Dactinomycin or Methotrexate in Treating Patients With Low-Risk Gestational Trophoblastic Neoplasia
- Conditions
- ChoriocarcinomaFIGO Stage I Gestational Trophoblastic TumorFIGO Stage II Gestational Trophoblastic TumorFIGO Stage III Gestational Trophoblastic TumorHydatidiform Mole
- Interventions
- Registration Number
- NCT01535053
- Lead Sponsor
- GOG Foundation
- Brief Summary
This randomized phase III trial studies how well methotrexate works compared to dactinomycin in treating patients with low-risk gestational trophoblastic neoplasia. Drugs used in chemotherapy, such as methotrexate and dactinomycin, work in different ways to stop the growth of tumor cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. It is not yet known whether methotrexate is more effective than dactinomycin in treating gestational trophoblastic disease.
- Detailed Description
PRIMARY OBJECTIVES:
I. To test the hypothesis that treatment with multi-day methotrexate is inferior to treatment with pulse actinomycin-D (dactinomycin) in patients with low-risk gestational trophoblastic disease with respect to complete response.
SECONDARY OBJECTIVES:
I. To describe the frequency of post protocol surgical treatment for each arm. II. To describe the frequency of post protocol multi-agent chemotherapy treatment for each arm.
III. To compare multi-day methotrexate to actinomycin-D with respect to frequency and severity of adverse events in patients with low-risk gestational trophoblastic neoplasia.
IV. To investigate the impact of treatment on overall quality-of-life (QOL) and explore the influence of treatment on issues such as body image, sexual functioning, and patient-reported side effects and disruption.
V. To assess whether uterine artery pulsatility index (UAPI) can provide independent prognostic information predictive of single-drug resistance.
OUTLINE: Patients are randomized to 1 of 2 treatment arms.
ARM I: Patients receive dactinomycin intravenously (IV) over 15 minutes on day 1.
ARM II: Patients receive methotrexate intramuscularly (IM) on days 1, 3, 5, and 7 and leucovorin calcium orally (PO) on days 2, 4, 6, and 8 OR single agent methotrexate IV on days 1-5.
In both arms, treatment repeats every 14 days for up to 20 courses\* in the absence of disease progression or unacceptable toxicity.
After completion of study treatment, patients are followed up monthly for 1 year and then every 3 months for 1 year.
NOTE: \* Patients will be treated for three courses after human chorionic gonadotropin (hCG) \< 5 mIU/mL or until evidence of treatment failure (biologic progression), disease progression, or unacceptable toxicity despite dose modifications. Upon normalization of hCG (\< 5 mIU/mL), patients will be treated with three additional courses.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- Female
- Target Recruitment
- 57
-
Patients who meet International Federation of Gynecology and Obstetrics (FIGO) stage I, II, or III criteria for low-risk gestational trophoblastic neoplasia (GTN): post molar GTN or choriocarcinoma (as defined below); patients may have had a second curettage but must still meet GTN criteria below:
-
Post molar GTN
-
For the purposes of this study, patients must have undergone evacuation of a complete or partial hydatidiform mole and then meet the criteria for GTN defined as:
- A < 10% decrease in the hCG level using as a reference the first value in the series of 4 values taken over a period of 3 weeks (> 50 mIU/ml minimum) OR
- A > 20% sustained rise in the hCG taking as a reference the first value in the series of 3 values taken over a period of 2 weeks (> 50 mIU/ml minimum) OR
- A persistently elevated hCG level a period of 6 months or more following the initial curettage (> 50 mIU/ml minimum)
-
-
Choriocarcinoma
- Histologically proven non-metastatic choriocarcinoma OR
- Histologically proven metastatic choriocarcinoma if the metastatic site(s) is restricted to one (or more) of the following: vagina, parametrium, or lung
-
-
World Health Organization (WHO) risk score 0-6
-
Patients must be willing to practice effective contraception for the duration of the study
-
White blood cell count (WBC) >= 3,000 cells/mcL
-
Granulocytes >= 1,500/mcL
-
Platelets >= 100,000/mcL
-
Creatinine =< 2.0 mg/dcL
-
Bilirubin =< 1.5 x institutional normal
-
Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) =< 3 x institutional normal
-
Alkaline phosphatase =< 3 x institutional normal
-
Patients who have met the pre-entry requirements
-
Before enrolling a patient, the institution must verify the availability of an adequate supply of methotrexate for a full course of therapy
-
Patients must have signed an approved informed consent and authorization permitting release of personal health information
- Patients who do not have GTN
- Patients with non-gestational choriocarcinoma
- Patients who have previously been treated with cytotoxic chemotherapy; however, patients who received prior low-dose methotrexate for treatment of an ectopic pregnancy will be eligible for this study
- Patients who have received prior pelvic radiation
- Patients with placental-site trophoblastic tumor (PSTT) or epithelioid trophoblastic tumor (ETT)
- Patients with Gynecologic Oncology Group (GOG) performance status of 3 or 4
- Patients with a history of other invasive malignancies, with the exception of non-melanoma skin cancer, are excluded if there is any evidence of other malignancy being present within the last five years; patients are also excluded if their previous cancer treatment contraindicates this protocol therapy
- Patients whose circumstances at the time of study entry do not permit completion of the study or required follow-up
- Patients who wish to breast-feed during treatment
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Arm I (dactinomcin) Dactinomycin Patients receive dactinomycin IV over 15 minutes on day 1. Arm I (dactinomcin) Quality-of-Life Assessment Patients receive dactinomycin IV over 15 minutes on day 1. Arm II (leucovorin calcium and methotrexate) Methotrexate Patients receive methotrexate IM on days 1, 3, 5, and 7 and leucovorin calcium PO on days 2, 4, 6, and 8 OR single agent methotrexate IV on days 1-5. Arm II (leucovorin calcium and methotrexate) Quality-of-Life Assessment Patients receive methotrexate IM on days 1, 3, 5, and 7 and leucovorin calcium PO on days 2, 4, 6, and 8 OR single agent methotrexate IV on days 1-5. Arm II (leucovorin calcium and methotrexate) Leucovorin Calcium Patients receive methotrexate IM on days 1, 3, 5, and 7 and leucovorin calcium PO on days 2, 4, 6, and 8 OR single agent methotrexate IV on days 1-5.
- Primary Outcome Measures
Name Time Method Percentage of Participants With Complete Response hCG testing is performed prior to each cycle to treatment until treatment is completed, up to 10 months. For patients who have responded to treatment hCG must be obtained every 4 weeks for 1 year after completing treatment. Complete Response is defined as 3 consecutive bi-weekly values of hCG\<5 over a minimum of 4 weeks of normal hCG values with no values greater than 5 mIU/ml
- Secondary Outcome Measures
Name Time Method Number of Participants With CTCAE v4 Graded Adverse Events With Low-risk Gestational Trophoblastic Neoplasia by Arm Assessed throughout the treatment period and within 2-4 weeks after discontinuation of treatment Maximum grade of physician assessed adverse events reported during treatment
The Number of Participants With Post Protocol Surgical Treatment for Each Arm. Anytime during post treatment follow-up for up to 2 years from study entry. The Number of Participants With Post Protocol Multi-agent Chemotherapy Treatment for Each Arm. Anytime during post treatment follow-up for up to 2 years from study entry. Patient-reported Quality of Life (QOL) at Baseline Prior to cycle 1 Patient reported quality of life was measured with the Functional Assessment of Cancer Therapy - Generic (FACT-G). The FACT-G is a scale for assessing general QOL of cancer patients. It consists of four subscales: Physical Well Being, Functional Well Being, Social/Family Well-Being, and Emotional Well-Being. Each item in the FACT-G was scored using a 5-point scale (0=not at all; 1=a little bit; 2=somewhat; 3=quite a bit; 4=very much). For the negative statements, reversal was performed prior to score calculation. According to the FACIT measurement system, a subscale score was the summation of the individual item scores if more than 50% of subscale items were answered. When unanswered items existed, a subscale score was prorated by multiplying the mean of the answered item scores by the number of items in the subscale. The FACT-G score is calculated as the sum of the subscale scores. The FACT-G score ranges 0-108. A larger score suggests better QOL.
Patient-reported Quality of Life (QOL) After Baseline Visit. Prior to cycle 3 (4 weeks after cycle 1 if off study treatment prior to cycle 3). Prior to cycle 5, Prior to cycle 7, 26 weeks after starting study treatment. Patient reported quality of life was measured with the Functional Assessment of Cancer Therapy - Generic (FACT-G). The FACT-G is a scale for assessing general QOL of cancer patients. It consists of four subscales: Physical Well Being, Functional Well Being, Social/Family Well-Being, and Emotional Well-Being. Each item in the FACT-G was scored using a 5-point scale (0=not at all; 1=a little bit; 2=somewhat; 3=quite a bit; 4=very much). For the negative statements, reversal was performed prior to score calculation. According to the FACIT measurement system, a subscale score was the summation of the individual item scores if more than 50% of subscale items were answered. When unanswered items existed, a subscale score was prorated by multiplying the mean of the answered item scores by the number of items in the subscale. The FACT-G score is calculated as the sum of the subscale scores. The FACT-G score ranges 0-108. A larger score suggests better QOL.
Trial Locations
- Locations (289)
Temple University Hospital
🇺🇸Philadelphia, Pennsylvania, United States
Kaiser Permanente Los Angeles Medical Center
🇺🇸Los Angeles, California, United States
Columbus Oncology and Hematology Associates Inc
🇺🇸Columbus, Ohio, United States
UPMC-Magee Womens Hospital
🇺🇸Pittsburgh, Pennsylvania, United States
Riverside Methodist Hospital
🇺🇸Columbus, Ohio, United States
The Mark H Zangmeister Center
🇺🇸Columbus, Ohio, United States
Mount Carmel Health Center West
🇺🇸Columbus, Ohio, United States
UPMC-Presbyterian Hospital
🇺🇸Pittsburgh, Pennsylvania, United States
UPMC-Saint Margaret
🇺🇸Pittsburgh, Pennsylvania, United States
University of Pittsburgh Cancer Institute (UPCI)
🇺🇸Pittsburgh, Pennsylvania, United States
UPMC Jefferson Regional Radiation Oncology
🇺🇸Pittsburgh, Pennsylvania, United States
Northwestern University
🇺🇸Chicago, Illinois, United States
Swedish Medical Center-First Hill
🇺🇸Seattle, Washington, United States
Women's Cancer Center of Nevada
🇺🇸Las Vegas, Nevada, United States
Hennepin County Medical Center
🇺🇸Minneapolis, Minnesota, United States
Health Partners Inc
🇺🇸Minneapolis, Minnesota, United States
Big Horn Basin Cancer Center
🇺🇸Cody, Wyoming, United States
Welch Cancer Center
🇺🇸Sheridan, Wyoming, United States
Mercy Hospital Springfield
🇺🇸Springfield, Missouri, United States
Bozeman Deaconess Hospital
🇺🇸Bozeman, Montana, United States
Community Hospital of Anaconda
🇺🇸Anaconda, Montana, United States
Saint James Community Hospital and Cancer Treatment Center
🇺🇸Butte, Montana, United States
Weston Park Hospital
🇬🇧Sheffield, England, United Kingdom
Saint Joseph's Hospital and Medical Center
🇺🇸Phoenix, Arizona, United States
Providence Portland Medical Center
🇺🇸Portland, Oregon, United States
Providence Saint Vincent Medical Center
🇺🇸Portland, Oregon, United States
Northeast Georgia Medical Center-Gainesville
🇺🇸Gainesville, Georgia, United States
Summit Cancer Care-Memorial
🇺🇸Savannah, Georgia, United States
Doctors Hospital
🇺🇸Columbus, Ohio, United States
Newark Radiation Oncology
🇺🇸Newark, Ohio, United States
Lancaster Radiation Oncology
🇺🇸Lancaster, Ohio, United States
Springfield Regional Medical Center
🇺🇸Springfield, Ohio, United States
Genesis Healthcare System Cancer Care Center
🇺🇸Zanesville, Ohio, United States
Northside Hospital-Forsyth
🇺🇸Cumming, Georgia, United States
Rush - Copley Medical Center
🇺🇸Aurora, Illinois, United States
Kootenai Cancer Clinic
🇺🇸Sandpoint, Idaho, United States
Carle Cancer Center
🇺🇸Urbana, Illinois, United States
Woodland Cancer Care Center
🇺🇸Michigan City, Indiana, United States
Ridgeview Medical Center
🇺🇸Waconia, Minnesota, United States
Reading Hospital
🇺🇸West Reading, Pennsylvania, United States
Geisinger Medical Group
🇺🇸State College, Pennsylvania, United States
UH Seidman Cancer Center at Lake Health Mentor Campus
🇺🇸Mentor, Ohio, United States
Knox Community Hospital
🇺🇸Mount Vernon, Ohio, United States
Licking Memorial Hospital
🇺🇸Newark, Ohio, United States
ProMedica Flower Hospital
🇺🇸Sylvania, Ohio, United States
Jefferson Abington Hospital
🇺🇸Abington, Pennsylvania, United States
Geisinger Medical Center
🇺🇸Danville, Pennsylvania, United States
UPMC-Heritage Valley Health System Beaver
🇺🇸Beaver, Pennsylvania, United States
Geisinger Medical Center-Cancer Center Hazleton
🇺🇸Hazleton, Pennsylvania, United States
UPMC-Johnstown/John P. Murtha Regional Cancer Center
🇺🇸Johnstown, Pennsylvania, United States
UPMC-Coraopolis/Heritage Valley Radiation Oncology
🇺🇸Moon, Pennsylvania, United States
UPMC-Shadyside Hospital
🇺🇸Pittsburgh, Pennsylvania, United States
UPMC-Passavant Hospital
🇺🇸Pittsburgh, Pennsylvania, United States
UPMC-Saint Clair Hospital Cancer Center
🇺🇸Pittsburgh, Pennsylvania, United States
UPMC Washington Hospital Radiation Oncology
🇺🇸Washington, Pennsylvania, United States
Women and Infants Hospital
🇺🇸Providence, Rhode Island, United States
Parkland Memorial Hospital
🇺🇸Dallas, Texas, United States
Cancer Care Center at Island Hospital
🇺🇸Anacortes, Washington, United States
UT Southwestern/Simmons Cancer Center-Dallas
🇺🇸Dallas, Texas, United States
Providence Regional Cancer System-Aberdeen
🇺🇸Aberdeen, Washington, United States
Swedish Cancer Institute-Edmonds
🇺🇸Edmonds, Washington, United States
Providence Regional Cancer System-Centralia
🇺🇸Centralia, Washington, United States
Providence Regional Cancer Partnership
🇺🇸Everett, Washington, United States
Providence Regional Cancer System-Lacey
🇺🇸Lacey, Washington, United States
PeaceHealth Saint John Medical Center
🇺🇸Longview, Washington, United States
Swedish Cancer Institute-Issaquah
🇺🇸Issaquah, Washington, United States
Minor and James Medical PLLC
🇺🇸Seattle, Washington, United States
Swedish Medical Center-Ballard Campus
🇺🇸Seattle, Washington, United States
Providence Regional Cancer System-Shelton
🇺🇸Shelton, Washington, United States
MultiCare Deaconess Cancer and Blood Specialty Center - Valley
🇺🇸Spokane Valley, Washington, United States
MultiCare Deaconess Cancer and Blood Specialty Center - North
🇺🇸Spokane, Washington, United States
PeaceHealth Southwest Medical Center
🇺🇸Vancouver, Washington, United States
North Star Lodge Cancer Center at Yakima Valley Memorial Hospital
🇺🇸Yakima, Washington, United States
Providence Regional Cancer System-Yelm
🇺🇸Yelm, Washington, United States
Aurora Cancer Care-Southern Lakes VLCC
🇺🇸Burlington, Wisconsin, United States
Monongalia Hospital
🇺🇸Morgantown, West Virginia, United States
Aurora Cancer Care-Grafton
🇺🇸Grafton, Wisconsin, United States
Aurora Health Care Germantown Health Center
🇺🇸Germantown, Wisconsin, United States
Bay Area Medical Center
🇺🇸Marinette, Wisconsin, United States
Cancer Center of Western Wisconsin
🇺🇸New Richmond, Wisconsin, United States
Aurora Cancer Care-Racine
🇺🇸Racine, Wisconsin, United States
Vince Lombardi Cancer Clinic-Sheboygan
🇺🇸Sheboygan, Wisconsin, United States
Aurora West Allis Medical Center
🇺🇸West Allis, Wisconsin, United States
Vince Lombardi Cancer Clinic-Two Rivers
🇺🇸Two Rivers, Wisconsin, United States
Aurora Cancer Care-Waukesha
🇺🇸Waukesha, Wisconsin, United States
Rocky Mountain Oncology
🇺🇸Casper, Wyoming, United States
Aurora Medical Center in Summit
🇺🇸Summit, Wisconsin, United States
Billings Clinic-Cody
🇺🇸Cody, Wyoming, United States
Iwate Medical University Hospital
🇯🇵Shiwa-gun, Iwate, Japan
Kagoshima City Hospital
🇯🇵Kagoshima City, Kagoshima, Japan
Hokkaido University Hospital
🇯🇵Sapporo, Hokkaido, Japan
University of the Ryukyus Hospital-Col Health Scnc
🇯🇵Nakagami-gun, Okinawa, Japan
Saitama Medical University International Medical Center
🇯🇵Saitama, Japan
Samsung Medical Center
🇰🇷Seoul, Korea, Korea, Republic of
Seoul National University Bundang Hospital
🇰🇷Seongnam City, Kyeonggi-do, Korea, Republic of
Gangnam Severance Hospital
🇰🇷Seoul, Korea, Republic of
Aurora Bay Area Medical Group-Marinette
🇺🇸Marinette, Wisconsin, United States
Aurora BayCare Medical Center
🇺🇸Green Bay, Wisconsin, United States
Aurora Cancer Care-Kenosha South
🇺🇸Kenosha, Wisconsin, United States
Aurora Cancer Care-Milwaukee West
🇺🇸Wauwatosa, Wisconsin, United States
Pacific Gynecology Specialists
🇺🇸Seattle, Washington, United States
Providence Saint Mary Regional Cancer Center
🇺🇸Walla Walla, Washington, United States
PeaceHealth Saint Joseph Medical Center
🇺🇸Bellingham, Washington, United States
Cox Cancer Center Branson
🇺🇸Branson, Missouri, United States
Geisinger Wyoming Valley/Henry Cancer Center
🇺🇸Wilkes-Barre, Pennsylvania, United States
Anchorage Associates in Radiation Medicine
🇺🇸Anchorage, Alaska, United States
Anchorage Radiation Therapy Center
🇺🇸Anchorage, Alaska, United States
Alaska Breast Care and Surgery LLC
🇺🇸Anchorage, Alaska, United States
Alaska Oncology and Hematology LLC
🇺🇸Anchorage, Alaska, United States
Alaska Regional Hospital
🇺🇸Anchorage, Alaska, United States
Alaska Women's Cancer Care
🇺🇸Anchorage, Alaska, United States
Anchorage Oncology Centre
🇺🇸Anchorage, Alaska, United States
Katmai Oncology Group
🇺🇸Anchorage, Alaska, United States
Cancer Center at Saint Joseph's
🇺🇸Phoenix, Arizona, United States
Providence Alaska Medical Center
🇺🇸Anchorage, Alaska, United States
Providence Saint Joseph Medical Center/Disney Family Cancer Center
🇺🇸Burbank, California, United States
UC San Diego Moores Cancer Center
🇺🇸La Jolla, California, United States
Loma Linda University Medical Center
🇺🇸Loma Linda, California, United States
Hartford Hospital
🇺🇸Hartford, Connecticut, United States
The Hospital of Central Connecticut
🇺🇸New Britain, Connecticut, United States
Augusta University Medical Center
🇺🇸Augusta, Georgia, United States
Northside Hospital
🇺🇸Atlanta, Georgia, United States
Dekalb Medical Center
🇺🇸Decatur, Georgia, United States
Lewis Cancer and Research Pavilion at Saint Joseph's/Candler
🇺🇸Savannah, Georgia, United States
Low Country Cancer Care
🇺🇸Savannah, Georgia, United States
Memorial Health University Medical Center
🇺🇸Savannah, Georgia, United States
Kootenai Health - Coeur d'Alene
🇺🇸Coeur d'Alene, Idaho, United States
Saint Luke's Cancer Institute - Fruitland
🇺🇸Fruitland, Idaho, United States
Saint Luke's Cancer Institute - Boise
🇺🇸Boise, Idaho, United States
Saint Luke's Cancer Institute - Nampa
🇺🇸Nampa, Idaho, United States
Saint Luke's Cancer Institute - Meridian
🇺🇸Meridian, Idaho, United States
Kootenai Clinic Cancer Services - Post Falls
🇺🇸Post Falls, Idaho, United States
Saint Luke's Cancer Institute - Twin Falls
🇺🇸Twin Falls, Idaho, United States
NorthShore University HealthSystem-Highland Park Hospital
🇺🇸Highland Park, Illinois, United States
University of Chicago Comprehensive Cancer Center
🇺🇸Chicago, Illinois, United States
Carle Physician Group-Effingham
🇺🇸Effingham, Illinois, United States
Carle on Vermilion
🇺🇸Danville, Illinois, United States
NorthShore University HealthSystem-Glenbrook Hospital
🇺🇸Glenview, Illinois, United States
NorthShore University HealthSystem-Evanston Hospital
🇺🇸Evanston, Illinois, United States
Sudarshan K Sharma MD Limited-Gynecologic Oncology
🇺🇸Hinsdale, Illinois, United States
Carle Physician Group-Mattoon/Charleston
🇺🇸Mattoon, Illinois, United States
Good Samaritan Regional Health Center
🇺🇸Mount Vernon, Illinois, United States
UC Comprehensive Cancer Center at Silver Cross
🇺🇸New Lenox, Illinois, United States
North Shore Medical Center
🇺🇸Skokie, Illinois, United States
Saint Vincent Hospital and Health Care Center
🇺🇸Indianapolis, Indiana, United States
Elkhart Clinic
🇺🇸Elkhart, Indiana, United States
Rush-Copley Healthcare Center
🇺🇸Yorkville, Illinois, United States
The Carle Foundation Hospital
🇺🇸Urbana, Illinois, United States
Michiana Hematology Oncology PC-Elkhart
🇺🇸Elkhart, Indiana, United States
Elkhart General Hospital
🇺🇸Elkhart, Indiana, United States
Community Howard Regional Health
🇺🇸Kokomo, Indiana, United States
Franciscan Saint Anthony Health-Michigan City
🇺🇸Michigan City, Indiana, United States
IU Health La Porte Hospital
🇺🇸La Porte, Indiana, United States
Cancer Care Partners LLC
🇺🇸Mishawaka, Indiana, United States
Saint Joseph Regional Medical Center-Mishawaka
🇺🇸Mishawaka, Indiana, United States
Michiana Hematology Oncology PC-Mishawaka
🇺🇸Mishawaka, Indiana, United States
Memorial Regional Cancer Center Day Road
🇺🇸Mishawaka, Indiana, United States
Michiana Hematology Oncology PC-Plymouth
🇺🇸Plymouth, Indiana, United States
Memorial Hospital of South Bend
🇺🇸South Bend, Indiana, United States
Michiana Hematology Oncology PC-South Bend
🇺🇸South Bend, Indiana, United States
Northern Indiana Cancer Research Consortium
🇺🇸South Bend, Indiana, United States
Michiana Hematology Oncology PC-Westville
🇺🇸Westville, Indiana, United States
Siouxland Regional Cancer Center
🇺🇸Sioux City, Iowa, United States
South Bend Clinic
🇺🇸South Bend, Indiana, United States
Mercy Medical Center-Sioux City
🇺🇸Sioux City, Iowa, United States
Maine Medical Center-Bramhall Campus
🇺🇸Portland, Maine, United States
Saint Luke's Regional Medical Center
🇺🇸Sioux City, Iowa, United States
Saint Elizabeth Healthcare Edgewood
🇺🇸Edgewood, Kentucky, United States
University of Maryland/Greenebaum Cancer Center
🇺🇸Baltimore, Maryland, United States
Brigham and Women's Hospital
🇺🇸Boston, Massachusetts, United States
Dana-Farber Cancer Institute
🇺🇸Boston, Massachusetts, United States
Maine Medical Center- Scarborough Campus
🇺🇸Scarborough, Maine, United States
Walter Reed National Military Medical Center
🇺🇸Bethesda, Maryland, United States
Bronson Battle Creek
🇺🇸Battle Creek, Michigan, United States
Cancer Research Consortium of West Michigan NCORP
🇺🇸Grand Rapids, Michigan, United States
Spectrum Health at Butterworth Campus
🇺🇸Grand Rapids, Michigan, United States
Bronson Methodist Hospital
🇺🇸Kalamazoo, Michigan, United States
Mercy Health Saint Mary's
🇺🇸Grand Rapids, Michigan, United States
West Michigan Cancer Center
🇺🇸Kalamazoo, Michigan, United States
Borgess Medical Center
🇺🇸Kalamazoo, Michigan, United States
Mercy Health Mercy Campus
🇺🇸Muskegon, Michigan, United States
Monroe Cancer Center
🇺🇸Monroe, Michigan, United States
Lakeland Hospital Niles
🇺🇸Niles, Michigan, United States
Spectrum Health Reed City Hospital
🇺🇸Reed City, 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
Metro Health Hospital
🇺🇸Wyoming, Michigan, United States
Fairview Southdale Hospital
🇺🇸Edina, Minnesota, United States
Fairview Ridges Hospital
🇺🇸Burnsville, Minnesota, United States
Mercy Hospital
🇺🇸Coon Rapids, Minnesota, United States
Unity Hospital
🇺🇸Fridley, Minnesota, United States
Hutchinson Area Health Care
🇺🇸Hutchinson, Minnesota, United States
Minnesota Oncology Hematology PA-Maplewood
🇺🇸Maplewood, Minnesota, United States
Saint John's Hospital - Healtheast
🇺🇸Maplewood, Minnesota, United States
New Ulm Medical Center
🇺🇸New Ulm, Minnesota, United States
Abbott-Northwestern Hospital
🇺🇸Minneapolis, Minnesota, United States
North Memorial Medical Health Center
🇺🇸Robbinsdale, Minnesota, United States
Metro Minnesota Community Oncology Research Consortium
🇺🇸Saint Louis Park, Minnesota, United States
Park Nicollet Clinic - Saint Louis Park
🇺🇸Saint Louis Park, Minnesota, United States
Regions Hospital
🇺🇸Saint Paul, Minnesota, United States
Lakeview Hospital
🇺🇸Stillwater, Minnesota, United States
United Hospital
🇺🇸Saint Paul, Minnesota, United States
Saint Francis Regional Medical Center
🇺🇸Shakopee, Minnesota, United States
Minnesota Oncology Hematology PA-Woodbury
🇺🇸Woodbury, Minnesota, United States
Rice Memorial Hospital
🇺🇸Willmar, Minnesota, United States
Freeman Health System
🇺🇸Joplin, Missouri, United States
Mercy Hospital Joplin
🇺🇸Joplin, Missouri, United States
Saint Louis Cancer and Breast Institute-South City
🇺🇸Saint Louis, Missouri, United States
Mercy Clinic-Rolla-Cancer and Hematology
🇺🇸Rolla, Missouri, United States
Delbert Day Cancer Institute at PCRMC
🇺🇸Rolla, Missouri, United States
Barnes-Jewish Hospital
🇺🇸Saint Louis, Missouri, United States
Washington University School of Medicine
🇺🇸Saint Louis, Missouri, United States
Mercy Hospital Saint Louis
🇺🇸Saint Louis, Missouri, United States
Cancer Research for the Ozarks NCORP
🇺🇸Springfield, Missouri, United States
CoxHealth South Hospital
🇺🇸Springfield, Missouri, United States
Billings Clinic Cancer Center
🇺🇸Billings, Montana, United States
Saint Vincent Healthcare
🇺🇸Billings, Montana, United States
Montana Cancer Consortium NCORP
🇺🇸Billings, Montana, United States
Great Falls Clinic
🇺🇸Great Falls, Montana, United States
Benefis Healthcare- Sletten Cancer Institute
🇺🇸Great Falls, Montana, United States
Saint Peter's Community Hospital
🇺🇸Helena, Montana, United States
Montana Cancer Specialists
🇺🇸Missoula, Montana, United States
Kalispell Regional Medical Center
🇺🇸Kalispell, Montana, United States
Saint Patrick Hospital - Community Hospital
🇺🇸Missoula, Montana, United States
Community Medical Hospital
🇺🇸Missoula, Montana, United States
University of New Mexico Cancer Center
🇺🇸Albuquerque, New Mexico, United States
Southwest Gynecologic Oncology Associates Inc
🇺🇸Albuquerque, New Mexico, United States
State University of New York Downstate Medical Center
🇺🇸Brooklyn, New York, United States
Carolinas Medical Center/Levine Cancer Institute
🇺🇸Charlotte, North Carolina, United States
Memorial Sloan Kettering Cancer Center
🇺🇸New York, New York, United States
Summa Health System - Akron Campus
🇺🇸Akron, Ohio, United States
Strecker Cancer Center-Belpre
🇺🇸Belpre, Ohio, United States
Adena Regional Medical Center
🇺🇸Chillicothe, Ohio, United States
Bethesda North Hospital
🇺🇸Cincinnati, Ohio, United States
Good Samaritan Hospital - Cincinnati
🇺🇸Cincinnati, Ohio, United States
Case Western Reserve University
🇺🇸Cleveland, Ohio, United States
Cleveland Clinic Foundation
🇺🇸Cleveland, Ohio, United States
Cleveland Clinic Cancer Center/Fairview Hospital
🇺🇸Cleveland, Ohio, United States
Ohio State University Comprehensive Cancer Center
🇺🇸Columbus, Ohio, United States
Columbus NCI Community Oncology Research Program
🇺🇸Columbus, Ohio, United States
Grant Medical Center
🇺🇸Columbus, Ohio, United States
Grady Memorial Hospital
🇺🇸Delaware, Ohio, United States
Fairfield Medical Center
🇺🇸Lancaster, Ohio, United States
Delaware Health Center-Grady Cancer Center
🇺🇸Delaware, Ohio, United States
Delaware Radiation Oncology
🇺🇸Delaware, Ohio, United States
Hillcrest Hospital Cancer Center
🇺🇸Mayfield Heights, Ohio, United States
Marietta Memorial Hospital
🇺🇸Marietta, Ohio, United States
Southern Ohio Medical Center
🇺🇸Portsmouth, Ohio, United States
Clackamas Radiation Oncology Center
🇺🇸Clackamas, Oregon, United States
Saint Ann's Hospital
🇺🇸Westerville, Ohio, United States
Saint Charles Health System
🇺🇸Bend, Oregon, United States
Oklahoma Cancer Specialists and Research Institute-Tulsa
🇺🇸Tulsa, Oklahoma, United States
University of Oklahoma Health Sciences Center
🇺🇸Oklahoma City, Oklahoma, United States
UPMC Cancer Centers - Arnold Palmer Pavilion
🇺🇸Greensburg, Pennsylvania, United States
Providence Newberg Medical Center
🇺🇸Newberg, Oregon, United States
Bay Area Hospital
🇺🇸Coos Bay, Oregon, United States
Providence Willamette Falls Medical Center
🇺🇸Oregon City, Oregon, United States
Providence Cancer Institute Clackamas Clinic
🇺🇸Clackamas, Oregon, United States
UPMC Cancer Center at UPMC McKeesport
🇺🇸McKeesport, Pennsylvania, United States
UPMC Cancer Center at UPMC Northwest
🇺🇸Seneca, Pennsylvania, United States
UPMC Uniontown Hospital Radiation Oncology
🇺🇸Uniontown, Pennsylvania, United States
University of Tennessee - Knoxville
🇺🇸Knoxville, Tennessee, United States
Saint Francis Hospital
🇺🇸Greenville, South Carolina, United States
Saint Francis Cancer Center
🇺🇸Greenville, South Carolina, United States
Swedish Cancer Institute-Eastside Oncology Hematology
🇺🇸Bellevue, Washington, United States
Kaiser Permanente Washington
🇺🇸Seattle, Washington, United States
MultiCare Deaconess Cancer and Blood Specialty Center - Downtown
🇺🇸Spokane, Washington, United States
Aurora Health Center-Fond du Lac
🇺🇸Fond Du Lac, Wisconsin, United States
Vince Lombardi Cancer Clinic - Oshkosh
🇺🇸Oshkosh, Wisconsin, United States
Odette Cancer Centre- Sunnybrook Health Sciences Centre
🇨🇦Toronto, Ontario, Canada
CHUM - Hopital Notre-Dame
🇨🇦Montreal, Quebec, Canada
Kure National Hospital
🇯🇵Kure, Hiroshima, Japan
Niigata University Medical and Dental Hospital
🇯🇵Niigata City, Niigata, Japan
Tohoku University School of Medicine
🇯🇵Sendai, Aoba-ku, Japan
Hiroshima University Hospital
🇯🇵Hiroshima City, Japan
Kindai University
🇯🇵Osaka, Japan
Catholic University of Korea-Seoul Saint Mary's Hospital
🇰🇷Seoul, Korea, Korea, Republic of
Gachon University Gil Hospital
🇰🇷Incheon, Korea, Republic of
Tottori University
🇯🇵Tottori, Japan
Seoul National University Hospital
🇰🇷Seoul, Korea, Republic of
Asan Medical Center
🇰🇷Seoul, Korea, Republic of
Korea Cancer Center Hospital
🇰🇷Seoul, Korea, Republic of
Wake Forest University Health Sciences
🇺🇸Winston-Salem, North Carolina, United States
Aurora Cancer Care-Milwaukee
🇺🇸Milwaukee, Wisconsin, United States
Aurora Saint Luke's Medical Center
🇺🇸Milwaukee, Wisconsin, United States
Aurora Sinai Medical Center
🇺🇸Milwaukee, Wisconsin, United States
Central Care Cancer Center - Bolivar
🇺🇸Bolivar, Missouri, United States
Dell Seton Medical Center at The University of Texas
🇺🇸Austin, Texas, United States