Cabozantinib-S-Malate Compared With Temozolomide or Dacarbazine in Treating Patients With Metastatic Melanoma of the Eye That Cannot Be Removed by Surgery
- Conditions
- Recurrent Uveal MelanomaStage IIIA Uveal Melanoma AJCC v7Stage III Uveal Melanoma AJCC v7Stage IIIB Uveal Melanoma AJCC v7Stage IIIC Uveal Melanoma AJCC v7Stage IV Uveal Melanoma AJCC v7
- Interventions
- Registration Number
- NCT01835145
- Lead Sponsor
- National Cancer Institute (NCI)
- Brief Summary
This randomized phase II trial studies how well cabozantinib-s-malate works compared with temozolomide or dacarbazine in treating patients with melanoma of the eye (ocular melanoma) that has spread to other parts of the body and cannot be removed by surgery. Cabozantinib-s-malate may stop the growth of tumor cells by blocking some of the enzymes needed for cell growth. Drugs used in chemotherapy, such as temozolomide and dacarbazine, 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. It is not yet known whether cabozantinib-s-malate works better than temozolomide or dacarbazine in treating patients with melanoma of the eye.
- Detailed Description
PRIMARY OBJECTIVES:
I. Compare the progression-free survival rate at 4 months (PFS4) of patients with ocular melanoma treated with cabozantinib-s-malate (cabozantinib) or temozolomide (or dacarbazine).
SECONDARY OBJECTIVES:
I. Estimate the distribution of progression-free survival (PFS) times. II. Estimate the distribution of overall survival (OS) times. III. Estimate the confirmed response rate as determined by the Response Evaluation Criteria in Solid Tumors (RECIST) criteria.
IV. Assess the safety of these agents by examining the toxicity profile. V. Correlate the response of MET molecular status.
OUTLINE: Patients are randomized to 1 of 2 treatment arms.
ARM I: Patients receive cabozantinib-s-malate orally (PO) once daily (QD) on days 1-28. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity.
ARM II: Patients receive temozolomide PO daily on days 1-5. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity. If temozolomide is not available, patients receive dacarbazine intravenously (IV) over 15-60 minutes on day 1. Courses repeat every 21 days in the absence of disease progression or unacceptable toxicity.
After completion of study treatment, patients are followed up every 12 weeks for 2 years.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 47
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Histologically or cytologically confirmed uveal melanoma that is metastatic or unresectable; if histologic or cytologic confirmation of the primary is not available, confirmation of the primary diagnosis of uveal melanoma by the treating investigator can be clinically obtained, as per standard practice for uveal melanoma; pathologic confirmation of diagnosis will be performed at the participating site
-
Measurable disease defined as at least one lesion that can be accurately measured in at least one dimension (longest diameter to be recorded for non-nodal lesions and short axis for nodal lesions) as >= 20 mm with conventional techniques or as >= 10 mm with spiral computed tomography (CT) scan or magnetic resonance imaging (MRI)
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Prior systemic therapies allowed, except for those treatments directed toward, or with activity against, c-Met or vascular endothelial growth factor/receptor (VEGF/R), and the chemotherapy agents temozolomide and dacarbazine; prior treatment must have been no earlier than 3 weeks prior to starting treatment with cabozantinib with exceptions noted below and the following: at least 4 weeks since prior hepatic infusion or at least 2 weeks since radiation therapy
-
No cytotoxic chemotherapy including investigational cytotoxic chemotherapy or biologic agents (e.g., cytokines or antibodies) within the last 3 weeks, or nitrosoureas/mitomycin C within 6 weeks before the first dose of study treatment; at least 6 weeks must have elapsed if the last regimen included an anti-cytotoxic T-lymphocyte antigen 4 (CTLA4) antibody; patients must have experienced disease progression on their prior therapy in the opinion of the treating investigator
-
No prior radiation therapy within the last 4 weeks, except as below
- To the thoracic cavity, abdomen, or pelvis within 12 weeks before the first dose of study treatment, or has ongoing complications, or is without complete recovery to < grade 1 toxicity
- To bone or brain metastasis within 14 days before the first dose of study treatment
- To any other site(s) within 28 days before the first dose of study treatment
- Prior radiation treatment may have included no more than 3000 centigray (cGy) to fields including substantial bone marrow
-
No prior radionuclide treatment within 6 weeks of the first dose of study treatment
-
No prior treatment with a small molecule kinase inhibitor or a hormonal therapy within 14 days or 5 half-lives (whichever is longer)
-
No concomitant anti-cancer therapy unless specified above
-
Eastern Cooperative Oncology Group (ECOG) performance status =< 1 (Karnofsky >= 70%)
-
A corrected QT interval calculated by the Fridericia formula (QTcF) =< 500 ms within 28 days before randomization; Note: if initial QTcF is found to be > 500 ms, two additional electrocardiograms (EKGs) separated by at least 3 minutes should be performed; if the average of these three consecutive results for QTcF is =< 500 ms, the patient meets eligibility in this regard
-
Common Terminology Criteria for Adverse Events (CTCAE) recovered to baseline or CTCAE =< grade 1 from toxicity due to all prior therapies except alopecia and other non-clinically significant adverse events (AEs)
-
No active brain metastases or epidural disease; patients with brain metastases previously treated with whole brain radiation or radiosurgery or patients with epidural disease previously treated with radiation or surgery who are asymptomatic and do not require steroid treatment for at least 2 weeks before starting study treatment are eligible; neurosurgical resection of brain metastases or brain biopsy is permitted if completed at least 12 weeks before starting study treatment; baseline brain imaging with contrast-enhanced CT or MRI scans for patients with known brain metastases is required to confirm eligibility
-
No clinically significant gastrointestinal bleeding within 24 weeks before the first dose of study treatment
-
No hemoptysis of >= 0.5 teaspoon (2.5 mL) of red blood within 12 weeks before the first dose of study treatment
-
No signs indicative of pulmonary hemorrhage within 12 weeks before the first dose of study treatment
-
No prior radiographic evidence of cavitating pulmonary lesion(s)
-
No tumor in contact with, invading or encasing any major blood vessels
-
No evidence of tumor invading the gastrointestinal (GI) tract (esophagus, stomach, small or large bowel, rectum or anus), or any evidence of endotracheal or endobronchial tumor within 28 days before the first dose of treatment
-
The patient may not have uncontrolled, significant intercurrent or recent illness including, but not limited to, the following conditions:
-
Cardiovascular disorders including:
-
Congestive heart failure (CHF): New York Heart Association (NYHA) class III (moderate) or class IV (severe) at the time of screening
-
Concurrent uncontrolled hypertension defined as sustained blood pressure (BP) > 140 mmHg systolic, or > 90 mmHg diastolic despite optimal antihypertensive treatment within 7 days of the first dose of study treatment
-
Any history of congenital long QT syndrome
-
Any of the following within 24 weeks before the first dose of study treatment:
- Unstable angina pectoris
- Clinically-significant cardiac arrhythmias
- Stroke (including transient ischemic attack [TIA], or other ischemic event)
- Myocardial infarction
- Thromboembolic event requiring therapeutic anticoagulation (Note: patients with a venous filter [e.g. vena cava filter] are not eligible for this study)
-
-
Gastrointestinal disorders particularly those associated with a high risk of perforation or fistula formation including:
-
Any of the following within 28 days before the first dose of study treatment
- Intra-abdominal tumor/metastases invading GI mucosa
- Active peptic ulcer disease
- Inflammatory bowel disease (including ulcerative colitis and Crohn's disease), diverticulitis, cholecystitis, symptomatic cholangitis or appendicitis
- Malabsorption syndrome
-
Any of the following within 24 weeks before the first dose of study treatment:
- Abdominal fistula
- Gastrointestinal perforation
- Intra-abdominal abscess; Note: complete resolution of an intra-abdominal abscess must be confirmed prior to initiating treatment with cabozantinib even if the abscess occurred more that 24 weeks before the first dose of study treatment
- Bowel obstruction or gastric outlet obstruction
-
-
Other clinically significant disorders such as:
-
Serious non-healing wound/ulcer/bone fracture within 28 days before the first dose of study treatment
-
History of organ transplant
-
Concurrent uncompensated hypothyroidism or thyroid dysfunction within 7 days before the first dose of study treatment
-
History of major surgery as follows:
- Major surgery in past 8 weeks of the first dose of cabozantinib if there were no wound healing complications or within 24 weeks of the first dose of cabozantinib if there were wound complications
- Minor surgery within 4 weeks of the first dose of cabozantinib if there were no wound healing complications or within 12 weeks of the first dose of cabozantinib if there were wound complications
- In addition, complete wound healing from prior surgery must be confirmed at least 28 days before the first dose of cabozantinib irrespective of the time from surgery
-
Active infection requiring systemic treatment within 28 days before the first dose of study treatment
-
-
-
No concomitant treatment, in therapeutic doses, with anticoagulants such as warfarin or warfarin-related agents, heparin, thrombin or factor Xa inhibitors, or antiplatelet agents (e.g., clopidogrel); low dose aspirin (=< 81 mg/day), low-dose warfarin (=< 1 mg/day), and prophylactic low molecular weight heparin (LMWH) are permitted; please note that drugs that strongly induce or inhibit cytochrome P450 family 3, subfamily A, polypeptide 4 (CYP3A4) or are associated with a risk of Torsades are not allowed; chronic concomitant treatment of CYP3A4 inducers is not allowed (e.g., dexamethasone, phenytoin, carbamazepine, rifampin, rifabutin, rifapentine, phenobarbital, and St. John's wort); as part of the enrollment/informed consent procedures, the patient will be counseled on the risk of interactions with other agents, and what to do if new medications need to be prescribed or if the patient is considering a new over-the-counter medicine or herbal product; the following drugs are strong inhibitors of CYP3A4 and are not allowed during the treatment with cabozantinib:
- Boceprevir
- Indinavir
- Nelfinavir
- Lopinavir/ritonavir
- Saquinavir
- Telaprevir
- Ritonavir
- Clarithromycin
- Conivaptan
- Itraconazole
- Ketoconazole
- Mibefradil
- Nefazodone
- Posaconazole
- Voriconazole
- Telithromycin
- Drugs with possible or conditional risk of torsades should be used with caution knowing that cabozantinib could prolong the QT interval
-
Patients who are pregnant or nursing are not eligible; women of child bearing potential must have a negative serum or urine pregnancy test within 16 days prior to registration; women of child-bearing potential include:
- Any female who has experienced menarche and who has not undergone surgical sterilization (hysterectomy, bilateral tubal ligation or bilateral oophorectomy) or is not postmenopausal (defined as amenorrhea >= 12 consecutive months)
- Women on hormone replacement therapy (HRT) with documented serum follicle stimulating hormone (FSH) level > 35m IU/mL
- Women who are using oral, implanted or injectable contraceptive hormones or mechanical products such as an intrauterine device or barrier methods (diaphragm, condoms, spermicides) to prevent pregnancy or practicing abstinence or where partner is sterile (e.g., vasectomy)
-
No history of allergic reactions attributed to compounds of similar chemical or biologic composition to cabozantinib, temozolomide and dacarbazine
-
Absolute neutrophil count >= 1,500/mcL
-
Platelets >= 100,000/mcL
-
Total bilirubin =< 1.5 × upper limit of normal (ULN)
-
Aspartate aminotransferase (AST) (serum glutamic oxaloacetic transaminase [SGOT])/alanine aminotransferase (ALT) (serum glutamate pyruvate transaminase [SGPT]) =< 5.0 × institutional upper limit of normal (for patients with metastases); AST (SGOT)/ALT (SGPT) =< 2.5 × institutional upper limit of normal (for patients without metastases)
-
Serum creatinine =< 1.5 × ULN, OR calculated creatinine clearance >= 30 mL/minute (modified Cockcroft and Gault formula)
-
Hemoglobin >= 9 g/dL
-
Serum albumin >= 2.8 g/dL
-
Urine protein/creatinine ratio (UPCR) =< 1; if urine/protein creatinine (UPC) >= 1, then a 24-hour urine protein must be assessed; eligible patients must have a 24-hour urine protein value < 1 g/L
-
Thyroid-stimulating hormone (TSH) within normal limits (WNL); supplementation is acceptable to achieve a TSH WNL; in patients with abnormal TSH however free T4 and free thyroxine index (FTI) are normal and patient is clinically euthyroid, patient is eligible
-
Prothrombin time (PT)/international normalized ratio (INR) must be =< 1.2 x the laboratory ULN
-
No clinical or radiographic evidence of pancreatitis
Not provided
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Arm II (temozolomide or dacarbazine) Laboratory Biomarker Analysis Patients receive temozolomide PO daily on days 1-5. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity. If temozolomide is not available, patients receive dacarbazine IV over 15-60 minutes on day 1. Courses repeat every 21 days in the absence of disease progression or unacceptable toxicity. Arm II (temozolomide or dacarbazine) Temozolomide Patients receive temozolomide PO daily on days 1-5. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity. If temozolomide is not available, patients receive dacarbazine IV over 15-60 minutes on day 1. Courses repeat every 21 days in the absence of disease progression or unacceptable toxicity. Arm I (cabozantinib-s-malate) Cabozantinib S-malate Patients receive cabozantinib-s-malate PO QD on days 1-28. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity. Arm I (cabozantinib-s-malate) Laboratory Biomarker Analysis Patients receive cabozantinib-s-malate PO QD on days 1-28. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity. Arm II (temozolomide or dacarbazine) Dacarbazine Patients receive temozolomide PO daily on days 1-5. Courses repeat every 28 days in the absence of disease progression or unacceptable toxicity. If temozolomide is not available, patients receive dacarbazine IV over 15-60 minutes on day 1. Courses repeat every 21 days in the absence of disease progression or unacceptable toxicity.
- Primary Outcome Measures
Name Time Method Proportion of Patients Without a Progression Free Survival Event at 4 Months (PFS4) At 4 months A patient will be declared a PFS4 success if they are on study and progression free for at least 4 months. Progression is defined as at least a 20% increase in the sum of the diameters of target lesions, taking as reference the smallest sum on study, with an absolute increase of at least 5 mm. The appearance of one or more new lesions is also considered progression. The success for each arm will be calculated independently as the number of successes divided by the total number of evaluable patients. A one-sided chi-squared test for a difference in PFS4 proportions will be used to test for a difference between arms.
- Secondary Outcome Measures
Name Time Method Percentage of Patients Who Experienced Grade 3+ Adverse Events Regardless of Attribution Up to 2 years percentage of patients who experienced grade 3+ adverse events regardless of attribution, graded according to the National Cancer Institute CTCAE version 4.0
Overall Survival (OS) Number of days from registration until death, assessed up to 2 years The distribution of OS time will be estimated using the method of Kaplan Meier.
PFS Number of days from registration until disease progression (or death), assessed up to 2 years The distribution of PFS time will be estimated using the method of Kaplan Meier and is defined as the number of days from registration until disease progression (or death). Progression is defined as at least a 20% increase in the sum of the diameters of target lesions, taking as reference the smallest sum on study, with an absolute increase of at least 5 mm. The appearance of one or more new lesions is also considered progression.
Confirmed Response Rate as Determined by the RECIST Criteria (Version 1.1) Up to 2 years The confirmed response rates will be estimated by dividing the number of confirmed responders by the number of evaluable patients. 95% confidence intervals will be calculated.
Trial Locations
- Locations (228)
University of Pennsylvania/Abramson Cancer Center
🇺🇸Philadelphia, Pennsylvania, United States
University of Chicago Comprehensive Cancer Center
🇺🇸Chicago, Illinois, United States
Kaiser Permanente Washington
🇺🇸Seattle, Washington, United States
Cancer and Blood Specialists-Shadow
🇺🇸Las Vegas, Nevada, United States
GenesisCare USA - Las Vegas
🇺🇸Las Vegas, Nevada, United States
HealthCare Partners Medical Group Oncology/Hematology-Maryland Parkway
🇺🇸Las Vegas, Nevada, United States
HealthCare Partners Medical Group Oncology/Hematology-San Martin
🇺🇸Las Vegas, Nevada, United States
Comprehensive Cancer Centers of Nevada - Northwest
🇺🇸Las Vegas, Nevada, United States
Las Vegas Cancer Center-Medical Center
🇺🇸Las Vegas, Nevada, United States
GenesisCare USA - Fort Apache
🇺🇸Las Vegas, Nevada, United States
HealthCare Partners Medical Group Oncology/Hematology-Centennial Hills
🇺🇸Las Vegas, Nevada, United States
Billings Clinic Cancer Center
🇺🇸Billings, Montana, United States
Saint Peter's Community Hospital
🇺🇸Helena, Montana, United States
Community Hospital of Anaconda
🇺🇸Anaconda, Montana, United States
Saskatoon Cancer Centre
🇨🇦Saskatoon, Saskatchewan, Canada
Saint Patrick Hospital - Community Hospital
🇺🇸Missoula, Montana, United States
Bozeman Deaconess Hospital
🇺🇸Bozeman, Montana, United States
Presence Saint Mary's Hospital
🇺🇸Kankakee, Illinois, United States
Katmai Oncology Group
🇺🇸Anchorage, Alaska, United States
Alaska Breast Care and Surgery LLC
🇺🇸Anchorage, Alaska, United States
Beebe Medical Center
🇺🇸Lewes, Delaware, United States
Kootenai Cancer Clinic
🇺🇸Sandpoint, Idaho, United States
Loyola University Medical Center
🇺🇸Maywood, Illinois, United States
Hematology Oncology Associates of Illinois - Skokie
🇺🇸Skokie, Illinois, United States
Munson Medical Center
🇺🇸Traverse City, Michigan, United States
Mercy Hospital
🇺🇸Coon Rapids, Minnesota, United States
Mercy Hospital Joplin
🇺🇸Joplin, Missouri, United States
McFarland Clinic PC-Marshalltown
🇺🇸Marshalltown, Iowa, United States
Green Bay Oncology - Escanaba
🇺🇸Escanaba, Michigan, United States
Spectrum Health Reed City Hospital
🇺🇸Reed City, Michigan, United States
Good Samaritan Regional Health Center
🇺🇸Mount Vernon, Illinois, United States
McFarland Clinic PC - Ames
🇺🇸Ames, Iowa, United States
Porubcin, Michael MD (UIA Investigator)
🇺🇸Moline, Illinois, United States
Trinity Medical Center
🇺🇸Moline, Illinois, United States
Heartland Regional Medical Center
🇺🇸Saint Joseph, Missouri, United States
Constantinou, Costas L MD (UIA Investigator)
🇺🇸Bettendorf, Iowa, United States
University of Iowa/Holden Comprehensive Cancer Center
🇺🇸Iowa City, Iowa, United States
Minnesota Oncology Hematology PA-Maplewood
🇺🇸Maplewood, Minnesota, United States
Lakeland Medical Center Saint Joseph
🇺🇸Saint Joseph, Michigan, United States
Cox Cancer Center Branson
🇺🇸Branson, Missouri, United States
Essentia Health Cancer Center
🇺🇸Duluth, Minnesota, United States
Essentia Health Saint Mary's Medical Center
🇺🇸Duluth, Minnesota, United States
Lakeland Hospital Niles
🇺🇸Niles, Michigan, United States
Saint John's Hospital - Healtheast
🇺🇸Maplewood, Minnesota, United States
Mercy Medical Center-Sioux City
🇺🇸Sioux City, Iowa, United States
Green Bay Oncology - Iron Mountain
🇺🇸Iron Mountain, Michigan, United States
Mercy Health Mercy Campus
🇺🇸Muskegon, Michigan, United States
Brigham and Women's Hospital
🇺🇸Boston, Massachusetts, United States
Spectrum Health at Butterworth Campus
🇺🇸Grand Rapids, Michigan, United States
Unity Hospital
🇺🇸Fridley, Minnesota, United States
Park Nicollet Clinic - Saint Louis Park
🇺🇸Saint Louis Park, Minnesota, United States
Minnesota Oncology Hematology PA-Woodbury
🇺🇸Woodbury, Minnesota, United States
Saint Francis Regional Medical Center
🇺🇸Shakopee, Minnesota, United States
Rice Memorial Hospital
🇺🇸Willmar, Minnesota, United States
Centerpoint Medical Center LLC
🇺🇸Independence, Missouri, United States
Mercy Hospital Springfield
🇺🇸Springfield, Missouri, United States
CoxHealth South Hospital
🇺🇸Springfield, Missouri, United States
Saint James Community Hospital and Cancer Treatment Center
🇺🇸Butte, Montana, United States
Montana Cancer Consortium NCORP
🇺🇸Billings, Montana, United States
Ohio State University Comprehensive Cancer Center
🇺🇸Columbus, Ohio, United States
GenesisCare USA - Vegas Tenaya
🇺🇸Las Vegas, Nevada, United States
Saint Charles Health System
🇺🇸Bend, Oregon, United States
Benefis Healthcare- Sletten Cancer Institute
🇺🇸Great Falls, Montana, United States
Saint Vincent Healthcare
🇺🇸Billings, Montana, United States
Cancer Research for the Ozarks NCORP
🇺🇸Springfield, Missouri, United States
Kalispell Regional Medical Center
🇺🇸Kalispell, Montana, United States
Radiation Oncology Centers of Nevada Central
🇺🇸Las Vegas, Nevada, United States
Community Medical Hospital
🇺🇸Missoula, Montana, United States
Cancer and Blood Specialists-Tenaya
🇺🇸Las Vegas, Nevada, United States
Comprehensive Cancer Centers of Nevada
🇺🇸Las Vegas, Nevada, United States
Overlook Hospital
🇺🇸Summit, New Jersey, United States
Prisma Health Cancer Institute - Spartanburg
🇺🇸Boiling Springs, South Carolina, United States
Comprehensive Cancer Centers of Nevada - Henderson
🇺🇸Henderson, Nevada, United States
GenesisCare USA - Henderson
🇺🇸Henderson, Nevada, United States
Cancer Therapy and Integrative Medicine
🇺🇸Las Vegas, Nevada, United States
HealthCare Partners Medical Group Oncology/Hematology-Tenaya
🇺🇸Las Vegas, Nevada, United States
Nevada Cancer Research Foundation NCORP
🇺🇸Las Vegas, Nevada, United States
Vidant Oncology-Kinston
🇺🇸Kinston, North Carolina, United States
Clackamas Radiation Oncology Center
🇺🇸Clackamas, Oregon, United States
Providence Newberg Medical Center
🇺🇸Newberg, Oregon, United States
The Christ Hospital
🇺🇸Cincinnati, Ohio, United States
Providence Milwaukie Hospital
🇺🇸Milwaukie, Oregon, United States
Bristol Regional Medical Center
🇺🇸Bristol, Tennessee, United States
Prisma Health Cancer Institute - Eastside
🇺🇸Greenville, South Carolina, United States
PeaceHealth Saint Joseph Medical Center
🇺🇸Bellingham, Washington, United States
Providence Regional Cancer System-Shelton
🇺🇸Shelton, Washington, United States
Prisma Health Cancer Institute - Faris
🇺🇸Greenville, South Carolina, United States
Prisma Health Cancer Institute - Greer
🇺🇸Greer, South Carolina, United States
Ballad Health Cancer Care - Kingsport
🇺🇸Kingsport, Tennessee, United States
Greenville Health System Cancer Institute-Andrews
🇺🇸Greenville, South Carolina, United States
Swedish Medical Center-Ballard Campus
🇺🇸Seattle, Washington, United States
Providence Regional Cancer System-Aberdeen
🇺🇸Aberdeen, Washington, United States
Swedish Cancer Institute-Eastside Oncology Hematology
🇺🇸Bellevue, Washington, United States
Swedish Cancer Institute-Issaquah
🇺🇸Issaquah, Washington, United States
MultiCare Deaconess Cancer and Blood Specialty Center - Downtown
🇺🇸Spokane, Washington, United States
Cancer Care Center at Island Hospital
🇺🇸Anacortes, Washington, United States
Minor and James Medical PLLC
🇺🇸Seattle, Washington, United States
Providence Regional Cancer Partnership
🇺🇸Everett, Washington, United States
PeaceHealth Saint John Medical Center
🇺🇸Longview, Washington, United States
North Star Lodge Cancer Center at Yakima Valley Memorial Hospital
🇺🇸Yakima, Washington, United States
Swedish Cancer Institute-Edmonds
🇺🇸Edmonds, Washington, United States
Swedish Medical Center-First Hill
🇺🇸Seattle, Washington, United States
Compass Oncology Vancouver
🇺🇸Vancouver, Washington, United States
Providence Regional Cancer System-Yelm
🇺🇸Yelm, Washington, United States
Providence Regional Cancer System-Centralia
🇺🇸Centralia, Washington, United States
Providence Saint Mary Regional Cancer Center
🇺🇸Walla Walla, Washington, United States
Holy Family Memorial Hospital
🇺🇸Manitowoc, Wisconsin, United States
Green Bay Oncology at Saint Vincent Hospital
🇺🇸Green Bay, Wisconsin, United States
Green Bay Oncology Limited at Saint Mary's Hospital
🇺🇸Green Bay, Wisconsin, United States
Cross Cancer Institute
🇨🇦Edmonton, Alberta, Canada
Big Horn Basin Cancer Center
🇺🇸Cody, Wyoming, United States
CHUM - Hopital Notre-Dame
🇨🇦Montreal, Quebec, Canada
Green Bay Oncology - Sturgeon Bay
🇺🇸Sturgeon Bay, Wisconsin, United States
Rocky Mountain Oncology
🇺🇸Casper, Wyoming, United States
Billings Clinic-Cody
🇺🇸Cody, Wyoming, United States
Welch Cancer Center
🇺🇸Sheridan, Wyoming, United States
Heartland Hematology and Oncology Associates Incorporated
🇺🇸Kansas City, Missouri, United States
Mercy Clinic-Rolla-Cancer and Hematology
🇺🇸Rolla, Missouri, United States
Saint Louis Cancer and Breast Institute-South City
🇺🇸Saint Louis, Missouri, United States
Oklahoma Cancer Specialists and Research Institute-Tulsa
🇺🇸Tulsa, Oklahoma, United States
Miller-Dwan Hospital
🇺🇸Duluth, Minnesota, United States
Ridgeview Medical Center
🇺🇸Waconia, Minnesota, United States
Regions Hospital
🇺🇸Saint Paul, Minnesota, United States
Metro Minnesota Community Oncology Research Consortium
🇺🇸Saint Louis Park, Minnesota, United States
United Hospital
🇺🇸Saint Paul, Minnesota, United States
Providence Regional Cancer System-Lacey
🇺🇸Lacey, Washington, United States
Prisma Health Greenville Memorial Hospital
🇺🇸Greenville, South Carolina, United States
University Medical Center of Southern Nevada
🇺🇸Las Vegas, Nevada, United States
Radiation Oncology Centers of Nevada Southeast
🇺🇸Las Vegas, Nevada, United States
Comprehensive Cancer Centers of Nevada-Summerlin
🇺🇸Las Vegas, Nevada, United States
OptumCare Cancer Care at Fort Apache
🇺🇸Las Vegas, Nevada, United States
Saint Vincent Hospital Cancer Center at Saint Mary's
🇺🇸Green Bay, Wisconsin, United States
Pacific Gynecology Specialists
🇺🇸Seattle, Washington, United States
AMG Libertyville - Oncology
🇺🇸Libertyville, Illinois, United States
MultiCare Deaconess Cancer and Blood Specialty Center - Valley
🇺🇸Spokane Valley, Washington, United States
University of Wisconsin Carbone Cancer Center
🇺🇸Madison, Wisconsin, United States
Fairview Southdale Hospital
🇺🇸Edina, Minnesota, United States
Research Medical Center
🇺🇸Kansas City, Missouri, United States
Bay Area Medical Center
🇺🇸Marinette, Wisconsin, United States
Morristown Medical Center
🇺🇸Morristown, New Jersey, United States
Anchorage Radiation Therapy Center
🇺🇸Anchorage, Alaska, United States
Alaska Oncology and Hematology LLC
🇺🇸Anchorage, Alaska, United States
Alaska Women's Cancer Care
🇺🇸Anchorage, Alaska, United States
Providence Alaska Medical Center
🇺🇸Anchorage, Alaska, United States
Providence Saint Joseph Medical Center/Disney Family Cancer Center
🇺🇸Burbank, California, United States
Christiana Gynecologic Oncology LLC
🇺🇸Newark, Delaware, United States
Christiana Care Health System-Christiana Hospital
🇺🇸Newark, Delaware, United States
Delaware Clinical and Laboratory Physicians PA
🇺🇸Newark, Delaware, United States
Helen F Graham Cancer Center
🇺🇸Newark, Delaware, United States
Medical Oncology Hematology Consultants PA
🇺🇸Newark, Delaware, United States
Christiana Care Health System-Wilmington Hospital
🇺🇸Wilmington, Delaware, United States
TidalHealth Nanticoke / Allen Cancer Center
🇺🇸Seaford, Delaware, United States
Beebe Health Campus
🇺🇸Rehoboth Beach, Delaware, United States
Holy Cross Hospital
🇺🇸Fort Lauderdale, Florida, United States
Jupiter Medical Center
🇺🇸Jupiter, Florida, United States
Mount Sinai Medical Center
🇺🇸Miami Beach, Florida, United States
Saint Luke's Cancer Institute - Fruitland
🇺🇸Fruitland, Idaho, United States
Saint Luke's Cancer Institute - Boise
🇺🇸Boise, Idaho, United States
Kootenai Health - Coeur d'Alene
🇺🇸Coeur d'Alene, Idaho, United States
Saint Luke's Cancer Institute - Meridian
🇺🇸Meridian, Idaho, United States
Saint Luke's Cancer Institute - Nampa
🇺🇸Nampa, Idaho, United States
Kootenai Clinic Cancer Services - Post Falls
🇺🇸Post Falls, Idaho, United States
Saint Luke's Cancer Institute - Twin Falls
🇺🇸Twin Falls, Idaho, United States
Hematology Oncology Associates of Illinois-Highland Park
🇺🇸Highland Park, Illinois, United States
Northwestern University
🇺🇸Chicago, Illinois, United States
Garneau, Stewart C MD (UIA Investigator)
🇺🇸Moline, Illinois, United States
Spector, David MD (UIA Investigator)
🇺🇸Moline, Illinois, United States
Illinois Cancer Specialists-Niles
🇺🇸Niles, Illinois, United States
Mary Greeley Medical Center
🇺🇸Ames, Iowa, United States
McFarland Clinic PC-Boone
🇺🇸Boone, Iowa, United States
McFarland Clinic PC-Trinity Cancer Center
🇺🇸Fort Dodge, Iowa, United States
Menorah Medical Center
🇺🇸Overland Park, Kansas, United States
Saint Luke's Regional Medical Center
🇺🇸Sioux City, Iowa, United States
Dana-Farber Cancer Institute
🇺🇸Boston, Massachusetts, United States
McFarland Clinic PC-Jefferson
🇺🇸Jefferson, Iowa, United States
Siouxland Regional Cancer Center
🇺🇸Sioux City, Iowa, United States
Massachusetts General Hospital Cancer Center
🇺🇸Boston, Massachusetts, United States
Kansas City NCI Community Oncology Research Program
🇺🇸Prairie Village, Kansas, United States
Saint Luke's South Hospital
🇺🇸Overland Park, Kansas, United States
Bronson Battle Creek
🇺🇸Battle Creek, 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
Fairview Ridges Hospital
🇺🇸Burnsville, Minnesota, United States
Abbott-Northwestern Hospital
🇺🇸Minneapolis, Minnesota, United States
New Ulm Medical Center
🇺🇸New Ulm, Minnesota, United States
North Memorial Medical Health Center
🇺🇸Robbinsdale, Minnesota, United States
Lakeview Hospital
🇺🇸Stillwater, Minnesota, United States
Saint Luke's East - Lee's Summit
🇺🇸Lee's Summit, Missouri, United States
Saint Luke's Hospital of Kansas City
🇺🇸Kansas City, Missouri, United States
Saint Joseph Oncology Inc
🇺🇸Saint Joseph, Missouri, United States
Great Falls Clinic
🇺🇸Great Falls, Montana, United States
Mercy Hospital Saint Louis
🇺🇸Saint Louis, Missouri, United States
Cancer and Blood Specialists-Henderson
🇺🇸Henderson, Nevada, United States
Las Vegas Cancer Center-Henderson
🇺🇸Henderson, Nevada, United States
Comprehensive Cancer Centers of Nevada-Southeast Henderson
🇺🇸Henderson, Nevada, United States
Comprehensive Cancer Centers of Nevada - Central Valley
🇺🇸Las Vegas, Nevada, United States
Bay Area Hospital
🇺🇸Coos Bay, Oregon, United States
Providence Cancer Institute Clackamas Clinic
🇺🇸Clackamas, Oregon, United States
Providence Willamette Falls Medical Center
🇺🇸Oregon City, Oregon, United States
Prisma Health Cancer Institute - Easley
🇺🇸Easley, South Carolina, United States
Prisma Health Cancer Institute - Butternut
🇺🇸Greenville, South Carolina, United States
Prisma Health Cancer Institute - Seneca
🇺🇸Seneca, South Carolina, United States
Wellmont Medical Associates Oncology and Hematology-Johnson City
🇺🇸Johnson City, Tennessee, United States
Wellmont Holston Valley Hospital and Medical Center
🇺🇸Kingsport, Tennessee, United States
UT Southwestern/Simmons Cancer Center-Dallas
🇺🇸Dallas, Texas, United States
Southwest VA Regional Cancer Center
🇺🇸Norton, Virginia, United States
PeaceHealth Southwest Medical Center
🇺🇸Vancouver, Washington, United States
Saint Vincent Hospital Cancer Center Green Bay
🇺🇸Green Bay, Wisconsin, United States
HSHS Saint Nicholas Hospital
🇺🇸Sheboygan, Wisconsin, United States
Saint Vincent Hospital Cancer Center at Oconto Falls
🇺🇸Oconto Falls, Wisconsin, United States
University Health Network-Princess Margaret Hospital
🇨🇦Toronto, Ontario, Canada
University of Alabama at Birmingham Cancer Center
🇺🇸Birmingham, Alabama, United States
Hennepin County Medical Center
🇺🇸Minneapolis, Minnesota, United States
Health Partners Inc
🇺🇸Minneapolis, Minnesota, United States
Mayo Clinic in Rochester
🇺🇸Rochester, Minnesota, United States
Nebraska Methodist Hospital
🇺🇸Omaha, Nebraska, United States
University of Nebraska Medical Center
🇺🇸Omaha, Nebraska, United States
Duke University Medical Center
🇺🇸Durham, North Carolina, United States
Wake Forest University Health Sciences
🇺🇸Winston-Salem, North Carolina, United States
University of Oklahoma Health Sciences Center
🇺🇸Oklahoma City, Oklahoma, United States
Providence Portland Medical Center
🇺🇸Portland, Oregon, United States
Providence Saint Vincent Medical Center
🇺🇸Portland, Oregon, United States
Medical College of Wisconsin
🇺🇸Milwaukee, Wisconsin, United States
Anchorage Oncology Centre
🇺🇸Anchorage, Alaska, United States
Marie Yeager Cancer Center
🇺🇸Saint Joseph, Michigan, United States
Hutchinson Area Health Care
🇺🇸Hutchinson, Minnesota, United States
Liberty Radiation Oncology Center
🇺🇸Liberty, Missouri, United States
Cancer Center of Western Wisconsin
🇺🇸New Richmond, Wisconsin, United States