Paclitaxel With or Without Pazopanib Hydrochloride in Treating Patients With Persistent or Recurrent Ovarian Epithelial, Fallopian Tube, or Peritoneal Cavity Cancer

Phase 2

Completed

Conditions: Recurrent Fallopian Tube Carcinoma
Recurrent Ovarian Carcinoma
Recurrent Primary Peritoneal Carcinoma

Interventions: Other: Laboratory Biomarker Analysis
Drug: Paclitaxel
Other: Placebo
Drug: Pazopanib Hydrochloride

Registration Number: NCT01468909

Lead Sponsor: National Cancer Institute (NCI)

Brief Summary: This randomized phase II trial studies how well paclitaxel when given together with or without pazopanib hydrochloride works in treating patients with ovarian epithelial, fallopian tube, or peritoneal cavity cancer that is persistent or has come back. Drugs used in chemotherapy, such as paclitaxel work in different ways to stop the growth of tumor cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. Pazopanib hydrochloride may stop the growth of tumor cells by blocking blood flow to the tumor or by blocking some of the enzymes needed for cell growth. It is not yet known whether paclitaxel is more effective when given with or without pazopanib hydrochloride in treating ovarian epithelial, fallopian tube, and peritoneal cavity cancer.

Detailed Description: PRIMARY OBJECTIVES:

I. To estimate the progression-free survival hazard ratio of the combination of weekly paclitaxel and pazopanib (pazopanib hydrochloride) compared to weekly paclitaxel and placebo in patients with persistent or recurrent ovarian, fallopian tube, or primary peritoneal cancer.

SECONDARY OBJECTIVES:

I. To determine the frequency and severity of adverse events as assessed by Common Terminology Criteria for Adverse Events (CTCAE).

II. To estimate and compare the proportion of patients responding to therapy by Response Evaluation Criteria in Solid Tumors (RECIST), cancer antigen 125 (CA125) response, the overall survival (OS), and the duration of response in each arm.

TERTIARY OBJECTIVES:

I. To explore the association between plasma cytokines and angiogenic markers and progression-free and overall survival.

II. To explore the association between single-nucleotide polymorphisms (SNPs) and progression-free and overall survival.

OUTLINE: Patients are randomized to 1 of 2 treatment arms.

ARM I: Patients receive paclitaxel intravenously (IV) over 1 hour on days 1, 8, and 15 and placebo orally (PO) daily on days 1-28.

ARM II: Patients receive paclitaxel as in Arm I and pazopanib hydrochloride PO daily on days 1-28.

In both arms, courses repeat every 28 days in the absence of disease progression or unacceptable toxicity.

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

Recruitment & Eligibility

Status: COMPLETED

Sex: Female

Target Recruitment: 106

Inclusion Criteria

Patients must have recurrent or persistent epithelial ovarian, fallopian tube, or primary peritoneal carcinoma; histologic documentation of the original primary tumor is required via the pathology report
Patients must have measurable disease or non-measurable (detectable) disease
- Measurable disease is defined as at least one lesion that can be accurately measured in at least one dimension (longest diameter to be recorded); each lesion must be greater than or equal to 10 mm when measured by computed tomography (CT), magnetic resonance imaging (MRI), or caliper measurement by clinical exam; or greater than or equal to 20 mm when measured by chest x-ray; lymph nodes must be greater than or equal to 15 mm in short axis when measured by CT or MRI
- Non-measurable (detectable) disease in a patient is defined in this protocol as one who does not have measurable disease but has at least one of the following conditions:
  - Ascites and/or pleural effusion attributed to tumor
  - Solid and/or cystic abnormalities on radiographic imaging that do not meet RECIST 1.1 definitions for target lesions
Patients with measurable disease must have at least one "target lesion" to be used to assess response on this protocol as defined by RECIST 1.1; tumors within a previously irradiated field will be designated as "non-target" lesions unless progression is documented or a biopsy is obtained to confirm persistence at least 90 days following completion of radiation therapy
Patients must not be eligible for a higher priority Gynecology Oncology Group (GOG) protocol, if one exists; in general, this would refer to any active GOG phase III or Rare Tumor protocol for the same patient population; in addition, patients must not be eligible for the currently active phase II cytotoxic protocol in platinum resistant disease
Patients who have received one prior regimen must have a GOG performance status of 0, 1, or 2
Patients who have received two or three prior regimens must have a GOG performance status of 0 or 1
Recovery from effects of recent surgery, radiotherapy, or chemotherapy
Patients should be free of active infection requiring antibiotics (with the exception of uncomplicated urinary tract infection [UTI])
Any hormonal therapy directed at the malignant tumor must be discontinued at least one week prior to registration
Any other prior therapy directed at the malignant tumor, including chemotherapy, biological/targeted (non-cytotoxic) agents, and immunologic agents, must be discontinued at least three weeks prior to registration; chimeric or human or humanized monoclonal antibodies (including bevacizumab) or vascular endothelial growth factor (VEGF) receptor fusion proteins (including VEGF TRAP/aflibercept) must be discontinued for at least 12 weeks prior to registration
At least 4 weeks must have elapsed since the patient underwent any major surgery (e.g., major: laparotomy, laparoscopy, thoracotomy, video-assisted thorascopic surgery [VATS]); there is no restriction on minor procedures (e.g., minor: central venous access catheter placement, ureteral stent placement or exchange, paracentesis, thoracentesis)
Patients must have had one prior platinum-based chemotherapeutic regimen for management of primary disease containing carboplatin, cisplatin, or another organoplatinum compound; this initial treatment may have included intraperitoneal therapy, consolidation, biologic/targeted (non-cytotoxic) agents (e.g., bevacizumab), or extended therapy administered after surgical or non-surgical assessment; if patients were treated with paclitaxel for their primary disease, this can have been given weekly or every 3 weeks
Patients are allowed to receive, but are not required to receive, two additional cytotoxic regimens for management of recurrent or persistent disease, with no more than 1 non-platinum, non-taxane regimen; treatment with weekly paclitaxel for recurrent or persistent disease is NOT allowed
Patients are allowed to receive, but are not required to receive, biologic/targeted (non-cytotoxic) therapy as part of their primary treatment regimen
Patients must have NOT received any biologic/targeted (non-cytotoxic) therapy targeting the VEGF and/or platelet-derived growth factor (PDGF) pathways for management of recurrent or persistent disease
For the purposes of this study, poly (ADP-ribose) polymerase (PARP) inhibitors will be considered "cytotoxic"; patients are allowed to receive, but are not required to receive, PARP inhibitors for management of primary or recurrent/persistent disease (either alone or in combination with cytotoxic chemotherapy); PARP inhibitors will NOT count as a prior regimen when given alone
Absolute neutrophil count (ANC) greater than or equal to 1,500/mcL
Platelets greater than or equal to 100,000/mcL
Hemoglobin greater than or equal to 9 g/dL
Prothrombin time (PT) such that international normalized ratio (INR) is less than or equal to 1.5 x upper limit of normal (ULN) (or an in-range INR, usually between 2 and 3, if a patient is on a stable dose of therapeutic warfarin)
Partial thromboplastin time (PTT) less than or equal to 1.5 x ULN
Creatinine less than or equal to 1.5 x institutional ULN
Urine protein should be screened by urinalysis; if urine protein is 2+ or higher, 24-hour urine protein should be obtained and the level must be < 1000 mg (< 1.0 g/24 hours [hrs]) for patient enrollment
Bilirubin less than or equal to 1.5 x ULN
Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) less than or equal to 2.5 x ULN
Subjects who have BOTH bilirubin greater than ULN and AST/ALT greater than ULN are not eligible
Alkaline phosphatase less than or equal to 2.5 x ULN
Patients must have normal baseline thyroid function tests (thyroid-stimulating hormone [TSH], T3, T4); a history of hypothyroidism and/or hyperthyroidism is allowed, as long as the patient has stable well-controlled thyroid function for a minimum of 2 months
Neuropathy (sensory and motor) less than or equal to grade 1
Patients of childbearing potential must have a negative pregnancy test prior to the study entry and be practicing an effective form of contraception; pregnant women are excluded from this study
Patients must have signed an approved informed consent and authorization permitting the release of personal health information
Patients must be capable of taking and absorbing oral medications; a patient must be clear of the following:
- Any lesion, whether induced by tumor, radiation, or other conditions, which makes it difficult to swallow tablets
- Prior surgical procedures affecting absorption including, but not limited to major resection of stomach or small bowel
- Active peptic ulcer disease
- Malabsorption syndrome
Any concomitant medications that are associated with a risk of corrected QT (QTc) prolongation and/or Torsades de Pointes should be discontinued or replaced with drugs that do not carry these risks, if possible; patients who must take medication with a risk of possible risk of Torsades de Pointes should be watched carefully for symptoms of QTc prolongation, such as syncope
Patients with personal or family history of congenital long QTc syndrome are NOT eligible
Strong inhibitors of cytochrome P-450 system (CYP)3A4 are prohibited
Strong inducers of CYP3A4 are prohibited
Concomitant use of agents with narrow therapeutic windows that are metabolized by CYP3A4, CYP2D6, or CYP2C8 is not recommended

Exclusion Criteria

Patients who have had previous treatment with pazopanib; patients who have had previous treatment with weekly paclitaxel for recurrent or persistent disease
Patients with a history of other invasive malignancies, with the exception of non-melanoma skin cancer and other specific malignancies are excluded if there is any evidence of other malignancy being present within the last three years; patients are also excluded if their previous cancer treatment contraindicates this protocol therapy
Patients who have received prior radiotherapy to any portion of the abdominal cavity or pelvis within the last three years are excluded; prior radiation for localized cancer of the breast, head and neck, or skin is permitted, provided that it was completed more than three years prior to registration, and the patient remains free of recurrent or metastatic disease
Patients who have received prior chemotherapy for any abdominal or pelvic tumor OTHER THAN for the treatment of ovarian, fallopian tube, or primary peritoneal cancer within the last three years; patients may have received prior adjuvant chemotherapy for localized breast cancer, provided that it was completed more than three years prior to registration, and the patient remains free of recurrent or metastatic disease
Patients with clinically significant cardiovascular disease; this includes:
- Uncontrolled hypertension, defined as systolic greater than 140 mm Hg or diastolic greater than 90 mm Hg despite antihypertensive medications
- Congenital long QT syndrome or baseline QTc greater than 480 milliseconds
- Myocardial infarction or unstable angina within 6 months prior to registration
- New York Heart Association (NYHA) class II or greater congestive heart failure
- History of serious ventricular arrhythmia (i.e., ventricular tachycardia or ventricular fibrillation) or serious cardiac arrhythmia requiring medication
  - This does not include asymptomatic atrial fibrillation with controlled ventricular rate
- Patients who have received prior treatment with an anthracycline (including doxorubicin and/or liposomal doxorubicin) must have an echocardiogram assessment and are excluded if they have an ejection fraction less than 50%
- CTCAE grade 2 or greater peripheral vascular disease (at least brief [less than 24 hours] episodes of ischemia managed non-surgically and without permanent deficit)
- History of cardiac angioplasty or stenting within 6 months prior to registration
- History of coronary artery bypass graft surgery within 6 months prior to registration
- Arterial thrombosis within 6 months prior to registration
Patients with serious non-healing wound, ulcer, or bone fracture; this includes history of abdominal fistula, gastrointestinal perforation or intra-abdominal abscess within 28 days prior to the first date of study treatment
Patients with active bleeding or pathologic conditions that carry high risk of bleeding, such as known bleeding disorder, coagulopathy, or tumor involving major vessels
Patients with history or evidence upon physical examination of central nervous system (CNS) disease, including primary brain tumor, seizures which are not controlled with non-enzyme inducing anticonvulsants, any brain metastases, or history of cerebrovascular accident (CVA, stroke), transient ischemic attack (TIA) or subarachnoid hemorrhage within six months prior to the first date of study treatment
History of allergic reactions attributed to compounds of similar chemical or biologic composition to pazopanib
Known human immunodeficiency virus (HIV)-positive subjects on combination antiretroviral therapy
Patients with any condition that may increase the risk of gastrointestinal bleeding or gastrointestinal perforation, including:
- Active peptic ulcer disease
- Known gastrointestinal intraluminal metastatic lesions (gastrointestinal serosa metastatic lesions are permitted)
- Inflammatory bowel disease (e.g., ulcerative colitis, Crohn's disease)
- Patients with clinical symptoms or signs of gastrointestinal obstruction
- Patients who require parenteral hydration and/or nutrition
Patients who are pregnant or nursing
History of hemoptysis in excess of 2.5 mL (½ teaspoon) within 8 weeks prior to first dose of pazopanib
Uncontrolled intercurrent illness including, but not limited to, psychiatric illness/social situations that would limit compliance with study requirements

Study & Design

Study Type: INTERVENTIONAL

Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Arm I (paclitaxel and placebo)	Laboratory Biomarker Analysis	Patients receive paclitaxel IV over 1 hour on days 1, 8, and 15 and placebo PO daily on days 1-28. Treatment repeats every 28 days in the absence of disease progression or unacceptable toxicity.
Arm I (paclitaxel and placebo)	Placebo	Patients receive paclitaxel IV over 1 hour on days 1, 8, and 15 and placebo PO daily on days 1-28. Treatment repeats every 28 days in the absence of disease progression or unacceptable toxicity.
Arm II (paclitaxel and pazopanib hydrochloride)	Laboratory Biomarker Analysis	Patients receive paclitaxel as in arm I and pazopanib hydrochloride PO daily on days 1-28. Treatment repeats every 28 days in the absence of disease progression or unacceptable toxicity.
Arm II (paclitaxel and pazopanib hydrochloride)	Pazopanib Hydrochloride	Patients receive paclitaxel as in arm I and pazopanib hydrochloride PO daily on days 1-28. Treatment repeats every 28 days in the absence of disease progression or unacceptable toxicity.
Arm I (paclitaxel and placebo)	Paclitaxel	Patients receive paclitaxel IV over 1 hour on days 1, 8, and 15 and placebo PO daily on days 1-28. Treatment repeats every 28 days in the absence of disease progression or unacceptable toxicity.
Arm II (paclitaxel and pazopanib hydrochloride)	Paclitaxel	Patients receive paclitaxel as in arm I and pazopanib hydrochloride PO daily on days 1-28. Treatment repeats every 28 days in the absence of disease progression or unacceptable toxicity.

Primary Outcome Measures

Name	Time	Method
Progression Free Survival	For those patients whose disease can be evaluated by physical examination, progression was assessed prior to each 21-day cycle. CT scan or MRI if used to follow lesion for measurable disease every other cycle, Up to 5 years	The time from randomization until disease progression, death, or date of last contact. Endpoints are progression or death. Patients who are not observed with an endpoint are censored. Progression is defined using Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.0), as a 20% increase in the sum of the longest diameter of target lesions, or a measurable increase in a non-target lesion, or the appearance of new lesions

Secondary Outcome Measures

Name	Time	Method
Adverse Events as Assessed by CTCAE v.4	From baseline to 30 days after last dose of drug.	All grade 3 or greater Adverse Events (AEs) occurring during treatment and up to 30 days after stopping the study treatment are reported.
Proportion of Participants With Tumor Response by RECIST	Every other cycle for 6 months, then every 3 months until disease progression,Up to 5 years	Patients with Complete and Partial Tumor Response by RECIST 1.1. Responses (CR and PR) require confirmation at greater than or equal to 4 weeks from initial documentation. Per Response Evaluation Criteria In Solid Tumors Criteria (RECIST v1.0) for target lesions and assessed by MRI: Complete Response (CR), Disappearance of all target lesions; Partial Response (PR), \>=30% decrease in the sum of the longest diameter of target lesions; Overall Response (OR) = CR + PR.
Percentage of Participants With Tumor Response by CA-125	Prior to each cycle of treatment. Then follow-up every three months for 2 years and then every 6 months for 3 years, up to 5 years.	Response as evaluated by CA-125 levels. Response is indicated if CA-125 reduced by 50% of the baseline measure.
Overall Survival (OS)	Every cycle while patient is receiving protocol therapy. Patients monitored for survival after off therapy every 3 months for 2 years, then every 6 months, up to 5 years	Overall survival

Trial Locations

Locations (142): Case Western Reserve University
🇺🇸
Cleveland, Ohio, United States
Cleveland Clinic Cancer Center/Fairview Hospital
🇺🇸
Cleveland, Ohio, United States
Christiana Care Health System-Christiana Hospital
🇺🇸
Newark, Delaware, United States
Gynecologic Oncology Associates-Newport Beach
🇺🇸
Newport Beach, California, United States
Providence Saint Joseph Medical Center/Disney Family Cancer Center
🇺🇸
Burbank, California, United States
The Hospital of Central Connecticut
🇺🇸
New Britain, Connecticut, United States
Summa Akron City Hospital/Cooper Cancer Center
🇺🇸
Akron, Ohio, United States
Novant Health Presbyterian Medical Center
🇺🇸
Charlotte, North Carolina, United States
Reading Hospital
🇺🇸
West Reading, Pennsylvania, United States
Greater Baltimore Medical Center
🇺🇸
Baltimore, Maryland, United States
Sinai Hospital of Baltimore
🇺🇸
Baltimore, Maryland, United States
Johns Hopkins University/Sidney Kimmel Cancer Center
🇺🇸
Baltimore, Maryland, United States
Northwestern University
🇺🇸
Chicago, Illinois, United States
Rush University Medical Center
🇺🇸
Chicago, Illinois, United States
Riverside Methodist Hospital
🇺🇸
Columbus, Ohio, United States
University of Pennsylvania/Abramson Cancer Center
🇺🇸
Philadelphia, Pennsylvania, United States
Indiana University/Melvin and Bren Simon Cancer Center
🇺🇸
Indianapolis, Indiana, United States
Saint Vincent Hospital and Health Care Center
🇺🇸
Indianapolis, Indiana, United States
Pacific Gynecology Specialists
🇺🇸
Seattle, Washington, United States
Fred Hutchinson Cancer Research Center
🇺🇸
Seattle, Washington, United States
Seattle Cancer Care Alliance
🇺🇸
Seattle, Washington, United States
Swedish Medical Center-First Hill
🇺🇸
Seattle, Washington, United States
Women's Cancer Center of Nevada
🇺🇸
Las Vegas, Nevada, United States
University of Cincinnati/Barrett Cancer Center
🇺🇸
Cincinnati, Ohio, United States
Cancer Center of Kansas-Kingman
🇺🇸
Kingman, Kansas, United States
Ascension Saint Mary's Hospital
🇺🇸
Rhinelander, Wisconsin, United States
Marshfield Clinic
🇺🇸
Marshfield, Wisconsin, United States
University of South Alabama Mitchell Cancer Institute
🇺🇸
Mobile, Alabama, United States
Hartford Hospital
🇺🇸
Hartford, Connecticut, United States
Smilow Cancer Hospital Care Center at Saint Francis
🇺🇸
Hartford, Connecticut, United States
Women's Cancer Associates
🇺🇸
Saint Petersburg, Florida, United States
University of Connecticut
🇺🇸
Farmington, Connecticut, United States
Northeast Georgia Medical Center-Gainesville
🇺🇸
Gainesville, Georgia, United States
Beebe Medical Center
🇺🇸
Lewes, Delaware, United States
Memorial Health University Medical Center
🇺🇸
Savannah, Georgia, United States
Central Georgia Gynecologic Oncology
🇺🇸
Macon, Georgia, United States
Saint Alphonsus Cancer Care Center-Boise
🇺🇸
Boise, Idaho, United States
Sudarshan K Sharma MD Limted-Gynecologic Oncology
🇺🇸
Hinsdale, Illinois, United States
McFarland Clinic PC - Ames
🇺🇸
Ames, Iowa, United States
Cancer Center of Kansas - El Dorado
🇺🇸
El Dorado, Kansas, United States
Cancer Center of Kansas - Fort Scott
🇺🇸
Fort Scott, Kansas, United States
Cancer Center of Kansas - Chanute
🇺🇸
Chanute, Kansas, United States
Cancer Center of Kansas - Dodge City
🇺🇸
Dodge City, Kansas, United States
Cancer Center of Kansas-Independence
🇺🇸
Independence, Kansas, United States
Cancer Center of Kansas-Liberal
🇺🇸
Liberal, Kansas, United States
Cancer Center of Kansas - Newton
🇺🇸
Newton, Kansas, United States
Cancer Center of Kansas - Parsons
🇺🇸
Parsons, Kansas, United States
Cancer Center of Kansas - Pratt
🇺🇸
Pratt, Kansas, United States
Cancer Center of Kansas - Salina
🇺🇸
Salina, Kansas, United States
Cancer Center of Kansas - Wellington
🇺🇸
Wellington, Kansas, United States
Associates In Womens Health
🇺🇸
Wichita, Kansas, United States
Cancer Center of Kansas-Wichita Medical Arts Tower
🇺🇸
Wichita, Kansas, United States
Cancer Center of Kansas - Wichita
🇺🇸
Wichita, Kansas, United States
Via Christi Regional Medical Center
🇺🇸
Wichita, Kansas, United States
Wichita NCI Community Oncology Research Program
🇺🇸
Wichita, Kansas, United States
Maine Medical Center-Bramhall Campus
🇺🇸
Portland, Maine, United States
Cancer Center of Kansas - Winfield
🇺🇸
Winfield, Kansas, United States
Union Hospital of Cecil County
🇺🇸
Elkton, Maryland, United States
Bronson Battle Creek
🇺🇸
Battle Creek, Michigan, United States
Lahey Hospital and Medical Center
🇺🇸
Burlington, Massachusetts, United States
Baystate Medical Center
🇺🇸
Springfield, Massachusetts, United States
Spectrum Health Big Rapids Hospital
🇺🇸
Big Rapids, Michigan, United States
Beaumont Hospital-Dearborn
🇺🇸
Dearborn, Michigan, United States
Genesys Regional Medical Center
🇺🇸
Grand Blanc, Michigan, United States
Cancer Research Consortium of West Michigan NCORP
🇺🇸
Grand Rapids, Michigan, United States
Mercy Health Saint Mary's
🇺🇸
Grand Rapids, Michigan, United States
Hurley Medical Center
🇺🇸
Flint, Michigan, United States
Spectrum Health at Butterworth Campus
🇺🇸
Grand Rapids, Michigan, United States
Saint Mary Mercy Hospital
🇺🇸
Livonia, Michigan, United States
Allegiance Health
🇺🇸
Jackson, Michigan, United States
Mercy Health Mercy Campus
🇺🇸
Muskegon, Michigan, United States
Sparrow Hospital
🇺🇸
Lansing, Michigan, United States
Lake Huron Medical Center
🇺🇸
Port Huron, Michigan, United States
Saint John Macomb-Oakland Hospital
🇺🇸
Warren, Michigan, United States
Saint Mary's of Michigan
🇺🇸
Saginaw, Michigan, United States
Munson Medical Center
🇺🇸
Traverse City, Michigan, United States
Freeman Health System
🇺🇸
Joplin, Missouri, United States
Washington University School of Medicine
🇺🇸
Saint Louis, Missouri, United States
University of Mississippi Medical Center
🇺🇸
Jackson, Mississippi, United States
Cancer Research for the Ozarks NCORP
🇺🇸
Springfield, Missouri, United States
Mercy Hospital Springfield
🇺🇸
Springfield, Missouri, United States
CoxHealth South Hospital
🇺🇸
Springfield, Missouri, United States
Women's Cancer Care Associates LLC
🇺🇸
Albany, New York, United States
Dartmouth Hitchcock Medical Center
🇺🇸
Lebanon, New Hampshire, United States
Cooper Hospital University Medical Center
🇺🇸
Camden, New Jersey, United States
Stony Brook University Medical Center
🇺🇸
Stony Brook, New York, United States
Lake University Ireland Cancer Center
🇺🇸
Mentor, Ohio, United States
Kettering Medical Center
🇺🇸
Kettering, Ohio, United States
Cleveland Clinic Foundation
🇺🇸
Cleveland, Ohio, United States
Hillcrest Hospital Cancer Center
🇺🇸
Mayfield Heights, Ohio, United States
Oklahoma Cancer Specialists and Research Institute-Tulsa
🇺🇸
Tulsa, Oklahoma, United States
Greenville Health System Cancer Institute-Faris
🇺🇸
Greenville, South Carolina, United States
Women and Infants Hospital
🇺🇸
Providence, Rhode Island, United States
Abington Memorial Hospital
🇺🇸
Abington, Pennsylvania, United States
Baylor All Saints Medical Center at Fort Worth
🇺🇸
Fort Worth, Texas, United States
Greenville Health System Cancer Institute-Spartanburg
🇺🇸
Spartanburg, South Carolina, United States
Greenville Health System Cancer Institute-Eastside
🇺🇸
Greenville, South Carolina, United States
UT Southwestern/Simmons Cancer Center-Dallas
🇺🇸
Dallas, Texas, United States
Greenville Health System Cancer Institute-Seneca
🇺🇸
Seneca, South Carolina, United States
PeaceHealth Medical Group PC
🇺🇸
Bellingham, Washington, United States
Harrison Medical Center
🇺🇸
Bremerton, Washington, United States
Skagit Valley Hospital Regional Cancer Care Center
🇺🇸
Mount Vernon, Washington, United States
Harrison HealthPartners Hematology and Oncology-Bremerton
🇺🇸
Bremerton, Washington, United States
Providence Regional Cancer Partnership
🇺🇸
Everett, Washington, United States
Harrison HealthPartners Hematology and Oncology-Poulsbo
🇺🇸
Poulsbo, Washington, United States
Kaiser Permanente Washington
🇺🇸
Seattle, Washington, United States
Northwest Hospital
🇺🇸
Seattle, Washington, United States
Olympic Medical Cancer Care Center
🇺🇸
Sequim, Washington, United States
University of Washington Medical Center
🇺🇸
Seattle, Washington, United States
MultiCare Tacoma General Hospital
🇺🇸
Tacoma, Washington, United States
Saint Joseph Medical Center
🇺🇸
Tacoma, Washington, United States
Wenatchee Valley Hospital and Clinics
🇺🇸
Wenatchee, Washington, United States
Marshfield Clinic Cancer Center at Sacred Heart
🇺🇸
Eau Claire, Wisconsin, United States
Providence Saint Mary Regional Cancer Center
🇺🇸
Walla Walla, Washington, United States
Green Bay Oncology at Saint Vincent Hospital
🇺🇸
Green Bay, Wisconsin, United States
Saint Vincent Hospital Cancer Center Green Bay
🇺🇸
Green Bay, Wisconsin, United States
Green Bay Oncology Limited at Saint Mary's Hospital
🇺🇸
Green Bay, Wisconsin, United States
Holy Family Memorial Hospital
🇺🇸
Manitowoc, Wisconsin, United States
Bay Area Medical Center
🇺🇸
Marinette, Wisconsin, United States
Marshfield Clinic-Minocqua Center
🇺🇸
Minocqua, Wisconsin, United States
Ascension Saint Michael's Hospital
🇺🇸
Stevens Point, Wisconsin, United States
Marshfield Clinic-Rice Lake Center
🇺🇸
Rice Lake, Wisconsin, United States
Marshfield Clinic - Weston Center
🇺🇸
Weston, Wisconsin, United States
Marshfield Clinic - Wisconsin Rapids Center
🇺🇸
Wisconsin Rapids, Wisconsin, United States
Gynecologic Oncology Group of Arizona
🇺🇸
Phoenix, Arizona, United States
Florida Hospital Orlando
🇺🇸
Orlando, Florida, United States
University of Hawaii Cancer Center
🇺🇸
Honolulu, Hawaii, United States
Iowa Methodist Medical Center
🇺🇸
Des Moines, Iowa, United States
Iowa-Wide Oncology Research Coalition NCORP
🇺🇸
Des Moines, Iowa, United States
Medical Oncology and Hematology Associates-Des Moines
🇺🇸
Des Moines, Iowa, United States
Medical Oncology and Hematology Associates-Laurel
🇺🇸
Des Moines, Iowa, United States
Mercy Medical Center - Des Moines
🇺🇸
Des Moines, Iowa, United States
Iowa Lutheran Hospital
🇺🇸
Des Moines, Iowa, United States
Michigan Cancer Research Consortium NCORP
🇺🇸
Ann Arbor, Michigan, United States
Saint Joseph Mercy Hospital
🇺🇸
Ann Arbor, Michigan, United States
Saint John Hospital and Medical Center
🇺🇸
Detroit, Michigan, United States
Nebraska Methodist Hospital
🇺🇸
Omaha, Nebraska, United States
UNC Lineberger Comprehensive Cancer Center
🇺🇸
Chapel Hill, North Carolina, United States
University of Oklahoma Health Sciences Center
🇺🇸
Oklahoma City, Oklahoma, United States
Cancer Care Northwest - Spokane South
🇺🇸
Spokane, Washington, United States
Rockwood Cancer Treatment Center-DHEC-Downtown
🇺🇸
Spokane, Washington, United States
Saint Joseph Mercy Oakland
🇺🇸
Pontiac, Michigan, United States