Glutathione in Preventing Peripheral Neuropathy Caused by Paclitaxel and Carboplatin in Patients With Ovarian Cancer, Fallopian Tube Cancer, and/or Primary Peritoneal Cancer
- Conditions
- Chemotherapeutic Agent ToxicityNeuropathyNeurotoxicity SyndromePainStage IIIA Fallopian Tube CancerStage IIIA Ovarian CancerStage IIIA Primary Peritoneal CancerStage IIIB Fallopian Tube CancerStage IIIB Primary Peritoneal CancerStage IIIB Ovarian Cancer
- Interventions
- Drug: CarboplatinDrug: GlutathioneOther: Laboratory Biomarker AnalysisOther: PlaceboDrug: PaclitaxelOther: Quality-of-Life Assessment
- Registration Number
- NCT02311907
- Lead Sponsor
- Alliance for Clinical Trials in Oncology
- Brief Summary
This randomized phase III trial is studying glutathione to see how well it works in preventing peripheral neuropathy caused by paclitaxel and carboplatin in patients with ovarian cancer, fallopian tube cancer, and/or primary peritoneal cancer. Drugs used in chemotherapy work in different ways to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Chemoprotective drugs, such as glutathione, may help prevent peripheral neuropathy caused by paclitaxel and carboplatin. It is not yet known whether glutathione is more effective than a placebo in preventing peripheral neuropathy.
- Detailed Description
PRIMARY OBJECTIVES:
I. To compare TAXOL (paclitaxel)/carboplatin (CBDCA) induced peripheral neuropathy as measured by European Organization for Research and Treatment of Cancer (EORTC)- Quality of Life (QOL)-chemotherapy induced peripheral neuropathy 20 (CIPN20) between glutathione (GSH) and placebo arms.
SECONDARY OBJECTIVES:
I. To compare the incidences of grade 2+ and grade 3+ TAXOL/CBDCA induced peripheral neuropathy measured by Common Terminology Criteria for Adverse Events (CTCAE) neuropathy scale between GSH and placebo arms.
II. To compare the time to onset of grade 2+ and grade 3+ TAXOL/CBDCA induced peripheral neuropathy between GSH and placebo arms, measured by CTCAE neuropathy scale.
III. To compare the proportion of patients requiring chemotherapy dose reductions secondary to TAXOL/CBDCA induced peripheral neuropathy between GSH and placebo arms.
IV. To compare the proportion of patients stopping TAXOL/CBDCA secondary to peripheral neuropathy between GSH and placebo arms.
V. To assess the toxicity profile of GSH in this situation. VI. To evaluate whether GSH influences the anti-tumor activity of TAXOL/CBDCA. VII. To evaluate patient quality of life (QOL) measured by Functional Assessment of Cancer Therapy-Ovarian (FACT-O) (ovarian/fallopian tube/primary peritoneal cancer patients only) and patient daily symptom questionnaires over time between GSH and placebo arms.
TERTIARY:
I. To explore the association of genetic variations in genes involved in taxane/platinum metabolism with incidence of grade 2+ TAXOL/CBDCA induced peripheral neuropathy.
II. As part of ongoing research for North Central Cancer Treatment Group (NCCTG) studies, we are banking blood products for future studies.
OUTLINE:
Patients are stratified according to baseline neuropathy (none vs grade 1), debulked status (no gross residual disease \[no clinically apparent residual lesions at the completion of primary surgery\] vs optimal \[largest residual lesion \< 1 cm at primary surgery\] vs sub-optimally debulked \[residual lesion \> 1 cm\] or not operated upon), and cancer type (ovarian/fallopian tube/primary peritoneal cancers vs lung cancer vs other). Patients are randomized to 1 of 2 treatment arms. Patients are grouped based on, Planned paclitaxel dose cycle length (Weekly vs. every 3 weeks vs. every 4 weeks). The stratification factors listed include demographic, prognostic factors and medication that can potentially impact the primary or secondary outcomes, so they need to be distributed evenly among the two arms. The 18 level combinations involved in these four stratification factors are within the maximum recommended of one half of the group sample size for the study.
Ideally, patients begin receiving glutathione before their first dose of chemotherapy, but must begin glutathione before their second dose of chemotherapy.
ARM I: Patients receive glutathione intravenously (IV) over 15 minutes, paclitaxel\* IV over 1 or 3 hours depending on planned dose cycle length and carboplatin IV over 30 minutes.
ARM II: Patients receive placebo IV over 15 minutes, paclitaxel\* IV over 1 or 3 hours depending on planned dose cycle length and carboplatin IV over 30 minutes.
NOTE: \*Alternatively, patients may receive paclitaxel IV over 1 hour and glutathione/placebo IV over 15 minutes weekly and carboplatin every 21 days for 12 weeks.
Blood samples are collected periodically for pharmacogenomic and other biomarker analyses. Patients complete questionnaires periodically, including quality-of-life assessments.
After completion of study treatment, patients are followed up every 3 months for 1 year.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 195
- Scheduled to undergo treatment with TAXOL at 150-200 mg/m2 and CBDCA at area under the curve (AUC) = 5-7 every 21 or 28 days for at least 12 weeks; alternatively, paclitaxel can be prescribed at 80 mg/m2 weekly for at least 12 weeks, with the same CBDCA dose of AUC = 5-7 every 21 days; additional chemotherapy agents are allowed (bevacizumab, etoposide, etc) per physician discretion, as long as they are not known to be neurotoxic; Note: patients ideally will begin GSH therapy prior to their first dose of this chemotherapy, but must begin GSH therapy prior to their second dose of chemotherapy
- Ability to sign informed consent and understand the nature of a placebo-controlled trial
- Eastern Cooperative Oncology Group (ECOG) performance status 0-2
- Ability to complete English language questionnaire(s) by themselves or with assistance
- Life expectancy >= 6 months
- Negative pregnancy test done =< 7 days prior to registration, for women of childbearing potential only, per clinician discretion
- Willingness to provide blood specimens as required by the protocol
- White blood cell (WBC) >= 3400
- Absolute neutrophil count (ANC) >= 1500
- Platelet (PLT) >= 100,000
- Hemoglobin (HgB) > 10.0
- Creatinine =< 1.5 x upper limit of normal (ULN)
-
Pre-existing history of peripheral neuropathy > grade 1 (National Cancer Institute [NCI] CTCAE version [v] 4.0) due to any cause (e.g., chemotherapy, diabetes, alcohol, toxin, or heredity)
-
Other medical conditions, which in the opinion of the treating physician/allied health professional would make this protocol unreasonably hazardous for the patient
-
Any of the following:
- Pregnant women
- Nursing women
- Women of childbearing potential who are unwilling to employ adequate contraception
-
Prior TAXOL and/or CBDCA chemotherapy treatment (other than the current treatment regimen)
-
Concurrent use of any agent being used specifically to prevent or treat neuropathy, including but not limited to the following:
- Gabapentin
- Glutamine powder or glutamine tablets
- Vitamin B6 or E
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Arm I (glutathione, carboplatin) Laboratory Biomarker Analysis Patients receive glutathione intravenously (IV) over 15 minutes, paclitaxel\* IV over 1 or 3 hours depending on planned dose cycle length and carboplatin IV over 30 minutes. Arm I (glutathione, carboplatin) Quality-of-Life Assessment Patients receive glutathione intravenously (IV) over 15 minutes, paclitaxel\* IV over 1 or 3 hours depending on planned dose cycle length and carboplatin IV over 30 minutes. Arm II (placebo, paclitaxel) Laboratory Biomarker Analysis Patients receive placebo IV over 15 minutes, paclitaxel\* IV over 1 or 3 hours depending on planned dose cycle length and carboplatin IV over 30 minutes. Arm II (placebo, paclitaxel) Placebo Patients receive placebo IV over 15 minutes, paclitaxel\* IV over 1 or 3 hours depending on planned dose cycle length and carboplatin IV over 30 minutes. Arm II (placebo, paclitaxel) Quality-of-Life Assessment Patients receive placebo IV over 15 minutes, paclitaxel\* IV over 1 or 3 hours depending on planned dose cycle length and carboplatin IV over 30 minutes. Arm I (glutathione, carboplatin) Glutathione Patients receive glutathione intravenously (IV) over 15 minutes, paclitaxel\* IV over 1 or 3 hours depending on planned dose cycle length and carboplatin IV over 30 minutes. Arm I (glutathione, carboplatin) Carboplatin Patients receive glutathione intravenously (IV) over 15 minutes, paclitaxel\* IV over 1 or 3 hours depending on planned dose cycle length and carboplatin IV over 30 minutes. Arm II (placebo, paclitaxel) Carboplatin Patients receive placebo IV over 15 minutes, paclitaxel\* IV over 1 or 3 hours depending on planned dose cycle length and carboplatin IV over 30 minutes. Arm I (glutathione, carboplatin) Paclitaxel Patients receive glutathione intravenously (IV) over 15 minutes, paclitaxel\* IV over 1 or 3 hours depending on planned dose cycle length and carboplatin IV over 30 minutes. Arm II (placebo, paclitaxel) Paclitaxel Patients receive placebo IV over 15 minutes, paclitaxel\* IV over 1 or 3 hours depending on planned dose cycle length and carboplatin IV over 30 minutes.
- Primary Outcome Measures
Name Time Method Paclitaxel/Carboplatin (PC) Induced Peripheral Neuropathy as Assessed by EORTC QLQ-CIPN20 (European Organization for Research and Treatment of Cancer (EORTC), Quality of Life (QLQ), Chemotherapy Induced Peripheral Neuropathy 20 (CIPN20)). Every 28 day cycle, up to 6 cycles. The CIPN sensory subscale will be calculated by standard scoring algorithm and converted to 0-100 scale (higher scores indicated less symptoms and better quality of life). Generalized linear models (repeated measures analysis of variance \[ANOVA\] if data are complete) will be used to compare the CIPN between Glutathione (GSH) and placebo arms.
- Secondary Outcome Measures
Name Time Method Change in Patient Reported Quality of Life as Assessed by Functional Assessment of Cancer Therapy-Ovarian (FACT-O) and Patient Daily-symptom Questionnaires Over Time. Baseline to 1 year Quality of life was measured by FACT-O (on a 0 to 100 scale, higher scores represent better life quality) from baseline and at the end of TAXOL/CBDCA. The change in Quality of Life was calculated as the difference between baseline measure and end of treatment measure (with range from -100 to 100). A negative change represents a worsening in QOL from baseline to one year. Abbreviations used: Change from Baseline (chg from bsl)
Recurrence-free Survival (for Patients Without Clinical Evidence of Disease) Up to 1 year A log-rank test and a Kaplan-Meier curve will be used to compare the recurrence free survival between GSH and placebo arms (for ovarian/fallopian tube/primary peritoneal patients only).
Paclitaxel Acute Pain Syndrome Incidence and Severity Between GSH and Placebo Arms Up to 1 year Descriptive statistics will be used to describe TAXOL/CBDCA acute pain syndrome incidence/severity between GSH and placebo arms. Pain was scored on a scale from 0-10, where 0 = 'No aches or pains' and 10 = 'Aches or pains as bad as can be.'
Percentage of Patients Delaying PC Chemotherapy Secondary to PN Up to 1 year Patients delaying TAXOL/CBDCA secondary to peripheral neuropathy between GSH and placebo arms.
Percentage of Patients Undergoing Dose Reductions Secondary to PCI PN Up to 1 year Proportion of patients requiring chemotherapy dose reductions secondary to TAXOL/CBDCA induced peripheral neuropathy between GSH and placebo arms.
Percentage of Patients With Grade 2+ and Grade 3+ Paclitaxel/Carboplatin-induced (PCI) Peripheral Neuropathy (PN) According to the Common Terminology Criteria for Adverse Events (CTCAE) Neuropathy Scale Up to 1 year Proportion of grade 2+ and grade 3+ chemotherapy induced peripheral neuropathy (CIPN) at any time during or at the end of the TAXOL/CBDCA based chemotherapy between GSH and placebo arms. Neuropathy scale has grades 1 through 5 (1-mild, Grade 2 Moderate, Grade 3 Severe, Grade 4 Life-threatening and Grade 5 Death related to AE).
Times to Onset of CTCAE Grade 2+ PN Up to 1 year Compare time to grade 2+ CIPN between GSH and placebo arms.
Times to Onset of CTCAE Grade 3+ PN Up to 5 years from registration Time to grade 3+ CIPN between GSH and placebo arms.
Trial Locations
- Locations (388)
Northside Hospital
🇺🇸Atlanta, Georgia, United States
Saint Joseph's Hospital of Atlanta
🇺🇸Atlanta, Georgia, United States
Pennsylvania Hospital
🇺🇸Philadelphia, Pennsylvania, United States
Greenville Health System Cancer Institute-Easley
🇺🇸Easley, South Carolina, United States
Eureka Hospital
🇺🇸Eureka, Illinois, United States
Illinois CancerCare-Eureka
🇺🇸Eureka, Illinois, United States
Elkhart General Hospital
🇺🇸Elkhart, Indiana, United States
Illinois CancerCare-Princeton
🇺🇸Princeton, Illinois, United States
Elkhart Clinic
🇺🇸Elkhart, Indiana, United States
Saint Joseph Oncology Inc
🇺🇸Saint Joseph, Missouri, United States
Presence Resurrection Medical Center
🇺🇸Chicago, Illinois, United States
Virginia Mason CCOP
🇺🇸Seattle, Washington, United States
Virginia Mason Medical Center
🇺🇸Seattle, Washington, United States
Pacific Medical Center-First Hill
🇺🇸Seattle, Washington, United States
Abbott-Northwestern Hospital
🇺🇸Minneapolis, Minnesota, United States
Hennepin County Medical Center
🇺🇸Minneapolis, Minnesota, United States
Minneapolis Veterans Medical Center
🇺🇸Minneapolis, Minnesota, United States
Nevada Cancer Research Foundation CCOP
🇺🇸Las Vegas, Nevada, United States
Rocky Mountain Oncology
🇺🇸Casper, Wyoming, United States
Swedish Medical Center
🇺🇸Englewood, Colorado, United States
Saint James Community Hospital and Cancer Treatment Center
🇺🇸Butte, Montana, United States
Northern Rockies Radiation Oncology Center
🇺🇸Billings, Montana, United States
Bozeman Deaconess Hospital
🇺🇸Bozeman, Montana, United States
Glacier Oncology PLLC
🇺🇸Kalispell, Montana, United States
Montana Cancer Consortium CCOP
🇺🇸Billings, Montana, United States
Frontier Cancer Center and Blood Institute-Billings
🇺🇸Billings, Montana, United States
Benefis Healthcare- Sletten Cancer Institute
🇺🇸Great Falls, Montana, United States
Montana Cancer Specialists
🇺🇸Missoula, Montana, United States
Kalispell Medical Oncology
🇺🇸Kalispell, Montana, United States
Community Medical Hospital
🇺🇸Missoula, Montana, United States
Billings Clinic Cancer Center
🇺🇸Billings, Montana, United States
Northern Montana Hospital
🇺🇸Havre, Montana, United States
Big Sky Oncology
🇺🇸Great Falls, Montana, United States
Great Falls Clinic
🇺🇸Great Falls, Montana, United States
Guardian Oncology and Center for Wellness
🇺🇸Missoula, Montana, United States
Saint Peter's Community Hospital
🇺🇸Helena, Montana, United States
Berdeaux, Donald MD (UIA Investigator)
🇺🇸Great Falls, Montana, United States
Kalispell Regional Medical Center
🇺🇸Kalispell, Montana, United States
Saint Patrick Hospital - Community Hospital
🇺🇸Missoula, Montana, United States
Rose Medical Center
🇺🇸Denver, Colorado, United States
Colorado Cancer Research Program CCOP
🇺🇸Denver, Colorado, United States
Porter Adventist Hospital
🇺🇸Denver, Colorado, United States
Presbyterian - Saint Lukes Medical Center - Health One
🇺🇸Denver, Colorado, United States
Mayo Clinic
🇺🇸Rochester, Minnesota, United States
Missouri Valley Cancer Consortium
🇺🇸Omaha, Nebraska, United States
Alegent Health Bergan Mercy Medical Center
🇺🇸Omaha, Nebraska, United States
Creighton University Medical Center
🇺🇸Omaha, Nebraska, United States
Columbia Saint Mary's Water Tower Medical Commons
🇺🇸Milwaukee, Wisconsin, United States
Providence Hospital
🇺🇸Mobile, Alabama, United States
Cancer Care Associates of Fresno Medical Group Inc
🇺🇸Fresno, California, United States
Fairbanks Memorial Hospital
🇺🇸Fairbanks, Alaska, United States
Mayo Clinic in Arizona
🇺🇸Scottsdale, Arizona, United States
Northbay Cancer Center
🇺🇸Fairfield, California, United States
Saint Joseph Hospital - Orange
🇺🇸Orange, California, United States
Oncare Hawaii Inc-Kuakini
🇺🇸Honolulu, Hawaii, United States
Mayo Clinic in Florida
🇺🇸Jacksonville, Florida, United States
Saint Mary's Hospital and Regional Medical Center
🇺🇸Grand Junction, Colorado, United States
Memorial Hospital
🇺🇸Carthage, Illinois, United States
The Cancer Center of Hawaii-Liliha
🇺🇸Honolulu, Hawaii, United States
Spector, David MD (UIA Investigator)
🇺🇸Moline, Illinois, United States
Well Star Cobb Hospital
🇺🇸Austell, Georgia, United States
Longmont United Hospital
🇺🇸Longmont, Colorado, United States
Saint Mary Corwin Medical Center
🇺🇸Pueblo, Colorado, United States
North Suburban Medical Center
🇺🇸Thornton, Colorado, United States
Wellstar Kennestone Hospital
🇺🇸Marietta, Georgia, United States
Graham Hospital Association
🇺🇸Canton, Illinois, United States
Greenwich Hospital
🇺🇸Greenwich, Connecticut, United States
Illinois CancerCare-Carthage
🇺🇸Carthage, Illinois, United States
Atlanta Regional CCOP
🇺🇸Atlanta, Georgia, United States
Straub Clinic and Hospital
🇺🇸Honolulu, Hawaii, United States
University of Hawaii Cancer Center
🇺🇸Honolulu, Hawaii, United States
Illinois CancerCare-Bloomington
🇺🇸Bloomington, Illinois, United States
Maui Memorial Medical Center
🇺🇸Wailuku, Hawaii, United States
Phoebe Putney Memorial Hospital
🇺🇸Albany, Georgia, United States
Oncare Hawaii Inc-POB II
🇺🇸Honolulu, Hawaii, United States
Stoffel, Thomas J MD (UIA Investigator)
🇺🇸Moline, Illinois, United States
Garneau, Stewart C MD (UIA Investigator)
🇺🇸Moline, Illinois, United States
Trinity Medical Center
🇺🇸Moline, Illinois, United States
Loyola University Medical Center
🇺🇸Maywood, Illinois, United States
Sharis, Christine M MD (UIA Investigator)
🇺🇸Moline, Illinois, United States
Holy Family Medical Center
🇺🇸Monmouth, Illinois, United States
Illinois CancerCare-Monmouth
🇺🇸Monmouth, Illinois, United States
Bromenn Regional Medical Center
🇺🇸Normal, Illinois, United States
Illinois CancerCare-Ottawa Clinic
🇺🇸Ottawa, Illinois, United States
Community Cancer Center Foundation
🇺🇸Normal, Illinois, United States
Illinois CancerCare-Community Cancer Center
🇺🇸Normal, Illinois, United States
Cancer Center of Kansas - El Dorado
🇺🇸El Dorado, Kansas, United States
Medical Oncology and Hematology Associates-Des Moines
🇺🇸Des Moines, Iowa, United States
Mercy Hospital
🇺🇸Coon Rapids, Minnesota, United States
OSF Saint Francis Medical Center Radiation Oncology Service at the Central Illinois Comprehensive CC
🇺🇸Peoria, Illinois, United States
Ottumwa Regional Health Center
🇺🇸Ottumwa, Iowa, United States
Illinois Valley Hospital
🇺🇸Peru, Illinois, United States
Perry Memorial Hospital
🇺🇸Princeton, Illinois, United States
Illinois CancerCare-Spring Valley
🇺🇸Spring Valley, Illinois, United States
Mercy Medical Center-Sioux City
🇺🇸Sioux City, Iowa, United States
Constantinou, Costas L MD (UIA Investigator)
🇺🇸Bettendorf, Iowa, United States
Northern Indiana Cancer Research Consortium CCOP
🇺🇸South Bend, Indiana, United States
Michiana Hematology Oncology PC-Westville
🇺🇸Westville, Indiana, United States
Iowa Oncology Research Association CCOP
🇺🇸Des Moines, Iowa, United States
Iowa Lutheran Hospital
🇺🇸Des Moines, Iowa, United States
Cancer Center of Kansas - Chanute
🇺🇸Chanute, Kansas, United States
Cancer Center of Kansas-Liberal
🇺🇸Liberal, Kansas, United States
Cancer Center of Kansas - Dodge City
🇺🇸Dodge City, Kansas, United States
Cancer Center of Kansas - Fort Scott
🇺🇸Fort Scott, Kansas, United States
Lawrence Memorial Hospital
🇺🇸Lawrence, Kansas, United States
Harold Alfond Center for Cancer Care
🇺🇸Augusta, Maine, United States
Kansas City CCOP
🇺🇸Prairie Village, Kansas, United States
Cancer Center of Kansas - Winfield
🇺🇸Winfield, Kansas, United States
Cancer Center of Kansas - Wellington
🇺🇸Wellington, Kansas, United States
Eastern Maine Medical Center
🇺🇸Bangor, Maine, United States
The Memorial Hospital at Easton
🇺🇸Easton, Maryland, United States
Highland Clinic
🇺🇸Shreveport, Louisiana, United States
Wichita CCOP
🇺🇸Wichita, Kansas, United States
Ochsner Medical Center Jefferson
🇺🇸New Orleans, Louisiana, United States
Louisiana State University Health Sciences Center Shreveport
🇺🇸Shreveport, Louisiana, United States
Saint John Hospital and Medical Center
🇺🇸Detroit, Michigan, United States
Genesys Regional Medical Center-West Flint Campus
🇺🇸Flint, Michigan, United States
Green Bay Oncology - Escanaba
🇺🇸Escanaba, Michigan, United States
West Michigan Cancer Center
🇺🇸Kalamazoo, Michigan, United States
Borgess Medical Center
🇺🇸Kalamazoo, Michigan, United States
Oakwood Hospital and Medical Center
🇺🇸Dearborn, Michigan, United States
Green Bay Oncology - Iron Mountain
🇺🇸Iron Mountain, Michigan, United States
Saint Mary Mercy Hospital
🇺🇸Livonia, Michigan, United States
Mayo Clinic Health Systems-Mankato
🇺🇸Mankato, Minnesota, United States
Lakeland Hospital
🇺🇸St. Joseph, Michigan, United States
Saint John Macomb-Oakland Hospital
🇺🇸Warren, Michigan, United States
Fairview Ridges Hospital
🇺🇸Burnsville, Minnesota, United States
Regions Hospital
🇺🇸Saint Paul, Minnesota, United States
Essentia Health Saint Mary's Medical Center
🇺🇸Duluth, Minnesota, United States
Miller-Dwan Hospital
🇺🇸Duluth, Minnesota, United States
Medini, Eitan MD (UIA Investigator)
🇺🇸Alexandria, Minnesota, United States
Fairview-Southdale Hospital
🇺🇸Edina, Minnesota, United States
Essentia Health Cancer Center
🇺🇸Duluth, Minnesota, United States
Metro-Minnesota NCI Community Oncology Research Program
🇺🇸Saint Louis Park, Minnesota, United States
Saint Francis Regional Medical Center
🇺🇸Shakopee, Minnesota, United States
Saint Luke's Hospital of Kansas City
🇺🇸Kansas City, Missouri, United States
Liberty Hospital
🇺🇸Liberty, Missouri, United States
Research Medical Center
🇺🇸Kansas City, Missouri, United States
Cancer Research for the Ozarks NCORP
🇺🇸Springfield, Missouri, United States
Saint Vincent Healthcare
🇺🇸Billings, Montana, United States
Liberty Radiation Oncology Center
🇺🇸Liberty, Missouri, United States
Heartland Regional Medical Center
🇺🇸Saint Joseph, Missouri, United States
Bozeman Deaconess Cancer Center
🇺🇸Bozeman, Montana, United States
Margaret R Pardee Memorial Hospital
🇺🇸Hendersonville, North Carolina, United States
Wentworth-Douglass Hospital
🇺🇸Dover, New Hampshire, United States
Saint Joseph Hospital
🇺🇸Nashua, New Hampshire, United States
Glens Falls Hospital
🇺🇸Glens Falls, New York, United States
Cone Health Cancer Center
🇺🇸Greensboro, North Carolina, United States
Mary Rutan Hospital
🇺🇸Bellefontaine, Ohio, United States
Kinston Medical Specialists PA
🇺🇸Kinston, North Carolina, United States
Mid Dakota Clinic
🇺🇸Bismarck, North Dakota, United States
Grant Medical Center
🇺🇸Columbus, Ohio, United States
Summa Barberton Hospital
🇺🇸Barberton, Ohio, United States
Akron General Medical Center
🇺🇸Akron, Ohio, United States
Riverside Methodist Hospital
🇺🇸Columbus, Ohio, United States
Grady Memorial Hospital
🇺🇸Delaware, Ohio, United States
Samaritan North Health Center
🇺🇸Dayton, Ohio, United States
Medical X-Ray Center
🇺🇸Sioux Falls, South Dakota, United States
Sanford USD Medical Center - Sioux Falls
🇺🇸Sioux Falls, South Dakota, United States
Geisinger Medical Group
🇺🇸State College, Pennsylvania, United States
Chester County Hospital
🇺🇸West Chester, Pennsylvania, United States
McLeod Regional Medical Center
🇺🇸Florence, South Carolina, United States
Blanchard Valley Hospital
🇺🇸Findlay, Ohio, United States
Licking Memorial Hospital
🇺🇸Newark, Ohio, United States
Marietta Memorial Hospital
🇺🇸Marietta, Ohio, United States
Knox Community Hospital
🇺🇸Mount Vernon, Ohio, United States
Greenville Health System Cancer Institute-Butternut
🇺🇸Greenville, South Carolina, United States
Geisinger Medical Center-Cancer Center Hazleton
🇺🇸Hazleton, Pennsylvania, United States
Greene Memorial Hospital
🇺🇸Xenia, Ohio, United States
Self Regional Healthcare
🇺🇸Greenwood, South Carolina, United States
Upper Valley Medical Center
🇺🇸Troy, Ohio, United States
Genesis HealthCare System
🇺🇸Zanesville, Ohio, United States
Roper Hospital
🇺🇸Charleston, South Carolina, United States
Geisinger Medical Center
🇺🇸Danville, Pennsylvania, United States
Sanford NCI Community Oncology Research Program of the North Central Plains
🇺🇸Sioux Falls, South Dakota, United States
AnMed Health Cancer Center
🇺🇸Anderson, South Carolina, United States
Greenville Health System Cancer Institute-Seneca
🇺🇸Seneca, South Carolina, United States
Wellmont Holston Valley Hospital and Medical Center
🇺🇸Kingsport, Tennessee, United States
Greenville Health System Cancer Institute-Spartanburg
🇺🇸Spartanburg, South Carolina, United States
University of Tennessee - Knoxville
🇺🇸Knoxville, Tennessee, United States
Saint Francis Hospital
🇺🇸Federal Way, Washington, United States
Saint Clare Hospital
🇺🇸Lakewood, Washington, United States
Providence - Saint Peter Hospital
🇺🇸Olympia, Washington, United States
Hematology Oncology Associates of Fredericksburg Inc
🇺🇸Fredericksburg, Virginia, United States
Southwest VA Regional Cancer Center
🇺🇸Norton, Virginia, United States
Green Bay Oncology at Saint Vincent Hospital
🇺🇸Green Bay, Wisconsin, United States
Gundersen Lutheran Medical Center
🇺🇸La Crosse, Wisconsin, United States
Edwards Comprehensive Cancer Center
🇺🇸Huntington, West Virginia, United States
Providence Regional Cancer System-Centralia
🇺🇸Centralia, Washington, United States
Green Bay Oncology Limited at Saint Mary's Hospital
🇺🇸Green Bay, Wisconsin, United States
Marshfield Clinic - Weston Center
🇺🇸Weston, Wisconsin, United States
Dean Hematology and Oncology Clinic
🇺🇸Madison, Wisconsin, United States
EvergreenHealth Medical Center
🇺🇸Kirkland, Washington, United States
MultiCare Allenmore Hospital
🇺🇸Tacoma, Washington, United States
Marshfield Clinic-Minocqua Center
🇺🇸Minocqua, Wisconsin, United States
Saint Nicholas Hospital
🇺🇸Sheboygan, Wisconsin, United States
Marshfield Clinic Cancer Center at Sacred Heart
🇺🇸Eau Claire, Wisconsin, United States
Green Bay Oncology - Sturgeon Bay
🇺🇸Sturgeon Bay, Wisconsin, United States
Bay Area Medical Center
🇺🇸Marinette, Wisconsin, United States
Green Bay Oncology - Oconto Falls
🇺🇸Oconto Falls, Wisconsin, United States
Marshfield Clinic
🇺🇸Marshfield, Wisconsin, United States
Marshfield Clinic Cancer Care at Saint Michael's Hospital
🇺🇸Stevens Point, Wisconsin, United States
Columbia Saint Mary's Hospital - Ozaukee
🇺🇸Mequon, Wisconsin, United States
Marshfield Clinic - Wisconsin Rapids Center
🇺🇸Wisconsin Rapids, Wisconsin, United States
Welch Cancer Center
🇺🇸Sheridan, Wyoming, United States
Mercy Hospital Springfield
🇺🇸Springfield, Missouri, United States
North Kansas City Hospital
🇺🇸Kansas City, Missouri, United States
Heartland Hematology and Oncology Associates Incorporated
🇺🇸Kansas City, Missouri, United States
Exempla Saint Joseph Hospital
🇺🇸Denver, Colorado, United States
North Colorado Medical Center
🇺🇸Greeley, Colorado, United States
Coborn Cancer Center at Saint Cloud Hospital
🇺🇸Saint Cloud, Minnesota, United States
Saint Cloud Hospital
🇺🇸Saint Cloud, Minnesota, United States
United Hospital
🇺🇸Saint Paul, Minnesota, United States
Unity Hospital
🇺🇸Fridley, Minnesota, United States
Hutchinson Area Health Care
🇺🇸Hutchinson, Minnesota, United States
Minnesota Oncology and Hematology PA-Woodbury
🇺🇸Woodbury, Minnesota, United States
Ridgeview Medical Center
🇺🇸Waconia, Minnesota, United States
Cancer Center of Kansas-Independence
🇺🇸Independence, Kansas, United States
Cancer Center of Kansas-Kingman
🇺🇸Kingman, Kansas, United States
Cancer Center of Kansas-Wichita Medical Arts Tower
🇺🇸Wichita, Kansas, United States
Cancer Center of Kansas - McPherson
🇺🇸McPherson, Kansas, United States
Kapiolani Medical Center for Women and Children
🇺🇸Honolulu, Hawaii, United States
Pacific Cancer Institute of Maui
🇺🇸Wailuku, Hawaii, United States
Saint Margaret's Hospital
🇺🇸Spring Valley, Illinois, United States
Siouxland Regional Cancer Center
🇺🇸Sioux City, Iowa, United States
Saint Mary's of Michigan
🇺🇸Saginaw, Michigan, United States
Michiana Hematology Oncology PC-Niles
🇺🇸Niles, Michigan, United States
Geisinger Wyoming Valley/Henry Cancer Center
🇺🇸Wilkes-Barre, Pennsylvania, United States
Alegent Health Immanuel Medical Center
🇺🇸Omaha, Nebraska, United States
Greenville Health System Cancer Institute-Eastside
🇺🇸Greenville, South Carolina, United States
Park Nicollet Clinic - Saint Louis Park
🇺🇸Saint Louis Park, Minnesota, United States
Michiana Hematology Oncology PC-Plymouth
🇺🇸Plymouth, Indiana, United States
Marie Yeager Cancer Center
🇺🇸Saint Joseph, Michigan, United States
Saint Luke's Regional Medical Center
🇺🇸Sioux City, Iowa, United States
Exempla Lutheran Medical Center
🇺🇸Wheat Ridge, Colorado, United States
Providence Hospital-Southfield Cancer Center
🇺🇸Southfield, Michigan, United States
Feather River Cancer Center
🇺🇸Paradise, California, United States
UC Irvine Health/Chao Family Comprehensive Cancer Center
🇺🇸Orange, California, United States
Boulder Community Hospital
🇺🇸Boulder, Colorado, United States
Penrose-Saint Francis Healthcare
🇺🇸Colorado Springs, Colorado, United States
Poudre Valley Hospital
🇺🇸Fort Collins, Colorado, United States
Sky Ridge Medical Center
🇺🇸Lone Tree, Colorado, United States
Front Range Cancer Specialists
🇺🇸Fort Collins, Colorado, United States
McKee Medical Center
🇺🇸Loveland, Colorado, United States
Saint Anthony Hospital
🇺🇸Lakewood, Colorado, United States
Saint Francis Hospital and Medical Center
🇺🇸Hartford, Connecticut, United States
Halifax Health Medical Center-Centers for Oncology
🇺🇸Daytona Beach, Florida, United States
Piedmont Hospital
🇺🇸Atlanta, Georgia, United States
John B Amos Cancer Center
🇺🇸Columbus, Georgia, United States
Georgia Regents University Medical Center
🇺🇸Augusta, Georgia, United States
Dekalb Medical Center
🇺🇸Decatur, Georgia, United States
Northeast Georgia Medical Center
🇺🇸Gainesville, Georgia, United States
Gwinnett Medical Center
🇺🇸Lawrenceville, Georgia, United States
Pali Momi Medical Center
🇺🇸Aiea, Hawaii, United States
Lewis Cancer and Research Pavilion at Saint Joseph's/Candler
🇺🇸Savannah, Georgia, United States
Harbin Clinic Medical Oncology and Clinical Research
🇺🇸Rome, Georgia, United States
Southern Regional Medical Center
🇺🇸Riverdale, Georgia, United States
Queen's Medical Center
🇺🇸Honolulu, Hawaii, United States
Wilcox Memorial Hospital and Kauai Medical Clinic
🇺🇸Lihue, Hawaii, United States
Castle Medical Center
🇺🇸Kailua, Hawaii, United States
Saint Joseph Medical Center
🇺🇸Tacoma, Washington, United States
Illinois CancerCare-Canton
🇺🇸Canton, Illinois, United States
Illinois CancerCare Galesburg
🇺🇸Galesburg, Illinois, United States
Decatur Memorial Hospital
🇺🇸Decatur, Illinois, United States
Mason District Hospital
🇺🇸Havana, Illinois, United States
Ingalls Memorial Hospital
🇺🇸Harvey, Illinois, United States
Adventist La Grange Memorial Hospital
🇺🇸La Grange, Illinois, United States
Illinois CancerCare-Havana
🇺🇸Havana, Illinois, United States
Illinois CancerCare-Kewanee Clinic
🇺🇸Kewanee, Illinois, United States
Illinois CancerCare-Macomb
🇺🇸Macomb, Illinois, United States
Mcdonough District Hospital
🇺🇸Macomb, Illinois, United States
Pekin Cancer Treatment Center
🇺🇸Pekin, Illinois, United States
Pekin Hospital
🇺🇸Pekin, Illinois, United States
Illinois Oncology Research Association CCOP
🇺🇸Peoria, Illinois, United States
Methodist Medical Center of Illinois
🇺🇸Peoria, Illinois, United States
Illinois CancerCare-Peoria
🇺🇸Peoria, Illinois, United States
Proctor Hospital
🇺🇸Peoria, Illinois, United States
OSF Saint Francis Medical Center
🇺🇸Peoria, Illinois, United States
Valley Radiation Oncology
🇺🇸Peru, Illinois, United States
Illinois CancerCare-Peru
🇺🇸Peru, Illinois, United States
Memorial Medical Center
🇺🇸Springfield, Illinois, United States
Franciscan St. Francis Health-Beech Grove
🇺🇸Beech Grove, Indiana, United States
Carle Cancer Center
🇺🇸Urbana, Illinois, United States
Michiana Hematology Oncology PC-Elkhart
🇺🇸Elkhart, Indiana, United States
Community Howard Regional Health
🇺🇸Kokomo, Indiana, United States
IU Health La Porte Hospital
🇺🇸La Porte, Indiana, United States
IU Health Arnett Cancer Care
🇺🇸Lafayette, Indiana, United States
Franciscan Saint Anthony Health-Michigan City
🇺🇸Michigan City, Indiana, United States
Michiana Hematology Oncology PC-Mishawaka
🇺🇸Mishawaka, Indiana, United States
Saint Joseph Regional Medical Center-Mishawaka
🇺🇸Mishawaka, Indiana, United States
Michiana Hematology Oncology PC-South Bend
🇺🇸South Bend, Indiana, United States
Memorial Hospital of South Bend
🇺🇸South Bend, Indiana, United States
Reid Hospital and Health Care Services
🇺🇸Richmond, Indiana, United States
McFarland Clinic PC-William R Bliss Cancer Center
🇺🇸Ames, Iowa, United States
South Bend Clinic
🇺🇸South Bend, Indiana, United States
Hematology Oncology Associates-Quad Cities
🇺🇸Bettendorf, Iowa, United States
Cedar Rapids Oncology Association
🇺🇸Cedar Rapids, Iowa, United States
Medical Oncology and Hematology Associates-West Des Moines
🇺🇸Clive, Iowa, United States
Iowa Methodist Medical Center
🇺🇸Des Moines, Iowa, United States
Mercy Medical Center - Des Moines
🇺🇸Des Moines, Iowa, United States
Oncology Associates at Mercy Medical Center
🇺🇸Cedar Rapids, Iowa, United States
Medical Oncology and Hematology Associates-Laurel
🇺🇸Des Moines, Iowa, United States
Saint Luke's South Hospital
🇺🇸Overland Park, Kansas, United States
Menorah Medical Center
🇺🇸Overland Park, Kansas, United States
Cancer Center of Kansas - Newton
🇺🇸Newton, Kansas, United States
Cancer Center of Kansas - Pratt
🇺🇸Pratt, Kansas, United States
Cancer Center of Kansas - Parsons
🇺🇸Parsons, Kansas, United States
Associates In Womens Health
🇺🇸Wichita, Kansas, United States
Cancer Center of Kansas - Salina
🇺🇸Salina, Kansas, United States
Cancer Center of Kansas - Main Office
🇺🇸Wichita, Kansas, United States
Ochsner Health Center-Summa
🇺🇸Baton Rouge, Louisiana, United States
Louisiana State University Sciences Center- Monroe
🇺🇸Monroe, Louisiana, United States
Cancer Trials Support Unit
🇺🇸Rockville, Maryland, United States
Bronson Methodist Hospital
🇺🇸Kalamazoo, Michigan, United States
Hurley Medical Center
🇺🇸Flint, Michigan, United States
Allegiance Health
🇺🇸Jackson, Michigan, United States
Sparrow Hospital
🇺🇸Lansing, Michigan, United States
McLaren-Macomb
🇺🇸Mount Clemens, Michigan, United States
Lakeview Hospital
🇺🇸Stillwater, Minnesota, United States
Minnesota Oncology Hematology PA-Maplewood
🇺🇸Maplewood, Minnesota, United States
Saint John's Hospital - Healtheast
🇺🇸Maplewood, Minnesota, United States
North Memorial Medical Health Center
🇺🇸Robbinsdale, Minnesota, United States
Rice Memorial Hospital
🇺🇸Willmar, Minnesota, United States
Saint Luke's Cancer Institute
🇺🇸Kansas City, Missouri, United States
Saint Joseph Health Center
🇺🇸Kansas City, Missouri, United States
Saint Luke's East - Lee's Summit
🇺🇸Lee's Summit, Missouri, United States
CoxHealth South Hospital
🇺🇸Springfield, Missouri, United States
Nebraska Cancer Research Center
🇺🇸Lincoln, Nebraska, United States
University Medical Center of Southern Nevada
🇺🇸Las Vegas, Nevada, United States
Staten Island University Hospital
🇺🇸Staten Island, New York, United States
Robert Wood Johnson University Hospital Somerset
🇺🇸Somerville, New Jersey, United States
Randolph Hospital
🇺🇸Asheboro, North Carolina, United States
Wayne Memorial Hospital
🇺🇸Goldsboro, North Carolina, United States
Annie Penn Memorial Hospital
🇺🇸Reidsville, North Carolina, United States
Saint Alexius Medical Center
🇺🇸Bismarck, North Dakota, United States
Sanford Bismarck Medical Center
🇺🇸Bismarck, North Dakota, United States
Altru Cancer Center
🇺🇸Grand Forks, North Dakota, United States
Trinity Cancer Care Center
🇺🇸Minot, North Dakota, United States
Adena Regional Medical Center
🇺🇸Chillicothe, Ohio, United States
Summa Akron City Hospital/Cooper Cancer Center
🇺🇸Akron, Ohio, United States
Mount Carmel Health Center West
🇺🇸Columbus, Ohio, United States
Doctors Hospital
🇺🇸Columbus, Ohio, United States
Dayton CCOP
🇺🇸Dayton, Ohio, United States
Columbus CCOP
🇺🇸Columbus, Ohio, United States
Good Samaritan Hospital - Dayton
🇺🇸Dayton, Ohio, United States
Grandview Hospital
🇺🇸Dayton, Ohio, United States
Miami Valley Hospital
🇺🇸Dayton, Ohio, United States
Atrium Medical Center-Middletown Regional Hospital
🇺🇸Franklin, Ohio, United States
Wayne Hospital
🇺🇸Greenville, Ohio, United States
Saint Rita's Medical Center
🇺🇸Lima, Ohio, United States
Fairfield Medical Center
🇺🇸Lancaster, Ohio, United States
Kettering Medical Center
🇺🇸Kettering, Ohio, United States
Springfield Regional Medical Center
🇺🇸Springfield, Ohio, United States
Wright-Patterson Medical Center
🇺🇸Wright-Patterson Afb, Ohio, United States
Saint Ann's Hospital
🇺🇸Westerville, Ohio, United States
Phoenixville Hospital
🇺🇸Phoenixville, Pennsylvania, United States
Guthrie Medical Group PC-Robert Packer Hospital
🇺🇸Sayre, Pennsylvania, United States
Clinton Memorial Hospital
🇺🇸Wilmington, Ohio, United States
Abington Memorial Hospital
🇺🇸Abington, Pennsylvania, United States
Greenville Health System Cancer Institute-Faris
🇺🇸Greenville, South Carolina, United States
Greenville Memorial Hospital
🇺🇸Greenville, South Carolina, United States
Cancer Centers of the Carolinas-Greer Medical Oncology
🇺🇸Greer, South Carolina, United States
Sanford Cancer Center-Oncology Clinic
🇺🇸Sioux Falls, South Dakota, United States
PeaceHealth Saint Joseph Medical Center
🇺🇸Bellingham, Washington, United States
Valley Medical Center
🇺🇸Renton, Washington, United States
MultiCare Good Samaritan Hospital
🇺🇸Puyallup, Washington, United States
Marshfield Clinic-Chippewa Center
🇺🇸Chippewa Falls, Wisconsin, United States
Northwest CCOP
🇺🇸Tacoma, Washington, United States
North Star Lodge Cancer Center at Yakima Valley Memorial Hospital
🇺🇸Yakima, Washington, United States
Multicare Health System
🇺🇸Tacoma, Washington, United States
Saint Mary's Hospital
🇺🇸Green Bay, Wisconsin, United States
Holy Family Memorial Hospital
🇺🇸Manitowoc, Wisconsin, United States
Marshfield Clinic at James Beck Cancer Center
🇺🇸Rhinelander, Wisconsin, United States
Marshfield Clinic-Rice Lake Center
🇺🇸Rice Lake, Wisconsin, United States
Sutter General Hospital
🇺🇸Sacramento, California, United States
The Medical Center of Aurora
🇺🇸Aurora, Colorado, United States
Saint Joseph Mercy Hospital
🇺🇸Ann Arbor, Michigan, United States
Michigan Cancer Research Consortium CCOP
🇺🇸Ann Arbor, Michigan, United States
Doctors Carrol, Sheth, Raghavan
🇺🇸Louisville, Kentucky, United States
Saint Vincent Hospital
🇺🇸Green Bay, Wisconsin, United States
Via Christi Regional Medical Center
🇺🇸Wichita, Kansas, United States
Sutter Roseville Medical Center
🇺🇸Roseville, California, United States
Saint Joseph Mercy Oakland
🇺🇸Pontiac, Michigan, United States
Porubcin, Michael MD (UIA Investigator)
🇺🇸Moline, Illinois, United States
Saint Joseph Mercy Port Huron
🇺🇸Port Huron, Michigan, United States
Ottawa Regional Hospital and Healthcare Center
🇺🇸Ottawa, Illinois, United States
Illinois CancerCare-Pekin
🇺🇸Pekin, Illinois, United States
Ochsner Health Center-Covington
🇺🇸Covington, Louisiana, United States