S1702 Isatuximab in Treating Patients With Relapsed or Refractory Primary Amyloidosis

Phase 2

Active, not recruiting

Conditions: Gastrointestinal Hemorrhage
Hepatomegaly
Nausea
Constipation
Primary Systemic Amyloidosis
Recurrent Primary Amyloidosis
Amorphous, Eosinophilic, and Acellular Deposit
Diarrhea
Purpura
Refractory Primary Amyloidosis

Interventions: Biological: Isatuximab
Other: Laboratory Biomarker Analysis

Registration Number: NCT03499808

Lead Sponsor: SWOG Cancer Research Network

Brief Summary: This phase II trial studies how well isatuximab works in treating patients with primary amyloidosis that has come back or does not respond to treatment. Monoclonal antibodies, such as isatuximab, may interfere with the ability of cancer cells to grow and spread.

Detailed Description: PRIMARY OBJECTIVES:

I. To assess the efficacy as measured by the confirmed overall hematologic response rate (partial response or better) of isatuximab in relapsed/refractory systemic light chain (AL) amyloidosis.

SECONDARY OBJECTIVES:

I. To evaluate toxicities in the treatment of relapsed/refractory AL amyloidosis with isatuximab.

II. To evaluate time to hematologic response. III. To evaluate duration of response. IV. To evaluate progression-free survival (PFS). V. To evaluate overall survival (OS).

TERTIARY OBJECTIVES:

I. To evaluate efficacy of isatuximab in relapsed/refractory immunoglobulin amyloid light chain (AL) amyloidosis as measured by organ specific response rates (cardiac, renal, gastrointestinal \[GI\], liver, soft tissue, nerve), in the subset of patients that can be evaluated for organ response.

II. To evaluate time to organ response in the subset of patients that can be evaluated for organ response.

OUTLINE:

Patients receive isatuximab intravenously (IV) on days 1, 8, 15, and 22 of course 1 and on days 1 and 15 of subsequent courses. Treatment repeats every 28 days for 24 courses in the absence of disease progression or unacceptable toxicity.

After completion of study treatment, patients are followed up within 30 days and then every at least every 6 months for up to 4 years.

Recruitment & Eligibility

Status: ACTIVE_NOT_RECRUITING

Sex: All

Target Recruitment: 43

Inclusion Criteria

Patient must have relapsed or refractory primary systemic AL amyloidosis, histologically-confirmed by positive Congo red stain with green by birefringence on polarized light microscopy, OR characteristic appearance by electron microscopy AND confirmatory AL amyloid typing (mass spectrometry-based proteomic analysis or immunofluorescence)
Patient must have measurable disease within 28 days prior to registration; serum beta2 microglobulin, serum quantitative immunoglobulins (immunoglobulin [Ig]G, IgA, and IgM), serum free kappa and lambda, and serum protein electrophoresis (SPEP) with M-protein quantification must be obtained within 14 days prior to registration
Patient must demonstrate a difference in the involved serum free light chains (kappa or lambda) versus the uninvolved serum free light chain of >= 4.5 mg/dL within 14 days prior to registration
Patient must have objective organ involvement defined by ONE (or more) of the following; all disease for involved organs must be assessed and documented on the AL baseline tumor assessment form
- Kidney: albuminuria greater than or equal to 500 mg per day on a 24-hour urine specimen within 35 days prior to registration, OR prior kidney biopsy (at time of diagnosis) showing amyloid deposition
- Heart: mean left ventricular wall thickness on echocardiogram greater than or equal to 12 mm in the absence of hypertension or valvular heart disease, OR N-terminal fragment brain natriuretic protein (NT-pro) brain natriuretic peptide (BNP) greater than 332 ng/mL provided that patient does not have impaired renal function (as defined by calculated creatinine clearance less than 25 mL/min) within 14 days prior to registration, OR prior cardiac biopsy (at time of diagnosis) showing amyloid deposition with past documented or presently noted clinical symptoms and signs supportive of a diagnosis of heart failure in the absence of an alternative explanation for heart failure
- Liver: hepatomegaly (total liver span > 15 cm) as demonstrated by computed tomography (CT) or magnetic resonance imaging (MRI) within 35 days prior to registration OR elevated alkaline phosphatase (ALP) greater than 1.5 times the upper limit of normal within 14 days prior to registration, OR prior liver biopsy (at time of diagnosis) showing amyloid deposition
- Gastrointestinal tract: prior biopsy showing amyloid deposition AND symptoms such as GI bleeding or persistent diarrhea (> 4 loose stools/day on most days over a consecutive 28-day period)
- Autonomic or peripheral nervous system: orthostatic blood pressure, symptoms of nausea, early satiety, diarrhea or constipation, abnormal sensory and/or motor findings on neurologic exam, or gastric atony by gastric emptying scan; Note: pulse and blood pressure must be recorded with the patient supine (lying down), and then again after at least 1 minute, but less than 3 minutes of standing; this assessment must be repeated on 2 separate occasions (at least 1 day apart; e.g. day -3 and day -1) within a 28-day screening period
- Soft tissue: macroglossia, or soft tissue deposits (including lymphadenopathy, recurrent peri-orbital purpura, peri-articular, skin or other soft tissue) requiring therapy
Patients must not have active symptomatic multiple myeloma, as defined by 2015 International Myeloma Working Group (IMWG) criteria (hypercalcemia, renal failure, anemia, and bone [CRAB] criteria; bone marrow plasmacytosis > 60%); kappa: lambda ratio > 100 is acceptable only if the clinical symptoms and sign are attributable only to amyloidosis and not multiple myeloma (hemoglobin [Hgb] < 8 g/dL)
Patient must be relapsed or refractory to at least one prior line of therapy (such as: transplant, radiation, or chemotherapy)
Patients must have completed other systemic therapy >= 14 days or investigational drug >= 28 days prior to registration, surgery (other than biopsies) >= 21 days prior to registration, and any autologous stem cell transplant (ASCT) >= 100 days prior to registration
Patients must not have received any or supplements which have been known to have some anti-amyloidogenic effect (such as: doxycycline; curcumin; prednisone; dexamethasone; epigallocatechin gallate [EGCG]) within 14 days prior to registration
Patients must not have any known allergies to isatuximab or other monoclonal antibody therapies
Patients must not have received daratumumab within 56 days prior to registration nor have been refractory to daratumumab
Patients must not be eligible for autologous stem cell transplantation
Patients must have a complete medical history and physical exam within 14 days prior to registration
Within 14 days prior to registration: Total bilirubin =< 2.0 x IULN (institutional upper limit of the norm) AND
Within 14 days prior to registration: Serum glutamic-oxaloacetic transaminase (SGOT)/aspartate aminotransferase (AST) and serum glutamate pyruvate transaminase (SGPT)/alanine aminotransferase (ALT) =< 4.0 x IULN
Creatinine clearance (CrCl) >= 25 mL/min, as measured by a 24-hour urine collection or as estimated by the Cockcroft and Gault formula; the serum creatinine value used in the calculation must have been obtained within 35 days prior to registration
Patients must have bone marrow aspirate, including fluorescence in situ hybridization (FISH) (including: del 17p; t11;14; t4;14, t14;16; and del 13q) and cytogenetic testing (normal ? XY; and all abnormalities) within 35 days prior to registration; central pathology analysis will not be required, however the local pathology report and FISH/cytogenetic data must be submitted in Medidata RAVE
Within 14 days prior to registration: Absolute neutrophil count (ANC) >= 1,000 cells/mcl without growth factor support, AND
Within 14 days prior to registration: Platelets >= 75,000 cells/mcl
Patients must have hemoglobin >= 8 g/dL within 14 days prior to registration; patients may have received transfusion if greater than 7 days prior to registration
New York Heart Association (NYHA) < class IV heart failure
Left ventricular ejection fraction (LVEF) by echocardiogram (ECHO) >= 35% within 35 days prior to registration; and
NT-proBNP =< 8500 ng/L within 14 days prior to registration
Patients must have a Zubrod performance status =< 2
Patients must not have any clinically significant uncontrolled systemic illness, including but not limited to uncontrolled, active infection requiring intravenous antibiotics, unstable angina pectoris, myocardial infarction within the past 6 months, uncontrolled cardiac arrhythmias, uncontrolled hypertension, or uncontrolled diabetes mellitus
- Uncontrolled diabetes: patients who have a diagnosis of diabetes must have an glycosylated hemoglobin (HbA1C) < 7% within 14 days prior to registration; the same criterion will be used in patients with confirmed diagnosis of diabetes mellitus who have been on a stable dietary or therapeutic regimen for this condition in the last three months
- Uncontrolled blood pressure and hypertension: all blood pressure measurements within the 14 days prior to registration must be systolic blood pressure (SBP) =< 160 and diastolic blood pressure (DBP) =< 100; an exception can be made by a healthcare provider for a patient with a single blood pressure elevation who upon rechecking has a normal blood pressure
Females of childbearing potential must have a negative baseline pregnancy test within 14 days prior to registration; this may be either a serum or urine pregnancy test, with a sensitivity of at least 50 mIU/mL; females of childbearing potential (FCBP) must also agree: (1) to have a pregnancy test prior to the start of each treatment cycle and (2) to either commit to continued abstinence from heterosexual intercourse or to use effective contraception while receiving study drug and for at least 12 weeks after receiving the last dose of study drug; females are considered to be of ?childbearing potential? if they have had menses at any time in the preceding 24 consecutive months; in addition to routine contraceptive methods, ?effective contraception? also includes heterosexual celibacy and surgery intended to prevent pregnancy (or with a side-effect of pregnancy prevention) defined as a hysterectomy, bilateral oophorectomy or bilateral tubal ligation; however, if at any point a previously celibate patient chooses to become heterosexually active during the time period for use of contraceptive measures outlined in the protocol, she is responsible for beginning contraceptive measures
Patients with evidence of hepatitis B virus (HBV) are eligible provided there is minimal hepatic injury and the patient has undetectable HBV on suppressive HBV therapy; patient must be willing to maintain adherence to HBV therapy; patients with previously treated and eradicated hepatitis C virus (HCV) who have minimal hepatic injury are eligible
Patients who are known to be human immunodeficiency virus (HIV)-positive at registration are eligible if at time of registration they meet all other protocol eligibility criteria in addition to the following:
- Patient has undetectable HIV viral load by standard polymerase chain reaction (PCR) clinical assay
- Patient is willing to maintain adherence to combination antiretroviral therapy
- Patient has no history of acquired immunodeficiency syndrome (AIDS) defining condition (other than CD4 cell count < 200 mm^3)
- Patient is otherwise likely to have a near normal lifespan if not for the presence of relapsed/refractory amyloid
No other prior malignancy is allowed except for the following: adequately treated basal cell or squamous cell skin cancer, in situ cervical cancer, adequately treated stage I or II cancer from which the patient is currently in complete remission, or any other cancer from which the patient has been disease free for at least two years

Exclusion Criteria

Not provided

Study & Design

Study Type: INTERVENTIONAL

Study Design: SINGLE_GROUP

Arm && Interventions

Group	Intervention	Description
Treatment (isatuximab)	Isatuximab	Patients receive isatuximab IV on days 1, 8, 15, and 22 of course 1 and on days 1 and 15 of subsequent courses. Treatment repeats every 28 days for 24 courses in the absence of disease progression or unacceptable toxicity.
Treatment (isatuximab)	Laboratory Biomarker Analysis	Patients receive isatuximab IV on days 1, 8, 15, and 22 of course 1 and on days 1 and 15 of subsequent courses. Treatment repeats every 28 days for 24 courses in the absence of disease progression or unacceptable toxicity.

Primary Outcome Measures

Name	Time	Method
Assess Efficacy by Confirmed Overall Hematologic Response	From date of enrollment until progression or death due to any cause, whichever occurs first, assessed up to 4 years	To assess the efficacy as measured by the confirmed overall hematologic response rate (partial response, very good partial response, complete response) of isatuximab in relapsed/ refractory systemic light chain (AL) amyloidosis. Measured as rate of partial response or better. Partial response is defined as a dFLC decrease of ≥ 50%, but remaining \> 4.0 mg/dL. Very good partial response is defined as the difference between involved and uninvolved FLCs \[dFLC\] \< 4.0 mg/dL. Complete response is defined as laboratory values within the normal range free light chain (FLC) ratio (0.25 - 1.65) and negative serum and urine immunofixation.

Secondary Outcome Measures

Name	Time	Method
To Evaluate Toxicities in the Treatment of Relapsed/Refractory AL Amyloidosis With Isatuximab.	From date of enrollment until progression or death due to any cause, whichever occurs first, assessed up to 4 years	Only adverse events that are possibly, probably or definitely related to study drug are reported.
Overall Survival (24 Month Estimate)	From date of enrollment up to 2 years	Overall survival is measured from date of registration to date of death due to any cause. Patients last known to be alive are censored at date of last contact. While OS was assessed up to 4 years, 4 year estimates were not reached. We are reporting the 24 month estimate (how many participants reached survival time of at least 24 months).
Duration of Response (24 Month Estimate)	Up to 2 years	Duration of response is measure as time between hematologic response and hematologic progression. Hematologic progression is defined as 50% increase from nadir. While duration of response was assessed up to 4 years, 4 year estimates were not reached. We are reporting the 24 month estimate (how many participants achieved 24 month duration of response)
Time to Hematologic Response	From registration to time of confirmed hematologic progression	To evaluate time to hematologic response. Partial response is defined as a dFLC decrease of ≥ 50%, but remaining \> 4.0 mg/dL. Very good partial response is defined as the difference between involved and uninvolved FLCs \[dFLC\] \< 4.0 mg/dL. Complete response is defined as laboratory values within the normal range free light chain (FLC) ratio (0.25 - 1.65) and negative serum and urine immunofixation.
Progression-free Survival (24 Month Estimate)	From registration to time of confirmed hematologic progression	To evaluate progression-free survival (24 month estimate) Hematologic progression is defined as 50% increase from nadir, or from baseline (if there was no response) in any ONE OR MORE of the following: 1. Serum M-protein: 50% increase in Serum M protein to a value greater than 0.5 g/dL. 2. Urine M protein: 50% increase in Urine M protein to a value greater than 200 mg/day (a visible peak must be present) 3. Free light chain increase of 50% to a value greater than 10 mg/dL

Trial Locations

Locations (344): Saint Mary Corwin Medical Center
🇺🇸
Pueblo, Colorado, United States
The Carle Foundation Hospital
🇺🇸
Urbana, Illinois, United States
Genesee Hematology Oncology PC
🇺🇸
Flint, Michigan, United States
Providence Saint Joseph Medical Center/Disney Family Cancer Center
🇺🇸
Burbank, California, United States
Rocky Mountain Cancer Centers - Pueblo
🇺🇸
Pueblo, Colorado, United States
Smilow Cancer Hospital Care Center at Saint Francis
🇺🇸
Hartford, Connecticut, United States
Southwest Oncology PC
🇺🇸
Durango, Colorado, United States
Swedish Medical Center
🇺🇸
Englewood, Colorado, United States
Saint Alphonsus Medical Center-Nampa
🇺🇸
Nampa, Idaho, United States
Carle Physician Group-Mattoon/Charleston
🇺🇸
Mattoon, Illinois, United States
Hurley Medical Center
🇺🇸
Flint, Michigan, United States
Sparrow Hospital
🇺🇸
Lansing, Michigan, United States
Saint Alphonsus Cancer Care Center-Boise
🇺🇸
Boise, Idaho, United States
Saint Luke's Mountain States Tumor Institute
🇺🇸
Boise, Idaho, United States
Illinois CancerCare-Carthage
🇺🇸
Carthage, Illinois, United States
Decatur Memorial Hospital
🇺🇸
Decatur, Illinois, United States
Illinois CancerCare-Canton
🇺🇸
Canton, Illinois, United States
Illinois CancerCare-Eureka
🇺🇸
Eureka, Illinois, United States
Weisberg Cancer Treatment Center
🇺🇸
Farmington Hills, Michigan, United States
Western Illinois Cancer Treatment Center
🇺🇸
Galesburg, Illinois, United States
Loyola University Medical Center
🇺🇸
Maywood, Illinois, United States
Saint John Macomb-Oakland Hospital
🇺🇸
Warren, Michigan, United States
Mercy Hospital
🇺🇸
Coon Rapids, Minnesota, United States
North Memorial Medical Health Center
🇺🇸
Robbinsdale, Minnesota, United States
Park Nicollet Clinic - Saint Louis Park
🇺🇸
Saint Louis Park, Minnesota, United States
Regions Hospital
🇺🇸
Saint Paul, Minnesota, United States
Central Care Cancer Center - Bolivar
🇺🇸
Bolivar, Missouri, United States
Community Medical Hospital
🇺🇸
Missoula, Montana, United States
Saint Elizabeth Regional Medical Center
🇺🇸
Lincoln, Nebraska, United States
East Carolina University
🇺🇸
Greenville, North Carolina, United States
Marshfield Clinic Stevens Point Center
🇺🇸
Stevens Point, Wisconsin, United States
Onslow Memorial Hospital
🇺🇸
Jacksonville, North Carolina, United States
Research Medical Center
🇺🇸
Kansas City, Missouri, United States
IHA Hematology Oncology Consultants-Chelsea
🇺🇸
Chelsea, Michigan, United States
Harrison HealthPartners Hematology and Oncology-Poulsbo
🇺🇸
Poulsbo, Washington, United States
Boston Medical Center
🇺🇸
Boston, Massachusetts, United States
Cleveland Clinic Foundation
🇺🇸
Cleveland, Ohio, United States
Swedish Medical Center-Cherry Hill
🇺🇸
Seattle, Washington, United States
Central Care Cancer Center - Garden City
🇺🇸
Garden City, Kansas, United States
Lawrence Memorial Hospital
🇺🇸
Lawrence, Kansas, United States
Welch Cancer Center
🇺🇸
Sheridan, Wyoming, United States
Saint Luke's South Hospital
🇺🇸
Overland Park, Kansas, United States
Cancer Center of Kansas-Wichita Medical Arts Tower
🇺🇸
Wichita, Kansas, United States
Kansas Institute of Medicine Cancer and Blood Center
🇺🇸
Lenexa, Kansas, United States
Billings Clinic-Cody
🇺🇸
Cody, Wyoming, United States
Central Care Cancer Center - Great Bend
🇺🇸
Great Bend, Kansas, United States
Abbott-Northwestern Hospital
🇺🇸
Minneapolis, Minnesota, United States
Hennepin County Medical Center
🇺🇸
Minneapolis, Minnesota, United States
Health Partners Inc
🇺🇸
Minneapolis, Minnesota, United States
Ascension Saint John Hospital
🇺🇸
Detroit, Michigan, United States
Wayne State University/Karmanos Cancer Institute
🇺🇸
Detroit, Michigan, United States
University of Oklahoma Health Sciences Center
🇺🇸
Oklahoma City, Oklahoma, United States
The Medical Center of Aurora
🇺🇸
Aurora, Colorado, United States
University of California Davis Comprehensive Cancer Center
🇺🇸
Sacramento, California, United States
University of Colorado Hospital
🇺🇸
Aurora, Colorado, United States
Denver Health Medical Center
🇺🇸
Denver, Colorado, United States
National Jewish Health-Main Campus
🇺🇸
Denver, Colorado, United States
Presbyterian - Saint Lukes Medical Center - Health One
🇺🇸
Denver, Colorado, United States
The Women's Imaging Center
🇺🇸
Denver, Colorado, United States
Porter Adventist Hospital
🇺🇸
Denver, Colorado, United States
Colorado Blood Cancer Institute
🇺🇸
Denver, Colorado, United States
Rocky Mountain Cancer Centers-Rose
🇺🇸
Denver, Colorado, United States
Rose Medical Center
🇺🇸
Denver, Colorado, United States
Western Surgical Care
🇺🇸
Denver, Colorado, United States
Saint Joseph Mercy Hospital
🇺🇸
Ann Arbor, Michigan, United States
University of Michigan Comprehensive Cancer Center
🇺🇸
Ann Arbor, Michigan, United States
Alegent Health Bergan Mercy Medical Center
🇺🇸
Omaha, Nebraska, United States
Mayo Clinic
🇺🇸
Rochester, Minnesota, United States
Creighton University Medical Center
🇺🇸
Omaha, Nebraska, United States
Alegent Health Immanuel Medical Center
🇺🇸
Omaha, Nebraska, United States
Hematology and Oncology Consultants PC
🇺🇸
Omaha, Nebraska, United States
Alegent Health Lakeside Hospital
🇺🇸
Omaha, Nebraska, United States
Providence Saint Vincent Medical Center
🇺🇸
Portland, Oregon, United States
Kaiser Permanente Northwest
🇺🇸
Portland, Oregon, United States
Smilow Cancer Center/Yale-New Haven Hospital
🇺🇸
New Haven, Connecticut, United States
Saints Mary and Elizabeth Hospital
🇺🇸
Louisville, Kentucky, United States
Jewish Hospital Medical Center Northeast
🇺🇸
Louisville, Kentucky, United States
Yale University
🇺🇸
New Haven, Connecticut, United States
Jewish Hospital
🇺🇸
Louisville, Kentucky, United States
Ochsner Medical Center Jefferson
🇺🇸
New Orleans, Louisiana, United States
Alaska Breast Care and Surgery LLC
🇺🇸
Anchorage, Alaska, United States
Anchorage Radiation Therapy Center
🇺🇸
Anchorage, Alaska, United States
Fremont - Rideout Cancer Center
🇺🇸
Marysville, California, United States
Providence Alaska Medical Center
🇺🇸
Anchorage, Alaska, United States
CHI Saint Vincent Cancer Center Hot Springs
🇺🇸
Hot Springs, Arkansas, United States
UC Irvine Health/Chao Family Comprehensive Cancer Center
🇺🇸
Orange, California, United States
Rocky Mountain Cancer Centers-Aurora
🇺🇸
Aurora, Colorado, United States
Rocky Mountain Cancer Centers-Boulder
🇺🇸
Boulder, Colorado, United States
Boulder Community Hospital
🇺🇸
Boulder, Colorado, United States
Rocky Mountain Cancer Centers-Penrose
🇺🇸
Colorado Springs, Colorado, United States
Rocky Mountain Cancer Centers-Midtown
🇺🇸
Denver, Colorado, United States
SCL Health Saint Joseph Hospital
🇺🇸
Denver, Colorado, United States
Mercy Medical Center
🇺🇸
Springfield, Massachusetts, United States
Comprehensive Cancer Care and Research Institute of Colorado LLC
🇺🇸
Englewood, Colorado, United States
Poudre Valley Hospital
🇺🇸
Fort Collins, Colorado, United States
Mountain Blue Cancer Care Center
🇺🇸
Golden, Colorado, United States
National Jewish Health-Western Hematology Oncology
🇺🇸
Golden, Colorado, United States
Good Samaritan Medical Center
🇺🇸
Lafayette, Colorado, United States
Saint Mary's Hospital and Regional Medical Center
🇺🇸
Grand Junction, Colorado, United States
North Colorado Medical Center
🇺🇸
Greeley, Colorado, United States
Rocky Mountain Cancer Centers-Littleton
🇺🇸
Littleton, Colorado, United States
Saint Anthony Hospital
🇺🇸
Lakewood, Colorado, United States
Rocky Mountain Cancer Centers-Lakewood
🇺🇸
Lakewood, Colorado, United States
Littleton Adventist Hospital
🇺🇸
Littleton, Colorado, United States
Rocky Mountain Cancer Centers-Sky Ridge
🇺🇸
Lone Tree, Colorado, United States
Longmont United Hospital
🇺🇸
Longmont, Colorado, United States
McKee Medical Center
🇺🇸
Loveland, Colorado, United States
Sky Ridge Medical Center
🇺🇸
Lone Tree, Colorado, United States
Rocky Mountain Cancer Centers-Longmont
🇺🇸
Longmont, Colorado, United States
Rocky Mountain Cancer Centers-Parker
🇺🇸
Parker, Colorado, United States
Parker Adventist Hospital
🇺🇸
Parker, Colorado, United States
National Jewish Health-Northern Hematology Oncology
🇺🇸
Thornton, Colorado, United States
Rocky Mountain Cancer Centers-Thornton
🇺🇸
Thornton, Colorado, United States
SCL Health Lutheran Medical Center
🇺🇸
Wheat Ridge, Colorado, United States
Smilow Cancer Hospital Care Center-Fairfield
🇺🇸
Fairfield, Connecticut, United States
Smilow Cancer Hospital-Derby Care Center
🇺🇸
Derby, Connecticut, United States
Yale-New Haven Hospital North Haven Medical Center
🇺🇸
North Haven, Connecticut, United States
Smilow Cancer Hospital-Orange Care Center
🇺🇸
Orange, Connecticut, United States
Smilow Cancer Hospital-Torrington Care Center
🇺🇸
Torrington, Connecticut, United States
Smilow Cancer Hospital-Waterbury Care Center
🇺🇸
Waterbury, Connecticut, United States
Smilow Cancer Hospital Care Center-Trumbull
🇺🇸
Trumbull, Connecticut, United States
Mayo Clinic in Florida
🇺🇸
Jacksonville, Florida, United States
Cleveland Clinic-Weston
🇺🇸
Weston, Florida, United States
Saint Alphonsus Cancer Care Center-Caldwell
🇺🇸
Caldwell, Idaho, United States
Kootenai Medical Center
🇺🇸
Coeur d'Alene, Idaho, United States
Walter Knox Memorial Hospital
🇺🇸
Emmett, Idaho, United States
Idaho Urologic Institute-Meridian
🇺🇸
Meridian, Idaho, United States
Saint Luke's Mountain States Tumor Institute - Meridian
🇺🇸
Meridian, Idaho, United States
Saint Luke's Mountain States Tumor Institute - Fruitland
🇺🇸
Fruitland, Idaho, United States
Saint Luke's Mountain States Tumor Institute - Nampa
🇺🇸
Nampa, Idaho, United States
Kootenai Cancer Center
🇺🇸
Post Falls, Idaho, United States
Kootenai Cancer Clinic
🇺🇸
Sandpoint, Idaho, United States
Saint Luke's Mountain States Tumor Institute-Twin Falls
🇺🇸
Twin Falls, Idaho, United States
Rush - Copley Medical Center
🇺🇸
Aurora, Illinois, United States
Memorial Hospital of Carbondale
🇺🇸
Carbondale, Illinois, United States
Illinois CancerCare-Bloomington
🇺🇸
Bloomington, Illinois, United States
SIH Cancer Institute
🇺🇸
Carterville, Illinois, United States
Centralia Oncology Clinic
🇺🇸
Centralia, Illinois, United States
Crossroads Cancer Center
🇺🇸
Effingham, Illinois, United States
Carle Physician Group-Effingham
🇺🇸
Effingham, Illinois, United States
Carle on Vermilion
🇺🇸
Danville, Illinois, United States
Cancer Care Specialists of Illinois - Decatur
🇺🇸
Decatur, Illinois, United States
Illinois CancerCare-Macomb
🇺🇸
Macomb, Illinois, United States
Illinois CancerCare-Kewanee Clinic
🇺🇸
Kewanee, Illinois, United States
Illinois CancerCare-Galesburg
🇺🇸
Galesburg, Illinois, United States
Marjorie Weinberg Cancer Center at Loyola-Gottlieb
🇺🇸
Melrose Park, Illinois, United States
Illinois CancerCare-Ottawa Clinic
🇺🇸
Ottawa, Illinois, United States
Illinois CancerCare-Peoria
🇺🇸
Peoria, Illinois, United States
Methodist Medical Center of Illinois
🇺🇸
Peoria, Illinois, United States
Illinois CancerCare-Pekin
🇺🇸
Pekin, Illinois, United States
Memorial Medical Center
🇺🇸
Springfield, Illinois, United States
Illinois CancerCare-Peru
🇺🇸
Peru, Illinois, United States
Illinois CancerCare-Princeton
🇺🇸
Princeton, Illinois, United States
Springfield Clinic
🇺🇸
Springfield, Illinois, United States
Southern Illinois University School of Medicine
🇺🇸
Springfield, Illinois, United States
Valley Radiation Oncology
🇺🇸
Peru, Illinois, United States
Southwest Illinois Health Services LLP
🇺🇸
Swansea, Illinois, United States
Cancer Care Specialists of Illinois-Swansea
🇺🇸
Swansea, Illinois, United States
Carle Cancer Center
🇺🇸
Urbana, Illinois, United States
Alegent Health Mercy Hospital
🇺🇸
Council Bluffs, Iowa, United States
Rush-Copley Healthcare Center
🇺🇸
Yorkville, Illinois, United States
Medical Oncology and Hematology Associates-West Des Moines
🇺🇸
Clive, Iowa, United States
Mercy Cancer Center-West Lakes
🇺🇸
Clive, Iowa, United States
Greater Regional Medical Center
🇺🇸
Creston, Iowa, United States
Mercy Medical Center-West Lakes
🇺🇸
West Des Moines, Iowa, United States
Menorah Medical Center
🇺🇸
Overland Park, Kansas, United States
Cancer Center of Kansas - Wichita
🇺🇸
Wichita, Kansas, United States
Minimally Invasive Surgery Hospital
🇺🇸
Lenexa, Kansas, United States
Flaget Memorial Hospital
🇺🇸
Bardstown, Kentucky, United States
Commonwealth Cancer Center-Corbin
🇺🇸
Corbin, Kentucky, United States
Saint Joseph London
🇺🇸
London, Kentucky, United States
Jewish Hospital Medical Center South
🇺🇸
Shepherdsville, Kentucky, United States
Harold Alfond Center for Cancer Care
🇺🇸
Augusta, Maine, United States
Eastern Maine Medical Center
🇺🇸
Bangor, Maine, United States
Waldo County General Hospital
🇺🇸
Belfast, Maine, United States
MaineHealth/SMHC Cancer Care and Blood Disorders-Biddeford
🇺🇸
Biddeford, Maine, United States
MaineHealth/SMHC Cancer Care and Blood Disorders-Sanford
🇺🇸
Sanford, Maine, United States
Stephens Memorial Hospital
🇺🇸
Norway, Maine, United States
Lafayette Family Cancer Center-EMMC
🇺🇸
Brewer, Maine, United States
IHA Hematology Oncology Consultants-Canton
🇺🇸
Canton, Michigan, United States
Saint Joseph Mercy Canton
🇺🇸
Canton, Michigan, United States
Caro Cancer Center
🇺🇸
Caro, Michigan, United States
Saint Joseph Mercy Chelsea
🇺🇸
Chelsea, Michigan, United States
Newland Medical Associates-Clarkston
🇺🇸
Clarkston, Michigan, United States
Hematology Oncology Consultants-Clarkston
🇺🇸
Clarkston, Michigan, United States
Great Lakes Cancer Management Specialists-Doctors Park
🇺🇸
East China Township, Michigan, United States
Genesee Cancer and Blood Disease Treatment Center
🇺🇸
Flint, Michigan, United States
Genesys Hurley Cancer Institute
🇺🇸
Flint, Michigan, United States
Great Lakes Cancer Management Specialists-Van Elslander Cancer Center
🇺🇸
Grosse Pointe Woods, Michigan, United States
Academic Hematology Oncology Specialists
🇺🇸
Grosse Pointe Woods, Michigan, United States
Michigan Breast Specialists-Grosse Pointe Woods
🇺🇸
Grosse Pointe Woods, Michigan, United States
Saint Mary Mercy Hospital
🇺🇸
Livonia, Michigan, United States
Hope Cancer Clinic
🇺🇸
Livonia, Michigan, United States
Great Lakes Cancer Management Specialists-Macomb Medical Campus
🇺🇸
Macomb, Michigan, United States
Saint Mary's Oncology/Hematology Associates of Marlette
🇺🇸
Marlette, Michigan, United States
Hope Cancer Center
🇺🇸
Pontiac, Michigan, United States
Michigan Breast Specialists-Macomb Township
🇺🇸
Macomb, Michigan, United States
Newland Medical Associates-Pontiac
🇺🇸
Pontiac, Michigan, United States
Great Lakes Cancer Management Specialists-Rochester Hills
🇺🇸
Rochester Hills, Michigan, United States
Saint Joseph Mercy Oakland
🇺🇸
Pontiac, Michigan, United States
Oncology Hematology Associates of Saginaw Valley PC
🇺🇸
Saginaw, Michigan, United States
Bhadresh Nayak MD PC-Sterling Heights
🇺🇸
Sterling Heights, Michigan, United States
Great Lakes Cancer Management Specialists-Macomb Professional Building
🇺🇸
Warren, Michigan, United States
Ascension Saint Joseph Hospital
🇺🇸
Tawas City, Michigan, United States
Advanced Breast Care Center PLLC
🇺🇸
Warren, Michigan, United States
Macomb Hematology Oncology PC
🇺🇸
Warren, Michigan, United States
Michigan Breast Specialists-Warren
🇺🇸
Warren, Michigan, United States
Saint Mary's Oncology/Hematology Associates of West Branch
🇺🇸
West Branch, Michigan, United States
Fairview Ridges Hospital
🇺🇸
Burnsville, Minnesota, United States
Huron Gastroenterology PC
🇺🇸
Ypsilanti, Michigan, United States
Cambridge Medical Center
🇺🇸
Cambridge, Minnesota, United States
IHA Hematology Oncology Consultants-Ann Arbor
🇺🇸
Ypsilanti, Michigan, United States
Fairview-Southdale Hospital
🇺🇸
Edina, Minnesota, United States
Unity Hospital
🇺🇸
Fridley, Minnesota, United States
Fairview Maple Grove Medical Center
🇺🇸
Maple Grove, Minnesota, United States
Minnesota Oncology Hematology PA-Maplewood
🇺🇸
Maplewood, Minnesota, United States
Saint John's Hospital - Healtheast
🇺🇸
Maplewood, Minnesota, United States
Monticello Cancer Center
🇺🇸
Monticello, Minnesota, United States
Fairview Northland Medical Center
🇺🇸
Princeton, Minnesota, United States
New Ulm Medical Center
🇺🇸
New Ulm, Minnesota, United States
Ridgeview Medical Center
🇺🇸
Waconia, 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
Lakeview Hospital
🇺🇸
Stillwater, Minnesota, United States
Rice Memorial Hospital
🇺🇸
Willmar, Minnesota, United States
Fairview Lakes Medical Center
🇺🇸
Wyoming, Minnesota, United States
Parkland Health Center-Bonne Terre
🇺🇸
Bonne Terre, Missouri, United States
Saint Francis Medical Center
🇺🇸
Cape Girardeau, Missouri, United States
Southeast Cancer Center
🇺🇸
Cape Girardeau, Missouri, United States
Centerpoint Medical Center LLC
🇺🇸
Independence, Missouri, United States
Capital Region Southwest Campus
🇺🇸
Jefferson City, Missouri, United States
Heartland Regional Medical Center
🇺🇸
Saint Joseph, Missouri, United States
Saint Luke's East - Lee's Summit
🇺🇸
Lee's Summit, Missouri, United States
Siteman Cancer Center-South County
🇺🇸
Saint Louis, Missouri, United States
Missouri Baptist Medical Center
🇺🇸
Saint Louis, Missouri, United States
Missouri Baptist Outpatient Center-Sunset Hills
🇺🇸
Sunset Hills, Missouri, United States
Sainte Genevieve County Memorial Hospital
🇺🇸
Sainte Genevieve, Missouri, United States
Missouri Baptist Sullivan Hospital
🇺🇸
Sullivan, Missouri, United States
Saint Vincent Healthcare
🇺🇸
Billings, Montana, United States
Saint Vincent Frontier Cancer Center
🇺🇸
Billings, Montana, 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
Billings Clinic Cancer Center
🇺🇸
Billings, Montana, United States
Saint Peter's Community Hospital
🇺🇸
Helena, Montana, United States
Saint Patrick Hospital - Community Hospital
🇺🇸
Missoula, Montana, United States
Great Falls Clinic
🇺🇸
Great Falls, Montana, United States
Benefis Healthcare- Sletten Cancer Institute
🇺🇸
Great Falls, Montana, United States
Kalispell Regional Medical Center
🇺🇸
Kalispell, Montana, United States
Heartland Hematology and Oncology
🇺🇸
Kearney, Nebraska, United States
CHI Health Saint Francis
🇺🇸
Grand Island, Nebraska, United States
CHI Health Good Samaritan
🇺🇸
Kearney, Nebraska, United States
Memorial Sloan Kettering Monmouth
🇺🇸
Middletown, New Jersey, United States
Memorial Sloan Kettering Basking Ridge
🇺🇸
Basking Ridge, New Jersey, United States
Midlands Community Hospital
🇺🇸
Papillion, Nebraska, United States
Memorial Sloan Kettering Commack
🇺🇸
Commack, New York, United States
NYP/Columbia University Medical Center/Herbert Irving Comprehensive Cancer Center
🇺🇸
New York, New York, United States
Memorial Sloan Kettering Nassau
🇺🇸
Uniondale, New York, United States
Memorial Sloan Kettering Cancer Center
🇺🇸
New York, New York, United States
University of Rochester
🇺🇸
Rochester, New York, United States
Carolinas Medical Center/Levine Cancer Institute
🇺🇸
Charlotte, North Carolina, United States
Memorial Sloan Kettering Westchester
🇺🇸
Harrison, New York, United States
Southeastern Medical Oncology Center-Clinton
🇺🇸
Clinton, North Carolina, United States
Southeastern Medical Oncology Center-Goldsboro
🇺🇸
Goldsboro, North Carolina, United States
Wayne Memorial Hospital
🇺🇸
Goldsboro, North Carolina, United States
Southeastern Medical Oncology Center-Jacksonville
🇺🇸
Jacksonville, North Carolina, United States
Good Samaritan Hospital - Cincinnati
🇺🇸
Cincinnati, Ohio, United States
TriHealth Cancer Institute-Anderson
🇺🇸
Cincinnati, Ohio, United States
Case Western Reserve University
🇺🇸
Cleveland, Ohio, United States
Bethesda North Hospital
🇺🇸
Cincinnati, Ohio, United States
TriHealth Cancer Institute-Westside
🇺🇸
Cincinnati, Ohio, United States
Clackamas Radiation Oncology Center
🇺🇸
Clackamas, Oregon, United States
Bay Area Hospital
🇺🇸
Coos Bay, Oregon, United States
Providence Oncology and Hematology Care Southeast
🇺🇸
Clackamas, Oregon, United States
Providence Newberg Medical Center
🇺🇸
Newberg, Oregon, United States
Saint Charles Health System
🇺🇸
Bend, Oregon, United States
Saint Alphonsus Medical Center-Baker City
🇺🇸
Baker City, Oregon, United States
Providence Portland Medical Center
🇺🇸
Portland, Oregon, United States
Saint Alphonsus Medical Center-Ontario
🇺🇸
Ontario, Oregon, United States
Oregon Health and Science University
🇺🇸
Portland, Oregon, United States
Saint Charles Health System-Redmond
🇺🇸
Redmond, Oregon, United States
Pocono Medical Center
🇺🇸
East Stroudsburg, Pennsylvania, United States
Lehigh Valley Hospital - Muhlenberg
🇺🇸
Bethlehem, Pennsylvania, United States
Lehigh Valley Hospital-Cedar Crest
🇺🇸
Allentown, Pennsylvania, United States
Lehigh Valley Hospital-Hazleton
🇺🇸
Hazleton, Pennsylvania, United States
Memorial Hospital
🇺🇸
Chattanooga, Tennessee, United States
Pulmonary Medicine Center of Chattanooga-Hixson
🇺🇸
Hixson, Tennessee, United States
Memorial GYN Plus
🇺🇸
Ooltewah, Tennessee, United States
Saint Joseph Regional Cancer Center
🇺🇸
Bryan, Texas, United States
Providence Regional Cancer System-Aberdeen
🇺🇸
Aberdeen, Washington, United States
PeaceHealth Saint Joseph Medical Center
🇺🇸
Bellingham, Washington, United States
Harrison HealthPartners Hematology and Oncology-Bremerton
🇺🇸
Bremerton, Washington, United States
Harrison Medical Center
🇺🇸
Bremerton, Washington, United States
Saint Elizabeth Hospital
🇺🇸
Enumclaw, Washington, United States
Highline Medical Center-Main Campus
🇺🇸
Burien, Washington, United States
Providence Regional Cancer System-Centralia
🇺🇸
Centralia, Washington, United States
Swedish Cancer Institute-Edmonds
🇺🇸
Edmonds, Washington, United States
Kadlec Clinic Hematology and Oncology
🇺🇸
Kennewick, Washington, United States
Saint Clare Hospital
🇺🇸
Lakewood, Washington, United States
Swedish Medical Center-Ballard Campus
🇺🇸
Seattle, Washington, United States
Kaiser Permanente Washington
🇺🇸
Seattle, Washington, United States
Providence Regional Cancer System-Lacey
🇺🇸
Lacey, Washington, United States
PeaceHealth Saint John Medical Center
🇺🇸
Longview, Washington, United States
Pacific Gynecology Specialists
🇺🇸
Seattle, Washington, United States
Swedish Medical Center-First Hill
🇺🇸
Seattle, Washington, United States
Franciscan Research Center-Northwest Medical Plaza
🇺🇸
Tacoma, Washington, United States
PeaceHealth Southwest Medical Center
🇺🇸
Vancouver, Washington, United States
Providence Regional Cancer System-Shelton
🇺🇸
Shelton, Washington, United States
PeaceHealth United General Medical Center
🇺🇸
Sedro-Woolley, Washington, United States
Providence Saint Mary Regional Cancer Center
🇺🇸
Walla Walla, Washington, United States
Northwest Medical Specialties PLLC
🇺🇸
Tacoma, Washington, United States
Providence Regional Cancer System-Yelm
🇺🇸
Yelm, Washington, United States
United Hospital Center
🇺🇸
Bridgeport, West Virginia, United States
WVUH-Berkely Medical Center
🇺🇸
Martinsburg, West Virginia, United States
West Virginia University Healthcare
🇺🇸
Morgantown, West Virginia, United States
Camden Clark Medical Center
🇺🇸
Parkersburg, West Virginia, United States
Marshfield Medical Center-EC Cancer Center
🇺🇸
Eau Claire, Wisconsin, United States
Marshfield Clinic-Minocqua Center
🇺🇸
Minocqua, Wisconsin, United States
Marshfield Medical Center-Rice Lake
🇺🇸
Rice Lake, Wisconsin, United States
Cheyenne Regional Medical Center-West
🇺🇸
Cheyenne, Wyoming, United States
Marshfield Medical Center-Marshfield
🇺🇸
Marshfield, Wisconsin, United States
Cancer Center of Western Wisconsin
🇺🇸
New Richmond, Wisconsin, United States
Marshfield Clinic - Weston Center
🇺🇸
Weston, Wisconsin, United States
Anchorage Associates in Radiation Medicine
🇺🇸
Anchorage, Alaska, United States
Alaska Oncology and Hematology LLC
🇺🇸
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
Penrose-Saint Francis Healthcare
🇺🇸
Colorado Springs, Colorado, United States
Washington University School of Medicine
🇺🇸
Saint Louis, Missouri, United States
Saint Luke's Hospital of Kansas City
🇺🇸
Kansas City, Missouri, United States
UNC Lineberger Comprehensive Cancer Center
🇺🇸
Chapel Hill, North Carolina, United States
Medical Oncology and Hematology Associates-Laurel
🇺🇸
Des Moines, Iowa, United States
Mercy Medical Center - Des Moines
🇺🇸
Des Moines, Iowa, United States
Saint Joseph Radiation Oncology Resource Center
🇺🇸
Lexington, Kentucky, United States
Saint Joseph Hospital East
🇺🇸
Lexington, Kentucky, United States
21st Century Oncology-Pontiac
🇺🇸
Pontiac, Michigan, United States
Ascension Saint Mary's Hospital
🇺🇸
Saginaw, Michigan, United States
IHA Hematology Oncology Consultants-Brighton
🇺🇸
Brighton, Michigan, United States
Saint Joseph Mercy Brighton
🇺🇸
Brighton, Michigan, United States
Providence Regional Cancer Partnership
🇺🇸
Everett, Washington, United States
Saint Francis Hospital
🇺🇸
Federal Way, Washington, United States
Swedish Cancer Institute-Issaquah
🇺🇸
Issaquah, Washington, United States