🇺🇸Kettering, Ohio, United States
Cancer Treatment Center
🇺🇸Wooster, Ohio, United States
UH Seidman Cancer Center at Salem Regional Medical Center
🇺🇸Salem, Ohio, United States
Salem Hospital
🇺🇸Salem, Oregon, United States
Greene Memorial Hospital
🇺🇸Xenia, Ohio, United States
Abington Memorial Hospital
🇺🇸Abington, Pennsylvania, United States
Reading Hospital
🇺🇸West Reading, Pennsylvania, United States
University of Texas Medical Branch
🇺🇸Galveston, Texas, United States
Southwest VA Regional Cancer Center
🇺🇸Norton, Virginia, United States
University of Vermont Medical Center
🇺🇸Burlington, Vermont, United States
Norris Cotton Cancer Center-North
🇺🇸Saint Johnsbury, Vermont, United States
Green Bay Oncology at Saint Vincent Hospital
🇺🇸Green Bay, Wisconsin, United States
North Star Lodge Cancer Center at Yakima Valley Memorial Hospital
🇺🇸Yakima, Washington, United States
Green Bay Oncology Limited at Saint Mary's Hospital
🇺🇸Green Bay, Wisconsin, United States
Saint Vincent Hospital Cancer Center at Saint Mary's
🇺🇸Green Bay, Wisconsin, United States
Wheeling Hospital/Schiffler Cancer Center
🇺🇸Wheeling, West Virginia, United States
Gundersen Lutheran Medical Center
🇺🇸La Crosse, Wisconsin, United States
Bay Area Medical Center
🇺🇸Marinette, Wisconsin, United States
ProHealth Oconomowoc Memorial Hospital
🇺🇸Oconomowoc, Wisconsin, United States
Green Bay Oncology - Sturgeon Bay
🇺🇸Sturgeon Bay, Wisconsin, United States
Green Bay Oncology - Oconto Falls
🇺🇸Oconto Falls, Wisconsin, United States
ProHealth Waukesha Memorial Hospital
🇺🇸Waukesha, Wisconsin, United States
CHU de Quebec-L'Hotel-Dieu de Quebec (HDQ)
🇨🇦Quebec City, Quebec, Canada
London Regional Cancer Program
🇨🇦London, Ontario, Canada
Allan Blair Cancer Centre
🇨🇦Regina, Saskatchewan, Canada
King Faisal Specialist Hospital and Research Centre
🇸🇦Riyadh, Saudi Arabia
Sutter Medical Center Sacramento
🇺🇸Sacramento, California, United States
University of California Davis Comprehensive Cancer Center
🇺🇸Sacramento, California, United States
Mercy General Hospital Radiation Oncology Center
🇺🇸Sacramento, California, United States
Michigan Cancer Research Consortium NCORP
🇺🇸Ann Arbor, Michigan, United States
Saint Joseph Mercy Hospital
🇺🇸Ann Arbor, Michigan, United States
Nebraska Methodist Hospital
🇺🇸Omaha, Nebraska, United States
Froedtert and the Medical College of Wisconsin
🇺🇸Milwaukee, Wisconsin, United States
University of Florida Health Science Center - Gainesville
🇺🇸Gainesville, Florida, United States
The James Graham Brown Cancer Center at University of Louisville
🇺🇸Louisville, Kentucky, United States
Truman Medical Center
🇺🇸Kansas City, Missouri, United States
Saint Luke's Hospital of Kansas City
🇺🇸Kansas City, Missouri, United States
Saint Joseph Health Center
🇺🇸Kansas City, Missouri, United States
North Kansas City Hospital
🇺🇸Kansas City, Missouri, United States
Heartland Hematology and Oncology Associates Incorporated
🇺🇸Kansas City, Missouri, United States
Research Medical Center
🇺🇸Kansas City, Missouri, United States
Medical University of South Carolina
🇺🇸Charleston, South Carolina, United States
Virginia Commonwealth University/Massey Cancer Center
🇺🇸Richmond, Virginia, United States
University of Wisconsin Hospital and Clinics
🇺🇸Madison, Wisconsin, United States
Ridgeview Medical Center
🇺🇸Waconia, Minnesota, United States