Nivolumab in Treating Patients With Persistent, Recurrent, or Metastatic Cervical Cancer

Phase 2

Active, not recruiting

Conditions: Cervical Adenocarcinoma
Cervical Adenosquamous Carcinoma
Stage IV Cervical Cancer AJCC v6 and v7
Recurrent Cervical Carcinoma
Stage IVB Cervical Cancer AJCC v6 and v7
Stage IVA Cervical Cancer AJCC v6 and v7

Interventions: Other: Laboratory Biomarker Analysis
Biological: Nivolumab

Registration Number: NCT02257528

Lead Sponsor: National Cancer Institute (NCI)

Brief Summary: This phase II trial studies the side effects and how well nivolumab works in treating patients with cervical cancer that has grown, come back, or spread to other places in the body. Monoclonal antibodies, such as nivolumab, may block tumor growth in different ways by targeting certain cells.

Detailed Description: PRIMARY OBJECTIVES:

I. To assess the antitumor activity (proportion of objective response by Response Evaluation Criteria in Solid Tumors \[RECIST\] 1.1 criteria) of nivolumab with objective tumor response in patients with persistent, recurrent or metastatic carcinoma of the cervix.

II. To determine the nature and degree of toxicity of nivolumab as assessed by Common Terminology Criteria for Adverse Events (CTCAE) in patients with persistent, recurrent or metastatic carcinoma of the cervix.

SECONDARY OBJECTIVES:

I. To estimate the duration of progression-free survival (PFS) and overall survival (OS).

TERTIARY OBJECTIVES:

I. To systematically evaluate programmed cell death (PD)-1 and B7 homolog 1 (B7-H1) (i.e., PD-1 ligand) expression in tumor infiltrating lymphocytes (TILs) and cervical cancer cells and explore their correlations with objective response, PFS, and OS in nivolumab-treated patients with PD-1 and B7-H1 scoring results.

II. To explore the composition of immune infiltrates in tumor specimens/biopsies from primary and/or metastatic/recurrent sites with selected markers including (but not limited) to cluster of differentiation (CD)4+, CD8+, forkhead box P3 (FoxP3), CD25, lymphocyte activation gene-3 (LAG-3), T cell immunoglobulin mucin-3 (TIM-3), and inducible T-cell co-stimulator (ICOS) and their correlations to objective response, PFS and OS in nivolumab-treated patients.

III. To evaluate human papillomavirus (HPV) status and to explore the changes of pre- and post-immune therapy responses to HPV16/18/31/35/45 E7 antigens in patients peripheral blood lymphocytes (PBL) and serum using proliferative and interferon (IFN)-gamma enzyme-linked immunospot (ELISPOT) (cellular immunity) and serological (enzyme-linked immunosorbent assay \[ELISA\]) assays.

IV. To explore the levels of circulating tumor cells (CTCs) pre-treatment and at 8 and 12 weeks and their association with patient outcome.

OUTLINE:

Patients receive nivolumab intravenously (IV) over approximately 60 minutes every 2 weeks for a maximum of 46 doses over 92 weeks in the absence of disease progression or unacceptable toxicity.

After completion of study treatment, patients are followed up every 3 months for 2 years and then every 6 months for 3 years.

Recruitment & Eligibility

Status: ACTIVE_NOT_RECRUITING

Sex: Female

Target Recruitment: 26

Inclusion Criteria

Patients must have persistent, recurrent or metastatic squamous cell carcinoma, adenosquamous carcinoma or adenocarcinoma of the cervix with documented disease progression (disease not amendable to curative therapy); NOTE: the following cervical tumors are not eligible: minimal deviation/adenoma malignum, gastric type adenocarcinoma, clear cell carcinoma and mesonephric carcinoma; histologic confirmation of the original primary tumor is required via the pathology report
All patents must have measurable disease as defined by RECIST 1.1; measurable disease is defined as at least one lesion that can be accurately measured in at least one dimension (longest diameter to be recorded); each lesion must be >= 10 mm when measured by computed tomography (CT), magnetic resonance imaging (MRI) or caliper measurement by clinical exam; or >= 20 mm when measured by chest x-ray; lymph nodes must be >= 15 mm in short axis when measured by CT or MRI
Patients must have at least one "target" lesion" to be used to assess response on this protocol as defined by RECIST 1.1; tumors within a previously irradiated field will be designated as "non-target" lesions unless progression is documented or a biopsy is obtained to confirm persistence at least 90 days following completion of radiation therapy
Appropriate for study entry based on the following diagnostic workup:
- History/physical examination within 28 days prior to registration
- Imaging of target lesion(s) within 28 days prior to registration
- Further protocol-specific assessments:
  - Recovery from adverse effects of recent surgery, radiotherapy or chemotherapy
  - Any other prior therapy directed at the malignant tumor including chemotherapy, biologic/targeted agents and immunologic agents must be discontinued at least three weeks prior to registration
  - Investigation agents must be discontinued for at least 30 days prior to registration
  - Any prior radiation therapy must be completed at least 4 weeks prior to registration
  - At least 4 weeks must have elapsed since any major surgery prior to registration
Patients must have had one prior systemic chemotherapeutic regimen for management of persistent, recurrent or metastatic carcinoma of the cervix (e.g.; paclitaxel/cisplatin, paclitaxel/cisplatin/bevacizumab); chemotherapy administered concurrent with primary radiation (e.g.; weekly cisplatin) is not counted as a systemic chemotherapy regimen; adjuvant chemotherapy given following the completion of radiation therapy (or concurrent chemotherapy and radiation therapy) is not counted as a systemic chemotherapy regimen (e.g.; paclitaxel and carboplatin for up to 4 cycles); NOTE: patients who have received more than one prior regimen are NOT eligible
Performance status of 0 or 1
Absolute neutrophil count (ANC) >= 1,500/ul
Platelets >= 100,000/ul
Creatinine =< 1.5 x institutional upper limit of normal (ULN) or creatinine clearance (CrCl) >= 40 mL/min using Cockcroft-Gault formula
Bilirubin =< 1.5 x ULN
Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) =< 3 x ULN
Normal thyroid function testing (thyroid stimulating hormone [TSH]) within 14 days prior to registration
The patient or a legally authorized representative must provide study-specific informed consent authorization permitting release of personal health information prior to study entry

Exclusion Criteria

Patients who have had prior therapy with nivolumab or with an anti-PD-1, anti-PD-ligand (L)1, anti-PD-L2, anti-cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) antibody, or any other antibody or drug specifically targeting T-cell co-stimulation or immune check point pathways
History of severe hypersensitivity reaction to any monoclonal antibody
Prior invasive malignancy (except non-melanomatous skin cancer) unless disease free for a minimum of 3 years
Patients with uncontrolled intercurrent illness including, but not limited to, ongoing or active infection, symptomatic congestive heart failure and unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements
Patients who are pregnant or nursing; women of child-bearing potential (WOCBP) must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) prior to study entry and for the duration of study participation; WOCBP should use an adequate method to avoid pregnancy for 23 weeks after the last dose of investigational drug; WOCBP must have a negative serum or urine pregnancy test (minimum sensitivity 25 IV/L or equivalent units of human chorionic gonadotropin [HCG]) within 24 hours prior to the start of nivolumab; women must not be breastfeeding
- Women who are not of childbearing potential (i.e., who are postmenopausal or surgically sterile or have undergone definitive radiation) do not require contraception
- Women of childbearing potential (WOCBP) is defined as any female who has experienced menarche and who has not undergone surgical sterilization (hysterectomy of bilateral oophorectomy) or who is not postmenopausal; menopause is defined clinically as 12 month amenorrhea in a woman over 45 in the absence of other biological or physiological causes; in addition, women under the age of 55 must have a documented serum follicle stimulating hormone (FSH) level greater than 40 mIU/mL
- WOCBP receiving nivolumab will be instructed to adhere to contraception for a period of 23 weeks after the last dose of investigational product
- Should a woman become pregnant or suspect she is pregnant while she is participating in this study, she should inform the treating physician immediately
Patients with known brain metastases or leptomeningeal metastases are excluded unless the following conditions are met:
- Metastases have been treated and there is no magnetic resonance imaging (MRI) evidence of progression for at least 4 weeks after treatment is complete (must be confirmed within 28 days prior to the first dose of nivolumab administration)
- There must also be no requirement for immunosuppressive doses of systemic corticosteroids (> 10 mg/day prednisone equivalents) for at least 2 weeks prior to study drug administration
Patients should be excluded if they have known history of testing positive for human immunodeficiency virus (HIV) or known acquired immunodeficiency syndrome (AIDS)
- Patients should be excluded if they have a positive test for hepatitis B virus surface antigen (HBV sAg) or hepatitis C virus ribonucleic acid (HCV antibody) indicating acute or chronic infection
Patients with active autoimmune disease or history of autoimmune disease that might recur, which may affect vital organ function or require immune suppressive treatment including systemic corticosteroids, should be excluded; these include but are not limited to patients with a history of immune related neurologic disease, multiple sclerosis, autoimmune (demyelinating) neuropathy, Guillain-Barre syndrome, myasthenia gravis; systemic autoimmune disease such as systemic lupus erythematosus (SLE), connective tissue diseases, scleroderma, inflammatory bowel disease (IRB), Crohn's, ulcerative colitis, hepatitis; and patients with a history of toxic epidermal necrolysis (TEN), Stevens-Johnson syndrome, or phospholipid syndrome should be excluded; patient with vitiligo, endocrine deficiencies including thyroiditis managed with replacement hormones including physiologic corticosteroids are eligible; patients with rheumatoid arthritis and other arthropathies, Sjogren's syndrome and psoriasis controlled with topical medication and patients with positive serology, such as antinuclear antibodies (ANA), anti-thyroid antibodies should be evaluated for the presence of target organ involvement and potential need for systemic treatment but should otherwise be eligible
- NOTE: patients are permitted to enroll if they have vitiligo, type I diabetes mellitus, residual hypothyroidism due to autoimmune condition only requiring hormone replacement, psoriasis not requiring systemic treatment, or conditions not expected to recur in the absence of an external trigger (precipitating event)
Patients should be excluded if they have a condition requiring systemic treatment with either corticosteroids (> 10 mg daily prednisone equivalents) or other immunosuppressive medications within 14 days of study drug administration; inhaled or topical steroids and adrenal replacement doses =< 10 mg daily prednisone equivalents are permitted in the absence of active autoimmune disease; patients are permitted to use topical, ocular, intra-articular, intranasal, and inhalational corticosteroids (with minimal systemic absorption); physiologic replacement doses of systemic corticosteroids are permitted, even if =< 10 mg/day prednisone equivalents; a brief course of corticosteroids for prophylaxis (e.g., contrast dye allergy) or for treatment of non-autoimmune conditions (e.g., delayed-type hypersensitivity reaction caused by contact allergen) is permitted
Patients who have had evidence of active or acute diverticulitis, intra-abdominal abscess, abdominal/pelvic fistula, gastrointestinal perforation, gastrointestinal (GI) obstruction and/or who require parenteral hydration and/or nutrition

Study & Design

Study Type: INTERVENTIONAL

Study Design: SINGLE_GROUP

Arm && Interventions

Group	Intervention	Description
Treatment (nivolumab)	Laboratory Biomarker Analysis	Patients receive nivolumab IV over approximately 60 minutes every 2 weeks for a maximum of 46 doses over 92 weeks in the absence of disease progression or unacceptable toxicity.
Treatment (nivolumab)	Nivolumab	Patients receive nivolumab IV over approximately 60 minutes every 2 weeks for a maximum of 46 doses over 92 weeks in the absence of disease progression or unacceptable toxicity.

Primary Outcome Measures

Name	Time	Method
Objective Tumor Response as Assessed by RECIST 1.1 Criteria	The average of study treatment time was 3.8 months.	Proportion of participants with objective tumor response. Objective tumor response is defined as complete or partial tumor response assessed by RECIST 1.1.
Adverse Events (Grade 3 or Higher) During Treatment Period as Assessed by CTCAE Version 4	Within 100 days of last protocol treatment	Number of participants with a maximum grade of 3 or higher during treatment period. Adverse events are graded and categorized using CTCAE v4.0.

Secondary Outcome Measures

Name	Time	Method
Overall Survival	Time from study entry to time of death or the date of last contact, up to 5 years of follow-up	Overall survival is defined as the duration of time from study entry to time of death or the date of last contact.
Progression-free Survival	Time from study entry to time of progression or death, whichever occurs first, up to 5 years of follow-up.	Progression-free survival is the period of time from study entry to time of disease progression, death or date of last contact, whichever occurs first. Progression is assessed by RECIST 1.1.

Trial Locations

Locations (332): Kaiser Permanente-Baldwin Park
🇺🇸
Baldwin Park, California, United States
Palo Alto Medical Foundation-Camino Division
🇺🇸
Mountain View, California, United States
Anchorage Oncology Centre
🇺🇸
Anchorage, Alaska, United States
Valley Radiation Oncology
🇺🇸
Peru, Illinois, United States
Kootenai Clinic Cancer Services - Post Falls
🇺🇸
Post Falls, Idaho, United States
Katmai Oncology Group
🇺🇸
Anchorage, Alaska, United States
Kootenai Clinic Cancer Services - Sandpoint
🇺🇸
Sandpoint, Idaho, United States
OSF Saint Francis Medical Center
🇺🇸
Peoria, Illinois, United States
Providence Alaska Medical Center
🇺🇸
Anchorage, Alaska, United States
CHI Saint Vincent Cancer Center Hot Springs
🇺🇸
Hot Springs, Arkansas, United States
Palo Alto Medical Foundation-Gynecologic Oncology
🇺🇸
Mountain View, California, United States
Sutter Auburn Faith Hospital
🇺🇸
Auburn, California, United States
Sutter Cancer Centers Radiation Oncology Services-Auburn
🇺🇸
Auburn, California, United States
Palo Alto Medical Foundation Health Care
🇺🇸
Palo Alto, California, United States
Saint Luke's Cancer Institute - Fruitland
🇺🇸
Fruitland, Idaho, United States
Illinois CancerCare-Peru
🇺🇸
Peru, Illinois, United States
Saint Luke's Cancer Institute - Meridian
🇺🇸
Meridian, Idaho, United States
Saint Luke's Cancer Institute - Nampa
🇺🇸
Nampa, Idaho, United States
University of Alabama at Birmingham Cancer Center
🇺🇸
Birmingham, Alabama, 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
Alta Bates Summit Medical Center-Herrick Campus
🇺🇸
Berkeley, California, United States
Providence Saint Joseph Medical Center/Disney Family Cancer Center
🇺🇸
Burbank, California, United States
Mills-Peninsula Medical Center
🇺🇸
Burlingame, California, United States
Sutter Cancer Centers Radiation Oncology Services-Cameron Park
🇺🇸
Cameron Park, California, United States
Eden Hospital Medical Center
🇺🇸
Castro Valley, California, United States
Sutter Davis Hospital
🇺🇸
Davis, California, United States
UC San Diego Moores Cancer Center
🇺🇸
La Jolla, California, United States
Memorial Medical Center
🇺🇸
Modesto, California, United States
Sutter Cancer Centers Radiation Oncology Services-Roseville
🇺🇸
Roseville, California, United States
Sutter Roseville Medical Center
🇺🇸
Roseville, California, United States
Sutter Medical Center Sacramento
🇺🇸
Sacramento, California, United States
Kaiser Permanente-San Diego Mission
🇺🇸
San Diego, California, United States
Kaiser Permanente-San Diego Zion
🇺🇸
San Diego, California, United States
California Pacific Medical Center-Pacific Campus
🇺🇸
San Francisco, California, United States
Kaiser Permanente-San Marcos
🇺🇸
San Marcos, California, United States
Palo Alto Medical Foundation-Santa Cruz
🇺🇸
Santa Cruz, California, United States
Sutter Pacific Medical Foundation
🇺🇸
Santa Rosa, California, United States
Palo Alto Medical Foundation-Sunnyvale
🇺🇸
Sunnyvale, California, United States
Sutter Solano Medical Center/Cancer Center
🇺🇸
Vallejo, California, United States
Yale University
🇺🇸
New Haven, Connecticut, United States
Beebe Medical Center
🇺🇸
Lewes, Delaware, United States
Delaware Clinical and Laboratory Physicians PA
🇺🇸
Newark, Delaware, United States
Helen F Graham Cancer Center
🇺🇸
Newark, Delaware, United States
Medical Oncology Hematology Consultants PA
🇺🇸
Newark, Delaware, United States
Christiana Care Health System-Christiana Hospital
🇺🇸
Newark, Delaware, United States
Beebe Health Campus
🇺🇸
Rehoboth Beach, Delaware, United States
TidalHealth Nanticoke / Allen Cancer Center
🇺🇸
Seaford, Delaware, United States
Christiana Care Health System-Wilmington Hospital
🇺🇸
Wilmington, Delaware, United States
Low Country Cancer Care
🇺🇸
Savannah, Georgia, United States
Memorial Health University Medical Center
🇺🇸
Savannah, Georgia, United States
Summit Cancer Care-Memorial
🇺🇸
Savannah, Georgia, United States
Lewis Cancer and Research Pavilion at Saint Joseph's/Candler
🇺🇸
Savannah, Georgia, United States
Saint Luke's Cancer Institute - Boise
🇺🇸
Boise, Idaho, United States
Kootenai Health - Coeur d'Alene
🇺🇸
Coeur d'Alene, Idaho, United States
Saint Luke's Cancer Institute - Twin Falls
🇺🇸
Twin Falls, Idaho, United States
OSF Saint Joseph Medical Center
🇺🇸
Bloomington, Illinois, United States
Illinois CancerCare-Bloomington
🇺🇸
Bloomington, Illinois, United States
Illinois CancerCare-Canton
🇺🇸
Canton, Illinois, United States
Memorial Hospital of Carbondale
🇺🇸
Carbondale, Illinois, United States
Illinois CancerCare-Carthage
🇺🇸
Carthage, Illinois, United States
Centralia Oncology Clinic
🇺🇸
Centralia, Illinois, United States
Northwestern University
🇺🇸
Chicago, Illinois, United States
Cancer Care Specialists of Illinois - Decatur
🇺🇸
Decatur, Illinois, United States
Decatur Memorial Hospital
🇺🇸
Decatur, Illinois, United States
Crossroads Cancer Center
🇺🇸
Effingham, Illinois, United States
Illinois CancerCare-Eureka
🇺🇸
Eureka, Illinois, United States
Illinois CancerCare-Galesburg
🇺🇸
Galesburg, Illinois, United States
Western Illinois Cancer Treatment Center
🇺🇸
Galesburg, Illinois, United States
Sudarshan K Sharma MD Limited-Gynecologic Oncology
🇺🇸
Hinsdale, Illinois, United States
Illinois CancerCare-Kewanee Clinic
🇺🇸
Kewanee, Illinois, United States
Illinois CancerCare-Macomb
🇺🇸
Macomb, Illinois, United States
SSM Health Good Samaritan
🇺🇸
Mount Vernon, Illinois, United States
Cancer Care Center of O'Fallon
🇺🇸
O'Fallon, Illinois, United States
Illinois CancerCare-Ottawa Clinic
🇺🇸
Ottawa, Illinois, United States
Radiation Oncology of Northern Illinois
🇺🇸
Ottawa, Illinois, United States
Illinois CancerCare-Pekin
🇺🇸
Pekin, Illinois, United States
OSF Saint Francis Radiation Oncology at Pekin
🇺🇸
Pekin, Illinois, United States
Illinois CancerCare-Peoria
🇺🇸
Peoria, Illinois, United States
OSF Saint Francis Radiation Oncology at Peoria Cancer Center
🇺🇸
Peoria, Illinois, United States
Methodist Medical Center of Illinois
🇺🇸
Peoria, Illinois, United States
Illinois CancerCare-Princeton
🇺🇸
Princeton, Illinois, United States
Central Illinois Hematology Oncology Center
🇺🇸
Springfield, Illinois, United States
Southern Illinois University School of Medicine
🇺🇸
Springfield, Illinois, United States
Springfield Clinic
🇺🇸
Springfield, Illinois, United States
Springfield Memorial Hospital
🇺🇸
Springfield, Illinois, United States
Indiana University/Melvin and Bren Simon Cancer Center
🇺🇸
Indianapolis, Indiana, United States
Sidney and Lois Eskenazi Hospital
🇺🇸
Indianapolis, Indiana, United States
Reid Health
🇺🇸
Richmond, Indiana, United States
Mercy Cancer Center-West Lakes
🇺🇸
Clive, Iowa, United States
UI Health Care Mission Cancer and Blood - West Des Moines Clinic
🇺🇸
Clive, Iowa, United States
Alegent Health Mercy Hospital
🇺🇸
Council Bluffs, Iowa, United States
Greater Regional Medical Center
🇺🇸
Creston, Iowa, United States
Mercy Medical Center - Des Moines
🇺🇸
Des Moines, Iowa, United States
UI Health Care Mission Cancer and Blood - Laurel Clinic
🇺🇸
Des Moines, Iowa, United States
University of Iowa/Holden Comprehensive Cancer Center
🇺🇸
Iowa City, Iowa, United States
Mercy Medical Center-West Lakes
🇺🇸
West Des Moines, Iowa, 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 - El Dorado
🇺🇸
El Dorado, Kansas, United States
Cancer Center of Kansas - Fort Scott
🇺🇸
Fort Scott, Kansas, United States
Cancer Center of Kansas-Independence
🇺🇸
Independence, Kansas, United States
Cancer Center of Kansas-Kingman
🇺🇸
Kingman, Kansas, United States
Lawrence Memorial Hospital
🇺🇸
Lawrence, Kansas, United States
Cancer Center of Kansas-Liberal
🇺🇸
Liberal, Kansas, United States
Cancer Center of Kansas - Newton
🇺🇸
Newton, Kansas, United States
Cancer Center of Kansas - Parsons
🇺🇸
Parsons, Kansas, United States
Cancer Center of Kansas - Pratt
🇺🇸
Pratt, Kansas, United States
Cancer Center of Kansas - Salina
🇺🇸
Salina, Kansas, United States
Cancer Center of Kansas - Wellington
🇺🇸
Wellington, Kansas, United States
Associates In Womens Health
🇺🇸
Wichita, Kansas, United States
Cancer Center of Kansas-Wichita Medical Arts Tower
🇺🇸
Wichita, Kansas, United States
Ascension Via Christi Hospitals Wichita
🇺🇸
Wichita, Kansas, United States
Cancer Center of Kansas - Wichita
🇺🇸
Wichita, Kansas, United States
Cancer Center of Kansas - Winfield
🇺🇸
Winfield, Kansas, United States
Flaget Memorial Hospital
🇺🇸
Bardstown, Kentucky, United States
Commonwealth Cancer Center-Corbin
🇺🇸
Corbin, Kentucky, United States
Saint Joseph Radiation Oncology Resource Center
🇺🇸
Lexington, Kentucky, United States
Saint Joseph Hospital East
🇺🇸
Lexington, Kentucky, United States
Jewish Hospital
🇺🇸
Louisville, Kentucky, United States
Saints Mary and Elizabeth Hospital
🇺🇸
Louisville, Kentucky, United States
UofL Health Medical Center Northeast
🇺🇸
Louisville, Kentucky, United States
Jewish Hospital Medical Center South
🇺🇸
Shepherdsville, Kentucky, United States
MaineHealth Maine Medical Center- Scarborough
🇺🇸
Scarborough, Maine, United States
Johns Hopkins University/Sidney Kimmel Cancer Center
🇺🇸
Baltimore, Maryland, United States
Massachusetts General Hospital Cancer Center
🇺🇸
Boston, Massachusetts, United States
Brigham and Women's Hospital
🇺🇸
Boston, Massachusetts, United States
Dana-Farber Cancer Institute
🇺🇸
Boston, Massachusetts, United States
Lahey Hospital and Medical Center
🇺🇸
Burlington, Massachusetts, United States
Henry Ford Cancer Institute-Downriver
🇺🇸
Brownstown, Michigan, United States
Henry Ford Macomb Hospital-Clinton Township
🇺🇸
Clinton Township, Michigan, United States
Henry Ford Medical Center-Fairlane
🇺🇸
Dearborn, Michigan, United States
Wayne State University/Karmanos Cancer Institute
🇺🇸
Detroit, Michigan, United States
Henry Ford Hospital
🇺🇸
Detroit, Michigan, United States
Weisberg Cancer Treatment Center
🇺🇸
Farmington Hills, Michigan, United States
Henry Ford Medical Center-Columbus
🇺🇸
Novi, Michigan, United States
Henry Ford West Bloomfield Hospital
🇺🇸
West Bloomfield, Michigan, United States
Central Care Cancer Center - Bolivar
🇺🇸
Bolivar, Missouri, United States
Parkland Health Center-Bonne Terre
🇺🇸
Bonne Terre, Missouri, United States
Cox Cancer Center Branson
🇺🇸
Branson, Missouri, United States
Mercy Cancer Center - Cape Girardeau
🇺🇸
Cape Girardeau, Missouri, United States
Saint Francis Medical Center
🇺🇸
Cape Girardeau, Missouri, United States
MU Health Care Goldschmidt Cancer Center
🇺🇸
Jefferson City, Missouri, United States
Freeman Health System
🇺🇸
Joplin, Missouri, United States
Mercy Hospital Joplin
🇺🇸
Joplin, Missouri, United States
Mercy Clinic-Rolla-Cancer and Hematology
🇺🇸
Rolla, Missouri, United States
Phelps Health Delbert Day Cancer Institute
🇺🇸
Rolla, Missouri, United States
Saint Louis Cancer and Breast Institute-South City
🇺🇸
Saint Louis, Missouri, United States
Missouri Baptist Medical Center
🇺🇸
Saint Louis, Missouri, United States
Mercy Hospital Saint Louis
🇺🇸
Saint Louis, Missouri, United States
Sainte Genevieve County Memorial Hospital
🇺🇸
Sainte Genevieve, Missouri, United States
Mercy Hospital Springfield
🇺🇸
Springfield, Missouri, United States
CoxHealth South Hospital
🇺🇸
Springfield, Missouri, United States
Missouri Baptist Sullivan Hospital
🇺🇸
Sullivan, Missouri, United States
BJC Outpatient Center at Sunset Hills
🇺🇸
Sunset Hills, Missouri, United States
Community Hospital of Anaconda
🇺🇸
Anaconda, Montana, United States
Billings Clinic Cancer Center
🇺🇸
Billings, Montana, United States
Saint Vincent Healthcare
🇺🇸
Billings, Montana, United States
Bozeman Health Deaconess Hospital
🇺🇸
Bozeman, Montana, United States
Saint James Community Hospital and Cancer Treatment Center
🇺🇸
Butte, Montana, United States
Benefis Sletten Cancer Institute
🇺🇸
Great Falls, Montana, United States
Great Falls Clinic
🇺🇸
Great Falls, Montana, United States
Saint Peter's Community Hospital
🇺🇸
Helena, Montana, United States
Logan Health Medical Center
🇺🇸
Kalispell, Montana, United States
Saint Patrick Hospital - Community Hospital
🇺🇸
Missoula, Montana, United States
Community Medical Center
🇺🇸
Missoula, Montana, United States
Nebraska Cancer Specialists/Oncology Hematology West PC
🇺🇸
Grand Island, Nebraska, United States
Fred and Pamela Buffett Cancer Center - Kearney
🇺🇸
Kearney, Nebraska, United States
CHI Health Good Samaritan
🇺🇸
Kearney, Nebraska, United States
Saint Elizabeth Regional Medical Center
🇺🇸
Lincoln, Nebraska, United States
Alegent Health Immanuel Medical Center
🇺🇸
Omaha, Nebraska, United States
Hematology and Oncology Consultants PC
🇺🇸
Omaha, Nebraska, United States
Alegent Health Bergan Mercy Medical Center
🇺🇸
Omaha, Nebraska, United States
Alegent Health Lakeside Hospital
🇺🇸
Omaha, Nebraska, United States
Creighton University Medical Center
🇺🇸
Omaha, Nebraska, United States
Midlands Community Hospital
🇺🇸
Papillion, Nebraska, United States
Women's Cancer Center of Nevada
🇺🇸
Las Vegas, Nevada, United States
Cooper Hospital University Medical Center
🇺🇸
Camden, New Jersey, United States
Hackensack University Medical Center
🇺🇸
Hackensack, New Jersey, United States
MD Anderson Cancer Center at Cooper-Voorhees
🇺🇸
Voorhees, New Jersey, United States
Southwest Gynecologic Oncology Associates Inc
🇺🇸
Albuquerque, New Mexico, United States
University of New Mexico Cancer Center
🇺🇸
Albuquerque, New Mexico, United States
Memorial Sloan Kettering Cancer Center
🇺🇸
New York, New York, United States
Sampson Radiation Oncology
🇺🇸
Clinton, North Carolina, 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
Wayne Radiation Oncology
🇺🇸
Goldsboro, North Carolina, United States
Onslow Memorial Hospital
🇺🇸
Jacksonville, North Carolina, United States
Southeastern Medical Oncology Center-Jacksonville
🇺🇸
Jacksonville, North Carolina, United States
UHHS-Chagrin Highlands Medical Center
🇺🇸
Beachwood, Ohio, United States
Strecker Cancer Center-Belpre
🇺🇸
Belpre, Ohio, United States
Dayton Physicians LLC-Miami Valley South
🇺🇸
Centerville, Ohio, United States
Miami Valley Hospital South
🇺🇸
Centerville, Ohio, United States
Adena Regional Medical Center
🇺🇸
Chillicothe, Ohio, United States
Good Samaritan Hospital - Cincinnati
🇺🇸
Cincinnati, Ohio, United States
Oncology Hematology Care Inc-Kenwood
🇺🇸
Cincinnati, Ohio, United States
Bethesda North Hospital
🇺🇸
Cincinnati, Ohio, United States
TriHealth Cancer Institute-Westside
🇺🇸
Cincinnati, Ohio, United States
TriHealth Cancer Institute-Anderson
🇺🇸
Cincinnati, Ohio, United States
Case Western Reserve University
🇺🇸
Cleveland, Ohio, United States
Cleveland Clinic Cancer Center/Fairview Hospital
🇺🇸
Cleveland, Ohio, United States
Cleveland Clinic Foundation
🇺🇸
Cleveland, Ohio, United States
Ohio State University Comprehensive Cancer Center
🇺🇸
Columbus, Ohio, United States
Mount Carmel East Hospital
🇺🇸
Columbus, Ohio, United States
Columbus Oncology and Hematology Associates Inc
🇺🇸
Columbus, Ohio, United States
Riverside Methodist Hospital
🇺🇸
Columbus, Ohio, United States
Grant Medical Center
🇺🇸
Columbus, Ohio, United States
The Mark H Zangmeister Center
🇺🇸
Columbus, Ohio, United States
Mount Carmel Health Center West
🇺🇸
Columbus, Ohio, United States
Doctors Hospital
🇺🇸
Columbus, Ohio, United States
Good Samaritan Hospital - Dayton
🇺🇸
Dayton, Ohio, United States
Miami Valley Hospital
🇺🇸
Dayton, Ohio, United States
Dayton Physician LLC - Englewood
🇺🇸
Dayton, Ohio, United States
Miami Valley Hospital North
🇺🇸
Dayton, Ohio, United States
Delaware Health Center-Grady Cancer Center
🇺🇸
Delaware, Ohio, United States
Delaware Radiation Oncology
🇺🇸
Delaware, Ohio, United States
Grady Memorial Hospital
🇺🇸
Delaware, Ohio, United States
Armes Family Cancer Center
🇺🇸
Findlay, Ohio, United States
Blanchard Valley Hospital
🇺🇸
Findlay, Ohio, United States
Orion Cancer Care
🇺🇸
Findlay, Ohio, United States
Atrium Medical Center-Middletown Regional Hospital
🇺🇸
Franklin, Ohio, United States
Dayton Physicians LLC-Atrium
🇺🇸
Franklin, Ohio, United States
Dayton Physicians LLC-Wayne
🇺🇸
Greenville, Ohio, United States
Wayne Hospital
🇺🇸
Greenville, Ohio, United States
Greater Dayton Cancer Center
🇺🇸
Kettering, Ohio, United States
Kettering Medical Center
🇺🇸
Kettering, Ohio, United States
Fairfield Medical Center
🇺🇸
Lancaster, Ohio, United States
Marietta Memorial Hospital
🇺🇸
Marietta, Ohio, United States
OhioHealth Marion General Hospital
🇺🇸
Marion, Ohio, United States
Hillcrest Hospital Cancer Center
🇺🇸
Mayfield Heights, Ohio, United States
UH Seidman Cancer Center at Landerbrook Health Center
🇺🇸
Mayfield Heights, Ohio, United States
UH Seidman Cancer Center at Lake Health Mentor Campus
🇺🇸
Mentor, Ohio, United States
Dayton Physicians LLC-Signal Point
🇺🇸
Middletown, Ohio, United States
Knox Community Hospital
🇺🇸
Mount Vernon, Ohio, United States
Licking Memorial Hospital
🇺🇸
Newark, Ohio, United States
Newark Radiation Oncology
🇺🇸
Newark, Ohio, United States
Southern Ohio Medical Center
🇺🇸
Portsmouth, Ohio, United States
Dayton Physicians LLC-Wilson
🇺🇸
Sidney, Ohio, United States
Springfield Regional Cancer Center
🇺🇸
Springfield, Ohio, United States
Springfield Regional Medical Center
🇺🇸
Springfield, Ohio, United States
Dayton Physicians LLC - Troy
🇺🇸
Troy, Ohio, United States
Upper Valley Medical Center
🇺🇸
Troy, Ohio, United States
University Hospitals Sharon Health Center
🇺🇸
Wadsworth, Ohio, United States
Saint Ann's Hospital
🇺🇸
Westerville, Ohio, United States
UHHS-Westlake Medical Center
🇺🇸
Westlake, Ohio, United States
Genesis Healthcare System Cancer Care Center
🇺🇸
Zanesville, Ohio, United States
University of Oklahoma Health Sciences Center
🇺🇸
Oklahoma City, Oklahoma, United States
Oklahoma Cancer Specialists and Research Institute-Tulsa
🇺🇸
Tulsa, Oklahoma, United States
Saint Charles Health System
🇺🇸
Bend, Oregon, United States
Clackamas Radiation Oncology Center
🇺🇸
Clackamas, Oregon, United States
Providence Cancer Institute Clackamas Clinic
🇺🇸
Clackamas, Oregon, United States
Bay Area Hospital
🇺🇸
Coos Bay, Oregon, United States
Providence Newberg Medical Center
🇺🇸
Newberg, Oregon, United States
Providence Willamette Falls Medical Center
🇺🇸
Oregon City, Oregon, United States
Providence Portland Medical Center
🇺🇸
Portland, Oregon, United States
Providence Saint Vincent Medical Center
🇺🇸
Portland, Oregon, United States
Jefferson Abington Hospital
🇺🇸
Abington, Pennsylvania, United States
Lehigh Valley Hospital-Cedar Crest
🇺🇸
Allentown, Pennsylvania, United States
Lehigh Valley Hospital - Muhlenberg
🇺🇸
Bethlehem, Pennsylvania, United States
Christiana Care Health System-Concord Health Center
🇺🇸
Chadds Ford, Pennsylvania, United States
Ephrata Cancer Center
🇺🇸
Ephrata, Pennsylvania, United States
Adams Cancer Center
🇺🇸
Gettysburg, Pennsylvania, United States
WellSpan Medical Oncology and Hematology
🇺🇸
Hanover, Pennsylvania, United States
University of Pennsylvania/Abramson Cancer Center
🇺🇸
Philadelphia, Pennsylvania, United States
Reading Hospital
🇺🇸
West Reading, Pennsylvania, United States
WellSpan Health-York Cancer Center
🇺🇸
York, Pennsylvania, United States
WellSpan Health-York Hospital
🇺🇸
York, Pennsylvania, United States
Women and Infants Hospital
🇺🇸
Providence, Rhode Island, United States
Prisma Health Cancer Institute - Spartanburg
🇺🇸
Boiling Springs, South Carolina, United States
Medical University of South Carolina
🇺🇸
Charleston, South Carolina, United States
Prisma Health Cancer Institute - Easley
🇺🇸
Easley, South Carolina, United States
Greenville Health System Cancer Institute-Andrews
🇺🇸
Greenville, South Carolina, United States
Saint Francis Hospital
🇺🇸
Federal Way, Washington, United States
Prisma Health Cancer Institute - Butternut
🇺🇸
Greenville, South Carolina, United States
Prisma Health Cancer Institute - Faris
🇺🇸
Greenville, South Carolina, United States
Prisma Health Greenville Memorial Hospital
🇺🇸
Greenville, South Carolina, United States
Saint Francis Cancer Center
🇺🇸
Greenville, South Carolina, United States
Prisma Health Cancer Institute - Eastside
🇺🇸
Greenville, South Carolina, United States
Prisma Health Cancer Institute - Greer
🇺🇸
Greer, South Carolina, United States
Prisma Health Cancer Institute - Seneca
🇺🇸
Seneca, South Carolina, United States
Avera Cancer Institute
🇺🇸
Sioux Falls, South Dakota, 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
M D Anderson Cancer Center
🇺🇸
Houston, Texas, United States
Huntsman Cancer Institute/University of Utah
🇺🇸
Salt Lake City, Utah, United States
South Jordan Health Center
🇺🇸
South Jordan, Utah, United States
Inova Fairfax Hospital
🇺🇸
Falls Church, Virginia, United States
Providence Regional Cancer System-Aberdeen
🇺🇸
Aberdeen, Washington, United States
Cancer Care Center at Island Hospital
🇺🇸
Anacortes, Washington, United States
Swedish Cancer Institute-Eastside Oncology Hematology
🇺🇸
Bellevue, Washington, United States
PeaceHealth Saint Joseph Medical Center
🇺🇸
Bellingham, 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
Saint Elizabeth Hospital
🇺🇸
Enumclaw, Washington, United States
Providence Regional Cancer Partnership
🇺🇸
Everett, Washington, United States
Swedish Cancer Institute-Issaquah
🇺🇸
Issaquah, Washington, United States
Providence Regional Cancer System-Lacey
🇺🇸
Lacey, Washington, United States
Saint Clare Hospital
🇺🇸
Lakewood, Washington, United States
PeaceHealth Saint John Medical Center
🇺🇸
Longview, Washington, United States
Harrison HealthPartners Hematology and Oncology-Poulsbo
🇺🇸
Poulsbo, Washington, United States
Minor and James Medical PLLC
🇺🇸
Seattle, Washington, United States
Pacific Gynecology Specialists
🇺🇸
Seattle, Washington, United States
Swedish Medical Center-Ballard Campus
🇺🇸
Seattle, Washington, United States
Fred Hutchinson Cancer Center
🇺🇸
Seattle, Washington, United States
Kaiser Permanente Washington
🇺🇸
Seattle, Washington, United States
Swedish Medical Center-First Hill
🇺🇸
Seattle, Washington, United States
University of Washington Medical Center - Northwest
🇺🇸
Seattle, Washington, United States
Women's Cancer Center of Seattle
🇺🇸
Seattle, Washington, United States
University of Washington Medical Center - Montlake
🇺🇸
Seattle, Washington, United States
Providence Regional Cancer System-Shelton
🇺🇸
Shelton, Washington, United States
Saint Michael Cancer Center
🇺🇸
Silverdale, Washington, United States
MultiCare Deaconess Cancer and Blood Specialty Center - Valley
🇺🇸
Spokane Valley, Washington, United States
MultiCare Deaconess Cancer and Blood Specialty Center - Downtown
🇺🇸
Spokane, Washington, United States
Evergreen Hematology and Oncology PS
🇺🇸
Spokane, Washington, United States
Franciscan Research Center-Northwest Medical Plaza
🇺🇸
Tacoma, Washington, United States
Northwest Medical Specialties PLLC
🇺🇸
Tacoma, Washington, United States
PeaceHealth Southwest Medical Center
🇺🇸
Vancouver, Washington, United States
Providence Saint Mary Regional Cancer Center
🇺🇸
Walla Walla, 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
Monongalia Hospital
🇺🇸
Morgantown, West Virginia, United States
Medical College of Wisconsin
🇺🇸
Milwaukee, Wisconsin, United States
Big Horn Basin Cancer Center
🇺🇸
Cody, Wyoming, United States
Billings Clinic-Cody
🇺🇸
Cody, Wyoming, United States
Welch Cancer Center
🇺🇸
Sheridan, Wyoming, United States