Dexamethasone in Reducing Everolimus-Induced Oral Stomatitis in Patients With Cancer

Phase 3

Terminated

Conditions: Malignant Neoplasm

Interventions: Other: Placebo
Drug: Dexamethasone
Other: Questionnaire
Other: Quality-of-Life Assessment
Drug: Everolimus

Registration Number: NCT03839940

Lead Sponsor: Alliance for Clinical Trials in Oncology

Brief Summary: This phase III trial studies how well dexamethasone works in reducing everolimus-induced oral stomatitis in patients with cancer. Dexamethasone may help to reduce the everolimus-induced oral stomatitis so as to improve quality of life in cancer patients.

Detailed Description: PRIMARY OBJECTIVES:

I. To determine if the initiation of dexamethasone at the start of everolimus treatment prevents mTOR inhibitor-associated stomatitis (mIAS)-associated pain, compared to the initiation of placebo.

II. To determine if the initiation of dexamethasone at the start of everolimus treatment will be superior compared to the initiation of placebo in terms of the overall severity of mIAS-associated pain.

SECONDARY OBJECTIVES:

I. To utilize the same measurement method that was reported in the SWISH trial: A combination of a patient reported pain scale, data from a normalcy of diet questionnaire, and clinician grading of stomatitis to determine the incidence of \> grade 2 mIAS.

II. To determine if the initiation of dexamethasone at the start of everolimus increases time to development of mouth pain using daily numerical analog scale patient-reported data collection.

III. To assess if quality of life is better when dexamethasone mouth rinse use starts at the same time as everolimus use versus at the time when mouth pain begins.

IV. To investigate if starting dexamethasone mouth rinse concurrent with starting everolimus improves patients' ability to adhere to everolimus therapy.

V. To compare dexamethasone prescription fill rates and timing between patients who received placebo versus study drug at the initiation of everolimus.

Trial Design:

OUTLINE: Patients are randomized to 1 of 2 groups.

GROUP I: Patients receive everolimus orally (PO) once daily (QD) as standard of care and dexamethasone as mouthwash over 2 minutes 4 times per day (QID) for 8 weeks.

GROUP II: Patients receive everolimus PO QD as standard of care and placebo as mouthwash over 2 minutes QID for 8 weeks.

Recruitment & Eligibility

Status: TERMINATED

Sex: All

Target Recruitment: 39

Inclusion Criteria

Current cancer diagnosis, about to receive oral everolimus 10 mg/day with or without an endocrine agent. Patients about to receive everolimus for off label use for any cancer are also eligible.
Not currently receiving chemotherapy or any other agent known to cause mucositis or stomatitis. Trastuzumab and ovarian function suppression are allowed.
Any prior chemotherapy or other stomatitis/mucositis-causing therapy must be completed at least 2 weeks prior to registration.
Not currently suffering from stomatitis/mucositis or mouth ulcers. Patients should not have had any stomatitis or mouth pain for at least 7 days prior to registration.
Patients should not receive any other agent which would be considered treatment for stomatitis or impact the primary endpoint.
No history of candida infection (thrush) within the last 3 months.
Not currently being treated with corticosteroids.
No uncontrolled diabetes mellitus, defined by hemoglobin A1C greater than 8%, although A1C is not needed for all patients, hemoglobin (Hgb)A1C < 8 is required for everyone with diabetes or suspected diabetes.
Patients must be able to read and comprehend English. Local translation, including verbal translation of professionals (PROs) is not permitted.
Not pregnant and not nursing, because this study involves an investigational agent whose genotoxic, mutagenic and teratogenic effects on the developing fetus and newborn are unknown. Therefore, for women of childbearing potential only, a negative pregnancy test done =< 7 days prior to registration is required.
Eastern Cooperative Oncology Group (ECOG) performance status 0, 1 or 2.

Exclusion Criteria

Not provided

Study & Design

Study Type: INTERVENTIONAL

Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Group I (dexamethasone)	Questionnaire	Patients receive 10mg oral everolimus daily as standard of care and 10ml dexamethasone oral mouthwash, swished for 2-minutes daily, for 8 weeks.
Group I (dexamethasone)	Quality-of-Life Assessment	Patients receive 10mg oral everolimus daily as standard of care and 10ml dexamethasone oral mouthwash, swished for 2-minutes daily, for 8 weeks.
Group I (dexamethasone)	Everolimus	Patients receive 10mg oral everolimus daily as standard of care and 10ml dexamethasone oral mouthwash, swished for 2-minutes daily, for 8 weeks.
Group II (placebo)	Placebo	Patients receive 10mg oral everolimus daily as standard of care and 10ml placebo oral mouthwash, swished for 2-minutes daily, for 8 weeks.
Group II (placebo)	Questionnaire	Patients receive 10mg oral everolimus daily as standard of care and 10ml placebo oral mouthwash, swished for 2-minutes daily, for 8 weeks.
Group II (placebo)	Quality-of-Life Assessment	Patients receive 10mg oral everolimus daily as standard of care and 10ml placebo oral mouthwash, swished for 2-minutes daily, for 8 weeks.
Group II (placebo)	Everolimus	Patients receive 10mg oral everolimus daily as standard of care and 10ml placebo oral mouthwash, swished for 2-minutes daily, for 8 weeks.
Group I (dexamethasone)	Dexamethasone	Patients receive 10mg oral everolimus daily as standard of care and 10ml dexamethasone oral mouthwash, swished for 2-minutes daily, for 8 weeks.

Primary Outcome Measures

Name	Time	Method
Incidence Rate of the mTOR Inhibitor-associated Stomatitis (mIAS)-Related Pain Based on Daily Self-reports Via the Numerical Analogue Scale	Up to 8 weeks	The numerical analogue mouth pain score (NAMPS) is a single item measured on a 0 to 10 scale, with 0 corresponding to "No pain" and 10 corresponding to "Pain as bad as it can be." Will compare the incidence rate of any mouth pain (i.e., any score greater than 0) as assessed by the NAMPS between the prevention versus early treatment approaches using a Chi-square test.
Severity of Mouth Pain Scores	Up to 8 weeks	Average Area Under the Curve per assessment (aAUCpa) of mouth pain scores as measured by NAMPS will be computed for each patient to summarize the sequence of numerical analogue mouth pain scores over the eight week study period. Scores are reported on a 0-100 scale, where 100 = better outcome QOL (i.e. less pain). The aAUCpa is the average of each AUC between each sequential assessment from treatment-initiation to the end of the treatment at 8 weeks post-treatment-initiation and will be compared between the two treatment arms.

Secondary Outcome Measures

Name	Time	Method
Incidence of Grade > 2 mIAS as Measured by the SWISH Trial	Up to 8 weeks	Original plan for collecting and analyzing this data did not occur due to study termination. Grade 2 mIAS is defined as having at least one of the following criteria:\> 1. Oral intake assessed at 50 on the Normalcy of Diet Scale 2. Patient's reported oral pain (using visual analogue scale 0-10) that meets one of the following: rating of 7 on two consecutive days rating of 8, 9, or 10 on any one day. The incidence of grade 2 mIAS for each treatment arm will be compared by a Chi-square test.
Time to Development of Mouth Pain	Up to 8 weeks	Original plan for collecting and analyzing this data did not occur due to study termination. Will determine if the initiation of dexamethasone at the start of everolimus is associated with the time to development of mild (score of 1-3), moderate (score of 4-6) and severe (score of 7-10) mouth pain as measured by the NAMPS. Will be assessed by Kaplan-Meier and cumulative incidence curves.
Sleep Level of Activity Interference With Daily Activities	Up to 8 weeks	Original plan for collecting and analyzing this data did not occur due to study termination. Will determine if the initiation of dexamethasone at the start of everolimus is associated with the level of interference with daily activities as measured by the PRO-CTCAE sleep item regarding level of interference with daily activities. The PRO-CTCAE sleep item regarding level of interference with daily activities is measured on a Likert 1-5 scale, with 1 corresponding to "Not at all" and 5 corresponding to "Very much." Will be assessed by independent samples t-tests.
Incidence of Mouth Pain	Up to 8 weeks	Original plan for collecting and analyzing this data did not occur due to study termination. Will determine if the initiation of dexamethasone at the start of everolimus is associated with the incidence and of mild (score of 1-3), moderate (score of 4-6) and severe (score of 7-10) mouth pain as measured by the NAMPS. Will be assessed by Chi-square tests.
Incidence of Patients Reducing Everolimus Dose	Up to 8 weeks	Original plan for collecting and analyzing this data did not occur due to study termination. Will compare the number of patients who reduced their everolimus dose between the treatment arms. Will be compared using Chi-squared tests.
Dexamethasone Prescription Fill Rates	Up to 8 weeks	Original plan for collecting and analyzing this data did not occur due to study termination. Will compare dexamethasone prescription fill rates between the treatment groups. This will be compared using Chi-squared tests.
Quality of Life Assessed by Linear Analogue Self-Assessment	Up to 8 weeks	Original plan for collecting and analyzing this data did not occur due to study termination. Will determine if the initiation of dexamethasone at the start of everolimus is associated with quality of life is by comparing numerical analogue scale scores as measured by the Linear Analogue Self-Assessment. The Linear Analogue Self Assessment for quality of life is measured on a 0 to 10 scale, with 0 corresponding to "Quality of life as bad as it can be" and 10 corresponding to "Quality of life as good as it can be." Will be assessed by independent samples t-tests.
Mouth/Throat Sore Level of Activity Interference With Daily Activities	Up to 8 weeks	Original plan for collecting and analyzing this data did not occur due to study termination. Will determine if the initiation of dexamethasone at the start of everolimus is associated with the level of interference with daily activities as measured by the Patient Reported Outcome (PRO) Common Terminology criteria for Adverse Events (CTCAE) mouth/throat item regarding level of interference with daily activities. The PRO-CTCAE mouth/throat item regarding level of interference with daily activities is measured on a Likert 1-5 scale, with 1 corresponding to "Not at all" and 5 corresponding to "Very much." Will be assessed by independent samples t-tests.
Adherence to Everolimus Therapy Dose	Up to 8 weeks	Original plan for collecting and analyzing this data did not occur due to study termination. Will compare mean daily dose of everolimus between the arms. The mean daily dose of everolimus over 8 weeks will be compared between study arms using independent samples t-tests.
Incidence of Patients Stopping Everolimus Early	Up to 8 weeks	Original plan for collecting and analyzing this data did not occur due to study termination. Will compare the number of patients who stopped everolimus early between the treatment arms. Will be compared using Chi-squared tests.
Time to Dexamethasone Prescription Fill	Up to 8 weeks	Original plan for collecting and analyzing this data did not occur due to study termination. Will compare the time to dexamethasone prescription fill between the treatment groups. This will be compared using Kaplan-Meier and cumulative incidence curves.
Time to Develop Mouth Sores Per Study Arm Assessed by PRO-CTCAE Mouth/Throat Sore Item Regarding Severity	Up to 8 weeks	Original plan for collecting and analyzing this data did not occur due to study termination. The time to develop at least mild, moderate, or severe (including "Very severe") mouth sores per study arm as measured by the PRO-CTCAE mouth-throat sore item regarding severity. The PRO-CTCAE mouth-throat sore item regarding severity is measured on a Likert 1-5 scale, with 1 corresponding to "None" and 5 corresponding to "Very severe". Will be assessed by Kaplan-Meier and cumulative incidence curves.
Mean Degrees of Patient-reported Mouth Sores Per Study Arm Assessed by NAMPS	Up to 8 weeks	Original plan for collecting and analyzing this data did not occur due to study termination. The mean degrees of patient-reported mouth sores per study arm as measured by the NAMPS will be assessed by independent samples t-tests.
Median Degree of Patient-reported Mouth Sores Per Study Arm Assessed by NAMPS	Up to 8 weeks	Original plan for collecting and analyzing this data did not occur due to study termination. The median degrees of patient-reported mouth sores per study arm as measured by the NAMPS will be assessed by independent samples t-tests.
Proportion of Patients Who Experience Grade 2 Stomatitis	Up to 2 months	Original plan for collecting and analyzing this data did not occur due to study termination. The proportion of patients who experience clinician-reported grade 2 stomatitis (as measured by the CTCAE and performed at 1 and 2 months post-baseline) per study arm will be assessed by Chi-squared tests.

Trial Locations

Locations (319): Mercy Hospital Fort Smith
🇺🇸
Fort Smith, Arkansas, United States
Saint Alphonsus Cancer Care Center-Boise
🇺🇸
Boise, Idaho, United States
Cancer Care Specialists of Illinois - Decatur
🇺🇸
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
Cancer Care Center of O'Fallon
🇺🇸
O'Fallon, Illinois, United States
Mercy Hospital
🇺🇸
Coon Rapids, Minnesota, United States
West Michigan Cancer Center
🇺🇸
Kalamazoo, Michigan, United States
Advanced Breast Care Center PLLC
🇺🇸
Warren, Michigan, United States
Minnesota Oncology Hematology PA-Woodbury
🇺🇸
Woodbury, Minnesota, United States
Heartland Regional Medical Center
🇺🇸
Saint Joseph, Missouri, United States
United Hospital
🇺🇸
Saint Paul, Minnesota, United States
OptumCare Cancer Care at Seven Hills
🇺🇸
Henderson, Nevada, United States
Las Vegas Urology - Green Valley
🇺🇸
Henderson, Nevada, United States
Radiation Oncology Associates
🇺🇸
Reno, Nevada, United States
Dublin Methodist Hospital
🇺🇸
Dublin, Ohio, United States
Riverside Methodist Hospital
🇺🇸
Columbus, Ohio, United States
Grant Medical Center
🇺🇸
Columbus, Ohio, United States
The Mark H Zangmeister Center
🇺🇸
Columbus, Ohio, United States
Las Vegas Urology - Pecos
🇺🇸
Las Vegas, Nevada, United States
Desert West Surgery
🇺🇸
Las Vegas, Nevada, United States
OptumCare Cancer Care at Oakey
🇺🇸
Las Vegas, Nevada, United States
University Medical Center of Southern Nevada
🇺🇸
Las Vegas, Nevada, United States
Radiation Oncology Centers of Nevada Central
🇺🇸
Las Vegas, Nevada, United States
Urology Specialists of Nevada - Central
🇺🇸
Las Vegas, Nevada, United States
21st Century Oncology
🇺🇸
Las Vegas, Nevada, United States
HealthCare Partners Medical Group Oncology/Hematology-Maryland Parkway
🇺🇸
Las Vegas, Nevada, United States
Sunrise Hospital and Medical Center
🇺🇸
Las Vegas, Nevada, United States
HealthCare Partners Medical Group Oncology/Hematology-San Martin
🇺🇸
Las Vegas, Nevada, United States
Urology Specialists of Nevada - Southwest
🇺🇸
Las Vegas, Nevada, United States
21st Century Oncology-Vegas Tenaya
🇺🇸
Las Vegas, Nevada, United States
Ann M Wierman MD LTD
🇺🇸
Las Vegas, Nevada, United States
Las Vegas Urology - Smoke Ranch
🇺🇸
Las Vegas, Nevada, United States
Urology Specialists of Nevada - Northwest
🇺🇸
Las Vegas, Nevada, United States
Comprehensive Cancer Centers of Nevada
🇺🇸
Las Vegas, Nevada, United States
Comprehensive Cancer Centers of Nevada - Central Valley
🇺🇸
Las Vegas, Nevada, United States
Hennepin County Medical Center
🇺🇸
Minneapolis, Minnesota, United States
Benefis Healthcare- Sletten Cancer Institute
🇺🇸
Great Falls, Montana, United States
Community Medical Hospital
🇺🇸
Missoula, Montana, United States
University of Alabama at Birmingham Cancer Center
🇺🇸
Birmingham, Alabama, United States
Legacy Good Samaritan Hospital and Medical Center
🇺🇸
Portland, Oregon, United States
Saint Alphonsus Cancer Care Center-Caldwell
🇺🇸
Caldwell, Idaho, United States
Rush - Copley Medical Center
🇺🇸
Aurora, Illinois, United States
Saint Alphonsus Medical Center-Nampa
🇺🇸
Nampa, Idaho, United States
Walter Knox Memorial Hospital
🇺🇸
Emmett, Idaho, United States
Illinois CancerCare-Peoria
🇺🇸
Peoria, Illinois, United States
Illinois CancerCare-Peru
🇺🇸
Peru, Illinois, United States
Illinois CancerCare-Eureka
🇺🇸
Eureka, Illinois, United States
Carle Physician Group-Mattoon/Charleston
🇺🇸
Mattoon, Illinois, United States
Valley Radiation Oncology
🇺🇸
Peru, Illinois, United States
Western Illinois Cancer Treatment Center
🇺🇸
Galesburg, Illinois, United States
Illinois CancerCare-Kewanee Clinic
🇺🇸
Kewanee, Illinois, United States
Springfield Clinic
🇺🇸
Springfield, Illinois, United States
Carle Cancer Center
🇺🇸
Urbana, Illinois, United States
Southwest Illinois Health Services LLP
🇺🇸
Swansea, Illinois, United States
Methodist West Hospital
🇺🇸
West Des Moines, Iowa, United States
Genesee Cancer and Blood Disease Treatment Center
🇺🇸
Flint, Michigan, United States
Genesee Hematology Oncology PC
🇺🇸
Flint, Michigan, United States
Genesys Hurley Cancer Institute
🇺🇸
Flint, Michigan, United States
Saint Mary Mercy Hospital
🇺🇸
Livonia, Michigan, United States
Great Lakes Cancer Management Specialists-Macomb Medical Campus
🇺🇸
Macomb, Michigan, United States
Cancer and Hematology Centers of Western Michigan - Norton Shores
🇺🇸
Norton Shores, Michigan, United States
Hope Cancer Center
🇺🇸
Pontiac, Michigan, United States
Huron Medical Center PC
🇺🇸
Port Huron, Michigan, United States
Spectrum Health Reed City Hospital
🇺🇸
Reed City, Michigan, United States
Lake Huron Medical Center
🇺🇸
Port Huron, Michigan, United States
Ascension Saint Mary's Hospital
🇺🇸
Saginaw, Michigan, United States
Washington University School of Medicine
🇺🇸
Saint Louis, Missouri, United States
Unity Hospital
🇺🇸
Fridley, Minnesota, United States
Metro Health Hospital
🇺🇸
Wyoming, Michigan, United States
Sanford Joe Lueken Cancer Center
🇺🇸
Bemidji, Minnesota, United States
Ridgeview Medical Center
🇺🇸
Waconia, Minnesota, United States
Bhadresh Nayak MD PC-Sterling Heights
🇺🇸
Sterling Heights, Michigan, United States
Ascension Saint Joseph Hospital
🇺🇸
Tawas City, Michigan, United States
Delbert Day Cancer Institute at PCRMC
🇺🇸
Rolla, Missouri, United States
Parkland Health Center-Bonne Terre
🇺🇸
Bonne Terre, Missouri, United States
Rice Memorial Hospital
🇺🇸
Willmar, Minnesota, United States
Sanford Thief River Falls Medical Center
🇺🇸
Thief River Falls, Minnesota, United States
Abbott-Northwestern Hospital
🇺🇸
Minneapolis, Minnesota, United States
Minnesota Oncology Hematology PA-Maplewood
🇺🇸
Maplewood, Minnesota, United States
Fairview Ridges Hospital
🇺🇸
Burnsville, Minnesota, United States
Saint Louis Cancer and Breast Institute-Ballwin
🇺🇸
Ballwin, Missouri, United States
North Memorial Medical Health Center
🇺🇸
Robbinsdale, Minnesota, United States
Park Nicollet Clinic - Saint Louis Park
🇺🇸
Saint Louis Park, Minnesota, United States
Saint John Macomb-Oakland Hospital
🇺🇸
Warren, Michigan, United States
Huron Gastroenterology PC
🇺🇸
Ypsilanti, Michigan, United States
Cambridge Medical Center
🇺🇸
Cambridge, Minnesota, United States
Fairview Clinics and Surgery Center Maple Grove
🇺🇸
Maple Grove, Minnesota, United States
Cox Cancer Center Branson
🇺🇸
Branson, Missouri, United States
Saint Louis Cancer and Breast Institute-South City
🇺🇸
Saint Louis, Missouri, United States
Mercy Hospital Joplin
🇺🇸
Joplin, Missouri, United States
Sanford Cancer Center Worthington
🇺🇸
Worthington, Minnesota, United States
Siteman Cancer Center-South County
🇺🇸
Saint Louis, Missouri, United States
Summerlin Hospital Medical Center
🇺🇸
Las Vegas, Nevada, United States
Virtua Memorial
🇺🇸
Mount Holly, New Jersey, United States
Radiation Oncology Centers of Nevada Southeast
🇺🇸
Las Vegas, Nevada, United States
Solinsky Center for Cancer Care
🇺🇸
Manchester, New Hampshire, United States
Las Vegas Cancer Center-Medical Center
🇺🇸
Las Vegas, Nevada, United States
Comprehensive Cancer Centers of Nevada - Henderson
🇺🇸
Henderson, Nevada, United States
Carson Tahoe Regional Medical Center
🇺🇸
Carson City, Nevada, United States
21st Century Oncology-Fort Apache
🇺🇸
Las Vegas, Nevada, United States
Saint Mary's Regional Medical Center
🇺🇸
Reno, Nevada, United States
Mercy Hospital Springfield
🇺🇸
Springfield, Missouri, United States
CoxHealth South Hospital
🇺🇸
Springfield, Missouri, United States
Kalispell Regional Medical Center
🇺🇸
Kalispell, Montana, United States
Southeast Nebraska Cancer Center - 68th Street Place
🇺🇸
Lincoln, Nebraska, United States
Cancer and Blood Specialists-Henderson
🇺🇸
Henderson, Nevada, United States
Mercy Hospital Saint Louis
🇺🇸
Saint Louis, Missouri, United States
Las Vegas Cancer Center-Henderson
🇺🇸
Henderson, Nevada, United States
Nebraska Hematology and Oncology
🇺🇸
Lincoln, Nebraska, United States
Comprehensive Cancer Centers of Nevada-Horizon Ridge
🇺🇸
Henderson, Nevada, United States
Bozeman Deaconess Hospital
🇺🇸
Bozeman, Montana, United States
Regional West Medical Center Cancer Center
🇺🇸
Scottsbluff, Nebraska, United States
21st Century Oncology-Henderson
🇺🇸
Henderson, Nevada, United States
OptumCare Cancer Care at Fort Apache
🇺🇸
Las Vegas, Nevada, United States
Sainte Genevieve County Memorial Hospital
🇺🇸
Sainte Genevieve, Missouri, United States
Great Falls Clinic
🇺🇸
Great Falls, Montana, United States
Renown Regional Medical Center
🇺🇸
Reno, Nevada, United States
Saint Peter's Community Hospital
🇺🇸
Helena, Montana, United States
Comprehensive Cancer Centers of Nevada-Southeast Henderson
🇺🇸
Henderson, Nevada, United States
Great Plains Health Callahan Cancer Center
🇺🇸
North Platte, Nebraska, United States
Hope Cancer Care of Nevada
🇺🇸
Las Vegas, Nevada, United States
Cancer and Blood Specialists-Shadow
🇺🇸
Las Vegas, Nevada, United States
Missouri Baptist Outpatient Center-Sunset Hills
🇺🇸
Sunset Hills, Missouri, United States
Billings Clinic Cancer Center
🇺🇸
Billings, Montana, United States
Faith Regional Health Services Carson Cancer Center
🇺🇸
Norfolk, Nebraska, United States
Alliance for Childhood Diseases/Cure 4 the Kids Foundation
🇺🇸
Las Vegas, Nevada, United States
Comprehensive Cancer Centers of Nevada - Town Center
🇺🇸
Las Vegas, Nevada, United States
HealthCare Partners Medical Group Oncology/Hematology-Centennial Hills
🇺🇸
Las Vegas, Nevada, United States
University Cancer Center
🇺🇸
Las Vegas, Nevada, United States
Mercy Hospital Washington
🇺🇸
Washington, Missouri, United States
Urology Specialists of Nevada - Green Valley
🇺🇸
Henderson, Nevada, United States
Community Hospital of Anaconda
🇺🇸
Anaconda, Montana, United States
Hematology Oncology Associates of Central New York-East Syracuse
🇺🇸
East Syracuse, New York, United States
Hematology Oncology Associates of Central New York-Onondaga Hill
🇺🇸
Syracuse, New York, United States
CaroMont Regional Medical Center
🇺🇸
Gastonia, North Carolina, United States
Sanford Bismarck Medical Center
🇺🇸
Bismarck, North Dakota, United States
Altru Cancer Center
🇺🇸
Grand Forks, North Dakota, United States
Sanford Roger Maris Cancer Center
🇺🇸
Fargo, North Dakota, United States
Mount Carmel Health Center West
🇺🇸
Columbus, Ohio, United States
Knox Community Hospital
🇺🇸
Mount Vernon, Ohio, United States
Licking Memorial Hospital
🇺🇸
Newark, Ohio, United States
Newark Radiation Oncology
🇺🇸
Newark, Ohio, United States
Southern Ohio Medical Center
🇺🇸
Portsmouth, Ohio, United States
Mercy Hospital Oklahoma City
🇺🇸
Oklahoma City, Oklahoma, United States
Saint Ann's Hospital
🇺🇸
Westerville, Ohio, United States
Genesis Healthcare System Cancer Care Center
🇺🇸
Zanesville, Ohio, United States
Saint Alphonsus Medical Center-Baker City
🇺🇸
Baker City, Oregon, United States
Legacy Mount Hood Medical Center
🇺🇸
Gresham, Oregon, United States
Saint Alphonsus Medical Center-Ontario
🇺🇸
Ontario, Oregon, United States
Overlake Medical Center
🇺🇸
Bellevue, Washington, United States
Valley Medical Center
🇺🇸
Renton, Washington, United States
Legacy Cancer Institute Medical Oncology and Day Treatment
🇺🇸
Vancouver, Washington, United States
Marshfield Medical Center-Marshfield
🇺🇸
Marshfield, Wisconsin, United States
Welch Cancer Center
🇺🇸
Sheridan, Wyoming, United States
Marshfield Medical Center-Rice Lake
🇺🇸
Rice Lake, Wisconsin, United States
Marshfield Clinic - Wisconsin Rapids Center
🇺🇸
Wisconsin Rapids, Wisconsin, United States
Marshfield Clinic Stevens Point Center
🇺🇸
Stevens Point, Wisconsin, United States
Marshfield Clinic-Wausau Center
🇺🇸
Wausau, Wisconsin, United States
Marshfield Clinic - Weston Center
🇺🇸
Weston, Wisconsin, United States
Billings Clinic-Cody
🇺🇸
Cody, Wyoming, United States
Saint Francis Medical Center
🇺🇸
Cape Girardeau, Missouri, United States
Freeman Health System
🇺🇸
Joplin, Missouri, United States
Capital Region Southwest Campus
🇺🇸
Jefferson City, Missouri, United States
Mercy Clinic-Rolla-Cancer and Hematology
🇺🇸
Rolla, Missouri, United States
Mercy Hospital South
🇺🇸
Saint Louis, Missouri, United States
Nebraska Cancer Specialists - Omaha
🇺🇸
Omaha, Nebraska, United States
Oncology Hematology West PC
🇺🇸
Omaha, Nebraska, United States
Health Partners Inc
🇺🇸
Minneapolis, Minnesota, United States
Saint John's Hospital - Healtheast
🇺🇸
Maplewood, Minnesota, United States
New Ulm Medical Center
🇺🇸
New Ulm, Minnesota, United States
Monticello Cancer Center
🇺🇸
Monticello, Minnesota, United States
Regions Hospital
🇺🇸
Saint Paul, Minnesota, United States
Lakeview Hospital
🇺🇸
Stillwater, Minnesota, United States
Kootenai Cancer Clinic
🇺🇸
Sandpoint, Idaho, United States
Hurley Medical Center
🇺🇸
Flint, Michigan, United States
Great Lakes Cancer Management Specialists-Macomb Professional Building
🇺🇸
Warren, Michigan, United States
Saint Mary's Oncology/Hematology Associates of West Branch
🇺🇸
West Branch, Michigan, United States
Comprehensive Cancer Centers of Nevada - Northwest
🇺🇸
Las Vegas, Nevada, United States
HealthCare Partners Medical Group Oncology/Hematology-Tenaya
🇺🇸
Las Vegas, Nevada, United States
Las Vegas Urology - Cathedral Rock
🇺🇸
Las Vegas, Nevada, United States
Kootenai Cancer Center
🇺🇸
Post Falls, Idaho, United States
Great Lakes Cancer Management Specialists-Rochester Hills
🇺🇸
Rochester Hills, Michigan, United States
Comprehensive Cancer Centers of Nevada-Summerlin
🇺🇸
Las Vegas, Nevada, United States
Illinois CancerCare-Pekin
🇺🇸
Pekin, Illinois, United States
Las Vegas Prostate Cancer Center
🇺🇸
Las Vegas, Nevada, United States
Missouri Baptist Medical Center
🇺🇸
Saint Louis, Missouri, United States
PCR Oncology
🇺🇸
Arroyo Grande, California, United States
Bay Area Breast Surgeons Inc
🇺🇸
Emeryville, California, United States
Contra Costa Regional Medical Center
🇺🇸
Martinez, California, United States
Kingman Regional Medical Center
🇺🇸
Kingman, Arizona, United States
Epic Care Partners in Cancer Care
🇺🇸
Emeryville, California, United States
Epic Care-Dublin
🇺🇸
Dublin, California, United States
Epic Care Cyberknife Center
🇺🇸
Walnut Creek, California, United States
Holy Cross Hospital
🇺🇸
Fort Lauderdale, Florida, United States
Bay Area Tumor Institute
🇺🇸
Oakland, California, United States
Idaho Urologic Institute-Meridian
🇺🇸
Meridian, Idaho, United States
Memorial Hospital of Carbondale
🇺🇸
Carbondale, Illinois, United States
Illinois CancerCare-Bloomington
🇺🇸
Bloomington, Illinois, United States
Illinois CancerCare-Canton
🇺🇸
Canton, Illinois, United States
SIH Cancer Institute
🇺🇸
Carterville, Illinois, United States
Centralia Oncology Clinic
🇺🇸
Centralia, Illinois, United States
Carle on Vermilion
🇺🇸
Danville, Illinois, United States
Illinois CancerCare-Carthage
🇺🇸
Carthage, Illinois, United States
Decatur Memorial Hospital
🇺🇸
Decatur, Illinois, United States
Carle Physician Group-Effingham
🇺🇸
Effingham, Illinois, United States
Illinois CancerCare-Dixon
🇺🇸
Dixon, Illinois, United States
Crossroads Cancer Center
🇺🇸
Effingham, Illinois, United States
Illinois CancerCare-Ottawa Clinic
🇺🇸
Ottawa, Illinois, United States
Methodist Medical Center of Illinois
🇺🇸
Peoria, Illinois, United States
Illinois CancerCare-Princeton
🇺🇸
Princeton, Illinois, United States
Memorial Medical Center
🇺🇸
Springfield, Illinois, United States
Southern Illinois University School of Medicine
🇺🇸
Springfield, Illinois, United States
The Carle Foundation Hospital
🇺🇸
Urbana, Illinois, United States
Rush-Copley Healthcare Center
🇺🇸
Yorkville, Illinois, United States
Physicians' Clinic of Iowa PC
🇺🇸
Cedar Rapids, Iowa, United States
Trinity Regional Medical Center
🇺🇸
Fort Dodge, Iowa, United States
LSU Health Sciences Center at Shreveport
🇺🇸
Shreveport, Louisiana, United States
Ochsner LSU Health Monroe Medical Center
🇺🇸
Monroe, Louisiana, United States
Lafayette Family Cancer Center-EMMC
🇺🇸
Brewer, Maine, United States
Mercy Medical Center
🇺🇸
Springfield, Massachusetts, United States
IHA Hematology Oncology Consultants-Canton
🇺🇸
Canton, Michigan, United States
Bronson Battle Creek
🇺🇸
Battle Creek, Michigan, United States
IHA Hematology Oncology Consultants-Brighton
🇺🇸
Brighton, Michigan, United States
Saint Joseph Mercy Brighton
🇺🇸
Brighton, Michigan, United States
Caro Cancer Center
🇺🇸
Caro, Michigan, United States
Saint Joseph Mercy Canton
🇺🇸
Canton, Michigan, United States
Ascension Saint John Hospital
🇺🇸
Detroit, Michigan, United States
IHA Hematology Oncology Consultants-Chelsea
🇺🇸
Chelsea, Michigan, United States
Great Lakes Cancer Management Specialists-Doctors Park
🇺🇸
East China Township, Michigan, United States
Saint Joseph Mercy Chelsea
🇺🇸
Chelsea, Michigan, United States
Hematology Oncology Consultants-Clarkston
🇺🇸
Clarkston, Michigan, United States
Newland Medical Associates-Clarkston
🇺🇸
Clarkston, Michigan, United States
Helen DeVos Children's Hospital at Spectrum Health
🇺🇸
Grand Rapids, Michigan, United States
Mercy Health Saint Mary's
🇺🇸
Grand Rapids, Michigan, United States
Academic Hematology Oncology Specialists
🇺🇸
Grosse Pointe Woods, Michigan, United States
Spectrum Health at Butterworth Campus
🇺🇸
Grand Rapids, Michigan, United States
Bronson Methodist Hospital
🇺🇸
Kalamazoo, Michigan, United States
Great Lakes Cancer Management Specialists-Van Elslander Cancer Center
🇺🇸
Grosse Pointe Woods, Michigan, United States
Michigan Breast Specialists-Grosse Pointe Woods
🇺🇸
Grosse Pointe Woods, Michigan, United States
Hope Cancer Clinic
🇺🇸
Livonia, Michigan, United States
Borgess Medical Center
🇺🇸
Kalamazoo, Michigan, United States
Sparrow Hospital
🇺🇸
Lansing, Michigan, United States
Michigan Breast Specialists-Macomb Township
🇺🇸
Macomb, Michigan, United States
Saint Mary's Oncology/Hematology Associates of Marlette
🇺🇸
Marlette, Michigan, United States
Lakeland Hospital Niles
🇺🇸
Niles, Michigan, United States
Mercy Health Mercy Campus
🇺🇸
Muskegon, Michigan, United States
Newland Medical Associates-Pontiac
🇺🇸
Pontiac, Michigan, United States
21st Century Oncology-Pontiac
🇺🇸
Pontiac, Michigan, United States
Saint Joseph Mercy Oakland
🇺🇸
Pontiac, Michigan, United States
Oncology Hematology Associates of Saginaw Valley PC
🇺🇸
Saginaw, Michigan, United States
Lakeland Medical Center Saint Joseph
🇺🇸
Saint Joseph, Michigan, United States
Marie Yeager Cancer Center
🇺🇸
Saint Joseph, Michigan, United States
Munson Medical Center
🇺🇸
Traverse City, Michigan, United States
Macomb Hematology Oncology PC
🇺🇸
Warren, Michigan, United States
Michigan Breast Specialists-Warren
🇺🇸
Warren, Michigan, United States
Fairview Southdale Hospital
🇺🇸
Edina, Minnesota, United States
IHA Hematology Oncology Consultants-Ann Arbor
🇺🇸
Ypsilanti, Michigan, United States
Fairview Northland Medical Center
🇺🇸
Princeton, Minnesota, United States
Mayo Clinic in Rochester
🇺🇸
Rochester, Minnesota, United States
Saint Francis Regional Medical Center
🇺🇸
Shakopee, Minnesota, United States
Fairview Lakes Medical Center
🇺🇸
Wyoming, Minnesota, United States
Siteman Cancer Center at West County Hospital
🇺🇸
Creve Coeur, Missouri, United States
Southeast Cancer Center
🇺🇸
Cape Girardeau, Missouri, United States
Parkland Health Center - Farmington
🇺🇸
Farmington, Missouri, United States
Siteman Cancer Center at Saint Peters Hospital
🇺🇸
Saint Peters, Missouri, United States
Siteman Cancer Center at Christian Hospital
🇺🇸
Saint Louis, Missouri, United States
Missouri Baptist Sullivan Hospital
🇺🇸
Sullivan, Missouri, United States
Las Vegas Urology - Pebble
🇺🇸
Henderson, Nevada, United States
Las Vegas Urology - Sunset
🇺🇸
Las Vegas, Nevada, United States
OptumCare Cancer Care at MountainView
🇺🇸
Las Vegas, Nevada, United States
Cancer and Blood Specialists-Tenaya
🇺🇸
Las Vegas, Nevada, United States
Hope Cancer Care of Nevada-Pahrump
🇺🇸
Pahrump, Nevada, United States
New Hampshire Oncology Hematology PA-Concord
🇺🇸
Concord, New Hampshire, United States
Hematology Oncology Associates of Central New York-Auburn
🇺🇸
Auburn, New York, United States
Virtua Samson Cancer Center
🇺🇸
Moorestown, New Jersey, United States
Virtua Voorhees
🇺🇸
Voorhees, New Jersey, United States
Sanford South University Medical Center
🇺🇸
Fargo, North Dakota, United States
Southpointe-Sanford Medical Center Fargo
🇺🇸
Fargo, North Dakota, United States
Sanford Medical Center Fargo
🇺🇸
Fargo, North Dakota, United States
Sanford Broadway Medical Center
🇺🇸
Fargo, North Dakota, United States
Strecker Cancer Center-Belpre
🇺🇸
Belpre, Ohio, United States
Columbus Oncology and Hematology Associates Inc
🇺🇸
Columbus, Ohio, United States
Adena Regional Medical Center
🇺🇸
Chillicothe, Ohio, United States
Mount Carmel East Hospital
🇺🇸
Columbus, Ohio, United States
Doctors Hospital
🇺🇸
Columbus, Ohio, United States
Delaware Health Center-Grady Cancer Center
🇺🇸
Delaware, Ohio, United States
Grady Memorial Hospital
🇺🇸
Delaware, Ohio, United States
Central Ohio Breast and Endocrine Surgery
🇺🇸
Gahanna, Ohio, United States
OhioHealth Marion General Hospital
🇺🇸
Marion, Ohio, United States
Mount Carmel Grove City Hospital
🇺🇸
Grove City, Ohio, United States
OhioHealth Mansfield Hospital
🇺🇸
Mansfield, Ohio, United States
Marietta Memorial Hospital
🇺🇸
Marietta, Ohio, United States
Fairfield Medical Center
🇺🇸
Lancaster, Ohio, United States
Legacy Meridian Park Hospital
🇺🇸
Tualatin, Oregon, United States
Lehigh Valley Hospital-Cedar Crest
🇺🇸
Allentown, Pennsylvania, United States
Lehigh Valley Hospital - Muhlenberg
🇺🇸
Bethlehem, Pennsylvania, United States
Pocono Medical Center
🇺🇸
East Stroudsburg, Pennsylvania, United States
Lehigh Valley Hospital-Hazleton
🇺🇸
Hazleton, Pennsylvania, United States
Self Regional Healthcare
🇺🇸
Greenwood, South Carolina, United States
Sanford Cancer Center Oncology Clinic
🇺🇸
Sioux Falls, South Dakota, United States
Sanford USD Medical Center - Sioux Falls
🇺🇸
Sioux Falls, South Dakota, United States
Legacy Salmon Creek Hospital
🇺🇸
Vancouver, Washington, United States
Marshfield Clinic-Chippewa Center
🇺🇸
Chippewa Falls, Wisconsin, United States
Mayo Clinic Health System-Eau Claire Clinic
🇺🇸
Eau Claire, Wisconsin, United States
Marshfield Medical Center-EC Cancer Center
🇺🇸
Eau Claire, Wisconsin, United States
Mayo Clinic Health System Eau Claire Hospital-Luther Campus
🇺🇸
Eau Claire, Wisconsin, United States
Mayo Clinic Health System-Franciscan Healthcare
🇺🇸
La Crosse, Wisconsin, United States
Marshfield Clinic-Minocqua Center
🇺🇸
Minocqua, Wisconsin, United States
Marshfield Clinic - Ladysmith Center
🇺🇸
Ladysmith, Wisconsin, United States
Cancer Center of Western Wisconsin
🇺🇸
New Richmond, Wisconsin, United States
Saint Joseph Mercy Hospital
🇺🇸
Ann Arbor, Michigan, United States
Iowa Methodist Medical Center
🇺🇸
Des Moines, Iowa, United States
Medical Oncology and Hematology Associates-Des Moines
🇺🇸
Des Moines, Iowa, United States
Broadlawns Medical Center
🇺🇸
Des Moines, Iowa, United States
Iowa Lutheran Hospital
🇺🇸
Des Moines, Iowa, United States
Alta Bates Summit Medical Center - Summit Campus
🇺🇸
Oakland, California, United States
Kootenai Medical Center
🇺🇸
Coeur d'Alene, Idaho, United States