Fulvestrant With or Without Lapatinib in Treating Postmenopausal Women With Stage III or Stage IV Breast Cancer That is Hormone Receptor-Positive
- Conditions
- Estrogen Receptor PositiveHER2 Positive Breast CarcinomaHER2/Neu NegativeProgesterone Receptor PositiveRecurrent Breast CarcinomaStage IIIB Breast Cancer AJCC v7Stage IIIC Breast Cancer AJCC v7Stage IV Breast Cancer AJCC v6 and v7
- Interventions
- Other: Laboratory Biomarker AnalysisOther: Placebo Administration
- Registration Number
- NCT00390455
- Lead Sponsor
- National Cancer Institute (NCI)
- Brief Summary
This randomized phase III trial studies fulvestrant and lapatinib to see how well they work compared to fulvestrant and a placebo in treating postmenopausal women with stage III or stage IV breast cancer that is hormone receptor-positive. Estrogen can cause the growth of breast cancer cells. Hormone therapy using fulvestrant may fight breast cancer by lowering the amount of estrogen the body makes. Lapatinib may stop the growth of breast cancer cells by blocking some of the enzymes needed for cell growth. It is not yet known whether fulvestrant is more effective with or without lapatinib in treating breast cancer.
- Detailed Description
PRIMARY OBJECTIVES:
I. To compare the effect, in terms of progression free survival, of the antiestrogen fulvestrant alone with fulvestrant administered in combination with the dual-kinase inhibitor lapatinib for postmenopausal women with estrogen receptor (ER) and/or progesterone receptor (PgR) positive advanced breast cancer.
SECONDARY OBJECTIVES:
I. To compare the effects of fulvestrant alone with fulvestrant and lapatinib on other clinical endpoints, including response rate, response and stable disease rate (complete response \[CR\] + partial response \[PR\] + stable disease \>= 6 months), duration of response, overall survival, symptom checklist scores, and toxicity.
II. To define predictive markers of clinical activity among women receiving fulvestrant with or without lapatinib.
III. To determine if the clinical benefits for combination of hormonal and growth factor inhibitor therapy are most pronounced in women whose tumors express higher levels of ER, epidermal growth factor receptor (EGFR), human epidermal growth factor receptor 2 (HER2), phosphorylated protein kinase B (pAkt), and/or phosphorylated mitogen-activated protein kinase 1/2 (pERK1/2).
IV. To serologically determine if HER2 extracellular domain (ECD) and EGFR ECD levels can identify patients with a greater likelihood of response and clinical benefit to fulvestrant with or without lapatinib.
OUTLINE: Patients are randomized to 1 of 2 treatment arms.
ARM I: Patients receive lapatinib ditosylate orally (PO) once daily (QD) on days 1-28 and fulvestrant intramuscularly (IM) on days 1 and 15 of course 1 and on day 1 of each subsequent course.
ARM II: Patients receive placebo PO QD on days 1-28 and fulvestrant as in Arm I.
In both arms, treatment repeats every 28 days in the absence of disease progression or unacceptable toxicity.
After completion of study treatment, patients are followed up every 6 months for 2 years and then annually for 3 years.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- Female
- Target Recruitment
- 295
-
Histologic, pathologic or cytologic diagnosis of cancer of the female breast in either primary or metastatic setting; histological documentation of metastatic/recurrent disease is not required if there is unequivocal clinical evidence for recurrence
-
Stage IV breast cancer (using American Joint Committee on Cancer [AJCC] criteria, 6th edition), or locally advanced (stage III) breast cancer not considered amenable to curative therapy
-
Patients with symptomatic brain metastases or other symptomatic central nervous system (CNS) metastases are not eligible for the study; no screening studies are required among asymptomatic patients; patients with previously treated brain metastases, who are free of symptoms referable to CNS disease and who are > 3 months from treatment for brain metastases are eligible
-
Tumors (as determined on pathology from either primary or metastatic sites) must be potentially sensitive to endocrine therapy, defined as expressing estrogen receptor (ER) and/or progesterone receptor (PgR) as determined immunohistochemical methods according to the local institution's standard protocol, >= 1% cells will be considered to be positive
-
The protocol has been amended to permit tumors with any HER2 status, though a determination of HER2 status must have been made; patients will be considered to be eligible if HER2 expression is documented by one of the following methods:
- Immunohistochemistry (IHC) 0 (i.e., negative), 1+, 2+, or 3+ levels of expression, or
- Gene amplification (fluorescent in situ hybridization [FISH]) positive or negative
-
Patients must have at least one lesion that can be accurately measured in at least one dimension (longest diameter to be recorded) as >= 2.0 cm with conventional techniques or as >= 1.0 cm with spiral computed tomography (CT) scan
-
Exception: Patients with lytic or blastic bone metastases as their only site of disease will be eligible for the study even though these patients are not considered to have measurable disease by Response Evaluation Criteria in Solid Tumors (RECIST) criteria; these patients will be evaluable for time to progression, but not response
-
Patients with all other lesions, including small lesions (longest diameter < 2.0 cm with conventional techniques or < 1.0 cm with spiral CT scan) and truly non-measurable lesions including those listed below are not eligible
-
Lesions that are considered non-measurable include the following:
- Bone lesions (women with bone lesions will be eligible as described above)
- Leptomeningeal disease
- Ascites
- Pleural/pericardial effusion
- Inflammatory breast cancer
- Lymphangitis cutis/pulmonitis
- Abdominal masses that are not confirmed and followed by imaging techniques
- Cystic lesions
-
-
Patients must have had one or two prior endocrine treatments for breast cancer in either the adjuvant or metastatic setting, exclusive of treatment-related amenorrhea or ovarian suppression; sequential use of two different third-generation aromatase inhibitors is considered "one" treatment; it is not required that tumors be resistant to such treatments; for example:
- A patient with de novo metastatic breast cancer who had never received endocrine therapy is not eligible;
- A patient who received adjuvant tamoxifen and subsequent therapy with an aromatase inhibitor (adjuvant or metastatic) is eligible;
- A patient who received an aromatase inhibitor in either the adjuvant or metastatic setting, and who discontinued therapy after several months because of side effects, is eligible;
- A patient who received an aromatase inhibitor in the adjuvant setting is eligible, regardless of whether they did or did not receive tamoxifen at some point;
- A patient who received adjuvant tamoxifen, and subsequently a nonsteroidal aromatase inhibitor and a steroidal aromatase inhibitor for advanced breast cancer in the adjuvant or metastatic setting is eligible;
- A patient who received adjuvant tamoxifen, and then a nonsteroidal aromatase inhibitor and subsequently megesterol acetate for advanced breast cancer is not eligible
-
Tumors potentially sensitive to endocrine therapy, defined as >= 3 months of prior endocrine therapy without disease progression in the adjuvant or metastatic setting
-
Patients must have had prior treatment in either the adjuvant or metastatic setting with a commercially available third-generation aromatase inhibitor (i.e. anastrozole, exemestane, or letrozole); it is not required that tumors be resistant to such therapies
-
Patients may have received up to one prior chemotherapy regimen for stage IV breast cancer; prior chemotherapy in the adjuvant and/or neoadjuvant setting is permitted; patients must have finished chemotherapy at least 1 week prior to starting protocol based treatment
-
Patients may have received prior trastuzumab therapy for stage IV breast cancer, in combination with up to one chemotherapy and/or endocrine therapy regimen, but that must have concluded at least 3 weeks prior to starting protocol-based therapy; prior trastuzumab therapy in the adjuvant and/or neoadjuvant setting is permitted, but must have concluded at least 3 weeks prior to starting protocol-based therapy
-
Prior therapy with commercially available inhibitor of EGFR (including but not limited to gefitinib, erlotinib, lapatinib or cetuximab) or experimental inhibitors of EGFR is prohibited
-
Patients may have initiated bisphosphonate therapy prior to study entry; such patients will have bone lesions considered evaluable for progression but not for response
-
Prior fulvestrant therapy is prohibited
-
Patients receiving a gonadotropin-releasing hormone (GnRH) agonist for ovarian suppression must remain on such therapy throughout the course of protocol treatment; patients must discontinue other endocrine treatments, including systemic hormone-replacement therapy and intravaginal estrogens prior to study entry; patients must have concluded radiation therapy prior to study entry; patients must be at least 1 week from prior chemotherapy or 3 weeks from prior trastuzumab therapy, with adequate recovery of bone marrow function and performance status
-
Patients must be postmenopausal women, defined as a woman fulfilling any of the following criteria:
- Age >= 60 years; or
- Age >= 45 years with an intact uterus and amenorrhea for 12 months or more; or
- History of bilateral oophorectomy; or
- Follicle stimulating hormone (FSH) levels within postmenopausal range according to the ranges established by the testing facility; or
- Treatment with a GnRH agonist for ovarian suppression for at least 3 consecutive months prior to study registration, and remaining on such therapy throughout the course of protocol treatment
- Women who are pregnant or nursing are not eligible for the study; clinicians should advise patients that there are no data for the safety of lapatinib or fulvestrant among pregnant patients, nor data on the impact of these agents on fertility or pregnancy
-
Eastern Cooperative Oncology Group (ECOG) (Zubrod) performance status 0-2
-
Absence of pending visceral crisis, in the opinion of the treating physician
-
Absence of acquired or inherited bleeding disorder
-
Absence of need for therapeutic systemic anticoagulation (defined as maintaining international normalized ratio [INR] > 1.6); patients may take low-dose warfarin or aspirin (or equivalent) for maintenance of central venous catheter patency
-
Granulocytes >= 1,000/μl
-
Platelet count >= 100,000/μl
-
Creatinine =< 2 mg/dl
-
Total bilirubin =< 1.5 x upper limits of normal (ULN) unless due to Gilbert's syndrome
-
Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) =< 2.5 x ULN without liver metastases; =< 5 x ULN with liver metastases
-
INR =< 1.6
-
Left ventricular ejection fraction (LVEF) within institutional limits of normal
Not provided
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Arm II (placebo) Laboratory Biomarker Analysis Patients receive placebo PO QD on days 1-28 and fulvestrant as in Arm I. Treatment repeats every 28 days in the absence of disease progression or unacceptable toxicity. Arm II (placebo) Placebo Administration Patients receive placebo PO QD on days 1-28 and fulvestrant as in Arm I. Treatment repeats every 28 days in the absence of disease progression or unacceptable toxicity. Arm I (lapatinib) Laboratory Biomarker Analysis Patients receive lapatinib ditosylate PO QD on days 1-28 and fulvestrant IM on days 1 and 15 of course 1 and on day 1 of each subsequent course. Treatment repeats every 28 days in the absence of disease progression or unacceptable toxicity. Arm I (lapatinib) Lapatinib Ditosylate Patients receive lapatinib ditosylate PO QD on days 1-28 and fulvestrant IM on days 1 and 15 of course 1 and on day 1 of each subsequent course. Treatment repeats every 28 days in the absence of disease progression or unacceptable toxicity. Arm I (lapatinib) Fulvestrant Patients receive lapatinib ditosylate PO QD on days 1-28 and fulvestrant IM on days 1 and 15 of course 1 and on day 1 of each subsequent course. Treatment repeats every 28 days in the absence of disease progression or unacceptable toxicity. Arm II (placebo) Fulvestrant Patients receive placebo PO QD on days 1-28 and fulvestrant as in Arm I. Treatment repeats every 28 days in the absence of disease progression or unacceptable toxicity.
- Primary Outcome Measures
Name Time Method Progression-free Survival (PFS) Interval from randomization until disease progression or death, whichever occurs first, assessed up to 5 years PFS was defined as the interval from study entry until disease progression or death resulting from any cause, which ever occurred first. Progression is defined as a 20% increase in the sum of longest diameter of target lesions (per RECIST criteria).
- Secondary Outcome Measures
Name Time Method Objective Tumor Response Rate Up to 5 years Response was defined by the Response Evaluation Criteria in Solid Tumors (RECIST). A responding participant had either a Complete Response (disappearance of all target lesions) or Partial Response (30% decrease in sum of longest diameter of target lesions). The response rate of measurable tumors will be estimated with its 95% confidence interval according to treatment arm.
Overall Survival (OS) Study entry to death or last follow-up, up to 5 years Overall survival was measured as the interval from study entry until death, from any cause, or last contact.
Trial Locations
- Locations (366)
Grant Medical Center
🇺🇸Columbus, Ohio, United States
University of Maryland Shore Medical Center at Easton
🇺🇸Easton, Maryland, United States
Saint Vincent Healthcare
🇺🇸Billings, Montana, United States
University of Mississippi Medical Center
🇺🇸Jackson, Mississippi, United States
Montana Cancer Specialists
🇺🇸Missoula, Montana, United States
Dana-Farber Cancer Institute
🇺🇸Boston, Massachusetts, United States
Swedish Medical Center-First Hill
🇺🇸Seattle, Washington, United States
University Medical Center of Southern Nevada
🇺🇸Las Vegas, Nevada, United States
Virginia Piper Cancer Institute
🇺🇸Minneapolis, Minnesota, United States
University of Arkansas for Medical Sciences
🇺🇸Little Rock, Arkansas, United States
PCR Oncology
🇺🇸Arroyo Grande, California, United States
UCSF Medical Center-Mount Zion
🇺🇸San Francisco, California, United States
Valley Medical Oncology Consultants-Castro Valley
🇺🇸Castro Valley, California, United States
Bronson Battle Creek
🇺🇸Battle Creek, Michigan, United States
UMass Memorial Medical Center - University Campus
🇺🇸Worcester, Massachusetts, United States
Spectrum Health at Butterworth Campus
🇺🇸Grand Rapids, Michigan, United States
Green Bay Oncology - Escanaba
🇺🇸Escanaba, Michigan, United States
Mercy Health Mercy Campus
🇺🇸Muskegon, Michigan, United States
Addison Gilbert Hospital
🇺🇸Gloucester, Massachusetts, United States
Oncology Care Associates PLLC
🇺🇸Saint Joseph, Michigan, United States
Fairview Ridges Hospital
🇺🇸Burnsville, Minnesota, United States
Unity Hospital
🇺🇸Fridley, Minnesota, United States
Munson Medical Center
🇺🇸Traverse City, Michigan, United States
Mid-Michigan Medical Center - Midland
🇺🇸Midland, Michigan, United States
West Michigan Cancer Center
🇺🇸Kalamazoo, Michigan, United States
Saint Luke's Hospital
🇺🇸Chesterfield, Missouri, United States
Saint John's Hospital - Healtheast
🇺🇸Maplewood, Minnesota, United States
Hutchinson Area Health Care
🇺🇸Hutchinson, Minnesota, United States
Bronson Methodist Hospital
🇺🇸Kalamazoo, Michigan, United States
Cancer Research Consortium of West Michigan NCORP
🇺🇸Grand Rapids, Michigan, United States
Minnesota Oncology Hematology PA-Maplewood
🇺🇸Maplewood, Minnesota, United States
Marie Yeager Cancer Center
🇺🇸Saint Joseph, Michigan, United States
Holland Community Hospital
🇺🇸Holland, Michigan, United States
Borgess Medical Center
🇺🇸Kalamazoo, Michigan, United States
Miller-Dwan Hospital
🇺🇸Duluth, Minnesota, United States
North Memorial Medical Health Center
🇺🇸Robbinsdale, Minnesota, United States
Mercy Health Saint Mary's
🇺🇸Grand Rapids, Michigan, United States
Lakeland Medical Center Saint Joseph
🇺🇸Saint Joseph, Michigan, United States
Lowell General Hospital
🇺🇸Lowell, Massachusetts, United States
Spectrum Health Big Rapids Hospital
🇺🇸Big Rapids, Michigan, United States
Green Bay Oncology - Iron Mountain
🇺🇸Iron Mountain, Michigan, United States
Saint Anne's Hospital
🇺🇸Fall River, Massachusetts, United States
Essentia Health Cancer Center
🇺🇸Duluth, Minnesota, United States
Saint Luke's Hospital of Duluth
🇺🇸Duluth, Minnesota, United States
Licking Memorial Hospital
🇺🇸Newark, Ohio, United States
Springfield Regional Medical Center
🇺🇸Springfield, Ohio, United States
Saint Patrick Hospital - Community Hospital
🇺🇸Missoula, Montana, United States
Upper Valley Medical Center
🇺🇸Troy, Ohio, United States
Genesis Healthcare System Cancer Care Center
🇺🇸Zanesville, Ohio, United States
Saint Mary Medical and Regional Cancer Center
🇺🇸Langhorne, Pennsylvania, United States
American Fork Hospital / Huntsman Intermountain Cancer Center
🇺🇸American Fork, Utah, United States
Southeastern Regional Medical Center
🇺🇸Lumberton, North Carolina, United States
Saint Francis Hospital
🇺🇸Greenville, South Carolina, United States
Medical X-Ray Center
🇺🇸Sioux Falls, South Dakota, United States
Wellmont Holston Valley Hospital and Medical Center
🇺🇸Kingsport, Tennessee, United States
Clinton Memorial Hospital
🇺🇸Wilmington, Ohio, United States
Sandra L Maxwell Cancer Center
🇺🇸Cedar City, Utah, United States
Zuckerberg San Francisco General Hospital
🇺🇸San Francisco, California, United States
Utah Cancer Specialists-Salt Lake City
🇺🇸Salt Lake City, Utah, United States
Huntsman Cancer Institute/University of Utah
🇺🇸Salt Lake City, Utah, United States
Cotton O'Neil Cancer Center / Stormont Vail Health
🇺🇸Topeka, Kansas, United States
Cancer Center of Kansas - Fort Scott
🇺🇸Fort Scott, Kansas, United States
Cancer Center of Kansas-Kingman
🇺🇸Kingman, Kansas, United States
Hospital District Sixth of Harper County
🇺🇸Anthony, Kansas, United States
Cancer Center of Kansas-Independence
🇺🇸Independence, Kansas, United States
Lawrence Memorial Hospital
🇺🇸Lawrence, Kansas, United States
Via Christi Hospital-Pittsburg
🇺🇸Pittsburg, Kansas, United States
Cancer Center of Kansas - Pratt
🇺🇸Pratt, Kansas, United States
Cancer Center of Kansas - Salina
🇺🇸Salina, Kansas, United States
Southwest Medical Center
🇺🇸Liberal, Kansas, United States
Associates In Womens Health
🇺🇸Wichita, Kansas, United States
Cancer Center of Kansas - Parsons
🇺🇸Parsons, Kansas, United States
Cancer Center of Kansas - Chanute
🇺🇸Chanute, Kansas, United States
Cancer Center of Kansas - Dodge City
🇺🇸Dodge City, Kansas, United States
Cancer Center of Kansas-Wichita Medical Arts Tower
🇺🇸Wichita, Kansas, United States
Welch Cancer Center
🇺🇸Sheridan, Wyoming, United States
Graham Hospital Association
🇺🇸Canton, Illinois, United States
Saint Barnabas Medical Center
🇺🇸Livingston, New Jersey, United States
Washington University School of Medicine
🇺🇸Saint Louis, Missouri, United States
Abbott-Northwestern Hospital
🇺🇸Minneapolis, Minnesota, United States
United Hospital
🇺🇸Saint Paul, Minnesota, United States
Regions Hospital
🇺🇸Saint Paul, Minnesota, United States
Saint Francis Regional Medical Center
🇺🇸Shakopee, Minnesota, United States
Ridgeview Medical Center
🇺🇸Waconia, Minnesota, United States
Woodwinds Health Campus
🇺🇸Woodbury, Minnesota, United States
Nebraska Methodist Hospital
🇺🇸Omaha, Nebraska, United States
Cleveland Clinic Wooster Family Health and Surgery Center
🇺🇸Wooster, Ohio, United States
Saint Ann's Hospital
🇺🇸Westerville, Ohio, United States
Wright-Patterson Medical Center
🇺🇸Wright-Patterson Air Force Base, Ohio, United States
Metro Health Hospital
🇺🇸Wyoming, Michigan, United States
Iowa-Wide Oncology Research Coalition NCORP
🇺🇸Des Moines, Iowa, United States
Medical Oncology and Hematology Associates-Des Moines
🇺🇸Des Moines, Iowa, United States
Dean Hematology and Oncology Clinic
🇺🇸Madison, Wisconsin, United States
Methodist Medical Center of Illinois
🇺🇸Peoria, Illinois, United States
Arroyo Grande Community
🇺🇸Arroyo Grande, California, United States
Providence Saint Joseph Medical Center/Disney Family Cancer Center
🇺🇸Burbank, California, United States
Eden Hospital Medical Center
🇺🇸Castro Valley, California, United States
East Bay Radiation Oncology Center
🇺🇸Castro Valley, California, United States
Valley Medical Oncology Consultants-Fremont
🇺🇸Fremont, California, United States
Bay Area Breast Surgeons Inc
🇺🇸Emeryville, California, United States
Glendale Memorial Hospital and Health Center
🇺🇸Glendale, California, United States
Saint Rose Hospital
🇺🇸Hayward, California, United States
Fremont - Rideout Cancer Center
🇺🇸Marysville, California, United States
Alta Bates Summit Medical Center - Summit Campus
🇺🇸Oakland, California, United States
Palo Alto Medical Foundation-Camino Division
🇺🇸Mountain View, California, United States
Bay Area Tumor Institute
🇺🇸Oakland, California, United States
Highland General Hospital
🇺🇸Oakland, California, United States
Hematology and Oncology Associates-Oakland
🇺🇸Oakland, California, United States
Tom K Lee Inc
🇺🇸Oakland, California, United States
Kaiser Permanente-San Diego Mission
🇺🇸San Diego, California, United States
Salinas Valley Memorial
🇺🇸Salinas, California, United States
Doctors Medical Center- JC Robinson Regional Cancer Center
🇺🇸San Pablo, California, United States
Northbay Cancer Center
🇺🇸Vacaville, California, United States
Poudre Valley Hospital
🇺🇸Fort Collins, Colorado, United States
Saint Vincent's Medical Center
🇺🇸Bridgeport, Connecticut, United States
Beebe Medical Center
🇺🇸Lewes, Delaware, United States
Christiana Care Health System-Christiana Hospital
🇺🇸Newark, Delaware, United States
MedStar Georgetown University Hospital
🇺🇸Washington, District of Columbia, United States
Sibley Memorial Hospital
🇺🇸Washington, District of Columbia, United States
Portneuf Medical Center
🇺🇸Pocatello, Idaho, United States
Saint Anthony's Health
🇺🇸Alton, Illinois, United States
Saint Joseph Medical Center
🇺🇸Bloomington, Illinois, United States
Rush - Copley Medical Center
🇺🇸Aurora, Illinois, United States
University of Chicago Comprehensive Cancer Center
🇺🇸Chicago, Illinois, United States
University of Illinois
🇺🇸Chicago, Illinois, United States
Decatur Memorial Hospital
🇺🇸Decatur, Illinois, United States
Heartland Cancer Research NCORP
🇺🇸Decatur, Illinois, United States
Joliet Oncology-Hematology Associates Limited
🇺🇸Joliet, Illinois, United States
Illinois CancerCare-Galesburg
🇺🇸Galesburg, Illinois, United States
Hopedale Medical Complex - Hospital
🇺🇸Hopedale, Illinois, United States
Western Illinois Cancer Treatment Center
🇺🇸Galesburg, Illinois, United States
Presence Saint Mary's Hospital
🇺🇸Kankakee, Illinois, United States
Memorial Hospital
🇺🇸Carthage, Illinois, United States
Valley Medical Oncology Consultants
🇺🇸Pleasanton, California, United States
Harold Leever Regional Cancer Center
🇺🇸Waterbury, Connecticut, United States
Valley Care Health System - Pleasanton
🇺🇸Pleasanton, California, United States
Saint Luke's Mountain States Tumor Institute
🇺🇸Boise, Idaho, United States
Good Samaritan Regional Health Center
🇺🇸Mount Vernon, Illinois, United States
UCHealth Memorial Hospital Central
🇺🇸Colorado Springs, Colorado, United States
Loyola University Medical Center
🇺🇸Maywood, Illinois, United States
Bromenn Regional Medical Center
🇺🇸Normal, Illinois, United States
Smilow Cancer Hospital-Torrington Care Center
🇺🇸Torrington, Connecticut, United States
Illinois CancerCare-Ottawa Clinic
🇺🇸Ottawa, Illinois, United States
AMITA Health Adventist Medical Center
🇺🇸La Grange, Illinois, United States
Galesburg Cottage Hospital
🇺🇸Galesburg, Illinois, United States
Saint Vincent Hospital Cancer Center at Oconto Falls
🇺🇸Oconto Falls, Wisconsin, United States
Ottawa Regional Hospital and Healthcare Center
🇺🇸Ottawa, Illinois, United States
Community Cancer Center Foundation
🇺🇸Normal, Illinois, United States
OSF Saint Francis Radiation Oncology at Pekin Cancer Treatment Center
🇺🇸Pekin, Illinois, United States
Pekin Hospital
🇺🇸Pekin, Illinois, United States
Illinois CancerCare-Peoria
🇺🇸Peoria, Illinois, United States
Proctor Hospital
🇺🇸Peoria, Illinois, United States
OSF Saint Francis Medical Center
🇺🇸Peoria, Illinois, United States
Illinois Valley Hospital
🇺🇸Peru, Illinois, United States
Valley Radiation Oncology
🇺🇸Peru, Illinois, United States
Perry Memorial Hospital
🇺🇸Princeton, Illinois, United States
OSF Saint Anthony Medical Center
🇺🇸Rockford, Illinois, United States
West Suburban Medical Center
🇺🇸River Forest, Illinois, United States
Saint Margaret's Hospital
🇺🇸Spring Valley, Illinois, United States
Carle Cancer Center
🇺🇸Urbana, Illinois, United States
Franciscan Saint Francis Health-Beech Grove
🇺🇸Beech Grove, Indiana, United States
Elkhart Clinic
🇺🇸Elkhart, Indiana, United States
Elkhart General Hospital
🇺🇸Elkhart, Indiana, United States
Goshen Center for Cancer Care
🇺🇸Goshen, Indiana, United States
Fort Wayne Medical Oncology and Hematology Inc-Parkview
🇺🇸Fort Wayne, Indiana, United States
Community Cancer Center East
🇺🇸Indianapolis, Indiana, United States
Community Cancer Center North
🇺🇸Indianapolis, Indiana, United States
IU Health La Porte Hospital
🇺🇸La Porte, Indiana, United States
Franciscan Saint Anthony Health-Michigan City
🇺🇸Michigan City, Indiana, United States
Saint Joseph Regional Medical Center-Mishawaka
🇺🇸Mishawaka, Indiana, United States
Michiana Hematology Oncology PC-South Bend
🇺🇸South Bend, Indiana, United States
Memorial Hospital of South Bend
🇺🇸South Bend, Indiana, United States
McFarland Clinic PC - Ames
🇺🇸Ames, Iowa, United States
University of Iowa Healthcare Cancer Services Quad Cities
🇺🇸Bettendorf, Iowa, United States
Oncology Associates at Mercy Medical Center
🇺🇸Cedar Rapids, Iowa, United States
Mercy Hospital
🇺🇸Coon Rapids, Minnesota, United States
Medical Oncology and Hematology Associates-West Des Moines
🇺🇸Clive, Iowa, United States
Heartland Oncology and Hematology LLP
🇺🇸Council Bluffs, Iowa, United States
Genesis Medical Center - East Campus
🇺🇸Davenport, Iowa, United States
Genesis Cancer Care Institute
🇺🇸Davenport, Iowa, United States
Mercy Capitol
🇺🇸Des Moines, Iowa, United States
Iowa Methodist Medical Center
🇺🇸Des Moines, Iowa, United States
Medical Oncology and Hematology Associates-Laurel
🇺🇸Des Moines, Iowa, United States
Mercy Medical Center - Des Moines
🇺🇸Des Moines, Iowa, United States
University of Iowa/Holden Comprehensive Cancer Center
🇺🇸Iowa City, Iowa, United States
Iowa Lutheran Hospital
🇺🇸Des Moines, Iowa, United States
Mercy Medical Center - North Iowa
🇺🇸Mason City, Iowa, United States
Siouxland Regional Cancer Center
🇺🇸Sioux City, Iowa, United States
Ottumwa Regional Health Center
🇺🇸Ottumwa, Iowa, United States
Mercy Medical Center-Sioux City
🇺🇸Sioux City, Iowa, United States
Saint Luke's Regional Medical Center
🇺🇸Sioux City, Iowa, United States
Baton Rouge General Medical Center
🇺🇸Baton Rouge, Louisiana, United States
Mary Bird Perkins Cancer Center
🇺🇸Baton Rouge, Louisiana, United States
Eastern Maine Medical Center
🇺🇸Bangor, Maine, United States
York Hospital
🇺🇸York, Maine, United States
University of Maryland/Greenebaum Cancer Center
🇺🇸Baltimore, Maryland, United States
Greater Baltimore Medical Center
🇺🇸Baltimore, Maryland, United States
Saint Agnes Hospital
🇺🇸Baltimore, Maryland, United States
Union Hospital of Cecil County
🇺🇸Elkton, Maryland, United States
Frederick Memorial Hospital
🇺🇸Frederick, Maryland, United States
Brigham and Women's Hospital
🇺🇸Boston, Massachusetts, United States
Beth Israel Deaconess Medical Center
🇺🇸Boston, Massachusetts, United States
Mercy Health Partners-Hackley Campus
🇺🇸Muskegon, Michigan, United States
Essentia Health Saint Mary's Medical Center
🇺🇸Duluth, Minnesota, United States
Fairview-Southdale Hospital
🇺🇸Edina, Minnesota, United States
Hennepin County Medical Center
🇺🇸Minneapolis, Minnesota, United States
Park Nicollet Clinic - Saint Louis Park
🇺🇸Saint Louis Park, Minnesota, United States
Metro Minnesota Community Oncology Research Consortium
🇺🇸Saint Louis Park, Minnesota, United States
Saint Joseph's Hospital - Healtheast
🇺🇸Saint Paul, Minnesota, United States
Rice Memorial Hospital
🇺🇸Willmar, Minnesota, United States
Minnesota Oncology Hematology PA-Woodbury
🇺🇸Woodbury, Minnesota, United States
Keesler Medical Center
🇺🇸Keesler Air Force Base, Mississippi, United States
Southeast Missouri Hospital
🇺🇸Cape Girardeau, Missouri, United States
Saint Francis Medical Center
🇺🇸Trenton, New Jersey, United States
Missouri Cancer Associates
🇺🇸Columbia, Missouri, United States
Center for Cancer Care and Research
🇺🇸Saint Louis, Missouri, United States
Missouri Baptist Medical Center
🇺🇸Saint Louis, Missouri, United States
Mercy Hospital Saint Louis
🇺🇸Saint Louis, Missouri, United States
Billings Clinic Cancer Center
🇺🇸Billings, Montana, United States
Northern Rockies Radiation Oncology Center
🇺🇸Billings, Montana, United States
Saint Vincent Frontier Cancer Center
🇺🇸Billings, Montana, United States
Montana Cancer Consortium NCORP
🇺🇸Billings, Montana, United States
Bozeman Deaconess Hospital
🇺🇸Bozeman, Montana, United States
Benefis Healthcare- Sletten Cancer Institute
🇺🇸Great Falls, Montana, United States
Saint James Community Hospital and Cancer Treatment Center
🇺🇸Butte, Montana, United States
Berdeaux, Donald MD (UIA Investigator)
🇺🇸Great Falls, Montana, United States
Great Falls Clinic
🇺🇸Great Falls, Montana, United States
Saint Peter's Community Hospital
🇺🇸Helena, Montana, United States
Kalispell Regional Medical Center
🇺🇸Kalispell, Montana, United States
Glacier Oncology PLLC
🇺🇸Kalispell, Montana, United States
Kalispell Medical Oncology
🇺🇸Kalispell, Montana, United States
Community Medical Hospital
🇺🇸Missoula, Montana, United States
Guardian Oncology and Center for Wellness
🇺🇸Missoula, Montana, United States
New Hampshire Oncology Hematology PA-Concord
🇺🇸Concord, New Hampshire, United States
New Hampshire Oncology Hematology PA-Hooksett
🇺🇸Hooksett, New Hampshire, United States
Elliot Hospital
🇺🇸Manchester, New Hampshire, United States
LRGHealthcare-Lakes Region General Hospital
🇺🇸Laconia, New Hampshire, United States
Morristown Medical Center
🇺🇸Morristown, New Jersey, United States
Cooper Hospital University Medical Center
🇺🇸Camden, New Jersey, United States
Virtua Memorial
🇺🇸Mount Holly, New Jersey, United States
Virtua Voorhees
🇺🇸Voorhees, New Jersey, United States
Northern Westchester Hospital
🇺🇸Mount Kisco, New York, United States
Hematology Oncology Associates of Central New York-East Syracuse
🇺🇸East Syracuse, New York, United States
Memorial Sloan Kettering Cancer Center
🇺🇸New York, New York, United States
Mission Hospital
🇺🇸Asheville, North Carolina, United States
State University of New York Upstate Medical University
🇺🇸Syracuse, New York, United States
Staten Island University Hospital
🇺🇸Staten Island, New York, United States
Duke University Medical Center
🇺🇸Durham, North Carolina, United States
Southeastern Medical Oncology Center-Goldsboro
🇺🇸Goldsboro, North Carolina, United States
Wayne Memorial Hospital
🇺🇸Goldsboro, North Carolina, United States
CaroMont Regional Medical Center
🇺🇸Gastonia, North Carolina, United States
Vidant Oncology-Kinston
🇺🇸Kinston, North Carolina, United States
Margaret R Pardee Memorial Hospital
🇺🇸Hendersonville, North Carolina, United States
Granville Medical Center
🇺🇸Oxford, North Carolina, United States
Duke Raleigh Hospital
🇺🇸Raleigh, North Carolina, United States
Rutherford Hospital
🇺🇸Rutherfordton, North Carolina, United States
Mid Dakota Clinic
🇺🇸Bismarck, North Dakota, United States
Saint Alexius Medical Center
🇺🇸Bismarck, North Dakota, United States
Sanford Bismarck Medical Center
🇺🇸Bismarck, North Dakota, United States
Trinity Cancer Care Center
🇺🇸Minot, North Dakota, United States
Mary Rutan Hospital
🇺🇸Bellefontaine, Ohio, United States
Adena Regional Medical Center
🇺🇸Chillicothe, Ohio, United States
Aultman Health Foundation
🇺🇸Canton, Ohio, United States
Cleveland Clinic Foundation
🇺🇸Cleveland, Ohio, United States
Riverside Methodist Hospital
🇺🇸Columbus, Ohio, United States
Mount Carmel Health Center West
🇺🇸Columbus, Ohio, United States
Doctors Hospital
🇺🇸Columbus, Ohio, United States
Grandview Hospital
🇺🇸Dayton, Ohio, United States
Miami Valley Hospital
🇺🇸Dayton, Ohio, United States
Good Samaritan Hospital - Dayton
🇺🇸Dayton, Ohio, United States
Blanchard Valley Hospital
🇺🇸Findlay, Ohio, United States
Miami Valley Hospital North
🇺🇸Dayton, Ohio, United States
Dayton Veterans Affairs Medical Center
🇺🇸Dayton, Ohio, United States
Grady Memorial Hospital
🇺🇸Delaware, Ohio, United States
Cleveland Clinic Cancer Center Independence
🇺🇸Independence, Ohio, United States
Kettering Medical Center
🇺🇸Kettering, Ohio, United States
Fairfield Medical Center
🇺🇸Lancaster, Ohio, United States
Atrium Medical Center-Middletown Regional Hospital
🇺🇸Franklin, Ohio, United States
Marietta Memorial Hospital
🇺🇸Marietta, Ohio, United States
Greene Memorial Hospital
🇺🇸Xenia, Ohio, United States
Saint Luke's University Hospital-Bethlehem Campus
🇺🇸Bethlehem, Pennsylvania, United States
Abington Memorial Hospital
🇺🇸Abington, Pennsylvania, United States
AnMed Health Hospital
🇺🇸Anderson, South Carolina, United States
Spartanburg Medical Center
🇺🇸Spartanburg, South Carolina, United States
Wake Forest University Health Sciences
🇺🇸Winston-Salem, North Carolina, United States
Avera Cancer Institute-Aberdeen
🇺🇸Aberdeen, South Dakota, United States
Rapid City Regional Hospital
🇺🇸Rapid City, South Dakota, United States
Avera McKennan Hospital and University Health Center
🇺🇸Sioux Falls, South Dakota, United States
Sanford USD Medical Center - Sioux Falls
🇺🇸Sioux Falls, South Dakota, United States
University of Tennessee Health Science Center
🇺🇸Memphis, Tennessee, United States
Cottonwood Hospital Medical Center
🇺🇸Murray, Utah, United States
Utah Valley Regional Medical Center
🇺🇸Provo, Utah, United States
Dixie Medical Center Regional Cancer Center
🇺🇸Saint George, Utah, United States
Central Vermont Medical Center/National Life Cancer Treatment
🇺🇸Berlin, Vermont, United States
LDS Hospital
🇺🇸Salt Lake City, Utah, United States
PeaceHealth Saint Joseph Medical Center
🇺🇸Bellingham, Washington, United States
Danville Regional Medical Center
🇺🇸Danville, Virginia, United States
Southwest VA Regional Cancer Center
🇺🇸Norton, Virginia, United States
University of Vermont and State Agricultural College
🇺🇸Burlington, Vermont, United States
Harrison HealthPartners Hematology and Oncology-Bremerton
🇺🇸Bremerton, Washington, United States
Kadlec Clinic Hematology and Oncology
🇺🇸Kennewick, Washington, United States
Kaiser Permanente Washington
🇺🇸Seattle, Washington, United States
Minor and James Medical PLLC
🇺🇸Seattle, Washington, United States
Skagit Valley Hospital
🇺🇸Mount Vernon, Washington, United States
Cancer Care Northwest - Spokane South
🇺🇸Spokane, Washington, United States
University of Washington Medical Center
🇺🇸Seattle, Washington, United States
Evergreen Hematology and Oncology PS
🇺🇸Spokane, Washington, United States
Green Bay Oncology at Saint Vincent Hospital
🇺🇸Green Bay, Wisconsin, United States
Saint Vincent Hospital Cancer Center Green Bay
🇺🇸Green Bay, Wisconsin, United States
Green Bay Oncology Limited at Saint Mary's Hospital
🇺🇸Green Bay, Wisconsin, United States
Saint Vincent Hospital Cancer Center at Saint Mary's
🇺🇸Green Bay, Wisconsin, United States
Holy Family Memorial Hospital
🇺🇸Manitowoc, Wisconsin, United States
Gundersen Lutheran Medical Center
🇺🇸La Crosse, Wisconsin, United States
Bay Area Medical Center
🇺🇸Marinette, Wisconsin, United States
Green Bay Oncology - Sturgeon Bay
🇺🇸Sturgeon Bay, Wisconsin, United States
University of California Davis Comprehensive Cancer Center
🇺🇸Sacramento, California, United States
Freeman Health System
🇺🇸Joplin, Missouri, United States
Memorial Medical Center
🇺🇸Springfield, Illinois, United States
Community Howard Regional Health
🇺🇸Kokomo, Indiana, United States
Eureka Hospital
🇺🇸Eureka, Illinois, United States
Kewanee Hospital
🇺🇸Kewanee, Illinois, United States
Saint Rita's Medical Center
🇺🇸Lima, Ohio, United States
Reid Health
🇺🇸Richmond, Indiana, United States
Overlook Hospital
🇺🇸Summit, New Jersey, United States
Maria Parham Hospital
🇺🇸Henderson, North Carolina, United States
Cleveland Clinic Akron General
🇺🇸Akron, Ohio, United States
Person Memorial Hospital
🇺🇸Roxboro, North Carolina, United States
FirstHealth of the Carolinas-Moore Regional Hospital
🇺🇸Pinehurst, North Carolina, United States
University of Tennessee - Knoxville
🇺🇸Knoxville, Tennessee, United States
Wenatchee Valley Hospital and Clinics
🇺🇸Wenatchee, Washington, United States
Case Western Reserve University
🇺🇸Cleveland, Ohio, United States
McKay-Dee Hospital Center
🇺🇸Ogden, Utah, United States
Prisma Health Cancer Institute - Eastside
🇺🇸Greenville, South Carolina, United States
University of Michigan Comprehensive Cancer Center
🇺🇸Ann Arbor, Michigan, United States
Mason District Hospital
🇺🇸Havana, Illinois, United States
Inspira Medical Center Vineland
🇺🇸Vineland, New Jersey, United States
Roswell Park Cancer Institute
🇺🇸Buffalo, New York, United States
Sanford Cancer Center Oncology Clinic
🇺🇸Sioux Falls, South Dakota, United States
Logan Regional Hospital
🇺🇸Logan, Utah, United States
Gene Upshaw Memorial Tahoe Forest Cancer Center
🇺🇸Truckee, California, United States
Saint Louis-Cape Girardeau CCOP
🇺🇸Saint Louis, Missouri, United States
Intermountain Health Care
🇺🇸Salt Lake City, Utah, United States
Mercyhealth Hospital and Cancer Center - Janesville
🇺🇸Janesville, Wisconsin, United States
El Camino Hospital
🇺🇸Mountain View, California, United States
Meeker County Memorial Hospital
🇺🇸Litchfield, Minnesota, United States
Boca Raton Regional Hospital
🇺🇸Boca Raton, Florida, United States
Mcdonough District Hospital
🇺🇸Macomb, Illinois, United States
Northern Indiana Cancer Research Consortium
🇺🇸South Bend, Indiana, United States
William Beaumont Hospital-Royal Oak
🇺🇸Royal Oak, Michigan, United States
University of Missouri - Ellis Fischel
🇺🇸Columbia, Missouri, United States
Altru Cancer Center
🇺🇸Grand Forks, North Dakota, United States
Yale University
🇺🇸New Haven, Connecticut, United States
Doctors Carrol, Sheth, Raghavan
🇺🇸Louisville, Kentucky, United States
UNC Lineberger Comprehensive Cancer Center
🇺🇸Chapel Hill, North Carolina, United States
Louisiana State University Health Science Center
🇺🇸New Orleans, Louisiana, United States
University Medical Center New Orleans
🇺🇸New Orleans, Louisiana, United States
Virginia Commonwealth University/Massey Cancer Center
🇺🇸Richmond, Virginia, United States
Ascension Via Christi Hospitals Wichita
🇺🇸Wichita, Kansas, United States
Cancer Center of Kansas - Wichita
🇺🇸Wichita, Kansas, United States
University of Kansas Cancer Center
🇺🇸Kansas City, Kansas, United States
Intermountain Medical Center
🇺🇸Murray, Utah, United States
Cancer Center of Kansas - El Dorado
🇺🇸El Dorado, Kansas, United States
Cancer Center of Kansas-Liberal
🇺🇸Liberal, Kansas, United States
Cancer Center of Kansas - Winfield
🇺🇸Winfield, Kansas, United States
Cancer Center of Kansas - Newton
🇺🇸Newton, Kansas, United States
Cancer Center of Kansas - Wellington
🇺🇸Wellington, Kansas, United States