S1827 (MAVERICK) Testing Whether the Use of Brain Scans Alone Instead of Brain Scans Plus Preventive Brain Radiation Affects Lifespan in Patients With Small Cell Lung Cancer
- Conditions
- Lung Small Cell CarcinomaLimited Stage Lung Small Cell CarcinomaExtensive Stage Lung Small Cell Carcinoma
- Interventions
- Procedure: Magnetic Resonance ImagingRadiation: Prophylactic Cranial Irradiation
- Registration Number
- NCT04155034
- Lead Sponsor
- SWOG Cancer Research Network
- Brief Summary
This phase III trial studies magnetic resonance imaging (MRI) surveillance and prophylactic cranial irradiation (PCI) to see how well they work compared to MRI surveillance alone in treating patients with small cell lung cancer. MRI scans are used to monitor the possible spread of the cancer with an MRI machine over time. PCI is radiation therapy that is delivered to the brain in hopes of preventing spread of cancer into the brain. The use of brain MRI alone may reduce side effects of receiving PCI and prolong patients' lifespan. Monitoring with MRI scans alone (delaying radiation until the actual spread of the cancer) may be at least as good as the combination of PCI with MRI scans.
- Detailed Description
PRIMARY OBJECTIVE:
I. To evaluate whether overall survival (OS) with magnetic resonance imaging (MRI) surveillance alone is not inferior to MRI surveillance combined with prophylactic cranial irradiation (PCI) for the treatment of small cell lung cancer (SCLC).
SECONDARY OBJECTIVES:
I. To compare cognitive failure free survival (CFFS) rate up to 12 months after randomization between the arms.
II. To compare brain-metastasis-free survival between the arms. III. To compare OS between the arms within the subgroups of patients with limited-stage and extensive-stage disease.
IV. To compare cognitive failure free survival (CFFS) rates at the assessment times between the arms.
V. To compare the cumulative incidence of cognitive failure with death as a competing risk between the arms.
VI. To compare the frequency and severity of toxicities between the two arms.
ADDITIONAL OBJECTIVE:
I. To collect blood for banking.
OUTLINE: Patients are randomized to 1 of 2 arms.
ARM I: Patients undergo conventional or hippocampal avoidance PCI over 20 minutes 5 days per week for 2 weeks. Patients also undergo MRI scan at 3, 6, 9, 12, 18, and 24 months.
ARM II: Patients undergo MRI scan at 3, 6, 9, 12, 18, and 24 months.
Recruitment & Eligibility
- Status
- RECRUITING
- Sex
- All
- Target Recruitment
- 668
-
Patient must have a histologically confirmed diagnosis of small-cell lung cancer (SCLC)
-
Patient must have an MRI of the brain performed within 28 days prior to registration documenting no evidence of brain metastases or leptomeningeal disease. Patient also must not have a history of brain metastases or leptomeningeal disease
-
Immunotherapy concurrent with and/or adjuvant to first-line therapy is allowed at the discretion of the treating physician. Patients with limited-stage (LS)-SCLC must have completed platinum-based chemotherapy and either definitive thoracic radiotherapy (including stereotactic body radiation therapy [SBRT] for early-stage T1-2 N0 M0 disease who do not undergo surgery) or definitive surgical resection; thoracic radiation in addition to definitive surgical resection is allowed at the discretion of the treating physician, but is not required. Patients with extensive-stage (ES)-SCLC must have completed platinum-based chemotherapy either with or without thoracic radiotherapy at the discretion of the treating physician
-
All adverse events from prior treatment must have resolved to =< grade 2 (Common Terminology Criteria for Adverse Events [CTCAE] version 5.0) prior to randomization
-
Patient must have had a response to first-line therapy and no evidence of progression in opinion of the treating investigator. Systemic imaging (computed tomography [CT] or positron emission tomography [PET]/CT including the chest and abdomen) must be performed within 28 days prior to randomization
-
No more than 8 weeks may have elapsed between day 1 of the last cycle of chemotherapy and randomization
-
Patient must not have received prior radiotherapy to the brain or whole brain radiotherapy. Patients who have undergone prior stereotactic radiosurgery for benign tumors or conditions (e.g., acoustic neuroma, grade I meningioma, trigeminal neuralgia) may be considered on a case-by-case basis
-
Patient must have Zubrod performance status of 0-2
-
Patient must not have a contraindication to MR imaging, such as implanted metal devices or foreign bodies
-
Patient must not have a contraindication to gadolinium contrast administration during MR imaging, such as allergy or insufficient renal function
-
Patient must not have other metastatic malignancies requiring current active treatment
-
Patient must not have any severe active comorbidities, defined as follows:
-
Unstable angina and/or congestive heart failure requiring hospitalization within 6 months prior to randomization
-
Transmural myocardial infarction within 6 months prior to randomization
-
Acute bacterial or fungal infection requiring intravenous antibiotics at the time of randomization
-
Chronic obstructive pulmonary disease exacerbation or other acute respiratory illness precluding study therapy at the time of randomization
-
Severe hepatic disease defined as a diagnosis of Child-Pugh class B or C hepatic disease
-
Human immunodeficiency virus (HIV) positive with CD4 count < 200 cells/microliter
- Note that patients who are HIV positive are eligible, provided they are under treatment with highly active antiretroviral therapy (HAART) and have a CD4 count >= 200 cells/microliter within 16 weeks prior to randomization
- Note also that HIV testing is not required for eligibility for this protocol
-
-
Patient must not be pregnant because of fetal risks from radiation exposure. Men must have agreed to use an effective contraceptive method during PCI and for six months after completing PCI. Women of reproductive potential must have agreed to use an effective contraceptive method during PCI. A woman is considered to be of "reproductive potential" if she has had menses at any time in the preceding 12 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, he/she is responsible for beginning contraceptive measures
-
Patients who speak and understand English or French must agree to participate in cognitive function testing
-
Patient must be offered the opportunity to have specimens submitted for banking
-
Patients must be informed of the investigational nature of this study and must sign and give written informed consent in accordance with institutional and federal guidelines
-
As a part of the Oncology Patient Enrollment Network (OPEN) randomization process the treating institution?s identity is provided in order to ensure that the current (within 365 days) date of institutional review board approval for this study has been entered in the system
Not provided
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Arm I (PCI, MRI) Prophylactic Cranial Irradiation Patients undergo conventional or hippocampal avoidance PCI over 20 minutes 5 days per week for 2 weeks. Patients also undergo MRI scan at 3, 6, 9, 12, 18, and 24 months. Arm I (PCI, MRI) Magnetic Resonance Imaging Patients undergo conventional or hippocampal avoidance PCI over 20 minutes 5 days per week for 2 weeks. Patients also undergo MRI scan at 3, 6, 9, 12, 18, and 24 months. Arm II (MRI) Magnetic Resonance Imaging Patients undergo MRI scan at 3, 6, 9, 12, 18, and 24 months.
- Primary Outcome Measures
Name Time Method Overall survival (OS) From the date of registration to date of death due to any cause, assessed up to 2 years after randomization Will evaluate OS with magnetic resonance imaging (MRI) surveillance alone and MRI surveillance combined with prophylactic cranial irradiation (PCI) for the treatment of small cell lung cancer (SCLC).
- Secondary Outcome Measures
Name Time Method Cognitive failure-free survival (CFFS) Baseline to first neurocognitive failure CF or death due to any cause, assessed up to 12 months after randomization The comparison of CFFS up to 12 months between the arms will be done using a 1-sided 5% level log-rank test.
CFFS rate Baseline to first neurocognitive failure CF or death due to any cause, assessed at 90, 180, 270, 360, 540, and 720 days after randomization There will be a comparison of the CFFS rates between the arms at each of the assessment times and the cumulative incidence of cognitive failure, evaluating death as a competing risk. The CFFS rates at the landmark times will be estimated using the method of Kaplan-Meier and the difference in rates will be evaluated using a 90% confidence interval using Greenwood?s formula.
Cumulative incidence of cognitive failure Neurocognitive function test will be assessed at 90, 180, 270, 360, 540, and 720 days after randomization The cumulative incidence of cognitive failure in the presence of the competing risk of death will be estimated used the method of Fine and Gray.
OS in an "as-treated" analysis From the date of registration to date of death due to any cause, assessed up to 2 years after randomization. Patients will be seen at day 90, 180, 270, 360, 540, and 720 The comparison of OS in the ?as-treated? analysis will be done as described for the primary analysis, however patients will be categorized per treatment received (patients who do not accept their randomized assignment will be analyzed per treatment received). The number of patients not accepting the randomized assignment will also be summarized.
Brain metastases-free survival (BMFS) Up to 2 years after randomization. Patients will have MRI on day 90, 180, 270, 360, 540, and 720 This will be estimated using the method of Kaplan-Meier and comparisons will be done using a log-rank test at the 1-sided 0.05 level. Hazard ratios and associated confidence intervals will be estimated using a Cox Proportional hazards model. Confidence intervals for medians will be estimated using the method of Brookmeyer-Crowley.
Incidence of adverse events Up to 2 years after randomization. Patients will be assessed for adverse event after PCI (for patients on PCI + MRI arm) and at month 3 (all patients) Binary proportions and associated confidence intervals will be estimated.
Trial Locations
- Locations (341)
Central Maryland Radiation Oncology in Howard County
🇺🇸Columbia, Maryland, United States
Aspirus Regional Cancer Center
🇺🇸Wausau, Wisconsin, United States
Dublin Methodist Hospital
🇺🇸Dublin, Ohio, United States
Guthrie Medical Group PC-Robert Packer Hospital
🇺🇸Sayre, Pennsylvania, United States
Geisinger Wyoming Valley/Henry Cancer Center
🇺🇸Wilkes-Barre, Pennsylvania, United States
Marshfield Medical Center - Weston
🇺🇸Weston, Wisconsin, United States
Allan Blair Cancer Centre
🇨🇦Regina, Saskatchewan, Canada
USC / Norris Comprehensive Cancer Center
🇺🇸Los Angeles, California, United States
Emory University Hospital/Winship Cancer Institute
🇺🇸Atlanta, Georgia, United States
Fox Chase Cancer Center
🇺🇸Philadelphia, Pennsylvania, United States
Ohio State University Comprehensive Cancer Center
🇺🇸Columbus, Ohio, United States
UPMC-Saint Margaret
🇺🇸Pittsburgh, Pennsylvania, United States
University of Pittsburgh Cancer Institute (UPCI)
🇺🇸Pittsburgh, Pennsylvania, United States
UPMC-Shadyside Hospital
🇺🇸Pittsburgh, Pennsylvania, United States
Rush University Medical Center
🇺🇸Chicago, Illinois, United States
University of Illinois
🇺🇸Chicago, Illinois, United States
Case Western Reserve University
🇺🇸Cleveland, Ohio, United States
Louis Stokes Cleveland VA Medical Center
🇺🇸Cleveland, Ohio, United States
TidalHealth Peninsula Regional
🇺🇸Salisbury, Maryland, United States
Baylor College of Medicine/Dan L Duncan Comprehensive Cancer Center
🇺🇸Houston, Texas, United States
Ben Taub General Hospital
🇺🇸Houston, Texas, United States
M D Anderson Cancer Center
🇺🇸Houston, Texas, United States
Michael E DeBakey VA Medical Center
🇺🇸Houston, Texas, United States
MD Anderson West Houston
🇺🇸Houston, Texas, United States
Brigham and Women's Hospital
🇺🇸Boston, Massachusetts, United States
University of Miami Miller School of Medicine-Sylvester Cancer Center
🇺🇸Miami, Florida, United States
Hennepin County Medical Center
🇺🇸Minneapolis, Minnesota, United States
Durham VA Medical Center
🇺🇸Durham, North Carolina, United States
Audie L Murphy VA Hospital
🇺🇸San Antonio, Texas, United States
Veterans Affairs Medical Center - San Francisco
🇺🇸San Francisco, California, United States
University of Utah Sugarhouse Health Center
🇺🇸Salt Lake City, Utah, United States
UCHealth Greeley Hospital
🇺🇸Greeley, Colorado, United States
Poudre Valley Hospital
🇺🇸Fort Collins, Colorado, United States
Northwestern University
🇺🇸Chicago, Illinois, United States
Hawaii Cancer Care - Savio
🇺🇸'Aiea, Hawaii, United States
Smilow Cancer Hospital Care Center - Guiford
🇺🇸Guilford, Connecticut, United States
Smilow Cancer Hospital-Hamden Care Center
🇺🇸Hamden, Connecticut, United States
UCHealth Highlands Ranch Hospital
🇺🇸Highlands Ranch, Colorado, United States
Smilow Cancer Hospital Care Center - Waterford
🇺🇸Waterford, Connecticut, United States
Smilow Cancer Hospital Care Center-Trumbull
🇺🇸Trumbull, Connecticut, United States
Northside Hospital-Alpharetta
🇺🇸Alpharetta, Georgia, United States
Beebe South Coastal Health Campus
🇺🇸Frankford, Delaware, United States
OSF Saint Francis Medical Center
🇺🇸Peoria, Illinois, United States
Northside Hospital
🇺🇸Atlanta, Georgia, United States
Cancer Care and Hematology-Fort Collins
🇺🇸Fort Collins, Colorado, United States
Pali Momi Medical Center
🇺🇸'Aiea, Hawaii, United States
UM Sylvester Comprehensive Cancer Center at Deerfield Beach
🇺🇸Deerfield Beach, Florida, United States
Beebe Health Campus
🇺🇸Rehoboth Beach, Delaware, United States
Alton Memorial Hospital
🇺🇸Alton, Illinois, United States
Morton Plant Hospital
🇺🇸Clearwater, Florida, United States
Christiana Care Health System-Christiana Hospital
🇺🇸Newark, Delaware, United States
Cancer Care Specialists of Illinois - Decatur
🇺🇸Decatur, Illinois, United States
Boca Raton Regional Hospital
🇺🇸Boca Raton, Florida, United States
Helen F Graham Cancer Center
🇺🇸Newark, Delaware, United States
Smilow Cancer Hospital Care Center at Greenwich
🇺🇸Greenwich, Connecticut, United States
Medical Oncology Hematology Consultants PA
🇺🇸Newark, Delaware, United States
Northside Hospital-Cherokee
🇺🇸Canton, Georgia, United States
Lewis Cancer and Research Pavilion at Saint Joseph's/Candler
🇺🇸Savannah, Georgia, United States
Loyola University Medical Center
🇺🇸Maywood, Illinois, United States
John B Amos Cancer Center
🇺🇸Columbus, Georgia, United States
Carle on Vermilion
🇺🇸Danville, Illinois, United States
Northwest Cancer Center - Hobart
🇺🇸Hobart, Indiana, United States
Saint Mary Medical Center
🇺🇸Hobart, Indiana, United States
Maine Medical Center-Bramhall Campus
🇺🇸Portland, Maine, United States
McFarland Clinic PC - Ames
🇺🇸Ames, Iowa, United States
Maine Medical Center- Scarborough Campus
🇺🇸Scarborough, Maine, United States
East Jefferson General Hospital
🇺🇸Metairie, Louisiana, United States
MaineHealth Coastal Cancer Treatment Center
🇺🇸Bath, Maine, United States
Lawrence Memorial Hospital
🇺🇸Lawrence, Kansas, United States
Northwest Oncology LLC
🇺🇸Dyer, Indiana, United States
Greater Regional Medical Center
🇺🇸Creston, Iowa, United States
Mercy Cancer Center-West Lakes
🇺🇸Clive, Iowa, United States
The Community Hospital
🇺🇸Munster, Indiana, United States
Northwest Cancer Center - Valparaiso
🇺🇸Valparaiso, Indiana, United States
University of Kansas Cancer Center
🇺🇸Kansas City, Kansas, United States
Methodist West Hospital
🇺🇸West Des Moines, Iowa, United States
Oncology Associates at Mercy Medical Center
🇺🇸Cedar Rapids, Iowa, United States
Mercy Medical Center-West Lakes
🇺🇸West Des Moines, Iowa, United States
21st Century Oncology-Pontiac
🇺🇸Pontiac, Michigan, United States
Boston Medical Center
🇺🇸Boston, Massachusetts, United States
Saint Joseph Mercy Canton
🇺🇸Canton, Michigan, United States
MaineHealth Cancer Care Center of York County
🇺🇸Sanford, Maine, United States
Dana-Farber/Brigham and Women's Cancer Center at South Shore
🇺🇸South Weymouth, Massachusetts, United States
Ascension Saint John Hospital
🇺🇸Detroit, Michigan, United States
Miller-Dwan Hospital
🇺🇸Duluth, Minnesota, United States
Lahey Hospital and Medical Center
🇺🇸Burlington, Massachusetts, United States
UM Baltimore Washington Medical Center/Tate Cancer Center
🇺🇸Glen Burnie, Maryland, United States
TidalHealth Richard A Henson Cancer Institute
🇺🇸Ocean Pines, Maryland, United States
Saint Joseph Mercy Oakland
🇺🇸Pontiac, Michigan, United States
Beaumont Hospital - Dearborn
🇺🇸Dearborn, Michigan, United States
Beth Israel Deaconess Hospital-Plymouth
🇺🇸Plymouth, Massachusetts, United States
Veterans Administration Medical Center-Baltimore
🇺🇸Baltimore, Maryland, United States
Saint Joseph Mercy Brighton
🇺🇸Brighton, Michigan, United States
Anne Arundel Medical Center
🇺🇸Annapolis, Maryland, United States
Dana-Farber Cancer Institute
🇺🇸Boston, Massachusetts, United States
Saint Joseph Mercy Chelsea
🇺🇸Chelsea, Michigan, United States
William Beaumont Hospital-Royal Oak
🇺🇸Royal Oak, Michigan, United States
Munson Medical Center
🇺🇸Traverse City, Michigan, United States
Oncology Hematology Associates of Saginaw Valley PC
🇺🇸Saginaw, Michigan, United States
William Beaumont Hospital - Troy
🇺🇸Troy, Michigan, United States
Trinity Health IHA Medical Group Hematology Oncology Ann Arbor Campus
🇺🇸Ypsilanti, Michigan, United States
Baptist Memorial Hospital and Cancer Center-Oxford
🇺🇸Oxford, Mississippi, United States
Saint James Community Hospital and Cancer Treatment Center
🇺🇸Butte, Montana, United States
Trinitas Hospital and Comprehensive Cancer Center - Williamson Street Campus
🇺🇸Elizabeth, New Jersey, United States
Missouri Baptist Medical Center
🇺🇸Saint Louis, Missouri, United States
The Cancer Institute of New Jersey Hamilton
🇺🇸Hamilton, New Jersey, United States
Baptist Memorial Hospital and Cancer Center-Desoto
🇺🇸Southhaven, Mississippi, United States
Rutgers Cancer Institute of New Jersey
🇺🇸New Brunswick, New Jersey, United States
Siteman Cancer Center at Christian Hospital
🇺🇸Saint Louis, Missouri, United States
Siteman Cancer Center-South County
🇺🇸Saint Louis, Missouri, United States
Overlook Hospital
🇺🇸Summit, New Jersey, United States
Community Medical Center
🇺🇸Toms River, New Jersey, United States
Roswell Park Cancer Institute
🇺🇸Buffalo, New York, United States
State University of New York Upstate Medical University
🇺🇸Syracuse, New York, United States
Carolinas Medical Center/Levine Cancer Institute
🇺🇸Charlotte, North Carolina, United States
Sanford Roger Maris Cancer Center
🇺🇸Fargo, North Dakota, United States
University of Cincinnati Cancer Center-UC Medical Center
🇺🇸Cincinnati, Ohio, United States
Cleveland Clinic Akron General
🇺🇸Akron, Ohio, United States
Sanford Broadway Medical Center
🇺🇸Fargo, North Dakota, United States
UHHS-Chagrin Highlands Medical Center
🇺🇸Beachwood, Ohio, United States
Mount Carmel Grove City Hospital
🇺🇸Grove City, Ohio, United States
Riverside Methodist Hospital
🇺🇸Columbus, Ohio, United States
Mercy Health - Saint Anne Hospital
🇺🇸Toledo, Ohio, United States
Mercy Health Perrysburg Cancer Center
🇺🇸Perrysburg, Ohio, United States
University Hospitals Parma Medical Center
🇺🇸Parma, Ohio, United States
University Hospitals Portage Medical Center
🇺🇸Ravenna, Ohio, United States
UPMC Hillman Cancer Center Erie
🇺🇸Erie, Pennsylvania, United States
University of Oklahoma Health Sciences Center
🇺🇸Oklahoma City, Oklahoma, United States
Crozer-Keystone Regional Cancer Center at Broomall
🇺🇸Broomall, Pennsylvania, United States
UPMC Cancer Centers - Arnold Palmer Pavilion
🇺🇸Greensburg, Pennsylvania, United States
UPMC Cancer Center at UPMC Horizon
🇺🇸Farrell, Pennsylvania, United States
Christiana Care Health System-Concord Health Center
🇺🇸Chadds Ford, Pennsylvania, United States
Fox Chase Cancer Center Buckingham
🇺🇸Furlong, Pennsylvania, United States
UPMC Pinnacle Cancer Center/Community Osteopathic Campus
🇺🇸Harrisburg, Pennsylvania, United States
UPMC Cancer Center - Monroeville
🇺🇸Monroeville, Pennsylvania, United States
UPMC-Saint Clair Hospital Cancer Center
🇺🇸Pittsburgh, Pennsylvania, United States
UPMC Uniontown Hospital Radiation Oncology
🇺🇸Uniontown, Pennsylvania, United States
UPMC Washington Hospital Radiation Oncology
🇺🇸Washington, Pennsylvania, United States
UPMC-Passavant Hospital
🇺🇸Pittsburgh, Pennsylvania, United States
Saint Francis Hospital
🇺🇸Greenville, South Carolina, United States
UPMC Cancer Center at UPMC Northwest
🇺🇸Seneca, Pennsylvania, United States
Avera Cancer Institute at Pierre
🇺🇸Pierre, South Dakota, United States
Sanford USD Medical Center - Sioux Falls
🇺🇸Sioux Falls, South Dakota, United States
UPMC Memorial
🇺🇸York, Pennsylvania, United States
Saint Francis Cancer Center
🇺🇸Greenville, South Carolina, United States
UPMC Susquehanna
🇺🇸Williamsport, Pennsylvania, United States
MD Anderson in Sugar Land
🇺🇸Sugar Land, Texas, United States
Marshfield Medical Center-Marshfield
🇺🇸Marshfield, Wisconsin, United States
Marshfield Clinic - Ladysmith Center
🇺🇸Ladysmith, Wisconsin, United States
Northwest Wisconsin Cancer Center
🇺🇸Ashland, Wisconsin, United States
UW Cancer Center at ProHealth Care
🇺🇸Waukesha, Wisconsin, United States
Huntsman Cancer Institute/University of Utah
🇺🇸Salt Lake City, Utah, United States
Spartanburg Medical Center
🇺🇸Spartanburg, South Carolina, United States
Gundersen Lutheran Medical Center
🇺🇸La Crosse, Wisconsin, United States
Baptist Memorial Hospital and Cancer Center-Collierville
🇺🇸Collierville, Tennessee, United States
Aurora BayCare Medical Center
🇺🇸Green Bay, Wisconsin, United States
Baptist Memorial Hospital and Cancer Center-Memphis
🇺🇸Memphis, Tennessee, United States
Self Regional Healthcare
🇺🇸Greenwood, South Carolina, United States
CHU de Quebec-L'Hotel-Dieu de Quebec (HDQ)
🇨🇦Quebec City, Quebec, Canada
BCCA-Vancouver Island Cancer Centre
🇨🇦Victoria, British Columbia, Canada
Froedtert West Bend Hospital/Kraemer Cancer Center
🇺🇸West Bend, Wisconsin, United States
ProHealth D N Greenwald Center
🇺🇸Mukwonago, Wisconsin, United States
Lakeridge Health Oshawa
🇨🇦Oshawa, Ontario, Canada
Marshfield Medical Center-EC Cancer Center
🇺🇸Eau Claire, Wisconsin, United States
Aurora West Allis Medical Center
🇺🇸West Allis, Wisconsin, United States
ThedaCare Regional Cancer Center
🇺🇸Appleton, Wisconsin, United States
Augusta Health Center for Cancer and Blood Disorders
🇺🇸Fishersville, Virginia, United States
Froedtert Menomonee Falls Hospital
🇺🇸Menomonee Falls, Wisconsin, United States
ProHealth Oconomowoc Memorial Hospital
🇺🇸Oconomowoc, Wisconsin, United States
Farmington Health Center
🇺🇸Farmington, Utah, United States
Marshfield Medical Center-River Region at Stevens Point
🇺🇸Stevens Point, Wisconsin, United States
Aspirus Cancer Care - Wisconsin Rapids
🇺🇸Wisconsin Rapids, Wisconsin, United States
Gibbs Cancer Center-Pelham
🇺🇸Greer, South Carolina, United States
CancerCare Manitoba
🇨🇦Winnipeg, Manitoba, Canada
University Health Network-Princess Margaret Hospital
🇨🇦Toronto, Ontario, Canada
The Research Institute of the McGill University Health Centre (MUHC)
🇨🇦Montreal, Quebec, Canada
Centre Hospitalier Regional de Trois-Rivieres
🇨🇦Trois-Rivieres, Quebec, Canada
Nebraska Methodist Hospital
🇺🇸Omaha, Nebraska, United States
Alegent Health Bergan Mercy Medical Center
🇺🇸Omaha, Nebraska, United States
Aurora Saint Luke's Medical Center
🇺🇸Milwaukee, Wisconsin, United States
Medical College of Wisconsin
🇺🇸Milwaukee, Wisconsin, United States
Aurora Sinai Medical Center
🇺🇸Milwaukee, Wisconsin, United States
Zablocki Veterans Administration Medical Center
🇺🇸Milwaukee, Wisconsin, United States
University of Missouri - Ellis Fischel
🇺🇸Columbia, Missouri, United States
Siteman Cancer Center at West County Hospital
🇺🇸Creve Coeur, Missouri, United States
Washington University School of Medicine
🇺🇸Saint Louis, Missouri, United States
Siteman Cancer Center at Saint Peters Hospital
🇺🇸Saint Peters, Missouri, United States
Sainte Genevieve County Memorial Hospital
🇺🇸Sainte Genevieve, Missouri, United States
Rocky Mountain Regional VA Medical Center
🇺🇸Aurora, Colorado, United States
University of Colorado Hospital
🇺🇸Aurora, Colorado, United States
Altru Cancer Center
🇺🇸Grand Forks, North Dakota, United States
University of Kansas Hospital-Westwood Cancer Center
🇺🇸Westwood, Kansas, United States
Sanford Joe Lueken Cancer Center
🇺🇸Bemidji, Minnesota, United States
North Colorado Medical Center
🇺🇸Greeley, Colorado, United States
CarolinaEast Medical Center
🇺🇸New Bern, North Carolina, United States
Genesis Healthcare System Cancer Care Center
🇺🇸Zanesville, Ohio, United States
University of Cincinnati Cancer Center-West Chester
🇺🇸West Chester, Ohio, United States
West Michigan Cancer Center
🇺🇸Kalamazoo, Michigan, United States
Henry Ford Hospital
🇺🇸Detroit, Michigan, United States
Adams Cancer Center
🇺🇸Gettysburg, Pennsylvania, United States
UPMC-Johnstown/John P. Murtha Regional Cancer Center
🇺🇸Johnstown, Pennsylvania, United States
UPMC Cancer Center at UPMC McKeesport
🇺🇸McKeesport, Pennsylvania, United States
UPMC Hillman Cancer Center at Rocco And Nancy Ortenzio Cancer Pavilion
🇺🇸Mechanicsburg, Pennsylvania, United States
Temple University Hospital
🇺🇸Philadelphia, Pennsylvania, United States
UPMC Hillman Cancer Center in Coraopolis
🇺🇸Moon, Pennsylvania, United States
UPMC-Magee Womens Hospital
🇺🇸Pittsburgh, Pennsylvania, United States
Moffitt Cancer Center
🇺🇸Tampa, Florida, United States
Memorial Hospital East
🇺🇸Shiloh, Illinois, United States
Southern Illinois University School of Medicine
🇺🇸Springfield, Illinois, United States
Marshfield Clinic-Minocqua Center
🇺🇸Minocqua, Wisconsin, United States
Drexel Town Square Health Center
🇺🇸Oak Creek, Wisconsin, United States
Saint Joseph Mercy Hospital
🇺🇸Ann Arbor, Michigan, United States
Medical Center of the Rockies
🇺🇸Loveland, Colorado, United States
Sechler Family Cancer Center
🇺🇸Lebanon, Pennsylvania, United States
Aurora Bay Area Medical Group-Marinette
🇺🇸Marinette, Wisconsin, United States
UH Seidman Cancer Center at Saint John Medical Center
🇺🇸Westlake, Ohio, United States
Springfield Clinic
🇺🇸Springfield, Illinois, United States
University of California Davis Comprehensive Cancer Center
🇺🇸Sacramento, California, United States
Sanford Cancer Center Oncology Clinic
🇺🇸Sioux Falls, South Dakota, United States
WellSpan Health-York Cancer Center
🇺🇸York, Pennsylvania, United States
The James Graham Brown Cancer Center at University of Louisville
🇺🇸Louisville, Kentucky, United States
Yale University
🇺🇸New Haven, Connecticut, United States
University of Alabama at Birmingham Cancer Center
🇺🇸Birmingham, Alabama, United States
University of Arizona Cancer Center-Orange Grove Campus
🇺🇸Tucson, Arizona, United States
University of Arizona Cancer Center-North Campus
🇺🇸Tucson, Arizona, United States
City of Hope Comprehensive Cancer Center
🇺🇸Duarte, California, United States
Los Angeles County-USC Medical Center
🇺🇸Los Angeles, California, United States
City of Hope South Pasadena
🇺🇸South Pasadena, California, United States
Memorial Hospital North
🇺🇸Colorado Springs, Colorado, United States
McKee Medical Center
🇺🇸Loveland, Colorado, United States
Veterans Affairs Connecticut Healthcare System-West Haven Campus
🇺🇸West Haven, Connecticut, United States
John Fitzgerald Kennedy Medical Center
🇺🇸Atlantis, Florida, United States
Augusta University Medical Center
🇺🇸Augusta, Georgia, United States
Northside Hospital-Forsyth
🇺🇸Cumming, Georgia, United States
The Cancer Center of Hawaii-Pali Momi
🇺🇸'Aiea, Hawaii, United States
Edward Hines Jr VA Hospital
🇺🇸Hines, Illinois, United States
Carle Physician Group-Effingham
🇺🇸Effingham, Illinois, United States
Methodist Medical Center of Illinois
🇺🇸Peoria, Illinois, United States
Carle Physician Group-Mattoon/Charleston
🇺🇸Mattoon, Illinois, United States
Decatur Memorial Hospital
🇺🇸Decatur, Illinois, United States
Carle Cancer Center
🇺🇸Urbana, Illinois, United States
Northwest Cancer Center - Main Campus
🇺🇸Crown Point, Indiana, United States
Memorial Medical Center
🇺🇸Springfield, Illinois, United States
Mercy Hospital
🇺🇸Cedar Rapids, Iowa, United States
Medical Oncology and Hematology Associates-West Des Moines
🇺🇸Clive, Iowa, United States
Saint Elizabeth Healthcare Edgewood
🇺🇸Edgewood, Kentucky, United States
Wesley Medical Center
🇺🇸Wichita, Kansas, United States
Ascension Via Christi Hospitals Wichita
🇺🇸Wichita, Kansas, United States
Saint Elizabeth Fort Thomas
🇺🇸Fort Thomas, Kentucky, United States
Lafayette Family Cancer Center-EMMC
🇺🇸Brewer, Maine, United States
UM Upper Chesapeake Medical Center
🇺🇸Bel Air, Maryland, United States
University of Maryland/Greenebaum Cancer Center
🇺🇸Baltimore, Maryland, United States
Trinity Health IHA Medical Group Hematology Oncology - Brighton
🇺🇸Brighton, Michigan, United States
Dana-Farber/Brigham and Women's Cancer Center at Milford Regional
🇺🇸Milford, Massachusetts, United States
University of Maryland Shore Medical Center at Easton
🇺🇸Easton, Maryland, United States
Henry Ford Cancer Institute-Downriver
🇺🇸Brownstown, Michigan, United States
Trinity Health Saint Mary Mercy Livonia Hospital
🇺🇸Livonia, Michigan, United States
Ascension Saint Joseph Hospital
🇺🇸Tawas City, Michigan, United States
Ascension Saint Mary's Hospital
🇺🇸Saginaw, Michigan, United States
Saint Mary's Oncology/Hematology Associates of West Branch
🇺🇸West Branch, Michigan, United States
Saint Francis Medical Center
🇺🇸Cape Girardeau, Missouri, United States
Henry Ford West Bloomfield Hospital
🇺🇸West Bloomfield, Michigan, United States
Freeman Health System
🇺🇸Joplin, Missouri, United States
Parkland Health Center - Farmington
🇺🇸Farmington, Missouri, United States
University of Kansas Cancer Center at North Kansas City Hospital
🇺🇸North Kansas City, Missouri, United States
University of Kansas Cancer Center - Lee's Summit
🇺🇸Lee's Summit, Missouri, United States
Benefis Healthcare- Sletten Cancer Institute
🇺🇸Great Falls, Montana, United States
Chilton Medical Center
🇺🇸Pompton, New Jersey, United States
Robert Wood Johnson University Hospital Somerset
🇺🇸Somerville, New Jersey, United States
Capital Health Medical Center-Hopewell
🇺🇸Pennington, New Jersey, United States
NYP/Columbia University Medical Center/Herbert Irving Comprehensive Cancer Center
🇺🇸New York, New York, United States
Glens Falls Hospital
🇺🇸Glens Falls, New York, United States
Sands Cancer Center
🇺🇸Canandaigua, New York, United States
Stony Brook University Medical Center
🇺🇸Stony Brook, New York, United States
CaroMont Regional Medical Center
🇺🇸Gastonia, North Carolina, United States
Sanford Bismarck Medical Center
🇺🇸Bismarck, North Dakota, United States
Cleveland Clinic Mercy Hospital
🇺🇸Canton, Ohio, United States
UH Seidman Cancer Center at Lake Health Mentor Campus
🇺🇸Mentor, Ohio, United States
UH Seidman Cancer Center at Southwest General Hospital
🇺🇸Middleburg Heights, Ohio, United States
UHHS-Westlake Medical Center
🇺🇸Westlake, Ohio, United States
Carlisle Regional Cancer Center
🇺🇸Carlisle, Pennsylvania, United States
Fox Chase Cancer Center - East Norriton Hospital Outpatient Center
🇺🇸East Norriton, Pennsylvania, United States
UPMC-Heritage Valley Health System Beaver
🇺🇸Beaver, Pennsylvania, United States
Ephrata Cancer Center
🇺🇸Ephrata, Pennsylvania, United States
Crozer Regional Cancer Center at Brinton Lake
🇺🇸Glen Mills, Pennsylvania, United States
Paoli Memorial Hospital
🇺🇸Paoli, Pennsylvania, United States
Geisinger Medical Oncology-Lewisburg
🇺🇸Lewisburg, Pennsylvania, United States
Lankenau Medical Center
🇺🇸Wynnewood, Pennsylvania, United States
Saint Joseph's/Candler - Bluffton Campus
🇺🇸Bluffton, South Carolina, United States
Avera Cancer Institute
🇺🇸Sioux Falls, South Dakota, United States
Avera Cancer Institute at Yankton
🇺🇸Yankton, South Dakota, United States
MD Anderson in The Woodlands
🇺🇸Conroe, Texas, United States
MD Anderson League City
🇺🇸League City, Texas, United States
Langlade Hospital and Cancer Center
🇺🇸Antigo, Wisconsin, United States
Marshfield Medical Center-Rice Lake
🇺🇸Rice Lake, Wisconsin, United States
Juravinski Cancer Centre at Hamilton Health Sciences
🇨🇦Hamilton, Ontario, Canada
Odette Cancer Centre- Sunnybrook Health Sciences Centre
🇨🇦Toronto, Ontario, Canada
National Cancer Center-Korea
🇰🇷Goyang-si, Gyeonggi-do, Korea, Republic of
Saint John Macomb-Oakland Hospital
🇺🇸Warren, Michigan, United States
Veterans Affairs Loma Linda Healthcare System
🇺🇸Loma Linda, California, United States
Atlanta VA Medical Center
🇺🇸Decatur, Georgia, United States
Delbert Day Cancer Institute at PCRMC
🇺🇸Rolla, Missouri, United States
Geisinger Medical Center
🇺🇸Danville, Pennsylvania, United States
Tibor Rubin VA Medical Center
🇺🇸Long Beach, California, United States
UCHealth Memorial Hospital Central
🇺🇸Colorado Springs, Colorado, United States
University of Kansas Cancer Center-Overland Park
🇺🇸Overland Park, Kansas, United States
Kalispell Regional Medical Center
🇺🇸Kalispell, Montana, United States
Atlantic Health Sciences Corporation-Saint John Regional Hospital
🇨🇦Saint John, New Brunswick, Canada
Instituto Nacional De Cancerologia de Mexico
🇲🇽Mexico City, Tlalpan, Mexico
Doctor H. Bliss Murphy Cancer Centre
🇨🇦St. John's, Newfoundland and Labrador, Canada
Louisiana State University Health Science Center
🇺🇸New Orleans, Louisiana, United States
University Medical Center New Orleans
🇺🇸New Orleans, Louisiana, United States
University of Kansas Cancer Center - North
🇺🇸Kansas City, Missouri, United States
VCU Massey Cancer Center at Stony Point
🇺🇸Richmond, Virginia, United States
Virginia Commonwealth University/Massey Cancer Center
🇺🇸Richmond, Virginia, United States
University of Florida Health Science Center - Gainesville
🇺🇸Gainesville, Florida, United States
Hawaii Cancer Care Inc - Waterfront Plaza
🇺🇸Honolulu, Hawaii, United States
Queen's Cancer Cenrer - POB I
🇺🇸Honolulu, Hawaii, United States
Queen's Medical Center
🇺🇸Honolulu, Hawaii, United States
Straub Clinic and Hospital
🇺🇸Honolulu, Hawaii, United States
Kuakini Medical Center
🇺🇸Honolulu, Hawaii, United States
Queen's Cancer Center - Kuakini
🇺🇸Honolulu, Hawaii, United States
The Cancer Center of Hawaii-Liliha
🇺🇸Honolulu, Hawaii, United States
Iowa Methodist Medical Center
🇺🇸Des Moines, Iowa, United States
Medical Oncology and Hematology Associates-Des Moines
🇺🇸Des Moines, Iowa, United States
Broadlawns Medical Center
🇺🇸Des Moines, Iowa, United States
Mercy Medical Center - Des Moines
🇺🇸Des Moines, Iowa, United States
Mission Cancer and Blood - Laurel
🇺🇸Des Moines, Iowa, United States
Iowa Lutheran Hospital
🇺🇸Des Moines, Iowa, United States
University of Kentucky/Markey Cancer Center
🇺🇸Lexington, Kentucky, United States
Montefiore Medical Center-Einstein Campus
🇺🇸Bronx, New York, United States
Montefiore Medical Center-Weiler Hospital
🇺🇸Bronx, New York, United States
Montefiore Medical Center - Moses Campus
🇺🇸Bronx, New York, United States
University of New Mexico Cancer Center
🇺🇸Albuquerque, New Mexico, United States
Lovelace Radiation Oncology
🇺🇸Albuquerque, New Mexico, United States
Highland Hospital
🇺🇸Rochester, New York, United States
University of Rochester
🇺🇸Rochester, New York, United States
UM Sylvester Comprehensive Cancer Center at Coral Gables
🇺🇸Coral Gables, Florida, United States
University of Kansas Health System Saint Francis Campus
🇺🇸Topeka, Kansas, United States
Missouri Baptist Sullivan Hospital
🇺🇸Sullivan, Missouri, United States
Women's Diagnostic Center - Munster
🇺🇸Munster, Indiana, United States