Sorafenib and Bevacizumab in Treating Patients With Metastatic Colorectal Cancer

Phase 2

Completed

Conditions: Recurrent Colon Cancer
Recurrent Rectal Cancer
Stage IV Colon Cancer
Stage IV Rectal Cancer

Interventions: Drug: sorafenib tosylate
Biological: bevacizumab

Registration Number: NCT00826540

Lead Sponsor: Alliance for Clinical Trials in Oncology

Brief Summary: This phase II trial is studying how well giving sorafenib together with bevacizumab works in treating patients with metastatic colorectal cancer. Sorafenib may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Monoclonal antibodies, such as bevacizumab, 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. Sorafenib and bevacizumab may also stop the growth of tumor cells by blocking blood flow to the tumor. Giving sorafenib together with bevacizumab may kill more tumor cells

Detailed Description: PRIMARY OBJECTIVES:

I. Evaluate proportion of patients who are progression-free at 3 months (in historic comparison with results for single-agent bevacizumab in ECOG 3200).

SECONDARY OBJECTIVES:

I. Response rate (RR) II. Overall survival (OS) III. Safety IV. Feasibility

OUTLINE: This is a multicenter study.

Patients receive sorafenib tosylate orally twice daily on days 1-5 and 8-12 and bevacizumab IV over 30-90 minutes on day 1. Courses repeat every 14 days in the absence of disease progression or unacceptable toxicity. Blood samples are collected at baseline and then periodically during study treatment for laboratory biomarker and pharmacogenetic studies.

After completion of study treatment, patients are followed periodically for up to 2 years.

Recruitment & Eligibility

Status: COMPLETED

Sex: All

Target Recruitment: 83

Inclusion Criteria

Diagnosis of stage IV colorectal cancer (histologic proof is not required)
Measurable disease
- Spiral CT scan required for both pre- and post-treatment tumor assessments of lesions measuring 1-2 cm
Progressive disease during or within 6 months of most recent prior chemotherapy regimen (bevacizumab, fluoropyrimidine, oxaliplatin, or irinotecan-based treatment) OR considered ineligible for standard therapy
Documentation of submission of tumor material for Kirsten Rat Sarcoma (KRAS) testing available
Prior anti-epidermal growth factor receptor (EGFR) antibody therapy (e.g., cetuximab or panitumumab) required for patients with wild-type KRAS tumor
No known brain metastasis
- Patients with neurological symptoms must undergo a CT scan or MRI of the brain to exclude brain metastasis
Eastern Cooperative Oncology Group (ECOG) performance status 0-1
Life expectancy ≥ 6 months
Hemoglobin ≥ 9.0 g/dL
Absolute neutrophil count (ANC) ≥ 1,500/mm³
Platelet count ≥ 100,000/mm³
White blood cell count (WBC) ≥ 3,400/mm³
International normalized ratio (INR) < 1.5 (≤ 3.0 if on anti-coagulation therapy [e.g., warfarin or heparin])
Total bilirubin ≤ 1.5 times upper limit of normal (ULN)
Aspartate aminotransferase (AST) ≤ 2.5 times ULN (≤ 5 times ULN if there is liver involvement)
Alkaline phosphatase ≤ 3 times ULN
Creatinine ≤ 1.5 times ULN
Urine protein:creatinine ratio < 1 OR urine dipstick < 2+ OR urine protein < 1,000 mg by 24-hour urine collection
Not pregnant or nursing
Negative pregnancy test
Fertile patients must use effective contraception during and for ≥ 6 months after completion of study treatment (≥ 2 weeks after completion of treatment with sorafenib tosylate alone)
Willing to provide mandatory blood samples for translational research studies
Able to swallow whole pills
No inadequately controlled hypertension (i.e., systolic BP > 150 mm Hg or diastolic BP > 100 mm Hg on anti-hypertensive medications)
No prior hypertensive crisis or hypertensive encephalopathy
No myocardial infarction or unstable angina within the past 6 months
No congestive heart failure requiring use of ongoing maintenance therapy for life-threatening ventricular arrhythmias
No thrombolic or embolic events (e.g., cerebrovascular accident, including transient ischemic attacks) within the past 6 months
No hemorrhage or bleeding event > grade 3 within the past 4 weeks
No evidence or history of bleeding diathesis or coagulopathy (in the absence of therapeutic anticoagulation)
No greater than normal risk of bleeding
No active or recent hemoptysis (≥ ½ teaspoon of bright red blood per episode) within the past 30 days
No concurrent uncontrolled illness including, but not limited to, any of the following:
- Ongoing or active infection
- Symptomatic congestive heart failure
- Unstable angina pectoris
- Cardiac arrhythmia requiring anti-arrhythmic drugs
- Psychiatric illness or social situations that would limit compliance with study requirements
No known HIV infection or chronic hepatitis B or C infection
No serious, non-healing wound, active ulcer, or untreated bone fracture
- Patients with fractures secondary to metastatic disease are eligible after appropriate radiotherapy
No significant traumatic injury within the past 4 weeks
No known or suspected allergy or hypersensitivity to any component of bevacizumab, sorafenib tosylate, or their excipients or to any other agent given in the course of this study
No malabsorption problem
None of the following within the past 6 months:
- Significant vascular disease (e.g., aortic aneurysm or aortic dissection)
- Peripheral arterial thrombosis
- Symptomatic peripheral vascular disease
- Abdominal fistula
- Gastrointestinal perforation
- Intra-abdominal abscess
No other active malignancy within the past 3 years except non melanoma skin cancer or carcinoma in situ of the cervix
- Prior malignancy allowed provided patient is not receiving other specific treatment for that malignancy (other than hormonal therapy)
No other concurrent investigational agent for this cancer
Prior radiotherapy allowed
No prior sorafenib tosylate
No prior discontinuation of bevacizumab due to adverse events
More than 4 weeks since prior and no concurrent participation in any other experimental drug study
More than 4 weeks since prior St. John's wort or rifampin
More than 4 weeks since prior and no concurrent major surgical procedure or open biopsy
More than 7 days since prior core biopsy or minor surgical procedure, including placement of a vascular access device
No concurrent anticoagulant, except low-dose warfarin or heparin for deep venous thrombosis prophylaxis

Exclusion Criteria

Not provided

Study & Design

Study Type: INTERVENTIONAL

Study Design: SINGLE_GROUP

Arm && Interventions

Group	Intervention	Description
Treatment (sorafenib tosylate and bevacizumab)	sorafenib tosylate	Patients receive sorafenib tosylate orally twice daily on days 1-5 and 8-12 and bevacizumab IV over 30-90 minutes on day 1. Courses repeat every 14 days in the absence of disease progression or unacceptable toxicity. Blood samples are collected at baseline and then periodically during study treatment for laboratory biomarker and pharmacogenetic studies
Treatment (sorafenib tosylate and bevacizumab)	bevacizumab	Patients receive sorafenib tosylate orally twice daily on days 1-5 and 8-12 and bevacizumab IV over 30-90 minutes on day 1. Courses repeat every 14 days in the absence of disease progression or unacceptable toxicity. Blood samples are collected at baseline and then periodically during study treatment for laboratory biomarker and pharmacogenetic studies

Primary Outcome Measures

Name	Time	Method
Progression-free Survival Rate	At 3 months	The primary endpoint of this trial is progression free survival at 3 months. All patients meeting the eligibility criteria who have signed a consent form and have begun treatment will be considered evaluable. Patients lost to follow-up before 3 months (e.g., progression, refusing further treatment, etc.) will be considered treatment failures. All eligible patients will be followed until death or a minimum of 3 years. The proportion of successes will be estimated by the number of successes divided by the total number of evaluable patients. Progression is defined as at least a 20% increase in the sum of longest liameter of target lesions taking as reference the smallest sum longest diameter recorded since the treatment started or the appearance of one or more new lesions.

Secondary Outcome Measures

Name	Time	Method
Response Rate	Up to 2 years	Simple frequency analysis will be conducted to see if response rate is related to prior treatment and the selected tumor biomarkers. Descriptive statistics will be used to investigate how prior treatment affects various other measures as well.
Overall Survival	Time from registration to death, assessed up to 2 years	The distribution of overall survival will be estimated using Kaplan-Meier methodology.
Feasibility of Study Treatment	Up to 2 years	Will be evaluated based on the number of patients who are able to\> tolerate the regimen, how long they tolerate it and whether they elect to stop treatment.

Trial Locations

Locations (210): Graham Hospital Association
🇺🇸
Canton, Illinois, United States
Elkhart General Hospital
🇺🇸
Elkhart, Indiana, United States
Siouxland Hematology Oncology Associates
🇺🇸
Sioux City, Iowa, United States
Saint John Macomb-Oakland Hospital
🇺🇸
Warren, Michigan, United States
Park Nicollet Clinic - Saint Louis Park
🇺🇸
Saint Louis Park, Minnesota, United States
Kettering Medical Center
🇺🇸
Kettering, Ohio, United States
Toledo Clinic Cancer Centers-Maumee
🇺🇸
Maumee, Ohio, United States
Toledo Radiation Oncology at Northwest Ohio Onocolgy Center
🇺🇸
Maumee, Ohio, United States
Upper Valley Medical Center
🇺🇸
Troy, Ohio, United States
Boulder Community Hospital
🇺🇸
Boulder, Colorado, United States
Penrose-Saint Francis Healthcare
🇺🇸
Colorado Springs, Colorado, United States
Saint Mary's Hospital and Regional Medical Center
🇺🇸
Grand Junction, Colorado, United States
North Colorado Medical Center
🇺🇸
Greeley, Colorado, United States
Longmont United Hospital
🇺🇸
Longmont, Colorado, United States
Sky Ridge Medical Center
🇺🇸
Lone Tree, Colorado, United States
Exempla Lutheran Medical Center
🇺🇸
Wheat Ridge, Colorado, United States
North Suburban Medical Center
🇺🇸
Thornton, Colorado, United States
McKee Medical Center
🇺🇸
Loveland, Colorado, United States
Saint Mary Corwin Medical Center
🇺🇸
Pueblo, Colorado, United States
Saint Joseph Medical Center
🇺🇸
Bloomington, Illinois, United States
Mayo Clinic in Florida
🇺🇸
Jacksonville, Florida, United States
Memorial Hospital
🇺🇸
Carthage, Illinois, United States
Eureka Hospital
🇺🇸
Eureka, Illinois, United States
Galesburg Cottage Hospital
🇺🇸
Galesburg, Illinois, United States
Galesburg Clinic
🇺🇸
Galesburg, Illinois, United States
Mcdonough District Hospital
🇺🇸
Macomb, Illinois, United States
Mason District Hospital
🇺🇸
Havana, Illinois, United States
Garneau, Stewart C MD (UIA Investigator)
🇺🇸
Moline, Illinois, United States
Porubcin, Michael MD (UIA Investigator)
🇺🇸
Moline, Illinois, United States
Sharis, Christine M MD (UIA Investigator)
🇺🇸
Moline, Illinois, United States
Stoffel, Thomas J MD (UIA Investigator)
🇺🇸
Moline, Illinois, United States
Bromenn Regional Medical Center
🇺🇸
Normal, Illinois, United States
Holy Family Medical Center
🇺🇸
Monmouth, Illinois, United States
Community Cancer Center Foundation
🇺🇸
Normal, Illinois, United States
Illinois CancerCare-Ottawa Clinic
🇺🇸
Ottawa, Illinois, United States
Ottawa Regional Hospital and Healthcare Center
🇺🇸
Ottawa, Illinois, United States
Pekin Cancer Treatment Center
🇺🇸
Pekin, Illinois, United States
Pekin Hospital
🇺🇸
Pekin, Illinois, United States
Illinois CancerCare-Peoria
🇺🇸
Peoria, Illinois, United States
Methodist Medical Center of Illinois
🇺🇸
Peoria, Illinois, United States
Proctor Hospital
🇺🇸
Peoria, Illinois, United States
Illinois Oncology Research Association CCOP
🇺🇸
Peoria, Illinois, United States
Saint Margaret's Hospital
🇺🇸
Spring Valley, Illinois, United States
Saint Francis Hospital and Health Centers
🇺🇸
Beech Grove, Indiana, United States
OSF Saint Francis Medical Center
🇺🇸
Peoria, Illinois, United States
Perry Memorial Hospital
🇺🇸
Princeton, Illinois, United States
Illinois Valley Hospital
🇺🇸
Peru, Illinois, United States
Reid Hospital and Health Care Services
🇺🇸
Richmond, Indiana, United States
Indiana University Health La Porte Hospital
🇺🇸
La Porte, Indiana, United States
Northern Indiana Cancer Research Consortium
🇺🇸
South Bend, Indiana, United States
Community Howard Regional Health
🇺🇸
Kokomo, Indiana, United States
Saint Joseph Regional Medical Center-Mishawaka
🇺🇸
Mishawaka, Indiana, United States
Memorial Hospital of South Bend
🇺🇸
South Bend, Indiana, United States
Constantinou, Costas L MD (UIA Investigator)
🇺🇸
Bettendorf, Iowa, United States
Oncology Associates at Mercy Medical Center
🇺🇸
Cedar Rapids, Iowa, United States
South Bend Clinic
🇺🇸
South Bend, Indiana, United States
Cedar Rapids Oncology Association
🇺🇸
Cedar Rapids, Iowa, United States
Mercy Hospital
🇺🇸
Coon Rapids, Minnesota, United States
Medical Oncology and Hematology Associates-West Des Moines
🇺🇸
Clive, Iowa, United States
Mercy Medical Center - North Iowa
🇺🇸
Mason City, Iowa, United States
Mercy Medical Center-Sioux City
🇺🇸
Sioux City, Iowa, United States
Saint Luke's Regional Medical Center
🇺🇸
Sioux City, Iowa, United States
Cancer Center of Kansas - Chanute
🇺🇸
Chanute, Kansas, United States
Cancer Center of Kansas-Independence
🇺🇸
Independence, Kansas, United States
Cancer Center of Kansas - Dodge City
🇺🇸
Dodge City, Kansas, United States
Cancer Center of Kansas - El Dorado
🇺🇸
El Dorado, Kansas, United States
Cancer Center of Kansas - Fort Scott
🇺🇸
Fort Scott, Kansas, United States
Cancer Center of Kansas-Kingman
🇺🇸
Kingman, Kansas, United States
Lawrence Memorial Hospital
🇺🇸
Lawrence, Kansas, United States
Cancer Center of Kansas - Newton
🇺🇸
Newton, Kansas, United States
Cancer Center of Kansas - Wellington
🇺🇸
Wellington, Kansas, United States
Hickman Cancer Center
🇺🇸
Adrian, Michigan, United States
Bixby Medical Center
🇺🇸
Adrian, Michigan, United States
Wichita CCOP
🇺🇸
Wichita, Kansas, United States
Oakwood Hospital
🇺🇸
Dearborn, Michigan, United States
Green Bay Oncology - Iron Mountain
🇺🇸
Iron Mountain, Michigan, United States
Green Bay Oncology - Escanaba
🇺🇸
Escanaba, Michigan, United States
Hurley Medical Center
🇺🇸
Flint, Michigan, United States
Genesys Regional Medical Center-West Flint Campus
🇺🇸
Flint, Michigan, United States
Allegiance Health
🇺🇸
Jackson, Michigan, United States
Saint Mary Mercy Hospital
🇺🇸
Livonia, Michigan, United States
Sparrow Hospital
🇺🇸
Lansing, Michigan, United States
Saint Joseph Mercy Oakland
🇺🇸
Pontiac, Michigan, United States
Mercy Memorial Hospital
🇺🇸
Monroe, Michigan, United States
Saint Joseph Mercy Port Huron
🇺🇸
Port Huron, Michigan, United States
Community Cancer Center of Monroe
🇺🇸
Monroe, Michigan, United States
Lakeland Hospital
🇺🇸
Saint Joseph, Michigan, United States
Sanford Clinic North-Bemidgi
🇺🇸
Bemidji, Minnesota, United States
Essentia Health Saint Mary's Medical Center
🇺🇸
Duluth, Minnesota, United States
Fairview Ridges Hospital
🇺🇸
Burnsville, Minnesota, United States
Essentia Health Duluth Clinic CCOP
🇺🇸
Duluth, Minnesota, United States
Hutchinson Area Health Care
🇺🇸
Hutchinson, Minnesota, United States
Immanuel-Saint Joseph Hospital-Mayo Health System
🇺🇸
Mankato, Minnesota, United States
Fairview-Southdale Hospital
🇺🇸
Edina, Minnesota, United States
Miller-Dwan Hospital
🇺🇸
Duluth, Minnesota, United States
Minnesota Oncology Hematology PA-Maplewood
🇺🇸
Maplewood, Minnesota, United States
Saint John's Hospital - Healtheast
🇺🇸
Maplewood, Minnesota, United States
North Memorial Medical Health Center
🇺🇸
Robbinsdale, Minnesota, United States
Regions Hospital
🇺🇸
Saint Paul, Minnesota, United States
United Hospital
🇺🇸
Saint Paul, Minnesota, United States
Ridgeview Medical Center
🇺🇸
Waconia, Minnesota, United States
Minnesota Oncology and Hematology PA-Woodbury
🇺🇸
Woodbury, Minnesota, United States
Saint Francis Regional Medical Center
🇺🇸
Shakopee, Minnesota, United States
Missouri Baptist Medical Center
🇺🇸
Saint Louis, Missouri, United States
Center for Cancer Care and Research
🇺🇸
Saint Louis, Missouri, United States
Saint Vincent Healthcare
🇺🇸
Billings, Montana, United States
Saint John's Hospital
🇺🇸
Springfield, Missouri, United States
Montana Cancer Consortium CCOP
🇺🇸
Billings, Montana, United States
Northern Rockies Radiation Oncology Center
🇺🇸
Billings, Montana, United States
Billings Clinic
🇺🇸
Billings, Montana, United States
Bozeman Deaconess Cancer Center
🇺🇸
Bozeman, Montana, United States
Saint James Community Hospital and Cancer Treatment Center
🇺🇸
Butte, Montana, United States
Northern Montana Hospital
🇺🇸
Havre, Montana, United States
Great Falls Clinic
🇺🇸
Great Falls, Montana, United States
Saint Peter's Community Hospital
🇺🇸
Helena, Montana, United States
Kalispell Medical Oncology
🇺🇸
Kalispell, Montana, United States
Community Medical Hospital
🇺🇸
Missoula, Montana, United States
Guardian Oncology and Center for Wellness
🇺🇸
Missoula, Montana, United States
Montana Cancer Specialists
🇺🇸
Missoula, Montana, United States
Bismarck Cancer Center
🇺🇸
Bismarck, North Dakota, United States
Saint Alexius Medical Center
🇺🇸
Bismarck, North Dakota, United States
Sanford Bismarck Medical Center
🇺🇸
Bismarck, North Dakota, United States
Altru Cancer Center
🇺🇸
Grand Forks, North Dakota, United States
Toledo Clinic Cancer Centers-Bowling Green
🇺🇸
Bowling Green, Ohio, United States
North Coast Cancer Care-Clyde
🇺🇸
Clyde, Ohio, United States
Grandview Hospital
🇺🇸
Dayton, Ohio, United States
Good Samaritan Hospital - Dayton
🇺🇸
Dayton, Ohio, United States
Miami Valley Hospital
🇺🇸
Dayton, Ohio, United States
Samaritan North Health Center
🇺🇸
Dayton, Ohio, United States
Dayton CCOP
🇺🇸
Dayton, Ohio, United States
Blanchard Valley Hospital
🇺🇸
Findlay, Ohio, United States
Hematology Oncology Center Incorporated
🇺🇸
Elyria, Ohio, United States
Atrium Medical Center-Middletown Regional Hospital
🇺🇸
Franklin, Ohio, United States
Wayne Hospital
🇺🇸
Greenville, Ohio, United States
Lima Memorial Hospital
🇺🇸
Lima, Ohio, United States
Saint Luke's Hospital
🇺🇸
Maumee, Ohio, United States
Toledo Clinic Cancer Centers-Oregon
🇺🇸
Oregon, Ohio, United States
North Coast Cancer Care
🇺🇸
Sandusky, Ohio, United States
Saint Charles Hospital
🇺🇸
Oregon, Ohio, United States
Flower Hospital
🇺🇸
Sylvania, Ohio, United States
Saint Vincent Mercy Medical Center
🇺🇸
Toledo, Ohio, United States
Mercy Hospital of Tiffin
🇺🇸
Tiffin, Ohio, United States
The Toledo Hospital/Toledo Children's Hospital
🇺🇸
Toledo, Ohio, United States
University of Toledo
🇺🇸
Toledo, Ohio, United States
Toledo Clinic Cancer Centers-Toledo
🇺🇸
Toledo, Ohio, United States
Mercy Cancer Center at Saint Anne Mercy Hospital
🇺🇸
Toledo, Ohio, United States
Fulton County Health Center
🇺🇸
Wauseon, Ohio, United States
Clinton Memorial Hospital
🇺🇸
Wilmington, Ohio, United States
Greene Memorial Hospital
🇺🇸
Xenia, Ohio, United States
Geisinger Medical Group
🇺🇸
State College, Pennsylvania, United States
Geisinger Medical Center-Cancer Center Hazelton
🇺🇸
Hazleton, Pennsylvania, United States
Geisinger Medical Center
🇺🇸
Danville, Pennsylvania, United States
Geisinger Wyoming Valley
🇺🇸
Wilkes-Barre, Pennsylvania, United States
Fredericksburg Oncology Inc
🇺🇸
Fredericksburg, Virginia, United States
Midelfort Clinic-Clairemont Campus
🇺🇸
Eau Claire, Wisconsin, United States
Mayo Clinic Health System Eau Claire Hospital - Luther Campus
🇺🇸
Eau Claire, Wisconsin, United States
Green Bay Oncology at Saint Vincent Hospital
🇺🇸
Green Bay, Wisconsin, United States
Saint Vincent Hospital
🇺🇸
Green Bay, Wisconsin, United States
Green Bay Oncology Limited at Saint Mary's Hospital
🇺🇸
Green Bay, Wisconsin, United States
Saint Mary's Hospital
🇺🇸
Green Bay, Wisconsin, United States
Holy Family Memorial Hospital
🇺🇸
Manitowoc, Wisconsin, United States
Green Bay Oncology - Oconto Falls
🇺🇸
Oconto Falls, Wisconsin, United States
Green Bay Oncology - Sturgeon Bay
🇺🇸
Sturgeon Bay, Wisconsin, United States
Bay Area Medical Center
🇺🇸
Marinette, Wisconsin, United States
Welch Cancer Center
🇺🇸
Sheridan, Wyoming, United States
Abbott-Northwestern Hospital
🇺🇸
Minneapolis, Minnesota, United States
Virginia Piper Cancer Institute
🇺🇸
Minneapolis, Minnesota, United States
Hennepin County Medical Center
🇺🇸
Minneapolis, Minnesota, United States
Cancer Center of Kansas - Main Office
🇺🇸
Wichita, Kansas, United States
Hospital District Sixth of Harper County
🇺🇸
Anthony, Kansas, United States
Cancer Center of Kansas - Pratt
🇺🇸
Pratt, Kansas, United States
Cancer Center of Kansas - Salina
🇺🇸
Salina, Kansas, United States
Mid Dakota Clinic
🇺🇸
Bismarck, North Dakota, United States
Sanford Medical Center-Fargo
🇺🇸
Fargo, North Dakota, United States
Cancer Center of Kansas-Wichita Medical Arts Tower
🇺🇸
Wichita, Kansas, United States
Cancer Center of Kansas - Parsons
🇺🇸
Parsons, Kansas, United States
Saint John Hospital and Medical Center
🇺🇸
Detroit, Michigan, United States
Metro-Minnesota CCOP
🇺🇸
Saint Louis Park, Minnesota, United States
Unity Hospital
🇺🇸
Fridley, Minnesota, United States
Toledo Community Hospital Oncology Program CCOP
🇺🇸
Toledo, Ohio, United States
Swedish Medical Center
🇺🇸
Englewood, Colorado, United States
The Medical Center of Aurora
🇺🇸
Aurora, Colorado, United States
Saint Anthony Central Hospital
🇺🇸
Denver, Colorado, United States
Porter Adventist Hospital
🇺🇸
Denver, Colorado, United States
Exempla Saint Joseph Hospital
🇺🇸
Denver, Colorado, United States
Saint Joseph Mercy Hospital
🇺🇸
Ann Arbor, Michigan, United States
Mayo Clinic
🇺🇸
Rochester, Minnesota, United States
Presbyterian - Saint Lukes Medical Center - Health One
🇺🇸
Denver, Colorado, United States
Rose Medical Center
🇺🇸
Denver, Colorado, United States
Colorado Cancer Research Program CCOP
🇺🇸
Denver, Colorado, United States
Michigan Cancer Research Consortium Community Clinical Oncology Program
🇺🇸
Ann Arbor, Michigan, United States
Adventist Medical Center
🇺🇸
Portland, Oregon, United States
Mayo Clinic in Arizona
🇺🇸
Scottsdale, Arizona, United States
Berdeaux, Donald MD (UIA Investigator)
🇺🇸
Great Falls, Montana, United States
Kalispell Regional Medical Center
🇺🇸
Kalispell, Montana, United States
Hematology-Oncology Centers of the Northern Rockies PC
🇺🇸
Billings, Montana, United States
Glacier Oncology PLLC
🇺🇸
Kalispell, Montana, United States
Saint Patrick Hospital - Community Hospital
🇺🇸
Missoula, Montana, United States
Mercy Capitol
🇺🇸
Des Moines, Iowa, United States
Iowa Methodist Medical Center
🇺🇸
Des Moines, Iowa, United States
Iowa Oncology Research Association CCOP
🇺🇸
Des Moines, Iowa, United States
Medical Oncology and Hematology Associates-Des Moines
🇺🇸
Des Moines, Iowa, United States
Medical Oncology and Hematology Associates
🇺🇸
Des Moines, Iowa, United States
Mercy Medical Center - Des Moines
🇺🇸
Des Moines, Iowa, United States
Iowa Lutheran Hospital
🇺🇸
Des Moines, Iowa, United States
Associates In Womens Health
🇺🇸
Wichita, Kansas, United States
Via Christi Regional Medical Center
🇺🇸
Wichita, Kansas, United States
Saint Mary's of Michigan
🇺🇸
Saginaw, Michigan, United States
Sanford Clinic North-Fargo
🇺🇸
Fargo, North Dakota, United States
Cancer Center of Kansas - Winfield
🇺🇸
Winfield, Kansas, United States