To Evaluate if Green Tea Can be Effective in Reducing the Progression of Prostate Cancer in Men on Close Monitoring
- Conditions
- Prostate Carcinoma
- Interventions
- Other: Quality-of-Life AssessmentDrug: Placebo AdministrationOther: Questionnaire AdministrationDrug: Sinecatechins
- Registration Number
- NCT04597359
- Lead Sponsor
- ECOG-ACRIN Cancer Research Group
- Brief Summary
This phase II trial studies how well green tea catechins work in preventing progression of prostate cancer from a low risk stage to higher risk stages in men who are on active surveillance. Green tea catechins may stabilize prostate cancer and lower the chance of prostate growing.
- Detailed Description
PRIMARY OBJECTIVE:
I. To compare the change in the percent (%) Ki-67 expression in a biopsy core positive for cancer from baseline to end-of-study (EOS) biopsy between men on active surveillance (AS) for prostate cancer (PCa), treated with green tea catechins (GTCs) or placebo for 6 months.
SECONDARY OBJECTIVES:
I. To assess apoptosis by caspase in tumor tissue from EOS biopsy by treatment. II. To assess % Ki-67: Apoptosis ratio from EOS biopsy by treatment. III. To evaluate the number of biopsy cores positive for cancer from EOS biopsy by treatment.
IV. To evaluate the percentage of any biopsy tissue core positive for cancer from EOS biopsy by treatment.
V. To evaluate % Ki-67 in EOS biopsy from the same quadrant matching the quadrant with the highest % Ki-67 at baseline treatment.
VI. To evaluate the Gleason sum from EOS biopsy by treatment. VII. To evaluate the change in serum prostate-specific antigen (PSA) from baseline to 3 months and to EOS by treatment.
VIII. To evaluate the safety of 6 month administration of GTC assessed by Common Toxicity Criteria (CTC) version 5.0, complete blood count (CBC), comprehensive metabolic panel (CMP) and liver function toxicities (LFTs) by treatment.
IX. To evaluate the change in geometric mean of % Ki-67 measures in all the cores positive for cancer from baseline to EOS biopsy by treatment.
EXPLORATORY OBJECTIVES:
I. To evaluate the change in catechin (epigallocatechin gallate \[EGCG\]) as indicated by change from EGCG measured in plasma from baseline and EOS by treatment.
II. To evaluate the adherence and acceptability to GTC based on the percentage compliance using agent logs (%) and pill counts monthly until EOS by treatment groups.
III. To evaluate the bioavailability of GTC as indicated by change from EGCG measured in plasma from baseline and EOS by treatment groups.
PATIENT REPORTED OUTCOMES OBJECTIVES:
I. To evaluate the change in lower urinary tract symptoms (LUTS) from baseline to 3 months and to EOS using the LUTS scale by treatment groups.
II. To evaluate the change in quality of life (QOL) scores from baseline to 3 months and to EOS using the Functional Assessment of Cancer Therapy (FACT)-Prostate by treatment groups.
OUTLINE: Patients are randomized to 1 of 2 arms.
ARM A: Patients receive green tea catechins orally (PO) twice daily (BID) for up to 6 months in the absence of disease progression or unacceptable toxicity.
ARM B: Patients receive placebo PO BID for up to 6 months.
After completion of study, patients are followed up at approximately 7 days, at 6 months, and then up to 12 months.
Recruitment & Eligibility
- Status
- RECRUITING
- Sex
- All
- Target Recruitment
- 360
-
INCLUSION CRITERIA FOR PREREGISTRATION (STEP 0: SCREENING)
-
Patient must have biopsy-proven (consisting of >= 12 tissue cores) adenocarcinoma of the prostate with cancer present in at least one biopsy core in the most recent biopsy using initial transrectal ultrasound (TRUS) biopsy or TRUS biopsy followed by multiparametric magnetic resonance imaging (mpMRI) of the prostate and a confirmatory targeted biopsy
-
Patient must be on active surveillance (very low, low and favorable intermediate risk as defined by the National Comprehensive Cancer Network [NCCN])
-
Patient must be scheduled for a follow up prostate biopsy 6 months after the initiation of treatment on this study
-
Patient must have a serum PSA < 10 ng/mL or prostate specific antigen density (PSAD) < 0.15 ng/mL/ g obtained within 30 days of registration
-
Patient must have an Eastern Cooperative Oncology Group (ECOG) performance status 0-1
-
Patient must be willing to abstain from consumption of any supplements containing green tea catechins
-
Patient must be willing to restrict tea consumption to less than three (3) servings of hot tea or three (3) servings of iced tea per week (serving size of 8 oz)
-
Patient must be willing to discontinue current vitamin/mineral supplement use and use one provided by study
-
Patient must be willing to take study agent or placebo at the dose specified with meals
-
Patient must have the ability to understand and the willingness to sign a written informed consent document
-
Absolute neutrophil count >= 1,200/mm^3 (>= 1.2 k/uL) (obtained within 30 days prior to registration)
-
Platelets >= 75,000/mm^3 (>= 75 k/uL) (obtained within 30 days prior to registration)
-
Total bilirubin =< 1.2 mg/dL (or =< 3.0 mg/dL for patients with Gilbert's syndrome) (obtained within 30 days prior to registration)
-
Aspartate aminotransferase (AST) (serum glutamic-oxaloacetic transaminase [SGOT])/alanine aminotransferase (ALT) (serum glutamate pyruvate transaminase [SGPT]) =< 1.5 x upper limit of normal (ULN) (obtained within 30 days prior to registration)
-
Serum creatinine =< 1.5 x ULN (obtained within 30 days prior to registration)
-
Human immunodeficiency virus (HIV)-infected patients on effective anti-retroviral therapy with undetectable viral load within 6 months are eligible for this trial
-
Sexually active males must use an accepted and effective method of double barrier contraception (vasectomy must be combined with a physical barrier method) or abstain from sexual intercourse for the duration of their participation in the study
-
Patients must have archived formalin-fixed paraffin-embedded (FFPE) tumor tissue specimen available for Gleason score confirmation and % Ki-67 expression (5% or more) in tumor tissue for eligibility and stratification. Tumor tissue can be submitted any time during screening
-
Tumor tissue specimen has been collected and is ready to ship to H. Lee Moffitt Cancer Center & Research Institute
- H. Lee Moffitt Cancer Center & Research Institute will perform Gleason score confirmation and % Ki-67 expression (5% or more) in tumor tissue and notify the Eastern Cooperative Oncology Group-American College of Radiology Imaging Network (ECOG-ACRIN) Operations Office and submitting institution within 3-4 business days of receipt of the tumor tissue specimen
-
-
INCLUSION CRITERIA FOR RANDOMIZATION (STEP 1)
-
Patient must meet all Step 0 eligibility criteria at the time of their registration to Step 1
-
Patient must have Gleason score (3+3) or predominant Gleason pattern 3 (3+4), =< 33% of biopsy cores, and =< 50% involvement of any biopsy core
-
Patient must have % Ki-67 expression of 5% or more in tumor tissue
- EXCLUSION CRITERIA FOR PREREGISTRATION (STEP 0: SCREENING)
- Patient must not have had prior treatment for prostate cancer, including focal therapy, with surgery, irradiation, local ablative (i.e., cryosurgery or high-intensity focused ultrasound), or androgen deprivation therapy
- Patient must not have a history of renal or hepatic disease, including history of hepatitis B and C
- Patient must not have prostate cancer with distant metastases
- Patient must not have undergone treatment of hormone therapy, immunotherapy, chemotherapy and/or radiation for any malignancies within the past 2 years. Patients with a prior or concurrent malignancy whose natural history or treatment does not have the potential to interfere with the safety or efficacy assessment of the investigational regimen are eligible for this trial
- Patient must not receive any other investigational agents while on this study
- Patient must not have a history of allergic reactions attributed to tea or other compounds of similar chemical or biologic composition to green tea extracts
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Arm A (green tea catechins) Quality-of-Life Assessment Patients receive green tea catechins PO BID for up to 6 months in the absence of disease progression or unacceptable toxicity. Arm A (green tea catechins) Questionnaire Administration Patients receive green tea catechins PO BID for up to 6 months in the absence of disease progression or unacceptable toxicity. Arm B (placebo) Placebo Administration Patients receive placebo PO BID for up to 6 months. Arm B (placebo) Quality-of-Life Assessment Patients receive placebo PO BID for up to 6 months. Arm B (placebo) Questionnaire Administration Patients receive placebo PO BID for up to 6 months. Arm A (green tea catechins) Sinecatechins Patients receive green tea catechins PO BID for up to 6 months in the absence of disease progression or unacceptable toxicity.
- Primary Outcome Measures
Name Time Method Change in the highest percent Ki-67 expression Baseline to 6 months Measured in a core positive for tumor from baseline to highest percent (%) Ki-67 expression measured in a core positive for tumor in the end of study (EOS) biopsy. This change will be compared between green tea catechins (GTC) and placebo arms. The highest % Ki-67 expressions from baseline and EOS biopsies will be used to estimate the change. If the change is not normally distributed, non-parametric test such as Wilcoxon-rank sum test or two-sample normal score test will be used to compare the changes in percent Ki-67 levels between the GTC and placebo arms.
- Secondary Outcome Measures
Name Time Method Apoptosis Up to 6 months Will be assessed by caspase in tumor tissue from EOS biopsy by treatment.
Apoptosis ratio Up to 6 months Will be evaluated from EOS biopsy by treatment groups. Descriptive statistics with confidence intervals will be presented. For continuous measures, will use two-sample t-test or Wilcoxon rank sum test (if non-parametric test is more appropriate) to compare the measurements by treatment.
Number of biopsy cores positive for cancer at end of study At 6 months Descriptive statistics with confidence intervals will be presented. For binary measures, will use Fisher's test.
Percent of any biopsy tissue core positive for cancer at end of study At 6 months Descriptive statistics with confidence intervals will be presented. For continuous measures, will use two-sample t-test or Wilcoxon rank sum test (if non-parametric test is more appropriate) to compare the measurements by treatment.
Percent Ki-67 Up to 6 months Descriptive statistics with confidence intervals will be presented. For continuous measures, will use two-sample t-test or Wilcoxon rank sum test (if non-parametric test is more appropriate) to compare the measurements by treatment.
Gleason sum at end of study At 6 months Descriptive statistics with confidence intervals will be presented. For binary measures, will use Fisher's test.
Change in serum prostate-specific antigen (PSA) Baseline up to 6 months Will use three mixed models (for PSA, PSA doubling time, and PSA density). For the first two, will log the PSA value. For PSA, will have intercepts and slopes for each patient, an unstructured covariance model, and 2 terms for the intercept and slope associated with the treatment group. For the PSA doubling time, will center the baseline values at 1, and estimate the slopes for each patient (from which the doubling time can be derived), along with a net slope effect for the treatment group. The mixed model for PSA density will be analogous to the one for PSA.
Incidence of adverse events Up to 12 months Will be assessed by Common Toxicity Criteria version 5.0, complete blood count, comprehensive metabolic panel, and liver function toxicities by treatment. All toxicity data will be summarized by category and grade in a standard fashion. Proportions experiencing the most common types of toxicity in this trial will be estimated and 95% confidence intervals calculated. Adverse event rates (such as worst grade 3 or higher) by arm will be estimated and compared.
Change in geometric mean of percent Ki-67 Baseline up to 6 months Descriptive statistics with confidence intervals will be presented. For binary measures, will use Fisher's test.
Trial Locations
- Locations (353)
Bethesda North Hospital
🇺🇸Cincinnati, Ohio, United States
Abbott-Northwestern Hospital
🇺🇸Minneapolis, Minnesota, United States
Cheyenne Regional Medical Center-West
🇺🇸Cheyenne, Wyoming, United States
Cancer Center at Saint Joseph's
🇺🇸Phoenix, Arizona, United States
Mercy Hospital Oklahoma City
🇺🇸Oklahoma City, Oklahoma, United States
The Women's Imaging Center
🇺🇸Denver, Colorado, United States
Colorado Blood Cancer Institute
🇺🇸Denver, Colorado, United States
Porter Adventist Hospital
🇺🇸Denver, Colorado, United States
Presbyterian - Saint Lukes Medical Center - Health One
🇺🇸Denver, Colorado, United States
Rose Medical Center
🇺🇸Denver, Colorado, United States
Rocky Mountain Cancer Centers-Midtown
🇺🇸Denver, Colorado, United States
Oregon Health and Science University
🇺🇸Portland, Oregon, United States
Portland VA Medical Center
🇺🇸Portland, Oregon, United States
Rocky Mountain Cancer Centers-Rose
🇺🇸Denver, Colorado, United States
UC San Diego Health System - Encinitas
🇺🇸Encinitas, California, United States
Pali Momi Medical Center
🇺🇸'Aiea, Hawaii, United States
Epic Care-Dublin
🇺🇸Dublin, California, United States
Queen's Cancer Center - Pearlridge
🇺🇸'Aiea, Hawaii, United States
Bay Area Tumor Institute
🇺🇸Oakland, California, United States
Mercy Cancer Center
🇺🇸Merced, California, United States
Mercy Cancer Center - Elk Grove
🇺🇸Elk Grove, California, United States
Mercy Hospital Fort Smith
🇺🇸Fort Smith, Arkansas, United States
Mercy Cancer Center - Rocklin
🇺🇸Rocklin, California, United States
UC San Diego Medical Center - Hillcrest
🇺🇸San Diego, California, United States
CARTI Cancer Center
🇺🇸Little Rock, Arkansas, United States
Mission Hope Medical Oncology - Arroyo Grande
🇺🇸Arroyo Grande, California, United States
Mercy Cancer Center - Carmichael
🇺🇸Carmichael, California, United States
UCSF Cancer Center - San Mateo
🇺🇸San Mateo, California, United States
Woodland Memorial Hospital
🇺🇸Woodland, California, United States
Marshall Hospital
🇺🇸Placerville, California, United States
UCHealth - Cherry Creek
🇺🇸Denver, Colorado, United States
BASS Medical Group - Lennon
🇺🇸Walnut Creek, California, United States
Mercy Medical Center
🇺🇸Durango, Colorado, United States
Boulder Community Foothills Hospital
🇺🇸Boulder, Colorado, United States
Hawaii Cancer Care - Westridge
🇺🇸'Aiea, Hawaii, United States
Rocky Mountain Cancer Centers-Thornton
🇺🇸Thornton, Colorado, United States
Mount Sinai Medical Center
🇺🇸Miami Beach, Florida, United States
Cancer Care Specialists of Illinois - Decatur
🇺🇸Decatur, Illinois, United States
Memorial Hospital of Carbondale
🇺🇸Carbondale, Illinois, United States
HSHS Saint Elizabeth's Hospital
🇺🇸O'Fallon, Illinois, United States
Rush - Copley Medical Center
🇺🇸Aurora, Illinois, United States
Illinois CancerCare-Bloomington
🇺🇸Bloomington, Illinois, United States
John H Stroger Jr Hospital of Cook County
🇺🇸Chicago, Illinois, United States
Centralia Oncology Clinic
🇺🇸Centralia, Illinois, United States
Carle Physician Group-Mattoon/Charleston
🇺🇸Mattoon, Illinois, United States
Decatur Memorial Hospital
🇺🇸Decatur, Illinois, United States
Illinois CancerCare-Galesburg
🇺🇸Galesburg, Illinois, United States
Illinois CancerCare-Macomb
🇺🇸Macomb, Illinois, United States
Good Samaritan Regional Health Center
🇺🇸Mount Vernon, Illinois, United States
Illinois CancerCare - Washington
🇺🇸Washington, Illinois, United States
Saint Anthony Regional Hospital
🇺🇸Carroll, Iowa, United States
Reid Health
🇺🇸Richmond, Indiana, United States
The Carle Foundation Hospital
🇺🇸Urbana, Illinois, United States
McFarland Clinic - Boone
🇺🇸Boone, Iowa, United States
Mission Cancer and Blood - West Des Moines
🇺🇸Clive, Iowa, United States
Commonwealth Cancer Center-Corbin
🇺🇸Corbin, Kentucky, United States
Greater Regional Medical Center
🇺🇸Creston, Iowa, United States
Mercy Medical Center-West Lakes
🇺🇸West Des Moines, Iowa, United States
Central Care Cancer Center - Great Bend
🇺🇸Great Bend, Kansas, United States
Methodist West Hospital
🇺🇸West Des Moines, Iowa, United States
Flaget Memorial Hospital
🇺🇸Bardstown, Kentucky, United States
Jewish Hospital Medical Center South
🇺🇸Shepherdsville, Kentucky, United States
Maine Medical Partners Urology
🇺🇸South Portland, Maine, United States
Saint Joseph London
🇺🇸London, Kentucky, United States
Caro Cancer Center
🇺🇸Caro, Michigan, United States
Trinity Health Medical Center - Brighton
🇺🇸Brighton, Michigan, United States
Ascension Saint John Hospital
🇺🇸Detroit, Michigan, United States
Genesee Hematology Oncology PC
🇺🇸Flint, Michigan, United States
Michigan Breast Specialists-Grosse Pointe Woods
🇺🇸Grosse Pointe Woods, Michigan, United States
Macomb Hematology Oncology PC
🇺🇸Warren, Michigan, United States
Minnesota Oncology - Burnsville
🇺🇸Burnsville, Minnesota, United States
Fairview Southdale Hospital
🇺🇸Edina, Minnesota, United States
Michigan Healthcare Professionals Pontiac
🇺🇸Pontiac, Michigan, United States
Hope Cancer Center
🇺🇸Pontiac, Michigan, United States
Monticello Cancer Center
🇺🇸Monticello, Minnesota, United States
Parkland Health Center - Farmington
🇺🇸Farmington, Missouri, United States
United Hospital
🇺🇸Saint Paul, Minnesota, United States
Saint Mary's Oncology/Hematology Associates of West Branch
🇺🇸West Branch, Michigan, United States
Great Lakes Cancer Management Specialists-Macomb Professional Building
🇺🇸Warren, Michigan, United States
Mercy Hospital
🇺🇸Coon Rapids, Minnesota, United States
University of Oklahoma Health Sciences Center
🇺🇸Oklahoma City, Oklahoma, United States
Mercy Health - Saint Anne Hospital
🇺🇸Toledo, Ohio, United States
Good Samaritan Hospital - Cincinnati
🇺🇸Cincinnati, Ohio, United States
TriHealth Cancer Institute-Westside
🇺🇸Cincinnati, Ohio, United States
Dayton Physicians LLC-Miami Valley South
🇺🇸Centerville, Ohio, United States
Regions Hospital
🇺🇸Saint Paul, Minnesota, United States
Lehigh Valley Hospital - Muhlenberg
🇺🇸Bethlehem, Pennsylvania, United States
Pocono Medical Center
🇺🇸East Stroudsburg, Pennsylvania, United States
Audie L Murphy VA Hospital
🇺🇸San Antonio, Texas, United States
Michigan Breast Specialists-Warren
🇺🇸Warren, Michigan, United States
North Memorial Medical Health Center
🇺🇸Robbinsdale, Minnesota, United States
Lakeview Hospital
🇺🇸Stillwater, Minnesota, United States
New Ulm Medical Center
🇺🇸New Ulm, Minnesota, United States
Delbert Day Cancer Institute at PCRMC
🇺🇸Rolla, Missouri, United States
Mercy Clinic-Rolla-Cancer and Hematology
🇺🇸Rolla, Missouri, United States
Oncology Hematology Care Inc-Kenwood
🇺🇸Cincinnati, Ohio, United States
Fairview Ridges Hospital
🇺🇸Burnsville, Minnesota, United States
Toledo Clinic Cancer Centers-Toledo
🇺🇸Toledo, Ohio, United States
Dayton Physicians LLC-Wayne
🇺🇸Greenville, Ohio, United States
Midlands Community Hospital
🇺🇸Papillion, Nebraska, United States
Saint John Macomb-Oakland Hospital
🇺🇸Warren, Michigan, United States
Wayne Hospital
🇺🇸Greenville, Ohio, United States
Upper Valley Medical Center
🇺🇸Troy, Ohio, United States
Saint Joseph Warren Hospital
🇺🇸Warren, Ohio, United States
Inova Fair Oaks Hospital
🇺🇸Fairfax, Virginia, United States
Saint Peter's University Hospital
🇺🇸New Brunswick, New Jersey, United States
Lehigh Valley Hospital-Cedar Crest
🇺🇸Allentown, Pennsylvania, United States
Saint Elizabeth Youngstown Hospital
🇺🇸Youngstown, Ohio, United States
Hennepin County Medical Center
🇺🇸Minneapolis, Minnesota, United States
Saint Francis Regional Medical Center
🇺🇸Shakopee, Minnesota, United States
Unity Hospital
🇺🇸Fridley, Minnesota, United States
Lake Regional Hospital
🇺🇸Osage Beach, Missouri, United States
Saint Louis Cancer and Breast Institute-Ballwin
🇺🇸Ballwin, Missouri, United States
Park Nicollet Clinic - Saint Louis Park
🇺🇸Saint Louis Park, Minnesota, United States
Heartland Regional Medical Center
🇺🇸Saint Joseph, Missouri, United States
Mercy Hospital South
🇺🇸Saint Louis, Missouri, United States
New Hampshire Oncology Hematology PA-Concord
🇺🇸Concord, New Hampshire, United States
Nebraska Cancer Specialists/Oncology Hematology West PC
🇺🇸Grand Island, Nebraska, United States
Solinsky Center for Cancer Care
🇺🇸Manchester, New Hampshire, United States
Queens Hospital Center
🇺🇸Jamaica, New York, United States
Indu and Raj Soin Medical Center
🇺🇸Beavercreek, Ohio, United States
CoxHealth South Hospital
🇺🇸Springfield, Missouri, United States
Greater Dayton Cancer Center
🇺🇸Kettering, Ohio, United States
Springfield Regional Cancer Center
🇺🇸Springfield, Ohio, United States
Springfield Regional Medical Center
🇺🇸Springfield, Ohio, United States
TriHealth Cancer Institute-Anderson
🇺🇸Cincinnati, Ohio, United States
University of Texas Health Science Center at San Antonio
🇺🇸San Antonio, Texas, United States
Elmhurst Hospital Center
🇺🇸Elmhurst, New York, United States
Lexington Medical Center
🇺🇸West Columbia, South Carolina, United States
Inova Schar Cancer Institute
🇺🇸Fairfax, Virginia, United States
Outer Banks Hospital
🇺🇸Nags Head, North Carolina, United States
Saint Francis Hospital
🇺🇸Federal Way, Washington, United States
Sovah Health Martinsville
🇺🇸Martinsville, Virginia, United States
Highline Medical Center-Main Campus
🇺🇸Burien, Washington, United States
Saint Elizabeth Hospital
🇺🇸Enumclaw, Washington, United States
Franciscan Research Center-Northwest Medical Plaza
🇺🇸Tacoma, Washington, United States
Alegent Health Immanuel Medical Center
🇺🇸Omaha, Nebraska, United States
Alegent Health Bergan Mercy Medical Center
🇺🇸Omaha, Nebraska, United States
Alegent Health Lakeside Hospital
🇺🇸Omaha, Nebraska, United States
Creighton University Medical Center
🇺🇸Omaha, Nebraska, United States
Saint Francis Medical Center
🇺🇸Cape Girardeau, Missouri, United States
Freeman Health System
🇺🇸Joplin, Missouri, United States
Saint Louis Cancer and Breast Institute-South City
🇺🇸Saint Louis, Missouri, United States
Mercy Hospital Saint Louis
🇺🇸Saint Louis, Missouri, United States
Mercy Hospital Springfield
🇺🇸Springfield, Missouri, United States
Missouri Baptist Sullivan Hospital
🇺🇸Sullivan, Missouri, United States
BJC Outpatient Center at Sunset Hills
🇺🇸Sunset Hills, Missouri, United States
Mercy Hospital Washington
🇺🇸Washington, Missouri, United States
Central Care Cancer Center - Garden City
🇺🇸Garden City, Kansas, United States
Castle Medical Center
🇺🇸Kailua, Hawaii, United States
Cambridge Medical Center
🇺🇸Cambridge, Minnesota, United States
Minnesota Oncology Hematology PA-Woodbury
🇺🇸Woodbury, Minnesota, United States
Fairview Clinics and Surgery Center Maple Grove
🇺🇸Maple Grove, Minnesota, United States
Rocky Mountain Cancer Centers - Swedish
🇺🇸Englewood, Colorado, United States
Southwest Oncology PC
🇺🇸Durango, Colorado, United States
Mountain Blue Cancer Care Center - Swedish
🇺🇸Englewood, Colorado, United States
Swedish Medical Center
🇺🇸Englewood, Colorado, United States
Poudre Valley Hospital
🇺🇸Fort Collins, Colorado, United States
The Melanoma and Skin Cancer Institute
🇺🇸Englewood, Colorado, United States
Rocky Mountain Cancer Centers-Littleton
🇺🇸Littleton, Colorado, United States
UCHealth Highlands Ranch Hospital
🇺🇸Highlands Ranch, Colorado, United States
Rocky Mountain Cancer Centers-Lakewood
🇺🇸Lakewood, Colorado, United States
Rocky Mountain Cancer Centers-Sky Ridge
🇺🇸Lone Tree, Colorado, United States
Medical Center of the Rockies
🇺🇸Loveland, Colorado, United States
Highlands Oncology Group
🇺🇸Springdale, Arkansas, United States
CHI Saint Vincent Cancer Center Hot Springs
🇺🇸Hot Springs, Arkansas, United States
Hurley Medical Center
🇺🇸Flint, Michigan, United States
Trinity Health Medical Center - Canton
🇺🇸Canton, Michigan, United States
Hematology Oncology Consultants-Clarkston
🇺🇸Clarkston, Michigan, United States
Great Lakes Cancer Management Specialists-Doctors Park
🇺🇸East China Township, Michigan, United States
Academic Hematology Oncology Specialists
🇺🇸Grosse Pointe Woods, Michigan, United States
University of Michigan Health - Sparrow Lansing
🇺🇸Lansing, Michigan, United States
Trinity Health Saint Mary Mercy Livonia Hospital
🇺🇸Livonia, Michigan, United States
Bhadresh Nayak MD PC-Sterling Heights
🇺🇸Sterling Heights, Michigan, United States
Oncology Hematology Associates of Saginaw Valley PC
🇺🇸Saginaw, Michigan, United States
Ascension Saint Joseph Hospital
🇺🇸Tawas City, Michigan, United States
Alegent Health Mercy Hospital
🇺🇸Council Bluffs, Iowa, United States
Thomas Jefferson University Hospital
🇺🇸Philadelphia, Pennsylvania, United States
Miami Valley Hospital
🇺🇸Dayton, Ohio, United States
Dayton Physician LLC - Englewood
🇺🇸Dayton, Ohio, United States
Miami Valley Hospital North
🇺🇸Dayton, Ohio, United States
Armes Family Cancer Center
🇺🇸Findlay, Ohio, United States
Atrium Medical Center-Middletown Regional Hospital
🇺🇸Franklin, Ohio, United States
Carle at The Riverfront
🇺🇸Danville, Illinois, United States
Illinois CancerCare-Dixon
🇺🇸Dixon, Illinois, United States
Southern Illinois University School of Medicine
🇺🇸Springfield, Illinois, United States
Carle Cancer Center
🇺🇸Urbana, Illinois, United States
Parker Adventist Hospital
🇺🇸Parker, Colorado, United States
Straub Medical Center - Kahului Clinic
🇺🇸Kahului, Hawaii, United States
Dayton Physicians LLC - Troy
🇺🇸Troy, Ohio, United States
Cox Cancer Center Branson
🇺🇸Branson, Missouri, United States
Ingalls Memorial Hospital
🇺🇸Harvey, Illinois, United States
Carle Physician Group-Effingham
🇺🇸Effingham, Illinois, United States
Mission Cancer and Blood - Ankeny
🇺🇸Ankeny, Iowa, United States
Hope Cancer Clinic
🇺🇸Livonia, Michigan, United States
Mercy Hospital Joplin
🇺🇸Joplin, Missouri, United States
Trinity Health IHA Medical Group Hematology Oncology - Chelsea Hospital
🇺🇸Chelsea, Michigan, United States
Trinity Health IHA Medical Group Hematology Oncology - Canton
🇺🇸Canton, Michigan, United States
Newland Medical Associates-Pontiac
🇺🇸Pontiac, Michigan, United States
Dayton Physicians LLC-Atrium
🇺🇸Franklin, Ohio, United States
Fairbanks Memorial Hospital
🇺🇸Fairbanks, Alaska, United States
Highlands Oncology Group - Fayetteville
🇺🇸Fayetteville, Arkansas, United States
Highlands Oncology Group - Rogers
🇺🇸Rogers, Arkansas, United States
Mercy San Juan Medical Center
🇺🇸Carmichael, California, United States
Marshall Cancer Center
🇺🇸Cameron Park, California, United States
UC San Diego Moores Cancer Center
🇺🇸La Jolla, California, United States
Bay Area Breast Surgeons Inc
🇺🇸Emeryville, California, United States
Epic Care Partners in Cancer Care
🇺🇸Emeryville, California, United States
Alta Bates Summit Medical Center - Summit Campus
🇺🇸Oakland, California, United States
Contra Costa Regional Medical Center
🇺🇸Martinez, California, United States
Pacific Central Coast Health Center-San Luis Obispo
🇺🇸San Luis Obispo, California, United States
Epic Care Cyberknife Center
🇺🇸Walnut Creek, California, United States
Mission Hope Medical Oncology - Santa Maria
🇺🇸Santa Maria, California, United States
Rocky Mountain Cancer Centers - Centennial
🇺🇸Centennial, Colorado, United States
Rocky Mountain Cancer Centers-Penrose
🇺🇸Colorado Springs, Colorado, United States
Rocky Mountain Cancer Centers-Boulder
🇺🇸Boulder, Colorado, United States
Penrose-Saint Francis Healthcare
🇺🇸Colorado Springs, Colorado, United States
UCHealth Greeley Hospital
🇺🇸Greeley, Colorado, United States
Cancer Care and Hematology-Fort Collins
🇺🇸Fort Collins, Colorado, United States
Saint Anthony Hospital
🇺🇸Lakewood, Colorado, United States
Littleton Adventist Hospital
🇺🇸Littleton, Colorado, United States
Longmont United Hospital
🇺🇸Longmont, Colorado, United States
Saint Mary Corwin Medical Center
🇺🇸Pueblo, Colorado, United States
MedStar Washington Hospital Center
🇺🇸Washington, District of Columbia, United States
Rocky Mountain Cancer Centers-Longmont
🇺🇸Longmont, Colorado, United States
Mount Sinai Comprehensive Cancer Center at Aventura
🇺🇸Aventura, Florida, United States
Holy Cross Hospital
🇺🇸Fort Lauderdale, Florida, United States
The Queen's Medical Center - West Oahu
🇺🇸'Ewa Beach, Hawaii, United States
Straub Pearlridge Clinic
🇺🇸'Aiea, Hawaii, United States
The Cancer Center of Hawaii-Pali Momi
🇺🇸'Aiea, Hawaii, United States
Wilcox Memorial Hospital and Kauai Medical Clinic
🇺🇸Lihue, Hawaii, United States
Saint Anthony's Health
🇺🇸Alton, Illinois, United States
SIH Cancer Institute
🇺🇸Carterville, Illinois, United States
Illinois CancerCare-Carthage
🇺🇸Carthage, Illinois, United States
Illinois CancerCare-Canton
🇺🇸Canton, Illinois, United States
Saint Mary's Hospital
🇺🇸Centralia, Illinois, United States
Western Illinois Cancer Treatment Center
🇺🇸Galesburg, Illinois, United States
Illinois CancerCare-Eureka
🇺🇸Eureka, Illinois, United States
Illinois CancerCare-Kewanee Clinic
🇺🇸Kewanee, Illinois, United States
Cancer Care Center of O'Fallon
🇺🇸O'Fallon, Illinois, United States
Illinois CancerCare-Ottawa Clinic
🇺🇸Ottawa, Illinois, United States
Illinois CancerCare-Pekin
🇺🇸Pekin, Illinois, United States
Methodist Medical Center of Illinois
🇺🇸Peoria, Illinois, United States
Illinois CancerCare-Peoria
🇺🇸Peoria, Illinois, United States
Illinois CancerCare-Princeton
🇺🇸Princeton, Illinois, United States
Memorial Medical Center
🇺🇸Springfield, Illinois, United States
Springfield Clinic
🇺🇸Springfield, Illinois, United States
Mary Greeley Medical Center
🇺🇸Ames, Iowa, United States
Rush-Copley Healthcare Center
🇺🇸Yorkville, Illinois, United States
McFarland Clinic - Ames
🇺🇸Ames, Iowa, United States
Mercy Cancer Center-West Lakes
🇺🇸Clive, Iowa, United States
McFarland Clinic - Trinity Cancer Center
🇺🇸Fort Dodge, Iowa, United States
Trinity Regional Medical Center
🇺🇸Fort Dodge, Iowa, United States
McFarland Clinic - Marshalltown
🇺🇸Marshalltown, Iowa, United States
McFarland Clinic - Jefferson
🇺🇸Jefferson, Iowa, United States
Mercy Health - Paducah Medical Oncology and Hematology
🇺🇸Paducah, Kentucky, United States
Saint Joseph Mount Sterling
🇺🇸Mount Sterling, Kentucky, United States
Hickman Cancer Center
🇺🇸Adrian, Michigan, United States
Trinity Health IHA Medical Group Hematology Oncology - Brighton
🇺🇸Brighton, Michigan, United States
Chelsea Hospital
🇺🇸Chelsea, Michigan, United States
Genesee Cancer and Blood Disease Treatment Center
🇺🇸Flint, Michigan, United States
Newland Medical Associates-Clarkston
🇺🇸Clarkston, Michigan, United States
Genesys Hurley Cancer Institute
🇺🇸Flint, Michigan, United States
Great Lakes Cancer Management Specialists-Van Elslander Cancer Center
🇺🇸Grosse Pointe Woods, Michigan, United States
Great Lakes Cancer Management Specialists-Macomb Medical Campus
🇺🇸Macomb, Michigan, United States
Michigan Breast Specialists-Macomb Township
🇺🇸Macomb, Michigan, United States
Saint Mary's Oncology/Hematology Associates of Marlette
🇺🇸Marlette, Michigan, United States
Toledo Clinic Cancer Centers-Monroe
🇺🇸Monroe, Michigan, United States
Trinity Health Saint Joseph Mercy Oakland Hospital
🇺🇸Pontiac, Michigan, United States
Ascension Saint Mary's Hospital
🇺🇸Saginaw, Michigan, United States
Advanced Breast Care Center PLLC
🇺🇸Warren, Michigan, United States
Huron Gastroenterology PC
🇺🇸Ypsilanti, Michigan, United States
Trinity Health IHA Medical Group Hematology Oncology Ann Arbor Campus
🇺🇸Ypsilanti, Michigan, United States
Minnesota Oncology Hematology PA-Maplewood
🇺🇸Maplewood, Minnesota, United States
Saint John's Hospital - Healtheast
🇺🇸Maplewood, Minnesota, United States
Health Partners Inc
🇺🇸Minneapolis, Minnesota, United States
Fairview Northland Medical Center
🇺🇸Princeton, Minnesota, United States
Fairview Lakes Medical Center
🇺🇸Wyoming, Minnesota, United States
Central Care Cancer Center - Bolivar
🇺🇸Bolivar, Missouri, United States
Rice Memorial Hospital
🇺🇸Willmar, Minnesota, United States
Southeast Cancer Center
🇺🇸Cape Girardeau, Missouri, United States
Missouri Baptist Medical Center
🇺🇸Saint Louis, Missouri, United States
Saint Elizabeth Regional Medical Center
🇺🇸Lincoln, Nebraska, United States
CHI Health Good Samaritan
🇺🇸Kearney, Nebraska, United States
Hackensack University Medical Center
🇺🇸Hackensack, New Jersey, United States
Saint Elizabeth Boardman Hospital
🇺🇸Boardman, Ohio, United States
Miami Valley Hospital South
🇺🇸Centerville, Ohio, United States
Blanchard Valley Hospital
🇺🇸Findlay, Ohio, United States
Orion Cancer Care
🇺🇸Findlay, Ohio, United States
Toledo Clinic Cancer Centers-Maumee
🇺🇸Maumee, Ohio, United States
Kettering Medical Center
🇺🇸Kettering, Ohio, United States
Lehigh Valley Hospital-Hazleton
🇺🇸Hazleton, Pennsylvania, United States
Reading Hospital
🇺🇸West Reading, Pennsylvania, United States
Chesapeake Regional Medical Center
🇺🇸Chesapeake, Virginia, United States
Inova Fairfax Hospital
🇺🇸Falls Church, Virginia, United States
Saint Joseph Regional Cancer Center
🇺🇸Bryan, Texas, United States
Inova Alexandria Hospital
🇺🇸Alexandria, Virginia, United States
Jefferson Healthcare
🇺🇸Port Townsend, Washington, United States
Saint Clare Hospital
🇺🇸Lakewood, Washington, United States
Saint Michael Cancer Center
🇺🇸Silverdale, Washington, United States
Saint Vincent Hospital Cancer Center Green Bay
🇺🇸Green Bay, Wisconsin, United States
Cancer Center of Western Wisconsin
🇺🇸New Richmond, Wisconsin, United States
Saint Vincent Hospital Cancer Center at Saint Mary's
🇺🇸Green Bay, Wisconsin, United States
FHP Health Center-Guam
🇬🇺Tamuning, Guam
Doctors Cancer Center
🇵🇷Manati, Puerto Rico
Centro Comprensivo de Cancer de UPR
🇵🇷San Juan, Puerto Rico
Trinity Health Saint Joseph Mercy Hospital Ann Arbor
🇺🇸Ann Arbor, Michigan, United States
Mercy Cancer Center - Sacramento
🇺🇸Sacramento, California, United States
Rocky Mountain Cancer Centers-Aurora
🇺🇸Aurora, Colorado, United States
Rocky Mountain Regional VA Medical Center
🇺🇸Aurora, Colorado, United States
UCHealth University of Colorado Hospital
🇺🇸Aurora, Colorado, United States
Saint Francis Cancer Center
🇺🇸Colorado Springs, Colorado, United States
Cancer Center-Metro Medical Center Bayamon
🇵🇷Bayamon, Puerto Rico
PROncology
🇵🇷San Juan, Puerto Rico
San Juan Community Oncology Group
🇵🇷San Juan, Puerto Rico
San Juan City Hospital
🇵🇷San Juan, Puerto Rico
Puerto Rico Hematology Oncology Group
🇵🇷Bayamon, Puerto Rico
Saints Mary and Elizabeth Hospital
🇺🇸Louisville, Kentucky, United States
Jewish Hospital
🇺🇸Louisville, Kentucky, United States
UofL Health Medical Center Northeast
🇺🇸Louisville, Kentucky, United States
UNC Lineberger Comprehensive Cancer Center
🇺🇸Chapel Hill, North Carolina, United States
Ralph H Johnson VA Medical Center
🇺🇸Charleston, South Carolina, United States
Medical University of South Carolina
🇺🇸Charleston, South Carolina, United States
VCU Massey Cancer Center at Stony Point
🇺🇸Richmond, Virginia, United States
Virginia Commonwealth University/Massey Cancer Center
🇺🇸Richmond, Virginia, United States
Hawaii Cancer Care Inc - Waterfront Plaza
🇺🇸Honolulu, Hawaii, United States
Queen's Cancer Cenrer - POB I
🇺🇸Honolulu, Hawaii, United States
Queen's Medical Center
🇺🇸Honolulu, Hawaii, United States
Straub Clinic and Hospital
🇺🇸Honolulu, Hawaii, United States
University of Hawaii Cancer Center
🇺🇸Honolulu, Hawaii, United States
Hawaii Cancer Care Inc-Liliha
🇺🇸Honolulu, Hawaii, United States
Hawaii Diagnostic Radiology Services LLC
🇺🇸Honolulu, Hawaii, United States
Kuakini Medical Center
🇺🇸Honolulu, Hawaii, United States
Queen's Cancer Center - Kuakini
🇺🇸Honolulu, Hawaii, United States
The Cancer Center of Hawaii-Liliha
🇺🇸Honolulu, Hawaii, United States
Kapiolani Medical Center for Women and Children
🇺🇸Honolulu, Hawaii, United States
Iowa Methodist Medical Center
🇺🇸Des Moines, Iowa, United States
Mission Cancer and Blood - Des Moines
🇺🇸Des Moines, Iowa, United States
Broadlawns Medical Center
🇺🇸Des Moines, Iowa, United States
Mercy Medical Center - Des Moines
🇺🇸Des Moines, Iowa, United States
Mission Cancer and Blood - Laurel
🇺🇸Des Moines, Iowa, United States
Iowa Lutheran Hospital
🇺🇸Des Moines, Iowa, United States
Saint Joseph Hospital
🇺🇸Lexington, Kentucky, United States
Saint Joseph Radiation Oncology Resource Center
🇺🇸Lexington, Kentucky, United States
Saint Joseph Hospital East
🇺🇸Lexington, Kentucky, United States
James J Peters VA Medical Center
🇺🇸Bronx, New York, United States
University of New Mexico Cancer Center
🇺🇸Albuquerque, New Mexico, United States
Valley Radiation Oncology
🇺🇸Peru, Illinois, United States
Illinois CancerCare-Peru
🇺🇸Peru, Illinois, United States
Crossroads Cancer Center
🇺🇸Effingham, Illinois, United States
Ridgeview Medical Center
🇺🇸Waconia, Minnesota, United States
MU Health Care Goldschmidt Cancer Center
🇺🇸Jefferson City, Missouri, United States
Sainte Genevieve County Memorial Hospital
🇺🇸Sainte Genevieve, Missouri, United States