Imatinib Mesylate With or Without Bevacizumab in Treating Patients With Metastatic or Unresectable Gastrointestinal Stromal Tumor

Phase 3

Terminated

Conditions: Gastrointestinal Stromal Tumor

Interventions: Biological: Bevacizumab
Drug: Imatinib Mesylate
Other: Laboratory Biomarker Analysis
Other: Pharmacological Study

Registration Number: NCT00324987

Lead Sponsor: National Cancer Institute (NCI)

Brief Summary: This randomized phase III trial studies imatinib mesylate and bevacizumab to see how well they work compared to imatinib mesylate alone in treating patients with gastrointestinal stromal tumor that has spread to other parts of the body or cannot be removed by surgery. Imatinib mesylate may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Monoclonal antibodies, such as bevacizumab, may interfere with the ability of tumor cells to grow and spread. It is not yet known whether imatinib mesylate and bevacizumab are more effective than imatinib mesylate alone in treating gastrointestinal stromal tumor.

Detailed Description: PRIMARY OBJECTIVES:

I. To determine whether treatment with imatinib (imatinib mesylate) plus bevacizumab leads to improved progression free survival (PFS) versus treatment with imatinib alone in first-line treatment of incurable gastrointestinal stromal tumor (GIST).

SECONDARY OBJECTIVES:

I. To compare response probabilities (confirmed and unconfirmed complete response \[CR\] and partial response \[PR\] for subset of patients with measurable disease), overall survival, and central-review based progression-free survival (CRb-PFS) in patients treated with imatinib and bevacizumab versus those treated with imatinib alone.

II. To compare the frequency and severity of toxicities associated with imatinib plus bevacizumab versus imatinib alone.

TERTIARY OBJECTIVES:

I. To explore the association between soluble vascular endothelial growth factor (VEGF), VEGF-factor D (VEGF-D), VEGF receptor (VEGFR)-1, VEGFR-2, angiopoietin-2 (Ang-2), platelet-derived growth factor receptor (PDGFR)-AA and PDGFR-BB levels, positron emission tomography (PET) imaging and immunohistochemistry for cyclin-dependent kinase inhibitor 2A (p16), VEGF and VEGFR, with kinase mutation status and clinical outcomes.

II. To explore imatinib pharmacokinetics with single nucleotide polymorphisms involving the adenosine triphosphate (ATP)-binding cassette, sub-family G (WHITE), member 2 (ABCG2) and cytochrome P450, family 3, subfamily A, polypeptide 4 (CYP3A4) genes, as well as other genes that are reported to influence the absorption, distribution, metabolism and elimination of imatinib.

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

ARM I (CLOSED TO ACCRUAL 10/1/2009): Patients receive imatinib mesylate orally (PO) once daily (QD) on days 1-21 and bevacizumab intravenously (IV) over 30-90 minutes on day 1.

ARM II (CLOSED TO ACCRUAL 10/1/2009): Patients receive imatinib mesylate PO QD on days 1-21.

In both arms, courses repeat every 21 days in the absence of disease progression or unacceptable toxicity.

After completion of study treatment, patients are followed at 1 month, every 6 months for 2 years, and then annually for 5 years.

Recruitment & Eligibility

Status: TERMINATED

Sex: All

Target Recruitment: 12

Inclusion Criteria

REGISTRATION # 1
Patient must have a biopsy proven diagnosis of gastrointestinal stromal tumor (GIST) that is distantly metastatic or unresectable; patients must be determined to be unresectable for cure
Patient may have measurable and/or non-measurable disease; computed tomography (CT) or magnetic resonance imaging (MRI) used for measurable disease must have been completed within 28 days prior to registration; CT or MRI used for non-measurable disease must have been completed within 42 days prior to registration; PET scans are not sufficient for disease assessment; all disease must be assessed and documented on the Baseline Tumor Assessment Form
CT/MRI scans must be performed and submitted for central review; archived tissue must be submitted as outlined
Institutions must seek additional patient consent for PET scans as outlined; if patient consents to the submission of PET scans, the patient must also be registered to Registration #2
Patient must not have known brain metastasis
Patient must have a Zubrod performance status of 0 - 3
Patient must have resolution of transient toxicities from any prior chemotherapy, radiation therapy or surgery to =< grade 1 (Common Terminology Criteria for Adverse Events [CTCAE] version 3.0)
Patient may have previously received traditional chemotherapeutic agents in any setting, provided at least 28 days have elapsed since completing chemotherapy and they have recovered to =< grade 1 from all drug-induced toxicities
Patient must not have received prior treatment with bevacizumab or other agents targeting VEGF, VEGFR, or PDGFR for advanced disease; those agents may have been used in the adjuvant setting if the patient did not recur for at least 12 months following the completion of treatment; patients may be receiving imatinib for advanced disease prior to registration provided they meet ALL of the following criteria:
- Patient must not have received more than 30 days of imatinib treatment prior to registration
- Patients have not been restaged; (baseline disease assessments prior to initiation of imatinib must fulfill requirements)
- Patients must have no clinical signs of progression
Prior radiotherapy is allowed, provided at least 28 days have elapsed since the last treatment and there is evidence of progressive disease within the radiation field or disease outside the radiation field
Patient must not have had a major surgical procedure, open biopsy, or significant traumatic injury within 28 days prior to registration, or anticipation of need for major surgical procedure during the course of the study; no fine needle aspirations or core biopsies are allowed within 7 days prior to registration; no procedure to place a port-a-cath is allowed within 7 days prior to registration
Patient must have a total bilirubin =< 2.0 x institutional upper limit of normal (IULN), obtained within 28 days prior to registration
Patients without liver involvement must have serum glutamic oxaloacetic transaminase (SGOT) or serum glutamate pyruvate transaminase (SGPT) =< 2.5 x IULN, obtained within 28 days prior to registration; patients with liver involvement must have SGOT or SGPT =< 5 x IULN
Patient must have adequate renal function as defined by a serum creatinine =< 1.5 x IULN obtained within 28 days prior to registration
Patient must have urine protein/creatinine ratio (UPC) < 1; this result must be obtained within 28 days prior to registration
Patient must have an absolute neutrophil count (ANC) >= 1,000/mcl obtained within 28 days prior to registration
Patient must have a platelet count >= 100,000/mcl obtained within 28 days prior to registration
Patient must have hemoglobin >= 9 gm/dl (this may be achieved by transfusion if needed) obtained within 28 days prior to registration
Patient must have an international normalized ratio (INR) =< 1.5, obtained within 28 days prior to registration
Patient must have a partial thromboplastin time (PTT) =< IULN, obtained within 28 days prior to registration
Patient must not be taking therapeutic doses of Coumadin (warfarin) as anticoagulation at the time of registration; patients requiring therapeutic anticoagulation may use low-molecular weight heparin (e.g., Lovenox) or other agents, and mini-dose Coumadin (1 mg PO QD) as prophylaxis is allowed
Patient must not have had a cerebrovascular accident (CVA), transient ischemic attack (TIA), myocardial infarction or unstable angina within 6 months prior to registration; patient must not have serious cardiac arrhythmia requiring medication, New York Heart Association (NYHA) class II or greater congestive heart failure, or clinically significant peripheral vascular disease
Patient must not have had an abdominal fistula, gastrointestinal perforation or intraabdominal abscess within 28 days prior to registration
Patient must not plan to use other investigational agents while on protocol treatment
Patient must have no contraindication to oral medications (e.g., severe dysphagia); patients with gastrostomy (G)- or jejunostomy (J)- tubes are eligible
Patient must not have blood pressure > 160/90; patients with a history of hypertension must be on a stable regimen of anti-hypertensive therapy
Patient must not have a serious, non-healing wound, ulcer, or bone fracture
Patient must not be pregnant or nursing; male and female patients of reproductive potential must agree to employ an effective barrier method of birth control throughout protocol treatment and for up to 6 months following discontinuation of study drugs
No other prior malignancy is allowed except for the following: adequately treated basal cell or squamous cell skin cancer, in situ cervical cancer, adequately treated stage I or II cancer from which the patient is currently in complete remission, or any other cancer from which the patient has been disease free for five years
If day 28 or 42 falls on a weekend or holiday, the limit may be extended to the next working day; in calculating days of tests and measurements, the day a test or measurement is done is considered day 0; therefore, if a test is done on a Monday, the Monday four weeks later would be considered day 28
All 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
At the time of patient registration, the treating institution's name and identification (ID) number must be provided to the Data Operations Center in Seattle in order to ensure that the current (within 365 days) date of institutional review board approval for this study has been entered into the data base
REGISTRATION #2 - PET SUBSTUDY:
Patient must have been registered to the main study
Patient must have consented to the submission of PET scans

Exclusion Criteria

Not provided

Study & Design

Study Type: INTERVENTIONAL

Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Arm I (CLOSED TO ACCRUAL 10/1/2009) (imatinib and bevacizumab)	Pharmacological Study	Patients receive imatinib mesylate PO QD on days 1-21 and bevacizumab IV over 30-90 minutes on day 1. Courses repeat every 21 days in the absence of disease progression or unacceptable toxicity.
Arm II (CLOSED TO ACCRUAL 10/1/2009) (imatinib)	Pharmacological Study	Patients receive imatinib mesylate PO QD on days 1-21. Courses repeat every 21 days in the absence of disease progression or unacceptable toxicity.
Arm I (CLOSED TO ACCRUAL 10/1/2009) (imatinib and bevacizumab)	Imatinib Mesylate	Patients receive imatinib mesylate PO QD on days 1-21 and bevacizumab IV over 30-90 minutes on day 1. Courses repeat every 21 days in the absence of disease progression or unacceptable toxicity.
Arm I (CLOSED TO ACCRUAL 10/1/2009) (imatinib and bevacizumab)	Bevacizumab	Patients receive imatinib mesylate PO QD on days 1-21 and bevacizumab IV over 30-90 minutes on day 1. Courses repeat every 21 days in the absence of disease progression or unacceptable toxicity.
Arm I (CLOSED TO ACCRUAL 10/1/2009) (imatinib and bevacizumab)	Laboratory Biomarker Analysis	Patients receive imatinib mesylate PO QD on days 1-21 and bevacizumab IV over 30-90 minutes on day 1. Courses repeat every 21 days in the absence of disease progression or unacceptable toxicity.
Arm II (CLOSED TO ACCRUAL 10/1/2009) (imatinib)	Imatinib Mesylate	Patients receive imatinib mesylate PO QD on days 1-21. Courses repeat every 21 days in the absence of disease progression or unacceptable toxicity.
Arm II (CLOSED TO ACCRUAL 10/1/2009) (imatinib)	Laboratory Biomarker Analysis	Patients receive imatinib mesylate PO QD on days 1-21. Courses repeat every 21 days in the absence of disease progression or unacceptable toxicity.

Primary Outcome Measures

Name	Time	Method
Progression Free Survival	Up to 7 years	From date of registration (defined as date of randomization) to date of first observation of progressive disease, death due to any cause or symptomatic deterioration. Patients last known to be alive and progression free are censored at last date of contact. Progression is defined as one or more of the following: 20% increase in the sum of longest diameters of target measurable lesions over smallest sum observed (over baseline if no decrease during therapy), provided at least one target lesion does NOT demonstrate uniform hypoattenuation over \> 90% of maximal cross sectional area; unequivocal progression of non-measurable disease; appearance of new lesion/site that is not uniformly hypoattenuating; a hyperattenuating region within a previously cystic/uniformly hypoattenuating lesion will be considered progressive disease if hyperattenuating region is either \>= 1 cm in longest diameter or round/oval and forms acute margins with border of target lesion; death due to disease.

Secondary Outcome Measures

Name	Time	Method
Overall Survival	up to 7 years	From date of registration (defined as date of randomization) to date of death due to any cause. Patients last known to be alive are censored at last date of contact. Note: median was not reached in the Imatinib arm due to limited follow-up data.
Central-review Based Progression-free Survival (CRb-PFS)	up to 7 years	From date of registration (defined as date of randomization) to date of first documentation of one of the following events: death; first documentation of progression based on central review of the appropriate computed tomography (CT) or magnetic resonance imaging (MRI) scans; development of new lesions or disease not identified on CT or MRI; or symptomatic deterioration. Patients not experiencing any of these events will be censored at last date of contact.
Response Rate	Up to 7 years	Confirmed response (CR) is two or more objective statuses of CR a minimum of four weeks apart documented before progression or symptomatic deterioration. Partial response (PR) is two or more objective statuses of PR or better a minimum of four weeks apart documented before progression or symptomatic deterioration. Unconfirmed CR is one objective status of CR documented before progression or symptomatic deterioration but not qualifying as CR or PR. Unconfirmed PR is one objective status of PR documented before progression or symptomatic deterioration but not qualifying as CR, PR or unconfirmed CR.
Number of Patients With Grade 3 Through Grade 5 Adverse Events That Are Related to Study Drug	Up to 7 years	Only adverse events that are possibly, probably or definitely related to study drug are reported.

Trial Locations

Locations (192): Community Medical Hospital
🇺🇸
Missoula, Montana, United States
Saint Patrick Hospital - Community Hospital
🇺🇸
Missoula, Montana, United States
Sanford Bismarck Medical Center
🇺🇸
Bismarck, North Dakota, United States
Wayne Hospital
🇺🇸
Greenville, Ohio, United States
Toledo Clinic Cancer Centers-Maumee
🇺🇸
Maumee, Ohio, United States
Kettering Medical Center
🇺🇸
Kettering, Ohio, United States
Marshfield Clinic - Weston Center
🇺🇸
Weston, Wisconsin, United States
Saint James Community Hospital and Cancer Treatment Center
🇺🇸
Butte, Montana, United States
Berdeaux, Donald MD (UIA Investigator)
🇺🇸
Great Falls, Montana, United States
Great Falls Clinic
🇺🇸
Great Falls, Montana, United States
Kalispell Medical Oncology
🇺🇸
Kalispell, Montana, United States
Billings Clinic Cancer Center
🇺🇸
Billings, Montana, United States
Saint Vincent Healthcare
🇺🇸
Billings, Montana, United States
Bozeman Deaconess Cancer Center
🇺🇸
Bozeman, Montana, United States
Glacier Oncology PLLC
🇺🇸
Kalispell, Montana, United States
Northern Montana Hospital
🇺🇸
Havre, Montana, United States
Kalispell Regional Medical Center
🇺🇸
Kalispell, Montana, United States
Montana Cancer Specialists
🇺🇸
Missoula, Montana, United States
Guardian Oncology and Center for Wellness
🇺🇸
Missoula, Montana, United States
The Polyclinic
🇺🇸
Seattle, Washington, United States
Harborview Medical Center
🇺🇸
Seattle, Washington, United States
Group Health Cooperative of Puget Sound Oncology Consortium
🇺🇸
Seattle, Washington, United States
Group Health Cooperative-Seattle
🇺🇸
Seattle, Washington, United States
Swedish Medical Center-First Hill
🇺🇸
Seattle, Washington, United States
University of Washington Medical Center
🇺🇸
Seattle, Washington, United States
Cancer Center of Kansas-Wichita Medical Arts Tower
🇺🇸
Wichita, Kansas, United States
Saint Joseph Mercy Oakland
🇺🇸
Pontiac, Michigan, United States
Mercy Memorial Hospital
🇺🇸
Monroe, Michigan, United States
Hickman Cancer Center
🇺🇸
Adrian, Michigan, United States
Cancer Center of Kansas - Salina
🇺🇸
Salina, Kansas, United States
Salina Regional Health Center
🇺🇸
Salina, Kansas, United States
Wichita CCOP
🇺🇸
Wichita, Kansas, United States
North Coast Cancer Care-Clyde
🇺🇸
Clyde, Ohio, United States
Sparrow Hospital
🇺🇸
Lansing, Michigan, United States
Miller-Dwan Hospital
🇺🇸
Duluth, Minnesota, United States
Meeker County Memorial Hospital
🇺🇸
Litchfield, Minnesota, United States
University of Rochester
🇺🇸
Rochester, New York, United States
Frontier Cancer Center and Blood Institute-Billings
🇺🇸
Billings, Montana, United States
Oakwood Hospital and Medical Center
🇺🇸
Dearborn, Michigan, United States
Toledo Clinic Cancer Centers-Bowling Green
🇺🇸
Bowling Green, Ohio, United States
Saint Peter's Community Hospital
🇺🇸
Helena, Montana, United States
Veteran Affairs Medical Center
🇺🇸
Dayton, Ohio, United States
Hurley Medical Center
🇺🇸
Flint, Michigan, United States
Northern Rockies Radiation Oncology Center
🇺🇸
Billings, Montana, United States
Saint Charles Hospital
🇺🇸
Oregon, Ohio, United States
Cancer Center of Kansas - Pratt
🇺🇸
Pratt, Kansas, United States
Bixby Medical Center
🇺🇸
Adrian, Michigan, United States
Fox Chase Cancer Center at Virtua Memorial Hospital of Burlington County
🇺🇸
Mount Holly, New Jersey, United States
Montana Cancer Consortium CCOP
🇺🇸
Billings, Montana, United States
Genesys Regional Medical Center-West Flint Campus
🇺🇸
Flint, Michigan, United States
Virtua West Jersey Hospital Voorhees
🇺🇸
Voorhees, New Jersey, United States
Allegiance Health
🇺🇸
Jackson, Michigan, United States
Saint Alexius Medical Center
🇺🇸
Bismarck, North Dakota, United States
Interlakes Foundation Inc-Rochester
🇺🇸
Rochester, New York, United States
Grandview Hospital
🇺🇸
Dayton, Ohio, United States
Saint Joseph Mercy Port Huron
🇺🇸
Port Huron, Michigan, United States
Samaritan North Health Center
🇺🇸
Dayton, Ohio, United States
Hutchinson Area Health Care
🇺🇸
Hutchinson, Minnesota, United States
Glens Falls Hospital
🇺🇸
Glens Falls, New York, United States
Roswell Park Cancer Institute
🇺🇸
Buffalo, New York, United States
Essentia Health Cancer Center
🇺🇸
Duluth, Minnesota, United States
Regions Hospital
🇺🇸
Saint Paul, Minnesota, United States
Woodwinds Health Campus
🇺🇸
Woodbury, Minnesota, United States
Mercy Hospital Springfield
🇺🇸
Springfield, Missouri, United States
Mid Dakota Clinic
🇺🇸
Bismarck, North Dakota, United States
Upper Valley Medical Center
🇺🇸
Troy, Ohio, United States
Good Samaritan Hospital - Dayton
🇺🇸
Dayton, Ohio, United States
Toledo Clinic Cancer Centers-Monroe
🇺🇸
Monroe, Michigan, United States
Lima Memorial Hospital
🇺🇸
Lima, Ohio, United States
Fred Hutchinson Cancer Research Center/University of Washington Cancer Consortium
🇺🇸
Seattle, Washington, United States
Saint Mary's of Michigan
🇺🇸
Saginaw, Michigan, United States
Saint John's Hospital - Healtheast
🇺🇸
Maplewood, Minnesota, United States
Saint Mary Mercy Hospital
🇺🇸
Livonia, Michigan, United States
Bozeman Deaconess Hospital
🇺🇸
Bozeman, Montana, United States
Providence Hospital-Southfield Cancer Center
🇺🇸
Southfield, Michigan, United States
Essentia Health Saint Mary's Medical Center
🇺🇸
Duluth, Minnesota, United States
Saint Joseph's Hospital - Healtheast
🇺🇸
Saint Paul, Minnesota, United States
Cancer Research for the Ozarks NCORP
🇺🇸
Springfield, Missouri, United States
Highland Hospital
🇺🇸
Rochester, New York, United States
Miami Valley Hospital
🇺🇸
Dayton, Ohio, United States
Kinston Medical Specialists PA
🇺🇸
Kinston, North Carolina, United States
Dayton CCOP
🇺🇸
Dayton, Ohio, United States
Saint Francis Regional Medical Center
🇺🇸
Shakopee, Minnesota, United States
Saint Luke's Hospital
🇺🇸
Maumee, Ohio, United States
Saint Vincent Mercy Medical Center
🇺🇸
Toledo, Ohio, United States
University of Toledo
🇺🇸
Toledo, Ohio, United States
Blanchard Valley Hospital
🇺🇸
Findlay, Ohio, United States
Minor and James Medical PLLC
🇺🇸
Seattle, Washington, United States
Toledo Clinic Cancer Centers-Oregon
🇺🇸
Oregon, Ohio, United States
Harrison HealthPartners Hematology and Oncology-Bremerton
🇺🇸
Bremerton, Washington, United States
Fredericksburg Oncology Inc
🇺🇸
Fredericksburg, Virginia, United States
North Coast Cancer Care
🇺🇸
Sandusky, Ohio, United States
PeaceHealth Saint Joseph Medical Center
🇺🇸
Bellingham, Washington, United States
Kadlec Clinic Hematology and Oncology
🇺🇸
Kennewick, Washington, United States
Fulton County Health Center
🇺🇸
Wauseon, Ohio, United States
Fox Chase Cancer Center
🇺🇸
Philadelphia, Pennsylvania, United States
Geisinger South Wilkes-Barre
🇺🇸
Wilkes-Barre, Pennsylvania, United States
Marshfield Clinic
🇺🇸
Marshfield, Wisconsin, United States
Rapid City Regional Hospital
🇺🇸
Rapid City, South Dakota, United States
Greene Memorial Hospital
🇺🇸
Xenia, Ohio, United States
Saint Joseph's Hospital
🇺🇸
Marshfield, Wisconsin, United States
Saint Michael's Hospital
🇺🇸
Stevens Point, Wisconsin, United States
Mercy Saint Anne Hospital
🇺🇸
Toledo, Ohio, United States
Toledo Clinic Cancer Centers-Toledo
🇺🇸
Toledo, Ohio, United States
Sacred Heart Hospital
🇺🇸
Eau Claire, Wisconsin, United States
Marshfield Clinic at James Beck Cancer Center
🇺🇸
Rhinelander, Wisconsin, United States
Marshfield Clinic-Chippewa Center
🇺🇸
Chippewa Falls, Wisconsin, United States
Virginia Piper Cancer Institute
🇺🇸
Minneapolis, Minnesota, United States
Hennepin County Medical Center
🇺🇸
Minneapolis, Minnesota, United States
University of Cincinnati
🇺🇸
Cincinnati, Ohio, United States
University Hospital
🇺🇸
San Antonio, Texas, United States
Audie L Murphy Veterans Affairs Hospital
🇺🇸
San Antonio, Texas, United States
University of Texas Health Science Center at San Antonio
🇺🇸
San Antonio, Texas, United States
Cancer Center of Kansas - Wellington
🇺🇸
Wellington, Kansas, United States
Lawrence Memorial Hospital
🇺🇸
Lawrence, Kansas, United States
Cancer Center of Kansas - Parsons
🇺🇸
Parsons, Kansas, United States
Cancer Center of Kansas-Independence
🇺🇸
Independence, Kansas, United States
Associates In Womens Health
🇺🇸
Wichita, Kansas, United States
Cancer Center of Kansas - Newton
🇺🇸
Newton, Kansas, United States
Carle Clinic-Urbana Main
🇺🇸
Urbana, Illinois, United States
Franciscan St. Francis Health-Beech Grove
🇺🇸
Beech Grove, Indiana, United States
Memorial Medical Center
🇺🇸
Springfield, Illinois, United States
Franciscan Saint Anthony Health-Michigan City
🇺🇸
Michigan City, Indiana, United States
Reid Hospital and Health Care Services
🇺🇸
Richmond, Indiana, United States
Carle Cancer Center
🇺🇸
Urbana, Illinois, United States
Alta Bates Summit Medical Center-Herrick Campus
🇺🇸
Berkeley, California, United States
Marin General Hospital
🇺🇸
Greenbrae, California, United States
Mills - Peninsula Hospitals
🇺🇸
Burlingame, California, United States
USC / Norris Comprehensive Cancer Center
🇺🇸
Los Angeles, California, United States
California Pacific Medical Center-Pacific Campus
🇺🇸
San Francisco, California, United States
Sutter Cancer Research Consortium
🇺🇸
Novato, California, United States
John B Amos Cancer Center
🇺🇸
Columbus, Georgia, United States
Memorial University Medical Center
🇺🇸
Savannah, Georgia, United States
South Georgia Medical Center
🇺🇸
Valdosta, Georgia, United States
Rush - Copley Medical Center
🇺🇸
Aurora, Illinois, United States
Presence Resurrection Medical Center
🇺🇸
Chicago, Illinois, United States
University of Chicago Comprehensive Cancer Center
🇺🇸
Chicago, Illinois, United States
Decatur Memorial Hospital
🇺🇸
Decatur, Illinois, United States
Joliet Oncology-Hematology Associates Limited
🇺🇸
Joliet, Illinois, United States
Adventist La Grange Memorial Hospital
🇺🇸
La Grange, Illinois, United States
Edward Hospital/Cancer Center
🇺🇸
Naperville, Illinois, United States
McFarland Clinic PC-William R Bliss Cancer Center
🇺🇸
Ames, Iowa, United States
Medical Oncology and Hematology Associates-West Des Moines
🇺🇸
Clive, Iowa, United States
Genesis Medical Center - East Campus
🇺🇸
Davenport, Iowa, United States
Genesis Medical Center - West Campus
🇺🇸
Davenport, Iowa, United States
MedStar Georgetown University Hospital
🇺🇸
Washington, D.C., District of Columbia, United States
Saint John Macomb-Oakland Hospital
🇺🇸
Warren, Michigan, United States
Oncology Care Associates PLLC
🇺🇸
Saint Joseph, Michigan, United States
Siouxland Regional Cancer Center
🇺🇸
Sioux 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 - Dodge City
🇺🇸
Dodge City, Kansas, United States
Cancer Center of Kansas - Fort Scott
🇺🇸
Fort Scott, Kansas, United States
Cancer Center of Kansas - El Dorado
🇺🇸
El Dorado, Kansas, United States
Cancer Center of Kansas-Kingman
🇺🇸
Kingman, Kansas, United States
Toledo Radiation Oncology at Northwest Ohio Onocolgy Center
🇺🇸
Maumee, Ohio, United States
West Virginia University Charleston
🇺🇸
Charleston, West Virginia, United States
Flower Hospital
🇺🇸
Sylvania, Ohio, United States
Mercy Hospital of Tiffin
🇺🇸
Tiffin, Ohio, United States
Toledo Community Hospital Oncology Program CCOP
🇺🇸
Toledo, Ohio, United States
Cancer Care Northwest - Spokane South
🇺🇸
Spokane, Washington, United States
Wenatchee Valley Hospital and Clinics
🇺🇸
Wenatchee, Washington, United States
Marshfield Clinic - Wisconsin Rapids Center
🇺🇸
Wisconsin Rapids, Wisconsin, United States
Tom Baker Cancer Centre
🇨🇦
Calgary, Alberta, Canada
Welch Cancer Center
🇺🇸
Sheridan, Wyoming, United States
BCCA-Vancouver Cancer Centre
🇨🇦
Vancouver, British Columbia, Canada
Marshfield Clinic-Wausau Center
🇺🇸
Wausau, Wisconsin, United States
Marshfield Clinic Cancer Center at Sacred Heart
🇺🇸
Eau Claire, Wisconsin, United States
Marshfield Clinic-Minocqua Center
🇺🇸
Minocqua, Wisconsin, United States
Orange Regional Medical Center
🇺🇸
Middletown, New York, United States
Sutter Solano Medical Center/Cancer Center
🇺🇸
Vallejo, California, United States
Hematology Oncology Center Incorporated
🇺🇸
Elyria, Ohio, United States
Atrium Medical Center-Middletown Regional Hospital
🇺🇸
Franklin, Ohio, United States
Clinton Memorial Hospital
🇺🇸
Wilmington, Ohio, United States
The Toledo Hospital/Toledo Children's Hospital
🇺🇸
Toledo, Ohio, United States
Marshfield Clinic-Rice Lake Center
🇺🇸
Rice Lake, Wisconsin, United States
Diagnostic and Treatment Center
🇺🇸
Weston, Wisconsin, 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-Laurel
🇺🇸
Des Moines, Iowa, United States
Mercy Medical Center - Des Moines
🇺🇸
Des Moines, Iowa, United States
Iowa Lutheran Hospital
🇺🇸
Des Moines, Iowa, United States
Saint Joseph Mercy Hospital
🇺🇸
Ann Arbor, Michigan, United States
Michigan Cancer Research Consortium CCOP
🇺🇸
Ann Arbor, Michigan, United States
Saint John Hospital and Medical Center
🇺🇸
Detroit, Michigan, United States
Adventist Medical Center
🇺🇸
Portland, Oregon, United States
Cancer Center of Kansas - Main Office
🇺🇸
Wichita, Kansas, United States
Via Christi Regional Medical Center
🇺🇸
Wichita, Kansas, United States
Cancer Center of Kansas - Winfield
🇺🇸
Winfield, Kansas, United States