Carboplatin and Paclitaxel Combined With Cetuximab and/or IMC-A12 in Patients With Advanced Non-Small Cell Lung Cancer
- Conditions
- Recurrent Non-small Cell Lung CancerStage IIIB Non-small Cell Lung CancerStage IV Non-small Cell Lung Cancer
- Interventions
- Registration Number
- NCT00986674
- Lead Sponsor
- National Cancer Institute (NCI)
- Brief Summary
This randomized phase II trial is studying how well giving carboplatin and paclitaxel together with cetuximab and/or cixutumumab (IMC-A12) works in treating patients with stage IIIB or stage IV non-small cell lung cancer. Drugs used in chemotherapy, such as carboplatin and paclitaxel, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Monoclonal antibodies, such as cetuximab and cixutumumab, can block tumor growth in different ways. Some block the ability of tumor cells to grow and spread. Others find tumor cells and help kill them or carry tumor-killing substances to them. Giving chemotherapy together with monoclonal antibody therapy may kill more tumor cells. It is not yet known whether carboplatin and paclitaxel are more effective when given with cetuximab and/or cixutumumab in treating non-small cell lung cancer.
- Detailed Description
PRIMARY OBJECTIVES:
I. To evaluate the progression-free survival of patients with non-small cell lung cancer (NSCLC) randomized to carboplatin plus paclitaxel plus cetuximab or carboplatin plus paclitaxel plus cixutumumab (IMC-A12) or carboplatin plus paclitaxel plus cetuximab plus cixutumumab.
SECONDARY OBJECTIVES:
I. To evaluate the response rate, disease control rate (complete response plus partial response plus stable disease), and toxicities for each arm.
II. To evaluate epidermal growth factor receptor (EGFR) by Immunohistochemistry (IHC), mutation, and gene copy number, Insulin-like growth factor 1 receptor (IGF-1R) and Insulin-like growth factor 2 receptor (IGF-2R) expression (both phosphorylated and unphosphorylated states), expression of p-AKT (ie, Protein Kinase B) by IHC, and k-ras mutation.
III. Plasma-based biomarkers will be evaluated for total and free insulin-like growth factor 1 and 2, IGF-growth factor binding protein 3 (IGFBP3) and circulating levels of epidermal growth factor (EGF) and Transforming growth factor (TGF) alpha.
IV. To evaluate overall survival on each of the three arms.
OUTLINE: This is a multicenter study. Patients are stratified according to gender and histology (squamous cell vs non-squamous cell). Patients are randomized to 1 of 3 treatment arms.
ARM I: Patients receive carboplatin intravenously (IV) over 15-30 minutes and paclitaxel IV over 3 hours on days 1 and 22 and cetuximab IV over 1-2 hours on days 1, 8, 15, 22, 29, and 36. Treatment repeats every 42 days for 2 courses. Patients with stable or responding disease after 2 courses proceed to maintenance therapy with cetuximab alone on days 1, 8, 15, 22, 29, and 36. Treatment with cetuximab repeats every 42 days in the absence of disease progression or unacceptable toxicity.
ARM II: Patients receive carboplatin and paclitaxel as in arm I. Patients also receive cixutumumab IV over 1 hour on days 1, 15, and 29. Treatment repeats every 42 days for 2 courses. Patients with stable or responding disease after 2 courses proceed to maintenance therapy with cixutumumab alone on days 1, 15, and 29. Treatment with cixutumumab repeats every 42 days in the absence of disease progression or unacceptable toxicity.
ARM III: Patients receive carboplatin, paclitaxel, and cetuximab as in arm I. Patients also receive cixutumumab as in arm II. Treatment repeats every 42 days for 2 courses. Patients with stable or responding disease after 2 courses proceed to maintenance therapy with cetuximab as in arm I and cixutumumab as in arm II.
Tumor tissue samples are collected at baseline for analysis of EGFR expression by IHC, mutation, and gene copy number; IGF-1R and IGF-2R expression (both phosphorylated and unphosphorylated states); p-AKT expression by IHC; and k-ras mutation. Blood, serum, and plasma samples are collected periodically for biomarker analysis.
After completion of study treatment, patients are followed up every 3 months for 2 years and then every 6 months for 1 year.
PROJECTED ACCRUAL: 200 patients
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 140
-
Histologically or cytologically confirmed non-small cell lung cancer (NSCLC)
-
Stage IIIB disease
- T4, NX with nodule in ipsilateral lung lobe allowed provided patient is not a candidate for combined chemotherapy and radiotherapy
-
Stage IV disease (includes M1a and M1b)
-
-
Measurable disease as defined by Response Evaluation Criteria in Solid Tumors (RECIST) criteria
-
Ineligible for or refused treatment with bevacizumab
-
No untreated or symptomatic central nervous system (CNS) metastases
-
Patients with a history of CNS metastases that are definitively treated, stable, and controlled are eligible provided the following criteria are met:
- Definitive therapy (surgery and/or radiotherapy) has been administered
- Not planning to undergo additional treatment for brain metastases
- Clinically stable
- Off corticosteroids or on a stable dose of corticosteroids for ≥ 14 days before study entry
-
-
ECOG performance status 0-1
-
Leukocytes > 3,000/mm^3
-
Absolute neutrophil count (ANC) > 1,500/mm^3
-
Hemoglobin > 9 g/dL
-
Platelet count > 100,000/mm^3
-
Total bilirubin ≤ 1.5 times upper limit of normal (ULN)
-
Aspartate Aminotransferase (AST) < 3 times ULN (< 5 times ULN if elevations due to liver metastases)
-
Creatinine < 1.5 times ULN OR creatinine clearance > 60 mL/min
-
Fasting serum glucose < 120 mg/dL
-
Partial thromboplastin time (PTT) ≤ 1.2 times ULN and international normalized ratio (INR) ≤ 1.5 (unless patient is on anticoagulation therapy)
-
Negative pregnancy test
-
Fertile patients must use effective contraception during and for 3 months after the last dose of cixutumumab
-
No poorly controlled diabetes mellitus
- Patients with a history of diabetes mellitus are eligible provided their blood glucose is within normal range and they are on a stable dietary or therapeutic regimen for this condition
-
No other prior or concurrent malignancy, except for the following:
- Curatively treated malignancy with no known active disease for ≥ 3 years AND is considered to be at low risk for recurrence by the treating physician
- Adequately treated nonmelanoma skin cancer or lentigo maligna with no evidence of disease
- Adequately treated cervical carcinoma in situ with no evidence of disease
- Prostatic intraepithelial neoplasia with no evidence of prostate cancer
-
Concurrent therapeutic anticoagulation allowed provided there is no bleeding and patient is on a stable dose of anticoagulation therapy (e.g., Warfarin with an INR of 2-3) for > 2 weeks prior to study entry
-
At least 21 days since prior radiotherapy
-
More than 4 weeks since prior major surgery or hormonal therapy (other than hormone replacement therapy) and recovered
-
More than 1 year since prior neoadjuvant or adjuvant chemotherapy
Exclusion criteria:
-
Small cell lung cancer or mixed small cell and NSCLC
-
History of allergic reactions attributed to compounds of similar chemical or biological composition to cixutumumab
-
History of any medical or psychiatric condition, addictive disorder, or laboratory abnormality that, in the opinion of the investigator, may increase the risks associated with study participation or study treatments or may interfere with the conduct of the study or interpretation of study results
-
Prior agents targeting the EGFR or Insulin-like growth factor (IGFR) pathways
-
Prior therapy for advanced NSCLC, except for surgery and/or radiotherapy
-
Prior systemic therapy, including bevacizumab for advanced stage NSCLC
-
Pregnant or nursing
-
Peripheral neuropathy > grade 1 as per Common Terminology Criteria for Adverse Event (CTCAE) v 4.0
-
History of or suspected interstitial pneumonitis or pulmonary fibrosis on imaging
-
Significant uncontrolled cardiac disease within the past 6 months, including any of the following:
- Uncontrolled hypertension (BP > 150/100 mm Hg)
- Unstable angina
- Recent myocardial infarction
- Uncontrolled congestive heart failure
- Cardiomyopathy with decreased ejection fraction
-
Arterial thrombosis, pulmonary embolus, deep vein thrombosis, or hemorrhagic disorders within the past 28 days
Not provided
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Arm II (carboplatin, paclitaxel, cixutumumab) cixutumumab Patients receive carboplatin and paclitaxel as in arm I. Patients also receive cixutumumab IV over 1 hour on days 1, 15, and 29. Treatment repeats every 42 days for 2 courses. Patients with stable or responding disease after 2 courses proceed to maintenance therapy with cixutumumab alone on days 1, 15, and 29. Treatment with cixutumumab repeats every 42 days in the absence of disease progression or unacceptable toxicity. Arm I (carboplatin, paclitaxel, cetuximab) paclitaxel Patients receive carboplatin IV over 15-30 minutes and paclitaxel IV over 3 hours on days 1 and 22 and cetuximab IV over 1-2 hours on days 1, 8, 15, 22, 29, and 36. Treatment repeats every 42 days for 2 courses. Patients with stable or responding disease after 2 courses proceed to maintenance therapy with cetuximab alone on days 1, 8, 15, 22, 29, and 36. Treatment with cetuximab repeats every 42 days in the absence of disease progression or unacceptable toxicity. Arm III (carboplatin, paclitaxel, cetuximab, cixutumumab) cixutumumab Patients receive carboplatin, paclitaxel, and cetuximab as in arm I. Patients also receive cixutumumab as in arm II. Treatment repeats every 42 days for 2 courses. Patients with stable or responding disease after 2 courses proceed to maintenance therapy with cetuximab as in arm I and cixutumumab as in arm II. Arm I (carboplatin, paclitaxel, cetuximab) cetuximab Patients receive carboplatin IV over 15-30 minutes and paclitaxel IV over 3 hours on days 1 and 22 and cetuximab IV over 1-2 hours on days 1, 8, 15, 22, 29, and 36. Treatment repeats every 42 days for 2 courses. Patients with stable or responding disease after 2 courses proceed to maintenance therapy with cetuximab alone on days 1, 8, 15, 22, 29, and 36. Treatment with cetuximab repeats every 42 days in the absence of disease progression or unacceptable toxicity. Arm III (carboplatin, paclitaxel, cetuximab, cixutumumab) cetuximab Patients receive carboplatin, paclitaxel, and cetuximab as in arm I. Patients also receive cixutumumab as in arm II. Treatment repeats every 42 days for 2 courses. Patients with stable or responding disease after 2 courses proceed to maintenance therapy with cetuximab as in arm I and cixutumumab as in arm II. Arm I (carboplatin, paclitaxel, cetuximab) carboplatin Patients receive carboplatin IV over 15-30 minutes and paclitaxel IV over 3 hours on days 1 and 22 and cetuximab IV over 1-2 hours on days 1, 8, 15, 22, 29, and 36. Treatment repeats every 42 days for 2 courses. Patients with stable or responding disease after 2 courses proceed to maintenance therapy with cetuximab alone on days 1, 8, 15, 22, 29, and 36. Treatment with cetuximab repeats every 42 days in the absence of disease progression or unacceptable toxicity. Arm II (carboplatin, paclitaxel, cixutumumab) paclitaxel Patients receive carboplatin and paclitaxel as in arm I. Patients also receive cixutumumab IV over 1 hour on days 1, 15, and 29. Treatment repeats every 42 days for 2 courses. Patients with stable or responding disease after 2 courses proceed to maintenance therapy with cixutumumab alone on days 1, 15, and 29. Treatment with cixutumumab repeats every 42 days in the absence of disease progression or unacceptable toxicity. Arm II (carboplatin, paclitaxel, cixutumumab) carboplatin Patients receive carboplatin and paclitaxel as in arm I. Patients also receive cixutumumab IV over 1 hour on days 1, 15, and 29. Treatment repeats every 42 days for 2 courses. Patients with stable or responding disease after 2 courses proceed to maintenance therapy with cixutumumab alone on days 1, 15, and 29. Treatment with cixutumumab repeats every 42 days in the absence of disease progression or unacceptable toxicity. Arm III (carboplatin, paclitaxel, cetuximab, cixutumumab) carboplatin Patients receive carboplatin, paclitaxel, and cetuximab as in arm I. Patients also receive cixutumumab as in arm II. Treatment repeats every 42 days for 2 courses. Patients with stable or responding disease after 2 courses proceed to maintenance therapy with cetuximab as in arm I and cixutumumab as in arm II. Arm III (carboplatin, paclitaxel, cetuximab, cixutumumab) paclitaxel Patients receive carboplatin, paclitaxel, and cetuximab as in arm I. Patients also receive cixutumumab as in arm II. Treatment repeats every 42 days for 2 courses. Patients with stable or responding disease after 2 courses proceed to maintenance therapy with cetuximab as in arm I and cixutumumab as in arm II.
- Primary Outcome Measures
Name Time Method Progression Free Survival Tumor measurements are repeated every 6 weeks while on treatment. After off treatment, assessed every 3 months if patient is < 2 years from study entry and every 6 months in year 3 Progression free survival is defined as time from registration to disease progression or death from any cause, whichever occurred earlier. Disease progression was assessed via Response Evaluation Criteria in Solid Tumors (RECIST) version 1.0, and defined as at least a 20% increase in the sum of the longest diameters of target lesions, taking as reference the smallest sum longest diameter recorded since the baseline measurements, and/or the appearance of one or more new lesion(s), and/or unequivocal progression of existing nontarget lesions .
All eligible and treated patients were included in the analysis.
- Secondary Outcome Measures
Name Time Method Overall Survival assessed every 3 months if patient is < 2 years from study entry and every 6 months in year 3 Overall survival is defined as time from registration to death from any cause.
Response Rate Tumor measurements are repeated every 6 weeks while on treatment. After off treatment, assessed every 3 months if patient is < 2 years from study entry and every 6 months in year 3 Tumor response was assessed via Response Evaluation Criteria in Solid Tumors (RECIST) version 1.0. Complete response (CR) was defined disappearance of all tumor lesions. Partial response (PR) was defined as as at least a 30% decrease in the sum of the longest diameters of target lesions, taking as reference the baseline sum longest diameter. Overall response rate= CR+PR.
Trial Locations
- Locations (247)
Greater Baltimore Medical Center
🇺🇸Baltimore, Maryland, United States
Abramson Cancer Center of The University of Pennsylvania
🇺🇸Philadelphia, Pennsylvania, United States
Albert Einstein Medical Center
🇺🇸Philadelphia, Pennsylvania, United States
Riverside Methodist Hospital
🇺🇸Columbus, Ohio, United States
Grant Medical Center
🇺🇸Columbus, Ohio, United States
Doctors Hospital
🇺🇸Columbus, Ohio, United States
Illinois CancerCare-Canton
🇺🇸Canton, Illinois, United States
Illinois CancerCare-Carthage
🇺🇸Carthage, Illinois, United States
Illinois CancerCare-Eureka
🇺🇸Eureka, Illinois, United States
Sky Ridge Medical Center
🇺🇸Lone Tree, Colorado, United States
Illinois CancerCare-Pekin
🇺🇸Pekin, Illinois, United States
North Colorado Medical Center
🇺🇸Greeley, Colorado, United States
Illinois CancerCare Galesburg
🇺🇸Galesburg, Illinois, United States
Mcdonough District Hospital
🇺🇸Macomb, Illinois, United States
Mason District Hospital
🇺🇸Havana, Illinois, United States
Saint Anthony Hospital
🇺🇸Lakewood, Colorado, United States
Rose Medical Center
🇺🇸Denver, Colorado, United States
McKee Medical Center
🇺🇸Loveland, Colorado, United States
Saint Mary Corwin Medical Center
🇺🇸Pueblo, Colorado, United States
Memorial Hospital
🇺🇸Carthage, Illinois, United States
Stanford University Hospitals and Clinics
🇺🇸Stanford, California, United States
Porubcin, Michael MD (UIA Investigator)
🇺🇸Moline, Illinois, United States
Illinois CancerCare-Monmouth
🇺🇸Monmouth, Illinois, United States
Illinois CancerCare-Kewanee Clinic
🇺🇸Kewanee, Illinois, United States
Stoffel, Thomas J MD (UIA Investigator)
🇺🇸Moline, Illinois, United States
Eureka Hospital
🇺🇸Eureka, Illinois, United States
Illinois CancerCare-Havana
🇺🇸Havana, Illinois, United States
Boulder Community Hospital
🇺🇸Boulder, Colorado, United States
Evanston CCOP-NorthShore University HealthSystem
🇺🇸Evanston, Illinois, United States
Illinois CancerCare-Macomb
🇺🇸Macomb, Illinois, United States
Bronson Methodist Hospital
🇺🇸Kalamazoo, Michigan, United States
Mary Rutan Hospital
🇺🇸Bellefontaine, Ohio, United States
Saint John's Hospital - Healtheast
🇺🇸Maplewood, Minnesota, United States
Saint Mary's Hospital and Regional Medical Center
🇺🇸Grand Junction, Colorado, United States
Saint John Macomb-Oakland Hospital
🇺🇸Warren, Michigan, United States
Saint Mary's of Michigan
🇺🇸Saginaw, Michigan, United States
Trinity Medical Center
🇺🇸Moline, Illinois, United States
Cancer Center of Kansas - Winfield
🇺🇸Winfield, Kansas, United States
Sharis, Christine M MD (UIA Investigator)
🇺🇸Moline, Illinois, United States
Illinois CancerCare-Princeton
🇺🇸Princeton, Illinois, United States
Saint Luke's Regional Medical Center
🇺🇸Sioux City, Iowa, United States
Cancer Center of Kansas-Wichita Medical Arts Tower
🇺🇸Wichita, Kansas, United States
Spector, David MD (UIA Investigator)
🇺🇸Moline, Illinois, United States
Illinois Valley Hospital
🇺🇸Peru, Illinois, United States
Allegiance Health
🇺🇸Jackson, Michigan, United States
IU Health Arnett
🇺🇸Lafayette, Indiana, United States
Lawrence Memorial Hospital
🇺🇸Lawrence, Kansas, United States
West Michigan Cancer Center
🇺🇸Kalamazoo, Michigan, United States
Elkhart General Hospital
🇺🇸Elkhart, Indiana, United States
Bromenn Regional Medical Center
🇺🇸Normal, Illinois, United States
Proctor Hospital
🇺🇸Peoria, Illinois, United States
Illinois CancerCare-Peoria
🇺🇸Peoria, Illinois, United States
Illinois CancerCare-Peru
🇺🇸Peru, Illinois, United States
Oakwood Hospital
🇺🇸Dearborn, Michigan, United States
Constantinou, Costas L MD (UIA Investigator)
🇺🇸Bettendorf, Iowa, United States
Mercy Hospital
🇺🇸Scranton, Pennsylvania, United States
Cancer Center of Kansas - Fort Scott
🇺🇸Fort Scott, Kansas, United States
Borgess Medical Center
🇺🇸Kalamazoo, Michigan, United States
Holy Family Medical Center
🇺🇸Monmouth, Illinois, United States
Hurley Medical Center
🇺🇸Flint, Michigan, United States
Community Cancer Center Foundation
🇺🇸Normal, Illinois, United States
Cedar Rapids Oncology Association
🇺🇸Cedar Rapids, Iowa, United States
Community Cancer Center of Monroe
🇺🇸Monroe, Michigan, United States
Illinois CancerCare-Spring Valley
🇺🇸Spring Valley, Illinois, United States
Community Howard Regional Health
🇺🇸Kokomo, Indiana, United States
Saint Margaret's Hospital
🇺🇸Spring Valley, Illinois, United States
Sparrow Hospital
🇺🇸Lansing, Michigan, United States
Associates In Womens Health
🇺🇸Wichita, Kansas, United States
Perry Memorial Hospital
🇺🇸Princeton, Illinois, United States
Memorial Hospital of South Bend
🇺🇸South Bend, Indiana, United States
Essentia Health Duluth Clinic CCOP
🇺🇸Duluth, Minnesota, United States
Cancer Center of Kansas - Newton
🇺🇸Newton, Kansas, United States
Cancer Center of Kansas - Pratt
🇺🇸Pratt, Kansas, United States
Cancer Center of Kansas - Wellington
🇺🇸Wellington, Kansas, United States
Green Bay Oncology - Escanaba
🇺🇸Escanaba, Michigan, United States
Virtua West Jersey Hospital Voorhees
🇺🇸Voorhees, New Jersey, United States
Case Western Reserve University
🇺🇸Cleveland, Ohio, United States
Saint Mary Mercy Hospital
🇺🇸Livonia, Michigan, United States
New York Oncology Hematology PC - Troy
🇺🇸Troy, New York, United States
Mercy Memorial Hospital
🇺🇸Monroe, Michigan, United States
Hematology Oncology Center Incorporated
🇺🇸Elyria, Ohio, United States
Fairfield Medical Center
🇺🇸Lancaster, Ohio, United States
Essentia Health Saint Mary's Medical Center
🇺🇸Duluth, Minnesota, United States
Saint Charles Hospital
🇺🇸Oregon, Ohio, United States
Saint Joseph Mercy Oakland
🇺🇸Pontiac, Michigan, United States
Fairview-Southdale Hospital
🇺🇸Edina, Minnesota, United States
New York Oncology Hematology PC - Amsterdam
🇺🇸Amsterdam, New York, United States
Newark Beth Israel Medical Center
🇺🇸Newark, New Jersey, United States
Lakeland Hospital
🇺🇸St. Joseph, Michigan, United States
Fairview Ridges Hospital
🇺🇸Burnsville, Minnesota, United States
Hunterdon Medical Center
🇺🇸Flemington, New Jersey, United States
Knox Community Hospital
🇺🇸Mount Vernon, Ohio, United States
Nebraska Cancer Research Center
🇺🇸Lincoln, Nebraska, United States
Saint Luke's Hospital
🇺🇸Maumee, Ohio, United States
Toledo Clinic Cancer Centers-Maumee
🇺🇸Maumee, Ohio, United States
Mount Carmel Health Center West
🇺🇸Columbus, Ohio, United States
Marietta Memorial Hospital
🇺🇸Marietta, Ohio, United States
Lima Memorial Hospital
🇺🇸Lima, Ohio, United States
New York Oncology Hematology PC -Albany Medical Center
🇺🇸Albany, New York, United States
North Coast Cancer Care
🇺🇸Sandusky, Ohio, United States
North Coast Cancer Care-Clyde
🇺🇸Clyde, Ohio, United States
Bryn Mawr Hospital
🇺🇸Bryn Mawr, Pennsylvania, United States
Natalie Warren Bryant Cancer Center at Saint Francis
🇺🇸Tulsa, Oklahoma, United States
Lancaster General Hospital
🇺🇸Lancaster, Pennsylvania, United States
UHHS-Westlake Medical Center
🇺🇸Westlake, Ohio, United States
Mercy Hospital of Tiffin
🇺🇸Tiffin, Ohio, United States
Geisinger Medical Center
🇺🇸Danville, Pennsylvania, United States
Grady Memorial Hospital
🇺🇸Delaware, Ohio, United States
Toledo Clinic Cancer Centers-Oregon
🇺🇸Oregon, Ohio, United States
Toledo Community Hospital Oncology Program CCOP
🇺🇸Toledo, Ohio, United States
Genesis HealthCare System
🇺🇸Zanesville, Ohio, United States
Saint Ann's Hospital
🇺🇸Westerville, Ohio, United States
Flower Hospital
🇺🇸Sylvania, Ohio, United States
Geisinger Medical Center-Cancer Center Hazelton
🇺🇸Hazleton, Pennsylvania, United States
Riverview Hospital
🇺🇸Wisconsin Rapids, Wisconsin, United States
Green Bay Oncology - Oconto Falls
🇺🇸Oconto Falls, Wisconsin, United States
Holy Family Memorial Hospital
🇺🇸Manitowoc, Wisconsin, United States
Marshfield Clinic-Wausau Center
🇺🇸Wausau, Wisconsin, United States
Indiana University Medical Center
🇺🇸Indianapolis, Indiana, United States
Wishard Hospital
🇺🇸Indianapolis, Indiana, United States
Abbott-Northwestern Hospital
🇺🇸Minneapolis, Minnesota, United States
Nevada Cancer Research Foundation CCOP
🇺🇸Las Vegas, Nevada, United States
Porter Adventist Hospital
🇺🇸Denver, Colorado, United States
Exempla Saint Joseph Hospital
🇺🇸Denver, Colorado, United States
Presbyterian - Saint Lukes Medical Center - Health One
🇺🇸Denver, Colorado, United States
Colorado Cancer Research Program CCOP
🇺🇸Denver, Colorado, United States
Saint John Hospital and Medical Center
🇺🇸Detroit, Michigan, United States
University of Pittsburgh
🇺🇸Pittsburgh, Pennsylvania, United States
Cancer Center of Kansas - El Dorado
🇺🇸El Dorado, Kansas, United States
North Suburban Medical Center
🇺🇸Thornton, Colorado, United States
Exempla Lutheran Medical Center
🇺🇸Wheat Ridge, Colorado, United States
Manchester Memorial Hospital
🇺🇸Manchester, Connecticut, United States
Danbury Hospital
🇺🇸Danbury, Connecticut, United States
Saint Francis Hospital and Medical Center
🇺🇸Hartford, Connecticut, United States
Medical Center of Central Georgia
🇺🇸Macon, Georgia, United States
Saint Joseph Medical Center
🇺🇸Bloomington, Illinois, United States
Hinsdale Hematology Oncology Associates Incorporated
🇺🇸Hinsdale, Illinois, United States
Garneau, Stewart C MD (UIA Investigator)
🇺🇸Moline, Illinois, United States
Illinois CancerCare-Ottawa Clinic
🇺🇸Ottawa, Illinois, United States
Illinois CancerCare-Community Cancer Center
🇺🇸Normal, Illinois, United States
Pekin Cancer Treatment Center
🇺🇸Pekin, Illinois, United States
Pekin Hospital
🇺🇸Pekin, Illinois, United States
Methodist Medical Center of Illinois
🇺🇸Peoria, Illinois, United States
Richard L. Roudebush Veterans Affairs Medical Center
🇺🇸Indianapolis, Indiana, United States
Indiana University Health La Porte Hospital
🇺🇸La Porte, Indiana, United States
Saint Joseph Regional Medical Center-Mishawaka
🇺🇸Mishawaka, Indiana, United States
Northern Indiana Cancer Research Consortium
🇺🇸South Bend, Indiana, United States
Mercy Medical Center-Sioux City
🇺🇸Sioux City, Iowa, United States
Oncology Associates at Mercy Medical Center
🇺🇸Cedar Rapids, Iowa, United States
Siouxland Hematology Oncology Associates
🇺🇸Sioux City, Iowa, United States
Cancer Center of Kansas - Main Office
🇺🇸Wichita, Kansas, United States
Green Bay Oncology - Iron Mountain
🇺🇸Iron Mountain, Michigan, United States
Genesys Regional Medical Center-West Flint Campus
🇺🇸Flint, Michigan, United States
Saint Joseph Mercy Port Huron
🇺🇸Port Huron, Michigan, United States
Marie Yeager Cancer Center
🇺🇸Saint Joseph, Michigan, United States
Miller-Dwan Hospital
🇺🇸Duluth, Minnesota, United States
Minnesota Oncology Hematology PA-Maplewood
🇺🇸Maplewood, Minnesota, United States
Unity Hospital
🇺🇸Fridley, Minnesota, United States
University Medical Center of Southern Nevada
🇺🇸Las Vegas, Nevada, United States
New York Oncology Hematology PC - Albany
🇺🇸Albany, New York, United States
New York Oncology Hematology PC - Latham
🇺🇸Latham, New York, United States
New York Oncology Hematology PC - Rexford
🇺🇸Rexford, New York, United States
New York Oncology Hematology PC-Hudson
🇺🇸Hudson, New York, United States
Toledo Clinic Cancer Centers-Bowling Green
🇺🇸Bowling Green, Ohio, United States
Summa Akron City Hospital/Cooper Cancer Center
🇺🇸Akron, Ohio, United States
UHHS-Chagrin Highlands Medical Center
🇺🇸Orange Village, Ohio, United States
Toledo Radiation Oncology at Northwest Ohio Onocolgy Center
🇺🇸Maumee, Ohio, United States
Licking Memorial Hospital
🇺🇸Newark, Ohio, United States
Springfield Regional Medical Center
🇺🇸Springfield, Ohio, United States
University of Toledo
🇺🇸Toledo, Ohio, United States
The Toledo Hospital/Toledo Children's Hospital
🇺🇸Toledo, Ohio, United States
Saint Vincent Mercy Medical Center
🇺🇸Toledo, Ohio, United States
Mercy Saint Anne Hospital
🇺🇸Toledo, Ohio, United States
Fulton County Health Center
🇺🇸Wauseon, Ohio, United States
Cancer Center of Kansas-Independence
🇺🇸Independence, Kansas, United States
Cancer Center of Kansas - Chanute
🇺🇸Chanute, Kansas, United States
Cancer Center of Kansas-Kingman
🇺🇸Kingman, Kansas, United States
Cancer Center of Kansas - Salina
🇺🇸Salina, Kansas, United States
Cancer Center of Kansas-Liberal
🇺🇸Liberal, Kansas, United States
Cancer Center of Kansas - Parsons
🇺🇸Parsons, Kansas, United States
Via Christi Regional Medical Center
🇺🇸Wichita, Kansas, United States
Paoli Memorial Hospital
🇺🇸Paoli, Pennsylvania, United States
Scranton Hematology Oncology
🇺🇸Scranton, Pennsylvania, United States
Pottstown Memorial Medical Center
🇺🇸Pottstown, Pennsylvania, United States
Geisinger Medical Group
🇺🇸State College, Pennsylvania, United States
Geisinger Wyoming Valley
🇺🇸Wilkes-Barre, Pennsylvania, United States
Lankenau Hospital
🇺🇸Wynnewood, Pennsylvania, United States
Mainline Health CCOP
🇺🇸Wynnewood, Pennsylvania, United States
Scott and White Memorial Hospital
🇺🇸Temple, Texas, United States
Nashville Oncology Associates PC
🇺🇸Nashville, Tennessee, United States
University of Virginia
🇺🇸Charlottesville, Virginia, United States
West Virginia University Charleston
🇺🇸Charleston, West Virginia, United States
Fredericksburg Oncology Inc
🇺🇸Fredericksburg, Virginia, United States
Fox Valley Hematology and Oncology
🇺🇸Appleton, Wisconsin, United States
Green Bay Oncology Limited at Saint Mary's Hospital
🇺🇸Green Bay, Wisconsin, United States
Marshfield Clinic-Chippewa Center
🇺🇸Chippewa Falls, Wisconsin, United States
Saint Vincent Hospital
🇺🇸Green Bay, Wisconsin, United States
Saint Mary's Hospital
🇺🇸Green Bay, Wisconsin, United States
Bay Area Medical Center
🇺🇸Marinette, Wisconsin, United States
Marshfield Clinic
🇺🇸Marshfield, Wisconsin, United States
Marshfield Clinic at James Beck Cancer Center
🇺🇸Rhinelander, Wisconsin, United States
Marshfield Clinic-Rice Lake Center
🇺🇸Rice Lake, Wisconsin, United States
Marshfield Clinic Cancer Care at Saint Michael's Hospital
🇺🇸Stevens Point, Wisconsin, United States
Marshfield Clinic - Weston Center
🇺🇸Weston, Wisconsin, United States
Green Bay Oncology - Sturgeon Bay
🇺🇸Sturgeon Bay, Wisconsin, United States
Marshfield Clinic - Wisconsin Rapids Center
🇺🇸Wisconsin Rapids, Wisconsin, United States
Vanderbilt-Ingram Cancer Center Cool Springs
🇺🇸Franklin, Tennessee, United States
North Memorial Medical Health Center
🇺🇸Robbinsdale, Minnesota, United States
Metro-Minnesota CCOP
🇺🇸Saint Louis Park, Minnesota, United States
Park Nicollet Clinic - Saint Louis Park
🇺🇸Saint Louis Park, Minnesota, United States
United Hospital
🇺🇸Saint Paul, Minnesota, United States
Saint Francis Regional Medical Center
🇺🇸Shakopee, Minnesota, United States
Ridgeview Medical Center
🇺🇸Waconia, Minnesota, United States
Rice Memorial Hospital
🇺🇸Willmar, Minnesota, United States
Longmont United Hospital
🇺🇸Longmont, Colorado, United States
Penrose-Saint Francis Healthcare
🇺🇸Colorado Springs, Colorado, United States
Illinois CancerCare-Bloomington
🇺🇸Bloomington, Illinois, United States
Gundersen Lutheran
🇺🇸La Crosse, Wisconsin, United States
Marshfield Clinic-Minocqua Center
🇺🇸Minocqua, Wisconsin, United States
Green Bay Oncology at Saint Vincent Hospital
🇺🇸Green Bay, Wisconsin, United States
Wheeling Hospital
🇺🇸Wheeling, West Virginia, United States
Adena Regional Medical Center
🇺🇸Chillicothe, Ohio, United States
Columbus CCOP
🇺🇸Columbus, Ohio, United States
Fisher-Titus Medical Center
🇺🇸Norwalk, Ohio, United States
Wichita CCOP
🇺🇸Wichita, Kansas, United States
Fox Chase Cancer Center at Virtua Memorial Hospital of Burlington County
🇺🇸Mount Holly, New Jersey, United States
Minnesota Oncology and Hematology PA-Woodbury
🇺🇸Woodbury, Minnesota, United States
Marshfield Clinic Cancer Center at Sacred Heart
🇺🇸Eau Claire, Wisconsin, United States
UW Cancer Center Johnson Creek
🇺🇸Johnson Creek, Wisconsin, United States
The Medical Center of Aurora
🇺🇸Aurora, Colorado, United States
Saint Joseph Mercy Hospital
🇺🇸Ann Arbor, Michigan, United States
Michigan Cancer Research Consortium Community Clinical Oncology Program
🇺🇸Ann Arbor, Michigan, United States
Alegent Health Immanuel Medical Center
🇺🇸Omaha, Nebraska, United States
Alegent Health Bergan Mercy Medical Center
🇺🇸Omaha, Nebraska, United States
Missouri Valley Cancer Consortium CCOP
🇺🇸Omaha, Nebraska, United States
Creighton University Medical Center
🇺🇸Omaha, Nebraska, United States
Graham Hospital Association
🇺🇸Canton, Illinois, United States
Swedish Medical Center
🇺🇸Englewood, Colorado, United States
UW Health Oncology - 1 South Park
🇺🇸Madison, Wisconsin, United States
University of Wisconsin Hospital and Clinics
🇺🇸Madison, Wisconsin, United States
Illinois Oncology Research Association CCOP
🇺🇸Peoria, Illinois, United States
OSF Saint Francis Medical Center
🇺🇸Peoria, Illinois, United States
Toledo Clinic Cancer Centers-Toledo
🇺🇸Toledo, Ohio, United States
Ottawa Regional Hospital and Healthcare Center
🇺🇸Ottawa, Illinois, United States
Bixby Medical Center
🇺🇸Adrian, Michigan, United States
Hickman Cancer Center
🇺🇸Adrian, Michigan, United States
Cancer Center of Kansas - Dodge City
🇺🇸Dodge City, Kansas, United States