Androgen Ablation Therapy With or Without Chemotherapy in Treating Patients With Metastatic Prostate Cancer

Phase 3

Active, not recruiting

• Conditions: Metastatic Hormone-sensitive Prostate Cancer
• Interventions: Drug: androgen-deprivation therapy; Drug: docetaxel

• Registration Number: NCT00309985
• Lead Sponsor: ECOG-ACRIN Cancer Research Group

Brief Summary

RATIONALE: Androgens can cause the growth of prostate cancer cells. Androgen ablation therapy may stop the adrenal glands from making androgens. Drugs used in chemotherapy, such as docetaxel, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. It is not yet known whether androgen-ablation therapy is more effective with or without docetaxel in treating metastatic prostate cancer.

PURPOSE: This randomized phase III trial is studying androgen-ablation therapy and chemotherapy to see how well they work compared to androgen-ablation therapy alone in treating patients with metastatic prostate cancer.

Detailed Description

OBJECTIVES:

Primary

* Evaluate the ability of early chemotherapy to improve overall survival of patients commencing androgen deprivation for metastatic prostate cancer.

Secondary

* Determine whether early chemotherapy can increase the time to clinical progression (radiographic or symptomatic deterioration due to disease) over hormonal therapy alone.

* Determine whether early chemotherapy can increase the time to development of hormone-refractory disease over hormonal therapy alone.

* Determine whether early chemotherapy can increase the time to serological progression over hormonal therapy alone.

* Determine rates of biochemical response at 6 months and 12 months in the chemohormonal arm versus the hormonal therapy alone arm.

* Determine the frequency of adverse events and the tolerability of chemotherapy combined with hormonal therapy versus hormonal therapy alone.

* Determine whether the postulated clinically meaningful increase in disease control is associated with an alteration in overall quality of life using the Functional Assessment of Cancer Therapy-Prostate questionnaire.

* Determine the ability of prostate-specific antigen (PSA) changes to be a surrogate for clinical benefit from therapy and overall survival.

Tertiary

* Determine whether there are proteins differentially translated from the genome in hormone-sensitive prostate cancer, prostate cancer that has responded to hormonal therapy, and hormone-refractory prostate cancer.

* Determine the frequency of constitutive polymorphisms of enzymes involved in steroid metabolism and other carcinogenic processes.

* Determine whether the amount and frequency of certain carcinogenic proteins in prostate cancer tissue such as C-X-C chemokine receptor type 4 (CXCR-4) and manganese superoxide dismutase can be correlated with a poor prognosis.

OUTLINE: This is a randomized, multicenter study. Patients are stratified according to age (≥ 70 vs \< 70), ECOG performance status (0-1 vs 2), combined androgen blockade for \> 30 days (yes vs no), duration of prior adjuvant hormonal therapy (\> 12 months vs ≤ 12 months), concurrent bisphosphonate use (yes vs no), and volume of disease (low vs high). Patients are randomized to 1 of 2 treatment arms.

* Arm A (Androgen-Deprivation Therapy and Docetaxel): Patients receive androgen-deprivation therapy (including luteinizing hormone-releasing hormone \[LHRH\] agonist therapy, LHRH antagonist therapy, or surgical castration). Patients also receive docetaxel intravenously (IV) over 1 hour on day 1. Treatment with docetaxel repeats every 21 days for up to 6 courses in the absence of disease progression or unacceptable toxicity.

* Arm B (Androgen-Deprivation Therapy alone): Patients receive androgen-deprivation therapy (as in arm A) alone.

Quality of life is assessed at baseline and at months 3, 6, 9 and 12.

After completion of study treatment, patients are followed up periodically for up to 10 years.

Study Timeline

• Study First Submitted: 2006-03-29
• Study First Submitted QC: 2006-03-29
• Study First Posted: 2006-04-03
• Study Start: 2006-09-26
• Primary Completion: 2013-12-23
• Results First Submitted: 2015-12-17
• Results First Submitted QC: 2016-02-01
• Results First Posted: 2016-03-03
• Status Verified: 2024-03
• Last Update Submitted: 2024-10-16
• Last Update Posted: 2024-10-28
• Study Completion: 2024-12

Recruitment & Eligibility

• Status: ACTIVE_NOT_RECRUITING
• Sex: Male
• Target Recruitment: 790

Inclusion Criteria

• Histologically or cytologically confirmed prostate cancer

• Metastatic disease

• On androgen-deprivation therapy for < 120 days

• Eastern Cooperative Oncology Group (ECOG) performance status (PS) 0-2

  • PS 2 eligible only if decline in PS is due to metastatic prostate cancer

• Absolute neutrophil count ≥ 1,500/mm^3

• Platelet count ≥ 100,000/mm^3

• Bilirubin ≤ upper limit of normal (ULN)

• Alanine aminotransferase (ALT) ≤ 2.5 times ULN

• Creatinine clearance ≥ 30 mL/min

• Prothrombin time (PT) and international normalized ratio (INR) ≤ 1.5 times ULN (unless on therapeutic anticoagulation)

• Partial thromboplastin time (PTT) ≤ 1.5 times ULN (unless on therapeutic anticoagulation)

• Fertile patients must use effective contraception

• At least 4 weeks since prior major surgery and recovered from all toxicity prior to randomization

• Prior adjuvant or neoadjuvant hormonal therapy allowed provided the following are true:

  • Therapy was discontinued ≥ 12 months ago AND there is no evidence of disease, as defined by 1 of the following:

    • PSA < 0.1 ng/dL after prostatectomy plus hormonal therapy
    • PSA < 0.5 ng/dL and has not doubled above nadir after radiotherapy plus hormonal therapy

  • Therapy lasted no more than 24 months

    • Last depot injection must have expired by the 24-month mark

• Prior palliative radiotherapy allowed if commenced within 30 days before starting androgen deprivation

• Anti-androgen therapy allowed as single-agent therapy ≤ 7 days before medial castration to prevent flare

• More than 30 days (or 6 half-lives) (whichever is longer) since prior participation in another clinical trial

• Concurrent participation in nontherapeutic trials allowed

• Concurrent antiandrogen therapy (e.g., bicalutamide or flutamide) allowed, but not as sole hormonal therapy

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Exclusion Criteria

• Prostate-specific antigen (PSA) level has risen and met criteria for progression from its lowest point between the start of androgen-deprivation therapy and randomization

• Prior malignancy in the past 5 years except for basal cell or squamous cell carcinoma of the skin

  • Other malignancies that are considered to have low potential to progress (e.g., grade 2, T1a transitional cell carcinoma) may be allowed if approved by study chair

• Peripheral neuropathy > grade 1

• History of severe hypersensitivity reaction to docetaxel or other drugs formulated with polysorbate 80

• Active cardiac disease, including the following:

  • Active angina
  • Symptomatic congestive heart failure
  • Myocardial infarction within the past 6 months

• Prior chemotherapy in adjuvant or neoadjuvant setting

• Prior hormone therapy in the metastatic setting

• Concurrent 5-alpha reductase inhibitors

• Simultaneous enrollment on Cancer and Leukemia Group B (CALGB) 90202

Read More

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Androgen-Deprivation Therapy alone	androgen-deprivation therapy	Patients receive androgen-deprivation therapy (including luteinizing hormone-releasing hormone \[LHRH\] agonist therapy, LHRH antagonist therapy, or surgical castration) alone.
Androgen-Deprivation Therapy and Docetaxel	androgen-deprivation therapy	Patients receive androgen-deprivation therapy (including luteinizing hormone-releasing hormone \[LHRH\] agonist therapy, LHRH antagonist therapy, or surgical castration). Patients also receive docetaxel IV over 1 hour on day 1. Treatment with docetaxel repeats every 21 days for up to 6 courses in the absence of disease progression or unacceptable toxicity.
Androgen-Deprivation Therapy and Docetaxel	docetaxel	Patients receive androgen-deprivation therapy (including luteinizing hormone-releasing hormone \[LHRH\] agonist therapy, LHRH antagonist therapy, or surgical castration). Patients also receive docetaxel IV over 1 hour on day 1. Treatment with docetaxel repeats every 21 days for up to 6 courses in the absence of disease progression or unacceptable toxicity.

Primary Outcome Measures

Name	Time	Method
Overall Survival	Assessed every 3 months if patient is < 2 years from study entry; every 6 months if patient is 2 - 5 years from study entry; then annually if patient is 5 - 10 years from study entry	Overall survival is defined as the time from randomization to death or date last known alive. Survival data reflects the database as of December 23, 2013.

Secondary Outcome Measures

Name	Time	Method
Time to Clinical Progression	Assessed every 3 months if patient is < 2 years from study entry; every 6 months if patient is 2 - 5 years from study entry; then annually if patient is 5 - 10 years from study entry	Time to clinical progression is defined as the time from randomization to clinical progression. Clinical progression is defined as increasing symptomatic bone metastases, progression per Response Evaluation Criteria In Solid Tumors (RECIST) criteria or clinical deterioration due to cancer per investigator's opinion. Patients without documented clinical progression were censored at the date of last disease assessment. Secondary endpoint data reflect the database as of December 23, 2014.
Time to Castration Resistant Prostate Cancer (Hormone Refractory Disease)	Assessed every 3 months if patient is < 2 years from study entry; every 6 months if patient is 2 - 5 years from study entry; then annually if patient is 5 - 10 years from study entry	Time to castration resistant prostate cancer is defined as the time from randomization to PSA progression or clinical progression, whichever occurred first. Patients without documented progression were censored at the date of last disease assessment. Secondary endpoint data reflect the database as of December 23, 2014.
Proportion of Patients With PSA Complete Response (CR) at 6 Months	Assessed at 6 months	PSA CR is defined as a PSA level less than 0.2 ng/ml measured for 2 consecutive measurements at least 4 weeks apart. Patients who met the criterion of PSA CR and had PSA level less than 0.2 ng/ml before and after the 6-month time point are considered as having a PSA CR at 6 months.
Proportion of Patients With PSA Complete Response (CR) at 12 Months	Assessed at 12 months	PSA CR is defined as a PSA level less than 0.2 ng/ml measured for 2 consecutive measurements at least 4 weeks apart. Patients who met the criterion of PSA CR and had PSA level less than 0.2 ng/ml before and after the 12-month time point are considered as having a PSA CR at 12 months.
QOL Change From Baseline to 3 Months	Assessed at baseline and 3 months	The primary QOL change was evaluated by the Functional Assessment of Cancer Therapy - Prostate (FACT-P) instrument. FACT-P is a self-report measure of both general and disease-specific QOL. Higher scores represent better QOL. The FACT-P (version 4) contains 39 likert items distributed over 5 subscales: physical (7 items), social/family (7 items), emotional (6 items), and functional (7 items) well-being, and the additional concerns related to prostate cancer scale (12 items). The FACT-P total score is calculated by summing all these 5 subscales and ranges from 0 to 156.

Trial Locations

Locations (343)

Hulston Cancer Center at Cox Medical Center South; 🇺🇸 Springfield, Missouri, United States

Hematology-Oncology Centers of the Northern Rockies - Billings; 🇺🇸 Billings, Montana, United States

Dana-Farber/Harvard Cancer Center at Dana-Farber Cancer Institute; 🇺🇸 Boston, Massachusetts, United States

CCOP - Virginia Mason Research Center; 🇺🇸 Seattle, Washington, United States

Indiana University Melvin and Bren Simon Cancer Center; 🇺🇸 Indianapolis, Indiana, United States

Veterans Affairs Medical Center - Indianapolis; 🇺🇸 Indianapolis, Indiana, United States

William N. Wishard Memorial Hospital; 🇺🇸 Indianapolis, Indiana, United States

Nevada Cancer Institute; 🇺🇸 Las Vegas, Nevada, United States

Virginia Piper Cancer Institute at Abbott - Northwestern Hospital; 🇺🇸 Minneapolis, Minnesota, United States

Hennepin County Medical Center - Minneapolis; 🇺🇸 Minneapolis, Minnesota, United States

California Pacific Medical Center - California Campus; 🇺🇸 San Francisco, California, United States

Hutchinson Hospital Corporation; 🇺🇸 Hutchinson, Kansas, United States

CCOP - MeritCare Hospital; 🇺🇸 Fargo, North Dakota, United States

St. Francis Comprehensive Cancer Center; 🇺🇸 Topeka, Kansas, United States

Hays Medical Center; 🇺🇸 Hays, Kansas, United States

Mount Carmel Regional Cancer Center; 🇺🇸 Pittsburg, Kansas, United States

Roger Maris Cancer Center at MeritCare Hospital; 🇺🇸 Fargo, North Dakota, United States

Mid Dakota Clinic, PC; 🇺🇸 Bismarck, North Dakota, United States

Graham Hospital; 🇺🇸 Canton, Illinois, United States

Idaho Urologic Institute, PA; 🇺🇸 Meridian, Idaho, United States

Saint Luke's Mountain States Tumor Institute; 🇺🇸 Nampa, Idaho, United States

Lombardi Comprehensive Cancer Center at Georgetown University Medical Center; 🇺🇸 Washington, District of Columbia, United States

Arkansas Cancer Research Center at University of Arkansas for Medical Sciences; 🇺🇸 Little Rock, Arkansas, United States

Mayo Clinic Scottsdale; 🇺🇸 Scottsdale, Arizona, United States

Frederick R. and Betty M. Smith Cancer Treatment Center; 🇺🇸 Sparta, New Jersey, United States

Mary Bird Perkins Cancer Center - Baton Rouge; 🇺🇸 Baton Rouge, Louisiana, United States

George Washington University Medical Center; 🇺🇸 Washington, District of Columbia, United States

Big Sky Oncology; 🇺🇸 Great Falls, Montana, United States

Regional Cancer Center at Singing River Hospital; 🇺🇸 Pascagoula, Mississippi, United States

Bozeman Deaconess Cancer Center; 🇺🇸 Bozeman, Montana, United States

Billings Clinic - Downtown; 🇺🇸 Billings, Montana, United States

Great Falls Clinic - Main Facility; 🇺🇸 Great Falls, Montana, United States

St. Peter's Hospital; 🇺🇸 Helena, Montana, United States

Kalispell Regional Medical Center; 🇺🇸 Kalispell, Montana, United States

CCOP - Nevada Cancer Research Foundation; 🇺🇸 Las Vegas, Nevada, United States

Glacier Oncology, PLLC; 🇺🇸 Kalispell, Montana, United States

Kalispell Medical Oncology at KRMC; 🇺🇸 Kalispell, Montana, United States

Montana Cancer Specialists at Montana Cancer Center; 🇺🇸 Missoula, Montana, United States

Veterans Affairs Medical Center - East Orange; 🇺🇸 East Orange, New Jersey, United States

Kings County Hospital Center; 🇺🇸 Brooklyn, New York, United States

Carol G. Simon Cancer Center at Morristown Memorial Hospital; 🇺🇸 Morristown, New Jersey, United States

Cleveland Clinic Beachwood Family Health and Surgery Center; 🇺🇸 Beachwood, Ohio, United States

Aultman Cancer Center at Aultman Hospital; 🇺🇸 Canton, Ohio, United States

MetroHealth Cancer Care Center at MetroHealth Medical Center; 🇺🇸 Cleveland, Ohio, United States

Hunterdon Regional Cancer Center at Hunterdon Medical Center; 🇺🇸 Flemington, New Jersey, United States

Cancer Institute of New Jersey at Hamilton; 🇺🇸 Hamilton, New Jersey, United States

Kinston Medical Specialists; 🇺🇸 Kinston, North Carolina, United States

Cancer Institute of New Jersey at UMDNJ - Robert Wood Johnson Medical School; 🇺🇸 New Brunswick, New Jersey, United States

Summa Center for Cancer Care at Akron City Hospital; 🇺🇸 Akron, Ohio, United States

MeritCare Broadway; 🇺🇸 Fargo, North Dakota, United States

SUNY Downstate Medical Center; 🇺🇸 Brooklyn, New York, United States

St. Alexius Medical Center Cancer Center; 🇺🇸 Bismarck, North Dakota, United States

Case Comprehensive Cancer Center; 🇺🇸 Cleveland, Ohio, United States

Medcenter One Hospital Cancer Care Center; 🇺🇸 Bismarck, North Dakota, United States

Adena Regional Medical Center; 🇺🇸 Chillicothe, Ohio, United States

CCOP - Columbus; 🇺🇸 Columbus, Ohio, United States

Zangmeister Center; 🇺🇸 Columbus, Ohio, United States

Cleveland Clinic Cancer Center at Fairview Hospital; 🇺🇸 Cleveland, Ohio, United States

Cleveland Clinic Taussig Cancer Center; 🇺🇸 Cleveland, Ohio, United States

Riverside Methodist Hospital Cancer Care; 🇺🇸 Columbus, Ohio, United States

Grant Medical Center Cancer Care; 🇺🇸 Columbus, Ohio, United States

Mount Carmel Health - West Hospital; 🇺🇸 Columbus, Ohio, United States

Licking Memorial Cancer Care Program at Licking Memorial Hospital; 🇺🇸 Newark, Ohio, United States

Hillcrest Cancer Center at Hillcrest Hospital; 🇺🇸 Mayfield Heights, Ohio, United States

Cleveland Clinic Foundation - Strongsville; 🇺🇸 Strongsville, Ohio, United States

Avera Cancer Institute; 🇺🇸 Sioux Falls, South Dakota, United States

Mount Carmel St. Ann's Cancer Center; 🇺🇸 Westerville, Ohio, United States

Genesis - Good Samaritan Hospital; 🇺🇸 Zanesville, Ohio, United States

Geisinger Hazleton Cancer Center; 🇺🇸 Hazleton, Pennsylvania, United States

Fox Chase Cancer Center - Philadelphia; 🇺🇸 Philadelphia, Pennsylvania, United States

CCOP - Main Line Health; 🇺🇸 Wynnewood, Pennsylvania, United States

University of Texas Health Science Center at San Antonio; 🇺🇸 San Antonio, Texas, United States

Lynchburg Hematology-Oncology Clinic; 🇺🇸 Lynchburg, Virginia, United States

Lankenau Cancer Center at Lankenau Hospital; 🇺🇸 Wynnewood, Pennsylvania, United States

Geisinger Medical Group - Scenery Park; 🇺🇸 State College, Pennsylvania, United States

Pacific Medical Center; 🇺🇸 Seattle, Washington, United States

Veterans Affairs Medical Center - San Antonio (Murphy); 🇺🇸 San Antonio, Texas, United States

Cancer Therapy and Research Center; 🇺🇸 San Antonio, Texas, United States

Frank M. and Dorothea Henry Cancer Center at Geisinger Wyoming Valley Medical Center; 🇺🇸 Wilkes-Barre, Pennsylvania, United States

University Hospital - San Antonio; 🇺🇸 San Antonio, Texas, United States

MBCCOP - Meharry Medical College - Nashville; 🇺🇸 Nashville, Tennessee, United States

York Cancer Center at Apple Hill Medical Center; 🇺🇸 York, Pennsylvania, United States

West Virginia University Health Sciences Center - Charleston; 🇺🇸 Charleston, West Virginia, United States

Marshfield Clinic Cancer Care at Regional Cancer Center; 🇺🇸 Eau Claire, Wisconsin, United States

Marshfield Clinic - Lakeland Center; 🇺🇸 Minocqua, Wisconsin, United States

St. Nicholas Hospital; 🇺🇸 Sheboygan, Wisconsin, United States

Saint Michael's Hospital Cancer Center; 🇺🇸 Stevens Point, Wisconsin, United States

Green Bay Oncology, Limited - Oconto Falls; 🇺🇸 Oconto Falls, Wisconsin, United States

Rocky Mountain Oncology; 🇺🇸 Casper, Wyoming, United States

Marshfield Clinic - Wisconsin Rapids Center; 🇺🇸 Wisconsin Rapids, Wisconsin, United States

University of Wisconcin Cancer Center at Aspirus Wausau Hospital; 🇺🇸 Wausau, Wisconsin, United States

Vince Lombardi Cancer Clinic - Sheboygan; 🇺🇸 Sheboygan, Wisconsin, United States

Ministry Medical Group at Saint Mary's Hospital; 🇺🇸 Rhinelander, Wisconsin, United States

Green Bay Oncology, Limited - Sturgeon Bay; 🇺🇸 Sturgeon Bay, Wisconsin, United States

Marshfield Clinic at Saint Michael's Hospital; 🇺🇸 Stevens Point, Wisconsin, United States

Marshfield Clinic - Wausau Center; 🇺🇸 Wausau, Wisconsin, United States

Aurora Medical Center; 🇺🇸 Summit, Wisconsin, United States

Oklahoma University Cancer Institute; 🇺🇸 Oklahoma City, Oklahoma, United States

Mayo Clinic Cancer Center; 🇺🇸 Rochester, Minnesota, United States

Shaw Regional Cancer Center; 🇺🇸 Edwards, Colorado, United States

Providence Cancer Center; 🇺🇸 Anchorage, Alaska, United States

Fairbanks Cancer Treatment Center at Fairbanks Memorial Hospital; 🇺🇸 Fairbanks, Alaska, United States

Mayo Clinic Hospital; 🇺🇸 Phoenix, Arizona, United States

Hembree Mercy Cancer Center at St. Edward Mercy Medical Center; 🇺🇸 Fort Smith, Arkansas, United States

Tibotec Therapeutics - Division of Ortho Biotech Products, LP; 🇺🇸 Marysville, California, United States

Alta Bates Summit Comprehensive Cancer Center; 🇺🇸 Berkeley, California, United States

Peninsula Medical Center; 🇺🇸 Burlingame, California, United States

USC/Norris Comprehensive Cancer Center and Hospital; 🇺🇸 Los Angeles, California, United States

Mather Veteran Affairs Medical Center; 🇺🇸 Mather, California, United States

Mercy Cancer Center at Mercy Medical Center; 🇺🇸 Merced, California, United States

Memorial Medical Center; 🇺🇸 Modesto, California, United States

Sutter Health - Western Division Cancer Research Group; 🇺🇸 Novato, California, United States

Saint Helena Hospital; 🇺🇸 Saint Helena, California, United States

Sutter Pacific Medical Foundation; 🇺🇸 Santa Rosa, California, United States

Veterans Affairs Medical Center - Denver; 🇺🇸 Denver, Colorado, United States

Tahoe Forest Cancer Center; 🇺🇸 Truckee, California, United States

Sutter Solano Medical Center; 🇺🇸 Vallejo, California, United States

St. Mary's Regional Cancer Center at St. Mary's Hospital and Medical Center; 🇺🇸 Grand Junction, Colorado, United States

Montrose Memorial Hospital Cancer Center; 🇺🇸 Montrose, Colorado, United States

Saint Francis/Mount Sinai Regional Cancer Center at Saint Francis Hospital and Medical Center; 🇺🇸 Hartford, Connecticut, United States

Michael and Dianne Bienes Comprehensive Cancer Center at Holy Cross Hospital; 🇺🇸 Fort Lauderdale, Florida, United States

Northeast Georgia Medical Center; 🇺🇸 Gainesville, Georgia, United States

Mountain States Tumor Institute at St. Luke's Regional Medical Center; 🇺🇸 Boise, Idaho, United States

Saint Luke's Mountain States Tumor Institute - Fruitland; 🇺🇸 Fruitland, Idaho, United States

Mountain States Tumor Institute - Meridian; 🇺🇸 Meridian, Idaho, United States

Illinois CancerCare - Havana; 🇺🇸 Havana, Illinois, United States

Mountain States Tumor Institute at St. Luke's; 🇺🇸 Twin Falls, Idaho, United States

Rush-Copley Cancer Care Center; 🇺🇸 Aurora, Illinois, United States

Illinois CancerCare - Carthage; 🇺🇸 Carthage, Illinois, United States

Hematology and Oncology Associates; 🇺🇸 Chicago, Illinois, United States

Decatur Memorial Hospital Cancer Care Institute; 🇺🇸 Decatur, Illinois, United States

Eureka Community Hospital; 🇺🇸 Eureka, Illinois, United States

Illinois CancerCare - Eureka; 🇺🇸 Eureka, Illinois, United States

St. Francis Hospital; 🇺🇸 Evanston, Illinois, United States

Galesburg Clinic, PC; 🇺🇸 Galesburg, Illinois, United States

Poudre Valley Hospital; 🇺🇸 Fort Collins, Colorado, United States

Front Range Cancer Specialists; 🇺🇸 Fort Collins, Colorado, United States

Roswell Park Cancer Institute; 🇺🇸 Buffalo, New York, United States

NYU Cancer Institute at New York University Medical Center; 🇺🇸 New York, New York, United States

SUNY Upstate Medical University Hospital; 🇺🇸 Syracuse, New York, United States

Dickstein Cancer Treatment Center at White Plains Hospital Center; 🇺🇸 White Plains, New York, United States

Fairview Ridges Hospital; 🇺🇸 Burnsville, Minnesota, United States

CCOP - Metro-Minnesota; 🇺🇸 Saint Louis Park, Minnesota, United States

Saint Francis Medical Center; 🇺🇸 Cape Girardeau, Missouri, United States

Hinsdale Hematology Oncology Associates; 🇺🇸 Hinsdale, Illinois, United States

Joliet Oncology-Hematology Associates, Limited - West; 🇺🇸 Joliet, Illinois, United States

Provena St. Mary's Regional Cancer Center - Kankakee; 🇺🇸 Kankakee, Illinois, United States

Illinois CancerCare - Kewanee Clinic; 🇺🇸 Kewanee, Illinois, United States

La Grange Memorial Hospital; 🇺🇸 La Grange, Illinois, United States

North Shore Oncology and Hematology Associates, Limited - Libertyville; 🇺🇸 Libertyville, Illinois, United States

Illinois CancerCare - Macomb; 🇺🇸 Macomb, Illinois, United States

McDonough District Hospital; 🇺🇸 Macomb, Illinois, United States

Cardinal Bernardin Cancer Center at Loyola University Medical Center; 🇺🇸 Maywood, Illinois, United States

Illinois CancerCare - Monmouth; 🇺🇸 Monmouth, Illinois, United States

Good Samaritan Regional Health Center; 🇺🇸 Mount Vernon, Illinois, United States

Hematology Oncology Consultants - Naperville; 🇺🇸 Naperville, Illinois, United States

Cancer Care and Hematology Specialists of Chicagoland - Niles; 🇺🇸 Niles, Illinois, United States

BroMenn Regional Medical Center; 🇺🇸 Normal, Illinois, United States

Community Cancer Center; 🇺🇸 Normal, Illinois, United States

Illinois CancerCare - Community Cancer Center; 🇺🇸 Normal, Illinois, United States

Mid-Illinois Hematology-Oncology Associates at Community Cancer Center; 🇺🇸 Normal, Illinois, United States

Community Hospital of Ottawa; 🇺🇸 Ottawa, Illinois, United States

Oncology Hematology Associates of Central Illinois, PC - Ottawa; 🇺🇸 Ottawa, Illinois, United States

Illinois CancerCare - Pekin; 🇺🇸 Pekin, Illinois, United States

Cancer Treatment Center at Pekin Hospital; 🇺🇸 Pekin, Illinois, United States

Proctor Hospital; 🇺🇸 Peoria, Illinois, United States

Oncology Hematology Associates of Central Illinois, PC - Peoria; 🇺🇸 Peoria, Illinois, United States

CCOP - Illinois Oncology Research Association; 🇺🇸 Peoria, Illinois, United States

Methodist Medical Center of Illinois; 🇺🇸 Peoria, Illinois, United States

Illinois CancerCare - Peru; 🇺🇸 Peru, Illinois, United States

Illinois Valley Community Hospital; 🇺🇸 Peru, Illinois, United States

Hematology Oncology Associates - Skokie; 🇺🇸 Skokie, Illinois, United States

Illinois CancerCare - Princeton; 🇺🇸 Princeton, Illinois, United States

Regional Cancer Center at Memorial Medical Center; 🇺🇸 Springfield, Illinois, United States

Illinois CancerCare - Spring Valley; 🇺🇸 Spring Valley, Illinois, United States

Elkhart Clinic, LLC; 🇺🇸 Elkhart, Indiana, United States

CCOP - Carle Cancer Center; 🇺🇸 Urbana, Illinois, United States

Michiana Hematology-Oncology, PC - Elkhart; 🇺🇸 Elkhart, Indiana, United States

Fort Wayne Medical Oncology and Hematology; 🇺🇸 Fort Wayne, Indiana, United States

Elkhart General Hospital; 🇺🇸 Elkhart, Indiana, United States

Howard Community Hospital; 🇺🇸 Kokomo, Indiana, United States

Center for Cancer Therapy at LaPorte Hospital and Health Services; 🇺🇸 La Porte, Indiana, United States

Saint Joseph Regional Medical Center; 🇺🇸 Mishawaka, Indiana, United States

Michiana Hematology-Oncology, PC - South Bend; 🇺🇸 Mishawaka, Indiana, United States

Medical Oncology and Hematology Associates - West Des Moines; 🇺🇸 Clive, Iowa, United States

Michiana Hematology Oncology PC - Plymouth; 🇺🇸 Plymouth, Indiana, United States

CCOP - Northern Indiana CR Consortium; 🇺🇸 South Bend, Indiana, United States

Memorial Hospital of South Bend; 🇺🇸 South Bend, Indiana, United States

McCreery Cancer Center at Ottumwa Regional; 🇺🇸 Ottumwa, Iowa, United States

Veterans Affairs Medical Center - Iowa City; 🇺🇸 Iowa City, Iowa, United States

California Cancer Care, Incorporated - Greenbrae; 🇺🇸 Greenbrae, California, United States

CCOP - Mount Sinai Medical Center; 🇺🇸 Miami Beach, Florida, United States

Ella Milbank Foshay Cancer Center at Jupiter Medical Center; 🇺🇸 Jupiter, Florida, United States

Evanston Hospital; 🇺🇸 Evanston, Illinois, United States

Illinois CancerCare - Bloomington; 🇺🇸 Bloomington, Illinois, United States

Illinois CancerCare - Cottage; 🇺🇸 Galesburg, Illinois, United States

Memorial Hospital; 🇺🇸 Carthage, Illinois, United States

Illinois CancerCare - Canton; 🇺🇸 Canton, Illinois, United States

Robert H. Lurie Comprehensive Cancer Center at Northwestern University; 🇺🇸 Chicago, Illinois, United States

Kellogg Cancer Care Center; 🇺🇸 Highland Park, Illinois, United States

Veterans Affairs Medical Center - Hines; 🇺🇸 Hines, Illinois, United States

Barberton Citizens Hospital; 🇺🇸 Barberton, Ohio, United States

Cleveland Clinic Cancer Center; 🇺🇸 Independence, Ohio, United States

Doctors Hospital at Ohio Health; 🇺🇸 Columbus, Ohio, United States

Grady Memorial Hospital; 🇺🇸 Delaware, Ohio, United States

Knox Community Hospital; 🇺🇸 Mount Vernon, Ohio, United States

Parma Community General Hospital; 🇺🇸 Parma, Ohio, United States

Southern Ohio Medical Center Cancer Center; 🇺🇸 Portsmouth, Ohio, United States

North Coast Cancer Care, Incorporated; 🇺🇸 Sandusky, Ohio, United States

Community Hospital of Springfield and Clark County; 🇺🇸 Springfield, Ohio, United States

Cleveland Clinic - Wooster; 🇺🇸 Wooster, Ohio, United States

Geisinger Cancer Institute at Geisinger Health; 🇺🇸 Danville, Pennsylvania, United States

Bryn Mawr Hospital; 🇺🇸 Bryn Mawr, Pennsylvania, United States

Kimmel Cancer Center at Thomas Jefferson University - Philadelphia; 🇺🇸 Philadelphia, Pennsylvania, United States

Delaware County Regional Cancer Center at Delaware County Memorial Hospital; 🇺🇸 Drexel Hill, Pennsylvania, United States

McGlinn Family Regional Cancer Center at Reading Hospital and Medical Center; 🇺🇸 Reading, Pennsylvania, United States

University of Virginia Cancer Center; 🇺🇸 Charlottesville, Virginia, United States

Langlade Memorial Hospital; 🇺🇸 Antigo, Wisconsin, United States

Marshfield Clinic - Chippewa Center; 🇺🇸 Chippewa Falls, Wisconsin, United States

Virginia Mason Medical Center; 🇺🇸 Seattle, Washington, United States

UW Cancer Center Johnson Creek; 🇺🇸 Johnson Creek, Wisconsin, United States

Vince Lombardi Cancer Clinic - Green Bay at Aurora BayCare Medical Center; 🇺🇸 Green Bay, Wisconsin, United States

Holy Family Memorial Medical Center Cancer Care Center; 🇺🇸 Manitowoc, Wisconsin, United States

Bay Area Cancer Care Center at Bay Area Medical Center; 🇺🇸 Marinette, Wisconsin, United States

Vince Lombardi Cancer Clinic - Marinette; 🇺🇸 Marinette, Wisconsin, United States

Vince Lombardi Cancer Clinic - Two Rivers; 🇺🇸 Two Rivers, Wisconsin, United States

Diagnostic and Treatment Center; 🇺🇸 Weston, Wisconsin, United States

Oncology Alliance, SC - Milwaukee - West; 🇺🇸 Wauwatosa, Wisconsin, United States

Siouxland Hematology-Oncology Associates, LLP; 🇺🇸 Sioux City, Iowa, United States

Mercy Medical Center - Sioux City; 🇺🇸 Sioux City, Iowa, United States

St. Luke's Regional Medical Center; 🇺🇸 Sioux City, Iowa, United States

Kansas Masonic Cancer Research Institute at the University of Kansas Medical Center; 🇺🇸 Kansas City, Kansas, United States

DeCesaris Cancer Institute at Anne Arundel Medical Center; 🇺🇸 Annapolis, Maryland, United States

Greenebaum Cancer Center at University of Maryland Medical Center; 🇺🇸 Baltimore, Maryland, United States

Veterans Affairs Medical Center - Baltimore; 🇺🇸 Baltimore, Maryland, United States

Greater Baltimore Medical Center Cancer Center; 🇺🇸 Baltimore, Maryland, United States

St. Agnes Hospital Cancer Center; 🇺🇸 Baltimore, Maryland, United States

Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; 🇺🇸 Baltimore, Maryland, United States

Boston University Cancer Research Center; 🇺🇸 Boston, Massachusetts, United States

Lahey Clinic Medical Center - Burlington; 🇺🇸 Burlington, Massachusetts, United States

Newton-Wellesley Hospital; 🇺🇸 Newton, Massachusetts, United States

Jordan Hospital Club Cancer Center; 🇺🇸 Plymouth, Massachusetts, United States

Commonwealth Hematology-Oncology, PC - Quincy; 🇺🇸 Quincy, Massachusetts, United States

Saint Joseph Mercy Cancer Center; 🇺🇸 Ann Arbor, Michigan, United States

Oakwood Cancer Center at Oakwood Hospital and Medical Center; 🇺🇸 Dearborn, Michigan, United States

Green Bay Oncology, Limited - Escanaba; 🇺🇸 Escanaba, Michigan, United States

Genesys Hurley Cancer Institute; 🇺🇸 Flint, Michigan, United States

Hurley Medical Center; 🇺🇸 Flint, Michigan, United States

Genesys Regional Medical Center; 🇺🇸 Grand Blanc, Michigan, United States

Van Elslander Cancer Center at St. John Hospital and Medical Center; 🇺🇸 Grosse Pointe Woods, Michigan, United States

West Michigan Cancer Center; 🇺🇸 Kalamazoo, Michigan, United States

Dickinson County Healthcare System; 🇺🇸 Iron Mountain, Michigan, United States

Borgess Medical Center; 🇺🇸 Kalamazoo, Michigan, United States

Foote Memorial Hospital; 🇺🇸 Jackson, Michigan, United States

Bronson Methodist Hospital; 🇺🇸 Kalamazoo, Michigan, United States

St. John's Regional Health Center; 🇺🇸 Springfield, Missouri, United States

Sparrow Regional Cancer Center; 🇺🇸 Lansing, Michigan, United States

St. Mary Mercy Hospital; 🇺🇸 Livonia, Michigan, United States

St. Joseph Mercy Oakland; 🇺🇸 Pontiac, Michigan, United States

Seton Cancer Institute at Saint Mary's - Saginaw; 🇺🇸 Saginaw, Michigan, United States

Lakeland Regional Cancer Care Center - St. Joseph; 🇺🇸 Saint Joseph, Michigan, United States

Lakeside Cancer Specialists, PLLC; 🇺🇸 Saint Joseph, Michigan, United States

St. John Macomb Hospital; 🇺🇸 Warren, Michigan, United States

St. Joseph's Medical Center; 🇺🇸 Brainerd, Minnesota, United States

Mercy and Unity Cancer Center at Mercy Hospital; 🇺🇸 Coon Rapids, Minnesota, United States

Duluth Clinic Cancer Center - Duluth; 🇺🇸 Duluth, Minnesota, United States

CCOP - Duluth; 🇺🇸 Duluth, Minnesota, United States

Miller - Dwan Medical Center; 🇺🇸 Duluth, Minnesota, United States

Mercy and Unity Cancer Center at Unity Hospital; 🇺🇸 Fridley, Minnesota, United States

Fairview Southdale Hospital; 🇺🇸 Edina, Minnesota, United States

Hutchinson Area Health Care; 🇺🇸 Hutchinson, Minnesota, United States

Minnesota Oncology - Maplewood; 🇺🇸 Maplewood, Minnesota, United States

New Ulm Medical Center; 🇺🇸 New Ulm, Minnesota, United States

CentraCare Clinic - River Campus; 🇺🇸 Saint Cloud, Minnesota, United States

Humphrey Cancer Center at North Memorial Outpatient Center; 🇺🇸 Robbinsdale, Minnesota, United States

Coborn Cancer Center; 🇺🇸 Saint Cloud, Minnesota, United States

United Hospital; 🇺🇸 Saint Paul, Minnesota, United States

Park Nicollet Cancer Center; 🇺🇸 Saint Louis Park, Minnesota, United States

Regions Hospital Cancer Care Center; 🇺🇸 Saint Paul, Minnesota, United States

CCOP - St. Louis-Cape Girardeau; 🇺🇸 Saint Louis, Missouri, United States

Midwest Hematology Oncology Group, Incorporated; 🇺🇸 Saint Louis, Missouri, United States

St. Francis Cancer Center at St. Francis Medical Center; 🇺🇸 Shakopee, Minnesota, United States

Lakeview Hospital; 🇺🇸 Stillwater, Minnesota, United States

Ridgeview Medical Center; 🇺🇸 Waconia, Minnesota, United States

Willmar Cancer Center at Rice Memorial Hospital; 🇺🇸 Willmar, Minnesota, United States

Minnesota Oncology - Woodbury; 🇺🇸 Woodbury, Minnesota, United States

University of Mississippi Cancer Clinic; 🇺🇸 Jackson, Mississippi, United States

Central Care Cancer Center at Carrie J. Babb Cancer Center; 🇺🇸 Bolivar, Missouri, United States

University of California Davis Cancer Center; 🇺🇸 Sacramento, California, United States

Skaggs Cancer Center at Skaggs Regional Medical Center; 🇺🇸 Branson, Missouri, United States

CCOP - Michigan Cancer Research Consortium; 🇺🇸 Ann Arbor, Michigan, United States

University of Michigan Comprehensive Cancer Center; 🇺🇸 Ann Arbor, Michigan, United States

Medical College of Wisconsin Cancer Center; 🇺🇸 Milwaukee, Wisconsin, United States

Mercy Regional Cancer Center at Mercy Hospital; 🇺🇸 Port Huron, Michigan, United States

Cascade Cancer Center at Evergreen Hospital Medical Center; 🇺🇸 Kirkland, Washington, United States

Marshfield Clinic - Marshfield Center; 🇺🇸 Marshfield, Wisconsin, United States

Michiana Hematology Oncology PC - La Porte; 🇺🇸 Westville, Indiana, United States

Saint Anthony Memorial Health Centers; 🇺🇸 Michigan City, Indiana, United States

Green Bay Oncology, Limited at St. Vincent Hospital Regional Cancer Center; 🇺🇸 Green Bay, Wisconsin, United States

Green Bay Oncology, Limited at St. Mary's Hospital; 🇺🇸 Green Bay, Wisconsin, United States

St. Mary's Hospital Medical Center - Green Bay; 🇺🇸 Green Bay, Wisconsin, United States

St. Vincent Hospital Regional Cancer Center; 🇺🇸 Green Bay, Wisconsin, United States

Marshfield Clinic - Weston Center; 🇺🇸 Weston, Wisconsin, United States

MeritCare Bemidji; 🇺🇸 Bemidji, Minnesota, United States

University of Colorado Cancer Center at UC Health Sciences Center; 🇺🇸 Aurora, Colorado, United States

HealthEast Cancer Care at St. John's Hospital; 🇺🇸 Maplewood, Minnesota, United States

Siteman Cancer Center at Barnes-Jewish Hospital - Saint Louis; 🇺🇸 Saint Louis, Missouri, United States

David C. Pratt Cancer Center at St. John's Mercy; 🇺🇸 Saint Louis, Missouri, United States

CCOP - Cancer Research for the Ozarks; 🇺🇸 Springfield, Missouri, United States

St. Vincent Healthcare Cancer Care Services; 🇺🇸 Billings, Montana, United States

CCOP - Montana Cancer Consortium; 🇺🇸 Billings, Montana, United States

St. James Healthcare Cancer Care; 🇺🇸 Butte, Montana, United States

Strecker Cancer Center at Marietta Memorial Hospital; 🇺🇸 Marietta, Ohio, United States

Fairfield Medical Center; 🇺🇸 Lancaster, Ohio, United States

St. Rita's Medical Center; 🇺🇸 Lima, Ohio, United States

Gundersen Lutheran Center for Cancer and Blood; 🇺🇸 La Crosse, Wisconsin, United States

Montana Cancer Center at St. Patrick Hospital and Health Sciences Center; 🇺🇸 Missoula, Montana, United States

Sletten Cancer Institute at Benefis Healthcare; 🇺🇸 Great Falls, Montana, United States

Saint Joseph's Hospital; 🇺🇸 Marshfield, Wisconsin, United States

Yale Cancer Center; 🇺🇸 New Haven, Connecticut, United States

Medical Center of Louisiana - New Orleans; 🇺🇸 New Orleans, Louisiana, United States

MBCCOP - LSU Health Sciences Center; 🇺🇸 New Orleans, Louisiana, United States

Truman Medical Center - Hospital Hill; 🇺🇸 Kansas City, Missouri, United States

University of Florida Shands Cancer Center; 🇺🇸 Gainesville, Florida, United States

CCOP - Iowa Oncology Research Association; 🇺🇸 Des Moines, Iowa, United States

John Stoddard Cancer Center at Iowa Methodist Medical Center; 🇺🇸 Des Moines, Iowa, United States

Medical Oncology and Hematology Associates at John Stoddard Cancer Center; 🇺🇸 Des Moines, Iowa, United States

Medical Oncology and Hematology Associates at Mercy Cancer Center; 🇺🇸 Des Moines, Iowa, United States

Mercy Cancer Center at Mercy Medical Center - Des Moines; 🇺🇸 Des Moines, Iowa, United States

John Stoddard Cancer Center at Iowa Lutheran Hospital; 🇺🇸 Des Moines, Iowa, United States

Lucille P. Markey Cancer Center at University of Kentucky; 🇺🇸 Lexington, Kentucky, United States

Dean Medical Center - Madison; 🇺🇸 Madison, Wisconsin, United States

University of Wisconsin Paul P. Carbone Comprehensive Cancer Center; 🇺🇸 Madison, Wisconsin, United States

Mayo Clinic - Jacksonville; 🇺🇸 Jacksonville, Florida, United States

Wayne Memorial Hospital, Incorporated; 🇺🇸 Goldsboro, North Carolina, United States

Overlook Hospital; 🇺🇸 Summit, New Jersey, United States

Tucker Center for Cancer Care at Orange Regional Medical Center; 🇺🇸 Middletown, New York, United States

Pardee Memorial Hospital; 🇺🇸 Hendersonville, North Carolina, United States

Adams Cancer Center; 🇺🇸 Gettysburg, Pennsylvania, United States

Cherry Tree Cancer Center; 🇺🇸 Hanover, Pennsylvania, United States

Cancer Center of Paoli Memorial Hospital; 🇺🇸 Paoli, Pennsylvania, United States

St. Joseph Medical Center; 🇺🇸 Reading, Pennsylvania, United States

Marshfield Clinic - Indianhead Center; 🇺🇸 Rice Lake, Wisconsin, United States